NBME Or National Board Of Medical Examiners Trivia Quiz

50 Questions | Total Attempts: 3178

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NBME Or National Board Of Medical Examiners Trivia Quiz

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Questions and Answers
  • 1. 
    A 2-year old girl takes oral cephalexin for treatment of Impetigo caused by group A beta-hemolytic Streptococcus, Which of the following is the mechanism of action of this antibiotic in this patient?
    • A. 

      Binding to bacterial 30S ribosomal subunits

    • B. 

      Binding to bacterial 50S ribosomal subunits

    • C. 

      Inhibition of bacterial dihydrofolate reductase

    • D. 

      Interference with bacterial cell wall synthesis

    • E. 

      Production of beta-lactamase

  • 2. 
    A 10 - year old boy who has had type 1 diabetes mellitus for 1 year is receiving insulin. One hour after his morning dose of insulin, he becomes tremulous and diaphoretic and has tachychardia. Several hours later, his symptoms resolve. His blood glucose concentration is now increased. Which of the following is the most likely cause of this patient’s hyperglycemia?
    • A. 

      Activation of hepatic adenylyl cyclase

    • B. 

      Activation of muscle glycogen synthase

    • C. 

      Activation of muscle phosphorylase

    • D. 

      Activation of muscle protein phosphatase

    • E. 

      Inhibition of hepatic protein kinase A

  • 3. 
    A 50-year old man comes to the physician because of a 2-month history of pain in his wrists, changes in skin color, and progressive fatigue. His brother has type 2 diabetes mellitus and cirrhosis. Physical examination shows bronze-colored skin, tenderness of the metacarpophalangeal joints in both hands, and hepatosplenomegaly. Serum studies show: AST 100 U/L ALT 110 U/L Ferritin 1200ng/mL Total iron-binding capacity 200ug/dL (N=250-400) Transferrin saturation 80% (N=20-50) Analysis of a liver biopsy specimen shows a markedly increased iron concentration and cirrhosis. Which of the following is the most likely cause of the findings in this patient?
    • A. 

      Ncreased erythropoietin action

    • B. 

      Increased intestinal iron absorption

    • C. 

      Increased oral iron intake

    • D. 

      Decreased erythropoiesis

    • E. 

      Decreased iron excretion

    • F. 

      Decreased serum transferrin concentration

  • 4. 
    A 63-year old man comes to the emergency department 30 minutes after the sudden onset of right-sided chest pain and shortness of breath that began after a 10-hour drive in his truck. The pain is more sever with inspiration. He does not smoke cigarettes. His pulse is 110/min, and respirations are 32/min. the lungs are clear to auscultation. Which of the following findings is most likely on ventilation-perfusion lung scans?
    • A. 

      Absence of perfusion in some areas that are ventilated

    • B. 

      Absence of ventilation in some areas that are perfused

    • C. 

      Absence of ventilation-perfusion mismatching

    • D. 

      Decreased perfusion gradient from the apices to the bases of the lungs

    • E. 

      Increased ventilation-perfusion ratios at lung bases compared with those at apices

  • 5. 
    A 25-year old man is diagnosed with advanced testicular cancer. Combination chemotherapy is being considered. Cisplatin is included in the regimen because of its effect on which of the following?
    • A. 

      Dihydrofolate reductase

    • B. 

      DNA

    • C. 

      Microtubules

    • D. 

      Purine ring biosynthesis

    • E. 

      Ribonucleotide reductase

  • 6. 
    A 70-year old man comes to the emergency department 30 minutes after the onset of weakness, nausea, and lower abdominal and back pain that radiates to the lower extremities. He appears pale and has a cold sweat. Pulse is 110/min and blood pressure is 90/60 mm Hg. Pulses in the lower extremities are weak. A faint bruit is heard in the lower abdomen. Muscle stretch reflexes are normal in both lower extremities. Which of the following is the most likely diagnosis?
    • A. 

      Acute compression fracture of the L-3 vertebral body

    • B. 

      Herniated L-3 to L-4 intervertebral disc

    • C. 

      Leaking aortic aneurysm

    • D. 

      Perforated rectum

    • E. 

      Perforated sigmoid colon

  • 7. 
    QUESTION & IS MISSING FROM THE ORIGINAL FILE
    • A. 

      True

    • B. 

      False

  • 8. 
    A 48-year old woman with ductal carcinoma of the right breast has a modified radical mastectomy. After the operation, she has winging of the scapula when she presses her outstretched arms against a wall. Which of the following nerves is most likely injured?
    • A. 

      Axillary

    • B. 

      Long thoracic

    • C. 

      Lower subscapular

    • D. 

      Suprascapular

    • E. 

      Thoracodorsal

  • 9. 
    A 78-year old man comes to the physician because of a 3-month history of increasingly severe back pain. He has had a 5.4-kg (12-lb) weight loss during this period. The pain occurs mostly at night, is exacerbated by movement, and is no longer relieved by aspirin. There has been no trauma to the area. He appears chronically ill. His pulse is 100/min, and blood pressure is 160/100 mm Hg. Physical examination shows point tenderness over L4-5 area; there are no skin lesions. Urinalysis shows 4+ proteins. A photomicrograph of findings from bone marrow aspiration is shown. Which of the following is the most likely diagnosis?
    • A. 

      Hyperparathyroidism

    • B. 

      Metastatic bone disease

    • C. 

      Multiple myeloma

    • D. 

      Osteitis deformans (Paget disease)

    • E. 

      Waldenstrom macroglobulinemia

  • 10. 
    A 39-year old man comes to the physician because he has had an intense, stabbing pain behind his left eye for 5 nights. The headaches generally begin 1 hour after he goes to bed and last for about 1 hour. During the pain, he has left-sided nasal stuffiness and tearing from his left eye. He had a similar series of nightly headaches for 6 weeks several years ago. Which of the following is the most likely diagnosis?
    • A. 

      Cluster headache

    • B. 

      Factitious disorder

    • C. 

      Generalized anxiety disorder

    • D. 

      Sinusitis

    • E. 

      Temporal arteritis

    • F. 

      Tension-type headache

  • 11. 
    A 40-year old man is brought to the emergency department after being involved in a motor vehicle collision. He is pronounced dead on arrival. He had a history of fever, headache, chills and pain in the upper right quadrant of the abdomen 5 days ago. During autopsy, histologic examination of a liver section shows disruption of the normal hepatic lobule. Small shrunken hepatocytes with intense eosinophilic cytoplasm, fragmented nuclear chromatin, and cytoplasmic bleb formations are noted. Which of the following processes is most likely occurring in the hepatocytes described?
    • A. 

      Apoptosis

    • B. 

      Atrophy

    • C. 

      Caseous necrosis

    • D. 

      Coagulation necrosis

    • E. 

      Dysplasia

    • F. 

      Fatty change

    • G. 

      Heterophagy

    • H. 

      Liquefaction necrosis

    • I. 

      Metaplasia

  • 12. 
    A 72-year old woman comes to the emergency department because if bloody diarrhea for the past 12 hours and diffuse abdominal pain for the past 4 days. History includes a cerebral infarction 3 years ago from which she completely recovered. Examination shows watery stool with red blood. Colonoscopy shows patchy ulceration at the area near the splenic flexure. Which of the following is the most likely diagnosis?
    • A. 

      Celiac sprue

    • B. 

      Irritable bowel syndrome

    • C. 

      Ischemic colitis

    • D. 

      Pancreatic insufficiency

    • E. 

      Regional enteritis

    • F. 

      Ulcerative colitis

  • 13. 
    Homologous pairing of chromosomes in prophase I is essential for which of the following normal processes?
    • A. 

      Centromere division

    • B. 

      Chromosome uncoiling

    • C. 

      Crossing over

    • D. 

      DNA replication

  • 14. 
    A 20-year-old man has had hemoptysis, hematuria, and a 10-kg (22-1b) weight loss over the past 3 months. Laboratory studies show a hypochromic microcytic anemia. Which of the following sets of microscopic findings is most likely in tissue obtained on biopsy of his kidney?
    • A. 

      A

    • B. 

      B

    • C. 

      C

    • D. 

      D

  • 15. 
    A 72-year old man is brought to the emergency department because of a 1-week history of increasingly severe abdominal pain, diarrhea, and loss of appetite. He had had a fever for 2 days. His temperature is 38.3C (101F), and pulse is 106/min. Abdominal examination shows distention and rebound tenderness localized to the left lower quadrant. His leukocyte count is 18,000/mm3 (80% segmented neutrophils, 10% bands, and 10% lymphocytes). An abdominal CT scan shows a 7-mm, thickened colonic wall, and pericolic fat inflammation; there is a collection of contrast in this region. Which of the following is the most likely diagnosis?
    • A. 

      Amebiasis

    • B. 

      Collagenous colitis

    • C. 

      Colon cancer

    • D. 

      Diverticulitis

    • E. 

      Ulcerative colitis

  • 16. 
    A 26-year old primigravid woman delivers a 2948-g (6-lb 8-oz) male newborn at term. Six months ago, she received a vaccine, Streptococcus agalactiae (group B), serotype III, during a clinical trial. Screening indicated that she had generated an antibody response to this polysaccharide antigen within 1 month of the vaccine. This antibody was detected in her serum immediately prior to the onset of labor. Eight hours after delivery, the newborn appears progressively lethargic, and his temperature is 38.2C (100.8F). Cerebrospinal fluid and blood cultures grow S. agalactiae (group B), serotype III. It is suspected that the mother produced only one antibody isotype in response to the vaccine. This isotype is most likely which of the following?
    • A. 

      IgA

    • B. 

      IgD

    • C. 

      IgE

    • D. 

      IgG

    • E. 

      IgM

  • 17. 
    A 52-year old man comes to the physician because of a 3-month history of epigastric abdominal pain; he also has had an unintentional 6.8-kg (15-lb) weight loss during this period. He has osteoarthritis treated with naproxen as needed. He immigrated to the USA from Japan 6 months ago. He eats mostly traditional Japanese food prepared by his wife. He has smoked 2 packs of cigarettes daily for 30 years and drinks three to four glasses of wine daily. He is 170 cm (5ft 7in) tall and now weighs 82kg (180 lb), BMI is 28 kg/m2. Physical examination shows epigastric tenderness. Upper gastrointestinal endoscopy shows a 4-cm ulcer in the stomach. Examination of a biopsy specimen of the lesion confirms adenocarcinoma. Which of the following is the strongest predisposing risk factor for this patient’s condition?
    • A. 

      Alcohol use

    • B. 

      Diet

    • C. 

      Ethnicity

    • D. 

      Naproxen use

    • E. 

      Tobacco use

  • 18. 
    A 31-year old woman is brought to the emergency department by her husband because of difficulty breathing and severe muscle weakness for 10 minutes. She has a 3-year history of myasthenia gravis treated with neostigmine. The husband reports that she doubled her dosage 2 days ago because she was feeling extraordinarily weak, but her weakness has increased since then. Which of the following events is the most likely cause of the increased muscle weakness in this patient?
    • A. 

      Autoimmune hyperactivation of nicotinic receptors

    • B. 

      Autoimmune inactivation of muscarinic receptors

    • C. 

      Desensitization of nicotinic receptors

    • D. 

      Hypersensitization of muscarinic receptors

    • E. 

      Insufficient release of acetylcholine

  • 19. 
    A cluster of three cases of nosocomial pneumonia caused by a highly resistant strain of Klebiella pneumonia occurs in a 13-bed intensive care unit (ICU). Each patient in the ICU is in a private, enclosed room. Which of the following infection control measures is most likely to decrease the spread of this organism to the other patients in the ICU and elsewhere in the hospital?
    • A. 

      Place infected patients in rooms with at least six air exchanges per hour

    • B. 

      Place patients in rooms with negative air pressure

    • C. 

      Place infected patients in rooms with positive air pressure

    • D. 

      Promote thorough hand cleansing before and after medical personnel visit each patient

    • E. 

      Require medical personnel to wear masks when visiting infected patients

  • 20. 
    During an experiment, Drug X is administered to treat trematode and cestode infestations. Results show that Drug X increases the permeability of the cell membranes to calcium, causing paralysis, dislodgement, and death of the parasite. Drug X most closely resembles which of the following?
    • A. 

      Albendazole

    • B. 

      Bithionol

    • C. 

      Diethylcarbamazine

    • D. 

      Niclosamide

    • E. 

      Praziquantel

  • 21. 
    A 23-year old woman is brought to the emergency department 45 minutes after sustaining an injury to her right shoulder when she was forcefully thrown into a swimming pool. The patient is holding her right arm in external rotation. There is an area of tenderness and absent sensation over the lateral aspect of the forearm. Immediately after reduction of the glenohumeral joint, she is unable to flex the elbow against gravity. Which of the following structures is most likely injured in this patient?
    • A. 

      Axillary nerve

    • B. 

      Musculocutaneous nerve

    • C. 

      Posterior cord of the brachial plexus

    • D. 

      Radial nerve

    • E. 

      Thoracodorsal nerve

  • 22. 
    A 6-year old boy is found to have almond-shaped eyes, temperature instability, mental retardation, hyperphagia, and obesity. Cytogenetic analysis shows a balanced translocation involving chromosome 15q11-q13. His father and paternal aunt are found to have an identical balanced translocation. His aunt’s 5-year old daughter has a history of inappropriate laughter, abnormal gait, and mental retardation. 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

  • 23. 
    The tracing shows contractile responses of a skeletal muscle preparation to electrical stimulation at five different frequencies. The amount of calcium sequestration in sarcoplasmic reticulurn is highest during which of the fallowing labeled responses?
    • A. 

      A

    • B. 

      B

    • C. 

      C

    • D. 

      D

    • E. 

      E

  • 24. 
    A prospective study examined the relationship between the development of gastric cancer and exposure to a diet rich in selenium. The investigators estimated the relative risk of gastric cancer to be 0.3 in individuals with a high-selenium diet (95% confidence interval 0.1-0.8). Which of the following is the most appropriate interpretation of this finding?
    • A. 

      Selenium causes gastric cancer

    • B. 

      Selenium exposure is unrelated to gastric cancer

    • C. 

      Selenium is associated with a higher risk of gastric cancer

    • D. 

      Selenium is associated with a lower risk of gastric cancer

    • E. 

      Selenium is positively correlated with gastric cancer

  • 25. 
    A male newborn delivered at 34 weeks gestation by an uncomplicated spontaneous vaginal delivery develops respiratory distress 30 minutes later. His respirations are 40/min. Physical examination shows cyanosis and lower rib retractions with respiration. Chest x-rays show fine densities with a reticulogranular appearance bilaterally. Which of the following is the most likely cause of these findings?
    • A. 

      Erythroblastosis fetalis

    • B. 

      Extralobar sequestration

    • C. 

      Intracranial hemorrhage

    • D. 

      Pulmonary surfactant deficiency

    • E. 

      Situs inversus

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