110644085-NBME-11-With-Answers

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N a titi on on a l B oa oa rd rd o f M e d ic ic a l E xa xa mi m i n er er s - G o o gl gl e C h ro ro m e

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Q https://www.starttest.eom/api/5.l.1.0/TTDStart.aspx?SVC=lbfd4732-460a-454b-90b5-9985c0560007

E x am S ection 1: Item 1 o f 50 H Mark

N a tio na l B oard o f M ed i c a l E x a m in e rs C o m p re h e n s i v e B as ic S c ie nce S elf-A ssessm ent

T im e R e m a in in g: 3 h r 59 m in 9 sec

1. A 62-year-old man is brought to the physician by his wife because of increasing confusion during the past 6 months. months. His wife says that he has bec ome lost twice in the the past month when going to work, even though he has been going to the sam e office for 12 years. She adds that he often has difficulty difficulty finding objects such as his glass es and keys, sometimes cannot recall his grandchildren's names, and has become very critical of her cooking, which he used to enjoy. When asked, he can name only the current president and none of the candidates for an upcoming pr esidential election, although he and his wife watch the television television news togethe r each night. Neurologic examination show s no motor or sensory a bnormalities. His Mini-Mental State Examination score is 19/30. Treatment with a cholinesterase inhibitor is most likely to to improve this patient's memory be cause o f its ability ability to target synaptic connections between which of the following structures? o A) The basal forebrain and neurons in the cerebral cortex B) The dentate nucleus and the thalamus C) The fornix and neurons in the mammillary bodies D) The substantia nigra and the neurons of the globus pallidus O E) The thalamus thalamus and neurons in layer 4 of the cerebral cortex

Q https://www.starttest.com/api/5.1.1.0/TTDStart.aspx?SVC=lbfd4732-460a-454b-90b5-9985c0560007

Exam Section 1: Item 2 of 50 H Mark

National Board of Medical Examiners Comprehensive Basic Science Self-Assessment

Time Remaining: 3 hr 58 min 52 sec

2. A 25-year-old man has acute lymphocytic leukemia that improves after the the administration of chemotherapy including methotrexate. The beneficial effect of this drug is most likely the result result of inhibition of which of the following following enzyme activities? A)

Ade nos ine d eam inas e

o B) DNA polymerase C)

Hypoxanthine-guanine phosphoribosyltransferase

0D) Thymidylate synthase C E) Xanthine oxidase

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Q https://www.starttest.eom/api/5.l.1.0/TTDStart.aspx?SVC=lbfd4732-460a-454b-90b5-9985c0560007 E x am S ection 1: Item 3 o f 50 H Mark Mark


T i m e R e m ai ni n g: 3 h r 58 m in 43 sec

3. A 30-year-old wom an come s to the physician for a follow-up examination because of a 10-year history of recurrent recurrent renal calculi. calculi. The The calculi have primarily been compose d of calcium oxalate. Physical examination shows no abnormalities. Serum calcium and p hosphorus concentrations are within the reference ranges. A 24-hour urine collection shows an increased calcium concentration. The physician recommends that the patient increase her consumption of water and decrease her consumption of sodium and protein. The physician also recommends pharmacotherapy with a drug that decrea ses urinary calcium concentrations. Which of the following is the most likely mechanism o f action of this drug? A) Dec reas es 1,25-d ihydro xycho lecalc iferol sy nthesis B) Decrea ses H +secretion in the distal tubule tubule C) Decreases magnesium reabsorption in the thick ascending limb of the loop of Henle o D) Increases calcium reabsorption in the distal tubule E) Increases H C 0303- secretion in the the proximal tubule F) Increases phosphate re absorption in the the proximal tubule G) Inhibits Inhibits parathyroid hormone secretion


E x am S ection 1: Item 4 o f 50 H Mark Mark

N a tio na l B oard o f M ed i c a l E x a m in e rs Comprehensive Basic Science Self-Assessment

T im e R e m a in in g:

4. A 55-year-old wom an undergoing ch emotherapy for melanoma develops a temperature of 39°C (102 .2°F) and neutropenia. Her absolute segmented neutrophil count count is 500/mm 3. In In addition to antibiotics, which of the following substances is most appropr iate to administer to this patient? o A) Granulocyte-macrophage colony-stimulating colony-stimulating factor © B) lnterleukin-8 (IL-8) © CJIL-10 D) Macrophage colony stimulating-factor E) Stem cell factor (C-kit ligand)





5. A 40-yea r-old woman come s to the physician because of a 2-month history of increasing increasing redness around her nose and cheeks, and p imples around her mouth. mouth. She appe ars very upset and tells the the physician, "I look like a teenaged Santa Claus." Which o f the the following initial responses by the the physician is most app ropriate? O A) "Ca n you tell tell me how often you go out in the sun and what kind of protection you use?" O B) "Don't worry. worry. Let me assure you this is not a serious condition." o C) "It's upsetting when you have a skin prob lem on your face ." D) "Maybe a little. little. At least you are k eeping your sen se of humor about the situation." O E) "You really do loo k rather odd. I can understan d why you are so upset."

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N a tio na l B oard o f M ed i c a l E x a m in e rs Comprehensive Basic Science Self-Assessment

T im e R e m a in in g:

6. A 46-year-old man is brought to the emergency department 2 hours after he fell headfirst into the the water while attempting to water ski. He says that he has pain when he tries to move his left arm. Physical examination shows that the patient is unable to abduct the left upper extremity due to pain. Which of the following following muscles is most likely injured injured in this patient? A) Infras pinatus B) Subscapularis o C) Supraspinatus © D) Teres major © E) Teres minor


E x am S ection 1: Item 7 o f 50 0 M ar ar k



7. A 6-year-old girl is brought to the physician by her mother because of a 2-week history of increased thirst and a 3-kg (6.6-lb) weight loss. Her mother says that the the patient is constantly drinking water. She is at the the 75th percentile for height and 50th percentile for weight. Physical exa mination shows tachypnea and dehydration. La boratory studies show hyperglycemia, metabolic a cidosis, and ketonemia. If a biopsy s pecimen were obtained from this patient's pancreas, which of the following following findings in islet cells would now be most likely? A)

Base ment memb rane th icken ing of cap illarie s

o B) Cellular necrosis and lymphocytic infiltration infiltration C)

Decre ase in mass and depos ition of amyloid

O D) Large (3cells and nuclei E) Marked atrophy and fibrosis

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8. A 1-year-old girl is brought to the emergency department beca use of a 5-day history of vomiting, copious diarrhe a, and markedly dec reased urinary frequency. Several other children at the day-care c enter that that she attends have had a similar illness during during the past week. She appe ars listless. Physical examination shows de crease d skin turgor, cracked lips, and a dry mouth mouth.. The virus identified by ELISA testing o f the the stool is res istant to treatment with ether and contains a double-stranded, segmented RNA genome. Which of the the following is the most likely causal virus? O A) Adenovirus B)

Cytomegalovirus

O C) Hepatitis A virus virus O D) Herpes simplex virus 1 O E) Influenza Influenza virus o F) Rotavirus

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9. A 28-year-old woman, g ravida 4, para 0, aborta 3, with with systemic lupus erythematosus comes to the physician at 12 weeks' g estation for an initial prenatal examination. examination. She is concerned that she will will not be able to carry her current pregnancy to term. term. The presence of which of the following following is most likely increasing the risk for com plications during pregnancy in this this patient? A) An timito chon drial antib odies B) Anti neutrophil cytoplasmic antibodies o C) Antiphospho lipid antibodies D)

Antistreptolysin 0 antibodies

O E) Rheumatoid factor

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Q https://www.starttest.eom/api/5.l.1.0/TTDStart.aspx?SVC=lbfd4732-460a-454b-90b5-9985c0560007 E x am S ection 1: Item 10 o f 50 H Mark



10. A study is conducted to assess the accuracy of a new rapid tes t to detect a virulent bacterial infection. infection. This infection has an 80% mortality rate rate if it is not identified early in its course; however, prompt administration of antibiotics dec reases the mortality rate to to less than 5%. The risks of this antibiotic therapy are minimal. A total of 10,000 participa nts are enrolled and undergo asses sment with the new test. test. The graph shows the distribution of infected and noninfected participants according to the results of the test. test. Which of the following following labeled points is most appr opriate for use as the optimal diagn ostic cut point for results of this test?

©A)

m B)

© C)

© D)

© E)




T im e R e m a in in g: 3 h r 49 m in 0 sec

11. A 60-year-old man comes to the physician because of a 6-month 6-month history of decreased libido and inability to sustain an erection. He also has had decreased energy during this this period and has been falling asleep by 7 pm each evening. He has not had chronic pain, feelings o f depression, or recent psychoso cial stressors. He has had a 2.54-cm (1-in) loss in height and a 7.62-cm (3-in) increase in waist circumference since his last visit 6 months ago. Physical examination shows mild gynecom astia and decre ased muscle mass throughout. throughout. Which of the the following is the most appropriate pharmacotherapy for this patient? A) 0 B)

Epoeti n alfa Human growth hormone

C) Modafinil D) Sildenafil o E) Testosterone



12.



An 80-year-old woman is brought to the the emergency departmen t by police 30 minutes after after she was found found wandering in the street, street, confused and disoriented. She says that she has no medical conditions and takes no medications. During history taking, she becomes annoyed and agitated, saying, saying, "Stop being so nosey! nosey! There's nothing nothing wrong with me! I feel fine fine and I just want to go home." She a ppe ars fra il but alert. Her vital s igns are within normal lim its. Physical exam ination shows mildly dry mu cous membr anes. There is no e viden ceof ceof trauma. She is oriented to person but not to place or time. She is able to p rovide her home ad dress. Which of the the following is the most appro priate ac tion by the physician?

o A) Attempt to contact the patient's family to find find out more information B) Arrange for transportation to take the patient home C) Arrange for the patient to be transferred to a s killed nursing care facility D) Administer a sedative-hypnotic medication E) Admit the patient to a psychiatric inpatient facility

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A

13. A 25-year-old man comes to the emergency departmen t 5 hours after after developing shortness of breath and chest pain during exercise; he has had no cough or bloody mucus. He has asthma and major depressiv e disorder. Current medications include fluticasone fluticasone inhaler and albuterol. albuterol. His temperature is 3 7.1°C (98.8°F), pulse is 110/min, respirations are 30/min, and blood pressure is 90/60 mm Hg. Pulse oximetry oximetry on room air shows an oxygen saturation of 93%. 93%. Card iac examination shows a normal and S2with no murmurs murmurs and no no increase in jugula r venous pressu re. Labo rator y stud ies show:

National Board of Medical Examiners - Google Chrome Q

https:/7 https:/7www.starttest.com/api/5.1.1.0/ITDStart.aspx?SVC=lbfd4732-460a-454b-90b5-9985c0560007 www.starttest.com/api/5.1.1.0/ITDStart.aspx?SVC=lbfd4732-460a-454b-90b5-9985c0560007

Exam Section 1: Item 13 of 50 I

M ark

National Board of Medical Examiners Comprehensive Basic Science Self-Assessment

Time Remaining: 3 hr 42 min 44 sec

13. A 25-year-old man comes to the emergency departmen t 5 hours after after developing shortness of breath and chest pain during exercise; he has had no cough or bloody mucus. He has asthma and major depressiv e disorder. Current medications include fluticasone fluticasone inhaler and albuterol. albuterol. His temperature is 3 7.1°C (98.8°F), pulse is 110/min, respirations are 30/min, and blood pressure is 90/60 mm Hg. Pulse oximetry oximetry on room air shows an oxygen saturation of 93%. 93%. Card iac examination shows a normal and S2with no murmurs murmurs and no no increase in jugula r venous pressu re. Labo rator y stud ies show: Hemoglobin Hematocrit Arter ial blood gas analysis on room air pH Pco2 Po 2 A chest x-ray is shown. W hich of the following pulmonary fin ding s ar e mo st likely in this pa tient? A) Crac kles on the left lung bas e and apex B) Crackles on the right lung lung base o C) Decrea sed breath sounds on the left left C D) Increased wheezes on the left left

13 g/dL 39% 7.46 26 mm Hg 60 mm Hg

110644085-NBME-11-With-Answers

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