NBME 19

Block 1/Question#1
53 yo woman with GERD.
Omeprazole


Block 1/Question#4
66 yo man, 2 months no erection
Libido: decreased; Noctural erections: normal


Block 1/Question#7
48 yo woman, 2 weeks fever and mucus in stool
Entamoeba histolytica


Block 1/Question#13
Mechanism of action of tumor suppressor genes
Inhibition of cell-cycle regulation


Block 1/Question#16
60 yo man, 2 weeks flank pain and blood in urine
Metastatic renal cell carcinoma


Block 1/Question#17
29 yo man untreated HIV
CD8+ T lymphocyte–mediated killing


Block 1/Question#24
62 yo woman sudden weakness of left leg
Right anterior cerebral artery


Block 1/Question#26
Niemann-Pick
Decreased lysosomal hydrolase activity


Block 1/Question#28
13 yo girl with mother for routine visit
Ask mother to leave the room before asking the patient any questions.


Block 1/Question#31
32 yo man on primaquine
Enzyme deficiency in the erythrocytes


Block 1/Question#34
12 yo girl, 5 days unable to walk but unconcerned
Conversion disorder


Block 1/Question#35
5 yo boy, right eye pain 1 week
Retinal cells


Block 1/Question#36
36 yo woman believes she had a heart attack
Panic disorder


Block 1/Question#42
Advantage of randomized controlled studies
Better control for confounding variables


Block 1/Question#44
Best testing strategy when treatment has serious side effects
Test 3 followed by test 1 if test 3 is positive


Block 1/Question#48
62 yo man, decreased speech fluency after cerebral infarct
Area labeled by letter 'A'


Block 2/Question#5
38 yo woman, 6 months depressed mood, joint pain, weakness, memory problems + erythema migrans
Lyme disease


Block 2/Question#6
24 yo man, generalized tonic-clonic seizure; somnolent, hyponatremia; drinks 6 liters of water in 24 hours but says he's not thirsty
Psychogenic polydipsia


Block 2/Question#8
Retinoic acid receptors and HOX gene products bind specific DNA sequences; what is the function of these molecules?
Transcription factors


Block 2/Question#9
Lab findings expected after administration of insulin and saline
Potassium decreased; Bicarbonate increased; BUN decreased; Arterial pH increased; blood CO2 increased


Block 2/Question#13
25 yo man, exercise test. Most likely physiologic changes
Arteriolar diameter increased; Tissue adenosine concentration increased; Vascular conductance increased


Block 2/Question#16
40 yo woman, chorionic villus sampling
Confined placental mosaicism


Block 2/Question#17
Scurvy symptoms associated with decreased activity of which enzyme?
Prolyl hydroxylase


Block 2/Question#23
10 yo girl, slightly painful 2 mm subcutaneous nodule on chin
Granuloma


Block 2/Question#25
48 yo woman, 3 months fatigue; X-rays reveal generalized osteopenia
Paracrine stimulation of osteoclasts by osteoblasts


Block 2/Question#27
Case-control study; 95 percent confidence interval was [reported range]. Most appropriate interpretation?
The likelihood is 95% that the true value for the odds ratio is between [the reported range]


Block 2/Question#34
Mechanism by which action potentials permit currents to flow deep within skeletal muscle fibers
Transmission along T tubules


Block 2/Question#36
75 yo man with dementia; no advanced directives
Encourage the family to come to a consensus based on their perception of the patient's wishes


Block 2/Question#37
2 day old newborn with jaundice
Conjugation of bilirubin to glucuronic acid


Block 2/Question#43
45 yo woman undergoing vinblastine chemotherapy
Decreased number of neutrophils


Block 2/Question#45
Pathway of the transepithelial transport of water
Pathway denoted by letter 'C'


Block 2/Question#46
Decreased pulmonary artery pressure facilitated by increase in the intracellular concentration of which molecule?
cGMP


Block 3/Question#5
30 yo woman, 1 week of visual difficulty
Right optic nerve


Block 3/Question#9
Cells most responsible for graft rejection?
T lymphocytes


Block 3/Question#12
23 yo woman engages in 30 minutes of strenuous exercise
Increased, as a result of distention and recruitment of microvessels


Block 3/Question#16
13 yo girl grows over the summer; what accounts for increased intestinal absorption of calcium?
Hormones derived from 7-dehydrocholesterol


Block 3/Question#17
45 yo patient, chronic alcohol dependence, foul-smelling brownish sputum
Chest radiograph labeled 'D'


Block 3/Question#19
30 yo man and 24 yo woman; best estimate that child will have oculocutaneous albinism?
1 in 600


Block 3/Question#22
Blood gas values: arterial O2 pressure: 96 mm Hg; Arterial O2 content: 12.0 vol%
Anemia


Block 3/Question#27
74 yo man; continuous systolic-diastolic bruit over R posterior flank
Renal artery stenosis


Block 3/Question#28
40 yo man, 1 month increasing malaise, nausea, abdominal pain; CD8+ T lymphocytes resulting in liver injury
Hepatocytes


Block 3/Question#29
15 yo girl receives bone marrow transplant; karyotype reveals 46,XY
Nonautologous donor


Block 3/Question#33
19 yo man stabbed in abdomen; has been incarcerated for armed robbery
Antisocial personality disorder


Block 3/Question#34
52 yo man, 4 hours of severe headache, anxiety, sweating, palpitations; what happens after injection with propranolol?
Increased total peripheral resistance and decreased cardiac output


Block 3/Question#39
45 yo man, lost outdoors in the Rocky Mountains for 10 days
Kidney


Block 3/Question#40
25 yo woman requests prenatal diagnosis at 12 weeks gestation
Chorionic villi sampling


Block 3/Question#41
41 yo woman, 34 weeks gestation; amniocentesis shows lecithin-to-sphingomyelin ratio of 1.5:1
Decreased functional residual capacity


Block 3/Question#42
Study conducted to determine effects of drug X on respiratory function
Tubocurarine


Block 3/Question#46
52 yo man, sudden onset of substernal chest pain
Histamine


Block 3/Question#49
Schematic representation of eukaryotic translation
Binding of aminoacyl-tRNA to the A site


Block 3/Question#50
39 yo man, 6 months of headache, muscle aches, fatigue; distal motor weakness of extremities
Basophilic stippling


Block 4/Question#13
26 yo woman after jejunoileal bypass for morbid obesity; most likely deficiency?
Vitamin A


Block 4/Question#14
11 yo boy, right mid-thigh pain for 2 weeks; femur X-ray reveals single osteolytic lesion in mid-diaphysis
Ewing sarcoma


Block 4/Question#15
60 yo woman, 1 year of episodic involuntary rhythmic jerking of R leg and foot; brain MRI reveals 2 cm round enhancing lesion within interhemispheric fissure
Meningioma


Block 4/Question#17
60 yo man, 20-year history of hypertension; shortness of breath and fatigue for 3 months
Cardiac output: decreased; CVP: increased


Block 4/Question#23
30 yo woman with Marfan syndrome, sudden onset of tearing chest pain
Cardiac index: 2.0;
Right atrial pressure: 18;
Pulmonary capillary wedge pressure: 18;
Pulmonary diastolic arterial pressure: 20;
Systemic vascular resistance: 2,000



Block 4/Question#26
54 yo man, routine exam; given an angiotensin converting enzyme (ACE) inhibitor
Area labeled by letter 'F' (efferent arteriole)


Block 4/Question#27
52 yo woman prescribed cisplatin for non-small cell carcinoma of the lung
Odansetron


Block 4/Question#33
Oral fluid therapy for diarrhea caused by Vibrio cholerae
Membrane transport mechanism denoted by letter 'C' (Sodium-Glucose cotransporter)


Block 4/Question#46
24 yo woman; renal oxygen consumption found to be 20 mL per minute; which process consumes the most oxygen?
Tubular reabsorption


Block 4/Question#49
30 yo woman with high-grade intraepithelial lesion
Superficial to the basement membrane