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NBME 30 EXAM QUESTIONS WITH 100% CORRECT ANSWERS
"Nodular glomerulosclerosis - CORRECT ANSWER assoc w/ diabetic nephropathy &
amyloidosis"
"supraoptic nucleus - CORRECT ANSWER responsible for ADH secretion from pituitary &
urine concentration"
"anterior hypothalamic nucleus - CORRECT ANSWER thermoregulation (cooling)"
"arcuate hypothalamic nucleus - CORRECT ANSWER appetite stimulation"
"dorsomedial hypothalamic nucleus - CORRECT ANSWER regulation of feeding & circadian
rhythm"
"lateral hypothalamic nucleus - CORRECT ANSWER promotes appetite (GHRELIN)"
"posterior hypothalamic nucleus - CORRECT ANSWER thermoregulating (heating)"
"ventromedial hypothalamic nucleus - CORRECT ANSWER satiety (LEPTIN)"
"osteopetrosis - CORRECT ANSWER excessive mineralization of bone & failure of
osteoclastic resorption
- mutation in macrophage colony stimulating factor"
"achondroplasia - CORRECT ANSWER human dwarfism
- AD mutation in fibroblast growth factor receptor 3 (FGFR3) gene"
"Chronic granulomatous disease - CORRECT ANSWER X-linked mutation affecting NADPH
oxidase causing dysfunctioning neutrophils and oxidative burst
- recurrent infections with catalase (+) organisms: S. aureus, Aspergillus & Nocardia"
"MPO deficiency - CORRECT ANSWER Recurrent candida infections"
"Wiskott-Aldrich syndrome - CORRECT ANSWER mutation in WAS gene; abnormal
cytoskeleton of B & T cells
- Eczema, recurrent respiratory infections, thrombocytopenia"
"Chediak-Higashi syndrome - CORRECT ANSWER Mutation in LYST (lysosomal trafficking
gene regulator) which causes accumulation of large cytoplasmic granules that cannot fuse with lysosomes
- increase of bacterial, viral, and fungal infections
- Albinism, photophobia, silver hair"
"Coccidioidomycosis - CORRECT ANSWER fungal infection endemic to Southwest US &
California
- respiratory illness, fever, fatigue, cough, arthralgia"
"Pores of Kohn - CORRECT ANSWER small openings in the alveolar walls that allow gases,
fluid, macrophages & BACTERIA to travel between the alveoli"
"Osgood-Schlatter disease - CORRECT ANSWER inflammation or irritation of the tibia at its
point of attachment with the PATELLAR TENDON
- common in YOUNG ATHLETES
- focal pain & tenderness w/ application of tension to tibial tubercle"
"increased risk of liver injury from acetaminophen + alcohol - CORRECT ANSWER alcohol
leads to induction of P450 enzymes that convert acetaminophen to NAPQI
- NAPQI can cause hepatotoxicity"
"childhood perception of death - CORRECT ANSWER - <3 years: no understanding of death
- age 3-5: death is temporary & reversible
5 years: all living things die (irreversible & inevitable)"
"Weber syndrome (lower midbrain stroke) - CORRECT ANSWER stroke of paramedic
branches of PCA
- ipsilateral CN III palsy (diplopia, ptosis, primary gaze palsy, pupillary constriction defects)
"Phases of clinical trials - CORRECT ANSWER 1. assess SAFETY in health volunteers
- assess EFFICACY in sick volunteers
- large, randomized trial comparing new intervention to placebo/standard
- post-marketing surveillance for long term & rare effects (FDA involvement)"
"first morphologic change in myocardial ischemia - CORRECT ANSWER swelling of
endoplasmic reticulum"
"guanosine analogs - CORRECT ANSWER acyclovir, famciclovir, valacyclovir
- must be phosphorylated by THYMIDINE KINASE"
"hemochromatosis - CORRECT ANSWER BRONZE DIABETES
- liver failure, DM, arthritis, gonadal atrophy, heart failure & hyperpigmentation
- EXCESS IRON"
"Type I hypersensitivity reaction - CORRECT ANSWER - mechanism: antigen/IgE cross
linking on mast cells & basophils
- ex: allergic reaction, asthma, anaphylaxis
- mnemonic: Acid"
"Type II hypersensitivity - CORRECT ANSWER - mechanism: cytotoxic IgM/IgG activates
complement
- ex: GOODPASTURE SYNDROME ("Cmooth"), myasthenia gravis, hemolytic disease of newborn, Grave's disease, AHA
- mnemonic: aCid"
"type III hypersensitivity - CORRECT ANSWER - mechanism: immune complex formation
b/w IgG & antigen (antibody-antigen)
- examples: SLE, serum sickness, PSGN ("lumpI bumpI" appearance)
- mnemonic: acId"
"Type IV hypersensitivity - CORRECT ANSWER delayed hypersensitivity; T-cell mediated
(CD8+ TH1 cells directly kill antigen)
- ex: Diabetes, Diagnosing TB (granulomas, PPD) & Dermatitis
- mnemonic: aciD"
"cystocele - CORRECT ANSWER hernia of the urinary bladder; seen as a bulge into anterior
vaginal wall on Valsalva maneuver
- caused by connective tissue disorders, previous vaginal delivery, menopause, prior pelvic surgery increased abdominal pressure
- presents w/ urinary retention/incontinence"
"uterine prolapse - CORRECT ANSWER the condition in which the uterus slides from its
normal position in the pelvic cavity and sags into the vagina
- due to pelvic floor weakness (elevator ani complex)
- lowering of cervix → vagina on Valsalva maneuver"
"peptic ulcer disease - CORRECT ANSWER epigastric or LUQ pain that worsens (gastric) or
improves (duodenal) with meals
- causes: H. pylori > NSAIDS > smoking >>> alcohol"
"tPA (tissue plasminogen activator) - CORRECT ANSWER Drug that immediately dissolves
clots
- thrombolytics used during MI/CVA → catalyze formation of PLASMIN to dissolve clot"
"Neurofibromatosis type 1 - CORRECT ANSWER autosomal dominant mutation of NF1 gene
on chromosome 17 w/ variable expressivity
- cutaneous neurofibromas, hyperpigmented lesions (cafe au lait spots), Lisch nodules in iris, optic gliomas (seizures), pheochromocytoma"
"cells involved in HIV - CORRECT ANSWER macrophages and CD4+ T cells
- both possess CD4 & CCR5 on their cell surface, which HIV binds to"
"perforated duodenal ulcer - CORRECT ANSWER - severe retrosternal pain radiating to the
epigastrum
- pneumoperitoneum, peritonitis, abdominal rigidity, rebound tenderness & guarding
- nausea, vomiting, possible septic shock (perforated viscus)"
"metaplasia in smokers - CORRECT ANSWER squamous
SCC → pulmonary cavitations, central location & hypercalcemia casuel by paraneoplastic PTH- related peptide (PTHrP) production"
"Barrett's esophagus - CORRECT ANSWER columnar metaplasia of distal esophagus from
GASTRIC CONTENTS (chemical irritation)
- increased risk for esophageal adenocarcinoma"
"lead poisoning on blood smear - CORRECT ANSWER - basophilic stippling (polka dots)
- due to inhibition of ferrochetalase and d-ALA dehydratase → decreased heme synthesis
- encephalopathy, cognitive dysfunction, peripheral neuropathy, hearing loss, interstitial nephritis, vomiting, abdominal pain, constipation & anemia"
"salt intake effects on renal function - CORRECT ANSWER increased salt intake suppresses
aldosterone & vice versa (b/c salt raises BP)
- aldosterone increases epithelial Na+ channel transcription & activity
- high salt diet → increased epithelial Na+ channel transcription & decreased resorption (b/c BP won't need to be lowered)"
"familial hyperchylomicronemia - CORRECT ANSWER LIPOPROTEIN LIPASE & Apo A-II
(activates lipoprotein lipase) DEFICIENCY
- inability of epithelial cells to catalyze breakdown of triglycerides from circulating CHYLOMICRONS → "milky appearance" & increased amylase
- PAIN AFTER FATTY MEALS, eruptive xanthomas & lipemia retinals (cream-colored discoloration of retina), STEATOSIS"
"councilman bodies - CORRECT ANSWER seen in hepatitis
"Ataxia Telangiectasia - CORRECT ANSWER AR disorder resulting from DNA REPAIR
DEFECT
- increased risk for Hodgkin lymphoma
- cerebellar ataxia, telangiectasias, abnormal eye movements & decreased Ig → recurrent sinopulmonary infections"
"degeneracy of the genetic code - CORRECT ANSWER multiple species of tRNA exist for most
amino acids
"mitral regurgitation - CORRECT ANSWER Reflux of blood from left ventricle into left atrium
during systole
- HOLOSYSTOLIC MURMUR best heard in midclavicular line → radiates to L axilla
- assoc w/ MVP or prior MI"
"carcinoid tumor - CORRECT ANSWER neuroendocrine cell tumor, often in small bowel
(SMALL INTESTINE)
- weight loss, flushing, diarrhea, bronchospasm, RIGHT SIDED HEART DISEASE, abdominal pain
- inc serotonin (5-HIAA)
- tx: ocreotide (somatostatin analog)"
"Pheochromocytoma - CORRECT ANSWER benign tumor of adrenal medulla → increase BP,
headaches, paliptations"
"anemia during pregnancy - CORRECT ANSWER expansion of intravascular volume →
dilution anemia & thrombocytopenia"
"senile/actinic purpura - CORRECT ANSWER due to atrophy of dermal collagen w/ age &
chronic sun exposure → blood vessel fragility
"Normal Pressure Hydrocephalus (NPH) - CORRECT ANSWER Dementia, ataxia, and
urinary incontinence EARLY IN DISEASE COURSE (vs. Alzheimers which is progressive)"
"steroid hormone binding - CORRECT ANSWER CORTISOL
- ex: estrogen, androgen, glucocorticoids"
"thyroid hormones bind at receptors on the... - CORRECT ANSWER NUCLEUS
- hyperthyroidism: hormones act on nuclear/retinoid X complexes w/ DNA"
"insulin & glucagon (peptide hormones) bind at receptors on the... - CORRECT ANSWER
CELL MEMBRANE"
"Erlichiosis - CORRECT ANSWER doxycycline - binds to 30S ribosomal subunit and inhibits
protein synthesis"
"p value 5% (0.05 or less) - CORRECT ANSWER probability that a type I error has been
committed & null hypothesis has been rejected
- statistically significant"
"Type II error - CORRECT ANSWER failing to reject a false null hypothesis
20% p value"
"majority of thyroid hormone & radioactive iodine uptake - CORRECT ANSWER T4 bound to
T4-binding globule (thyroxin + thyroglobulin)"
"valve replacement - CORRECT ANSWER - aortic & mitral are most commonly replaced
- when looking at a LATERAL xray, draw a diagonal line from carina → cardiac apex (aortic is superior, mitral is inferior)
- when looking at POSTERIOR-ANTERIOR, draw a line from widest point of left & right (aortic is superior, mitral is inferior)"
"paraneoplastic syndrome assoc w/ small cell lung carcinoma - CORRECT ANSWER Cushing
syndrome, SIADH, Lambert Eaton myasthenia syndrome, paraneoplastic myelitis, encephalitis & subacute cerebellar degeneration
- composed of neuroendocrine cells
- DOES NOT RESPOND TO DEXAMETHASONE"
"adrenal carcinoma - CORRECT ANSWER responds to dexamethasone (decreases ACTH)"
"calcium oxalate kidney stones - CORRECT ANSWER increased Ca2+ resorption in distal
tubule → Ca2+ in urine → octahedral radiopacities
- tx: low sodium diet, THIAZIDES (act on DCT), oral citric acid"
"pathophysiology of diabetic peripheral neuropathy - CORRECT ANSWER persistent
activated of voltage gated Na+ channels in the nociceptor
- tx: TCAs & carbamazepine → block Na+ channels"
"Methemoglobinemia - CORRECT ANSWER impaired binding of O2 to hemoglobin
- cyanosis, tachypnea, tachycardia & subcostal/intercostal retractions
- DARK BROWN BLOOD
- tx: supplemental O2 & methylene blue → reduces Fe3+ to Fe2+ allowing O2 to bind to Hb"
"tx Diabetic Ketoacidosis (DKA) - CORRECT ANSWER Fluids, insulin, and electrolyte
repletion (eg, K+)
- insulin up regulates GLUCOKINASE → phosphorylation of glucose to G6P → hepatic glycolysis
- insulin administration may result in refractory HYPERglycemia due to activation of hepatic ADENYLYL CYCLASE in attempts to restore glucose homeostasis"
"the kidney is derived from ... - CORRECT ANSWER Metanephros (mesoderm)"
"Leber hereditary optic neuropathy - CORRECT ANSWER Mitochondrial disorder creates a
defective enzyme responsible for converting oxygen, fats, and simple sugars to energy
- VISION LOSS
- IMPAIRED COMPLEX I: decrease ability to oxidize NADH, normal FADH2"
- ex: 250/1250 have depression, the following year 100 more people develop depression so incidence = 100/1000 = 10%"
"both polio virus vaccines (live attenuated & killed) share this feature: - CORRECT ANSWER
neutralizing antibodies in the circulation"
"differentiating b/w IBD & IBS - CORRECT ANSWER IBD: occult blood/melena, nighttime
awakening from pain/diarrhea, worsening abdominal pain, family hx of IBD/colon cancer, weight loss"
"Reflux Esophagitis (GERD) - CORRECT ANSWER inflammation of tissue at the lower end of
the esophagus
- burning epigastric/chest pain in assoc w/ large meal or trigger food
- mucosal erythema, hyperplasia, eosinophilic infiltrate & erosions"
"thyroid hormone changes in pregnancy (euthyroid) - CORRECT ANSWER estrogen
increases b/c of production by placenta → T4 (thyroxine) increased, TSH normal"
"hurler syndrome - CORRECT ANSWER Mucopolysaccharides accumulate due to lysosomal
storage deficiency
- COARSE FACIAL FEATURES (HIRSUTISM), CORNEAL CLOUDING, hepatosplenomegaly, skeletal abnormalities (dysostosis multiplex), intellectual disability & developmental delay
- heart failure, hydrocephalus, hearing loss"
"intraperitoneal hemorrhage posterior to liver after trauma - CORRECT ANSWER avulsion of
hepatic veins from IVC"
"Benzodiazepines MOA - CORRECT ANSWER Positive allosteric modulators at GABA
receptors - potentiates the actions of GABA promoting hyperpolarization
- BINDS AT A DIFFERENT SITE THAN GABA"
"papillary transitional cell carcinoma - CORRECT ANSWER bladder cancer → painless gross
hematuria
- cigarette smoking, NAPTHYLAMINE (rubber), aniline dyes"
"vinyl chloride - CORRECT ANSWER Angiosarcoma of liver
- occupational exposure; used to make polyvinyl chloride (PVC) for use in pipes"
"myasthenia gravis - CORRECT ANSWER autoantibody to NICOTINIC ACh receptor
- tx: pyridostigmine (acetylcholinesterase inhibitor)"
"Organs in left upper quadrant - CORRECT ANSWER stomach, spleen (posterior), portion of
colon"
"ACE inhibitors (-pril) - CORRECT ANSWER targets RAAS and increases bradykinin, slowing
down HR (vasodilatory effect)
"Reflux nephropathy - CORRECT ANSWER Renal scarring & blunted calyces due to
pyelonephritis from vesicoureteral reflux"
"EBV - CORRECT ANSWER affects B cells through CD
- CD8+ T cells react to the virus → lymphocytic leukocytosis (abundant Lacey cytoplasm on blood smear)"
"what measure is most predictive of a clonal lymphoid proliferation? - CORRECT ANSWER
surface kappa:lambda ratio
- normally equal; predominance of kappa or lambs light chains suggests CLL"
"NMDA receptor antagonist - CORRECT ANSWER Memantine (Namenda)
- protects against excitotoxicity by decreasing Ca2+ entry into neurons"
"Zidovudine (AZT, Retrovir) - CORRECT ANSWER Nucleoside reverse transcriptase inhibitor
(NRTI)
- inhibit RNA-DEPENDENT DNA polymerase"
"protease inhibitors (-navir) - CORRECT ANSWER "Navir tease a protease"
- left testicle appears smaller than right, enlarged spermatic cord w/ Valsalva"
"VIPoma (WDHA) - CORRECT ANSWER assoc w/ MEN
- chronic & watery diarrhea, hypokalemia, hypercalcemia, achlorhydria, alkalosis, flushing & vasodilation
- tx: OCREOTIDE"
"Niacin deficiency (vit B3) - CORRECT ANSWER pellagra: dermatitis, diarrhea, dementia,
death"
"Vitamin E deficiency - CORRECT ANSWER Hemolytic anemia, posterior and
spincocerebellar tract demyelination
- IMPAIRED INTESTINAL FAT ABSORPTION"
"large uptake of radioactive iodine is due to... - CORRECT ANSWER ectopic (retrosternal)
thyroid tissue"
"hypoxic injury in the brain - CORRECT ANSWER cytotoxic edema → neuronal enlargement
in susceptible areas i.e. hippocampus, cerebellum, watershed area"
"Calcineurin inhibitors - CORRECT ANSWER Cyclosporine
Tacrolimus
- inhibit T cell proliferation, preventing transcription of IL2"
"Aspergilloma (fungus ball) - CORRECT ANSWER colonization of lung cavities (TB,
emphysema, sarcoidosis)
- bloody, persistent cough usually in immunosuppressed pt
- cell wall consists of 1, 3,B-D gluten"
"uterine atony - CORRECT ANSWER The most common cause of postpartum hemorrhage
(boggy uterus)
- tx with uterine massage & oxytocin (Gq protein coupled receptor) → increased Ca2+ to increase uterine myometrium contraction"
“difference b/w Kwashiorkor & Marasmus - CORRECT ANSWER - kwashiorkor (edematous
malnutrition): marasmus PLUS EDEMA
- marasmus (WASTING SYNDROME): skin lesions, fatty liver, acute protein-energy malnutrition with decreased arm circumference, weight per length or BMI"
"deformation - CORRECT ANSWER disruption in organ morphogenesis occurring AFTER
embryonic period; extrinsic force limits normal organ development"
"vascular changes in chronic HTN - CORRECT ANSWER - hyaline arteriolosclerosis: protein
deposition in vessel walls
- hyperplastic arteriosclerosis (arteriolitis): concentric thickening of vessel wall w/ laminar appearance caused by proliferation of smooth muscle cells
- commonly affects renal arterioles"
"porphyria cutanea tarda - CORRECT ANSWER severe cutaneous photosensitivity with
blistering & hyperpigmentation after exposure to sunlight
- decreased activity of uroporphyringoen decarboxylase enzyme in the production of HEME"
"CD8+ T lymphocytes - CORRECT ANSWER responsible for CLEARING a virus
- class I MHC receptors present a virus to CD8+ T cell on an APC
- CD8+ T cell has a specific TCR for the virus; responds by secreting inflammatory mediators (to attract other cells) perforin/granzyme or interacting with Fas/FasL to trigger apoptosis"
"Class II MHC - CORRECT ANSWER are on the surface of antigen-presenting cells (APCs),
including B cells
- trigger CD4+ T cells, which recruit CD8+ cytotoxic T cells"
"PKU - CORRECT ANSWER deficiency of phenylalanine hydroxylase
- supplementation of TYROSINE is required for synthesis of catecholamines (norepinephrine, epinephrine & dopamine)"
"leuprolide - CORRECT ANSWER GnRH agonist used for the treatment of prostate cancer
- decreased LH & testosterone release"
"rapid plasma reagent (RPR) false positive - CORRECT ANSWER SLE → antiphospholipid
antibodies will yield false (+) RPR/VDRL are used to detect antibodies against syphilis"
"cold agglutinins - CORRECT ANSWER Mycoplasma pneumoniae, EBV
"heterophiles antibodies - CORRECT ANSWER Infectious mononucleosis (EBV)"
"p24 antigen - CORRECT ANSWER HIV1/2"
"glucose-independent insulinotrophic peptide (GIP) - CORRECT ANSWER secreted by K cells
in the duodenum & jejunum
- decrease gastric acid production & stimulate insulin release from pancreas
- secreted in response to glucose/fatty acids to lower blood sugar"
"ureteral constriction - CORRECT ANSWER hydronephrosis
- vesicoureteral junction, crossing point over COMMON ILIAC ARTERY or ureteropelvic junction ^ renal calculi tend to lodge at these 3 locations"
"most common artery to obstruct the ureter - CORRECT ANSWER COMMON ILIAC"
"21-hydroxylase deficiency - CORRECT ANSWER excessive androgens, low aldosterone &
cortisol
- female: hypoaldosteronism & virilization during infancy (develops male characteristics)
- male: precocious puberty in childhood"
"5a-reductase deficiency - CORRECT ANSWER Inability to convert testosterone into DHT
- Male internal genitalia, ambiguous external genitalia until puberty"
"Androgen Insensitivity Syndrome (AIS) - CORRECT ANSWER - XY fetus → blind vagina
- internal testes/ambiguous genitalia, increased LH, testosterone & estrogen"
"acromegaly - CORRECT ANSWER excessive GH & IGF1 (insulin-like growth factor 1)
- increased rates of DM & hypertriglyceridemia
- increased adipolysis & hepatic gluconeogenesis → since IGF1, body thinks it's always in a hypoglycemic state, so you produce more glucose
- decreased muscle glucose uptake"
"wound healing - CORRECT ANSWER 1. platelet aggregation & homeostasis
- neutrophils & macrophages infiltrate area & stimulate fibroblast production & migration via FIBRONECTIN
- granulation tissue, collagen & neovascularization
- epidermal cells migrate along collagen to form new skin
- scar formation & remodeling via MMP collagen breakdown" "Proteasome inhibitors
- Bortezomib (Velcade)
- Carfilzomib (Kyprolis) - CORRECT ANSWER prevent antigen processing and presentation to CD8+ (cytotoxic) T cells
- while these are effective for tx of multiple myeloma, they lead to immunosuppression"
"Virchow's triad - CORRECT ANSWER - stasis: bed ridden, long plane ride
- endothelial damage: smoking, HTN
- hyper coagulability: OCP use
- DVT may bypass pulmonary circulation & cause STROKE in patients with PATENT FORAMEN OVALE"
"Twin-to-Twin Transfusion Syndrome (TTTS) - CORRECT ANSWER complication of blood
supply w/ 1 twin receiving a low amount (the donor) & the other receiving too much (the recipient)
- caused by ARTERY-TO-ARTERY CHORIONIC SURFACE ANASTOMOSES"
