NBME 13 Section 1 (Qst 1-50)

50 Questions | Total Attempts: 3711

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NBME 13 Section 1 (Qst 1-50)

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Questions and Answers
  • 1. 
    A 28 year old woman comes to the physician for a health maintenance examination. During the interview, she tearfully tells the physician that she and her new husband are having problems. She says she wants to go out with friends, but he does not enjoy being with people, referring individual activities such as hiking. She says he seems indifferent to sexual intimacy and neither shows much emotion nor understands her feelings at all. Which of the following personality styles best explains the husband’s behavior?
    • A. 

      Avoidant

    • B. 

      Narcissistic

    • C. 

      Paranoid

    • D. 

      Schizoid

    • E. 

      Schizotypal

  • 2. 
    A 55-year-old woman is scheduled to undergo transvaginal hysterectomy and oophorectomy for dysfunctional uterine bleeding. During the procedure, the uterus must be separated from all surrounding pelvic structures. Identification and incision of which of the following structures that attaches to the cervical region and extends posteriorly is most appropriate in this patient?
    • A. 

      Mmesometrium

    • B. 

      Mesosalpinx

    • C. 

      Mesovarium

    • D. 

      Ovarian ligament

    • E. 

      Round ligament of the uterus

    • F. 

      Uterosacral ligament

  • 3. 
    A 27-year-old woman comes to the physician because of a 2-year history of sporadic vision and a 1 year history of intermittent numbness and tingling in her arms. The symptoms became more severe 5 days ago after a 4-day visit from her husband’s parents. During the past year, she also has had four episodes of urinary incontinence. Physical examination shows mild dysarthria. On mental status examination, she has a mildly worried mood and a reactive affect. MRI of the brain shows a few small, scattered, nonspecific white-matter plaques. Which of the following is the most likely diagnosis?
    • A. 

      Complex partial seizure disorder

    • B. 

      Conversion disorder

    • C. 

      Huntington disease

    • D. 

      Multiple sclerosis

    • E. 

      Panic disorder without agoraphobia

  • 4. 
    • A. 

      Excessive parathyroid hormone production

    • B. 

      Excessive parathyroid hormone-related protein production

    • C. 

      Increased fractional calcium gastrointestinal absorption

    • D. 

      Local interleukin-1 (IL-1) and tumor necrosis factor effect

    • E. 

      Unregulated 1,25-dihydroxycholecalciferol production

  • 5. 
    During an experiment, a cuff occluder is placed on the left renal artery of a normal rat and inflated to cause a 90% decrease in the cross-sectional area of the artery. A catheter is placed in the left and right renal veins to sample the effluent. The concentration of which of the following substances will most likely be higher in the effluent from the left renal vein than that from the right renal vein
    • A. 

      ADH (vasopressin)

    • B. 

      Aldosterone

    • C. 

      Endothelin

    • D. 

      Epinephrine

    • E. 

      Renin

  • 6. 
     A healthy 21-year-old man dies suddenly of cardiac arrest after snorting cocaine. Cocaine-induced inhibition or which of the following is the most likely explanation for the cardiac arrest?
    • A. 

      Acetylcholinesterase

    • B. 

      A2-Adrenergic receptors

    • C. 

      B2-Adrenergic receptors

    • D. 

      Monoamine oxidase

    • E. 

      Muscarinic receptors

    • F. 

      Norepinephrine reuptake

  • 7. 
    A 30-year-old woman, gravida 2, para 2, develops severe vaginal bleeding immediately after vaginal delivery of a male newborn at tern.The hemorrhage continues during the next hour and the patient undergoes an emergency hysterectomy to control the bleeding. Examination of the uterus shows fragments of placenta adherent to the uterine wall. There is absence of the decidua basalis. Which of the following is the most likely diagnosis?
    • A. 

      Abruptio placentae

    • B. 

      Chronic villitis

    • C. 

      Circumvallate placenta

    • D. 

      Placenta accreta

    • E. 

      Succenturiate lobe

  • 8. 
    A healthy 22-year-old man is a subject in a study investigating the regulation of heart rate dung exercise. He is sitting on a stationary bicycle and is instructed to begin pedaling in 5 minutes. One minute before he begins to pedal, his heart rate increases. An increase in which of the following transmitters acting at the indicated receptor best explains the increase in heart rate in this man? TRANSMITTER ------ RECEPTOR A) Acetylcholine ------ muscarinic B) Acetylcholine ------ nicotinic C) Norepinephrine ------ a1 D) Norepinephrine ------ B1 E) Norepinephrine ------ B2
    • A. 

      A

    • B. 

      B

    • C. 

      C

    • D. 

      D

    • E. 

      E

  • 9. 
    • A. 

      Apo A-1

    • B. 

      Apo A-11

    • C. 

      Apo B

    • D. 

      Apo C

    • E. 

      Apo E

  • 10. 
    • A. 

      Alcohol dehydrogenase

    • B. 

      Aldehyde dehydrogenase

    • C. 

      Formaldehyde dehydrogenase

    • D. 

      Lactate dehydrogenase

    • E. 

      Pyruvate dehydrogenase

  • 11. 
    A 49-year-old man with pancreatic cancer undergoes a Whipple procedure to resect the distal stomach, duodenum, and head of the pancreas. During the procedure, the cut and of the remaining stomach is joined to the side of the jejunum (gastrojejunostomy). Which of the following nerve structures can be cut to decrease stomach acid output and decrease the likelihood of ulcers forming in the jejunum at the site of junction with the stomach?
    • A. 

      Celiac plexus

    • B. 

      Iliohypogastric nerves

    • C. 

      Phrenic nerves

    • D. 

      Subcostal nerves

    • E. 

      Sympathetic chain

    • F. 

      Vagal trunks

  • 12. 
    A 40-year-old woman comes to the physician for genetic counseling because of a family history of muscle weakness. She says that she has not sought treatment because her symptoms are not severe, but her children have profound muscle weakness and fatigue. Sequence analysis of mitochondrial DNA shows a mutation in 50% of the mothers mitochondria DNA and in 100% of each other children's mitochondrial DNA. A pedigree is shown. Which of the following genetic principles best explains the findings in this family?
    • A. 

      Anticipation

    • B. 

      Genetic drift

    • C. 

      Heteroplasmy

    • D. 

      Imprinting

    • E. 

      Pseudodominant inheritance

  • 13. 
    A 52 year old man with a family history of renal failure comest to the physician because of abdominal pain over the last 6 months. He has been treated in the past for renal calculi and hypertension. Physical examination shows bilateral palpable masses in the upper abdomen. Urinalysis shows crenated erythrocytes and mild proteinuria. A CT scan of the abdomen identifies the cause of the patient’s problem. Which of the following is the most likely diagnosis?
    • A. 

      Adrenal adenoma

    • B. 

      Glomerulonephritis

    • C. 

      Henoch-Schonlein purpura

    • D. 

      Polycystic kidney disease

    • E. 

      Renal cell adenoma

  • 14. 
    • A. 

      Bladder cancer

    • B. 

      Bladder diverticulum

    • C. 

      Interstitial cystitis

    • D. 

      Nephrolithiasis

    • E. 

      Urinary tract infection

  • 15. 
    A previously healthy 6-year-old girl is brought to the emergency department because of severe abdominal pain, nausea, and vomiting that began 4 hours after attending a friend's birthday party. Cake and other pastries were served at the party. She appears acutely ill and mildly dehydrated. Her temperature is 37°C (98.6°F), pulse is 104/min, respirations are 20/min, and blood pressure is 96/60 mm Hg. Examination shows no abnormalities of the skin. Bowel sounds are hyperactive. Which of the following is the most likely cause of these findings?
    • A. 

      Bacteremia

    • B. 

      Enterotoxin ingestion

    • C. 

      Intestinal mucosa inflammation

    • D. 

      Lead toxicity

    • E. 

      Villus atrophy

    • F. 

      Viremia

  • 16. 
    A 39-year-old woman with end-stage renal disease caused by systemic lupus erythernatosus undergoes kidney transplantation from a living, unrelated donor. Despite aggressive immunosuppressive therapy, the transplant is rejected after 6 months. Analysis of a biopsy specimen of the transplant shows numerous infiltrating CD8+ T lymphocytes. Which of the following is the most likely cause of rejection of the transplant in this patient?
    • A. 

      Antibody synthesis

    • B. 

      Complement activation

    • C. 

      Direct cytotoxicity

    • D. 

      Histamine release

    • E. 

      Nitric oxide production

  • 17. 
    • A. 

      Alcohol

    • B. 

      Heroin

    • C. 

      LSD

    • D. 

      Marijuana

    • E. 

      Psilocybin

  • 18. 
    • A. 

      Antiphospholipid antibody syndrome

    • B. 

      Factor V Leiden mutation

    • C. 

      Increased factor VIII (antihemophilic factor) concentration

    • D. 

      Protein C deficiency

    • E. 

      Prothrombin G20210A mutation

  • 19. 
    A 2-month-old boy dies of meningitis despite appropriate antibiotic therapy. Culture of his cerebrospinal fluid grows Mycobacterium tuberculosis. Two of his brothers died of atypical mycobacterial infections. Which of the following immunodeficiencies most likely explains this familial history?
    • A. 

      Complement deficiency

    • B. 

      Interferon-y receptor deficiency

    • C. 

      Leukocyte adhesion deficiency

    • D. 

      X-linked agammaglobulinemia

  • 20. 
    A 64-year-old woman comes to the physician because of a 6-month history of heartburn and difficulty swallowing solid food and liquid. She has not had nausea or vomiting. She also has a 2-year history of pain and swelling of her wrists and hands. She has not seen a physician in 5 years. She takes no medications. She does not smoke. Physical examination shows no wrinkles on the face and neck. Her vital signs are within normal limits. There is synovial thickening of the wrists bilaterally. A photograph of the left hand is shown. Abdominal examination shows no abnormalities. Which of the following sets of findings is most likely on esophageal manometry?           Esophageal                  Lower Esophageal            Peristalsis                       Sphincter Tone A)        Increased                               increased B)         Increased                              decreased C)          Normal                                  increased D)         Normal                                  decreased E)         Decreased                              increased F)         Decreased                             decreased    
    • A. 

      A

    • B. 

      B

    • C. 

      C

    • D. 

      D

    • E. 

      E

    • F. 

      F

  • 21. 
    Question missing from original
    • A. 

      True

    • B. 

      False

  • 22. 
    A 36-year-old man comes to the physician for a routine examination. He has a 5-year history of recurrent episodes of genital herpes treated with acyclovir. He says, "I`ve been taking the medication, but I still occasionally get lesions. When will I be cured?" The physician informs him that herpes simplex is a lifelong infection, with no cure at the present time. Which of the following best explains the longevity of the herpes simplex virus?
    • A. 

      Continual replication in dendrite cells

    • B. 

      Continual replication in epithelial cells of the skin

    • C. 

      Continual replication in sacral root ganglia

    • D. 

      Continual replication in T lymphocytes

    • E. 

      Establishment of a latent infection in B lymphocytes

    • F. 

      Establishment of a latent infection in circulating immune cells

    • G. 

      Establishment of a latent infection in epithelial cells of the skin

    • H. 

      Establishment of a latent infection in sensory nerve cells

  • 23. 
    A 24-year-old woman comes to the physician because of a 1-day history of pain in her left leg while walking Her temperature is 37°C (98.6°F), pulse is 84/min, and blood pressure is 135.78 mm Hg. Examination of the left lower extremity shows only a markedly decreased pulse in the left lower extremity. An intermittent faint diastolic heart murmur is heard at the apex. Angiography of the left lower extremity shows complete obstruction of the distal left femoral artery by what appears to be a thrombus. The occlusion is removed using a catheter. Microscopic examination of the removed specimen shows scattered mesenchymal cells in an abundant extracellular matrix. Echocardiography confirms a diagnosis of cardiac tumor. This patient most likely has which of the following types of cardiac tumors?
    • A. 

      Fibroelastoma

    • B. 

      Fibroma.

    • C. 

      Hamartoma

    • D. 

      Hemangioma

    • E. 

      Myxoma

  • 24. 
    A 48-year-old manic brought to the emergency department because of difficulty opening his mouth and stiffness of his neck, shoulders, and back for 4 hours. He sustained a puncture wound to his arm 1 week ago. He has received no medical care for 30 years. Physical examination shows trismus and opisthotonos. Which of the following best describes the process in this patient?  
    • A. 

      Blockade of inhibitory neurotransmitter release

    • B. 

      Cell death in central nervous system neurons.

    • C. 

      Cell death in muscles

    • D. 

      Cell death in peripheral nervous system neurons

    • E. 

      Demyelinization

  • 25. 
    A 33-year-old woman comes to the physician because of a 16-kg (35-1b)weight gain during the past 6 months despite dieting. She is 168 cm (5 fl 6 in) tall and now weighs 114 kg (230 lb); BMI is 37 kg/m2. Her blood pressure is 156106 mm Hg. Physical examination shows a round, ruddy face with hirsutism, excess weight predominantly in the shoulders and abdomen: and purple striae over the abdomen. An MRI shows a mass in the pituitary gland. A CT scan of the abdomen shows enlarged adrenal glands. Which of the following histologic changes would be expected in this patient's adrenal glands?
    • A. 

      Cortical hyperplesia

    • B. 

      Cortical hypertrophy.

    • C. 

      Cortical mstaplasia

    • D. 

      Medullary hyperplasia

    • E. 

      Medullary hypertrophy

    • F. 

      Medullary metaplasia