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NBME 30 EXAM QUESTIONS AND VERIFIED CORRECT ANSWERS
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"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 - CORRECT ANSWER 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. Caspase, chymotrypsin, and trypsin-like protease capabilities of this enzyme complex are critical to their role as APC; intracellular peptides are processed in the proteasomme for presentation on Class I MHC. Which are recogized by CD8 T lympocytes." "12 y/o girl sliced her left palm with a knife. Would is cleaned and suture. One week later, sutures are removed. At this time, which of the following factors is most instrumental in migration of fibroblasts into area of would healing?
- collagen
- fibronectin
- heparin
- IG
- plasminogen - CORRECT ANSWER Fibronectin.
Collagen is then synthesized by the fibroblasts."
"What is the most common brain tumor in adults? - CORRECT ANSWER Meningiomas - most
common primary brain tumor. Patients may be asymptomatic or experience seisures or focal neurologic deficits related to tumor locaiton. Malignant ones may grow rapidly - leading to symptoms of ICP"
"Glioblastoma - CORRECT ANSWER 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."
"infant understanding of death - CORRECT ANSWER zero"
"4 year old understanding of death - CORRECT ANSWER temporary and reversible"
"brief psychotic disorder - CORRECT ANSWER characterized by acute onset of one or more
psychotic symptoms (delusions, hallucinations disorganized speech, d/o behavior) lasting less than one month. schizoaffective = 6 m/o"
"vasopressin is made in - CORRECT ANSWER the paraventricular and supraoptic nuclei"
"transformation required ____ DNA - CORRECT ANSWER naked (not a/w
proteins/lipids/molecules)"
"Waardenburg syndrome - CORRECT ANSWER syndrome of patchy depigmentation of skin,
hair, irises, cochlear dysfunction AD neural crest cells do not properly differentiate into melanoblasts
- white forelock, eyelashes, depigmented skin patches, iridic heterochromia, sensorineural deafness, eyes may be laterally displaced"
"Glucose-dependent insulinotropic peptide (GIP) - CORRECT ANSWER 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"
"RR = x per 10,000 / y per 10,000 - CORRECT ANSWER RR = x/y"
"obese vs. non obese same drug administered - CORRECT ANSWER greater volume of
distribution so takes longer to get to therapeutic dose"
"chronic hypertension on kidneys - CORRECT ANSWER hyperplastic arteriolitis"
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 - CORRECT ANSWER people who smoke"
"PEEP is for - CORRECT ANSWER preventing absorption atelectasis - keeps alveoli stented
open to prevent impaired gas exchange (further)"
"Muir-Torre syndrome - CORRECT ANSWER hereditary nonpolyposis CC affected
individuals are prone to developing colon, genitourinary, skinc ancer, keratoacanthomas and sebaceous glad tumors"
"Peutz-Jeghers syndrome - CORRECT ANSWER AD
hamartomatous polyps in colon/GI tract and pigmented macules in the mouth/lips/hands/genitalia"
"cowden disease - CORRECT ANSWER AD polyposis a/e hamartomatous polyps in GI tract.
a/w mucocutaneous neuromas, oral papillomas, and cutaneous trichilemmomas."
"fibrinolytic (thrombolytics) drugs - CORRECT ANSWER catalyze the formation of plasmin
plasmin is a serine protease that cleaves fibrin clots"
"NF1 - CORRECT ANSWER AD
with complete penetrance and variable expressibity"
"cleidocranial dysplasia - CORRECT ANSWER 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."
"tonic-clonic seizure, diaphoresis, tachycardia, high BP post undergoing abdominal operation -
CORRECT ANSWER alcohol withdrawal"
"sperm autoanibodies - CORRECT ANSWER 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"
"tb is a ____ HS reaction - CORRECT ANSWER type IV"
"trigeminal neuralgia - CORRECT ANSWER neuroapthic pain disorder that presents as
severe shooting or burning pain wihtin innervated regions of sensory branches of V can occur by microvascular compression of trigeminal nerve triggere dby light touch, etc. tx with carbamazepine"
"what activates acyclovir - CORRECT ANSWER thymidine kinase"
"sickle cell can trigger ______ kidney path - CORRECT ANSWER renal papillary necrosis
2ndary to ischemia and infarction"
"subacute thyroiditis - CORRECT ANSWER de Quervain - self-limited condition of thyroid
that often follows acute viral illness. increased t3, t4, decreased TSH diaphoresis, palpitations, neck pain, dysphagia, fever, tachycardia painful, tender thyroid absence of iodine uptake on radionuclide scan and presence of multinucleated giant cells on FNA"
"small cell carcinoma of lung - CORRECT ANSWER 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"
open"
"can't move R upper and lower extremitis - CORRECT ANSWER left corticospinal tract
lesion"
"familial hyperchylomicronemia - CORRECT ANSWER - LPL deficiency or *Apo C-II
deficiency* (affects LPL docking)
- Accumulation of chylomicrons
- Extremely high triglyceride levels (blood looks like milk; get deposits in the skin)
- Xanthomas (fat bubbles in skin)
- Treatment: Diet control (decrease TGs) andincreased amylase activity"
"external validity - CORRECT ANSWER determines whether an experiment can be
generalized and its conclusion applied to groups beyond those considered in study populations."
"face validity - CORRECT ANSWER weak form of validity assessemnet that asks whether the
test or experiment measures what it is supposed to measure"
"PCL p - CORRECT ANSWER prevents the tibia from moving backward with respect to the
femur"
"increased glucokinase - CORRECT ANSWER DKA"
"decrease spasticity - CORRECT ANSWER activation of GABA receptors in muscle spindle
afferents muscle spindles are stretch receptors located within the muscle which sense changes in the length of a muscle fiber. muscle contraction is controlled by signal transduction from Upper and lower motor neurons, motor end plate, and myocyte calcium release. spasticity, hyperreflexia etc. = loss of UMN control over spinal reflex arcs which results in exaggerated response transmission of stretch reflex is inhibited by GABA signaling - muscle relaxants like baclofen."
"HSV - CORRECT ANSWER CD4+ T lymphocytes + macrophages"
"partial agonist - CORRECT ANSWER bind to and activate a R at same site as a full agonist but
have decreased efficacy" "hypovolemic shock AV Po2 differrence lactic acid ADH
systemic capillary fluid transfer - CORRECT ANSWER increased Po2 AV difference
increased lactic acid increased ADH systemic capillary fluid transfer = reabsorption"
"burned nutrition & fluid requirements - CORRECT ANSWER both increased bc disrupted
skin barrier and hypermetabolic state"
"renal agenesis - CORRECT ANSWER failure of metanephros to response to stimulus by
ureteric bud"
"mesonerphos - CORRECT ANSWER precursor to nephrons"
"heroin withdrawal - CORRECT ANSWER abdominal crams and diarrhea, axious,
piloerection, abdominal tenderless"
"salmonella enterica abx - CORRECT ANSWER prolonded fecal excretion of organism"
"right kidney extension into pelvis (psoterior) going to get what - CORRECT ANSWER psoas
fascia involvement"
"normal-pressure hydrocephalus - CORRECT ANSWER type of communicated
hydrocephalus in ventricles are enlarged leading to damage of white matter tracts connecting frontal lobes and basal ganglia - older patients with dementia, gait apraxia, urinary incontinence. (wet, wobbly, and wacky) postural instability and mild nystagmus"
"estrogen increases transport proteins like TH-BG - CORRECT ANSWER more thyroid
hormone to be bound by protein in plasma"
"cyclosporine blocks - CORRECT ANSWER calcineurin"
"avulsion of hepative veins from IVC - CORRECT ANSWER occult slow bleeding posterior to
the liver supine position throughout hospital cource may have permitted autotamponage of the avulsion injury"
"less sensitive to zidovudine? - CORRECT ANSWER polymerage"
"hypoglycemia --> increase glucagon --> - CORRECT ANSWER hepatic adenylyl cyclase
activation fixes hypoglycemia"
"clonal lymphoid proliferation - CORRECT ANSWER surface kappa:lambda ratio shoudl be
about equal"
"brain hypoxic injruy what is hurt! - CORRECT ANSWER hippocampus - CA1 region of the
hippocampal cortex because of high meetabolic demands"
"myasthenia gravis - CORRECT ANSWER antibodies to nicotinic acetylcholin R"
"pleural effusion in cirrhosis - CORRECT ANSWER decreaed plasma coloid osmotic pressure"
"Carcinogens in cigarette smoke - CORRECT ANSWER Polycyclic Hydrocarbons, Arsenic,
Naphthylamine, cyclophosphamide"
"bacterial pneumonia primary cause of hypoxemia - CORRECT ANSWER pulmonary arterial
blood traversing poorly arerated alveloil"
"restrict valine for what - CORRECT ANSWER maple syrup urine disease"
"musculocutaneous nerve - CORRECT ANSWER coracobrachialis, biceps brachii, brachialis
(flex elbow active by tnot against resistance)"
"graves disease - CORRECT ANSWER caused by hormones acting on nuclear/retinoid x
binding DNA receptors" "testicle that is smaller than right and enlarged spermatic cord that increases in size with
valsalva? oligospermia? - CORRECT ANSWER varicocele"
"uterine atony - CORRECT ANSWER presents as postpartum hemorrhage and a boggy uterus
on PE - macrosomia, multiple gestation, prolonger labor, uterine infection, spianl anehesia. IV fluid, uterine massgae, oxytocin infusion (G protein couple R to Gq)"
"leukemoid reation - CORRECT ANSWER repsonse to stress, infarction or infeciton that
reulsts in peripheral circulating leukocutes"
"cystic fibrosis - CORRECT ANSWER vita ADEK def"
"mucopolysaccardioses - LSD - CORRECT ANSWER enzyme deficity that prevents the
degradaiton fo GAGs in lysosome."
"hurler syndrome - CORRECT ANSWER • AR
- α-L-iduronidase deficiency
- Heparan sulfate, dermatan sulfate accumulates in phagocytic cells & in endothelial & intimal smooth muscle
- normal @ birth then by 6-24 mo Developmental delay, gargoylism, airway obstruction, corneal clouding, hepatosplenomegaly, short neck, vacuoles in lymphocytes, coarse facies hydrocephalus, hearing loss, recurrect RTI"
"retrosternal thyroid tissue - CORRECT ANSWER uptake of iodine"
"glycogen phosphorylase def - CORRECT ANSWER mcardledisease"
"glutamate antagonist - CORRECT ANSWER decreaed calcium into neurons promotes
recovery from acute cerebral infarction"
"13 beta-D glucan - CORRECT ANSWER polysaccharid ecomponent of fungal cell walls"
“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 What's impaired:
- Acetylocholinesterase
- Binding of ACh on postsynaptic membrane
- Direct depolarization of muscle by Ca
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)"
"renal autoregulation - CORRECT ANSWER 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."
"Round ligament - CORRECT ANSWER 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" "an investigator is conducting a study of the effects of a newly discovered spider venom on NM transmission. Isolated nerve muscle preparation is bathed in a solution containing the venom; there is a decreased in the end-plate potential amplitude following stimulation of the nerve. Presence of venom does not change the amplitude of the nerve AP or the response to exogenous acetylcholine. Blockage of which of the following is the MOA?
- Chloride conductance
- Function of acetylocholinesterase
- Inactivate of voltage-gated Na channels in muscle
- Insertion of AChR into muscle membrane
- Presynaptic, voltage-gated calcium channels - CORRECT ANSWER Presynaptic, voltage- gated calcium channels decreased end-plate potential amplitude. normally: AP --> depolarization of terminal bouton of axon --> presynaptic voltage-gated Ca channels consequently open and allow calcium influx which triggers exocytosis of ACh filled vesicles into synaptic cleft."
"pores of Kohn - CORRECT ANSWER 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"
"PKU patient supplement with what for catecholamine production - CORRECT ANSWER
tyrosine (can't convert phenylalanine to tyrosine)"
"PO2 in the renal vein is high compared with venous PO2 from other organs. What explains this
finding? - CORRECT ANSWER 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"
"Gerstmann syndrome - CORRECT ANSWER Angular gyrus lesion
finger tap agnosia, alexia (inability to read), acalculia (inability to use arithmetic operations), agraphia (inability to copy), and left-right confusion."
"Dejerine-Roussy syndrome - CORRECT ANSWER dorsolateral thalamus stroke
connects wiht the limbic system adn may mediate emotional aspects of pain. post-stroke intractable pain known as thalamic pain syndrome"
"Wallenberg syndrome - CORRECT ANSWER lower medulla (lesions may affects nuceli of
multiple CNs, spinal trigeminal nucleus, solitary nucleus, vestibular nuclei, nucleus ambiguus, the sympathetic, spinothalamic, and spinocerebellar tracts. ipsilateral facial numbness, impaired taste sensation, vertigo with nystagmus, dysphonia, dysgia, Horner syndrome, pain and temperatiev sensation deficits in the contralateral arms and legs and/or ipslateral ataxia. constellation of symptoms is wallenberg syndrome"
"Weber syndrome - CORRECT ANSWER lower midbrain
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."
"Horner syndrome - CORRECT ANSWER upper spinal cord
sympathetic nerve supply to ipsilateral face and eye - ipsilateral ptosis, miosis, anhidrosis."
"malignant mesothelioma - CORRECT ANSWER 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"
"leuprolide for prostate cancer - CORRECT ANSWER decreased LH and testosterone
GnRH analon - contuned non-pulsatile fasino GnRH R antagonist"
"euthyroid sick syndrome - CORRECT ANSWER 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 - CORRECT ANSWER 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"
"giant cell carcinoma of lung - CORRECT ANSWER rare carcinoma of lung
pleomorphic giant, multinucleated cells upper lobes and periphery"
"adenocarcinoma of lung - CORRECT ANSWER most common overall
nonsmokers chronic consolidation in periphery, glandular"
"Alloimmune hemolytic disease of newborn - CORRECT ANSWER patient show are Rh
positive mom Rh negative but were previously sensitized by prior birth or blood transfusion to make anti- Rh ab"
"baby arm jerk - CORRECT ANSWER subluxation of radial head"
"twins with one hematocrit 68% and other other with 25% - CORRECT ANSWER artery to
artery chorionic surface anastomoses"
"twin-twin transfusion syndrome - CORRECT ANSWER formation of AV anastomoses in
chorion of placenta that allow blood to pass from one fetus to another. or A to artery chorionic surface anastomoses. presents on prenatal U/s with unequal amniotic fluic indices between two amniotic sacs."
"Twin anemia-polycythemia sequence (TAPS) - CORRECT ANSWER anemia of one fetus and
polycythemia of the other fetus when chronic"
"Crohn disease given lactulose why urine excretion higher - CORRECT ANSWER tight
junction inflammation associated changes - more permeable to substances"
"CCR5 mans cell times in this patient also infected with HIV - CORRECT ANSWER
macrophages"
"synthetic androgen why are testicles small - CORRECT ANSWER increased negavtive
feedback on gonadotropin secretion (specifically decreased LH)"
"Granulomatosis with polyangiitis (Wegener) - CORRECT ANSWER necrotizing
granulomatous vasculitis that affects small and medicume vessels. c-ANCA. sinopulmonary tract, kidneys, and skin."
"ataxia telangiectasia - CORRECT ANSWER ATM gene mutations leading to DNA repair
defect cerebellar atrophy, prpogresisve ataxia, telangiectatic lesions of eyes and skins, dystonia, abnormal eye movements, decreased Ig concentrations. a/w pulmonary disease and hematologic malignancies AR"
"Adalimumab - CORRECT ANSWER for rheumatoid arthritis (binds with TNF-a)"
"IL-1 - CORRECT ANSWER Osteoclast activating factor promotes bone re-absorption and
cartilage destruction. increased in RANK ligand signaling and subsequent osteoclast-mediated bone resorption. IL-1 is a potent cytokine that can induce bone erosion in inflammatory sites such as rheumatoid joint regions via activation of osteoclasts. Not only is IL-1 capable of activating osteoclasts, but it is also a key cytokine involved in the differentiation, multinucleation, and survival of osteoclasts. It is also important for regulating inflammation and tissue damage beyond inflammation."
"thyroid scan with radioactive iodide larged about of iodide after a week would be - CORRECT
ANSWER t4 bound to t4-BG the vast majority of TH exists as T4 bound to T4 binding globulin"
"degeneracy - CORRECT ANSWER multiple species of tRNAas exit for most amino acid
different codons can encode the same individual amino acids"
