NBME CBSE USMLE STEP 2 EXAM 202 4 LATEST
VERSION WITH 200+ QUESTIONS AND CORRECT
ANSWERS (100% CORRECT VERIFIED ANSWERS)
WITH EXPLANATIONS/ STEP 2 NBME CK ACTUAL
EXAM QUESTIONS AND CORRECT ANSWERS
GRADED A+ (BRAND NEW!!)
37yo M with 3-day history of diarrhea. Six to eight watery stools daily that occasionally contain streaks of blood. Family does not have similar symptoms. No travel. Two weeks ago, he completed course of oral ciprofloxacin for acute prostatitis. CBC normal. Stool for leukocytes and clostridium difficile toxin is positive. Next step?-Metronidazole -Vancomycin - ANSWER-Metronidazole!
-In cases when the WBC is <15k, oral metronidazole is the correct answer.Remember that in patient's with WBC >20k, lactacte >2.2, toxic megacolon and/or severe ileus, the patient will need emergent surgery -Oral vancomycin is reserved for more severe cases, particularly when WBC > 15k and creatinine is >1.5x the patient's baseline.
A 15 year old girl is brought to the physician because of a 1 week history of vaginal discharge and 2 day history of sore throat and recurrent candidal infections of the skin and mucous membranes since childhood. She has a 2 year history of type 1 diabetes mellitus and thyroiditis. Medications include insulin and levothyroxine. Exam shows oral candidiasis. Pelvic exam shows to have thick white and budding yeasts. Which of the following is the most likely mechanism of her recurrent candidal infections?
- Autoimmune destruction of thymus 1 / 4
- Blunting of inflammatory response from complement deficiency
- Deficiency of anticandidal antibodies
- Impaired cell-mediated immunity
- Inability of macrophage to present candidal infection - ANSWER-Chronic
mucocutaneous candidiasis?
-absent in vitro T-cell proliferation in response to Candida antigens
43 - A 77-year-old woman is brought to the emergency department by paramedics
- hour after the sudden onset of right-sided weakness and difficulty speaking. Her
son found her at home after he became concerned because he did not get his usual morning phone call. She has a history of hypertension and hypercholesterolemia treated with a β-adrenergic blocking agent and a lipid-lowering agent. Her pulse is 72/min, and blood pressure is 160/90 mm Hg. During examination, she is only able to give single-word answers with many paraphasic errors. She has good comprehension. Examination shows normal visual fields. There is weakness of the right side of the mouth. Muscle strength of the right upper extremity is 2/5. There is mild weakness of flexion of the right hip; muscle strength of the right lower extremity is otherwise normal. Sensation to pinprick is decreased over the right upper extremity. Deep tendon reflexes are more - ANSWER-L MCA -facial deficits -motor deficits -BROCA, WERNICKE"S APHASIA!!!
*ICA stroke symptoms
-AMAUROSIS FUGAX!!!
-motor symptoms on part of that side of body (arms, legs, face, etc) -sensory symptoms on part of that side of body (arms, legs, face, etc) -personality symptoms 2 / 4
37 yr old with 12 hours of vomiting, abd cramping and swelling. He has had constipation for 4 days. Diagnosed with Crohns 7 years ago. His symptoms of diarrhea and pain have been well controlled with mesalalmine for past 3 years. His t 96.8, pulse 98 regular, BP 110/70. Exam shows diffusely distended, tympanitic abdomen and visible peristalsis. High pitched bowel sounds are heart. Rectal exam shows no stool in rectal vault. Xray shows SBO. Which is the most likely cause?-colon cancer -ileocecal fistula -small bowel adhesions -small bowel fibrotic stricture -small bowel intussusception - ANSWER-Small bowel fibrotic stricture -more likely in Crohn's
-no history of surgery (adhesions)
A 62-year-old woman with hypertension comes to the physician for a follow-up examination. Her hypertension was well controlled until 1 year ago; during the past year, her blood pressure has ranged between 160/100 mm Hg and 180/120 mm Hg.Treatment with maximal doses of an ACE inhibitor, a diuretic, and a 6-adrenergic blocking agent for 10 months has not controlled her hypertension. She has a 2-year history of increasing leg pain with walking that improves with rest; she is otherwise asymptomatic. Her last menstrual period was 7 years ago. She smoked one to two packs of cigarettes dai ly for 40 years but quit 1 year ago. Her exercise capacity has improved during the past year. She is 152 cm (5 ft) tall and weighs 48 kg (105 lb); BMI is 21 kg/m . Her pulse is 85/min and regular, and blood pressure is 160/100 mm Hg in the right arm, 175/105 mm Hg in the left arm, and 155/90 mm Hg in the right leg. Cardiac examination sh - ANSWER-Atherosclerotic renal artery stenosis -BP of 155/90 mm Hg in the right leg is also due to atherosclerotic change.-in coarctation BP in leg would b much lower than 155/90 3 / 4
*in coarctation--- pressure in RIGHT arm is more than the left because of back- up!!!
A 3 month old infant has had tachypnea and tachycardia for 10 days; during this period he has been feeding poorly. A grade 3/6 systolic murmur and a grade 2/6, apical mid-diastolic murmur are heard. An x-ray of the chest shows cardiomegaly with increased pulmonary vascular markings. Echocardiography shows a large ventricular septal defect. Whch of the following is the most likely cause of these symptoms
A)Excessive Pulmonary blood flow
- Mitral Valve obstruction
- reduced left ventricular contractibility
- Reduced right ventricular preload
- Right Ventricular pressure overload - ANSWER-Excessive pulmonary blood
flow -more mixing of blood --> more goes back into pulmonary circuit -increased pulmonary vascular markings
A 10-month old infant is brought to the emergency department because of laboured breathing for 1 hour. She has cough, coryza and fever for 18 hours. Her temperature is 39°C (102.2°F) , pulse is 120/min, respirations are 54/min, and blood pressure is 82/60 mm Hg. Pulse oximetry shows an oxygen saturation if 92%. Bilateral wheezes and basilar crackles are heard.
- Allergen-induced bronchospasm
- Barotrauma-related alveolar disease
- Cardiac-induced pulmonary edema
- Chemical irritant pneumonitis
- / 4