NBME Form 16 Practice Test

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• In a tumor with a G alpha s subunit lacking GTPase activity, which component is increased as a consequence?
• Strengthening the infraspinatus and teres minor muscles would most improve which shoulder movement when resisted?
• In mitochondrial diseases, what term explains why there is variable clinical expression among family members?
• Pemphigus vulgaris is characterized by which histologic finding?
• Which histopathologic features are typical of bullous pemphigoid?
• Which diagnosis is characterized by gait ataxia, dysarthria, scoliosis, and is caused by GAA repeat expansion in the frataxin gene?
• A patient with obesity who uses thyroxine for weight loss and has normal thyroid function. What histopathologic finding would you expect in the thyroid gland?
• A newborn male is tachypneic and hypoxemic after birth. The most likely cause is reduced surfactant production due to decreased lamellar bodies in type II pneumocytes. Which structural change explains this condition?
• Which components are used to determine the TNM classification in cancer staging?
• Where is the lesion most likely if a patient has ipsilateral motor weakness on the right side due to a spinal cord injury?
• In atrophic gastritis with macrocytic anemia, which gastric cell type is absent?
• A 1-year-old boy with pale hair and blue eyes cries when exposed to light. The pale skin color is most likely due to which mechanism?
• Two weeks after an allogeneic transplant, a patient develops a erythematous maculopapular rash, diarrhea, and elevated liver enzymes. What is the most likely mediator of these symptoms?
• A 54-year-old woman with an acute MI develops acute shortness of breath and a new systolic murmur two days later. Which description best matches a mitral regurgitation murmur due to papillary muscle ischemia?
• A cystic fibrosis patient with weakness, numbness, and ataxia due to poor adherence presents with neurological symptoms. Which vitamin deficiency is most likely responsible?
• Which factor most increases the risk of aspiration pneumonia in an alcoholic with poor dentition?
• A newborn boy has multiple congenital anomalies and the mother has a history of recurrent miscarriages. What is the most likely genetic mechanism?
• In a child with sudden progressive dyspnea, eosinophilia, and Charcot-Leyden crystals, which mediator is primarily involved in the pathogenesis of asthma?
• Which triad describes Chediak-Higashi syndrome?
• Marfan syndrome is caused by mutations in which gene encoding a connective tissue glycoprotein?
• What is the first-line pharmacologic treatment for schizophrenia?
• A patient with acute myeloid leukemia receives high-dose cyclophosphamide before hematopoietic stem cell transplantation. Which agent is most likely to decrease the toxicity of this regimen?
• In a young woman with facial flesh-colored papules in the nasolabial folds and MRI showing subependymal nodules, what is the most likely diagnosis?
• What is the mechanism most consistent with fatigable weakness in myasthenia gravis?
• A 31-year-old woman with invasive squamous cell carcinoma of the cervix expresses HPV type 16 antigens. Which cells recognize and kill these virus-infected tumor cells?
• During radical prostatectomy, which structure is at greatest risk for injury?
• Which mechanism explains the ability of Streptococcus pneumoniae to change its capsule type via DNA uptake, evidenced by DNase blocking capsule expression?
• A patient with a markedly prolonged aPTT and normal PT suggests dysfunction of which coagulation pathway, with kallikrein as a key activator?
• In a patient receiving asparaginase as part of ALL induction therapy, which adverse effect is most commonly associated?
• In DiGeorge syndrome, which electrolyte abnormality is typically present due to parathyroid aplasia?
• In a normal 28-day cycle with ovulation on day 14, on which day would you expect to measure elevated estradiol with low progesterone?
• What is the effect of cigarette smoke on airway cilia?
• Which cell type clears necrotic brain tissue after an ischemic stroke?
• Six hours after a bee sting, the indurated lesion at the sting site is best explained by which process?
• A sigmoid colon mass revealing adenocarcinoma would metastasize primarily to which lymph node group?
• Which histologic feature most closely indicates a high-grade tumor?
• In suspected MEN1 presenting with gastrinoma, which measurements should be followed regularly?
• A 30-year-old man with hemoptysis, dyspnea, and hematuria has diffuse pulmonary hemorrhages and focal glomerular necrosis with crescents; immunofluorescence shows linear deposition of IgG and C3 along the glomerular basement membrane. Which mechanism underlies his kidney disease?
• A patient has loss of pain and temperature sensation in a cape-like distribution over the shoulders and arms, with preservation of touch, vibration, and proprioception, and wasting of small hand muscles. Which condition is most likely?
• Friedreich ataxia is inherited in which pattern?
• Vancomycin-resistant Enterococcus faecalis achieves resistance by which mechanism?
• Which parameter describes the relative solubility of an inhaled anesthetic in blood compared to inspired air and determines the rate at which its brain partial pressure rises?
• In an elderly man with osteoblastic bone metastases and a proximal femur lesion, the most likely primary cancer is from which organ?
• A man develops fever after completing a 10-km run. The fever returns to normal primarily due to which mechanism?
• A cavitary lesion in the lung with surrounding infiltrate in an alcoholic with poor dentition is most consistent with which diagnosis?
• In sarcoidosis, which cell type is primarily responsible for the excess production of active vitamin D (1,25-dihydroxyvitamin D)?
• In schistosomiasis with hepatosplenomegaly and ascites, portal hypertension is most likely due to which process?
• A 38-year-old woman awakens from anesthesia after cholecystectomy and experiences postoperative nausea and vomiting. Which is the appropriate treatment for her symptoms?
• In sarcoidosis with noncaseating granulomas and hypercalcemia, which serum alteration is typically increased due to granuloma macrophages?
• A patient presents with tenesmus and bloody diarrhea. The colon findings extend from the rectum to the mid ascending colon with a normal terminal ileum; histology shows microabscesses in crypts and depletion of goblet cell mucus. Which disease is most likely?
• An abdominal aortic aneurysm has cross-sectional area 2 cm^2 and a blood flow velocity of 20 cm/s. What is the flow rate in L/min through the aneurysm?
• Which lymph node group primarily drains the sigmoid colon?
• In an elderly man who recently underwent urinary catheterization for prostatic obstruction and now has fever and a diastolic murmur, which organism is most commonly associated with endocarditis after genitourinary procedures?
• Which finding indicates invasion into stromal tissues on histology?
• Neomycin is used in hepatic encephalopathy to reduce ammonia by what mechanism?
• Which cell type is primarily responsible for clearing inhaled debris in the alveolar space?
• Goodpasture syndrome shows Crescentic glomerulonephritis with linear deposition of IgG and C3 along the glomerular basement membrane. What is the characteristic glomerular lesion?
• In vitamin D intoxication, a mild hypercalcemia is best explained by which mechanism?
• A patient with chronic cough and sinus congestion notes constipation after taking a medication. Which ingredient is most likely responsible?
• Reid index refers to the relative thickness of submucosal mucus glands; which statement describes an increased Reid index?
• A brain lesion showing EMA positivity and CEA negativity most strongly suggests a metastasis from which organ?
• A 5-year-old boy with Prader-Willi syndrome has no deletion at the usual site on chromosome 15. Which finding would best confirm PWS?
• IV infusion of normal saline increases pulmonary lymph flow by increasing capillary hydrostatic pressure. Which of the following best describes this effect?
• Which molecule is required to transport long-chain fatty acids into mitochondria for beta-oxidation?
• In left-sided heart failure, which hemodynamic parameter is typically elevated?
• Which medication is contraindicated in a patient with heart failure and an EF of 30% due to risk of severe hypotension when combined with nitrates?
• Multiple endocrine neoplasia type 1 is caused by mutation in which gene?
• To visualize the LAD during angiography, into which artery's orifice should the catheter tip be placed?
• Cholesterol emboli from vascular procedures most commonly lodge in which retinal artery, explaining acute vision loss in this scenario?
• For a patient with a long-chain fatty acid oxidation disorder, which type of fat is used therapeutically to provide energy?
• A patient with gastrinoma in the setting of MEN1 is most likely to show which electrolyte abnormality due to associated parathyroid disease?
• In Ascaris lumbricoides infection, which phase is associated with pulmonary symptoms due to larval migration?
• Which renal structure is particularly vulnerable to ischemia due to its high metabolic activity?
• Daily penicillin prophylaxis in a 6-week-old with homozygous HbS reduces the risk of infection with which organism?
• An increase in iron inside cultured hepatocytes leads to increased ferritin protein detected by Western blot but not by Northern blot or PCR. This indicates iron increases the frequency of which cellular process?
• Immobilization causing calf atrophy is due to which protein degradation pathway?
• A 38-year-old woman with gastrinoma and multiple lipomas is started on a proton pump inhibitor. Which laboratory value should be monitored due to associated hyperparathyroidism in this syndrome?
• A case-control study investigates an association between herbicide exposure and non-Hodgkin lymphoma. Controls are matched by age, gender, and race; exposure is determined by interview. The odds ratio is 3.2 (CI 1.4-5.4). Which factor is most likely to affect the validity of this study?
• Which enzyme initiates intracellular killing during the neutrophil respiratory burst?
• Which population is at higher risk for pseudofolliculitis barbae?
• Capsaicin cream relieves neuropathic toe pain by affecting which type of sensory fiber?
• In the same induction regimen, which drug is a corticosteroid?
• In a one-week smoke exposure study, which pulmonary defense parameter increases?
• A newborn with hypothyroidism has absent thyroid tissue on ultrasound. How can development be normal?
• Ondansetron treats postoperative nausea by blocking which receptor?
• ALS involves degeneration of which neurons?
• Which organ systems are commonly affected in acute graft-versus-host disease?
• Graft-versus-host disease after bone marrow transplant results from donor immune cells attacking host tissues. This is best described as which type of hypersensitivity reaction?
• Vitamin K deficiency characteristically affects coagulation. Which laboratory parameter is most affected?
• A 24-year-old African American man presents with a 3-month history of red bumps on the face and chin. They are itchy and painful; exam shows hyperpigmented papules on the cheeks, jawline, and neck. What is the most likely diagnosis?
• In bullous pemphigoid, which cell-adhesion structure is targeted by autoantibodies?
• Left atrial myxoma most commonly presents with which of the following clinical features?
• A 64-year-old man with hilar densities has biopsy showing small round cells with little cytoplasm. Which electrolyte abnormality would you expect if this represents a small cell carcinoma with SIADH?
• Rupture of which artery leads to a third nerve palsy with pupillary involvement?
• A 75-year-old woman with osteopenia has decreased creatinine clearance over 10 years but stable weight and no overt kidney disease. Which is the most likely cause of the decreased creatinine clearance?
• Approximately what percentage of adult brain tumors are metastatic?
• Chronic hypoxia at high altitude induces which hematologic adaptation?
• Cholesterol emboli are seen on funduscopic exam. They most likely originate from which artery on the same side?
• Brief psychotic disorder is best defined as: sudden onset psychotic symptoms lasting less than one month. Which option describes this condition?
• A 28-year-old woman presents with one week of fever and chills, 10 lb weight loss, several years of chronic sinusitis with obstruction, and chest imaging showing multiple pulmonary nodules. Antibodies against proteinase 3 are positive. Which diagnosis best explains these findings?
• In a patient with hypertension and diabetes mellitus, which drug class is first-line to protect renal function?
• During lumbar epidural anesthesia, which ligament must be traversed to reach the canal?
• Which neurological sign is characteristically associated with hepatic encephalopathy?
• During radical prostatectomy, which neural structure is most at risk for injury leading to erectile dysfunction?
• An 8-year-old presents with breast development and minimal pubic hair. What is the appropriate interpretation for mothers concerned about puberty timing?
• Asplenic patients are at increased risk for meningitis due to which organism?
• Which description best matches a tumor with a high nucleus-to-cytoplasm ratio and prominent nucleoli?
• Chronic pyelonephritis is best characterized by which imaging finding?
• Identification of budding yeast cells on culture from a catheter specimen strongly suggests which organism?
• In DiGeorge syndrome, thymic aplasia predisposes to T-cell deficiency. The thymus and parathyroid glands originate from which embryologic structures?
• A young woman with irregular menses, hirsutism, and acne is most likely to have which pattern of hormonal abnormalities?
• Night blindness is most directly caused by a deficiency of which vitamin?
• In a man with fever and dysuria and an enlarged prostate, what is the most common causative organism of urinary tract infection?
• A 35-year-old man with burning epigastric pain after meals and a pancreatic mass has immunohistochemistry showing antibodies against a hormone. Which hormone is overproduced by this tumor?
• A retired athlete with Parkinsonian features after years of head trauma is most likely suffering from what underlying condition?
• In Type 1 diabetes presenting with hypoglycemia and loss of consciousness, what is the appropriate treatment?
• A 12-year-old from central Africa has severe abdominal pain and hematemesis; hepatosplenomegaly and ascites; stool shows parasite eggs. Which drug would treat this infection?
• Which type of hemorrhoid typically presents with painless bleeding?
• Which finding is most characteristic of a lower motor neuron lesion?
• Which mechanism explains how 1,25-dihydroxyvitamin D increases serum calcium?
• A patient with breast cancer undergoing chemotherapy develops numbness and tingling in the hands and feet during treatment cycles. Which chemotherapeutic agent is most likely responsible for this peripheral neuropathy?
• A patient on diazepam develops obtundation after starting an OTC heartburn medication. Which interaction is most likely responsible?
• A heterogeneous pedunculated mass is located in the left atrium of a young adult. What is the most likely diagnosis?
• Genital herpes typically presents with which finding?
• Which degradation pathway is primarily responsible for disuse muscle atrophy leading to muscle protein loss?
• A patient with a postoperative urinary tract infection shows an oxidase-positive organism that produces a diffusible green pigment; which organism is most likely?
• Renal cell carcinoma commonly presents with a paraneoplastic syndrome due to ectopic erythropoietin production. Which lab finding would you expect?
• Biopsy shows high-grade histology with invasion but no metastasis. How is the cancer best described in terms of grade and stage?
• In a severely neutropenic patient with fever, which antifungal is commonly used as initial therapy for suspected invasive fungal infection?
• In a scenario where exogenous angiotensin II is administered with a drug that blocks angiotensin II formation, what best describes the drug’s action?
• Cystic fibrosis patients are frequently chronically colonized by which bacterium?
• Pemphigus vulgaris involves autoantibodies against desmogleins 3 and 1, leading to which histologic change?
• Which histologic feature is most characteristic of ulcerative colitis?
• In a neutropenic patient with suspected invasive fungal infection presenting with fever and left pleural effusion, the appropriate initial antifungal therapy is?
• Which deficiency is associated with impaired beta-oxidation of long-chain fatty acids?
• Which inheritance pattern explains maternal transmission of a mitochondrial disorder?
• Which pattern of colitis is most characteristic of ulcerative colitis?
• Which statement about fecal occult blood testing for colon cancer screening is correct?
• Sharp intermittent chest pain, sudden onset, relieved by leaning forward, with a harsh scratchy sound present in both systole and diastole. What is the most likely diagnosis?
• Praziquantel is used to treat infections caused by which class of organisms?
• Cystic fibrosis is associated with a defect in which aspect in bronchial epithelium?
• Which drug in the standard induction regimen for acute lymphoblastic leukemia is an anthracycline?
• Which statement about medium-chain triglyceride therapy in fatty acid oxidation disorders is correct?
• A patient with suspected herpes simplex infection is treated with acyclovir. This drug inhibits which viral enzyme?
• In a study assessing neurodevelopment in children with parental lead exposure, which group would serve as the proper control?
• Granulomatosis with polyangiitis (Wegener) is characteristically associated with which antibody?
• A 15-year-old girl ingested vitamin D in a suicide attempt. One month later, calcium is mildly elevated. What is the mechanism for the increased calcium?
• Which diagnostic modality would most directly measure flow through an abdominal aortic aneurysm by assessing velocity of blood flow?
• During surgical removal of an ovarian mass, which structure passing inferior to the ovary must be protected?
• Thrombosis of the superior mesenteric artery most directly deprives blood flow to which portion of the small intestine?
• Which lipid-lowering agent reduces hepatic VLDL secretion and can raise HDL?
• Which agent in the induction regimen is a microtubule inhibitor?
• Prostate cancer commonly metastasizes to bone with which radiographic pattern?
• Polyarteritis nodosa presents with which histologic feature?
• A patient with two months of diarrhea and abdominal pain relieved by meals and antacids has elevated serum gastrin and acid secretion. What is the most definitive treatment to decrease risk of complications?
• An adult with fever, cough, myalgia, and headache could have been prevented by which vaccine?
• A newborn with cyanosis and chest X-ray showing left-sided cystic appearing areas and decreased aeration on the right. The most likely diagnosis is:
• Which drug is a nonselective antagonist at both alpha-1 and beta receptors?
• A patient presents with deep venous thrombosis after a long flight. What is the mechanism of action of the anticoagulant that should be used?
• In a pulmonary embolism, which region is ventilated but not perfused, i.e., dead space?
• A 44-year-old man with abdominal pain and diarrhea has a gastrinoma with high gastrin and acid secretion; what is the most definitive treatment to decrease risk for complications?
• A patient has hypoketotic hypoglycemia with accumulation of 16-carbon fatty acids such as palmitate. Which deficiency best explains this?
• A 5-year-old boy with eight months of recurrent middle ear and upper respiratory infections has hepatosplenomegaly. Cultured skin fibroblasts show inclusion bodies and deficiency in N-acetylglucosamine-1-phosphotransferase; enzymes are secreted in large amounts into the culture medium and are unable to target which organelle?
• Persistent truncus arteriosus results from failure of a specific cell population to form the aorticopulmonary septum. Which cells are these?
• Charcot-Leyden crystals are formed from which eosinophil-derived protein?
• An iron-deficient anemia is suggested by the lab in a 38-year-old woman. Which ferritin pattern is characteristic?
• If four rather than ten measurements are made, what is the expected impact on the size of the 95% confidence interval about the mean blood pressure?
• Lack of intrinsic factor due to parietal cell destruction results in deficiency of which vitamin?
• Which combination of tumors is most characteristic of MEN1?
• An elderly patient with a history of hip fracture asks how to reduce the risk of a future fracture. Which daily activity is most effective for fracture prevention?
• During swallowing and coughing, the vocal cords move in which sequence?
• A 28-year-old woman presents with a red perianal area, itching, pain during defecation, constipation, and bright red blood on wiping. Most likely diagnosis?
• Poliovirus lacks a 5' cap but is still translated. Which mechanism explains how translation initiates in this virus?
• A 66-year-old man with a brain mass, heavy smoking history, polycythemia, hypercalcemia, and microscopic hematuria has immunostaining positive for EMA and negative for CEA. Which organ is the most likely site of the primary neoplasm?
• In diabetics with hypertension, which of the following statements is true about renal-protective therapy?
• In I-cell disease, which organ enlargement is commonly observed?
• Which lipid-lowering agent reduces hepatic VLDL secretion and is commonly used to treat dyslipidemia?
• A cardiac imaging finding shows a heterogeneous pedunculated mass in the left atrium. What is the most likely diagnosis?
• Which antiretroviral inhibits HIV entry by preventing fusion of the viral envelope with the host cell membrane?
• A 70-year-old man, recently widowed, reports insomnia and crying but no suicidal ideation. What is the best initial management approach?
• In cystic fibrosis, fat malabsorption commonly leads to fat-soluble vitamin deficiencies. Which organ dysfunction primarily causes this malabsorption?
• In glycolysis, what enzyme would be inhibited indirectly if intracellular glucose concentrations are very high?
• A child presents with anemia after splenectomy and cholecystectomy. Labs show low hemoglobin, normal MCV, an increased reticulocyte count, and peripheral smear with pale red cells. What underlying defect is most likely?
• A patient presents with hypotonia, hypoketotic hypoglycemia, and episodes of myoglobinuria with muscle weakness. Which condition fits this presentation?
• A 3-pound neonate has a continuous machine-like murmur along the left sternal border due to a patent ductus arteriosus. Indomethacin closes the PDA by inhibiting production of PGE2, which is produced by cyclooxygenase. Which enzyme is inhibited?
• A 3-year-old alcoholic, homeless man presents with fever and cachexia. He has clubbing of the fingers, halitosis, missing teeth, and numerous dental caries. Chest examination shows increased fremitus, dullness to percussion, and tubular breath sounds in the right lower lung. Sputum culture yields purulence with gram-positive cocci in chains and gram-negative bacilli. A chest X-ray shows a cavitary lesion in the right lower lobe with surrounding infiltrate. Sputum is most likely to grow which of the following?
• A 2-year-old with moderate splenomegaly, lymphocytes with cytoplasmic projections, and tartrate-resistant acid phosphatase positivity. Diagnosis?
• Which organism is most likely responsible for a 3-year-old with a nonproductive cough, wheezing, and a stool culture showing a 1.6-cm roundworm larva with bilateral pulmonary infiltrates on chest X-ray?
• Which organ systems are commonly involved in acute graft-versus-host disease?
• In cystic fibrosis, the bronchial epithelial defect is best described as a defect in which type of protein?
• Which statement best defines a leukemoid reaction in the context of infection or stress?
• Which symptom is classically associated with Zollinger-Ellison syndrome due to gastrinoma?
• A patient presents with fever and erythema with marked leukocytosis (WBC 57,000). The described response is best labeled as which of the following?
• In a patient with thoracic spinal cord injury who preserves reflexogenic erection, which two nerves form the reflex arc responsible for erection?
• In a premenopausal woman with irregular menses and hot flashes, which hormonal pattern is most likely?
• Which statement correctly describes the subcellular locations of acyl transferase and CPT II?
• A 55-year-old man with fever, vomiting, poor intake, dry mucous membranes, and orthostatic changes has which most likely diagnosis?
• Spider angiomata are a cutaneous manifestation most commonly associated with which condition?
• Which laboratory finding supports a diagnosis of hairy cell leukemia?
• Lambert-Eaton syndrome is most strongly associated with which cancer?
• In a liver biopsy showing centrilobular pallor and swelling of hepatocytes due to decreased ATP production, what is the most likely mechanism of cellular swelling?
• Blockage of trafficking vesicles from the endoplasmic reticulum to the Golgi leads to what change in the endoplasmic reticulum?
• In rheumatoid arthritis, if prednisone and methotrexate fail, the next step is a drug that blocks the effects of which cytokine?
• Symptoms similar to McArdle disease but occurring after prolonged exercise point to which metabolic deficiency?
• Which immunohistochemical markers are commonly positive in neuroendocrine tumors such as small cell lung carcinoma?
• In long-chain fatty acid oxidation disorders, which metabolite accumulates in tissues such as palmitate?
• What is the best approach when a patient with recent trauma requests additional opioid prescriptions?
• A 52-year-old man presents with a 3-week history of increased thirst and urinary frequency and weight loss. He has hypertension and hyperlipidemia and a BMI in the obesity range. Which laboratory finding is most likely increased in this patient?
• Papillary muscle rupture causing acute mitral regurgitation most commonly occurs within what time frame after a myocardial infarction?
• Parietal cells in the stomach produce which crucial factor?
• A diastolic murmur best heard at the left sternal border that increases when the patient leans forward indicates which valvular lesion?
• A healthy 27-year-old woman presents with chest pain that worsens with chest wall palpation; there is no dyspnea or systemic symptoms. What is the most likely diagnosis?
• In hereditary spherocytosis, which morphological finding is most characteristic on peripheral smear?
• A brain lesion with tumor cells expressing cytokeratin, chromogranin, and synaptophysin most likely metastasized from which primary cancer?
• Young man with left flank pain radiating to the groin and left flank tenderness, with mild bowel hypoactivity and negative fecal occult blood. Which diagnosis is most likely?
• A patient with Sjögren syndrome reports burning pain in the toes; temperature sensation is decreased but other modalities are normal. Which neurotransmitter mediates this pain?
• Which brain imaging finding is most characteristic of tuberous sclerosis?
• Which study design is described by matching cases and controls on several variables and assessing exposure retrospectively?