NBME Form 13 Practice Test

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• A 47-year-old with 6-month back pain worsened by sitting and rising, focal L4-5 tenderness, normal rest. Most likely diagnosis?
• In Crohn's disease involving the terminal ileum, vitamin B12 deficiency commonly presents with which neurological symptom?
• A cancer patient with SIADH exhibits low serum osmolality and inappropriately concentrated urine. Which tumor type is classically associated with SIADH?
• A 3-year-old child presents with mutism after a visit; parental visitation reveals some stressors. What is the best next step in evaluating potential trauma?
• A patient with COPD has decreased diffusion capacity; which gas exchange abnormality would you expect?
• Which iron parameter is decreased in a microcytic anemia due to iron deficiency?
• In a patient with Wolff-Parkinson-White pattern, what is the next step in management?
• Which thyroid function pattern is typical of primary hypothyroidism?
• Which imaging modality is preferred to assess heart failure?
• Which statement describes second-line migraine prophylaxis?
• In WPW syndrome with acute arrhythmia, which drug is used to terminate the arrhythmia?
• In patients with plasma cell disorders, nephrotic syndrome can result from which process?
• Which imaging modality is most appropriate to evaluate suspected pancreatic cancer?
• When initiating urate-lowering therapy for gout, which precaution is recommended to prevent a flare?
• Treatment for Pityriasis Rosea?
• Which laboratory findings are most consistent with acute adrenal insufficiency?
• A patient with pneumonia and hyponatremia is classically associated with infection by which organism?
• A patient on lisinopril develops nonpruritic lip edema after a meal; no urticaria. What is the best next step?
• In frontotemporal dementia with depressive symptoms, which medication is appropriate to address mood symptoms?
• Gilbert syndrome is most accurately described by which statement?
• In lumbar spinal stenosis, what is the evidence for steroid injections?
• In membranous nephropathy, which immunosuppressive approach is described as prednisone plus another agent?
• What test confirms the diagnosis of insulinoma?
• Selective IgA deficiency presents with recurrent mucosal infections. Which immunoglobulin is deficient?
• Which procedure is a surgical option for lumbar spinal stenosis?
• A traveler with fever every 48 hours and paroxysms is most consistent with which malaria species?
• Ovulation is initiated by a surge in which hormone?
• In a patient on chronic glucocorticoids, osteoporosis primarily results from which cellular process?
• In a patient with left renal agenesis and right hydronephrosis, what is the best step to prevent progression?
• Which noninvasive test currently provides the best detection of Helicobacter pylori infection?
• Which noninvasive test detects Helicobacter pylori infection by measuring exhaled carbon dioxide after ingestion of labeled urea?
• The beta-globin gene mutation in sickle cell disease is best described as which type of mutation?
• Autoimmune hemolytic anemia involving IgG corresponds to which hypersensitivity type?
• A patient presents with facial flushing and laboratory findings showing markedly elevated hematocrit and erythrocyte mass; which diagnosis is most likely?
• What is a definitive treatment for bilateral renal artery stenosis causing ACE inhibitor–induced AKI?
• Hepatic encephalopathy is associated with elevated blood levels of which toxin that causes neuropsychiatric abnormalities?
• How do you protect the airway in a patient with epiglottitis?
• CA 19-9 is a tumor marker most commonly elevated in which cancer?
• In frostbite care, which statement about assessment timing is true?
• A patient on warfarin has an increased INR. Which vitamin reverses warfarin anticoagulation?
• Which organism is classically described as catalase-positive, coagulase-positive, and capable of fermenting mannitol?
• First-line antidepressants for major depressive disorder with favorable side effect profile?
• Which statement about pityriasis rosea management is true?
• Precocious puberty is defined as sexual maturation before what ages?
• After initial X-rays, which imaging modality best delineates the extent of an osteosarcoma?
• Edema treated with furosemide; which electrolyte abnormality is most likely?
• Which statement correctly describes ACE inhibitors in heart failure with reduced EF?
• A patient presents with bone pain, kidney dysfunction, monoclonal gammopathy, and lytic bone lesions. What is the most likely diagnosis?
• In Addison disease, which electrolyte abnormality is typical?
• In WPW with acute arrhythmia, which is NOT recommended due to risk of ventricular arrhythmias?
• A patient received a 10x higher dose of Hydromorphone 3 hours ago and is currently asymptomatic. What is the best next step?
• A wound culture grows gram-positive cocci in clusters that are catalase-positive and coagulase-positive and ferment mannitol. Which virulence factor binds the Fc portion of IgG?
• Which nutritional deficiencies are commonly associated with gastric bypass surgery?
• What is the pathophysiology described by Eisenmenger syndrome?
• What is the first-line pharmacologic management for cardiogenic shock?
• Positive Kell antibodies are most likely due to exposure to which of the following?
• In diabetes mellitus, which metric reflects average blood glucose over the prior 2-3 months?
• HbA1c reflects average blood glucose over approximately how many months?
• In an elderly patient with hypertension and atherosclerosis who develops AKI after starting an ACE inhibitor, what is the most likely cause?
• In chronic kidney disease, hyperkalemia is typically associated with which acid-base disturbance?
• Which individuals should receive antibiotic prophylaxis after exposure to meningococcal disease?
• Most common long-term complication of an unrepaired atrial septal defect?
• An 82-year-old with a cauliflower-like lesion between the vagina and rectum; likely diagnosis?
• Which statement is true regarding calcium channel blockers in heart failure?
• A patient with amaurosis fugax presents with yellow, refractive cholesterol emboli. What is the most likely arterial source?
• In Addison disease with hyperkalemia, hyponatremia, and hypotension, which organ dysfunction is primary?
• A patient with pneumonia symptoms and bilateral interstitial infiltrates is most likely infected with which pathogen?
• Which syndrome presents with intermittent unconjugated hyperbilirubinemia that worsens with fasting?
• In neutropenia (drug-induced), what is the initial management step?
• If sexual abuse is suspected in a child, what is the appropriate immediate action?
• Which receptor mediates detrusor relaxation during bladder filling?
• What is the recommended time frame for performing PCI after first medical contact?
• A diabetic patient presents with weakness of dorsiflexion and toe extension on the left foot, indicating a mononeuropathy of which nerve?
• In an acute gout attack, which medication is commonly prescribed?
• Kayser-Fleischer rings are seen in Wilson disease due to copper deposition; which organ system is primarily affected?
• If renal pathology is suspected in urinary incontinence, which tests should be performed?
• Ovulation is triggered by a surge in which hormone?
• A 6-week pregnant woman has Hb 9.8, MCV 72, ferritin 42. What is the best next step?
• What are common complications of scaphoid fracture?
• A patient on psychotropic medication presents with hyperthermia, autonomic instability, and neuromuscular excitability. What is the likely diagnosis?
• Laxative overuse can cause which metabolic disturbance?
• In frontotemporal dementia, what pharmacologic therapy is used to manage irritability and agitation?
• Which antibodies mediate heparin-induced thrombocytopenia after exposure?
• Which antiretroviral class blocks viral entry by targeting the CCR5 receptor?
• Which drug is used for meningococcal prophylaxis after exposure?
• Unconjugated hyperbilirubinemia that worsens with fasting due to reduced hepatic conjugation most likely indicates which syndrome?
• In frostbite management, which method is recommended for rapid rewarming in frostbite management?
• A patient with mucocutaneous bleeding and prolonged bleeding time most likely has which defect?
• A dehydrated patient with reduced renal perfusion shows activation of which system that increases renin and angiotensin II?
• A screening test with 90% sensitivity and 95% specificity in a population with disease prevalence of 5% yields a positive predictive value closest to which percentage?
• Pityriasis Rosea typically resolves in how many weeks?
• In suspected osteosarcoma, what is the recommended order of imaging studies?
• What is the recommended treatment for transient synovitis of the hip?
• Which aldosterone antagonist reduces mortality in heart failure?
• Which hormone is produced by the placenta to maintain pregnancy in the later stages?
• Which test result best distinguishes ACTH-dependent Cushing syndrome from ACTH-independent forms?
• In the context of severe acute pancreatitis, which mediator is most closely linked to triggering systemic inflammatory response syndrome?
• Which autoantibody is commonly present and highly specific for type 1 diabetes?
• In systolic heart failure, which class of drug has been shown to improve survival?
• Which peptide fragment is derived from the amyloid precursor protein and forms extracellular deposits in Alzheimer's disease?
• Which imaging modality is best for evaluating carotid atherosclerosis as a cause of amaurosis fugax?
• Which pattern best describes ferritin and TIBC in iron deficiency anemia?
• Acid-fast bacilli seen on sputum smear; which disease?
• Decreased maternal alpha-fetoprotein during pregnancy is associated with increased risk of which fetal condition?
• Which statement about NSAIDs in gout management is true?
• Which statement best describes an evidence-based approach to treating conversion disorder?
• Which infection-prevention measures are recommended for patients with sickle cell anemia?
• Which of the following is a conservative treatment for lumbar spinal stenosis?
• What is the effect of supervised exercise programs on claudication symptoms in peripheral artery disease?
• According to the USPSTF, screening mammography for women aged 40 and older should be performed at what interval?
• Vitamin C deficiency impairs collagen synthesis by preventing hydroxylation of which residues?
• Which description best captures first-line prophylaxis for migraines?
• A young man develops acute intravascular hemolysis after ingestion of fava beans; which enzyme deficiency is responsible?
• Which combination is recommended for subacute thyroiditis?
• A pregnant woman is told that the corpus luteum is maintained by hCG in early pregnancy. Which hormone is produced by the placenta to maintain pregnancy later?
• Which combination of lifestyle modifications is recommended for gout management?
• A patient with sepsis and hypotension unresponsive to fluids, vasopressors, and antibiotics presents with hyponatremia, hyperkalemia, hypochloremia, and elevated BUN and creatinine. What is the most likely cause?
• Which class of medications has been shown to reduce mortality in heart failure with reduced ejection fraction?
• In rheumatic heart disease, what is the typical pattern of valvular involvement over time?
• What are the ECG findings in Wolff-Parkinson-White pattern?
• Which of the following is an initial management step for membranous nephropathy?
• Which agent is typically used to treat an acute gout attack?
• Which drug should NOT be used in treating subacute thyroiditis?
• What is the role of prednisone in pericarditis management?
• In acute STEMI, which initial therapy has the strongest evidence for reducing mortality?
• In heart failure with reduced EF, which drug class is added after the patient is stable and compensated?
• Which valve is most commonly affected by rheumatic heart disease?
• Deficiency causing dermatitis, alopecia, and taste disturbances?
• In SIADH, which electrolyte abnormality is most characteristic?
• In asthma, which drug inhibits phosphodiesterase, has a narrow therapeutic index, and is used as a bronchodilator?
• In hereditary angioedema due to C1 esterase inhibitor deficiency, which laboratory finding is typically decreased?
• Which enzyme deficiency predisposes to oxidative stress–induced intravascular hemolysis?
• A patient with acute respiratory failure and rising CO2 has which acid-base disturbance?
• In heart failure with reduced EF, which drug class is preferable in every patient as initial mortality-reducing therapy?
• In severe acute pancreatitis, which cytokine is a key mediator of the systemic inflammatory response?
• Which metabolic marker helps differentiate vitamin B12 deficiency from folate deficiency?
• In autoimmune hemolytic anemia of the IgG-mediated type II hypersensitivity, what is the general mechanism?
• Which medication class provides renal protection and reduces proteinuria in membranous nephropathy?
• Treatment of X-Linked Agammaglobulinemia?
• Regarding loperamide use in patients with C. difficile infection, which statement is true?
• In Crohn's disease with terminal ileum involvement, a deficiency of which vitamin is likely?
• Which agent is a recombinant uricase used for chronic gout therapy?
• A patient has a blood pressure of 160/100 in the right arm and 105/65 in the left arm with a heavy smoking history. What is the most likely diagnosis?
• For moderate-to-severe hidradenitis suppurativa, which treatment is recommended?
• To differentiate ACTH-dependent from ACTH-independent Cushing syndrome, which measurement is most informative?
• Which receptor mediates relaxation of the detrusor muscle to allow bladder filling in overactive bladder?
• The key finding in myotonic dystrophy in a newborn is dysfunctional muscle relaxation. Which description best matches this?
• In peripheral artery disease, which antiplatelet approach is recommended unless contraindicated?
• In advanced obstructive sleep apnea, what happens to left ventricular end-diastolic pressure and why?
• When should influenza vaccination be started in infants?
• For hidradenitis suppurativa, what is the initial step in management?
• In multiple myeloma, which imaging finding is commonly seen?
• Bloody diarrhea after a missionary trip in the Caribbean. Which organism is most likely?
• Which lung cancer is most commonly associated with hypercalcemia?
• Which medication class is not known to reduce mortality in heart failure with reduced EF?
• What is the recommended HbA1c screening criterion for diabetes?
• Which organ is primarily responsible for detoxifying ammonia by converting it to urea in the urea cycle?
• Management of phentermine overdose causing hypertensive emergency?
• In epithelioid sarcoma with limb involvement and aggressive behavior, which surgical approach is commonly preferred?
• Daily prophylactic penicillin until what age is recommended for children with sickle cell anemia?
• In Wilson disease, which laboratory finding is typically decreased?
• Which organism is a gram-positive diplococcus that causes community-acquired pneumonia and is bile soluble?
• In diabetic ketoacidosis, the high anion gap metabolic acidosis is due to accumulation of which molecules?
• For cherry angiomas, what is the recommended management?
• Pseudomonas aeruginosa exotoxin A inactivates elongation factor 2. This contributes to pathogenicity by inhibiting which cellular process?
• What is standard initial treatment for acute pericarditis?
• Which statement is NOT a component of membranous nephropathy treatment?
• What is the classic mechanism of injury for the most common carpal bone fracture?
• In diabetic ketoacidosis, the high anion gap metabolic acidosis is due to accumulation of which molecules?
• Which imaging modality is used to diagnose intussusception?
• Which residues require hydroxylation for collagen synthesis, a process impaired by vitamin C deficiency?
• Which of the following is a risk factor for breast cancer?
• In Hereditary Spherocytosis, which procedure can be indicated but is not the definitive treatment?
• What test is used to diagnose obstructive sleep apnea?
• An allergic reaction after a bee sting involves cross-linking of IgE on which cells?
• A pediatric patient with severe hip pain after AOM and no signs of infection or fracture is most likely diagnosed with which condition?
• Definitive treatment of Hereditary Spherocytosis?
• What is the most common carpal bone fracture?
• The presence of acetylcholinesterase in amniotic fluid aids diagnosis of which condition?
• An older patient with unilateral vision loss, headaches, fatigue, proximal weakness, and an elevated ESR. What is the recommended treatment?
• In peripheral artery disease, which approach is considered a core part of treatment?
• In a healthy child with constipation and no red flags, the most likely diagnosis is which of the following?
• In suspected degenerative disc disease without red flags, what is the initial management?
• In a patient treated for UTI with piperacillin-tazobactam and gentamicin, what step helps prevent nephrotoxicity?
• Which class of HIV drugs blocks viral entry by binding to the CCR5 receptor?
• True; lithium can cause serotonin syndrome.
• A patient has intermittent right lower quadrant pain; pelvic ultrasound shows a cystic ovarian mass. What is the diagnosis?
• Phentermine mechanism of action?
• Elevated WBC with metamyelocytes and myelocytes are seen. Which diagnosis is most likely?
• The ACTH stimulation test result in primary adrenal insufficiency?
• Macrocytic anemia with neurologic symptoms; which metabolic marker is elevated in vitamin B12 deficiency but not in folate deficiency?
• A patient presents with nausea and RUQ tenderness along with marked transaminase elevations; what is the most likely diagnosis?
• What diagnostic test would confirm Entamoeba histolytica infection?
• What is the prognosis for conversion disorder with appropriate treatment?
• In intermittent ovarian torsion due to an ovarian cyst, what is the recommended surgical management to preserve ovarian function?
• Which quality-improvement cycle is described as Plan-Do-Study-Act?
• In suspected latent TB infection, what is the next step to evaluate for active disease?
• The recommended time frame for PCI after first medical contact is within how many minutes?
• What are the initial diagnostic steps for urinary incontinence?
• Which laxative is commonly used to treat functional constipation in children?
• Which test confirms chronic bacterial prostatitis?
• Eisenmenger syndrome is defined by which finding?
• A 70-year-old man with painless jaundice and a pancreatic mass is most likely to have elevation of which tumor marker?
• In a patient with ulcerative colitis and signs suggestive of toxic megacolon, what is the next best step?
• Which peptide fragment is derived from the amyloid precursor protein and accumulates extracellularly in Alzheimer's disease?
• In meningitis, which cerebrospinal fluid cell differential is typical for viral meningitis?
• Which electrophoresis finding is typical of beta-thalassemia trait?
• Which therapy is used to treat neutropenia by stimulating neutrophil production?
• Which drug is a xanthine oxidase inhibitor used for chronic gout management?