NBME 13 Section 3 Prt 1 Of 2

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NBME 13 Section 3 Prt 1 Of 2

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Questions and Answers
  • 1. 
    A 25-year-old man comes to the physician because of a 4-day history of pain and burning with urination and frequent urinary urgency. He is sexually active and has several female partners; he does not use condoms. His temperature is 37°C (98.6°F). Urinalysis shows 2+ protein; cultures grow on chocolate agar. A Gram stain shows gram-negative diplococci. The organism causing this patient’s symptoms most likely produces which of the following virulence factors?
    • A. 

      Elementary bodies

    • B. 

      Exotoxins

    • C. 

      Free radicals

    • D. 

      Pili

    • E. 

      Spores

  • 2. 
    • A. 

      Activation of nuclear gene transcription

    • B. 

      Decreased CAMP production

    • C. 

      Displaced vitamin A from cellular stores

    • D. 

      Increased sebum production

    • E. 

      Protection of keratinocytes from UVB irradiation

  • 3. 
        A 22-year-old man comes to the physician because of a 2-year history of episodes of shortness of breath and wheezing. His respirations are 12/min. Physical examination shows no abnormalities. It is found that the symptoms occur after he takes certain over-the-counter medications containing aspirin. Laboratory studies show a serum IgE concentration within the reference range and no eosinophilia. This patients symptoms are most likely caused by excessive production of which of the following substances?
    • A. 

      Cyclooxygenase

    • B. 

      Hydroxyeicosatetraenoic acid

    • C. 

      Leukotrienes

    • D. 

      Prostacyclin (PGI,)

    • E. 

      Prostaglandins

    • F. 

      Thromboxane A,

  • 4. 
    A 59-year-old woman with metastatic renal carcinoma is receiving cyclophosphamide, paclitaxel , and interleukin-2 (IL-2). Which of the following is the reason for including 1L-2 in the regimen?
    • A. 

      Decreasing bone marrow suppression

    • B. 

      Decreasing the likelihood of hemorrhagic cystitis

    • C. 

      Decreasing the likelihood of peripheral neuropathy

    • D. 

      Decreasing nausea and vomiting

    • E. 

      Stimulating T lymphocytes

  • 5. 
    A 73-year-old woman is brought to the physician because of a 1-month history of urinary frequency and urgency. She also has had a 3-month history of difficulties with walking, conversation. and memory. Neurologic examination shows normal strength and sensation. Her Mini-Mental State Examination score is 21/30. She walks with a wide-based, shuffling gait. A CT scan of the head shows marked enlargement of the ventricles. Which of the following is the most likely diagnosis?
    • A. 

      Atherosclerosis of the carotid artery

    • B. 

      Dementia, Alzheimer type

    • C. 

      Huntington disease

    • D. 

      Normal-pressure hydrocephalus

    • E. 

      Parkinson disease

    • F. 

      Small vessel disease

  • 6. 
    A 35-year-old man who is a farmer is brought to the hospital by his wife because of difficulty breathing, sweating, excess salivation, and diarrhea for the past 2 hours. His wife says that the symptoms started when he was applying a new insecticide to his crops. Temperature is 36°C (96.8°F), pulse is 50/min, respirations are 22/min, and blood pressure is 90/60 mm Hg. Which of the following is the most appropriate treatment?    
    • A. 

      Atropine

    • B. 

      Lpratropium

    • C. 

      Mecamylamine

    • D. 

      Neostigmine

    • E. 

      Propantheline

  • 7. 
    An experimental model of treatment for sickle cell disease involves reactivating the genes that code for the chains of fetal hemoglobin. This treatment is most likely to increase the affinity of hemoglobin for which of the following?
    • A. 

      2,3-Bisphosphoglycerate

    • B. 

      Carbon dioxide

    • C. 

      Chloride ions

    • D. 

      Oxygen

    • E. 

      Protons

  • 8. 
    • A. 

      Candida tropicalis

    • B. 

      Coccidoides Immitis

    • C. 

      Cryptococcus neoformans

    • D. 

      Cytomegalovirus

    • E. 

      Mycobacterium tuberculosis

    • F. 

      Pneumocystis jiroveci ( formerly P. carnii )

  • 9. 
    • A. 

      Gemiline mosaicisrn

    • B. 

      Loss of heterozygosity

    • C. 

      P53 Gene amplification

    • D. 

      Pericentric inversion involving p53 and locus Z

    • E. 

      Point Mutation of allele n

  • 10. 
    • A. 

      Bacterial overgrowth

    • B. 

      Cholera

    • C. 

      Inactivation of lipase

    • D. 

      Lactose intolerance

    • E. 

      Vasoactive intestinal polypeptide secretion

  • 11. 
    A 60-year-old woman comes to the physician because of a 2-day history of flank pain and pain with urination. She has hypertension, recurrent urinary tract infections, and hypothyroidism. Her temperature is 37°C (98.6`F), pulse is 96/min, and blood pressure is 152/92 mm Hg. Physical examination shows no other abnormalities. Urinalysis shows 3+ blood, 1+ leukocytes, and few bacteria. Ultrasonography of the abdomen shows a large calculus filling the entire right renal pelvis. The renal calculus in this patient is most likely composed of which of the following substances?
    • A. 

      Calcium oxalate

    • B. 

      Cystine

    • C. 

      Struvite

    • D. 

      Uric acid

  • 12. 
    A 65-year-old man dies 4 days after complete occlusion of the left coronary artery. The left ventricle contains a large irregular area that is soft and pale. Which of the following processes is most likely responsible?         
    • A. 

      Caseation necrosis

    • B. 

      Coagulation necrosis

    • C. 

      Dystrophic calcification

    • D. 

      Fat necrosis

    • E. 

      Gangrenous neCrOSIS

    • F. 

      Liquefaction necrosis

    • G. 

      Metastatic calcification

  • 13. 
    A 76-year-old man with congestive heart failure comes to the physician because of a 1-month history of shortness of breath after walking up a flight of stairs. He has had frequent nausea, and he has had to use two pillows to sleep during this period.  Diffuse, moist crackles are heard over both lungs. There is pitting edema above the ankles. Which of the following best describes the function of the product secreted by the atrial myocytes in this patient?
    • A. 

      Decreased glomerular filtration rate

    • B. 

      Increased sodium reabsorption

    • C. 

      Induction of vasoconstriction

    • D. 

      Inhibition of renin release

    • E. 

      Stimulation of aldosterone release

  • 14. 
    A 32-year-old man comes to the physician because of back pain and joint stiffness for 3 months. His symptoms improve after mild exercise. During this illness, he also has had fatigue and a 3.2-kg (7-1b) weight loss. Physical examination and x-rays of the sacroiliac joints confirm a diagnosis of ankylosing spondylitis. Which of the following laboratory tests would be most appropriate for the patient's two children to evaluate their susceptibility to this disease?
    • A. 

      Analysis of class I MHC allele expression

    • B. 

      Measurement of B-Iymphocyte mitogen responses to pokeweed mitogen

    • C. 

      Measurement of T-Iymphocyte mitogen responses to phytohemaggiutinin

    • D. 

      Polymerase chain reaction assay for bc1-2 gene expression

    • E. 

      Polymerase chain reaction assay for tyrosine kinase gene expression

  • 15. 
    An autopsy is done on a 50-year-old man who died of pneumonia despite 5 days of antibiotic therapy in the intensive care unit. He had a 15-year history of alcoholism. A photograph of a sagital section of the brain is shown, Based on this pathology, which of the following findings was most likely present on neurologic examination of the patient prior to his death?
    • A. 

      Dysdiadochokinesia

    • B. 

      Dysmetria on finger-nose testing

    • C. 

      Essential tremor

    • D. 

      Gait ataxia

    • E. 

      Present Romberg sign

  • 16. 
    A 6-week-old male newborn has persistent nonbilious projectile vomiting. Physical examination shows prominent peristalsis. Laboratory findings are indicative of a metabolic alkalosis. Which of the following is the most likely mechanism of this condition?           
    • A. 

      Aganglionosis of the large bowel

    • B. 

      Congenital atresia of the bile ducts

    • C. 

      Congenital defect in the diaphragm

    • D. 

      Hypertrophy of the pyloric sphincter

    • E. 

      Intestinal obstruction by meconium

  • 17. 
    A 76-year-old woman who is a resident of a skilled nursing care facility is brought to the physician because of a 2-day history of fever and cough. Her temperature is 38.5°C (101.3°F). Treatment with ciprofloxacin is begun. Two days later, she is admitted to the hospital because of a progressive cough and a temperature of 39°C (102.2°F). Culture of sputum at this time grows Streptococcus pneumoniae. A mutation in genes encoding which of the following enzymes is the most likely cause of the organism's resistance to ciprofloxacin?
    • A. 

      Acetyl transferase

    • B. 

      DNA gyrase

    • C. 

      B-Lactamase

    • D. 

      Tetrahydrofolate reductase

    • E. 

      Transpeptidase

  • 18. 
    A 55-year-old man comes to the physician because of intermittent heartburn during the past 3 months. He says that he has approximately two episodes weekly during which he develops burning pain between his chest and abdomen when he lies down for a nap after dinner. A bitter taste sometimes accompanies the pain. He often has an alcoholic drink before dinner and several glasses of wine with the meal. He is 178 cm (5 ft 10 in) tail and weighs 113 kg (250 lb); BMI is 36 kg/m2. Physical examination shows no other abnormalities. In addition to weight loss and decreased alcohol consumption, which of the following drugs is most appropriate for this patient?
    • A. 

      Loperamide

    • B. 

      Misoprostol

    • C. 

      Omeprazole

    • D. 

      Prochlorperazine

    • E. 

      Sucralfate

  • 19. 
    A 2-year-old girl is brought to the physician by her mother because of fever and a sore throat for 3 days. She has difficulty swallowing and has become irritable, listless, and uninterested in eating. She was recently adopted from a developing country, and her immunization history is unknown. Her temperature is 38.5°C (101.37), pulse is 150/min, and respirations are 40/min. Physical examination shows a dull red throat. A gray exudate is present on the tonsils, pharynx, uvula, and tongue, and the exudate can be lifted with a tongue blade. There is marked cervical lymphadenopathy. The most likely causal organism produces a toxin that causes ADP-ribosylation of which of the following targets?
    • A. 

      Acetylcholinesterase

    • B. 

      Adenylyl cyclase

    • C. 

      Elongation factor-2

    • D. 

      GTPase Gs subunit

    • E. 

      Guanylyl cyclase

    • F. 

      Ribosomal protein S1

  • 20. 
    A 92-year-old man is brought to the emergency department because of a 6-hour history of chest pain and shortness of breath. A diagnosis of congestive heart failure is made. Diuretic therapy is initiated, and his symptoms resolve over the next 3 days. However, his pulse remains at 44(min, and he has fatigue with minimal exertion. His physician believes that he should receive a pacemaker, however, the patient has expressed a desire to forego all invasive procedures. The physician presents the benefits of the pacemaker fully, but he describes the risks and follow-up in a cursory manner. The patient consents to the procedure. This physician has violated which of the following ethical principles?
    • A. 

      Beneficence

    • B. 

      Informed consent

    • C. 

      Justice

    • D. 

      Nonmaleficence

    • E. 

      Veracity

  • 21. 
    A female newborn is delivered at 34 weeks gestation in an advanced-care setting where special delivery systems are available. The diagnosis of persistent pulmonary hypertension is made. Considering that the newborn can be carefully monitored for methemoglobinemia, which of the following is the most appropriate therapy?
    • A. 

      Desflurane

    • B. 

      Hyperbaric oxygen

    • C. 

      Nitric oxide

    • D. 

      Nitrous oxide

    • E. 

      Oxygen diluted with helium

  • 22. 
    A 19-year-old woman comes to the physician because of increasingly severe pain in the right hip during the past month. She has a 4-year history of refractory inflammatory bowel disease with arthritis in the hands treated with corticosteroids for the past 2 years, An x-ray of the pelvis shows collapse of the superior half of the right femoral head with preservation of the articular cartilage. The left hip appears normal. Which of the following is the most likely cause of the hip abnormality?
    • A. 

      Ankylosing spondylitis

    • B. 

      Aseptic necrosis

    • C. 

      Gouty arthritis

    • D. 

      Multiple myeloma

    • E. 

      Septic arthritis

  • 23. 
    A 15-year-old boy is brought to the physician by his mother because of a 2-month history of sneezing, coughing, and watery eyes immediately after he mows the lawn. Fifteen minutes after his symptoms first begin, he develops a red rash containing areas that are soft to the touch. Physical examination shows boggy, soft, raised, pruritic, erythematous lesions with wheal and fiare eruptions over the face, trunk, and back. Which of the following describes the most likely underlying mechanism of the rash in this patient?
    • A. 

      Type I (immediate) hypersensitivity

    • B. 

      Type II (complement-mediated cytotoxic) hypersensitivity

    • C. 

      Type III (immune complex-mediated) hypersensitivity

    • D. 

      Type IV (delayed) hypersensitivity

  • 24. 
    An investigator is studying  B2-adrenoreceptors in female experimental animals. During the experiment, epinephrine is injected intramuscularly into each animal, and the effects on B2- adrenoreceptors are then observed. Which of the following physiologic effects is most likely to be observed in these animals?
    • A. 

      Increased myocardial contractility

    • B. 

      Internal urethral sphincter contraction

    • C. 

      Lipolysis

    • D. 

      Pilomotor contraction

    • E. 

      Papillary dilation

    • F. 

      Uterine relaxation

  • 25. 
    A 25-year-old man receives a bupivacaine injection for median nerve block as treatment of carpal tunnel syndrome. Which of the following is the mechanism of action of this drug on the membrane?      
    • A. 

      Activation of the Na+/K+ ATPase

    • B. 

      Decreased permeability to Ca++

    • C. 

      Decreased permeability to Na+

    • D. 

      Increased reuptake glutamate

    • E. 

      Inhibition of the Na+/Ca++ antiporter