NBME-13.pdf
March 8, 2017 | Author: zdakra | Category: N/A
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N ationa: Board o f M ed ica l Examiners - G o o g le C hrom e
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Exam Section 1: Item 1 o f 50 ■ M ark
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
1. A 64-year-old woman comes to the physician because of a 6-month history of heartburn and difficulty swallowing solid food and liquid. She has not had nausea or vomiting. She also has a 2-year history of pain and swelling of her wrists and hands. She has not seen a physician in 5 years. She takes no medications. She does not smoke. Physical examination shows no wrinkles on the face and neck. Her vital signs are within normal limits. There is synovial thickening of the wrists bilaterally. A photograph of the left hand is shown. Abdominal examination shows no abnormalities. Which of the following sets of findings is most likely on esophageal manometry?
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A) B) C) D) E) F)
Esophageal Peristalsis
Lower Esophageal Sphincter Tone
Increased Increased Normal Normal Decreased Decreased
increased decreased increased decreased increased decreased
T im e R em aining: 4 hr 19 m in 0 sec
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Exam Section 1: Item 2 o f 50 I
Mark
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 4 hr 16 m in 41 sec
2. A 31-year-old woman is evaluated because of a 1-year history of infertility. Her hysterosalpingogram is shown. The most likely cause of these findings is malformation of which of the following embryonic tissues? © A) Germ cells
"S T s T -
B) Gonadal ridges C) Mesonephric (wolffian) ducts D) Paramesonephric (mullerian) ducts © E) Urogenital folds F) Urogenital sinus
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Exam Section 1: Item 3 o f 50 I
Mark
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 4 hr 16 m in 4 sec
3. A 52-year-old man with a family history of renal failure comes to the physician because of abdominal pain over the past 6 months. He has been treated in the past for renal calculi and hypertension. Physical examination shows bilateral palpable masses in the upper abdomen. Urinalysis shows crenated erythrocytes and mild proteinuria. A CT scan of the abdomen identifies the cause of the patient's problem. Which of the following is the most likely diagnosis? A) Adrenal adenoma B) Glomerulonephritis O C) Henoch-Schonlein purpura O D) Polycystic kidney disease E) Renal cell adenoma
N ationa: Board o f M ed ica l Examiners - G o o g le C hrom e
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Exam Section 1: Item 4 o f 50 ■ M ark
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 4 hr 13 m in 31 sec
4. A 55-year-old man comes to the physician because of two episodes of painless, blood-tinged urine during the past week. His last episode was 2 days ago. He has smoked 1 pack of cigarettes daily for 35 years. Vital signs are within normal limits. Physical examination shows no abnormalities. Urinalysis shows normal findings except for microscopic blood. Which of the following is the most likely diagnosis? O A) Bladder cancer B) Bladder diverticulum C) Interstitial cystitis D) Nephrolithiasis O E) Urinary tract infection
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Exam Section 1: Item 5 o f 50 ■ M ark
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 4 hr 12 m in 14 sec
5. A mouse melanoma, B-16, is highly metastatic. A clone of the B-16 melanoma cells is injected intravenously into the tail vein of mice, and 3 weeks later tumor nodules are found in the lungs, liver, and ovaries. When an antibody to a liver cell surface antigen is injected 1 hour prior to injection of the B-16 melanoma cells, formation of tumor nodules in the liver is prevented, but tumor nodules develop in the ovaries and lungs. In vitro studies do not show any cytotoxic effect of the antibody on B-16 or hepatic cells. Which of the following processes is most likely to be affected by the antibody? O A) Homing B)
Initiation
O C) Invasion O D) Motility O E) Progression O F) Promotion
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Exam Section 1: Item 6 o f 50 I
Mark
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 4 hr 6 m in 13 sec
6. A retrospective study is conducted to assess the incidence and outcome of subarachnoid hemorrhage in a midwestern state. The annual incidence of this condition is 15 per 100,000 people, and the case fatality rate is 40%. Based on these data, which of the following represents the annual mortality rate for subarachnoid hemorrhage per 100,000 people in this state? © A) 0.4 x 15 © B) 0.4 x 100,000 © C) 0.6 x 15 © D) 0.6 x 100,000
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Exam Section 1: Item 7 o f 50 I
Mark
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 51 m in 22 sec
7. A 24-year-old woman comes to the physician because of a 1-day history of pain in her left leg while walking. Her temperature is 37°C (98.6°F), pulse is 84/min, and blood pressure is 135/78 mm Hg. Examination of the left lower extremity shows only a markedly decreased pulse in the left lower extremity. An intermittent faint diastolic heart murmur is heard at the apex. Angiography of the left lower extremity shows complete obstruction of the distal left femoral artery by what appears to be a thrombus. The occlusion is removed using a catheter. Microscopic examination of the removed specimen shows scattered mesenchymal cells in an abundant extracellular matrix. Echocardiography confirms a diagnosis of cardiac tumor. This patient most likely has which of the following types of cardiac tumors? O A) Fibroelastoma O B) Fibroma C)
Hamartoma
O D) Hemangioma O E) Myxoma
N a tio n a i Board o f M ed ica l Examiners - G o o g le C hrom e
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Exam Section 1: Item 8 o f 50 ■ M ark
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 49 m in 1 sec
8. An 18-year-old woman with mild mental retardation is brought to the physician because of a 3-day history of decreased ability to see in reduced light. She has a lifelong history of chronic diarrhea. Two years ago, she developed a lack of muscle control of her arms and legs, and generalized weakness. Her 16-year-old brother has had similar symptoms. Ophthalmologic examination shows bilateral retinitis pigmentosa. There is ataxia and loss of deep tendon reflexes. Laboratory studies show erythrocytes with spiny projections and a serum total cholesterol concentration of 40 mg/dL. Which of the following apolipoproteins is most likely deficient in this patient? © A) Apo A-l © B) Apo A-ll © C) Apo B © D) Apo C © E) Apo E
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Exam Section 1: Item 9 o f 50 I
Mark
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 47 m in 43 sec
9. A 21 -year-old African American man with sickle cell disease is brought to the emergency department 2 hours after the sudden onset of severe pain in his abdomen and knees. He has had six similar episodes within the past 4 years; he was admitted to the hospital each time for treatment of the pain. His course has been complicated by two episodes of pneumonia and a small cerebral infarction in the past 2 years. The patient asks the physician for extra pain medication to "kill me because I can't take it anymore." Which of the following initial actions by the physician regarding the patient's request is most appropriate? A) Contact the hospital ethics committee B) Restrain the patient C) Reevaluate the patient after his pain has been controlled D) Administer general anesthesia for sedation O E) Comply with the patient's request
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Exam Section 1: Item 10 o f 50 I
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
Mark
T im e R em aining: 3 hr 40 m in 18 sec
10. A 40-year-old woman comes to the physician for genetic counseling because of a family history of muscle weakness. She says that she has not sought treatment because her symptoms are not severe, but her children have profound muscle weakness and fatigue. Sequence analysis of mitochondrial DNA shows a mutation in 50% of the mother's mitochondrial DNA and in 100% of each of her children's mitochondrial DNA. A pedigree is shown. Which of the following genetic principles best explains the findings in this family? A)
Anticipation
f i l l
O B) Genetic drift
1
O C) Heteroplasmy D) Imprinting E) Pseudodominant inheritance
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Unaffected male
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Exam Section 1: Item 11 o f 50
National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment
H Mark
Tim e Remaining: 3 hr 37 min 44 sec
11. During an experiment, a cuff occluder is placed on the left renal artery of a normal rat and inflated to cause a 90% decrease in the cross-sectional area of the artery. A catheter is placed in the left and right renal veins to sample the effluent. The concentration of which of the following substances will most likely be higher in the effluent from the left renal vein than that from the right renal vein? O A )A D H (vasopressin) O B) Aldosterone 0 C) Endothelin 0 D) Epinephrine o E) Renin
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Exam Section 1: Item 12 o f 50 ■ Mark
National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment
Tim e Remaining: 3 hr 37 min 35 sec
12. A previously healthy 32-year-old man is brought to the emergency department because of a 1-day history of intermittent flashing spots and blurred vision, vomiting, confusion, and difficulty walking. He is a painter and says that yesterday he cleaned up a spilled bottle of paint thinner. Ophthalmologic examination shows dilated pupils with hyperemia of the optic disc and retinal edema. Physical examination shows tachypnea. Serum studies show an anion gap metabolic acidosis. The most appropriate pharmacotherapy for this patient is most likely to inhibit the activity of which of the following? A) Alcohol dehydrogenase B) Aldehyde dehydrogenase C) Formaldehyde dehydrogenase D) Lactate dehydrogenase O E) Pyruvate dehydrogenase
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Exam Section 1: Item 13 o f 50 I
Mark
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 35 m in 50 sec
13. A 48-year-old man is brought to the emergency department because of difficulty opening his mouth and stiffness of his neck, shoulders, and back for 4 hours. He sustained a puncture wound to his arm 1 week ago. He has received no medical care for 30 years. Physical examination shows trismus and opisthotonos. Which of the following best describes the process in this patient? A) Blockade of inhibitory neurotransmitter release B) Cell death in central nervous system neurons C) Cell death in muscles D) Cell death in peripheral nervous system neurons O E) Demyelinization
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Exam Section 1: Item 14 o f 50 I
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N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 35 m in 34 sec
14. A 76-year-old woman is brought to the emergency department because of a 3-hour history of severe headache, slurred speech, and confusion. She has a 2-year history of atrial fibrillation. She has difficulty understanding and answering questions, but she is cooperative. Ophthalmologic examination shows hemianopia and a tendency to gaze to the right. The pupils are normal sized and reactive to light. Neurologic examination shows left-sided numbness and paralysis that are more severe in the face and upper extremity than in the lower extremity. Which of the following arteries is most likely involved in this patient's condition? O A) Anterior cerebral O B) Anterior spinal O C) Middle cerebral O D) Posterior cerebral O E) Vertebral
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Exam Section 1: Item 15 o f 50 I
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N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 34 m in 19 sec
15. A 54-year-old woman comes to the physician because of a 5-day history of severe mid-back pain. Physical examination shows point tenderness over the T6 vertebra. Serum studies show a calcium concentration of 13.4 mg/dl_; urinalysis shows Bence Jones proteins. Which of the following is the most likely cause of this patient's hypercalcemia? A) Excessive parathyroid hormone production B) Excessive parathyroid hormone-related protein production C) Increased fractional calcium gastrointestinal absorption O D) Local interleukin-1 (IL-1) and tumor necrosis factor effects E) Unregulated 1,25-dihydroxycholecalciferol production
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Exam Section 1: Item 16 o f 50 I
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N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 31 m in 41 sec
16. A male newborn is delivered at 38 weeks' gestation following an uncomplicated pregnancy. Twelve-hours later, he begins sucking frantically and crying inconsolably. He overreacts to stimuli around him and has a marked startle response. The symptoms slowly resolve over the next 2 to 3 weeks. The most likely explanation for these symptoms is maternal use of which of the following substances during pregnancy? O A) Alcohol 0 B) Heroin © C) LSD D) 0
Marijuana
E) Psilocybin
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Exam Section 1: Item 17 o f 50 I
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N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 28 m in 23 sec
17. A 27-year-old woman comes to the physician because of a 2-year history of sporadic double vision and a 1-year history of intermittent numbness and tingling in her arms. The symptoms became more severe 5 days ago after a 4-day visit from her husband's parents. During the past year, she also has had four episodes of urinary incontinence. Physical examination shows mild dysarthria. On mental status examination, she has a mildly worried mood and a reactive affect. MRI of the brain shows a few small, scattered, nonspecific white-matter plaques. Which of the following is the most likely diagnosis? A)
Complex partial seizure disorder
O B) Conversion disorder O C) Huntington disease o D) Multiple sclerosis E) Panic disorder without agoraphobia
N ationa: Board o f M ed ica l Examiners - G o o g le C hrom e
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Exam Section 1: Item 18 o f 50 ■ M ark
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 28 m in 14 sec
18. A 30-year-old woman, gravida 2, para 2, develops severe vaginal bleeding immediately after vaginal delivery of a male newborn at term. The hemorrhage continues during the next hour, and the patient undergoes an emergency hysterectomy to control the bleeding. Examination of the uterus shows fragments of placenta adherent to the uterine wall. There is absence of the decidua basalis. Which of the following is the most likely diagnosis? O A) Abruptio placentae O B) Chronic villitis C) Circumvallate placenta D) Placenta accreta O E) Succenturiate lobe
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Exam Section 1: Item 19 o f 50 I
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
Mark
T im e R em aining: 3 hr 27 m in 45 sec
19. A 55-year-old man with hepatic encephalopathy is brought to the physician because of confusion and increased lethargy during the past 24 hours. He has a history of cirrhosis of the liver caused by hepatitis C. He is easily arousable despite the lethargy. His temperature is 37°C (98.6°F). Physical examination shows scleral icterus, asterixis, a protuberant abdomen, and ascites. Test of the stool for occult blood is negative. Administration of which of the following drugs is most likely to improve this patient's mental status? O A) Bisacodyl O B) Docusate © C) Lactulose 0 D) Octreotide 0; E) Omeprazole 0 F) Sucralfate 0 G) Ursodiol
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Exam Section 1: Item 20 o f 50 I
Mark
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 27 m in 17 sec
20. A 76-year-old man is admitted to the hospital because of a 2-week history of a persistent urinary tract infection. He is 165 cm (5 ft 5 in) and weighs 55 kg (121 lb); BMI is 20 kg/m2. The physician plans to initiate treatment. A component of the initial treatment includes an intravenous bolus dose of an antibiotic to attain an initial peak serum concentration of 8 mg/L. The volume of distribution of the antibiotic is 0.35 L/kg. Laboratory studies show a 24-hour urine creatinine clearance within the reference range. Which of the following is the most appropriate loading dose of this drug for this patient (in mg)? © A) 25 © B) 50 © C) 100 © D ) 150 © E )200
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Exam Section 1: Item 21 o f 50 I
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
Mark
T im e R em aining: 3 hr 17 m in 39 sec
21. A healthy 22-year-old man is a subject in a study investigating the regulation of heart rate during exercise. He is sitting on a stationary bicycle and is instructed to begin pedaling in 5 minutes. One minute before he begins to pedal, his heart rate increases. An increase in which of the following transmitters acting at the indicated receptor best explains the increase in heart rate in this man?
© © © © ©
A) B) C) D) E)
Transmitter
Receptor
Acetylcholine Acetylcholine Norepinephrine Norepinephrine Norepinephrine
muscarinic nicotinic a pi P2
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Exam Section 1: Item 22 o f 50 I
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22.
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 16 m in 12 sec
A 15-year-old boy has intracranial neoplasms, mental retardation, and seizures associated with tuberous sclerosis complex, an autosomal dominant disorder. His 41-year-old mother is healthy but has angiofibromas, which are benign skin lesions characteristic of tuberous sclerosis complex. Which of the following best explains the findings in the boy and his mother? A) Alternate paternity B) Anticipation C) Parental germline mosaicism
O D) Reduced penetrance E) Variable expressivity
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Exam Section 1: Item 23 o f 50 I
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
Mark
T im e R em aining: 3 hr 14 m in 45 sec
23. A 40-year-old woman is brought to the emergency department 30 minutes after sustaining severe chest injuries in a motor vehicle collision. Despite appropriate treatment, she dies 1 hour later. She had a 25-year history of a wellcontrolled seizure disorder. A photograph of a coronal section of the brain obtained at autopsy is shown. Which of the following is the most likely cause of this patient's seizure disorder? A) Glioblastoma multiforme B) Herpes simplex encephalitis C) Mesial temporal sclerosis D) Neonatal ischemic stroke E) Vascular malformation
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Exam Section 1: Item 24 o f 50 H Mark
National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment
Tim e Remaining: 3 hr 12 min 3 sec
24. A 51-year-old man comes to the physician because of a 2-week history of cough productive of blood. He also has had a 3-kg (6.6-lb) weight loss during the past month. He has smoked 2 packs of cigarettes daily for 32 years. He has hypertension treated with metoprolol. Physical examination shows clubbing of the fingernails. Wheezes are heard over the right upper lobe anteriorly; there are no crackles. Laboratory studies show: Serum Na+ K+ c i3Urea nitrogen Creatinine Osmolality hco
Urine osmolality
125 mEq/L 3.9 mEq/L 85 mEq/L 25 mEq/L 8 mg/dL 0.4 mg/dL 262 mOsmol/kg 564 mOsmol/kg
A CT scan of the chest shows a 2.4 x 1.2-cm, spiculated noncalcified mass in the right upper lobe eroding into the right bronchus. This patient's laboratory findings are most likely caused by an excess of which of the following hormones? O A) ADH (vasopressin) O B) Adrenocorticotropic hormone O C) Brain natriuretic peptide © D) Cortisol O E) Thyroxine (T4)
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11:54 AM 28/08/2012
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Exam Section 1: Item 25 o f 50 I
Mark
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 10 m in 48 sec
25. A 60-year-old man comes to the physician because of weakness and light-headedness for 3 months. His diet consists of a healthy balance of fruits, vegetables, whole grains, and lean chicken and fish. He has a 10-year history of chronic autoimmune (Hashimoto) thyroiditis treated with thyroxine. Physical examination shows pallor. Serum studies show increased concentrations of methylmalonic acid and total homocysteine. A peripheral blood smear shows megaloblastic anemia. Which of the following is the most likely cause of the findings in this patient? A)
Cystathionine 3-synthase deficiency
O B) Failure of intrinsic factor production © C) Folic acid deficiency D)
Helicobacter pylori gastritis
E) Methylmalonyl-CoA mutase deficiency
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Exam Section 1: Item 26 o f 50
National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment
H Mark
26.
Tim e Remaining: 3 hr 9 min 28 sec
A 55-year-old woman is scheduled to undergo transvaginal hysterectomy and oophorectomy for dysfunctional uterine bleeding. During the procedure, the uterus must be separated from all surrounding pelvic structures. Identification and incision of which of the following structures that attaches to the cervical region and extends posteriorly is most appropriate in this patient?
C A) Mesometrium B)
Mesosalpinx
C C) Mesovarium D)
Ovarian ligament
C E) Round ligament of the uterus F) Uterosacral ligament
O
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Exam Section 1: Item 27 o f 50
National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment
H Mark
27.
Tim e Remaining: 3 hr 8 min 51 sec
A 33-year-old woman comes to the physician because of a 16-kg (35-lb) weight gain during the past 6 months despite dieting. She is 168 cm (5 ft 6 in) tall and now weighs 104 kg (230 lb); BMI is 37 kg/m2. Her blood pressure is 156/96 mm Hg. Physical examination shows a round, ruddy face with hirsutism, excess weight predominantly in the shoulders and abdomen, and purple striae over the abdomen. An MRI shows a mass in the pituitary gland. A CT scan of the abdomen shows enlarged adrenal glands. Which of the following histologic changes would be expected in this patient's adrenal glands? A)
Cortical hyperplasia
C B) Cortical hypertrophy C) Cortical metaplasia D) Medullary hyperplasia E) Medullary hypertrophy F) Medullary metaplasia
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Exam Section 1: Item 28 o f 50 I
Mark
28.
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 6 m in 43 sec
A 22-year-old woman comes to the physician for a follow-up examination. One year ago, she was diagnosed with a pulmonary embolism. Two years ago, she delivered a female stillborn at 23 weeks' gestation. Physical examination today shows no abnormalities. Laboratory studies show a platelet count of 250,000/mm3, a prothrombin time within the reference range, and an increased partial thromboplastin time. The findings in this patient are most consistent with which of the following conditions? A)
Antiphospholipid antibody syndrome
O B) Factor V Leiden mutation C)
Increased factor VIII (antihemophilic factor) concentration
© D) Protein C deficiency © E) Prothrombin G20210A mutation
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Exam Section 1: Item 29 o f 50 I
Mark
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 5 m in 17 sec
29. A 54-year-old man comes to the physician because of a 2-week history of burning epigastric pain. He is recently divorced. His diet mainly consists of fast food. He smokes cigars and drinks one to two 12-ounce cans of beer on the weekends. He was treated for Helicobacter pylori infection 1 year ago. He uses high doses (600 mg daily) of over-the-counter ibuprofen for chronic joint pain. Abdominal examination shows tenderness to deep palpation of the epigastric area. A peptic ulcer is suspected. Which of the following is the strongest predisposing risk factor for this patient's condition? O A) High-fat diet O B) Ibuprofen use O C) Ingestion of alcohol D)
Recent psychosocial stressor
O E) Smoking cigars
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Exam Section 1: Item 30 o f 50 I
Mark
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 4 m in 11 sec
30. A 22-year-old nulligravid woman comes to the physician because she has been unable to conceive for 18 months. She has had irregular menses since menarche at the age of 13 years. She is 165 cm (5 ft 5 in) tall and weighs 88 kg (195 lb); BMI is 32 kg/m2. Her temperature is 36.8°C (98.2°F), pulse is 88/min, respirations are 14/min, and blood pressure is 140/90 mm Hg. Physical examination shows moderate hirsutism and mild acne over the face and back. Pelvic examination shows no abnormalities of the exterior genitalia; a bimanual examination is limited by the patient's obesity. Which of the following is the most likely cause of this patient's infertility? A) Hypothyroidism B) Klinefelter syndrome C) Pituitary adenoma D) Polycystic ovarian syndrome E) Primary ovarian failure
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Exam Section 1: Item 31 o f 50 I
Mark
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 3 m in 14 sec
31. A 9-year-old girl is brought to the emergency department by her father because of severe pain in her right shoulder after a fall 1 hour ago. Physical examination shows pain on movement of the right shoulder and a tender right clavicle. An x-ray of the shoulder shows a nondisplaced fracture of the right clavicle. Which of the following structures of the clavicle will most likely assist in producing new bone to heal this fracture? O A) Epiphysis B)
Haversian canal
© C) Lamella © D) Periosteum E) Volkmann canal
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Exam Section 1: Item 32 o f 50 H Mark
National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment
32. A 2-month-old boy dies of meningitis despite appropriate antibiotic therapy. Culture of his cerebrospinal fluid grows mycobacterial infections. Which of the following immunodeficiencies most likely explains this familial history?
Tim e Remaining: 3 hr 1 min 30 sec
Mycobacterium tuberculosis. Two of his brothers died of atypical
C A) Complement deficiency C B) Interferon-Y receptor deficiency C C) Leukocyte adhesion deficiency D)X-linked agammaglobulinemia
O
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Exam Section 1: Item 33 o f 50 I
Mark
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 1 m in 15 sec
33. A previously healthy 25-year-old man is admitted to the hospital for treatment of viral pneumonia. He is mechanically ventilated because of respiratoryfailure due to hypoxemia. An openlung biopsy specimen is obtained and shows a pattern of acute lung injury. The presence of which of the following in the biopsy specimen most clearly suggests diffuse alveolar damage rather than bronchiolitis obliterans-organizing pneumonia in this patient? A) Alveolar hyaline membrane B) Foamy macrophages C) Interstitial collagen deposition O D) Masson bodies E) Uniform fibroblastic proliferation
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Exam Section 1: Item 34 o f 50 I
Mark
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 2 hr 59 m in 45 sec
34. A 39-year-old woman with end-stage renal disease caused by systemic lupus erythematosus undergoes kidney transplantation from a living, unrelated donor. Despite aggressive immunosuppressive therapy, the transplant is rejected after 6 months. Analysis of a biopsy specimen of the transplant shows numerous infiltrating CD8+ T lymphocytes. Which of the following is the most likely cause of rejection of the transplant in this patient? O A) Antibody synthesis O B) Complement activation O C) Direct cytotoxicity D)
Histamine release
O E) Nitric oxide production
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Exam Section 1: Item 35 o f 50 I
Mark
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 2 hr 58 m in 11 sec
35. A 7-year-old girl is brought to the physician by her parents because of a 3-year history of temper tantrums when her parents leave her. She refuses to sleep alone and recently would not attend her friend's birthday slumber party. She calls to her mother if she is in another room of the house. Each morning, the patient's teacher has to carry her into school crying. Her mother recently returned to work full-time and says that she is quite angry that her daughter is behaving in such a defiant way. Her father recalls that he behaved the same way when he was her age. Which of the following is the most likely explanation for this patient's behavior? O A) Conduct disorder B) Oppositional defiant disorder C) Post-traumatic stress disorder D) Separation anxiety disorder O E) Normal behavior
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Exam Section 1: Item 36 o f 50 I
Mark
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 2 hr 56 m in 25 sec
36. A 49-year-old man with pancreatic cancer undergoes a Whipple procedure to resect the distal stomach, duodenum, and head of the pancreas. During the procedure, the cut end of the remaining stomach is joined to the side of the jejunum (gastrojejunostomy). Which of the following nerve structures can be cut to decrease stomach acid output and decrease the likelihood of ulcers forming in the jejunum at the site of junction with the stomach? O A) Celiac plexus B)
Iliohypogastric nerves
© C) Phrenic nerves O D) Subcostal nerves O E) Sympathetic chain O F) Vagal trunks
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Exam Section 1: Item 37 o f 50 I
Mark
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 2 hr 56 m in 9 sec
37. A 35-year-old man comes to the physician for a routine examination. He has a 5-year history of recurrent episodes of genital herpes treated with acyclovir. He says, "I've been taking the medication, but I still occasionally get lesions. When will I be cured?" The physician informs him that herpes simplex is a lifelong infection, with no cure at the present time. Which of the following best explains the longevity of the herpes simplex virus? A) Continual replication in dendritic cells B) Continual replication in epithelial cells of the skin C) Continual replication in sacral root ganglia D) Continual replication in T lymphocytes E) Establishment of a latent infection in B lymphocytes F) Establishment of a latent infection in circulating immune cells G) Establishment of a latent infection in epithelial cells of the skin H) Establishment of a latent infection in sensory nerve cells
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Exam Section 1: Item 38 o f 50 I
Mark
38.
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 2 hr 52 m in 57 sec
A 3-year-old boy is brought to the emergency department because of multiple ecchymoses, bleeding into the joints, and bloody diarrhea 48 hours after ingesting an unknown quantity of warfarin that he took from his grandmother's purse. Prothrombin time is 80 sec (INR=20). Which of the following is the most appropriate initial therapy? A)
Factor IX (plasma thromboplastin component) concentrate
O B) Fibrinogen concentrate C)
Fresh frozen plasma
O D) Platelet concentrates E) Vitamin B 12(cyanocobalamin), parenterally
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Exam Section 1: Item 39 o f 50 I
Mark
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 2 hr 52 m in 4 sec
39. An 18-year-old man comes to the physician 6 hours after he twisted his ankle while playing football. Physical examination shows looseness of the lateral collateral ligament, suggestive of a tear. Lack of which of the following components in the ligament will most likely limit healing of this injury? O A) Blood vessels O B) Collagen fibers O C) Elastic fibers O D) Lymphatic vessels © E) Nerves
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Exam Section 1: Item 40 o f 50 I
Mark
40.
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 2 hr 51 m in 17 sec
A previously healthy 6-year-old girl is brought to the emergency department because of severe abdominal pain, nausea, and vomiting that began 4 hours after attending a friend's birthday party. Cake and other pastries were served at the party. She appears acutely ill and mildly dehydrated. Her temperature is 37°C (98.6°F), pulse is 104/min, respirations are 20/min, and blood pressure is 96/60 mm Hg. Examination shows no abnormalities of the skin. Bowel sounds are hyperactive. Which of the following is the most likely cause of these findings?
O A) Bacteremia B) Enterotoxin ingestion C) Intestinal mucosa inflammation O D) Lead toxicity E)
Villus atrophy
© F)Virem ia
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Exam Section 1: Item 41 o f 50
National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment
H Mark
Tim e Remaining: 2 hr 50 min 2 sec
41. A 28-year-old woman comes to the physician for a health maintenance examination. During the interview, she tearfully tells the physician that she and her new husband are having problems. She says she wants to go out with friends, but he does not enjoy being with people, preferring individual activities such as hiking. She says he seems indifferent to sexual intimacy and neither shows much emotion nor understands her feelings at all. Which of the following personality styles best explains the husband's behavior? © A) Avoidant C B) Narcissistic © C) Paranoid D)
Schizoid
C E) Schizotypal
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Exam Section 1: Item 42 o f 50
National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment
H Mark
Tim e Remaining: 2 hr 48 min 16 sec
42. A 23-year-old woman is treated with acetazolamide to prevent acute altitude sickness 3 days before going on a mountain-climbing expedition. Acetazolamide acts predominately in which of the following areas of the kidney in this patient? O A) Ascending loop of Henle O B) Collecting ducts O C) Descending loop of Henle © D) Distal tubule © E) Proximal tubule
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Exam Section 1: Item 43 o f 50 I
Mark
43.
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 2 hr 47 m in 47 sec
A study is conducted to assess the effectiveness of vitamin C in preventing common colds in children. Patients are randomly assigned to receive either vitamin C or no intervention. Outcome events (common cold) are reported by the parents on a monthly basis for 1 year. Results show that those taking vitamin C have fewer colds compared with those who received no intervention (p
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Exam Section 2: Item 25 o f 50 H Mark
National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment
Tim e Remaining: 4 hr 4 min 19 sec
25. A 77-year-old woman dies in the hospital after a long illness. Her vertebral column, obtained at autopsy, is shown in the photograph. The process shown is most likely associated with an increase in which of the following? O A) Calcium O B) Estrogen O C) Interleukin-1 (IL-1) D)
Monoclonal immunoglobulin
O E) Vitamin D
O
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Exam Section 2: Item 26 o f 50 I
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
Mark
T im e R em aining: 3 hr 52 m in 22 sec
26. Two clinical trials, Trial X and Trial Y, are conducted to assess the potential therapeutic efficacy of a new experimental antibiotic compared to the currently used antibiotic for treatment of urinary tract infections. The two studies are identical, except the statistical power is 0.8 in Study X, and 0.9 in Study Y. Which of the following is the most accurate conclusion regarding the likelihood of a type II error? O A) Greater in Trial X than in Trial Y O B) Greater in Trial Y than in Trial X © C) The same in Trial X and in Trial Y D) Cannot be calculated from the data given
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Exam Section 2: Item 27 o f 50 I
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
Mark
T im e R em aining: 3 hr 52 m in 12 sec
27. A 3-year-old boy with a history of unexplained fever, lack of perspiration, absence of response to noxious stimuli, and self-mutilating behavioris diagnosed withcongenital insensitivity to pain with anhidrosis. Genetic analysis shows a missense mutation of the tyrosine kinasedomain of the TrkA gene. Assuming this is theonly signaling defectin this patient, which of the following processes has most likely been disrupted? O A) Binding of nerve growth factor to its receptor B) Formation of TrkA homodimer in response to nerve growth factor C) Phosphorylation of downstream molecules in response to nerve growth factor D) Retrograde transport of nerve growth factor from nerve terminals O E) Synthesis of nerve growth factor
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Exam Section 2: Item 28 o f 50 I
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
Mark
T im e R em aining: 3 hr 45 m in 8 sec
28. A 4-year-old boy is brought to the emergency department because of a 1-hour history of headache, nausea and vomiting, and dizziness. Physical examination shows severe lethargy. His venous blood is bright red; carboxyhemoglobin saturation is 30% (reference range < 5%). Which of the following steps in the electron transport pathway is primarily affected in this patient? A Reduced substrate
, n -t
B
Flavin mononucleotide © A)
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© E)
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Exam Section 4: Item 23 o f 50 ■ M ark
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 53 m in 10 sec
23. A 50-year-old man with a long-standing history of type 2 diabetes mellitus comes to the physician because of several fainting episodes and fatigue during the past month. He appears chronically ill. His temperature is 37°C (98.6°F), pulse is 95/min, respirations are 17/min, and blood pressure is 155/95 mm Hg. Physical examination shows pallor. Laboratory studies show: Hemoglobin Hematocrit Mean corpuscular hemoglobin Mean corpuscular hemoglobin concentration Mean corpuscular volume Leukocyte count Platelet count Serum Urea nitrogen Creatinine Total bilirubin Which of the following is the most appropriate pharmacotherapy for this patient? O A) Cyclosporine O B) Deferoxamine O C) Erythropoietin D)
Filgrastim
0
E) Folic acid
0
F)Oprelvekin G) Vitamin B 12(cyanocobalamin)
8 g/dL 24% 30 pg/cell 33% Hb/cell 85 pm3 8000/mm3 200,000/mm3 60 mg/dL 6 mg/dL 0.9 mg/dL
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Exam Section 4: Item 24 o f 50 I
Mark
24.
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 51 m in 55 sec
An investigator studying the molecular events in the underlying causes of an autoimmune disease develops a collection of monoclonal antibodies to ribosomal proteins. One of these monoclonal antibodies is found to inhibit the ribosome peptidyl transferase. Which of the following is most likely affected in the presence of this antibody? A) Assembly of 80S ribosomal subunits B) Attachment of amino acids to tRNA C) Dissociation of 80S ribosomes into 60S and 40S subunits D) Establishment of covalent bonding between amino acids
O E) Release of the mRNA from ribosomes
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Exam Section 4: Item 25 o f 50 I
Mark
25.
B)
Amphetamine
C) Amyl nitrate D)
0
T im e R em aining: 3 hr 46 m in 34 sec
A 15-year-old boy is brought to the physician by his father because of behavioral changes during the past month. He has been failing his classes at school and staying out late at night. His father reports that the family moved to a new neighborhood 2 months ago, and that the local teenagers are "all drug addicts and criminals." His pulse is 110/min, respirations are 24/min, and blood pressure is 140/85 mm Hg. Physical examination shows pupillary dilation and diaphoresis. On mental status examination, his affect is agitated, and his thought process is confused. Intoxication with which of the following substances is the most likely cause of this patient's symptoms?
O A) Alcohol 0
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
Cannabis
E) Heroin
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Exam Section 4: Item 26 o f 50 I
Mark
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 45 m in 8 sec
26. Homologous pairing of chromosomes in prophase I is essential for which of the following normal processes? O A) Centromere division O B) Chromosome uncoiling O C) Crossing over O D) DNA replication
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Exam Section 4: Item 27 o f 50 I
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N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 45 m in 3 sec
27. A 9-year-old boy is brought to the emergency department because of fever, chest pain, and migratory joint pain of his shoulders, hips, and knees for 2 days. Four weeks ago, he had a febrile pharyngitis, which resolved 2 weeks later without treatment. His temperature is 39°C (102.2°F). The lungs are clear to auscultation. A pericardial friction rub and quiet heart sounds are heard. Throat cultures do not grow any pathogens. Laboratory testing shows increased antibody titers to streptolysin 0 . The greatest risk for death at this time is from which of the following? O A) Aortic stenosis O B) Embolism C)
Mitral insufficiency
O D) Myocarditis © E) Septic shock
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Exam Section 4: Item 28 o f 50 I
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N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 44 m in 13 sec
28. A previously healthy 40-year-old man is brought to the emergency department 1 hour after the sudden onset of severe pain in his left leg while playing tennis. He is found to have ruptured the left Achilles tendon and undergoes operative repair and long leg cast immobilization. Six months later, the left calf shows a 2-cm decrease in circumference compared with the right calf. Which of the following is the most likely cause of this decrease? A) Decreased glycogen synthesis B) Decreased myosin light chain phosphatase activity C) Increased phosphatidyl degradation D) Increased protein degradation E) Mitochondria damage O F) Necrosis of muscle fibers
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Exam Section 4: Item 29 o f 50 I
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N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 42 m in 49 sec
29. A 52-year-old man comes to the physician because of a 3-month history of epigastric abdominal pain; he also has had an unintentional 6.8-kg (15-lb) weight loss during this period. He has osteoarthritis treated with naproxen as needed. He immigrated to the USA from Japan 6 months ago. He eats mostly traditional Japanese food prepared by his wife. He has smoked 2 packs of cigarettes daily for 30 years and drinks three to four glasses of wine daily. He is 170 cm (5 ft 7 in) tall and now weighs 82 kg (180 lb); BMI is 28 kg/m2. Physical examination shows epigastric tenderness. Upper gastrointestinal endoscopy shows a 4-cm ulcer in the stomach. Examination of a biopsy specimen of the lesion confirms adenocarcinoma. Which of the following is the strongest predisposing risk factor for this patient's condition? © A) Alcohol use o B) Diet O C) Ethnicity © D) Naproxen use © E) Tobacco use
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Exam Section 4: Item 30 o f 50 I
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30.
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 42 m in 43 sec
A 57-year-old man dies of a myocardial infarction. At autopsy, examination of lung tissue shows alveoli containing epithelial cells that are cuboidal in shape with electron dense lamellar bodies 1—2 m in diameter. These cells most likely produce which of the following?
O A) Collagen, type I B)
Epinephrine
O C) Histamine O D)lgG O E) Surfactant
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Exam Section 4: Item 31 o f 50 I
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N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 42 m in 21 sec
31. A 63-year-old man comes to the emergency department 30 minutes after the sudden onset of right-sided chest pain and shortness of breath that began after a 10-hour drive in his truck. The pain is more severe with inspiration. He does not smoke cigarettes. His pulse is 110/min, and respirations are 32/min. The lungs are clear to auscultation. Which of the following findings is most likely on ventilation-perfusion lung scans? A) Absence of perfusion in some areas that are ventilated B) Absence of ventilation in some areas that are perfused C) Absence of ventilation-perfusion mismatching D) Decreased perfusion gradient from the apices to the bases of the lungs E) Increased ventilation-perfusion ratios at lung bases compared with those at the apices
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Exam Section 4: Item 32 o f 50 I
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N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 40 m in 38 sec
32. A 55-year-old man is brought to the emergency department 45 minutes after he collapsed at home. His pulse is 120/min, respirations are 16/min, and blood pressure is 80/45 mm Hg. Physical examination shows no other abnormalities. His hemoglobin concentration is 8 g/dL, hematocrit is 24%, and platelet count is 240,000/mm3. Endoscopy shows a bleeding duodenal ulcer, which is surgically repaired. He receives 4 units of packed red blood cells. Two days later, laboratory studies show: Hemoglobin Hematocrit Serum Urea nitrogen Creatinine Urine Blood Sediment Volume Total protein Sodium Fractional excretion of sodium Osmolality
10 g/dL 30% 70 mg/dL 3 mg/dL absent granular casts 100 ml_/24 h 100 mg/24 h 50 mEq/L 2.5% 300 mOsmol/kg H20
Two weeks later, the urine sediment is clear and renal function is normal. Histologic examination of a renal biopsy specimen is most likely to show which of the following at this time? A) Coagulation necrosis B) Collagen scar C) Granulation tissue D) Lymphocytic infiltrate and fibrogenesis E) Regenerating tubular epithelial cells
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Exam Section 4: Item 33 o f 50 I
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N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 38 m in 42 sec
33. Twenty subjects participate in a study of cardiopulmonary physiology. The pulmonary circulation of these subjects most likely has which of the following characteristics compared with their bronchial circulation? A) Greater number of branches supplying the visceral pleura B) Larger number of anastomoses with the intercostal arteries C) Larger percentage of cardiac output D) Larger volume of nutrient blood to the conducting airways O E) Lower-volume, higher-pressure system
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Exam Section 4: Item 34 o f 50 I
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N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 36 m in 46 sec
34. A 40-year-old man is brought to the emergency department after being involved in a motor vehicle collision. He is pronounced dead on arrival. He had a history of fever, headache, chills, and pain in the right upper quadrant of the abdomen 5 days ago. During autopsy, histologic examination of a liver section shows disruption of the normal hepatic lobule. Small shrunken hepatocytes with intense eosinophilic cytoplasm, fragmented nuclear chromatin, and cytoplasmic bleb formations are noted. Which of the following processes is most likely occurring in the hepatocytes described? O A)Apoptosis O B) Atrophy O C) Caseous necrosis D) Coagulation necrosis E) Dysplasia © F) Fatty change G)
Heterophagy
© H) Liquefaction necrosis I) Metaplasia
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Exam Section 4: Item 35 o f 50 ■ M ark
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 36 m in 1 sec
35. The tracing shows contractile responses of a skeletal muscle preparation to electrical stimulation at five different frequencies. The amount of calcium sequestration in sarcoplasmic reticulum is highest during which of the following labeled responses?
©A)
© B)
© C)
© D)
© E)
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Exam Section 4: Item 36 o f 50 I
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N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 35 m in 25 sec
36. A 26-year-old primigravid woman delivers a 2948-g (6-lb 8-oz) male newborn at term. Six months ago, she received a vaccine, Streptococcus agalactiae (group B), serotype III, during a clinical trial. Screening indicated that she had generated an antibody response to this polysaccharide antigen within 1 month of the vaccination. This antibody was detected in her serum immediately prior to the onset of labor. Eight hours after delivery, the newborn appears progressively lethargic, and his temperature is 38.2°C (100.8°F). Cerebrospinal fluid and blood cultures grow S. agalactiae (group B), serotype III. It is suspected that the mother produced only one antibody isotype in response to the vaccine. This isotype is most likely which of the following? © A) IgA C B)lgD © C) IgE C D)lgG © E)lgM
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Exam Section 4: Item 37 o f 50 I
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37.
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 34 m in 46 sec
A 4-year-old girl has had "puffy" eyes for the past 3 days. She has had an upper respiratory tract infection for the past week. A urine dipstick test shows 3+ protein. Urinalysis shows no red or white blood cells or casts. Which of the following mechanisms is the most likely cause of this patient's condition? A)
Attack by antiglomerular basement membrane antibodies
O B) Damage to the loop of Henle C) Damage to the proximal renal tubule D) Loss of negative glomerular charge O E) Presence of a posterior urethral valve
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Exam Section 4: Item 38 o f 50 I
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N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 34 m in 15 sec
38. A 25-year-old man with cystic fibrosis comes to the physician because of a 3-day history of fever, cough, and progressive shortness of breath. His temperature is 38°C (100.4°F), and respirations are 32/min. Bilateral crackles and rhonchi are heard on auscultation of the chest. A nutrient agar plate seeded with bronchial secretions grows an aerobic, oxidase-positive, gram-negative rod that forms slimy colonies and produces pyocyanin. The organism does not ferment lactose. Treatment with multiple appropriate antibiotics has not led to eradication of the causal organism. Which of the following is the most likely explanation for the persistent colonization of this patient by this organism? A) Bacteriophage superinfection B) Biofilm formation in the lower respiratory tract C) Overgrowth of acapsular strains O D) Pyocyanin synthesis O E) Synthesis of exotoxin A
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Exam Section 4: Item 39 o f 50 I
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39.
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 32 m in 10 sec
A 10-year-old boy who has had type 1 diabetes mellitus for 1 year is receiving insulin. One hour after his morning dose of insulin, he becomes tremulous and diaphoretic and has tachycardia. Several hours later, his symptoms resolve. His blood glucose concentration is now increased. Which of the following is the most likely cause of this patient's hyperglycemia? A) Activation of hepatic adenylyl cyclase B) Activation of muscle glycogen synthase C) Activation of muscle phosphorylase D) Activation of muscle protein phosphatase
O E) Inhibition of hepatic protein kinase A
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Exam Section 4: Item 40 o f 50 I
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N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 29 m in 46 sec
40. A 16-year-old boy has a 6-month history of type 1 diabetes mellitus and requires daily insulin injections. His blood glucose control has been poor recently, which the physician suspects may be related to the patient's reluctance to self-administer insulin. Which of the following questions is most appropriate to broach this issue with the patient? A) "Giving yourself insulin injections can be difficult. What's it like for you?" B) "I get the feeling you have not been taking your insulin regularly. Would you like me to arrange some training for you by our nurses?" C) "It's been my experience that most poorly controlled diabetics have trouble giving themselves insulin. Do you have this problem?" D) "You are clearly having difficulty with insulin injections. Would you like to arrange for a family member to give you your shots?" O E) "You seem to have missed your shots. How often has this happened?"
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Exam Section 4: Item 41 o f 50 I
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41.
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 28 m in 51 sec
A 50-year-old man comes to the physician because of a 2-month history of pain of his wrists, changes in skin color, and progressive fatigue. His brother has type 2 diabetes mellitus and cirrhosis. Physical examination shows bronze-colored skin, tenderness of the metacarpophalangeal joints in both hands, and hepatosplenomegaly. Serum studies show: AST ALT Ferritin Total iron-binding capacity Transferrin saturation
100 U/L 110 U/L 1200ng/mL 200 pg/dL (N=250-400) 80% (N=20-50)
Analysis of a liver biopsy specimen shows a markedly increased iron concentration and cirrhosis. Which of the following is the most likely cause of the findings in this patient? O A) Increased erythropoietin action B) Increased intestinal iron absorption C) Increased oral iron intake O D) Decreased erythropoiesis O E) Decreased iron excretion F) Decreased serum transferrin concentration
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Exam Section 4: Item 42 o f 50 H Mark
National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment
42. An autopsy is done on a 46-year-old woman who died of adenocarcinoma of the colon. Examination of the neck shows a 5-cm, rounded mass next to the bifurcation of the carotid artery. A section of the mass is shown in the photomicrograph. Immunohistochemistry of the section is positive for synaptophysin, chromogranin and neuron-specific enolase. Electron microscopy shows numerous electron-dense, membrane-bound neurosecretory granules. Examination of the adrenal glands shows no masses. Which of the following is the most likely diagnosis? A) Metastatic colonic adenocarcinoma B) Metastatic squamous cell carcinoma of the larynx C) Papillary carcinoma of the thyroid gland D) Paraganglioma E) Parathyroid adenoma
Tim e Remaining: 3 hr 28 min 11 sec
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Exam Section 4: Item 43 o f 50 I
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N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 26 m in 23 sec
43. A 29-month-old boy is brought to the physician by his mother because of a 2-week history of a green nasal discharge and cough. He has a past history of frequent respiratory tract illnesses and pneumonia. The mother states that her son has a 6-month history of large, foul-smelling stools and a salty taste when she kisses him. There is no family history of a similar condition. He is at the 5th percentile for height and below the 3rd percentile for weight. His temperature is 38.3°C (100.9°F). Abdominal examination shows distention. Genetic testing shows a mutation in the Phe residue at position 508 in the cystic fibrosis transmembrane conductance regulator gene. Which of the following types of modification is required prior to destruction of misfolded proteins in this patient's proteasomes? O A) Dimerization B)
Glycosylation
O C) Phosphorylation O D) Sulfation O E) Ubiquitination
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Exam Section 4: Item 44 o f 50 0 M ark
N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 25 m in 17 sec
44. A 60-year-old man comes to the physician because of a 2-week history of fatigue and exercise intolerance. One month ago, he was diagnosed with stage I hypertension and began treatment with propranolol. His pulse is 56/min, compared with 72/min 1 month ago. His treatment is switched to pindolol. His symptoms resolve within 1 month, and his pulse is 68/min. Which of the following mechanisms of action of pindolol best explains its effect on this patient's heart rate? O A) Competitive agonism B)
Competitive antagonism
O C) Inverse agonism o D) Partial agonism
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Exam Section 4: Item 45 o f 50 I
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N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 24 m in 59 sec
45. A 24-year-old man comes to the physician with his 25-year-old wife because they have been unable to conceive for 3 years. The wife has been evaluated for infertility, and the test results were normal. Analysis of the man’s semen shows normal numbers of living sperm but they are immotile. In addition to infertility, this man is most likely to have which of the following associated conditions? A) Cholelithiasis B) Coronary artery disease C) Fat malabsorption D) Glomerulonephritis O E) Sinusitis
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Exam Section 4: Item 46 o f 50 I
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N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 23 m in 51 sec
46. A 72-year-old woman comes to the emergency department because of bloody diarrhea for the past 12 hours and diffuse abdominal pain for the past 4 days. History includes a cerebral infarction 3 years ago from which she recovered completely. Examination shows watery stool with red blood. Colonoscopy shows patchy ulceration at the area near the splenic flexure. Which of the following is the most likely diagnosis? © A) Celiac sprue B)
Irritable bowel syndrome
O C) Ischemic colitis D)
Pancreatic insufficiency
© E) Regional enteritis © F) Ulcerative colitis
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Exam Section 4: Item 47 o f 50 I
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N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 23 m in 15 sec
47. A male newborn delivered at 34 weeks’ gestation by an uncomplicated spontaneous vaginal delivery develops respiratory distress 30 minutes later. His respirations are 40/min. Physical examination shows cyanosis and lower rib retractions with respiration. Chest x-rays show fine densities with a reticulogranular appearance bilaterally. Which of the following is the most likely cause of these findings? A) Erythroblastosis fetalis B) Extralobar sequestration C) Intracranial hemorrhage D) Pulmonary surfactant deficiency O E) Situs inversus
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Exam Section 4: Item 48 o f 50 I
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N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 22 m in 42 sec
48. A 23-year-old woman is brought to the emergency department 45 minutes after sustaining an injury to her right shoulder when she was forcefully thrown into a swimming pool. The patient is holding her right arm in external rotation. There is an area of tenderness and absent sensation over the lateral aspect of the forearm. Immediately after reduction of the glenohumeral joint, she is unable to flex the elbow against gravity. Which of the following structures is most likely injured in this patient? O A) Axillary nerve B) Musculocutaneous nerve C) Posterior cord of the brachial plexus O D) Radial nerve O E) Thoracodorsal nerve
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Exam Section 4: Item 49 o f 50 I
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N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 21 m in 25 sec
49. A 33-year-old woman who is right-handed is brought to the physician because of a 3-day history of progressive weakness and numbness of her arms and legs. Neurologic examination shows proximal and distal weakness of the upper and lower extremities. There is areflexia. Sensation to vibration and joint position is decreased in the fingers and toes. Nerve conduction studies show a slow conduction velocity in the median, ulnar, peroneal, and tibial nerves. These electrophysiologic findings most likely indicate impaired function of which of the following ion channels? A) Neurotransmitter-gated Ca2+ channels B) Neurotransmitter-gated K +channels C) Neurotransmitter-gated Na+channels D) Voltage-gated C a2+ channels E) Voltage-gated K +channels F) Voltage-gated Na+channels
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Exam Section 4: Item 50 o f 50 I
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N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment
T im e R em aining: 3 hr 18 m in 27 sec
50. A study is conducted to evaluate the onset and course of cardiovascular disease in African American men and women in the USA. Census data from the year 2000 are used to select the study sample. A series of factors including family income and years of education is defined. Census tracts most representative of the national census data for the factors selected are used for sampling. Which of the following best describes this sampling technique? A) Blocked randomization O B) Population-based O C) Sample of convenience O D) Self-selection O E) Sequential
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