NBME CBSE STEP 1 EXAM 2024-2025 NEWEST
VERSION WITH 200 QUESTIONS AND CORRECT
ANSWERS (100% CORRECT VERIFIED
ANSWERS) MEDICAL EXAMINATION LATEST
EXAM VERSION 2(NEW!)
58yo F in ED for 2-hour hx of SOB and chest pain radiates to her back between the shoulder blades. Resp 28/min, PE shows diaphoresis. ECG normal. Coronary angiography shows occlusion of marginal branch of LAD coronary artery.Revascularization done with stent placement. CK-MB and troponin I increased.Mechanism of these lab findings? - ANSWER-Peroxidase-mediated membrane damage
6yo girl with 4-day hx of round shiny bumps in areas where she has eczema. Her mother saw similar bumps on a playmate at pool party 3 weeks ago. No other Sx.PE shows firm, smooth, umbilicated papules 2 to 4 mm diameter in clusters.Causal organism? - ANSWER-Poxvirus
60yo M exam prior to employment. PE normal. Labs show Hb 14, HCT 42%, WBC 12k (PMN 45%, lymphos 50%, Monos 5%), platelets 250k
Flow cytometry analysis of peripheral lymphocytes shows:
CD3 50%, CD4 40%, CD8 10%, Kappa 47%, lambda 3% Which is most predictive of a clonal lymphoid proliferation? - ANSWER-Suface
kappa:lambda ration
60yo M with 6-month hx of fatigue. Four years ago, had subtotal gastrectomy after gunshot wound. Drinks 6-8 beers daily. PE shows paresthesias of both hands. Labs show: Hb 8, HCT 24%, MCV 115, WBC 5k, Platelets 165k, RBC Folic acid 500 1 / 4
(N = 125-600), B12 10 (N = 160-195). Cause is absence of? - ANSWER- Pernicious anemia--> loss of parietal cells
80yo F in ED for 2-day hx of "feeling funny." "Lost my pep." Hx of poorly controlled hypertension. Just started medication 2 weeks ago. BP 130/85. Pe normal. Serum potassium is 3. Which drug? - ANSWER-HCTZ
69yo F with weakness of left leg since awakening. PE shows weakness. Babinski present on left. Decreased somatic sensation in left foot, agraphesthesia on plantar surfaces of the toes, and decreased position sense in the toes. MRI shows edematous area in cerebral cortex of right hemisphere. Lesion? - ANSWER-UMN lesion--> motor cortex
53yo M returned from Africa, has fever, headache, and abdominal discomfort.Received appropriate vaccinations prior to the trip. T 39.4C. A wright-stained peripheral smear shown (ring forms in RBCs). Dx? - ANSWER-Malaria
68yo F with T2DM and hypertension that has been poorly controlled despite hydrochlorothiazide treatment. BP 150/96, Labs show serum glucose concentration of 130 and proteinuria. In addition to current Rx, which is most appropriate pharmacotherapy? - ANSWER-ACE I (Lisinopril)
68yo M in for a hemiorrhaphy. Surgeon gives info of risks and benefits. Patient says that he understands what he has been told, and his family will be able to discuss later. In this patient, which combination of components fulfill the criteria for fully informed consent? - ANSWER-Information, competence, voluntariness
47yo F with psoriasis for follow-up. Was given several topical creams, to be used in specified sequence twice daily. No improvements apparent at this appointment.How to begin discussion of compliance? - ANSWER-"most people find it difficult to adhere to a routine, how did you do" 2 / 4
Male newborn has macrocephaly with poor skull mineralization, shortened extremities with misshaped long bones, and several fx. Defect in which? - ANSWER-Collagen
27yo F in ED 30 min after ejected through windshield during MVC. Unrestrained front-seat passenger. PE shws marked edema and tenderness of the jaw. Panorex x- ray of mouth shown. Which is injured? - ANSWER-Inferior alveolar nerve (branch of mandibular n)
66yo M with stage IV colon cancer with 3-day hx of severe diarrhea after receiving chemotherapy with flourouracil, leucovorin, and irinotecan. Prescribed opioid antidiarrheal agent with no CNS effects. Which med? - ANSWER-Loperamide
35yo M in ED with 2-hour hx of sever fatigue and dizziness. Had profuse, watery diarrhea for 8 hours despite a lack of oral intake. Recently returned from a medical relief trip to a remove village in Honduras. T 36.7 C, P 122/min, BP 90/50. PE shows dry skin and decreased capillary refill. Stool for occult blood is negative; stool is gray and turbid. Gram stain shows gram-negative, comma-shaped bacteria; no erythrocytes of leukocytes. MOA of toxin? - ANSWER-V. Cholerae--> activates AC
16yo girl with 3-day hx of fever, nonproductive cough, and fatigue. T 38.3, P 88/min, BP 102-70. PE shows pale conjunctivae. CXR shows bilateral interstitial infiltrates. Blood spontaenously agglutinates while awaiting transport to the laboratory. Antibody isotypes causing agglutination? - ANSWER-IgM (mono and mycoplasma)
24yo M with small tender blisters on his penis 3 days after unprotected sex.Photograph shown. Causal agent? - ANSWER-HSV-2
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42yo F with 3-year hx of an intermittent facial rash, including the forehead, eyelids, nose, and cheeks. Rash seems to be getting worse since she moved from New York to Florida last year. Spicy foods precipitate a flushing reaction that seems to exacerbate the rash. PE shows erythema over the nose and cheeks, with scattered telangiectasias and a few papules. Dx? - ANSWER-Rosacea
70yo M dies in a motor vehicle collision. Was undergoing evaluation for occult blood in the stool. Photo of transverse colon shown. Dx? - ANSWER-Tubular adenoma or villous polyp. GI blood loss suggests a risk for malignancy
38yo M truck driver with 1-week hx of watery, itchy eyes and a runny nose.Physical shows inflamed nasal mucosa. No congestion in lower lung.Pharmacotherapy? - ANSWER-Loratadine--> less sedating antihistamine
59yo F with gradual onset of lack of muscle control in her left arm and leg. Sx 1 mo ago after dx with metastatic breast cancer. PE shows ataxia of left upper and lower extremities. Muscle strength, DTR, sensation, proprioception normal.Metastatic tumor in which location? - ANSWER-Cerebellum
Newborn delivered at 38 weeks' gestation weighs 1800 g. PE shows petechial rash,
microcephaly, and hepatosplenomegaly. Serologic test for CMV: IgG + in mother,
- in newborn; IGM - in mother, + in newborn. Explanation? - ANSWER-
Congenital CMV infection
Female newborn is delivered at 38 weeks' gestation. Apgar 8 and 8 at 1/5 min. PE shows a bulging, fluod0filled mass approximately 5 cm in diameter in the midline over the lumbosacral region. No spontaneous movements of the lower extremities.Abnormality most likely occurred because of abnormal development during which periods of postconception (in days)? - ANSWER-15-40; neutral tube closes at about 4 weeks
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