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NBME 19 Answers

Block 1/Question#1
53 yo woman w/GERD. Diet change, stress reduction do not ...
Omeprazole

Block 1/Question#4
66 yo man, 2 months of not being able to maintain an ...
Libido: decreased; Noctural erections: normal

Block 1/Question#7
48 yo woman, 2 weeks of fever and stool with mucus; recent ...
Entamoeba histolytica

Block 1/Question#13
What mechanism of action do tumor-suppressor genes have that ...
Inhibition of cell-cycle regulation

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

Block 1/Question#17
29 yo man with untreated HIV infection; what explains ...
CD8+ T lymphocyte–mediated killing

Block 1/Question#24
62 yo woman with sudden weakness of left leg; infarct in ...
Right anterior cerebral artery

Block 1/Question#26
Niemann-Pick disease is characterized by which of the following?
Decreased lysosomal hydrolase activity

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

Block 1/Question#31
32 yo man given primaquine for malaria prophylaxis; develops ...
Enzyme deficiency in the erythrocytes

Block 1/Question#34
12 yo girl unable to walk for 5 days but is unconcerned about ...
Conversion disorder

Block 1/Question#35
5 yo boy, R eye pain for 1 week; retinal exam shows a mass. ...
Retinal cells

Block 1/Question#36
36 yo woman presents to ED after believing she suffered a ...
Panic disorder

Block 1/Question#42
What advantage does randomized controlled study have over ...
Better control for confounding variables

Block 1/Question#44
Three tests are developed to identify rotavirus in children ...
Test 3 followed by test 1 if test 3 is positive

Block 1/Question#48
62 yo man, right-handed, suffers decreased speech fluency ...
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

Block 0/Question#0
A 27-year-old woman has an episode of pneumococcal pneumonia ...
Direct antiglobulin (Coombs) test

Block 0/Question#0
During an experiment, an isolated skeletal muscle is placed ...
pH

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