NBME 18

Block 1/Question#3
5 yo boy, history of motion sickness
Antagonist at muscarinic-3 receptors


Block 1/Question#10
25 yo woman, polycystic kidneys
HCO3: decreased; inorganic PO4: increased; parathryroid hormone: increased


Block 1/Question#11
67 yo man, fine resting tremor in both hands
Alpha-synuclein


Block 1/Question#13
10 yo boy, nosebleeds and easy bruising
Antibodies directed against the glycoprotein (Gp) IIb/IIIa complex


Block 1/Question#14
26 yo man with 27 yo wife, inability to conceive
Primary spermatocyte


Block 1/Question#15
experimental animal with defect in an innate gastrointestinal defence mechanism
Chronic gastritis


Block 1/Question#17
4 day old boy, vomited throughout night after breastfeeding
21-Hydroxylase


Block 1/Question#18
68 yo man, chronically increased hydrostatic pressure in Bowman space
Benign prostatic hyperplasia


Block 1/Question#19
70 yo woman, increasingly severe pain in right knee over 3 months
Pleomorphic neoplastic cells producing new woven bone


Block 1/Question#23
22 yo man, professional cyclist
Eccentric hypertrophy


Block 1/Question#26
50 yo woman, chronic obstructive pulmonary disease
Endothelial nitric oxide synthase production


Block 1/Question#28
Cholera toxin is a catalyst that results in the inhibition of GTPase activity of G-stimulator protein
Concentration of cAMP


Block 1/Question#30
29 yo woman irregular menstrual periods
Provide follow-up appointments to assess the patient's progress in attaining her goals


Block 1/Question#31
7 yo boy appendectomy
Low blood solubility


Block 1/Question#32
52 yo man with chest pain and shortness of breath
Proximal tubule: isotonic; Macula densa: hypotonic; Medullary collecting duct: hypertonic


Block 1/Question#33
35 yo woman with pain and swelling of breasts, pelvic discomfort
Have a chaperone join them for the remainder of the examination


Block 1/Question#34
60 yo man, 1 day of fever, chills, confusion and memory loss
Vibrio vulnificus


Block 1/Question#38
45 yo homeless man found unconscious
Methylmalonic Acid: normal; Homocysteine: increased


Block 1/Question#43
18 yo man cracked lips and sunburned skin
Barrier


Block 1/Question#44
26 yo man skiing accident
Axillary


Block 1/Question#45
55 yo man; father and brother died of myocardial infarct at early age
Increased transcription of HMG-CoA reductase


Block 1/Question#46
65 yo man, generalized tonic-clonic seizures
High-grade fibrillary astrocytoma


Block 2/Question#8
39 yo man, polycystic kidney disease
pH: 7.22; PCO2: 28; HCO2: 11


Block 2/Question#9
19 yo woman being treated for meningococcal meningitis
Adrenocorticotropic hormone stimulation test


Block 2/Question#15
38 yo man, 1 week history of shortness of breath with exertion
Aortic regurgitation


Block 2/Question#17
65 yo woman, 1 week of swollen, painful knee
Uric acid


Block 2/Question#18
Researcher testing new cancer drug
Neutrophil counts


Block 2/Question#21
66 yo woman, 2 days of fever, flank pain, pain with urination, nausea
Calcium carbonate


Block 2/Question#25
40 yo man, 1 year of orthostatic hypotension and loose stools
Motility disorder


Block 2/Question#27
58 yo man, 4 years of recurrent cough and sputum
Pseudostratified columnar epithelial cells


Block 2/Question#29
32 yo woman, new neurologic finding; imaging shows cavernous sinus thrombosis
Inability to abduct the eye


Block 2/Question#30
35 yo man, 4 weeks of severe midline back pain
ACTH


Block 2/Question#32
Investigator studying vancomycin-resistant Enterococcus faecalis
Plasmid loss


Block 2/Question#34
25 yo woman, fatigue for 3 weeks
Greening reaction on blood agar


Block 2/Question#37
34 yo man, semiconscious and combative
Pseudocholinesterase


Block 2/Question#41
35 yo woman, 3 days fever and sharp chest pain
Virus


Block 2/Question#44
35 yo woman, passed out while washing dishes
K+: decreased; HCO3: increased; Anion gap: normal; pH: increased


Block 3/Question#3
17 yo boy septic shock
alpha-1-Adrenoreceptors


Block 3/Question#5
82 yo woman, 24 hours of constant severe lower abdominal pain
Fibrin


Block 3/Question#6
32 yo woman, diagnosis of hyperparathyroidism
Abnormal migration of endoderm from the fourth pharyngeal pouch


Block 3/Question#9
35 yo woman with infertility
Spillage of contrast, which is normal


Block 3/Question#12
58 yo woman, 6 months shortness of breath, nonproductive cough
Pulmonary hypertension


Block 3/Question#13
35 yo woman, 2 days pain in left leg
Drug-related antibodies


Block 3/Question#14
2 yo boy, 2 days of fever, sore throat, rash
Erythrogenic toxin


Block 3/Question#17
46 yo woman, 1 week of fever and joint pain
Inflammatory infiltrates in the interstitium


Block 3/Question#21
48 yo woman, gradual onset of back pain over 2 weeks
Metastatic carcinoma of the breast


Block 3/Question#22
70 yo woman routine pelvic examination
Cystocele


Block 3/Question#25
63 yo man, 2 weeks of fullness in left upper quadrant of abdomen
Myelofibrosis


Block 3/Question#26
33 yo man, diagnosed with epilepsy
He is medically qualified to drive


Block 3/Question#31
28 yo woman, 4 days of palpitations, severe neck pain, fatigue, malaise
Subacute granulomatous thyroiditis


Block 3/Question#32
25 yo woman, 2 years of intermittent, diffuse, cramping lower abdominal pain
Accentuation of mu-opioid myenteric plexus receptor


Block 3/Question#33
4 yo boy, clumsy gait for 1 year
1/4


Block 3/Question#34
52 yo woman with breast cancer
Contraction


Block 3/Question#40
47 yo woman with irregular, raised, multicolored dark lesion
Subcutaneous tissue


Block 3/Question#41
24 yo man, 3 days of progressive numbness of both feet
Myelinated primary afferents


Block 3/Question#45
65 yo patient with lung region underventilated but well perfused
Physiologic shunt


Block 3/Question#46
45 yo man for annual health maintenance examination
Fenofibrate


Block 3/Question#47
19 yo woman, 2 days of pain in left index finger
Flexor digitorum profundus tendon


Block 3/Question#48
52 yo man, chronic pancreatitis
Colipase


Block 4/Question#3
68 yo man, 3 days of increasingly severe deep chest pain
Aortic aneurysm


Block 4/Question#4
36 yo woman, 2 weeks of fatigue, bleeding gums, bone pain
Histone acetylase


Block 4/Question#14
18 yo woman ingests 100 aspirin tablets in suicide attempt
pH: 7.32; PCO2: 15; HCO3: 8


Block 4/Question#15
45 yo man follows up 1 week after appendectomy
Gilbert syndrome


Block 4/Question#27
54 yo man, normal renal function, receives heart transplant
Cyclosporine


Block 4/Question#29
65 yo man, cancer of the cecum
Ileocolic → superior mesenteric → portal → right hepatic branch of the portal


Block 4/Question#30
5 yo girl, 1 day severe leg pain after falling off sled
Intestinal calcium absorption


Block 4/Question#31
57 yo man with alcoholism
Liquefaction


Block 4/Question#35
73 yo man, 4 months poor appetite and 25 pound weight loss
Cytokine effect


Block 4/Question#36
18 yo woman given general anesthesia for wisdom tooth extraction
Sarcoplasmic Ca2+ release


Block 4/Question#37
66 yo man, 1 month nonproductive cough, 6 months progressive shortness of breath
Idiopathic pulmonary fibrosis


Block 4/Question#42
4 month old boy, abnormal glycogen storage
alpha-1,4-Glucosidase


Block 4/Question#45
35 yo man, prolonged QT interval
Outward (delayed) rectifying potassium channel