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NBME CBSE REAL EXAM 200 QUESTIONS AND
ANSWERS LATEST (USMLE STEP 1)MEDICAL
EXAMINATION
70yo M dies in a motor vehicle collision. Was undergoing evaluation for occult blood in the stool. Photo of transverse colon shown. Dx?
Tubular adenoma. CORRECT ANSWER: Tubular adenoma.
38yo M with 1-week hx of watery, itchy eyes and a runny nose.Physical shows inflamed nasal mucosa. No congestion in lower lung. Pharmacotherapy?
Loratadine. CORRECT ANSWER: Loratadine.
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 spontaneously agglutinates while awaiting transport to the laboratory. Antibody isotypes causing agglutination?
IgM. CORRECT ANSWER: IgM.
24yo M with small tender blisters on his penis 3 days after unprotected sex. Photograph shown. Causal agent?
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HSV-2. CORRECT ANSWER: HSV-2.
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?
Rosacea. CORRECT ANSWER: Rosacea.
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.Dx?
Malaria. CORRECT 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?
Lisinopril. CORRECT ANSWER: Lisinopril.
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66yo M with stage IV colon cancer with 3-day hx of severe diarrhea after receiving chemotherapy with fluorouracil, leucovorin, and Irinotecan. prescribed opioid antidiarrheal agent with no CNS effects. Which med?
Loperamide. CORRECT ANSWER: Loperamide.
35yo M in ED with 2-hour hx of severe 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 remote 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 or leukocytes.MOA of toxin?
Activation of adenylyl cyclase. CORRECT ANSWER: Activation
of adenylyl cyclase.
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?
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Cerebellum. CORRECT 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?
Congenital cytomegalovirus infection. CORRECT ANSWER:
Congenital cytomegalovirus infection.
Female newborn is delivered at 38 weeks' gestation. Apgar 8 and 8 at 1/5 min. PE shows a bulging, fluid-filled 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)?
15 to 40. CORRECT ANSWER: 15 to 40.
64yo M in ED 3 hours after SOB with exertion and extreme fatigue. Has ischemic heart disease. P 125/min, BP 105/60. ECG shows atrial fibrillation. Intravenous ibutilide is administered.