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NBME CBSE (USMLE STEP 1) MEDICAL EXAMINATION EXAM
QUESTIONS WITH COMPLETE SOLUTIONS GUARANTEED PASS
BRAND NEW 2025
18 yo man yellow nodules on Achilles tendon and extensor tendons on hand. Foamy histiocytes within dermis. Increase in LDL. Dx? - ANSWER - >Absence of functional LDL receptors in hepatocytes Familial hypercholesterolemia, AD Absent or defective LDL receptors, or defective ApoB- 100 Accelerated atherosclerosis, tendon (Achilles) xanthomas 14 yo boy with daily HA. BL aching in his temples, "has not been himself" for past few months. Seems more confused, forgetting names, dates and places. Clumsy with frequent falls and declined school performance. Chronic abuse of what? - ANSWER>>Inhaled glue
Aldosterone-secreting adrenal adenoma has what renin level? - ANSWER - >Decreased renin Pincer grasp, finger feeding, standing while holding onto table, playing peekaboo. Age in months? - ANSWER
9 months Distributive shock - ANSWER - >Sepsis, anaphylaxis, CNS injury Warm skin if sepsis or anaphylaxis Dry if CNS injury ONLY ONE WITH DECREASED AFTERLOAD/SVR ONLY ONE WITH INCREASED OUTPUT Decreased afterload because release of inflammatory mediators = vasodilation, therefore pts feel red Increased CO bc of compensatory increase in sympa drive and increased cardiac
R tibia. Tx = cast immobilization of R UE and R knee and ankle. After 10 wks, which DTR is strongest? - ANSWER -
L Achilles tendon Cerebral cortex has UMNs! An 80-year-old man with type 2 diabetes mellitus is brought to the physician because a 2-month history of severe constipation. Use of over-the-counter laxatives has not relieved his symptoms. Abdominal examination shows distention. Colonoscopy shows no abnormalities. This patient most likely has dysfunction of which of the following nerves? - ANSWER - >Pelvic splanchnic Parasympathetic 59y/o female comes in with gradual onset of lack of muscle control in here left arm and legs. symptoms began 1 month ago after being diagnosed with breast cancer that has metastasized. P/E shows ataxia of left upper and lower extremities. muscle strength , dtrs , proprioception, sensation , are NORMAL. pts condition is due to metastatic tumor in which of the locations on left? - ANSWER - >Cerebellum Translation start codon is underlined. A mutation from G - > A at position 355 (bold italics) is most likely to lead to beta- thalassemia by which of the following mechanisms? -
ANSWER - >Disruption of normal splicing by creation of a new 3' splice site Beta thal mutations are usually promoter or splice site mutations 30 yo woman 20 weeks gestation comes to physician. Fundal ht greater than expected. US showed markedly increased amniotic fluid volume. Abnormality that caused this finding? - ANSWER - >Tracheoesophageal atresia (inability to swallow fluid) - polyhydramnios Vs oligohydramnios is due to renal agenesis 45 yo woman diagnosed with invasive ductal cell CA breast. Started on tamoxifen and serum analysis showed decreased conc. of endoxifen, the active metabolite of prodrug tamoxifen. Genetic analysis showed homozygous presence of CYP450 2D6*4 alleles. Which of following best represents the likelihood that this patient sister has same alleles
- ANSWER - >25% Do Punnett square
An 80 year old woman is being evaluated for suspected temporal arteritis. Her ESR is 100mm/hr. Treatment of TA involves the use of glucocorticoids, which could have serious adverse effects. The pretest probability for TA is 50% in this patient. In evaluation of TA, ESR has sensitivity of 99%, and a specificity of 60%. Based on the results of the ESR testing in this patient, which of the following is the most appropriate step in management? - ANSWER - >Additional testing to confirm dx of TA In a nuclear transplantation experiment, mouse embryos are produced with two pronuclei, of the same parental origin. When both pronuclei are from the mom, the products of conception have poorly developed extraembryonic structures. When the two pronuclei are from the dad, then the products of conception have poorly developed embryonic tissue. What is the most compatible genetic mechanism? - ANSWER - >Imprinting Vs loss of heterozygosity = "two-hit hypothesis" 69 yo woman comes to the physician because she has had weakness of her left leg since awakening that morning. Physical exam shows weakness of the extremity. A Babinski sign is present on the left. Sensory testing shows decreased somatic sensation in the left foot, agraphesthesia on the plantar surfaces of the toes and decreased position sense in the toes. An MRI of the brain
shows an edematous are in the cerebral cortex of the right hemisphere. The most likely cause of this condition is a lesion located at which of the following labeled areas in the photographs of normal brains shown? - ANSWER>>G ACA is supplying this area A 12 yo boy is swimming in a mountain stream. he is immersed up to his neck n 60F water for 20 mins. which of the following sets of physiologic changes is most likely to occur in this boy? Central Blood volume / ADH / ANP A up/ up/ up B up/up/down C up/ down/ up D up/ down/ down E down/ up/ up F down/ up/ down G down/ down/ up H down/ down/ down - ANSWER - >C If he's in cold water, his peripheral arterioles are going to intensely vasoconstrict, leading to increased central blood volume. As a result of this increased central blood volume,
B. Gut malrotation C. Immature lower esophageal sphincter D. Neuromuscular abnormality of esophagus E. Pyloric Stenosis F. Tracheoesophageal fistula - ANSWER - >C NOT E bc typically in boys and will feel olive shaped mass 65 yo woman with ovarian CA tx with cyclophosphamide. What does it affect? - ANSWER>>DNA replication it is an alkylating agent; cross-link DNA at guanine. Nitrogen mustard. A 15-year-old girl who recently emigrated from India is brought to the physician because of several lesions on her neck for 2 weeks. Physical examination shows a hypopigmented, hypoesthetic area over the left side of the forehead and 4-cm lesions on the neck. A biopsy specimen of a lesion shows acid-fast bacilli. Which of the following best explains why the causal organism results in dermal rather than in visceral infections? A)CO2 requirement B) Innate antibacterial compounds C) Lipid content
D) Oxygen tolerance E) Temperature sensitivity - ANSWER - >E Leprosy! A patient who has a history of chronic obstructive pulmonary disease (COPD) was hospitalized for increasing shortness of breath and chronic hypoxemia (SaO2 levels of 89% to 90%). In planning for discharge, which action by the nurse will be most effective in improving compliance with discharge teaching? A. Have the patient repeat the instructions immediately after teaching B. Accomplish the patient teaching just before the scheduled discharge C. Arrange for the patient's caregiver to be present during the teaching D. Start giving the patient discharge teaching during the admission process - ANSWER - >C. Arrange for the patient's caregiver to be present during the teaching A patient is scheduled for a computed tomography (CT) scan of the chest with contrast media. Which assessment findings should the nurse report to the healthcare provider before the patient goes for the CT? Select all that apply. A. Allergy to shellfish B. Patient reports claustrophobia
are also appropriate but should be done after attempting to clear the nose. A patient with a possible pulmonary embolism complains of chest pain and difficulty breathing. The nurse finds a heart rate of 142 beats/min, blood pressure of 100/ mmHg, and respirations of 42 breaths/min. Which action should the nurse take first? A. Administer anticoagulant drug therapy B. Notify the patient's health care provider C. Pressure patient for a spiral computed tomography (CT) D. Elevate the head of the bed to a semi-Fowler's position - ANSWER - >D. Elevate the head of the bed to a semi- Fowler's position The emergency department nurse is evaluating the effective of therapy for a patient who has received treatment during an asthma attack. Which assessment finding is the best indicator that the therapy has been effective? A. No wheezes are audible B. O2 saturation is >90% C. Accessory muscle use has decreased D. Respiratory rate is 16 breaths/minute - ANSWER - >B. O2 saturation is >90%
A patient in the clinic with cystic fibrosis (CF) reports increased sweating and weakness during the summer months. Which action by the nurse would be most appropriate? A. Teach the patient signs of hypoglycemia B. Have the patient add dietary salt to meals C. Suggest decreasing intake of dietary fat and calories D. Instruct the patient about pancreatic enzyme replacements - ANSWER - >B. Have the patient add dietary salt to meals The nurse is caring for a patient with aortic stenosis. Which assessment data obtained by the nurse would be most important to report to the health care provider? A. The patient complains of chest pressure when ambulating B. A loud systolic murmur is heard along the right sternal border C. A thrill is palpated at the second intercostal space, right sternal border D. The point of maximum impulse (PMI) is at the left midclavicular line - ANSWER - >A. The patient complains of chest pressure when ambulating
systolic murmur is noted, and the aortic or mitral valves are most often affected in most patient with IE E. IE generally requires treatment with antibiotic for 4- 6 weeks and bed rest - ANSWER>>A. The infection leading to heart failure, sepsis and heart block C. Symptoms of subacute IE include arthralgias, myalgias and clubbing of fingers D. Worsening or new onset of systolic murmur is noted, and the aortic or mitral valves are most often affected in most patient with IE E. IE generally requires treatment with antibiotic for 4- 6 weeks and best rest A patient with a history of chronic stable angina begins to feel a squeezing, heavy kind of ache in their chest that radiates to between their shoulder blades. Expecting that they may be experiencing an angina attack, what is the first thing the nurse will do? A. Check the patient's blood pressure and heart rate B. Obtain a 12-lead ECG C. Position patient upright and administer supplemental oxygen D. Administer sublingual nitroglycerin - ANSWER - >C. Position patient upright and administer supplemental oxygen Which of the following is not a major risk factor of Coronary Artery Disease?
A. Depression B. Tobacco use C. Fasting triglyceride level of 120 mg/dL D. Physical inactivity - ANSWER - >C. Fasting triglyceride level of 120 mg/dL A patient with acute coronary syndrome undergoes coronary artery bypass graft (CABG) surgery. The nurse plans to administer Metoprolol Succinate postoperatively to prevent which common complication? A. Stroke B. Atrial fibrillation C. Cognitive dysfunction D. Infection - ANSWER - >B. Atrial fibrillation Which of the following would indicate a common complication of aortic dissection? A. Hypertension B. Bounding pulse
A patient with suspected meningitis is scheduled for a lumbar puncture. Before the procedure, the nurse will plan to A. Enforce NPO status for 4 hours B. Transfer the patient to radiology C. Administer a sedative medication D. Help the patient to a lateral position - ANSWER - >D. Help the patient to a lateral position During the neurologic assessment, the patient is unstable to respond verbally to the nurse but cooperates with the nurse's directions to move his hands and feet. The nurse will suspect A. Cerebellar injury B. A brainstem lesion C. Frontal lobe damage D. A temporal lobe lesion - ANSWER - >C. Frontal lobe damage
Expressive speech is controlled by Broca's area in the frontal lobe. The temporal lobe contains Wernicke's area, which is responsible for receptive speech. The cerebellum and brainstem do not affect higher cognitive functions such as speech. The nurse is caring for a patient who was admitted previously with a basilar skull fracture after a motor vehicle crash. Which assessment findings indicates a possible complication that should be reported to the healthcare provider? A. Complaint of severe headache s B. Large contusion behind left ear C. Bilateral periorbital ecchymosi D. Temperature of 101.4 F (38.6 C) - ANSWER - >D. Temperature of 101.4 F (38.6 C) Patients who have basilar skull fractures are at risk for meningitis, so the elevated temperature should be reported to the health care provider. The other findings are typical of a patient with a basilar skull fracture.
