id string | form string | question_number int64 | stem string | options string | correct_answer string | explanation string | subject string | organ_system string | difficulty string | high_yield int64 | word_count int64 |
|---|---|---|---|---|---|---|---|---|---|---|---|
nbme27_page-178 | NBME 27 | 30 | 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 ... | [{"letter": "A", "text": "Epiphysis"}, {"letter": "B", "text": "Haversian canal"}, {"letter": "C", "text": "Lamella"}, {"letter": "D", "text": "Periosteum"}, {"letter": "E", "text": "Volkmann canal"}] | D | When a fracture occurs, stem cells from the periosteum and endosteum are recruited to the site of injury to generate a healing response. There are two main types of bone healing. Primary bone healing occurs when bones are rigidly fixed together, with remodeling occurring via the haversian canal system. More frequently,... | hematology | Hematologic | medium | 0 | 74 |
nbme120_q020 | NBME 120 | 20 | A 6-year-old girl is brought to the office because of two episodes of vaginal bleeding during the past 2 months. She has no history of serious illness and receives no medications. She does not appear to be in distress. She is at the 60th percentile for height, 40th percentile for weight, and 35th percentile for BMI. Vi... | {"A": "Central activation of neurons", "B": "Ectopic prolactin secretion", "C": "Exogenous sex steroid secretion", "D": "Germline GNAS activating mutation", "E": "21-Hydroxylase deficiency"} | A | Central precocious puberty (GnRH-dependent) in a 6-year-old with breast buds, pubic hair, and vaginal bleeding. Central activation of hypothalamic GnRH neurons initiates early activation of the HPG axis. Bone age would be advanced. | physiology | Endocrine | Medium | 1 | 104 |
nbme27_page-89 | NBME 27 | 41 | A 45-year-old woman is brought to the emergency department because of a 6-hour history of constant right flank pain, fever, pain with urination, and blood in the urine. Antibiotic treatment was initiated 2 weeks ago for a urinary tract infection caused by Proteus mirabilis. She is writhing on the hospital bed, unable t... | [{"letter": "A", "text": "Calcium oxalate"}, {"letter": "B", "text": "Calcium phosphate"}, {"letter": "C", "text": "Cystine"}, {"letter": "D", "text": "Struvite"}, {"letter": "E", "text": "Uric acid"}] | D | Struvite is the most likely substance implicated in the formation of a staghorn renal calculus, especially in the setting of a recent urinary tract infection with Proteus mirabilis, which is a gram-negative bacterium that produces urease. Urease catalyzes the conversion of urinary urea to ammonia and carbon dioxide, wh... | nephrology | Renal & Urinary | medium | 0 | 123 |
nbme29_q0103 | NBME 29 | 3 | In an experimental model of mild thermal injury to skin (a single application of $ 54^{\circ} $C for 20 seconds), the following pattern of extravasation of intravenously administered dye is observed. Administration of an antihistamine prior to thermal injury would have significantly blunted the extent of dye extravasat... | [{"letter": "A", "text": "A) Peak A only"}, {"letter": "B", "text": "B) Peak B only"}, {"letter": "C", "text": "C) Both Peak A and B"}, {"letter": "D", "text": "D) Neither Peak A nor B"}] | A | Mild thermal injury produces a biphasic pattern of vascular extravasation. The early phase (Peak A, within minutes) is mediated primarily by histamine released from mast cells, and is significantly blunted by antihistamine pretreatment. The later phase (Peak B, hours later) is mediated by other inflammatory mediators i... | None | Multisystem | easy | 0 | 56 |
form31_page-85 | Form 31 | 47 | The figure shows the effects of drug X, administered intravenously, on heart rate, atrioventricular (AV) conduction velocity, and force of ventricular contraction. Drug X most likely has which of the following actions? | [{"letter": "A", "text": "\u03b1-Adrenergic agonist"}, {"letter": "B", "text": "\u03b1-Adrenergic antagonist"}, {"letter": "C", "text": "\u03b2-Adrenergic agonist"}, {"letter": "D", "text": "\u03b2-Adrenergic antagonist"}, {"letter": "E", "text": "Muscarinic agonist"}, {"letter": "F", "text": "Muscarinic antagonist"}] | F | The autonomic nervous system is responsible for controlling heart rate, atrioventricular (AV) conduction velocity, and the force of ventricular contraction through its action on a variety of receptors. The sympathetic nervous system primarily acts through α- and β-adrenergic receptors, which are stimulated by dopamine,... | pharmacology | Pharmacology | medium | 0 | 32 |
form30_page-11 | Form 30 | 12 | An investigator is conducting a study of the effects of a newly discovered spider venom on neuromuscular transmission. An isolated nerve muscle preparation is bathed in a solution containing the venom; there is a decrease in the end-plate potential amplitude following stimulation of the nerve. The presence of the venom... | [{"letter": "A", "text": "Chloride conductance in the nerve terminal"}, {"letter": "B", "text": "Function of acetylcholinesterase"}, {"letter": "C", "text": "Inactivation of voltage-gated sodium channels in the muscle"}, {"letter": "D", "text": "Insertion of acetylcholine receptors into the muscle membrane"}, {"letter"... | E | The blockade of presynaptic, voltage-gated calcium channels would lead to decreased end-plate potential amplitude. Normally, action potentials lead to depolarization in the terminal bouton of the axon. Presynaptic, voltage-gated calcium channels consequently open and allow calcium influx, which triggers the exocytosis ... | musculoskeletal | Musculoskeletal & Anatomy | easy | 0 | 96 |
nbme27_page-36 | NBME 27 | 38 | A 66-year-old right-handed man has a thrombotic stroke. A CT scan of the head is shown. Which of the following is the most likely neurologic finding in this patient? | [{"letter": "A", "text": "Global aphasia"}, {"letter": "B", "text": "Left hemiparesis"}, {"letter": "C", "text": "Spatial neglect"}, {"letter": "D", "text": "Weakness of all muscles of facial expression on the right"}, {"letter": "E", "text": "Weakness of the lower two thirds of the face on the left"}] | A | This axial, noncontrast CT image shows hypodensity (darkness) of most of the left hemisphere (sparing the anterior and posterior cerebrum) and is consistent with an ischemic infarction involving the territory of the middle cerebral artery (MCA). The MCA supplies large portions of the lateral frontal, parietal, and temp... | nephrology | Renal & Urinary | medium | 0 | 29 |
form31_page-75 | Form 31 | 34 | A 15-year-old girl with a 7-year history of asthma is brought to the physician for a follow-up examination. She has been taking oral prednisolone for 2 months for exacerbations of her condition. Her respirations are 28/min. Physical examination shows expiratory wheezing. Pulmonary function studies show decreased FEV₁ a... | [{"letter": "A", "text": "G protein-coupled"}, {"letter": "B", "text": "Ligand-gated"}, {"letter": "C", "text": "Nuclear"}, {"letter": "D", "text": "Protein kinase"}, {"letter": "E", "text": "Voltage-gated"}] | A | Leukotriene receptor antagonists, such as montelukast, are used in the treatment of persistent asthma. Leukotrienes are synthesized from arachidonic acid by the enzyme 5-lipoxygenase. There are two groups of leukotrienes, distinguished by the presence of an amino acid moiety. Leukotrienes C4, D4, and E4 have the amino ... | pharmacology | Pharmacology | medium | 0 | 75 |
23 | NBME 28 | 23 | A 17-year-old boy is brought to the physician by his mother because she is concerned that his puberty is delayed. The mother states, "He is so short. His father is 6 feet 5 inches tall. I don't understand why he has not had his growth spurt." When the mother leaves the room, the patient states, "I'm fine. I don't know ... | [{"letter": "A", "text": "A) \"Since your son is fine with his height, you should try to accept him as he is.\""}, {"letter": "B", "text": "B) \"Tell me more about your concerns about your son's height.\""}, {"letter": "C", "text": "C) \"We'll do some blood tests just to be sure that all your son's hormone levels are o... | C | .
Tumor necrosis factor-a (TNF-a) is a cytokine secreted by macrophages , which supports granuloma formation. Granulomas are collections of histiocytes, or macrophages with abundant pink cytoplasm that often contain multi-nucleated giant cells and are
surrounded by lymphocytes One purpose of granulo | None | Multisystem | easy | 0 | 194 |
form30_page-80 | Form 30 | 31 | The table reports survival of patients who had an operation for a particular form of cancer. Which of the following is the probability of a patient surviving 4 years? | [{"letter": "A", "text": "(.875 \u2212 .80) x .90 x .90"}, {"letter": "B", "text": ".875"}, {"letter": "C", "text": ".90"}, {"letter": "D", "text": ".80 x .875 x .90 x .90"}, {"letter": "E", "text": "(.875 \u2212 .80) x .90"}] | D | A survival analysis is used to convey the fraction of a group of patients who are alive at a given time point after an intervention has been made. Graphically, this is often done with a Kaplan-Meier survival curve, the data for which is shown in the table. For this particular cancer the time interval of 0 to 1 year is ... | oncology | Oncology | medium | 0 | 29 |
nbme29_q0107 | NBME 29 | 7 | A 68-year-old man comes to the physician because of difficulty swallowing solids for 2 months. He has a history of dilated cardiomyopathy. X-rays of the esophagus with barium contrast show indentation and posterior displacement of the esophagus. Enlargement of which of the following structures is the most likely cause ... | [{"letter": "A", "text": "A) Left atrium"}, {"letter": "B", "text": "B) Left ventricle"}, {"letter": "C", "text": "C) Right atrium"}, {"letter": "D", "text": "D) Right ventricle"}, {"letter": "E", "text": "E) Superior vena cava"}] | A | The esophagus is anatomically posterior to the left atrium. In patients with dilated cardiomyopathy, the left atrium can become significantly enlarged, compressing the esophagus and causing dysphagia (difficulty swallowing). Barium swallow shows indentation and posterior displacement of the esophagus, characteristic of... | None | Multisystem | hard | 0 | 52 |
form30_page-150 | Form 30 | 1 | A 16-year-old girl is brought to the emergency department because of a 2-hour history of rash and burning pain on her shoulders and arms. She had been hiking outdoors on a sunny day for several hours before the symptoms began. Her only medication is oral tetracycline for facial acne. Her temperature is 37°C (98.6°F). P... | [{"letter": "A", "text": "Atopic dermatitis"}, {"letter": "B", "text": "Contact dermatitis"}, {"letter": "C", "text": "Drug-induced lupus"}, {"letter": "D", "text": "Phototoxic reaction"}, {"letter": "E", "text": "Polymorphous light eruption"}] | D | Phototoxicity is a common adverse effect of oral tetracyclines including tetracycline, doxycycline, and minocycline. All patients prescribed these medications should be counseled on the importance of sun-protective behaviors including using sunscreen, avoiding mid-day sun, and wearing sun-protective clothing. Clinical ... | gastroenterology | Gastrointestinal | hard | 0 | 80 |
form30_page-199 | Form 30 | 50 | A 25-year-old woman comes to the physician because of palpitations and insomnia for 5 months; she also has had a 5-kg (11-lb) weight loss during this period. Her pulse is 125/min. Physical examination shows exophthalmos, thyromegaly, and hand tremors. Serum studies show a thyroid-stimulating hormone concentration of le... | [{"letter": "A", "text": "Cytokine-linked kinase"}, {"letter": "B", "text": "G protein-coupled receptor"}, {"letter": "C", "text": "Nuclear retinoid X binding to DNA"}, {"letter": "D", "text": "Serine/threonine kinase"}, {"letter": "E", "text": "Tyrosine kinase"}] | C | Graves disease is the most common cause of hyperthyroidism. It is caused by an autoantibody that activates the thyroid stimulating hormone receptors (TSH-R) on thyroid follicular cells. Both T3 and T4 are hormones that act on nuclear receptors, requiring them to enter the target cell to exert effects. Unlike other lipo... | endocrinology | Endocrine | hard | 0 | 84 |
5 | NBME 28 | 5 | Cycle (day)[Serum estradiol] pg/mL 25110 2760 2840 3035 3238 3440 3642 3845 4048 4250 4452 4655 4858 5060 5262 5465 5668 5870 6072 6275 6478 6680 6885 7090 7295 74100 76110 78125 80140 82160 84180 86200 88220 90230 92210 94180 96150 98120 100100 10290 10485 10680 10875 11070 11265 11460 11655 11850 12045 12240 12435 12... | [{"letter": "A", "text": "A) Granulosa"}, {"letter": "B", "text": "B) Luteal"}, {"letter": "C", "text": "C) Stromal"}, {"letter": "D", "text": "D) Theca externa"}, {"letter": "E", "text": "E) Theca interna"}] | A | The first half of the menstrual cycle ; the follicular phase: which varies in length, begins with menses. During menses, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) concentrations increase and stimulate the developing follicle. Androstenedione
is converted to estrone and estradio | None | Multisystem | easy | 0 | 292 |
form30_page-39 | Form 30 | 40 | An 18-month-old boy has pinched, wrinkled facies and total loss of subcutaneous fat. He is alert. His height is at the 50th percentile and his weight is at the 2nd percentile for his age. The liver is not enlarged, and there is no edema. Which of the following is the most likely diagnosis? | [{"letter": "A", "text": "Kwashiorkor"}, {"letter": "B", "text": "Marasmus"}, {"letter": "C", "text": "Pellagra"}, {"letter": "D", "text": "Rickets"}, {"letter": "E", "text": "Scurvy"}] | B | Acute protein-energy malnutrition is characterized clinically by a decrease in mid-upper arm circumference, weight for length, or body mass index. Unlike in chronic malnutrition, children maintain their linear growth because the weight is more quickly impacted than the height. Acute malnutrition can be divided into two... | cardiology | Cardiovascular | hard | 0 | 53 |
nbme120_q058 | NBME 120 | 58 | A 56-year-old woman comes to the physician because of a 2-year history of recurrent urinary tract infections accompanied by left flank pain. Physical examination shows no abnormalities. Renal ultrasonography shows left-sided hydronephrosis. A T2-weighted coronal MRI of the abdomen is shown; the arrow indicates the hydr... | {"A": "Absent expression of C5", "B": "Bilobed neutrophil nuclei with abnormal granule morphology", "C": "Decreased absolute CD8+ T-lymphocyte count", "D": "Decreased serum concentration of IgG", "E": "Dysfunctional interferon- $ \\gamma $ receptors"} | D | Recurrent UTIs with left hydronephrosis suggest a ureteral obstruction. In women, the ureter crosses anterior to the uterine artery ('water under the bridge') and is susceptible to compression. The most common sites of ureteral obstruction are the ureteropelvic junction, where the ureter crosses the pelvic brim/iliac v... | anatomy | Renal & Urinary | Medium | 1 | 65 |
77 | NBME 28 | 27 | 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 hepatosplen... | [{"letter": "A", "text": "A) Increased erythropoietin action"}, {"letter": "B", "text": "B) Increased intestinal iron absorption"}, {"letter": "C", "text": "C) Increased oral iron intake"}, {"letter": "D", "text": "D) Decreased erythropoiesis"}, {"letter": "E", "text": "E) Decreased iron excretion"}, {"letter": "F", "t... | A | Argininosuccinate is an important .ntermediate within the urea cycle, tt is formed from cifruIJine by argininosuccinate synthetase and is converted to arginine by argininosuccinate lyase (ASL) . Mutations in the gene encoding ASL result in argininosuccinic aciduria,
characterized by the accumulation | None | Multisystem | medium | 0 | 106 |
nbme120_q007 | NBME 120 | 7 | A 68-year-old man comes to the office because of a 6-month history of pain and cramping of his right and left lower legs. He says the pain is more severe with walking but improves with rest. He has a history of coronary artery disease, dyslipidemia, hypertension, and type 2 diabetes mellitus with nephropathy. Current m... | {"A": "Fibromuscular dysplasia", "B": "Giant cell arteritis", "C": "Hyaline arteriosclerosis", "D": "Segmental inflammation of medium-sized vessels", "E": "Vascular obstruction by lipid-rich plaques"} | E | Peripheral arterial disease from atherosclerosis. Classic claudication (pain with walking, relieved by rest), absent pulses, atrophic skin, hair loss. Multiple risk factors (DM, HTN, smoking, dyslipidemia). Mechanism: obstructive lipid-rich atherosclerotic plaques. | pathology | Cardiovascular | Easy | 1 | 122 |
form30_page-83 | Form 30 | 34 | During a study, a healthy 35-year-old woman and a 35-year-old woman with Crohn disease are given an oral solution of radiolabeled lactulose. The appearance of radioactivity in their urine is monitored over the next 24 hours. Urinary excretion of radioactivity in the patient with Crohn disease is much greater than that ... | [{"letter": "A", "text": "Adherens junctions (zonulae adherentes)"}, {"letter": "B", "text": "Basement membrane"}, {"letter": "C", "text": "Desmosomes (maculae adherentes)"}, {"letter": "D", "text": "Gap junctions"}, {"letter": "E", "text": "Tight junctions (zonulae occludentes)"}] | E | Tight junctions (zonulae occludentes) are a type of epithelial cell connection composed of proteins called claudins and occludins. Tight junctions are located between two cells, toward the apical surface, and create a watertight seal to prevent the paracellular movement of solutes or water through an epithelial or endo... | pulmonology | Respiratory | hard | 0 | 74 |
nbme120_q087 | NBME 120 | 87 | 8 | {"B": "Correct answer (B)", "A": "Option A", "C": "Option C", "D": "Option D", "E": "Option E"} | B | Right chest knife wound, trachea shifted left → tension pneumothorax. Air in pleural space under pressure causes tracheal deviation away from the affected side. On the right: fremitus decreased (air dampens vibration), percussion hyperresonant (air-filled), breath sounds decreased. Answer: B. | physiology | Respiratory | Medium | 1 | 1 |
nbme27_page-139 | NBME 27 | 41 | A 52-year-old man comes to the emergency department 2 hours after developing shortness of breath and nearly fainting while exercising. He is currently asymptomatic. He has a 6-month history of similar episodes that are becoming increasingly severe. He also has a 2-month history of intermittent chest pain with exertion.... | [{"letter": "A", "text": "Congenital bicuspid valve"}, {"letter": "B", "text": "Degenerative sclerosis of valve leaflets"}, {"letter": "C", "text": "Inadequate preload"}, {"letter": "D", "text": "Increased resistance in pulmonary artery"}, {"letter": "E", "text": "Stenosis of the left main coronary artery"}] | A | The pressure tracing is characterized by a large peak pressure gradient between the left ventricle and aorta during systole, which is consistent with the diagnosis of aortic stenosis. In the setting of aortic stenosis, the left ventricle must generate higher pressures in order to overcome the opening resistance of the ... | cardiology | Cardiovascular | medium | 0 | 143 |
192 | NBME 28 | 43 | A 28-year-old man is participating in a study of the effect of altitude and conditioning on combat readiness. He is a Special Forces sergeant in the army. While he exercises in an environmental chamber, the ambient $ PO_{2} $ is decreased from 160 mm Hg to 60 mm Hg. The decrease in ambient $ PO_{2} $ will most likely c... | [{"letter": "A", "text": "A) Arterial diastolic pressure"}, {"letter": "B", "text": "B) Arterial pulse pressure"}, {"letter": "C", "text": "C) Arterial systolic pressure"}, {"letter": "D", "text": "D) Mean arterial pressure"}, {"letter": "E", "text": "E) Mean pulmonary artery pressure"}] | E | A decrease in the ambient partial pressure of oxygen (Po2) results in hypoxic pulmonary vasoconstriction with a resultant increase in the mean pulmonary artery pressure. Acute hypoxia stimulates contraction of smooth muscle cells in the pulmonary vasculature.
This mechanism diverts blood flow away f | None | Multisystem | easy | 0 | 91 |
nbme27_page-84 | NBME 27 | 36 | A 3-year-old boy is brought to the physician because of a 4-hour history of abdominal pain and vomiting. His mother says that she also has occasionally noticed several 20-cm, white worms in his stool during the past month. He recently immigrated to the USA from India with his family. Abdominal examination shows marked ... | [{"letter": "A", "text": "Ancylostoma caninum"}, {"letter": "B", "text": "Ascaris lumbricoides"}, {"letter": "C", "text": "Enterobius vermicularis"}, {"letter": "D", "text": "Strongyloides stercoralis"}, {"letter": "E", "text": "Trichuris trichiura"}] | B | Ascaris lumbricoides infection likely explains this patient's abdominal pain, vomiting, and presence of large white worms in the stool. Infection with Ascaris lumbricoides is called ascariasis. This worm is endemic to India and other parts of Asia, Africa, and South America, with transmission occurring via food or wate... | cardiology | Cardiovascular | easy | 0 | 71 |
nbme29_q0006 | NBME 29 | 6 | A study is done to determine the efficacy of St. John's wort (Hypericum perforatum) for treatment of endogenous depression. One hundred patients with mild depression are randomly assigned to either a treatment group (900 mg of St. John's wort daily) or a placebo group. Scores on a Hamilton Depression Rating Scale are r... | [{"letter": "A", "text": "A) Case-control"}, {"letter": "B", "text": "B) Cohort"}, {"letter": "C", "text": "C) Controlled trial"}, {"letter": "D", "text": "D) Crossover"}, {"letter": "E", "text": "E) Cross-sectional"}] | C | This study is a randomized controlled trial (controlled trial). Patients were randomly assigned to either a treatment group (St. John's wort) or a placebo group, with outcomes measured before and after the intervention. A case-control study (A) starts with outcome and looks back at exposures. A cohort study (B) follows... | behavioral_science | Behavioral & Psychiatry | medium | 0 | 76 |
nbme29_q0146 | NBME 29 | 46 | A 1-year-old girl is brought to the physician by her mother because of a 1-day history of blisters on her skin. The mother says that she has had several previous similar episodes earlier in the summer. Physical examination shows areas of dense freckling over sun-exposed areas, with hypo- and hyperpigmented macules. The... | [{"letter": "A", "text": "A) Base excision repair"}, {"letter": "B", "text": "B) Mismatch repair"}, {"letter": "C", "text": "C) Nonhomologous end joining"}, {"letter": "D", "text": "D) Nucleotide excision repair"}, {"letter": "E", "text": "E) Recombination repair"}] | D | Xeroderma pigmentosum (XP) is an autosomal recessive disorder characterized by defective nucleotide excision repair (NER), which normally removes UV-induced pyrimidine dimers. Patients present with severe photosensitivity, marked freckling in sun-exposed areas, skin atrophy, hypo- and hyperpigmentation, and high risk o... | biochemistry | Biochemistry & Genetics | easy | 0 | 75 |
148 | NBME 28 | 49 | 49. A 38-year-old man comes to the physician because of a 1-week history of a discharge from his penis and testicular pain. He is sexually active and uses condoms inconsistently. Physical examination shows a thick green urethral discharge and exquisite tenderness of the right testis. The pain is relieved by elevation o... | [{"letter": "A", "text": "A) Chlamydia trachomatis"}, {"letter": "B", "text": "B) Mycoplasma genitalium"}, {"letter": "C", "text": "C) Neisseria gonorrhoeae"}, {"letter": "D", "text": "D) Trichomonas vaginalis"}, {"letter": "E", "text": "E) Ureaplasma urealyticum"}] | C | This patient presents with signs and symptoms suggestive of epididymitis: which frequently occurs due to infection with Neisseria gonorrhoeas or Chlamydia trachomatis This patient's symptoms of thick , green urethral discharge and photomicrograph
demonstrating accumulation of Gram-negative diplococc | None | Multisystem | hard | 0 | 90 |
form30_page-81 | Form 30 | 32 | A 45-year-old man is admitted to the hospital because of congestive heart failure. Two first-degree relatives died in their 40s with dilated cardiomyopathy and cirrhosis. Physical examination shows cardiac enlargement and generalized hyperpigmentation. His serum glucose concentration is 320 mg/dL. Histologic examinatio... | [{"letter": "A", "text": "Amyloid"}, {"letter": "B", "text": "\u03b11-Antitrypsin"}, {"letter": "C", "text": "Cerebroside"}, {"letter": "D", "text": "Copper"}, {"letter": "E", "text": "Eosinophils"}, {"letter": "F", "text": "Iron"}, {"letter": "G", "text": "Lysosomal glycogen"}, {"letter": "H", "text": "Mucopolysacchar... | F | Iron deposition will most likely be appreciated on histologic examination of endomyocardial tissue in this patient with a probable diagnosis of hemochromatosis. Hemochromatosis may be acquired or inherited secondary to mutations in the HFE gene, leading to abnormally increased intestinal absorption of iron. This result... | cardiology | Cardiovascular | hard | 0 | 57 |
65 | NBME 28 | 15 | A moderately obese 55-year-old man is brought to the emergency department because of a 10-hour history of severe chest pain. He has a 5-year history of exercise-induced angina. His pulse is 109/min, respirations are 15/min, and blood pressure is 132/92 mm Hg. Physical examination shows diaphoresis. A blood sample obtai... | [{"letter": "A", "text": "A) Increased Golgi complex activity"}, {"letter": "B", "text": "B) Increased permeability of the plasma membrane"}, {"letter": "C", "text": "C) Mitochondrial swelling"}, {"letter": "D", "text": "D) Nuclear lysis"}, {"letter": "E", "text": "E) Proliferation of the endoplasmic reticulum"}] | D | When a patient asks questions about naturopathic treatments such as glucosamine, physicians should initially ask open-ended questions to explore the patient 's understanding and goals. It is possible that this patient does not understand the risks and benefits of
ibuprofen versus glucosamine, and th | None | Multisystem | hard | 0 | 99 |
nbme27_page-21 | NBME 27 | 22 | A 31-year-old man who works as a chef comes to the emergency department 30 minutes after accidentally cutting his right thumb with a knife. Examination of the right hand shows a 3-cm-long, 0.6-cm-deep laceration of the thumb. The wound is cleaned, sutured, and heals normally, leaving a faint scar by 1 year after the in... | [{"letter": "A", "text": "Chemokines"}, {"letter": "B", "text": "Interleukin-1 (IL-1)"}, {"letter": "C", "text": "Matrix metalloproteinases"}, {"letter": "D", "text": "Transforming growth factor-\u03b2"}, {"letter": "E", "text": "Tumor necrosis factor"}] | C | Matrix metalloproteinases (MMPs) are enzymes that lyse proteins using a chelated metal ion cofactor. MMPs are necessary for the healing of wounds as well as for the remodeling of bone and cartilage. Wound healing occurs via a staged process. In early wound healing, platelet aggregation and platelet plug formation occur... | hematology | Hematologic | medium | 0 | 76 |
form30_page-109 | Form 30 | 10 | A 1-year-old boy receives a left cochlear implant that consists of an array of electrodes. Six months ago, he was diagnosed with severe bilateral hearing deficit. Which of the following elements of the auditory system must remain intact for this patient to perceive auditory stimulation via activation of the electrodes ... | [{"letter": "A", "text": "Auditory hair cells"}, {"letter": "B", "text": "Auditory nerve"}, {"letter": "C", "text": "Ossicles"}, {"letter": "D", "text": "Round window"}, {"letter": "E", "text": "Tympanic membrane"}] | B | Cochlear implants directly stimulate the auditory nerve endings in the cochlea and therefore require a functioning auditory nerve. Sensorineural hearing loss typically results from damage of the hair cells in the cochlea. Cochlear implants bypass the damaged cochlea. The external microphone of the implant converts mech... | other | Multisystem | medium | 0 | 53 |
nbme27_page-168 | NBME 27 | 20 | A 27-year-old man who works in a boiler room comes to the physician because he and his 32-year-old wife have been unable to conceive a child for the past 3 years. He had the mumps at the age of 12 years. He tells the physician that his wife was evaluated for infertility and test results were normal. He adds, "Could it ... | [{"letter": "A", "text": "Excessive testicular temperature"}, {"letter": "B", "text": "Gonadotropin-releasing hormone deficiency"}, {"letter": "C", "text": "Obstruction of seminal vesicles"}, {"letter": "D", "text": "Use of exogenous testosterone"}, {"letter": "E", "text": "Viral orchitis"}, {"letter": "F", "text": "XX... | D | Spermatogenesis is the process by which sperm are created and takes place in the seminiferous tubules of the testes. Lining the seminiferous tubules are spermatogonia, which generate the primary spermatocytes that will ultimately become sperm. Sertoli cells are also present within the seminiferous tubules and are requi... | nephrology | Renal & Urinary | medium | 0 | 139 |
nbme29_q0008 | NBME 29 | 8 | A 12-year-old boy is brought to the office by his mother for an annual well-child examination. He has asthma well controlled with inhaled budesonide. The mother says that the boy recently has voiced concern about his height and is bothered by the fact that he is considerably shorter than the other boys on his basketbal... | [{"letter": "A", "text": "A) Constitutional growth delay"}, {"letter": "B", "text": "B) Familial short stature"}, {"letter": "C", "text": "C) Growth hormone deficiency"}, {"letter": "D", "text": "D) Hypopituitarism"}, {"letter": "E", "text": "E) Hypothyroidism"}, {"letter": "F", "text": "F) Steroid-induced growth failu... | A | This patient has constitutional growth delay (delayed puberty). He has maintained a steady 3rd-percentile growth curve during the past 8 years (normal growth velocity), both parents are of average-to-tall stature, and his SMR (Tanner stage) is 1 at age 12, indicating delayed pubertal onset. Growth potential is excellen... | None | Multisystem | hard | 0 | 152 |
form30_page-25 | Form 30 | 26 | A 65-year-old woman dies 6 months after the onset of severe headaches. Her brain as seen at autopsy is shown in the photograph. Which of the following is the most likely cell of origin of this neoplasm? | [{"letter": "A", "text": "Astrocyte"}, {"letter": "B", "text": "Endothelial"}, {"letter": "C", "text": "Melanocyte"}, {"letter": "D", "text": "Meningeal"}, {"letter": "E", "text": "Squamous epithelial"}] | D | Meningiomas are the most common primary brain tumors in adults and arise from the meninges (the protective coverings of the brain). This patient's meningioma is pictured along the inferior aspect of the forebrain within the anterior interhemispheric fissure between the frontal lobes, resulting in significant mass effec... | neurology | Neurologic | easy | 0 | 37 |
nbme29_q0176 | NBME 29 | 26 | A 57-year-old man undergoes coronary artery bypass grafting. The stress of the operation results in increased secretion of cortisol from the adrenal gland postoperatively. Which of the following cells is the most likely origin of the stimulus of this cortisol secretion? | [{"letter": "A", "text": "A) Acidophil of the anterior pituitary gland"}, {"letter": "B", "text": "B) Alpha cell of the islet of Langerhans"}, {"letter": "C", "text": "C) Basophil of the anterior pituitary gland"}, {"letter": "D", "text": "D) Beta cell of the islet of Langerhans"}, {"letter": "E", "text": "E) Delta cel... | C | The stress of surgery activates the hypothalamic-pituitary-adrenal (HPA) axis: the hypothalamus releases CRH, which stimulates the anterior pituitary to secrete ACTH, which then acts on the adrenal cortex to produce cortisol. ACTH is produced by corticotroph cells of the anterior pituitary, which are classified as baso... | anatomy | Musculoskeletal & Anatomy | hard | 0 | 41 |
nbme120_q080 | NBME 120 | 80 | A 25-year-old woman, gravida 1, para 1, comes to the office because of a 2-week history of palpitations and heat intolerance. She delivered her child 3 months ago following an uncomplicated pregnancy and delivery. She is breastfeeding. She has no history of serious illness and takes no medications. She is 163 cm (5 ft ... | {"A": "Activation of mutations of TSH receptors", "B": "Increased serum thyroglobulin concentration", "C": "Ischemic injury to the hypothalamus", "D": "Lymphocytic infiltration of the thyroid", "E": "Presence of TSH receptor autoantibodies"} | D | Postpartum woman (3 months after delivery) with hyperthyroidism (tachycardia, lid lag, enlarged thyroid, low TSH, high T4/T3) without exophthalmos → postpartum thyroiditis. This is an autoimmune destructive thyroiditis (lymphocytic infiltration) caused by rebound immune activation after pregnancy. It typically progress... | pathology | Endocrine | Medium | 1 | 148 |
nbme29_q0004 | NBME 29 | 4 | Cholestyramine prevents the reabsorption of bile acids from the lumen of the intestine. This decreases serum cholesterol concentrations by which of the following mechanisms? | [{"letter": "A", "text": "A) Activating lecithin-cholesterol acyltransferase (LCAT)"}, {"letter": "B", "text": "B) Decreasing VLDL production"}, {"letter": "C", "text": "C) Inhibiting hepatic cholesterol synthesis"}, {"letter": "D", "text": "D) Stimulating HDL production"}, {"letter": "E", "text": "E) Upregulating hepa... | E | Cholestyramine is a bile-acid binding resin that prevents the reabsorption of bile acids in the terminal ileum, interrupting their enterohepatic circulation. The liver responds by converting more cholesterol into bile acids (via 7α-hydroxylase), depleting hepatic cholesterol stores. This depletion upregulates hepatic L... | biochemistry | Biochemistry & Genetics | hard | 0 | 24 |
nbme29_q0087 | NBME 29 | 37 | A 70-year-old woman comes to the physician because of a 3-month history of frequent constipation and fatigue. She has had a 4.5-kg (10-lb) weight loss during this period. Her vital signs are within normal limits. Abdominal examination shows mild tenderness. Rectal examination shows a 10-cm firm mass. Laboratory studies... | [{"letter": "A", "text": "A) Kidney"}, {"letter": "B", "text": "B) Liver"}, {"letter": "C", "text": "C) Lung"}, {"letter": "D", "text": "D) Skin"}, {"letter": "E", "text": "E) Uterus"}] | B | This patient has colon cancer presenting with a rectal mass, iron deficiency anemia (microcytic anemia with Hb 7.5, MCV 70), leukocytosis, and thrombocytosis. Colorectal adenocarcinoma most commonly metastasizes to the liver via the portal vein, making the liver the organ at greatest risk for complications. The liver i... | anatomy | Musculoskeletal & Anatomy | easy | 0 | 89 |
nbme27_page-65 | NBME 27 | 17 | A 15-month-old boy is brought to the physician by his mother because of a 9-month history of recurrent bacterial infections. The patient has not had recurrent viral infections. He is at the 10th percentile for length and weight. Physical examination shows multiple areas of honey yellow, crusted lesions over the lower e... | [{"letter": "A", "text": "Cytokine production"}, {"letter": "B", "text": "Helper T-cell function"}, {"letter": "C", "text": "Immunoglobulin gene rearrangement"}, {"letter": "D", "text": "Killing of intracellular bacteria"}, {"letter": "E", "text": "Migration"}] | E | Leukocyte adhesion deficiency (LAD) results from a defect in the attachment of leukocytes to the vascular endothelium, which consequently results in the impaired recruitment and migration to sites of extravascular inflammation or infection. LAD type 1 is caused by a dysfunctional LFA-1 integrin (CD18) protein on the le... | infectious_disease | Infectious Disease | medium | 0 | 109 |
form31_page-58 | Form 31 | 15 | A 14-year-old boy is brought to the office for a health maintenance examination. He tells the physician that he is concerned about a small lump that he noticed under his left breast 2 months ago. His vital signs are within normal limits. He is at the 50th percentile for height and 75th percentile for weight. Physical e... | [{"letter": "A", "text": "Breast cancer"}, {"letter": "B", "text": "Costochondritis"}, {"letter": "C", "text": "Physiologic gynecomastia"}, {"letter": "D", "text": "Sebaceous cyst"}, {"letter": "E", "text": "Seminiferous tubule dysgenesis (Klinefelter syndrome)"}] | C | Physiologic, or pubertal, gynecomastia refers to an increase in the amount of glandular breast tissue in males and is common during puberty. Pubertal gynecomastia is caused by a disruption in the normal balance of androgens and estrogens and is common in boys aged 12 to 14 years. The increased levels of estrogen are du... | reproductive | Reproductive | medium | 0 | 99 |
nbme120_q101 | NBME 120 | 101 | A 25-year-old man comes to the office because of a 4-hour history of irritability, restlessness, tremor, and palpitations. He is a known user of amphetamines. His pulse is 120/min, respirations are 25/min, and blood pressure is 150/100 mm Hg. Physical examination shows no abnormalities. The most likely cause of this pa... | {"A": "Adverse effect of pancuronium", "B": "Adverse effect of sevoflurane", "C": "Cholinergic crisis", "D": "Myasthenia gravis", "E": "Myasthenic (Lambert-Eaton) syndrome", "F": "Increased release of biogenic amines"} | F | Amphetamines (and related drugs like methamphetamine, MDMA) cause sympathomimetic effects by increasing release of biogenic amines (dopamine, norepinephrine, serotonin) from presynaptic nerve terminals. They also block reuptake and inhibit MAO. This explains the tachycardia, hypertension, tremor, and agitation. Answer:... | pharmacology | Behavioral & Psychiatry | Easy | 1 | 61 |
form30_page-86 | Form 30 | 37 | A 51-year-old man develops diaphoresis, tachycardia, and a blood pressure of 155/100 mm Hg 24 hours after undergoing an abdominal operation. Two hours later, he has a generalized tonic-clonic seizure. Which of the following is most likely responsible for these adverse effects in this patient? | [{"letter": "A", "text": "Acute renal failure"}, {"letter": "B", "text": "Alcohol withdrawal"}, {"letter": "C", "text": "Anaphylactic reaction"}, {"letter": "D", "text": "Narcotic pain medication"}, {"letter": "E", "text": "Sepsis from a gram-positive organism"}] | B | Alcohol withdrawal typically leads to sympathetic overdrive and, in severe cases, generalized seizures. Chronic alcohol use causes changes in the expression of different subunits of the N-methyl-D-aspartate (NMDA) and gamma-aminobutyric acid (GABA) receptors. As a result of these adaptations, the discontinuation of alc... | nephrology | Renal & Urinary | medium | 0 | 45 |
nbme27_page-187 | NBME 27 | 39 | The neoplasm indicated by X in the MRI of the head is most likely to first cause which of the following symptoms? | [{"letter": "A", "text": "Dilated pupil"}, {"letter": "B", "text": "Diplopia"}, {"letter": "C", "text": "Dry cornea"}, {"letter": "D", "text": "Ptosis"}, {"letter": "E", "text": "Visual field deficit"}] | E | Benign adenomas are the most common neoplasms identified in the pituitary gland. The pituitary gland rests in the bony sella turcica, just inferior to the optic nerve and chiasm. The medial fibers that supply the nasal retina within each optic nerve decussate at the optic chiasm, which is located immediately superior t... | endocrinology | Endocrine | medium | 0 | 22 |
nbme29_q0043 | NBME 29 | 43 | A 40-year-old man with type 2 diabetes mellitus comes to the physician for a follow-up examination. Treatment with glyburide and metformin has been ineffective in controlling his disease. The decision is made to try pioglitazone. This drug produces a beneficial effect through which of the following mechanisms of action... | [{"letter": "A", "text": "A) Blockade of ATP-sensitive potassium channels in the pancreatic $ \\beta $ cells"}, {"letter": "B", "text": "B) Increased insulin synthesis by promoting the effect of physiologic insulin secretagogues"}, {"letter": "C", "text": "C) Increased insulin uptake by muscle and adipose tissue, thus ... | E | Pioglitazone is a thiazolidinedione (TZD) that acts as a high-affinity agonist of peroxisome proliferator-activated receptor gamma (PPAR-γ), a nuclear receptor primarily expressed in adipose tissue. PPAR-γ activation promotes adipocyte differentiation and enhances insulin sensitivity in adipose, muscle, and liver tissu... | pharmacology | Pharmacology | medium | 0 | 49 |
form31_page-87 | Form 31 | 49 | A 54-year-old man with severe hypertension suddenly collapses and loses consciousness while having an argument on the telephone. Physical examination shows pinpoint pupils and decorticate posturing. A CT scan of the head is most likely to show which of the following types of hemorrhage? | [{"letter": "A", "text": "Epidural"}, {"letter": "B", "text": "Intraparenchymal"}, {"letter": "C", "text": "Intraventricular"}, {"letter": "D", "text": "Subarachnoid"}, {"letter": "E", "text": "Subdural"}] | B | Intraparenchymal hemorrhages (IPH) occur most often in the setting of uncontrolled hypertension. IPHs often occur in the putamen, thalamus, pons, and cerebellum. Clinical presentation varies based on the location of the hemorrhage. This patient presenting with collapse, pinpoint pupils, and decorticate posturing most l... | neurology | Neurologic | hard | 0 | 44 |
nbme29_q0031 | NBME 29 | 31 | A 50-year-old man who has had paraplegia for the past 5 years is admitted to the hospital for treatment of a urinary tract infection. Addressing which of the following factors is most likely to prevent the development of decubitus ulcers in this patient? | [{"letter": "A", "text": "A) Arterial blood flow"}, {"letter": "B", "text": "B) Bacterial skin flora"}, {"letter": "C", "text": "C) Nutritional status"}, {"letter": "D", "text": "D) Pressure"}, {"letter": "E", "text": "E) Venous stenosis"}] | D | Decubitus ulcers (pressure injuries) develop most directly from sustained unrelieved pressure over bony prominences, causing ischemia and necrosis of skin and subcutaneous tissue. In paraplegic patients, immobility and inability to sense discomfort lead to prolonged pressure, especially over the sacrum, ischial tuberos... | microbiology | Infectious Disease | hard | 0 | 43 |
nbme27_page-120 | NBME 27 | 22 | An animal study is conducted to assess the effects of smoking on pulmonary defense and maintenance mechanisms. For 1 week, normal male rats are exposed to levels of cigarette smoke comparable to those encountered by humans who smoke cigarettes. Results of pulmonary testing are compared with baseline levels obtained the... | [{"letter": "A", "text": "Mucus Production and Secretion: \u2191, Activity of Airway Cilia: \u2191, Alveolar Macrophage Function: \u2191"}, {"letter": "B", "text": "Mucus Production and Secretion: \u2191, Activity of Airway Cilia: \u2191, Alveolar Macrophage Function: \u2193"}, {"letter": "C", "text": "Mucus Production... | C | Smoking is associated with numerous detrimental effects on the respiratory system. Tobacco smoke directly disrupts the ability of the airway to clear foreign material by resulting in increased mucus production and secretion by the respiratory epithelium, decreased activity of airway cilia, and inhibition of alveolar ma... | pulmonology | Respiratory | medium | 0 | 68 |
nbme27_page-138 | NBME 27 | 40 | A 23-year-old woman is brought to the emergency department by her roommate because she was found unresponsive on the living room floor. Examination shows constricted pupils and stupor. Which of the following substances is most likely responsible for these effects? | [{"letter": "A", "text": "Amphetamine"}, {"letter": "B", "text": "Androstenedione"}, {"letter": "C", "text": "Caffeine"}, {"letter": "D", "text": "Cocaine"}, {"letter": "E", "text": "Heroin"}, {"letter": "F", "text": "LSD"}, {"letter": "G", "text": "Marijuana"}, {"letter": "H", "text": "Nicotine"}, {"letter": "I", "tex... | E | This patient is likely intoxicated with an opiate such as heroin. Opiates are central nervous system (CNS) depressants used as analgesics and recreational drugs. Opiates act throughout the CNS and peripheral nervous system and interact with several neurotransmitter systems, leading to diverse effects. Opiate intoxicati... | pulmonology | Respiratory | hard | 0 | 40 |
form31_page-11 | Form 31 | 14 | A 56-year-old man comes to the physician because of a 2-month history of cough productive of blood-tinged sputum. He has smoked 1 pack of cigarettes daily for 30 years. A CT scan of the chest shows a 4-cm mass in the right upper lobe that is obstructing the superior vena cava. Blood from this patient's neck and right u... | [{"letter": "A", "text": "Anterior jugular and transverse scapular veins"}, {"letter": "B", "text": "Facial and inferior temporal veins"}, {"letter": "C", "text": "Internal mammary and intercostal veins"}, {"letter": "D", "text": "Jugular and subclavian veins"}, {"letter": "E", "text": "Suprascapular and thyrocervical ... | C | When the superior vena cava (SVC) is obstructed, blood from the upper body returns to the heart via several collateral pathways, including the internal mammary and intercostal veins. The internal mammary vein runs intersuperiorly along the anterior chest wall, collecting drainage from the anterior intercostal veins bef... | cardiology | Cardiovascular | hard | 0 | 73 |
form30_page-7 | Form 30 | 8 | A study is conducted to assess the accuracy of a new rapid test to detect a virulent bacterial infection. This infection has an 80% mortality rate if it is not identified early in its course; however, prompt administration of antibiotics decreases the mortality rate to less than 5%. The risks of this antibiotic therapy... | [{"letter": "A", "text": "A"}, {"letter": "B", "text": "B"}, {"letter": "C", "text": "C"}, {"letter": "D", "text": "D"}, {"letter": "E", "text": "E"}] | B | The cut point of the test should be set such that all persons with the infection result as positive so that there are few false negatives. The threshold should be set to maximize sensitivity, which equals the true positive test results divided by the sum of true positive and false negative test results. Therefore, as s... | infectious_disease | Infectious Disease | medium | 0 | 109 |
nbme27_page-17 | NBME 27 | 18 | A 56-year-old man with a history of alcohol dependence comes to the emergency department because of fever, night sweats, and a cough productive of bloody sputum. Laboratory studies of his sputum show numerous acid-fast rods arranged in small arrays. Which of the following components of the causal organism may be direct... | [{"letter": "A", "text": "Cord factor"}, {"letter": "B", "text": "Cytoplasmic membrane"}, {"letter": "C", "text": "Endotoxin"}, {"letter": "D", "text": "Polysaccharide capsule"}, {"letter": "E", "text": "Teichoic acid"}] | A | Cord factor is a glycolipid found as part of the cell wall of Mycobacterium tuberculosis (MTB) and is responsible for much of its virulence. Ingestion of MTB by phagocytes should lead to the intracellular killing of the organism, but the presence of cord factor prevents fusion of the vesicles containing MTB with the ly... | infectious_disease | Infectious Disease | hard | 0 | 54 |
form30_page-140 | Form 30 | 41 | A 23-year-old woman who was recently diagnosed with rheumatoid arthritis comes to the physician for a follow-up examination. Two months ago, she began treatment with adalimumab, which binds with tumor necrosis factor-α. The patient says that her symptoms have not improved. Physical examination shows mild swelling of th... | [{"letter": "A", "text": "IgA"}, {"letter": "B", "text": "IgE"}, {"letter": "C", "text": "Interleukin-1 (IL-1)"}, {"letter": "D", "text": "IL-4"}, {"letter": "E", "text": "Vascular endothelial growth factor"}] | C | Rheumatoid arthritis (RA) is an autoimmune disease that causes extensive inflammation in synovial tissues. The clinical course is characterized by joint destruction, periarticular bone loss, synovial hypertrophy, as well as extraarticular manifestations such as rheumatoid nodules and skin rash. Patients often present w... | oncology | Oncology | medium | 0 | 71 |
nbme120_q031 | NBME 120 | 31 | A 28-year-old woman, gravida 2, para 1, comes to the office after a home pregnancy test result was positive. Her last menstrual period was 12 weeks ago. Laboratory studies performed during her first pregnancy showed that she is blood group A, Rh-negative. Her husband is blood group A, Rh-positive. Their first child, a ... | {"A": "\"Do you have any concerns about your alcohol use?\"", "B": "\"How has your alcohol use been this week compared to last week: more, less, or about the same?\"", "C": "\"So you're here because you're concerned about your alcohol use. Is that correct?\"", "D": "\"When was your last drink?\"", "E": "\"Would you be ... | A | Rh(D) alloimmunization prevention. Rh-negative mother with Rh-positive partner and prior positive Coombs titer. Rho(D) immune globulin (RhoGAM) at 12 weeks prevents anti-D antibody formation and hemolytic disease of the newborn. | immunology | Reproductive | Medium | 1 | 132 |
form31_page-138 | Form 31 | 2 | Numerous cross-sectional studies in different populations have shown a significant relationship between the use of tanning beds and the development of melanoma. The odds ratios of these studies range from 3.2 to 7.1. In addition, the number of hours of tanning bed use was highly correlated with an increase in the size ... | [{"letter": "A", "text": "Biologic plausibility"}, {"letter": "B", "text": "Consistency of the findings"}, {"letter": "C", "text": "Dose response"}, {"letter": "D", "text": "Strength of association"}, {"letter": "E", "text": "Temporal sequence of events"}] | E | A cross-sectional study seeks to identify the prevalence of a condition at a particular point in time. In this scenario, these studies examine the use of tanning beds and the development of melanoma at a single cross-section of time. Thus, the risk factor (tanning beds) and the outcomes (melanoma) are measured simultan... | biostatistics | Biostatistics & Epidemiology | medium | 0 | 71 |
form31_page-126 | Form 31 | 39 | A 68-year-old man is diagnosed with metastatic prostate cancer. The most appropriate treatment should include a drug with which of the following mechanisms of action? | [{"letter": "A", "text": "Androstenedione aromatase inhibitor"}, {"letter": "B", "text": "Estrogen receptor partial agonist-antagonist"}, {"letter": "C", "text": "Gonadotropin-releasing hormone agonist"}, {"letter": "D", "text": "Microtubule function inhibitor"}, {"letter": "E", "text": "Somatostatin receptor agonist"}... | C | Prostate cancer is a hormonally sensitive neoplasm, and androgens play a critical role in its growth. Gonadotropin-releasing hormone (GnRH) acts as an agonist of the GnRH receptor and promotes secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) when secreted in its physiologic, pulsatile fashio... | pharmacology | Pharmacology | medium | 0 | 25 |
nbme120_q034 | NBME 120 | 34 | 3 | {"C": "Correct answer (C)", "A": "Option A", "B": "Option B", "D": "Option D", "E": "Option E"} | C | Insufficient stem data in extracted file. Official NBME answer: C. | pathology | Multisystem | Medium | 0 | 1 |
nbme27_page-24 | NBME 27 | 25 | A 70-year-old woman with osteoporosis comes to the physician for her scheduled injection of ibandronate. She is accompanied by her 75-year-old husband. Physical examination shows no abnormalities. The husband asks the physician, "Why don't I have osteoporosis? For the past 50 years we have done everything together, inc... | [{"letter": "A", "text": "\"Drinking alcohol when you were younger was protective against osteoporosis.\""}, {"letter": "B", "text": "\"Exercising is good for both of us, but it is more protective for men.\""}, {"letter": "C", "text": "\"Men start out with a higher peak bone mass compared with women.\""}, {"letter": "D... | C | Osteoporosis is a common condition that is characterized by the progressive loss of bone mineral density leading to decreased bone strength. This decreased bone mineral density often leads to fragility fractures, which can greatly decrease mobility, and even lead to death in elderly individuals. The disease classically... | endocrinology | Endocrine | medium | 0 | 77 |
nbme29_q0119 | NBME 29 | 19 | A male newborn develops vomiting and convulsions 4 hours after delivery. There is slight bulging of the fontanelles. Which of the following organisms is most likely responsible for these findings? | [{"letter": "A", "text": "A) Escherichia coli"}, {"letter": "B", "text": "B) Haemophilus influenzae"}, {"letter": "C", "text": "C) Neisseria meningitidis"}, {"letter": "D", "text": "D) Staphylococcus aureus"}, {"letter": "E", "text": "E) Streptococcus pneumoniae"}] | A | Early-onset neonatal meningitis (within the first week of life) is most commonly caused by Group B Streptococcus (Streptococcus agalactiae) or Escherichia coli. Among the options given, E. coli is the most common gram-negative cause of neonatal meningitis. Newborns present with nonspecific signs including vomiting, sei... | anatomy | Musculoskeletal & Anatomy | medium | 0 | 30 |
163 | NBME 28 | 14 | A 73-year-old man with stage IV colon cancer begins chemotherapy with 5-fluorouracil, irinotecan, and leucovorin. This patient is at greatest risk for developing signs of drug toxicity in which of the following tissues? A) Bone marrow, gut mucosa, and hair follicles B) Liver, kidney, and endocrine organs C) Nerves, bon... | [{"letter": "A", "text": "A) Bone marrow, gut mucosa, and hair follicles"}, {"letter": "B", "text": "B) Liver, kidney, and endocrine organs"}, {"letter": "C", "text": "C) Nerves, bone, and heart muscle"}, {"letter": "D", "text": "D) Skeletal muscle, heart, and bone"}, {"letter": "E", "text": "E) Trachea, bronchial epit... | A | Cytotoxic chemotherapy is commonly employed in the treatment of malignancy. These medications are effective by targeting actively dividing cells. These include malignant neoplasms as well as normal host cells that demonstrate high rates of replication such as
the bone marrow, gut mucosa , and hair f | None | Multisystem | easy | 0 | 65 |
nbme27_page-72 | NBME 27 | 24 | Which of the following abnormalities is most likely to result from occlusion of the vessel indicated by the arrow in the vertebral angiogram shown? | [{"letter": "A", "text": "Contralateral facial weakness"}, {"letter": "B", "text": "Contralateral visual field deficit"}, {"letter": "C", "text": "Ipsilateral anesthesia of the face"}, {"letter": "D", "text": "Ipsilateral ataxia of extremity movements"}, {"letter": "E", "text": "Ipsilateral palsy of lateral gaze"}] | B | The vessel identified in the vertebral angiogram represents the posterior cerebral artery (PCA), the occlusion of which would result in infarction of the ipsilateral occipital lobe and a contralateral homonymous hemianopsia with macular sparing. The PCA originates near the rostral end of the basilar artery and contribu... | neurology | Neurologic | medium | 0 | 24 |
nbme120_q108 | NBME 120 | 108 | A 27-year-old woman is brought to the emergency department because of a 2-week history of double vision. Neurologic examination shows that the left eye does not adduct past the midline on horizontal gaze when the patient looks to the right. Leftward horizontal gaze is normal. This patient's ocular movement deficit is m... | {"A": "Arteriovenous nicking", "B": "Melanocytes in the uvea", "C": "Optic neuritis", "D": "Posterior subcapsular cataracts", "E": "Tractional retinal detachment", "F": "Right nucleus of the abducens nerve"} | B | Left eye does not adduct when looking right (failure of left medial rectus to contract), but leftward gaze is normal (intact left lateral rectus). This pattern = left internuclear ophthalmoplegia (INO). Lesion in left medial longitudinal fasciculus (MLF) disrupts signal from right abducens internuclear neurons to left ... | anatomy | Neurologic | Medium | 1 | 62 |
nbme27_page-0 | NBME 27 | 1 | A 40-year-old woman at 5 months' gestation comes to the physician for amniocentesis. Results show a normal 46,XY karyotype of the fetus. Four months later, the newborn is delivered and examination shows a female phenotype with mild clitoral enlargement. Ultrasonography shows the presence of male but not female genital ... | [{"letter": "A", "text": "Anti-paramesonephric (mullerian) hormone"}, {"letter": "B", "text": "5\u03b1-Reductase"}, {"letter": "C", "text": "SRY protein"}, {"letter": "D", "text": "Steroid sulfatase"}, {"letter": "E", "text": "Zinc finger transcription factor Wilms tumor 1"}] | B | 5α-Reductase is an enzyme that catalyzes the metabolism of testosterone to dihydrotestosterone (DHT). Testosterone promotes the development of the mesonephric (wolffian) duct that develops into the seminal vesicles, epididymis, vas deferens, and ejaculatory duct. DHT promotes the development of male external genitalia ... | gastroenterology | Gastrointestinal | medium | 0 | 66 |
152 | NBME 28 | 3 | A 35-year-old woman, gravida 1, para 1, comesto the physician for a follow-up examination 1 month after delivering a healthy male newborn. During her pregnancy, she was diagnosed with gestational diabetes. Her mother and sister also developed this condition during pregnancy. Today, laboratory studies show a serum gluco... | [{"letter": "A", "text": "A) D13 kinase"}, {"letter": "B", "text": "B) Glucokinase"}, {"letter": "C", "text": "C) Mevalonate kinase"}, {"letter": "D", "text": "D) Phosphofructokinase"}, {"letter": "E", "text": "E) Pyruvate kinase"}] | B | Glucokinase catalyzes the phosphorylation of glucose to glucose-6-phosphate during glycolysis. While glucose can freely diffuse into and out of ceils , glucose-6-phosphate is sequestered in the cell due to its charged phosphate group. Glucokinase is present in
hepatocytes and the pancreatic (3 cells | None | Multisystem | medium | 0 | 79 |
form31_page-155 | Form 31 | 22 | A 47-year-old woman comes to the physician because of a 1-week history of yellow eyes and itching skin. Physical examination shows scleral icterus and excoriations over the trunk. Serum studies show:
Total bilirubin 8 mg/dL
Alkaline phosphatase 450 U/L
ALT 45 U/L
Antimitochondrial antibody titer 1:80 (N=absent)
This ... | [{"letter": "A", "text": "Folic acid"}, {"letter": "B", "text": "Vitamin A"}, {"letter": "C", "text": "Vitamin B1 (thiamine)"}, {"letter": "D", "text": "Vitamin B6 (pyridoxine)"}, {"letter": "E", "text": "Vitamin B12 (cobalamin)"}, {"letter": "F", "text": "Vitamin C"}] | B | This patient has signs of primary biliary cholangitis (PBC) with signs of cholestasis (increased bilirubin and alkaline phosphatase), supported further by the presence of antimitochondrial antibodies. PBC is an autoimmune destruction of intralobular bile ducts. It generally presents in middle-aged women with pruritus, ... | dermatology | Dermatologic | hard | 0 | 60 |
nbme27_page-8 | NBME 27 | 9 | A 3-year-old girl is brought to the emergency department by her mother 1 hour after she was found with a half-empty bottle of her grandmother's diabetes medication. The mother tells the physician that the child consumed approximately 25 metformin tablets. Physical examination shows no abnormalities. This patient is at ... | [{"letter": "A", "text": "Decreased calcium concentration"}, {"letter": "B", "text": "Decreased glucose concentration"}, {"letter": "C", "text": "Decreased sodium concentration"}, {"letter": "D", "text": "Increased AST and ALT activities"}, {"letter": "E", "text": "Increased creatinine concentration"}, {"letter": "F", ... | F | Metformin is an oral biguanide agent used in the management of type 2 diabetes mellitus. It decreases gluconeogenesis, increases peripheral tissue glucose uptake, and decreases serum free fatty acid concentration. Because of its efficacy, tolerability, safety, and low cost, it serves as the first-line treatment for typ... | gastroenterology | Gastrointestinal | medium | 0 | 58 |
form31_page-47 | Form 31 | 4 | A 35-year-old man is admitted to the hospital because of confusion, indifference, and lethargy for 3 months. Ophthalmologic examination shows sluggish pupillary responses and horizontal nystagmus; neither eye moves past the midline on lateral gaze. A Romberg test is positive, and his gait is severely ataxic. He develop... | [{"letter": "A", "text": "Central pontine myelinolysis"}, {"letter": "B", "text": "Hepatic encephalopathy"}, {"letter": "C", "text": "Hepatolenticular degeneration (Wilson disease)"}, {"letter": "D", "text": "Ruptured cerebral aneurysm"}, {"letter": "E", "text": "Traumatic injury"}, {"letter": "F", "text": "Wernicke en... | F | The photograph of this patient's brain shows atrophy of the mammillary bodies, which is consistent with Wernicke encephalopathy. The presence of esophageal varices, a sign of cirrhosis, supports this diagnosis. Patients with alcohol use disorder typically develop a significant thiamine (vitamin B1) deficiency due to po... | neurology | Neurologic | medium | 0 | 75 |
nbme120_q060 | NBME 120 | 60 | A 53-year-old woman comes to the clinic because of a 2-year history of an enlarging lump under the skin of her chest. Three years ago, she underwent resection of a lesion in the same area. Vital signs and oxygen saturation on room air are within normal limits. Physical examination discloses a 2-cm, subcutaneous mass at... | {"A": "Macrophages", "B": "Mast cells", "C": "Melanocytic cells", "D": "Mesothelial cells", "E": "Myeloblasts", "F": "Myocytes", "G": "Myofibroblasts"} | G | Recurrent enlarging subcutaneous mass at a prior biopsy/excision site is dermatofibrosarcoma protuberans (DFSP), a low-grade sarcoma that commonly recurs locally. DFSP arises from myofibroblasts (or fibroblastic/dendritic cells). Histology shows a storiform pattern of spindle cells. Answer: myofibroblasts. | pathology | Musculoskeletal & Anatomy | Hard | 1 | 87 |
182 | NBME 28 | 33 | A 72-year-old woman with coronary artery disease comes to the physician because of a 2-month history of progressive angina symptoms with exertion. Five months ago, the patient underwent stent placement for significant stenoses of the proximal anterior interventricular (left anterior descending) and right coronary arter... | [{"letter": "A", "text": "A) Aneurysm of the right coronary artery"}, {"letter": "B", "text": "B) Dissection of the right coronary artery"}, {"letter": "C", "text": "C) Neointima formation in the right coronary stent"}, {"letter": "D", "text": "D) Thrombosis of the right coronary stent"}, {"letter": "E", "text": "E) Va... | C | .
Neointima formation in the right coronary stent is the most likely cause of the patient's recurrent symptoms. The location of ST-segment changes in the exercise stress test suggests impairment of blood flow to the right coronary artery territory. Neointima formation is
a common cause of vascular r | None | Multisystem | hard | 0 | 136 |
form30_page-100 | Form 30 | 1 | A pharmaceutical company develops a new opioid drug (Drug X) that binds to the same receptor as morphine does. Drug X is compared with morphine to test its analgesic effect. The graph shows the log dose-response curves for morphine and Drug X. Based on these results, which of the following best describes Drug X? | [{"letter": "A", "text": "Competitive antagonist"}, {"letter": "B", "text": "Full agonist"}, {"letter": "C", "text": "Inverse agonist"}, {"letter": "D", "text": "Noncompetitive antagonist"}, {"letter": "E", "text": "Partial agonist"}] | E | Partial agonists are drugs that bind to and activate a receptor at the same site as a full agonist but have decreased efficacy relative to the full agonist. In this case, Drug X is a partial agonist that binds to the same opioid receptors as morphine (mu, delta, and kappa), and exhibits a similar effect. However, its e... | pharmacology | Pharmacology | hard | 0 | 54 |
nbme27_page-185 | NBME 27 | 37 | A 25-year-old woman is brought to the emergency department 4 hours after she fell on an icy sidewalk and landed on her right arm. Examination of the right upper extremity shows decreased strength with elbow flexion. Sensation to pinprick is decreased over the lateral aspect of the forearm. A CT scan-style cross section... | [{"letter": "A", "text": "C4-6"}, {"letter": "B", "text": "C5-7"}, {"letter": "C", "text": "C5-T1"}, {"letter": "D", "text": "C6-8"}, {"letter": "E", "text": "C8-T1"}] | B | The musculocutaneous nerve arises from the lateral cord of the brachial plexus and receives contributions from the C5, C6, and C7 cervical nerve roots. This nerve travels between the biceps brachii and the brachialis muscles providing motor innervation to both of these, as depicted in the diagram. The musculocutaneous ... | musculoskeletal | Musculoskeletal & Anatomy | medium | 0 | 86 |
nbme29_q0078 | NBME 29 | 28 | A 7-year-old boy is brought to the physician by his parents because of a 1-month history of progressive double vision and a 2-week history of imbalance. Physical examination shows weakness of abduction of the right eye, mild weakness of the left extremities, increased muscle stretch reflexes of the left extremities, an... | [{"letter": "A", "text": "A) Arnold-Chiari malformation"}, {"letter": "B", "text": "B) Brain stem glioma"}, {"letter": "C", "text": "C) Guillain-Barr\u00e9 syndrome"}, {"letter": "D", "text": "D) Multiple sclerosis"}, {"letter": "E", "text": "E) Myasthenia gravis"}] | B | This 7-year-old patient has progressive right CN VI palsy (abduction weakness of right eye), left-sided weakness with hyperreflexia (UMN signs), and gait ataxia. This constellation of findings localizes to the right side of the brainstem — specifically involving the CN VI nucleus (causing ipsilateral lateral rectus pal... | anatomy | Musculoskeletal & Anatomy | easy | 0 | 62 |
form31_page-129 | Form 31 | 42 | An 18-year-old woman with a 3-year history of type 1 diabetes mellitus is brought to the emergency department because of a 2-day history of light-headedness and urinary frequency with a large volume of urine. She has had nausea and has not eaten or taken her insulin for the past 2 days. She appears tired. Her pulse is ... | [{"letter": "A", "text": "Decreased formation of 3-hydroxybutyric acid"}, {"letter": "B", "text": "Decreased gluconeogenesis from lactic acid"}, {"letter": "C", "text": "Decreased glycogenolysis"}, {"letter": "D", "text": "Increased activity of hormone-sensitive lipase"}, {"letter": "E", "text": "Increased cholesterol ... | D | Diabetic ketoacidosis (DKA) occurs as a result of accumulation of serum ketones such as β-hydroxybutyric acid, acetoacetic acid, and acetone in the setting of insulin deficiency, and is more common in patients with type 1 diabetes mellitus. Patients present with signs and symptoms of tachycardia, tachypnea, fatigue, po... | endocrinology | Endocrine | medium | 0 | 96 |
form31_page-139 | Form 31 | 3 | An 18-year-old female college freshman comes to the health center because of a 3-month history of fatigue and intermittent headaches. She also has had an unintentional weight loss of 4 kg (9 lb) during the past 6 weeks and difficulty concentrating on her schoolwork. She moved from her home to a campus dormitory 5 month... | [{"letter": "A", "text": "\"Although this is a difficult time for many, I'm concerned that you're not coping well. Have you had any feelings of hurting yourself?\""}, {"letter": "B", "text": "\"Have you made any friends on campus yet? Sometimes a student support group is the best remedy for transitional stress.\""}, {"... | A | This young patient is exhibiting neurovegetative symptoms suggestive of major depressive disorder (MDD). The physician should express concern about the patient's well-being and conduct a thorough suicide risk assessment including questions about suicidal ideation or attempts. Symptoms of MDD typically include 2 or more... | psychiatry | Behavioral & Psychiatry | hard | 0 | 153 |
form31_page-173 | Form 31 | 41 | Two randomized, double-blind studies (Study X and Study Y) are conducted to assess the efficacy of a new chemotherapeutic agent. For each study, patients are randomized to receive either placebo or the new experimental chemotherapy. All subjects are then followed for a mean of 5 years. Follow-up rates are 92% in Study ... | [{"letter": "A", "text": "Bias"}, {"letter": "B", "text": "Difference in follow-up rates"}, {"letter": "C", "text": "Difference in number of patients"}, {"letter": "D", "text": "Different population"}, {"letter": "E", "text": "Randomization error"}] | C | These two randomized clinical trials are similar in their design. However, they provide discrepant results in the confidence intervals (CI) of their respective relative risks (RR). RR describes the risk for developing an outcome in a group with a particular exposure divided by the risk for developing the outcome in a g... | biostatistics | Biostatistics & Epidemiology | easy | 0 | 107 |
130 | NBME 28 | 30 | A 5-month-old girl is brought to the physician because of a 3-day history of "floppiness" when she sits. She also has had difficulty feeding and irritability since the age of 1 month. She is at the 3 rd percentile for length, 50 th percentile for weight, and 3 rd percentile for head circumference. Her temperature is $ ... | [{"letter": "A", "text": "A) Coupling of electron transport to proton gradient formation"}, {"letter": "B", "text": "B) Coupling of proton gradient to ATP synthesis"}, {"letter": "C", "text": "C) Oxidation of succinate to fumarate"}, {"letter": "D", "text": "D) Reduction of pyruvate to lactate"}, {"letter": "E", "text"... | A | This patient presenting with hypoalgesia, weakness, and atrophy of the upper extremities most likely has syringomyelia, which features a cystic lesion involving midline spinal cord structures and both ventral horns in the cervical enlargement. Syringomyelia involves
a progressively expanding cavity | None | Multisystem | hard | 0 | 169 |
form31_page-35 | Form 31 | 40 | A 55-year-old man volunteers as a subject for a cardiac function study. Vital signs and a physical examination are obtained. Echocardiography shows thickening of muscle tissue of the left ventricle. Subsequent testing is most likely to show which of the following underlying conditions in this man? | [{"letter": "A", "text": "Aortic regurgitation"}, {"letter": "B", "text": "Coronary artery disease"}, {"letter": "C", "text": "Hypertension"}, {"letter": "D", "text": "Mitral stenosis"}, {"letter": "E", "text": "Mitral valve prolapse"}] | C | Hypertension is a common cause of chronic systolic and diastolic dysfunction, and chronic hypertension is associated with left ventricular hypertrophy as a result of constant work against an increased afterload. The thickened myocardium results in impaired left ventricular relaxation and increased diastolic filling pre... | cardiology | Cardiovascular | medium | 0 | 46 |
nbme29_q0005 | NBME 29 | 5 | A 70-year-old woman comes to the physician for a follow-up examination. She had breast cancer 5 years ago and underwent partial mastectomy of the left breast at that time. She has received treatment with tamoxifen since then. Physical examination and mammography show no evidence of recurrence. Which of the following me... | [{"letter": "A", "text": "A) Competitive inhibition of estradiol activation of cyclin D1 and E2 proteins"}, {"letter": "B", "text": "B) Competitive inhibition of estradiol binding to its receptor"}, {"letter": "C", "text": "C) Competitive inhibition of estradiol synthase in ovaries and adrenal cortex"}, {"letter": "D",... | B | Tamoxifen is a selective estrogen receptor modulator (SERM) that acts as a competitive antagonist of estrogen at estrogen receptors (ER) in breast tissue. By binding to ERs without activating them, tamoxifen blocks estradiol from binding and prevents estrogen-mediated transcription of growth-promoting genes (e.g., cycl... | pathology | Pathology | medium | 0 | 63 |
nbme27_page-184 | NBME 27 | 36 | A 12-year-old boy is brought to the physician by his mother because of swelling, itching, and redness of his back that began 10 minutes after he was lying in the grass shirtless. Physical examination shows linear edematous eruptions on the back. A secondary mediator of this patient's hypersensitivity reaction is produc... | [{"letter": "A", "text": "C-reactive protein"}, {"letter": "B", "text": "C3b component of complement"}, {"letter": "C", "text": "Interferon alpha"}, {"letter": "D", "text": "Interleukin-1 (IL-1)"}, {"letter": "E", "text": "Prostaglandin"}] | E | The patient is displaying signs and symptoms of a type I hypersensitivity reaction to an environmental allergen. The type I hypersensitivity reaction is composed of two phases, the immediate and the late phase. In the immediate phase, preformed IgE on the surface of mast cells and basophils is crosslinked by an antigen... | pulmonology | Respiratory | easy | 0 | 78 |
nbme29_q0112 | NBME 29 | 12 | A 6-year-old girl of Mediterranean ancestry has severe anemia. Analysis shows normal production of $ \alpha $-globin gene mRNA. Production of $ \beta $-globin gene mRNA is decreased 75% because of a splice-site mutation within both of the patient's $ \beta $-globin genes. Which of the following is the most likely expla... | [{"letter": "A", "text": "A) Decreased production of $ \\alpha $-4 tetramers compared with normal individuals"}, {"letter": "B", "text": "B) Decreased production of $ \\beta $-4 tetramers compared with normal individuals"}, {"letter": "C", "text": "C) Imbalance in the synthesis of the $ \\alpha $- and $ \\beta $-globin... | C | This patient has β-thalassemia major (Cooley anemia), confirmed by a splice-site mutation in both β-globin genes leading to 75% reduction in β-globin mRNA. The α-globin genes are normal. The resulting imbalance between α- and β-globin synthesis causes excess free α-globin chains to precipitate, damaging erythroid precu... | biochemistry | Biochemistry & Genetics | easy | 0 | 55 |
64 | NBME 28 | 14 | A 26-year-old woman comes to the physician because of a 1-week history of rectal pain that is made more severe by defecation, and occasional blood on the toilet tissue after a bowel movement. She says that her stools appear normal and that she has not had any trauma. She has a history of chronic constipation. Visual re... | [{"letter": "A", "text": "A) Anal fissure"}, {"letter": "B", "text": "B) Bowen carcinoma"}, {"letter": "C", "text": "C) Condyloma acuminatum"}, {"letter": "D", "text": "D) Perianal abscess"}, {"letter": "E", "text": "E) Prolapsed internal hemorrhoid"}] | B | Creatine kinase MB (CKMB) is a cardiac enzyme that is detectable within six hours of myocardial ischemia and early coagulation necrosis . Increased plasma membrane permeability is a feature of early coaguiative necrosis and allows; CKMB and troponin to be
released from cardiac myocytes. Other featur | None | Multisystem | hard | 0 | 89 |
nbme29_q0097 | NBME 29 | 47 | A previously healthy 12-year-old girl is brought to the physician because of a 1-week history of brief generalized tonic-clonic seizures. Her family recently emigrated from Mexico. Physical examination shows no abnormalities. A CT scan of the head shows multiple calcified nodules and some cysts. The most likely cause o... | [{"letter": "A", "text": "A) Cryptococcus neoformans"}, {"letter": "B", "text": "B) Herpes simplex virus"}, {"letter": "C", "text": "C) HIV"}, {"letter": "D", "text": "D) Listeria monocytogenes"}, {"letter": "E", "text": "E) Mycobacterium tuberculosis"}, {"letter": "F", "text": "F) Streptococcus pneumoniae"}, {"letter"... | G | This patient has neurocysticercosis, the most common parasitic infection of the CNS worldwide, caused by the larval stage of Taenia solium (pork tapeworm). Recent emigration from Mexico (an endemic area), presentation with new-onset seizures, and CT showing multiple calcified nodules and cysts are highly characteristic... | microbiology | Infectious Disease | medium | 0 | 60 |
nbme27_page-102 | NBME 27 | 4 | A 30-year-old woman has excessive gingival bleeding 8 hours after a tooth extraction. She has taken 400 mg of acetaminophen every 3 hours since the procedure. Laboratory studies show:
Platelet count: normal
Platelet morphology: normal
Platelet aggregation: normal by collagen stimulation assay
Partial thromboplastin ti... | [{"letter": "A", "text": "End-stage hepatic disease"}, {"letter": "B", "text": "Hemophilia A"}, {"letter": "C", "text": "Hemophilia B"}, {"letter": "D", "text": "Vitamin K deficiency"}, {"letter": "E", "text": "von Willebrand disease"}] | E | Von Willebrand disease accounts for this patient's mucocutaneous bleeding in the setting of a normal platelet count with moderately low concentrations of Factor VIII, suppression of ristocetin cofactor activity, and increased bleeding time. Von Willebrand disease is one of the most common hereditary bleeding disorders ... | hematology | Hematologic | easy | 0 | 72 |
form30_page-113 | Form 30 | 14 | A 25-year-old man comes to the emergency department because of a 3-day history of abdominal cramps and diarrhea. He appears anxious. Physical examination shows piloerection and diffuse abdominal tenderness. Neurologic examination shows no abnormalities. He is oriented to person, place, and time. The most likely cause o... | [{"letter": "A", "text": "Alcohol"}, {"letter": "B", "text": "Benzodiazepine"}, {"letter": "C", "text": "Cocaine"}, {"letter": "D", "text": "Heroin"}, {"letter": "E", "text": "Marijuana"}] | D | This patient is likely withdrawing from heroin, an opiate. Opiates are central nervous system (CNS) depressants. Opiate intoxication causes sedation, bradycardia, hypotension, depressed respiratory drive, and constricted pupils. Opiates are commonly used for analgesia and act on receptors within the gastrointestinal tr... | pulmonology | Respiratory | hard | 0 | 58 |
59 | NBME 28 | 9 | A 19-year-old man who is a college student is brought to the emergency department because of the sudden onset of right-sided chest pain and difficulty breathing after an accident in which he was thrown from his bicycle. He has difficulty walking and cannot climb stairs because of pain and shortness of breath. He is sli... | [{"letter": "A", "text": "A) Bronchophony"}, {"letter": "B", "text": "B) Expiratory stridor"}, {"letter": "C", "text": "C) Inspiratory stridor"}, {"letter": "D", "text": "D) Subcutaneous crepitus"}, {"letter": "E", "text": "E) Succession splash"}] | A | Increased airway resistance and increased lung compliance are features of chronic obstructive pulmonary disease (CORD) . Lung compliance is the ability of the lung to stretch and expand; increased compliance means that the lung has a greater ability to
expand: but it does not imply that the lung has | None | Multisystem | easy | 0 | 87 |
nbme27_page-106 | NBME 27 | 8 | A 79-year-old woman with a history of severe dementia, type 2 diabetes mellitus, and hypertension is brought to the emergency department by her son because of chest pain and agitation for 4 hours. She had smoked 2 packs of cigarettes daily until the age of 70 years, when she quit. The son is not aware of the patient's ... | [{"letter": "A", "text": "Acute coronary syndrome"}, {"letter": "B", "text": "Acute pericarditis"}, {"letter": "C", "text": "Bilateral pneumonia"}, {"letter": "D", "text": "Cerebrovascular event"}, {"letter": "E", "text": "Pulmonary embolism"}] | A | Acute coronary syndrome classically presents with acute-onset chest pain, often radiating to the neck, jaw, or arm, along with shortness of breath, nausea, and/or light-headedness. Risk factors include a history of smoking, diabetes, hypertension, hyperlipidemia, and/or obesity. If the infarction results in left ventri... | cardiology | Cardiovascular | medium | 0 | 127 |
form30_page-154 | Form 30 | 5 | A 25-year-old man comes to the physician 10 days after injuring his right elbow while trying to lift an 80-lb dumbbell at the gym. When he attempted to lift the weight from the rack, he felt a popping sensation and pain in his right elbow. He uses anabolic steroids. His pulse is 78/min, and blood pressure is 150/95 mm ... | [{"letter": "A", "text": "Anterior interosseous"}, {"letter": "B", "text": "Median"}, {"letter": "C", "text": "Musculocutaneous"}, {"letter": "D", "text": "Radial"}, {"letter": "E", "text": "Ulnar"}] | C | The biceps muscle, located in the anterior arm, arises from a long and short head originating from the intra-articular supraglenoid tubercle (ie, long head) and coracoid process (ie, short head). The biceps tendon inserts at the radial tuberosity. Injury to the biceps tendon or biceps muscle, such as in this patient, r... | neurology | Neurologic | medium | 0 | 139 |
nbme27_page-100 | NBME 27 | 2 | In a historical study, 4753 nulliparous women with confirmed pregnancies were randomized to either folic acid supplementation or trace element supplementation. In both the folic acid and trace element groups, 88% of the women had pregnancies ending in live birth, late fetal death, stillbirth, or termination of pregnanc... | [{"letter": "A", "text": "0"}, {"letter": "B", "text": "0.29"}, {"letter": "C", "text": "1.3"}, {"letter": "D", "text": "2.3"}, {"letter": "E", "text": "80"}, {"letter": "F", "text": "100"}, {"letter": "G", "text": "120"}, {"letter": "H", "text": "344"}, {"letter": "I", "text": "4756"}] | F | Number needed to treat (NNT) is an epidemiological measure used to characterize an intervention that clarifies the effectiveness of that intervention. Formally, the NNT is the number of patients who must receive an intervention in order to prevent the occurrence of one negative outcome. For example, a cardiovascular dr... | reproductive | Reproductive | hard | 0 | 125 |
nbme29_q0094 | NBME 29 | 44 | A 25-year-old man is lost in the desert for 1 week with an ample supply of water but no food. Which of the following changes in enzyme activities and regulatory molecule concentrations in liver is most likely in this patient? Fructose Glucose Phosphoeno/pyruvate Pyruvate 2, 6-bisphosphate 6-phosphatase Carboxykinase Ki... | [{"letter": "A", "text": "A) $ \\uparrow $ | $ \\uparrow $ | $ \\uparrow $ | $ \\downarrow $"}, {"letter": "B", "text": "B) $ \\uparrow $ | $ \\uparrow $ | $ \\downarrow $ | $ \\downarrow $"}, {"letter": "C", "text": "C) $ \\uparrow $ | $ \\downarrow $ | $ \\downarrow $ | $ \\uparrow $"}, {"letter": "D", "text": "D) $ ... | D | In the fasting/starvation state (1 week without food), the liver shifts from glycolysis to gluconeogenesis to maintain blood glucose. Fructose-2,6-bisphosphate (F-2,6-BP) is a potent allosteric activator of phosphofructokinase-1 (PFK-1, glycolysis) and inhibitor of fructose-1,6-bisphosphatase (gluconeogenesis). In star... | biochemistry | Biochemistry & Genetics | easy | 0 | 153 |
nbme29_q0142 | NBME 29 | 42 | A 61-year-old man is prescribed fluoxetine for major depressive disorder. This drug has its initial effects on neurons arising in which of the following structures? | [{"letter": "A", "text": "A) Amygdala"}, {"letter": "B", "text": "B) Insular cortex"}, {"letter": "C", "text": "C) Locus caeruleus"}, {"letter": "D", "text": "D) Raphe nuclei"}, {"letter": "E", "text": "E) Substantia nigra"}] | D | Fluoxetine is a selective serotonin reuptake inhibitor (SSRI). Serotonergic neurons originate in the raphe nuclei of the brainstem (medial and dorsal raphe), which project diffusely throughout the forebrain. SSRIs block the serotonin transporter (SERT) on presynaptic terminals of these raphe-derived neurons, increasing... | pharmacology | Pharmacology | hard | 0 | 25 |
nbme27_page-96 | NBME 27 | 48 | A 37-year-old woman is brought to the emergency department after her husband found her unconscious. Her temperature is 36°C (96.8°F), pulse is 128/min, and blood pressure is 70/40 mm Hg. Physical examination shows cool, pale extremities, jugular venous distention, faint peripheral pulses, and crackles over the bottom t... | [{"letter": "A", "text": "Anaphylactic"}, {"letter": "B", "text": "Cardiogenic"}, {"letter": "C", "text": "Hypovolemic"}, {"letter": "D", "text": "Neurogenic"}, {"letter": "E", "text": "Septic"}] | B | Cardiogenic shock can occur in the setting of acute myocardial infarction, severe valvular dysfunction, severe heart failure, heart block, or arrhythmia. Patients may experience cardiogenic pulmonary edema resulting in shortness of breath, tachypnea, hypoxia, and audible rales on examination. Physical examination demon... | cardiology | Cardiovascular | medium | 0 | 84 |
form31_page-180 | Form 31 | 48 | A 72-year-old woman with mild dementia is brought to the office because of a nosebleed for 2 hours. She has no history of previous bleeding problems. There is no family history of bleeding disorder. She lives in a dilapidated farmhouse infested by rodents and has extensive exposure to rat poisons. Her temperature is 37... | [{"letter": "A", "text": "Aggregation into high-molecular-weight polymers"}, {"letter": "B", "text": "Association with soluble cofactor molecules"}, {"letter": "C", "text": "Gamma carboxylation of glutamate residues"}, {"letter": "D", "text": "Rearrangement of disulfide bonds"}, {"letter": "E", "text": "Removal of N-te... | C | Vitamin K plays a critical role in the synthesis of hepatic coagulation proteins; it is oxidized in the liver during the post-translational gamma carboxylation of glutamate residues on coagulation factors II, VII, IX, X, and proteins C and S. It is a co-factor for vitamin K epoxide reductase, which reduces vitamin K fo... | hematology | Hematologic | medium | 0 | 136 |
form30_page-23 | Form 30 | 24 | A 45-year-old woman is brought to the emergency department 30 minutes after the sudden onset of left-sided facial drooping and left arm and leg weakness. One week ago, she returned from a business trip that involved a 6-hour airplane flight. She has no history of major medical illness. She does not smoke. Her only medi... | [{"letter": "A", "text": "Aortic stenosis"}, {"letter": "B", "text": "Endocarditis"}, {"letter": "C", "text": "Hypertrophy of the interventricular septum"}, {"letter": "D", "text": "Mitral valve prolapse"}, {"letter": "E", "text": "Patent foramen ovale"}] | E | This patient with a deep venous thrombosis (DVT) most likely possesses a patent foramen ovale, allowing a thromboembolism to bypass the pulmonary circulation and cause a thromboembolic cerebrovascular accident (CVA, or stroke). DVT typically presents with lower extremity edema, erythema, warmth, and pain at rest along ... | cardiology | Cardiovascular | hard | 0 | 128 |
form31_page-63 | Form 31 | 20 | A 33-year-old man comes to the physician with his wife for a routine health maintenance examination. His medical records show that he has a 10-year history of alcoholism. The patient minimizes the amount and impact of his drinking and says, 'I do not have a drinking problem.' However, further questioning suggests a con... | [{"letter": "A", "text": "Ask the patient to attend a few 12-step program meetings before his next appointment"}, {"letter": "B", "text": "Ask the patient's wife to encourage him to stop drinking"}, {"letter": "C", "text": "Express concern about the drinking and ask the patient to return after thinking about it"}, {"le... | C | This patient with longstanding alcohol use disorder is displaying physical examination signs of liver disease (palpable liver edge and palmar erythema) and mild alcohol withdrawal (tremulousness). However, the patient appears precontemplative about changing his drinking habits, which is closely related to his lack of i... | gastroenterology | Gastrointestinal | hard | 0 | 79 |
form31_page-93 | Form 31 | 5 | A 55-year-old man with a 10-day history of a blistering rash on his back comes to the physician for a follow-up examination. He completed a course of antiviral medication 3 days ago, and he continues to have moderate pain. His vital signs are within normal limits. Physical examination shows the findings in the photogra... | [{"letter": "A", "text": "T4"}, {"letter": "B", "text": "T7"}, {"letter": "C", "text": "T11"}, {"letter": "D", "text": "L1"}, {"letter": "E", "text": "S1"}] | C | A dermatome describes an area of skin supplied by a spinal nerve ganglion. Nerve fibers from the dermatome send afferent signals to the central nervous system which responds with efferent signals causing pain in the affected area. The T11 dermatome travels in a band-like arc from the lower thoracic spine to the anterio... | dermatology | Dermatologic | hard | 0 | 66 |
form30_page-16 | Form 30 | 17 | The patient whose cardiac function is illustrated most likely has which of the following? | [{"letter": "A", "text": "Arteriovenous malformation"}, {"letter": "B", "text": "Cardiac tamponade"}, {"letter": "C", "text": "Congestive heart failure"}, {"letter": "D", "text": "Cor pulmonale"}, {"letter": "E", "text": "Restrictive cardiomyopathy"}] | C | The Frank-Starling mechanism describes the phenomena by which cardiac output is dependent on the amount of cardiomyocyte fiber stretch prior to contraction, as represented by the left ventricular end-diastolic volume. A greater pre-contraction stretch results in a greater force of contraction (to a point), and the rela... | cardiology | Cardiovascular | easy | 0 | 14 |
84 | NBME 28 | 34 | Item 34 of 50 Mark 34. A 32-year-old woman comes to the physician for a follow-up examination after atypical cell swarrow noted on a recent Pap smear. Physical examination shows a $ 1 \times 1 $ cm area of leukoplakia on the cervix. A biopsy specimen of the lesion shows invasive squamous cell carcinoma. Malignant cells... | [{"letter": "A", "text": "A) FemoralB) Inferior mesentericC) Internal iliacD) LumbarE) Superficial inguinal\u2460\u2461"}] | E | A tubular adenoma is shown in the gross picture of the transverse colon obtained during autopsy. Chronic occult gastrointestinal (Gl.) bleeding is a common presenting symptom of coforectal carcinoma (CRC) and for this reason: all patients with unexplained Gl
bleeding should undergo colonoscopy1o rul | None | Multisystem | medium | 0 | 69 |
form31_page-76 | Form 31 | 35 | A 52-year-old man who lives in Indiana comes to the physician because of a 1-month history of fever and nonproductive cough. He is a construction worker. His temperature is 38.4°C (101.1°F), pulse is 84/min, respirations are 14/min, and blood pressure is 110/70 mm Hg. Scattered crackles are heard over all lung fields. ... | [{"letter": "A", "text": "N-Acetylglucosamine\u2013N-acetylmuramic acid"}, {"letter": "B", "text": "Cellulose"}, {"letter": "C", "text": "Glucans"}, {"letter": "D", "text": "Polyglutamic acid"}, {"letter": "E", "text": "Teichoic acid"}] | C | This patient likely has histoplasmosis, an endemic mycosis caused by Histoplasma capsulatum. The photomicrograph shows characteristic oval yeast forms within macrophages. Pulmonary histoplasmosis can present in acute, subacute, or chronic phases, generally characterized by fever, malaise, myalgia, cough, and hemoptysis... | pulmonology | Respiratory | hard | 0 | 88 |
166 | NBME 28 | 17 | Which of the following characteristics of the glucocorticoid receptor is the most likely cause of the persistence of the pharmacologic effects of dexamethasone after the drug is eliminated from the body? A) Catalyzes formation of stable tyrosine-phosphate bonds B) Competes with $ \beta $-arrestin for binding to adrener... | [{"letter": "A", "text": "A) Catalyzes formation of stable tyrosine-phosphate bonds"}, {"letter": "B", "text": "B) Competes with $ \\beta $-arrestin for binding to adrenergic receptors"}, {"letter": "C", "text": "C) Couples to G proteins with low intrinsic GTPase activity"}, {"letter": "D", "text": "D) Depletes cellula... | E | Steroid hormones, such as dexamethasone. bind and activate intracellular receptors and is able to traverse the cell membrane due to their lipophilic nature . Other steroid hormones include estrogen, progesterone , testosterone, and aldosterone. All of these
hormones are derived from cholesterol as a | None | Multisystem | medium | 0 | 76 |
form30_page-38 | Form 30 | 39 | A 20-year-old man is brought to the physician because of a 4-hour history of abdominal pain, nausea, and vomiting. He says that he had been drinking ethanol heavily all weekend, and he took three doses of acetaminophen within 2 hours after the onset of a severe headache Monday morning. This patient is at increased risk... | [{"letter": "A", "text": "Activation of IgE-mediated mast cell degranulation"}, {"letter": "B", "text": "Decreased acetaminophen clearance via glucuronidation"}, {"letter": "C", "text": "Increased bioavailability of acetaminophen"}, {"letter": "D", "text": "Induction of cytochrome P450 enzymes that activate acetaminoph... | D | Acetaminophen poisoning is more common in patients with underlying risk factors, including exposure to alcohol and hepatotoxic drugs. When taken at therapeutic doses, acetaminophen is safely metabolized through phase II conjugations, including glucuronidation and sulfation. In the setting of acetaminophen overdose, sat... | gastroenterology | Gastrointestinal | medium | 0 | 67 |
nbme120_q063 | NBME 120 | 63 | 6 | {"E": "Correct answer (E)", "A": "Option A", "B": "Option B", "C": "Option C", "D": "Option D"} | E | Image-based question (stem '6'). Cannot classify without the image. Official answer: E. | other | Multisystem | Medium | 0 | 1 |
form30_page-32 | Form 30 | 33 | A 56-year-old woman comes to the physician because of a 3-week history of increasing weakness of her arms and legs. She has smoked 1 pack of cigarettes daily for 30 years. Physical examination shows pronounced weakness of the hip girdle muscles and lesser weakness of the shoulder girdle muscles, both of which improve w... | [{"letter": "A", "text": "Acetylcholinesterase"}, {"letter": "B", "text": "Binding of acetylcholine on the postsynaptic membrane"}, {"letter": "C", "text": "Direct depolarization of muscle fibers by Ca2+"}, {"letter": "D", "text": "Postsynaptic membrane potential"}, {"letter": "E", "text": "Presynaptic release of acety... | E | Lambert-Eaton myasthenic syndrome (LEMS) is an uncommon neurologic condition that affects neuromuscular junction transmission. Normally, action potentials lead to depolarization in the terminal bouton of the axon. Voltage-gated calcium channels consequently open and allow calcium influx, which triggers the exocytosis o... | pulmonology | Respiratory | medium | 0 | 88 |
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