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NBME 30 Exam | Questions and Answers | 100%
Correct Elaborations | Latest 2025/2026 Update |
GRADED A.
Question:
56 y/o F comes to physician 3 wk hx increasing weakness of arms and legs.
- Smoking
- Weakness of hip girdle muscles, lesser weakness of shoulder girdle muscles.
- Weakness improves with repetitive testing.
- Hilar lung mass
Question:
What is impaired:
- Acetylocholinesterase
- Binding of ACh on postsynaptic membrane
- Direct depolarization of muscle by Ca
- Postsynaptic membrane potential
- Presynaptic release of ACh Presynaptic release of ACh
- Lambert Eaton myasthenic syndrome (ab to voltage-gated calcium channels on presynaptic LMNs, which decreased calcium influx and ACh release to postsynaptic SkM cells
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23 y/o F 1 wk history of intermittent fever, chills, rash
- Hx 4 operations (1) scoliosis, (2) tonsillectomy, (3) appendectomy, (4) lipoma.
- Hx admission for N/V
- Dermabrasion to correct acne scarring
- PE: 12 evenly spaced punctate marks in linear patten on abdomen and UE, LE
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Diagnosis?
- AML
- Factitious d/o
- ITP
- Lyme disease
- Syphilis Factitious disorder
- patients produced symptoms for primary gain. Primary gain is motivation to be cared for, which constitutes unconscious motivator in patients production of symptoms. "Care seeking" tx - regular f/u with one physician who oversees management & psychotherapy
Question:
An investigator is studying the adverse effects of a proteasome inhibitor, bortezomib, on immune responses. Administered to group of pts with relapsed MM and immune response observed. Which immunologic processes affected by drug?
- Activation of complement cascade
- Activation of perforin
- Presentation of antigens to CD8+ T lymphocytes
- Secretion of histamine by mast cells
- Secretion of IL-1 by macrophages Presentation of antigens to CD8+ T lymphocytes
- Proteasomes are elarge proteases with numerous domains that ar epresent in cytoplasm and nuceli. Made of alpha and beta subunits and have extensive role in cell cycle regulations and immune function.
highly malignant brain tumor in intraaxial mass in cerebral hemispheres, which typically demonstrate areas of necrosis and can spread to opposite hemisphere across corpus callosum.
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infant understanding of death zero
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4 - year-old understanding of death temporary and reversible
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20 y/o man with 4hr history abd pain, N/V. Binge drinking all weekend. Three doses of tylenol for HA. Increased risk for liver injury why? Induction of CYP450 that activate acetaminophen to a hepatotoxic metabolite. Ethanol lead sto induction of P450 enzymes that result in increased production of NAPQI when high doses of tylenol taken. depletin of glutathione. give NAC.
Question:
Translocations balanced - no significant consequence unless the break point affects a regulatory sequence or section of an exam that results in reduced or absent translation of encoded protein.
regulatory sequences: promoters, enhancers, silencers
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Frank Starling mechanism relationship between cardiac output and LVEDV - preload. CHF - line falls down AVM - increased CO per this relationship Tamponade - decreased ventricular filling but no change on this curve Cor pulmonale - RVF from chronic pulm HTN no change on this curve Restrictive cardiomyopathy - decreased compliance of ventricular wall disatolic dysfunction and preserved LV systolic function (CO would be preserved)
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Renal autoregulation relatively constantly GFR despite change sin glomerular perfusion and is mediated by delivery of filtered sodium to macula densea in ealry DCT. in Renal a. stenosis, there is a decreased glomerular perfusion --> decreased filtration and decreased sodium delivery to macula densa. COmpensates by promoting activatoin of RAASD system --> constriction of efferent arteriolar. Induces increased intraglomerular pressure to maintain GFR.
Question:
Round ligament fibromusclar band of tissue that extends from superolateral part of uterus where fallopian tubes insert, passes through the inguinal canal, ends in labia majora. remnant of gubernaculum. this is stretched in preganancy --> pain
vasopressin is made in the paraventricular and supraoptic nuclei
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Transformation required ____ DNA naked (not a/w proteins/lipids/molecules)
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Warrensburg syndrome syndrome of patchy depigmentation of skin, hair, irises, cochlear dysfunction AD
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Neural crest cells do not properly differentiate into melanoblasts
- white forelock, eyelashes, depigmented skin patches, iridic heterochromia, sensorineural deafness, eyes may be laterally displaced
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Glucose-dependent insulinotropic peptide (GIP) secreted by duodenum & jejunum (K cells), paracrine and classical signaling to pancreas. Stimulates insulin secretion, triggered by glucose in the duodenum. to decreased gastric acid production and stimulate insulin release from pancrease
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RR = x per 10,000 / y per 10, RR = x/y
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Obese vs. non obese same drug administered greater volume of distribution so takes longer to get to therapeutic dose
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Pores of Kohn connections between alveoli and are present in normla lung tissue. type II alveolar cell sand llow for the passage of air, gluid, phagocytes, and in the setting of pneumonia, bacteria between adjacent alveoli
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PKU patient supplement with what for catecholamine production tyrosine (can't convert phenylalanine to tyrosine)
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PO2 in the renal vein is high compared with venous PO2 from other organs. What explains this finding? blood flow per gram of tissue is greater in kidneys than in other organs it is in excess of what is needed to meet its metabolic demands
paramedian branchs of PCA affect the cerebral peduncle contianing the corticospinal tract and neighboring oculomotor nerve. Diplopia, ptosis, primary gaze palsy, popully constriction deficits) and contralalteral hemiparesis with UMN patter of dysfuntion.
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Horner syndrome upper spinal cord sympathetic nerve supply to ipsilateral face and eye - ipsilateral ptosis, miosis, anhidrosis.
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Malignant mesothelioma chronic cough, SOB, pleural effusion + calcified pleural plague a/w asbestosis (working in shipyard, roofing, plumbing) exudative pleural effusion caused by the malignant pleural disease
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Leuprolide for prostate cancer decreased LH and testosterone GnRH analon - contuned non-pulsatile fasino GnRH R antagonist
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Androgen insensitivity syndrome caused by defect in androgen receptor complex resulting genotypic XY male to develop external female or ambiguous genitalia and female secondary sex characteristics. testes are present. increased concentrations of testosterone, estrogen, and LH (no uterus or ovaries)
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Chronic hypertension on kidneys hyperplastic arteriolitis
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Marasmus acute protein energy malnutrition = decrease din mid-upper arm circumference, weight for length, BMI. maintain linear growth because weight is more quickly impacted than height.
- deficient caloric intake but no specific vitamins or minerals are missing. wasting of muscle mass and consumption of body fat stores NO EDEMA
Question:
What produces progesterone in pregnancy corpus luteum to maintian the endometrial lining slowly, the placenta that begins to secrete HCG which then maintains the corpus letum and its secretion of progesterone. as the placenta develops it becomes primarily repsonisble for progesterone production around seven to ten weeks of gestation.
URI infection clearance is most dependent on what class I MHC viral peptide complex presentation and subsequent activation of CD8+ T lymphocytes
Question:
40 year old man evaluated because skin etremely sensitivy to sunlight. -->> vesciles and blisters on skin which take weeks to heal which biochemical pathwya is most defective in patient heme synthesis porphyria cutanea tarda - severre cutaneous photosentivity wiht blistering and hyperpigmentation after exposure to sunlight and is most common of the porphyrias. decreaed acitvity of uroporphyringogen decarboxylase. which is also used in the production of heme. no OCPs (Oral contraceptive pills) in people who smoke
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PEEP is for preventing absorption atelectasis - keeps alveoli stented open to prevent impaired gas exchange (further)
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Muir-Torre syndrome hereditary nonpolyposis CC affected individuals are prone to developing colon, genitourinary, skinc ancer, keratoacanthomas and sebaceous glad tumors
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Peutz-Jeghers syndrome AD hamartomatous polyps in colon/GI tract and pigmented macules in the mouth/lips/hands/genitalia
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Cowden disease AD polyposis a/e hamartomatous polyps in GI tract. a/w mucocutaneous neuromas, oral papillomas, and cutaneous trichilemmomas.
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Clamp coronary artery. What is the first thing that's going to happen? Swelling of endoplasmic reticulum (swelling of the cell and its organelles is the first cellular change that occurs after cessation of blood flow from shut down of NA/K ATPase, which results in intracellular accumulation of sodium which shifts the osmotic gradient and leads to cellular swelling
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Zellweger syndrome genetic mutations that leads to absence of peroxisomes - increased VLCFA, seizures, ID< hypotonia, hepatomegaly, jaundice, kidney disease, cataracts, hearing loss, and craniofacial abnormalities
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Allosteric activator
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Decreased Na consumption increased epithelial Na channel transcription
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Low salt intake ANP decreased bp
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ANP
secreted by atrial cardiac myocytes in repsonse to increased hydrostatic pressure
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Fibrinolytic (thrombolytics) drugs catalyze the formation of plasmin plasmin is a serine protease that cleaves fibrin clots
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NF
AD
with complete penetrance and variable expressibity
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Cleidocranial dysplasia inherited either de novo ro in an AD manner and presents with bony dysplasia. diminution or absence of clavicle permits abnormal movement of shoulders anteriorly. impaired skull development, Wormian (intrasutural) bones, supernumerary teeth, hypoplasia or maxilla, frontal bossing, hypertelorism, delayed ossification of pubic symphysis. CBFA1 gene may be mutated. osteoblasts are dysfunction. membranous bone along midline is most commonly affected.
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Tonic-clonic seizure, diaphoresis, tachycardia, high BP post undergoing abdominal operation alcohol withdrawal
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Sperm autoanibodies sertoli cells lining seminiderous tubles create blood testis barries with tight junctions when this barrier is dysrupted the sperm and meet the immune system and immune system thinks they are bad news so antibodies are formed = male infertility
Question:
Tb is a ____ HS reaction type IV
painful, tender thyroid absence of iodine uptake on radionuclide scan and presence of multinucleated giant cells on FNA
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Thyroid sick syndrome acute systemic illness and is characterized by decreased concentrations of thyroid hormone and normal TSH level; no enlargement or tenderness of thyroid squamous cell carcinoma of lung central lesion tobacco use, secondary hand smoke, asbestos, radon exposure, FHx pulmonary cavitations, central location, hypercalcemia (PTHrP) polygonal cells with intercellular bridges, eosinophilic cytoplasm and keratin pearls and extensive necrosis
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Giant cell carcinoma of lung rare carcinoma of lung pleomorphic giant, multinucleated cells upper lobes and periphery
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Adenocarcinoma of lung most common overall nonsmokers chronic consolidation in periphery, glandular
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Small cell carcinoma of lung centrally located and TOB use NE cells a/w numerous paraneoplastic syndrome - cushing syndrome, SIADH, Lmabert-Eaton, limbic encephalitis, subacute cerebellar degeneration small dark blue tumor cells lacking nucelioli with high nuclear to cytoplasm ratio
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Trochanteric bursa pain and swelling pain over lateral aspect of the hip fluctuant tender circumscribed mass without limited range of motion or pain the joint itself
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