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nbme27_page-82 | NBME 27 | Musculoskeletal | 0 | During a clinical study, a researcher finds that as children approach puberty, the consumption of milk in the diet is partially replaced by the consumption of soft drinks. This results in a decrease in calcium intake. This dietary change is most likely to have which of the following effects on bone mineralization or me... | [{"letter": "A", "text": "Decreased parathyroid hormone secretion because of increased phosphorus intake"}, {"letter": "B", "text": "Decreased peak bone accretion during adolescence"}, {"letter": "C", "text": "Hypophosphatasia"}, {"letter": "D", "text": "Rickets resulting from calcium deficiency"}, {"letter": "E", "tex... | 2 | Bone tissue is constantly remodeling throughout human life. During childhood and adolescence, bone mineral density increases until the early third decade of life in females and the late third decade in males. According to Wolff's law, bone density will increase in response to stress applied. In turn, weightbearing exer... | true | images_crop/nbme27_page-82.webp | ||
nbme27_page-174 | NBME 27 | Gastroenterology | 0 | An 83-year-old man from Puerto Rico is admitted to the hospital because of abdominal pain and blood in his stool for 1 month. He has had an 11-kg (25-lb) weight loss during this period. The patient speaks little English and is accompanied by his children and extended family. The physician wishes to evaluate the patient... | [{"letter": "A", "text": "Have the family present when the diagnosis is shared with the patient, and allow them to participate in treatment planning"}, {"letter": "B", "text": "Inform the family that HIPAA requires that the patient receive this information and make his own decisions regarding his care"}, {"letter": "C"... | 5 | Physicians should elicit patients' preferences about how much information they prefer to receive about consequential diagnoses. When a patient's family expresses an opinion about a patient's care, including the delivery of a diagnosis, the physician should take this opinion under advisement but needs to ultimately hono... | false | |||
nbme27_page-26 | NBME 27 | Endocrinology | 0 | A 56-year-old woman with type 2 diabetes mellitus is being treated with pioglitazone to improve her sensitivity to insulin and with gemfibrozil to decrease her serum triglyceride concentration. These drugs both initiate their therapeutic effects by binding to which of the following receptor groups? | [{"letter": "A", "text": "\u03b2-Adrenergic receptors"}, {"letter": "B", "text": "Farnesoid X receptors"}, {"letter": "C", "text": "Insulin-like growth factor receptors"}, {"letter": "D", "text": "Peroxisome proliferator-activated receptors"}, {"letter": "E", "text": "Toll-like receptors"}] | 4 | Type 2 diabetes mellitus is a common disorder in resource-rich nations. Initial treatment consists of diet and activity modification, weight loss, and metformin monotherapy. If these measures fail to achieve adequate blood glucose control, additional oral antihyperglycemics may be considered. Common options for second-... | false | |||
nbme27_page-27 | NBME 27 | Dermatology | 0 | A 49-year-old man comes to the emergency department because of a persistent and painful erection since he took a drug for erectile dysfunction 4 hours ago. His temperature is 37°C (98.6°F), and blood pressure is 110/65 mm Hg. Physical examination shows flushing of the skin and priapism. The most likely cause of this pa... | [{"letter": "A", "text": "General sensory fibers from the pudendal nerve"}, {"letter": "B", "text": "Parasympathetic fibers from the pelvic plexus"}, {"letter": "C", "text": "Somatic motor fibers from the pudendal nerve"}, {"letter": "D", "text": "Sympathetic fibers from the prostatic plexus"}, {"letter": "E", "text": ... | 4 | Sympathetic fibers from the prostatic plexus are involved in detumescence of the penile erectile tissue, signifying that a lack of input from these fibers can lead to priapism. From the prostatic plexus, the cavernous and pudendal nerves both carry sympathetic fibers that release norepinephrine to extinguish penile ere... | false | |||
nbme27_page-8 | NBME 27 | Gastroenterology | 0 | 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", ... | 6 | 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... | false | |||
nbme27_page-118 | NBME 27 | Gastroenterology | 0 | A 16-year-old girl with a medulloblastoma is scheduled to begin chemotherapy with a combination of agents, including cisplatin. Addition of ondansetron may decrease emesis by blocking which of the following receptors? | [{"letter": "A", "text": "\u03b1\u2082-Adrenergic"}, {"letter": "B", "text": "Dopaminergic (D\u2081)"}, {"letter": "C", "text": "Histaminergic (H\u2081)"}, {"letter": "D", "text": "Muscarinic (M\u2081)"}, {"letter": "E", "text": "Serotoninergic (5-HT\u2083)"}] | 5 | The presence of nausea and vomiting depends on a complex interaction between the central nervous system, parasympathetic autonomic nervous system, gastrointestinal system, and endocrine system. Stimuli that cause nausea and emesis can originate in the viscera, vestibular system, or chemoreceptor trigger zone. Visceral ... | false | |||
nbme27_page-44 | NBME 27 | Infectious Disease | 0 | A 7-year-old girl is brought to the physician by her mother because of increasingly severe left knee pain during the past 12 hours. Her temperature is 39.1°C (102.3°F), pulse is 115/min, respirations are 18/min, and blood pressure is 110/60 mm Hg. Physical examination shows a tender, swollen left knee that is unable to... | [{"letter": "A", "text": "Juvenile rheumatoid arthritis"}, {"letter": "B", "text": "Lyme disease"}, {"letter": "C", "text": "Rheumatic fever"}, {"letter": "D", "text": "Septic arthritis"}, {"letter": "E", "text": "Viral synovitis"}] | 4 | Septic arthritis commonly occurs in children. Risk factors include trauma to the joint permitting translocation of cutaneous organisms as well as procedures causing transient bacteremia (eg, dental procedures). The most common organism found on aspiration is Staphylococcus aureus. Septic arthritis classically presents ... | false | |||
nbme27_page-81 | NBME 27 | Gastroenterology | 0 | A 34-year-old woman comes to the office because of a 6-month history of progressive swelling of her hands and feet. Her blood pressure is 140/89 mm Hg. Physical examination shows 1+ edema of the hands and 2+ edema of the feet. Serum studies show a potassium concentration of 3.3 mEq/L, decreased aldosterone concentratio... | [{"letter": "A", "text": "\u03944-5\u03b1-Dehydrogenase"}, {"letter": "B", "text": "1\u03b1-Hydroxylase"}, {"letter": "C", "text": "21-Hydroxylase"}, {"letter": "D", "text": "11\u03b2-Hydroxysteroid dehydrogenase type II"}, {"letter": "E", "text": "3-Oxosteroid \u03944-dehydrogenase"}] | 4 | The patient likely consumed a supplement containing licorice, the active ingredient of which is glycyrrhetinic acid, or enoxolone. This compound inhibits a variety of enzymes, including the enzyme 11β-hydroxysteroid dehydrogenase type II, which catalyzes the conversion of cortisol to cortisone in the zona fasciculata o... | true | images_crop/nbme27_page-81.webp | ||
nbme27_page-45 | NBME 27 | Nephrology | 0 | A group of men between the ages of 25 and 30 years and a group of men between the ages of 75 and 80 years were deprived of water for 24 hours. Renal function measurements for both groups are shown.
[Table: 25-30 Years: Urine specific gravity 1.030, Urine osmolality (mOsmol/kg) 1100; 75-80 Years: Urine specific gravity... | [{"letter": "A", "text": "Decreased renal blood flow"}, {"letter": "B", "text": "Decreased renal tubule responsiveness to ADH (vasopressin)"}, {"letter": "C", "text": "Decreased single nephron filtration rate"}, {"letter": "D", "text": "Increased release of atrial natriuretic peptide"}, {"letter": "E", "text": "Increas... | 2 | Decreased renal tubule responsiveness to ADH (vasopressin) most likely explains the disparities in urine concentrating abilities between younger and older men. ADH is a peptide hormone made in the hypothalamus and released from the posterior pituitary in response to decreased effective circulating volume or states of h... | false | |||
nbme27_page-63 | NBME 27 | Cardiology | 0 | A 44-year-old man comes to the physician for a follow-up examination 1 month after receiving a cadaveric kidney transplant. He says he feels well. Current medications include mycophenolate and prednisone. Physical examination shows an arteriovenous fistula in the left upper extremity and a well-healing surgical wound o... | [{"letter": "A", "text": "Donor CD4+ T lymphocytes recognize class II MHC molecules on host dendritic cells"}, {"letter": "B", "text": "Donor CD4+ T lymphocytes recognize class II MHC molecules on host lymphocytes"}, {"letter": "C", "text": "Donor CD8+ T lymphocytes recognize class I MHC molecules on host dendritic cel... | 5 | Host CD8+ T lymphocytes recognize class I MHC molecules on allograft cells. This leads to acute T-lymphocyte-mediated transplant rejection (TCMR), typified by an asymptomatic rise in creatinine and biopsy showing an inflammatory infiltrate affecting the small arterioles. This most commonly occurs within the first six m... | false | |||
nbme27_page-137 | NBME 27 | Nephrology | 0 | A 25-year-old woman comes to the physician because of a 3-year history of irregular menses. Menarche was at the age of 14 years. Puberty began at the age of 12 years and progressed normally. Her blood pressure is 116/62 mm Hg. Physical examination shows increased hair growth on the face and chest. Pelvic examination sh... | [{"letter": "A", "text": "11\u03b2-Hydroxylase"}, {"letter": "B", "text": "17\u03b1-Hydroxylase"}, {"letter": "C", "text": "21-Hydroxylase"}, {"letter": "D", "text": "3\u03b2-Hydroxysteroid dehydrogenase"}, {"letter": "E", "text": "5\u03b1-Reductase"}] | 3 | This patient most likely has a deficiency of 21-hydroxylase, which prevents the conversion of progesterone and 17-hydroxyprogesterone to precursors that ultimately produce aldosterone and cortisol, respectively, in the adrenal glands. In the setting of deficiency, precursors are shunted away from the production of mine... | false | |||
nbme27_page-101 | NBME 27 | Neurology | 0 | A 13-year-old girl is brought to the physician by her mother because of a 5-month history of behavioral problems. The mother states that her daughter alternates from being sad and socially withdrawn to being extremely angry and aggressive. After further evaluation, a diagnosis of bipolar disorder is made. Treatment wit... | [{"letter": "A", "text": "mRNA splicing"}, {"letter": "B", "text": "Polyadenylation"}, {"letter": "C", "text": "Post-translational processing"}, {"letter": "D", "text": "Transcription"}, {"letter": "E", "text": "Translation"}] | 4 | Valproate, a mood stabilizer used in bipolar disorder, increases DNA transcription by inhibiting histone deacetylase. Histones are basic proteins with many positively charged amino acid residues, which attract negatively charged phosphate groups on DNA, condensing and packing the DNA into complexes called chromatin. As... | true | images_crop/nbme27_page-101.webp | ||
nbme27_page-138 | NBME 27 | Pulmonology | 0 | 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... | 5 | 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... | false | |||
nbme27_page-155 | NBME 27 | Cardiology | 0 | A 55-year-old man comes to the office for an initial visit at the insistence of his wife. He has not seen a physician for the past 15 years. He has a 1-month history of mild shortness of breath when climbing stairs. He also has had a 23-kg (50-lb) weight gain during the past 15 years. He is 175 cm (5 ft 9 in) tall and ... | [{"letter": "A", "text": "Decreases serum LDL-cholesterol concentration"}, {"letter": "B", "text": "Decreases serum triglyceride concentration"}, {"letter": "C", "text": "Increases the serum total cholesterol/HDL-cholesterol ratio"}, {"letter": "D", "text": "Increases the serum triglyceride/HDL-cholesterol ratio"}] | 1 | Metabolic syndrome is a common disorder that is associated with an increased risk for developing cardiovascular disease, type 2 diabetes mellitus, and nonalcoholic fatty liver disease. It is characterized by hypertension, abdominal obesity, insulin resistance with hyperglycemia, increased serum triglyceride concentrati... | false | |||
nbme27_page-119 | NBME 27 | Gastroenterology | 0 | A 47-year-old man comes to the physician because of a 2-day history of yellow eyes and skin. He has undergone a total colectomy and reanastomosis at the age of 20 years because of the presence of numerous colon polyps, and he has a family history of colon cancer. Physical examination shows scleral icterus, generalized ... | [{"letter": "A", "text": "Biallelic loss of function of the APC gene"}, {"letter": "B", "text": "Instability of microsatellite regions of the genome"}, {"letter": "C", "text": "Lack of expression of a mismatch repair gene"}, {"letter": "D", "text": "Methylation of the MLH1 promoter region"}, {"letter": "E", "text": "Pr... | 1 | Familial adenomatous polyposis (FAP) is an autosomal dominant genetic syndrome resulting from biallelic loss of function of the APC gene. It is characterized by the presence of thousands of adenomatous polyps arising after puberty. Colonic neoplasia often begins with the formation of a polyp that undergoes malignant tr... | false | |||
nbme27_page-64 | NBME 27 | Other | 0 | A 25-year-old man comes to the physician because of a 6-week history of daytime fatigue, irritability, and emotional lability; he has had a 4.5-kg (10-lb) weight loss during this period. He says that he is sleep-deprived, but he is unable to fall asleep readily. He is a medical student and has recently finished an inte... | [{"letter": "A", "text": "\"Have a glass of wine before bedtime.\""}, {"letter": "B", "text": "\"Make sure you sleep late whenever you can to catch up on your sleep.\""}, {"letter": "C", "text": "\"Stay in bed, even if you can't fall asleep.\""}, {"letter": "D", "text": "\"Take it easy. Exercise at this point will just... | 5 | This patient likely has a circadian rhythm sleep disorder caused by the long and irregular hours of his intensive care unit rotation and should adopt sleep hygiene habits such as a regular wake-up time. Circadian rhythm sleep disorders feature misalignment between environmental light-dark phases and an individual's int... | false | |||
nbme27_page-7 | NBME 27 | Oncology | 0 | A 60-year-old woman comes to the physician because of vaginal bleeding for 6 weeks. Menarche occurred at the age of 12 years, and menses had occurred at regular 30-day intervals. She had three term pregnancies by the age of 25 years. She has been receiving conjugated equine estrogen therapy since menopause 10 years ago... | [{"letter": "A", "text": "Alcohol use"}, {"letter": "B", "text": "Cigarette smoking"}, {"letter": "C", "text": "Early menarche"}, {"letter": "D", "text": "Estrogen therapy"}, {"letter": "E", "text": "Multiparity"}] | 4 | Vaginal bleeding in a postmenopausal woman should raise suspicion for malignancy, including uterine or cervical carcinoma. Estrogen excess without adequate opposition by progestin is a strong risk factor for atypical endometrial hyperplasia and endometrial carcinoma, as this malignancy is estrogen-sensitive. This is on... | true | images_crop/nbme27_page-7.webp | ||
nbme27_page-65 | NBME 27 | Infectious Disease | 0 | 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"}] | 5 | 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... | false | |||
nbme27_page-28 | NBME 27 | Pulmonology | 0 | A study is conducted to measure survival following a diagnosis of lung, colon, or bladder cancer. Data from a statewide cancer registry are used. The graph shows survival plotted against the number of years after diagnosis for each cancer. Which of the following is the most accurate interpretation of these data concern... | [{"letter": "A", "text": "1-Year mortality after a diagnosis of colon cancer is the same as 1-year mortality after a diagnosis of lung cancer"}, {"letter": "B", "text": "3-Year mortality after a diagnosis of lung cancer is lower than 3-year mortality after a diagnosis of bladder cancer"}, {"letter": "C", "text": "3-Yea... | 4 | Survival curves are a useful tool in evaluating the natural history of a disease or the efficacy of treatment. The survival curve in this study plots the number of patients still alive (Y-axis) against time (X-axis). A perfect treatment, in which all patients survived the disease, would be reflected by a horizontal lin... | false | |||
nbme27_page-156 | NBME 27 | Nephrology | 0 | A 43-year-old man with advanced chronic renal failure comes to the physician to discuss the possibility of undergoing kidney transplantation. He also has type 2 diabetes mellitus and hepatitis C. He has been receiving treatment with hemodialysis for 1 year. Before the physician has a chance to initiate the discussion o... | [{"letter": "A", "text": "\"The chances of you dying after receiving the kidney transplant are greatest 3 to 4 years after the procedure.\""}, {"letter": "B", "text": "\"I want to be sure that I understand your concerns about getting a transplant.\""}, {"letter": "C", "text": "\"I want you to know that transplantation ... | 2 | Physicians should elicit patient-specific concerns when discussing consequential decisions such as undergoing kidney transplantation. One important role of physicians is to understand patients' underlying values and goals and assist the patients in achieving their goals, an approach that honors autonomy. Before educati... | true | images_crop/nbme27_page-156.webp | ||
nbme27_page-175 | NBME 27 | Nephrology | 0 | A 3-year-old girl is brought to the physician because of intermittent abdominal pain, constipation, and irritability for 1 month. She lives with her family in a 50-year-old house that is currently being renovated. Physical examination shows pallor. Laboratory studies show a normocytic, hypochromic anemia and an increas... | [{"letter": "A", "text": "Ferrochelatase"}, {"letter": "B", "text": "Porphobilinogen deaminase"}, {"letter": "C", "text": "Protoporphyrinogen IX oxidase"}, {"letter": "D", "text": "Uroporphyrinogen III"}, {"letter": "E", "text": "Uroporphyrinogen decarboxylase"}] | 1 | Although lead is generally no longer used in the manufacture of paint and gasoline, children can continue to be exposed to lead through ingestion of paint chips and dust in older homes or from contaminated drinking water. Children are susceptible to the toxic effects of lead because of an immature central nervous syste... | false | |||
nbme27_page-83 | NBME 27 | Nephrology | 0 | A 1-year-old boy is admitted to the hospital for antimicrobial treatment of perianal pain and erythema. He has a history of recurrent infections, including an admission to the hospital at the age of 2 weeks because of high-grade fever and swelling and redness around the umbilical cord stump. Physical examination shows ... | [{"letter": "A", "text": "C9"}, {"letter": "B", "text": "IgG"}, {"letter": "C", "text": "\u03b2\u2082 integrin"}, {"letter": "D", "text": "Interferon alpha"}, {"letter": "E", "text": "Tumor necrosis factor-\u03b1"}] | 3 | 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 dysfunctional LFA-1 integrin (CD18) protein on the leuk... | false | |||
nbme27_page-100 | NBME 27 | Reproductive | 0 | 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"}] | 6 | 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... | true | images_crop/nbme27_page-100.webp | ||
nbme27_page-102 | NBME 27 | Hematology | 0 | 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"}] | 5 | 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 ... | false | |||
nbme27_page-46 | NBME 27 | Cardiology | 0 | A 4-year-old boy is brought to the emergency department by his mother 6 hours after she noticed that his urine was red. He is otherwise feeling well. Fifteen days ago, the patient had a sore throat, fever, and cough. His mother thought he had the flu and treated him symptomatically with rest and analgesics, and his sta... | [{"letter": "A", "text": "Membranous nephropathy"}, {"letter": "B", "text": "Minimal change disease"}, {"letter": "C", "text": "Papillary necrosis"}, {"letter": "D", "text": "Proliferative glomerulonephritis"}, {"letter": "E", "text": "Tubulointerstitial nephritis"}] | 4 | Proliferative glomerulonephritis is a general term that refers to histologic characteristics on kidney biopsy but is commonly used to describe postinfectious glomerulonephritis. In this instance, the patient is a young boy with nephritic syndrome following acute pharyngitis. This is most consistent with poststreptococc... | true | images_crop/nbme27_page-46.webp | ||
nbme27_page-9 | NBME 27 | Gastroenterology | 0 | A 28-year-old man comes to the physician for a routine health maintenance examination. He is from Jamaica. He has practiced Rastafarianism all his life and follows a diet consisting only of natural juices, fruits, and grains. He also regularly smokes marijuana as part of his religion. Physical examination shows no abno... | [{"letter": "A", "text": "Color: Normal, Size (in Diameter): small, Shape: normal"}, {"letter": "B", "text": "Color: Normal, Size (in Diameter): small, Shape: 10% sickle, 90% normal"}, {"letter": "C", "text": "Color: Normal, Size (in Diameter): large, Shape: normal"}, {"letter": "D", "text": "Color: Normal, Size (in Di... | 5 | Choice E corresponds with a diagnosis of iron deficiency anemia (IDA). Erythrocytes in the setting of IDA are pale (hypochromic) and small in size (microcytic) but are normal in shape. Iron is required for the synthesis of heme, which is a necessary component of the hemoglobin molecule and, thus, of erythrocytes. It fu... | true | images_crop/nbme27_page-9.webp | ||
nbme27_page-176 | NBME 27 | Musculoskeletal | 0 | A 22-year-old woman comes to the physician 3 months after she noticed a painless, slowly enlarging mass on the left side of her neck. Physical examination shows a freely mobile, soft cystic mass with a cutaneous surface opening. The physician explains that it is from incomplete fusion during embryonic development. Whic... | [{"letter": "A", "text": "Anterior to the sternocleidomastoid muscle"}, {"letter": "B", "text": "Midline on the neck"}, {"letter": "C", "text": "Postauricular"}, {"letter": "D", "text": "Posterior to the parotid gland"}, {"letter": "E", "text": "Submental"}] | 1 | Branchial cleft cysts are developmental abnormalities that result from failure of fusion of the mesodermal branchial arches, with subsequent failure of obliteration of the ectodermal branchial clefts. The second through fourth branchial clefts are most commonly affected. Branchial cleft cysts appear as a cystic mass in... | true | images_crop/nbme27_page-176.webp | ||
nbme27_page-139 | NBME 27 | Cardiology | 0 | 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"}] | 1 | 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 ... | true | images_crop/nbme27_page-139.webp | ||
nbme27_page-177 | NBME 27 | Endocrinology | 0 | A 35-year-old woman undergoes flexible nasopharyngoscopy because of chronic episodes of bacterial sinusitis. Purulent discharge from the right sphenoethmoidal recess is noted during the procedure. Which of the following best describes the location of this structure? | [{"letter": "A", "text": "Anterior to the nasolacrimal duct"}, {"letter": "B", "text": "Distal to the vestibule"}, {"letter": "C", "text": "Inferior to the hiatus semilunaris"}, {"letter": "D", "text": "Posterior to the middle concha"}, {"letter": "E", "text": "Proximal to the fusion of the hard and soft palates"}, {"l... | 6 | The sphenoethmoidal recess is the site of drainage of the sphenoid sinus and the posterior ethmoid air cells. It is found in the superior aspect of the nasal cavity both superior and posterior to the superior nasal concha. The sphenoethmoidal recess can be used to visualize drainage from the sphenoid sinus, as in this ... | true | images_crop/nbme27_page-177.webp | ||
nbme27_page-157 | NBME 27 | Nephrology | 0 | A 56-year-old man comes to the physician because of a 4-day history of fatigue and malaise. He has hypertension treated with a diuretic and an ACE inhibitor and osteoarthritis and gout treated with nonsteroidal anti-inflammatory drugs. Two weeks ago, allopurinol was added to his medication regimen. His temperature is 3... | [{"letter": "A", "text": "Immune reaction"}, {"letter": "B", "text": "Ischemia secondary to prostaglandin inhibition"}, {"letter": "C", "text": "Ischemia secondary to vascular hyaline deposition"}, {"letter": "D", "text": "Renal deposition of Tamm-Horsfall protein"}, {"letter": "E", "text": "Vesicoureteral reflux"}] | 1 | Immune reaction in response to the addition of an offending drug—in this case allopurinol—explains this patient's fever, erythematous rash, acute kidney injury with pyuria and hematuria, and renal biopsy showing periglomerular and peritubular lymphocytic/histiocytic infiltrate. This collection of signs and symptoms in ... | true | images_crop/nbme27_page-157.webp | ||
nbme27_page-10 | NBME 27 | Cardiology | 0 | A 22-year-old man is brought to the emergency department 30 minutes after collapsing at home. He has a 3-year history of intravenous drug use. He appears confused. His temperature is 39.5°C (103.1°F). Physical examination shows subungual hemorrhages of the fingers and jugular venous distention. A holosystolic murmur is... | [{"letter": "A", "text": "A"}, {"letter": "B", "text": "B"}, {"letter": "C", "text": "C"}, {"letter": "D", "text": "D"}] | 3 | Intravenous drug use is a risk factor for infective endocarditis and valvular dysfunction as a result of the nonsterile injection of material into the venous system. Though left-sided infective endocarditis is more common in general, the tricuspid valve is most commonly involved in the setting of intravenous drug use. ... | true | images_crop/nbme27_page-10.webp | ||
nbme27_page-29 | NBME 27 | Nephrology | 0 | An investigator is testing the hypothesis that advanced glycosylation end products (AGEs) lead to an increased synthesis of extracellular matrix by human renal mesangial cells. The cells are plated on two media: type I collagen treated extensively with glucose 6-phosphate to produce AGEs (first medium), and a control m... | [{"letter": "A", "text": "Endothelial nitric oxide synthase"}, {"letter": "B", "text": "Fibronectin"}, {"letter": "C", "text": "NADPH oxidase"}, {"letter": "D", "text": "Nuclear factor-\u03baB"}, {"letter": "E", "text": "Vascular endothelial growth factor"}] | 2 | Fibronectin mRNA would most likely be increased in renal mesangial cells incubated in a medium containing glucose-6-phosphate, as fibronectin is a critical component of the extracellular matrix (ECM). Soluble fibronectin is secreted from cells—in this case, renal mesangial cells—into the extracellular space where it bi... | true | images_crop/nbme27_page-29.webp | ||
nbme27_page-47 | NBME 27 | Dermatology | 0 | A 9-year-old girl is brought to the clinic by her mother because of areas of hair loss on her scalp that the mother first noticed 1 week ago. The patient otherwise has been well. There is no personal or family history of serious illness. She receives no medications. The patient transferred from her neighborhood element... | [{"letter": "A", "text": "Alopecia areata"}, {"letter": "B", "text": "Hypothyroidism"}, {"letter": "C", "text": "Menkes disease"}, {"letter": "D", "text": "Tinea capitis"}, {"letter": "E", "text": "Trichotillomania (hair-pulling disorder)"}] | 5 | Focal, irregular patches of hair loss with broken hairs is consistent with trichotillomania. Trichotillomania is a psychiatric, impulse control disorder that presents with repetitive hair pulling resulting in noticeable hair loss and several unsuccessful attempts to stop hair pulling. Patients also commonly experience ... | true | images_crop/nbme27_page-47.webp | ||
nbme27_page-120 | NBME 27 | Pulmonology | 0 | 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... | 3 | 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... | true | images_crop/nbme27_page-120.webp | ||
nbme27_page-121 | NBME 27 | Other | 0 | A 70-year-old man comes to the physician because of difficulty sleeping since his wife died 8 months ago. He states that he sometimes wakes up an hour earlier than usual without being able to go back to sleep. He also often cries when he thinks about his wife. He tells the physician that he once briefly followed a woma... | [{"letter": "A", "text": "Schedule regular appointments to monitor the patient"}, {"letter": "B", "text": "Obtain neuropsychological testing"}, {"letter": "C", "text": "Order a sleep study"}, {"letter": "D", "text": "Prescribe antidepressant therapy"}, {"letter": "E", "text": "Prescribe diphenhydramine"}] | 1 | In this patient who is likely experiencing an uncomplicated grief reaction, the physician should schedule regular appointments to monitor the patient for suicidality and the development of psychiatric disorders such as major depressive disorder. Acute, uncomplicated grief presents in diverse ways and can include sadnes... | true | images_crop/nbme27_page-121.webp | ||
nbme27_page-140 | NBME 27 | Neurology | 0 | A 22-year-old woman is brought to the emergency department 30 minutes after stepping on a piece of glass while jogging on the beach. Physical examination shows a 1-cm laceration of the right foot with a deeply embedded glass shard. The shard is removed, and the wound is cleaned and sutured. After 3 days, the pain at th... | [{"letter": "A", "text": "Astrocytes"}, {"letter": "B", "text": "Basal keratinocytes"}, {"letter": "C", "text": "Fibroblasts"}, {"letter": "D", "text": "Myoepithelial cells"}, {"letter": "E", "text": "Satellite cells"}, {"letter": "F", "text": "Schwann cells"}] | 6 | Schwann cells surround peripheral neurons with layers of myelin to increase the speed of action potential conduction. In addition, they are essential in nerve repair and axon regrowth following nerve injury. During injury to a peripheral nerve, the severed distal axon degenerates in a process known as Wallerian degener... | true | images_crop/nbme27_page-140.webp | ||
nbme27_page-11 | NBME 27 | Nephrology | 0 | A 73-year-old woman has a 3-month history of increasing fatigue, weakness, and a 9.0-kg (20-lb) weight loss. Examination shows hepatosplenomegaly. An M-protein spike is observed on serum electrophoresis. Which of the following is the most likely diagnosis? | [{"letter": "A", "text": "Acute myelogenous leukemia"}, {"letter": "B", "text": "B-lymphocyte neoplasia"}, {"letter": "C", "text": "Chronic myelogenous leukemia"}, {"letter": "D", "text": "Leukemoid reaction"}, {"letter": "E", "text": "T-lymphocyte neoplasia"}] | 2 | B-lymphocyte neoplasia likely accounts for this patient's presentation with an M-protein spike (M-spike). While an M-spike may occur in a variety of B cell malignancies including Waldenstrom macroglobulinemia, plasma cell leukemia, smoldering myeloma, amyloidosis, or plasmacytoma, it is most commonly recognized in the ... | true | images_crop/nbme27_page-11.webp | ||
nbme27_page-84 | NBME 27 | Cardiology | 0 | 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"}] | 2 | 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... | true | images_crop/nbme27_page-84.webp | ||
nbme27_page-158 | NBME 27 | Pulmonology | 0 | A 48-year-old man is brought to the emergency department because of a 2-day history of shortness of breath, fatigue, decreased appetite, and cough productive of blood-tinged sputum. He has a 2-month history of hypertension that is currently untreated. His temperature is 37.1°C (98.8°F), pulse is 88/min, respirations ar... | [{"letter": "A", "text": "Acute tubular necrosis"}, {"letter": "B", "text": "Chronic renal failure"}, {"letter": "C", "text": "Goodpasture syndrome"}, {"letter": "D", "text": "Prerenal azotemia"}, {"letter": "E", "text": "Urinary tract obstruction"}] | 3 | The clinical presentation of hemoptysis, hematuria, hypertension, and proteinuria is consistent with a diagnosis of Goodpasture syndrome. Goodpasture syndrome is a type 2 hypersensitivity reaction that results in autoimmune antibody targeting of collagen, type IV, in the pulmonary capillaries and glomerular basement me... | true | images_crop/nbme27_page-158.webp | ||
nbme27_page-141 | NBME 27 | Hematology | 0 | During an experiment, a strain of knockout mouse is developed that has an isolated deficiency of carbonic anhydrase in erythrocytes. No other type of cell or tissue is deficient in this enzyme. Compared with normal mice, venous blood in the knockout mouse will most likely have a higher concentration of which of the fol... | [{"letter": "A", "text": "Ca2+"}, {"letter": "B", "text": "Cl-"}, {"letter": "C", "text": "HCO3-"}, {"letter": "D", "text": "K+"}, {"letter": "E", "text": "Mg2+"}, {"letter": "F", "text": "Na+"}] | 2 | Chloride (Cl-) will be present in greater concentrations in the venous blood of mice with erythrocytes that are deficient in carbonic anhydrase, an enzyme utilized in erythrocytes to convert carbon dioxide (CO2) and water (H2O) to bicarbonate (HCO3-) and hydrogen ions (H+). H+ binds to hemoglobin and modulates the unlo... | true | images_crop/nbme27_page-141.webp | ||
nbme27_page-30 | NBME 27 | Pulmonology | 0 | An autopsy is done on a 50-year-old man who died of pneumonia despite 5 days of antibiotic therapy in the intensive care unit. He had a 15-year history of alcoholism. A photograph of a sagittal section of the brain is shown. Based on this pathology, which of the following findings was most likely present on neurologic ... | [{"letter": "A", "text": "Dysdiadochokinesia"}, {"letter": "B", "text": "Dysmetria on finger-nose testing"}, {"letter": "C", "text": "Essential tremor"}, {"letter": "D", "text": "Gait ataxia"}, {"letter": "E", "text": "Present Romberg sign"}] | 4 | This patient's cerebellar vermis (pictured in cross section) appears atrophic, which could present with gait ataxia. The cerebellar vermis is in the medial zone of the cerebellum (smaller in cross-sectional surface area than the cerebellar hemisphere behind the vermis). The cerebellar vermis controls the motor function... | true | images_crop/nbme27_page-30.webp | ||
nbme27_page-85 | NBME 27 | Pulmonology | 0 | A 67-year-old man comes to the physician because of a 2-month history of unexplained weight loss. He has a 50-year history of type 1 diabetes mellitus. He underwent gallstone removal 12 years ago. He has smoked 1 pack of cigarettes daily for 45 years. He is 188 cm (6 ft 2 in) tall and weighs 120 kg (265 lb). BMI is 34 ... | [{"letter": "A", "text": "BMI of 34 kg/m\u00b2"}, {"letter": "B", "text": "Cigarette smoking"}, {"letter": "C", "text": "History of gallstone disease"}, {"letter": "D", "text": "Hypercalcemia"}, {"letter": "E", "text": "Type 1 diabetes mellitus"}] | 2 | Cigarette smoking is the most important preventable risk factor for pancreatic cancer. Increased risk for pancreatic cancer is observed in smokers, especially heavy smokers. This excess risk slowly declines after smoking cessation. Other important risk factors for pancreatic cancer include obesity and type 2 diabetes m... | true | images_crop/nbme27_page-85.webp | ||
nbme27_page-122 | NBME 27 | Pulmonology | 0 | A 38-year-old woman comes to the physician because of nasal congestion, cough, and shortness of breath for 5 days. She has asthma and allergic rhinitis currently treated with montelukast, an inhaled β₂-adrenergic agonist, and nasal and inhaled corticosteroids. Physical examination shows an erythematous nasal mucosa. Bi... | [{"letter": "A", "text": "Churg-Strauss syndrome"}, {"letter": "B", "text": "Goodpasture syndrome"}, {"letter": "C", "text": "Sarcoidosis"}, {"letter": "D", "text": "Takayasu arteritis"}, {"letter": "E", "text": "Wegener granulomatosis"}] | 1 | Churg-Strauss syndrome or eosinophilic granulomatosis with polyangiitis is a small-vessel vasculitis. The most common symptoms include asthma, ear, nasal, and sinus inflammation, and peripheral neuropathy. It can affect multiple organ systems and can present with clinical manifestations including arthralgia, skin lesio... | true | images_crop/nbme27_page-122.webp | ||
nbme27_page-104 | NBME 27 | Musculoskeletal | 0 | In some inherited disorders of collagen, lysyl oxidase activity is deficient. This enzyme deaminates the ε-amino group of a lysyl residue in collagen and forms a reactive aldehyde. In turn, this aldehyde interacts with which of the following amino acid residues of another collagen molecule to cause cross-linking? | [{"letter": "A", "text": "Arginine"}, {"letter": "B", "text": "Aspartic acid"}, {"letter": "C", "text": "Cysteine"}, {"letter": "D", "text": "Histidine"}, {"letter": "E", "text": "Lysine"}] | 5 | Collagen molecules are glycoproteins and are among the most ubiquitous proteins in the body. Collagen has a high tensile strength and provides much of the support of the human musculoskeletal system. During the production of collagen, tropocollagen molecules are cross-linked at hydroxylysine residues. Collagen synthesi... | true | images_crop/nbme27_page-104.webp | ||
nbme27_page-48 | NBME 27 | Oncology | 0 | A 75-year-old woman is brought to the physician because of a 1-day history of fever and back pain. Her temperature is 39.5°C (103.1°F), pulse is 111/min, respirations are 32/min, and blood pressure is 115/79 mm Hg. Physical examination shows left-sided costovertebral angle tenderness. Laboratory studies show a leukocyt... | [{"letter": "A", "text": "Attaches to cytokine receptor"}, {"letter": "B", "text": "Facilitates proteolytic cleavage of NF-\u03baB dimers"}, {"letter": "C", "text": "Phosphorylates NF-\u03baB"}, {"letter": "D", "text": "Releases NF-\u03baB after undergoing phosphorylation"}, {"letter": "E", "text": "Translocates to the... | 4 | NF-κB (nuclear factor kappa-light-chain-enhancer of activated B cells) comprises a family of transcription factors that induce the expression of several proinflammatory genes, promoting the production of cytokines, chemokines, and other inflammatory mediators in response to infection, as in this patient's case of pyelo... | true | images_crop/nbme27_page-48.webp | ||
nbme27_page-49 | NBME 27 | Gastroenterology | 0 | A 52-year-old man comes to the physician because of inability to achieve an erection 6 weeks after undergoing operative removal of a tumor on the distal portion of the rectum. During the excision, the tumor was found to be extensively attached to the posterior aspect of the prostate. Damage to which of the following ne... | [{"letter": "A", "text": "Gray rami from the sympathetic chain"}, {"letter": "B", "text": "Pelvic splanchnics"}, {"letter": "C", "text": "Pudendal"}, {"letter": "D", "text": "Superior hypogastric"}, {"letter": "E", "text": "Ventral rami of S2-4"}] | 2 | Damage to the pelvic splanchnic nerves is the most likely cause of this patient's erectile dysfunction. The pelvic splanchnic nerves are efferent parasympathetic preganglionic nerves that arise from the intermediolateral column of spinal cord levels S2 to S4. These nerves innervate the smooth muscle of the distal anter... | false | |||
nbme27_page-178 | NBME 27 | Hematology | 0 | 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"}] | 4 | 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,... | false | |||
nbme27_page-159 | NBME 27 | Nephrology | 0 | A 10-year-old boy is evaluated because of malaise and dark brown urine for the past 2 days. Laboratory studies show: Hemoglobin 7.2 g/dL, Hematocrit 21.6%, Leukocyte count 8400/mm³, Reticulocyte count 6%, Platelet count 90,000/mm³, Prothrombin time 12 sec (INR=1.0), Partial thromboplastin time (activated) 28 sec, Serum... | [{"letter": "A", "text": "Acute lymphoblastic leukemia"}, {"letter": "B", "text": "Acute poststreptococcal glomerulonephropathy"}, {"letter": "C", "text": "Chronic myelogenous leukemia"}, {"letter": "D", "text": "Hemolytic uremic syndrome"}, {"letter": "E", "text": "Minimal change disease"}, {"letter": "F", "text": "Si... | 4 | Hemolytic uremic syndrome (HUS) most likely explains this patient's acute renal failure, thrombocytopenia, and microangiopathic hemolytic anemia (MAHA). HUS is typically seen in children and is often caused by infection with Shiga toxin-producing E. coli (O157:H7), which is usually accompanied by bloody diarrhea. There... | true | images_crop/nbme27_page-159.webp | ||
nbme27_page-68 | NBME 27 | Other | 0 | A 5-year-old boy who had intrauterine growth restriction has continued to grow slowly. Psychomotor development is normal. His parents are of average stature. Genetic studies show that he has uniparental maternal heterodisomy for chromosome 7. Which of the following mechanisms best explains his slow growth? | [{"letter": "A", "text": "Expansion of an unstable trinucleotide repeat"}, {"letter": "B", "text": "Expression of an autosomal dominant disorder"}, {"letter": "C", "text": "Expression of an autosomal recessive disorder"}, {"letter": "D", "text": "Genomic imprinting of growth genes"}, {"letter": "E", "text": "Somatic mo... | 4 | Uniparental heterodisomy is the inheritance of a pair of nonidentical chromosomes from a single parent that results from an error during meiosis I. In contrast, uniparental isodisomy is the inheritance of a pair of identical chromosomes caused by errors during meiosis II or postzygotic duplication of the chromosome. Un... | false | |||
nbme27_page-12 | NBME 27 | Endocrinology | 0 | An investigator is studying a new hormone, Hormone X. To determine its cell target, a purified, radioactively labeled form of Hormone X is added to tissue cultures. Subsequent analysis shows that the radioactivity is detected only around the region of the plasma membrane. Hormone X is most similar to which of the follo... | [{"letter": "A", "text": "Aldosterone"}, {"letter": "B", "text": "Cortisol"}, {"letter": "C", "text": "Estradiol"}, {"letter": "D", "text": "Prolactin"}, {"letter": "E", "text": "Thyroxine (T4)"}] | 4 | Prolactin is a single-chain polypeptide hormone that is structurally homologous to growth hormone. It is secreted by the basophils in the anterior pituitary gland. Prolactin binds to the prolactin receptor, a member of the Class I cytokine receptor family, which spans the plasma membrane. It has an extracellular bindin... | false | |||
nbme27_page-66 | NBME 27 | Pulmonology | 0 | A 45-year-old man is undergoing a surgical procedure. Which of the following maneuvers by the anesthesiologist would result in an increase in intracranial pressure? | [{"letter": "A", "text": "Decreasing airway pressures"}, {"letter": "B", "text": "Decreasing fractional inspired oxygen (FIO\u2082)"}, {"letter": "C", "text": "Decreasing respiratory rate"}, {"letter": "D", "text": "Increasing airway pressures"}, {"letter": "E", "text": "Increasing FIO\u2082"}, {"letter": "F", "text": ... | 3 | Intracranial pressure (ICP) is dependent on the volumes of the brain, cerebrospinal fluid (CSF), and blood as a result of the fixed space of the skull. Brain volume can be increased with a mass or cerebral edema secondary to ischemic injury. CSF volume can be increased by increased production, decreased reabsorption, o... | false | |||
nbme27_page-103 | NBME 27 | Gastroenterology | 0 | A 56-year-old man comes to the physician because of a 1-week history of fever, headache, and painful sores on his penis. Two weeks ago, he had unprotected sexual intercourse with a new female partner. His temperature is 38.2°C (100.8°F), pulse is 85/min, respirations are 15/min, and blood pressure is 128/72 mm Hg. Phys... | [{"letter": "A", "text": "Chancroid"}, {"letter": "B", "text": "Genital herpes"}, {"letter": "C", "text": "Human papillomavirus infection"}, {"letter": "D", "text": "Lymphogranuloma venereum"}, {"letter": "E", "text": "Syphilis"}] | 2 | This patient's vesicular and ulcerative lesions on the penis are likely caused by herpes simplex virus (HSV) in the form of genital herpes. HSV-1 and HSV-2 are both members of the herpesvirus family of double-stranded DNA, enveloped viruses. Genital herpes is most often caused by HSV-2 but can also be caused by HSV-1. ... | true | images_crop/nbme27_page-103.webp | ||
nbme27_page-160 | NBME 27 | Gastroenterology | 0 | A 25-year-old man sustains perforation of the large bowel in the area of the cecum during a motor vehicle collision. An exploratory operation is planned to resect the affected bowel. To prevent excessive intraoperative hemorrhage in this patient, it is most appropriate to ligate the terminal branch of which of the foll... | [{"letter": "A", "text": "Celiac"}, {"letter": "B", "text": "Inferior mesenteric"}, {"letter": "C", "text": "Inferior rectal"}, {"letter": "D", "text": "Left colic"}, {"letter": "E", "text": "Middle colic"}, {"letter": "F", "text": "Superior mesenteric"}] | 6 | The superior mesenteric artery (SMA) supplies arterial blood to the distal duodenum, jejunum, and ileum, as well as the large bowel including the cecum, ascending colon, and proximal two-thirds of the transverse colon. The arterial blood supply to the cecum is supplied by the ileocolic artery, a branch of the SMA. The ... | true | images_crop/nbme27_page-160.webp | ||
nbme27_page-67 | NBME 27 | Endocrinology | 0 | An 82-year-old woman with type 2 diabetes mellitus and painful neuropathy comes to the physician for a follow-up examination. At her last visit 3 months ago, the physician prescribed a topical cream and recommended use of acetaminophen as needed for pain. The patient reports that the topical therapy helped more than sh... | [{"letter": "A", "text": "Arachidonic acid"}, {"letter": "B", "text": "Bradykinin"}, {"letter": "C", "text": "Histamine"}, {"letter": "D", "text": "Serotonin"}, {"letter": "E", "text": "Substance P"}] | 5 | Substance P has likely been depleted by the use of capsaicin cream, an agonist of transient receptor potential vanilloid 1 receptor (TRPV1) on nociceptive nerves. This initially results in a painful stimulus; however, the continued use of capsaicin completely depletes these nerve fibers of substance P. As substance P r... | false | |||
nbme27_page-142 | NBME 27 | Cardiology | 0 | A 57-year-old man with a 4-year history of type 2 diabetes mellitus has increased skin pigmentation, moderate ascites, and esophagogastric varices. Tissue obtained from biopsy of the liver is shown. Which of the following substances is most likely to be markedly increased in hepatocytes? | [{"letter": "A", "text": "\u03b11-Antitrypsin"}, {"letter": "B", "text": "Copper"}, {"letter": "C", "text": "Glycogen"}, {"letter": "D", "text": "Iron"}, {"letter": "E", "text": "Melanin"}] | 4 | Hemochromatosis may be acquired or inherited secondary to mutations in the HFE gene, leading to abnormally increased intestinal absorption of iron. This results in accumulation of iron in the body, increased serum iron, and increased ferritin. Iron can accumulate in several organs, including the liver, pancreas, skin, ... | true | images_crop/nbme27_page-142.webp | ||
nbme27_page-105 | NBME 27 | Oncology | 0 | A 75-year-old man has the painless lesions shown. He worked outside for 30 years maintaining the grounds of a golf course. The lesions are rough to the touch. Which of the following is the most likely diagnosis? | [{"letter": "A", "text": "Actinic keratosis"}, {"letter": "B", "text": "Angioma"}, {"letter": "C", "text": "Seborrheic keratosis"}, {"letter": "D", "text": "Solar lentigines"}, {"letter": "E", "text": "Xanthelasma"}] | 1 | Actinic keratosis is a premalignant lesion that may progress to squamous cell carcinoma. Clinically, lesions typically appear as light pink, ill-defined macules with a gritty texture in areas of prolonged sun exposure, such as the face, ears, and dorsal hands. Some actinic keratoses may develop a thick, hyperkeratotic,... | true | images_crop/nbme27_page-105.webp | ||
nbme27_page-86 | NBME 27 | Neurology | 0 | A 7-year-old boy is brought to the physician by his mother because of a 3-hour history of pain and stiffness of his neck. Two days ago, he fell off his bike and hurt his neck. Physical examination shows decreased range of motion of the neck. Neurologic examination shows no abnormalities. AP and lateral x-rays of the ce... | [{"letter": "A", "text": "Atlantoaxial joint"}, {"letter": "B", "text": "Interventricular foramen of Monro"}, {"letter": "C", "text": "Sternocleidomastoid muscles"}, {"letter": "D", "text": "Vertebral artery"}] | 1 | The spinal column is comprised of bony vertebrae, intervertebral discs made of fibrocartilage and gel-like material (nucleus pulposus), and ligaments that maintain the structure of the column. Function of the spinal column is based upon having numerous mobile segments; the facet joints and intervertebral discs between ... | false | |||
nbme27_page-31 | NBME 27 | Neurology | 0 | A healthy 25-year-old man participates in a study of muscle function. The electrophysiologic observations made on a muscle biopsy specimen are shown. Via iontophoresis, 1 μM acetylcholine (ACh) was applied to the muscle surface. Extracellular Ca2+ concentration was decreased to prevent end-plate potentials from acting ... | [{"letter": "A", "text": "epp Amplitude 1 mV, mepp Amplitude 0.5 mV, Response to ACh 0.5 mV"}, {"letter": "B", "text": "epp Amplitude 1 mV, mepp Amplitude 1 mV, Response to ACh 1 mV"}, {"letter": "C", "text": "epp Amplitude 2 mV, mepp Amplitude 0.2 mV, Response to ACh 0.2 mV"}, {"letter": "D", "text": "epp Amplitude 5 ... | 2 | Skeletal muscle activity is controlled by neurons which synapse on muscles at the neuromuscular junction. At this junction, the action potential from the neuron signals for the presynaptic release of acetylcholine leading to endplate potentials on the myocyte membrane. These endplate potentials then stimulate the dihyd... | true | images_crop/nbme27_page-31.webp | ||
nbme27_page-123 | NBME 27 | Nephrology | 0 | A 66-year-old man is brought to the emergency department 30 minutes after sustaining injuries in a motor vehicle collision. He is pronounced dead on arrival. A photograph of the left kidney and a photomicrograph of a section of the distal left ureter taken at autopsy are shown. Examination of the right kidney and urete... | [{"letter": "A", "text": "Alcoholism"}, {"letter": "B", "text": "Arylamine exposure"}, {"letter": "C", "text": "Cigarette smoking"}, {"letter": "D", "text": "Radiation exposure"}, {"letter": "E", "text": "Schistosomiasis"}, {"letter": "F", "text": "Vinyl chloride exposure"}] | 3 | Cigarette smoking is a primary risk factor for the development of urothelial cell carcinoma (also known as transitional cell carcinoma), a malignancy affecting the urinary tract epithelium. It can develop in the renal collecting tubules, calyx, renal pelvis, ureter, urethra, or bladder, as all of these structures share... | true | images_crop/nbme27_page-123.webp | ||
nbme27_page-195 | NBME 27 | Musculoskeletal | 0 | A 4-year-old boy is brought to the physician by his parents because of developmental delays and speech difficulty. He has two maternal uncles with intellectual disability. His height and weight are at the 30th percentile. Physical examination shows a large, long head with a prominent jaw, wide forehead, and large ears.... | [{"letter": "A", "text": "Down syndrome"}, {"letter": "B", "text": "Fragile X syndrome"}, {"letter": "C", "text": "Gonadal dysgenesis 45,X (Turner syndrome)"}, {"letter": "D", "text": "Hurler syndrome"}, {"letter": "E", "text": "Trisomy 18"}] | 2 | This patient's constellation of findings, including intellectual disability, an elongated face with a prominent jaw, a high-arched palate, large ears, and hyperextensible joints is highly suggestive of Fragile X syndrome. Patients may also present with macroorchidism after reaching puberty. Fragile X syndrome is the mo... | false | |||
nbme27_page-50 | NBME 27 | Pulmonology | 0 | A female newborn delivered at 26 weeks' gestation is found to have hyaline membrane disease. She is intubated and mechanically ventilated. Her vital signs are continuously monitored, and inspired oxygen is maintained at a level that will sustain an oxygen saturation between 92% and 95%. The primary goal of this treatme... | [{"letter": "A", "text": "Basal ganglia"}, {"letter": "B", "text": "Choroid plexus"}, {"letter": "C", "text": "Cochlea"}, {"letter": "D", "text": "Ductus arteriosus"}, {"letter": "E", "text": "Retina"}] | 5 | Fetal retinal vascularization is not complete until term. Fetal retinal blood vessels continue to grow outward from the optic nerve and posterior pole towards the ora serrata throughout the third trimester in a process that is dependent on a chemical gradient of vascular endothelial growth factor (VEGF). Premature birt... | false | |||
nbme27_page-179 | NBME 27 | Endocrinology | 0 | Clomiphene enhances female fertility because of which of the following characteristics? | [{"letter": "A", "text": "Antiestrogenic - decreases"}, {"letter": "B", "text": "Antiestrogenic - increases"}, {"letter": "C", "text": "Estrogenic - decreases"}, {"letter": "D", "text": "Estrogenic - increases"}] | 2 | Clomiphene is a selective estrogen receptor modulator, a class that exhibits a mix of agonist or antagonist effects on the estrogen receptor in different tissues. Clomiphene binds the estrogen receptors in the pituitary gland. By binding the estrogen receptor, it blocks the negative feedback from circulating estrogen a... | false | |||
nbme27_page-124 | NBME 27 | Cardiology | 0 | A 25-year-old woman, gravida 2, para 1, at 20 weeks' gestation comes to the physician for a routine prenatal visit. She has no history of any major medical illness. She says that she feels healthy, but her 2-year-old daughter recently had pneumonia. Her respirations before the pregnancy were 16/min. Her pulse is 80/min... | [{"letter": "A", "text": "Incipient respiratory infection"}, {"letter": "B", "text": "Metabolic adjustment for fetal lung immaturity"}, {"letter": "C", "text": "Occult pulmonary embolus"}, {"letter": "D", "text": "Pressure on the diaphragm from the enlarging uterus"}, {"letter": "E", "text": "Respiratory compensation f... | 5 | There are a variety of changes in maternal physiology during pregnancy. In the cardiovascular and respiratory system, pregnancy results in an increased cardiac output, increased oxygen demand, and increased minute ventilation. Increased minute ventilation and respirations are results of progesterone causing increased c... | true | images_crop/nbme27_page-124.webp | ||
nbme27_page-32 | NBME 27 | Neurology | 0 | A 12-year-old girl is brought to the physician by her parents because of a 2-day history of dizziness and headache. She is intelligent and does well in school. Her mother had a cerebellar tumor removed during childhood and is concerned that her daughter might have a similar condition. A normal reaction to which of the ... | [{"letter": "A", "text": "Babinski sign"}, {"letter": "B", "text": "Doll's eye (oculocephalic) maneuver"}, {"letter": "C", "text": "Glabellar tap"}, {"letter": "D", "text": "Rapid alternating movements"}, {"letter": "E", "text": "Tinel sign"}] | 4 | The inability to perform rapid alternating movements, also known as dysdiadochokinesia, indicates cerebellar dysfunction. Rapid alternating movements involve quickly alternating between clapping the palms and the dorsum of one hand. The cerebellum mediates motor learning and calculates movement course changes in respon... | true | images_crop/nbme27_page-32.webp | ||
nbme27_page-69 | NBME 27 | Infectious Disease | 0 | A 60-year-old man comes to the emergency department because of swelling of his right elbow that began after he struck it against the edge of a file cabinet earlier that day. On physical examination, the tip of the olecranon is obscured by a golf ball-sized fluctuant mass with well-defined borders. The mass is swollen, ... | [{"letter": "A", "text": "Bursa"}, {"letter": "B", "text": "Cartilage"}, {"letter": "C", "text": "Joint capsule"}, {"letter": "D", "text": "Ligament"}, {"letter": "E", "text": "Synovium"}, {"letter": "F", "text": "Tendon"}] | 1 | Bursae are thin, sac-like, fluid-filled structures that decrease friction and permit motion between layers of connective tissue. Bursae are frequently implicated in pathology and are often associated with pain and swelling, such as the subacromial bursa which can cause pain in the shoulder, the trochanteric bursa which... | false | |||
nbme27_page-87 | NBME 27 | Pharmacology | 0 | An investigator creates Drug Z that interferes with protein synthesis by binding to the anticodon on the human tRNA shown in the diagram. Drug Z is most likely binding in the place of which of the following codons? | [{"letter": "A", "text": "AUG"}, {"letter": "B", "text": "CCG"}, {"letter": "C", "text": "GCC"}, {"letter": "D", "text": "GCU"}, {"letter": "E", "text": "GUA"}, {"letter": "F", "text": "UCG"}] | 1 | AUG is the codon to which this tRNA anticodon would normally bind in the absence of Drug Z. tRNA is a specialized RNA that recognizes a codon on mRNA molecules, which consists of three nucleotides in a specific sequence. It carries the associated amino acid for a given mRNA codon and is therefore critical in protein sy... | true | images_crop/nbme27_page-87.webp | ||
nbme27_page-106 | NBME 27 | Cardiology | 0 | 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"}] | 1 | 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... | true | images_crop/nbme27_page-106.webp | ||
nbme27_page-143 | NBME 27 | Pulmonology | 0 | An investigator is studying a respiratory epithelial cell line. The cell line is infected with a newly discovered coronavirus. Which of the following steps is essential for the reproduction of this new virus? | [{"letter": "A", "text": "Formation of double-stranded DNA"}, {"letter": "B", "text": "Integration into host DNA"}, {"letter": "C", "text": "Lysis of the host cell"}, {"letter": "D", "text": "Replication in the nucleus"}, {"letter": "E", "text": "Translation by the host ribosome"}] | 5 | Translation by the host ribosome is necessary for the reproduction of this new coronavirus in the respiratory epithelium. The coronavirus family describes a set of enveloped RNA viruses of great clinical significance. Some examples include the virus that causes severe acute respiratory syndrome (SARS), middle eastern r... | true | images_crop/nbme27_page-143.webp | ||
nbme27_page-13 | NBME 27 | Endocrinology | 0 | In the hypothetical distribution of laboratory values for a particular laboratory test in "normal" and "diseased" populations, respectively, which of the following lettered decision points will produce the maximum sensitivity for the detection of the disease? | [{"letter": "A", "text": "A"}, {"letter": "B", "text": "B"}, {"letter": "C", "text": "C"}, {"letter": "D", "text": "D"}, {"letter": "E", "text": "E"}] | 1 | Any population of patients will include those who have the disease and those who do not, and overlap may exist between these groups when considering testing with a range of possible values. For example, one diagnostic criteria for type 2 diabetes mellitus is two fasting serum blood glucose concentrations greater than 1... | true | images_crop/nbme27_page-13.webp | ||
nbme27_page-180 | NBME 27 | Infectious Disease | 0 | A 27-year-old woman has had severe lower left quadrant abdominal pain and vomiting for 3 hours. She is weak and hypovolemic. She has a history of regular menstrual cycles and frequent pelvic infections. Her last menstrual period began 9 weeks ago and lasted 4 days. Which of the following is the most likely site of the ... | [{"letter": "A", "text": "Cervix"}, {"letter": "B", "text": "Ovary"}, {"letter": "C", "text": "Rectouterine pouch (of Douglas)"}, {"letter": "D", "text": "Uterine tube"}, {"letter": "E", "text": "Vermiform appendix"}] | 4 | Pregnancy is suspected when there is a missed or delayed menstrual period. Ectopic pregnancy often presents with symptoms including lower quadrant abdominopelvic pain, vaginal bleeding, nausea, or vomiting. Ectopic pregnancy is an abnormal pregnancy in which the fertilized ovum implants in the uterine (fallopian) tube ... | true | images_crop/nbme27_page-180.webp | ||
nbme27_page-33 | NBME 27 | Dermatology | 0 | A 40-year-old man comes to the physician for a routine examination. He has smoked 2 packs of cigarettes daily for 20 years. Which of the following initial statements by the physician is likely to be most effective in encouraging this patient to stop smoking? | [{"letter": "A", "text": "Do you have any relatives who died of lung cancer?"}, {"letter": "B", "text": "Let me show you a picture of what lungs look like after a lifetime of smoking."}, {"letter": "C", "text": "Please tell me how I can help you to stop smoking."}, {"letter": "D", "text": "Smoking causes lung cancer an... | 5 | Asking an open-ended question about the patient's thoughts about quitting smoking is the best way to engage and motivate the patient and can also assess the patient's readiness for behavioral change. The stages of behavioral change are used to define a patient's readiness to change a health-related behavior such as smo... | true | images_crop/nbme27_page-33.webp | ||
nbme27_page-51 | NBME 27 | Pulmonology | 0 | A 48-year-old man comes to the emergency department because of a 3-day history of fever, chills, headache, and nonproductive cough. He underwent renal transplantation 5 years ago. Current medications include corticosteroids. His temperature is 40°C (104°F). Coarse rhonchi are heard over the right lower lobe on ausculta... | [{"letter": "A", "text": "Ciprofloxacin"}, {"letter": "B", "text": "Metronidazole"}, {"letter": "C", "text": "Rifampin"}, {"letter": "D", "text": "Tetracycline"}, {"letter": "E", "text": "Vancomycin"}] | 1 | Pneumonia commonly presents with cough, shortness of breath, pleuritic chest pain, fever, and abnormal breath sounds. It often follows an upper respiratory infection or aspiration of oropharyngeal microbes and is more common in immunocompromised persons. Corticosteroid use is a risk factor for infection with atypical o... | false | |||
nbme27_page-14 | NBME 27 | Pulmonology | 0 | A 34-year-old man who is seropositive for HIV has a neoplasm manifested as violaceous raised cutaneous plaques (erythematous cutaneous plaques). Examination of tissue obtained on biopsy of the neoplasm is most likely to show which of the following? | [{"letter": "A", "text": "Dense, relatively acellular fibrous tissue with few typical fibroblasts"}, {"letter": "B", "text": "Large polygonal and giant cells with myofibrils"}, {"letter": "C", "text": "Malignant gland-forming cells with mucin"}, {"letter": "D", "text": "Poorly differentiated malignant squamous cells"},... | 5 | Kaposi sarcoma is a neoplasm of vascular endothelial cells, which may be induced by human herpesvirus 8 (HHV-8) in patients with poorly controlled HIV or who are otherwise immunosuppressed. Histologically, proliferating spindle cells forming slit-like spaces filled with blood confirms the diagnosis. Kaposi sarcoma also... | true | images_crop/nbme27_page-14.webp | ||
nbme27_page-70 | NBME 27 | Neurology | 0 | A 10-month-old female infant is brought to the physician because of a 1-day history of a rash. Her mother says that the infant also had a 3-day history of high fever and irritability, which spontaneously resolved 2 days ago. The patient is alert and playful. Her temperature is 37°C (98.6°F). Physical examination shows ... | [{"letter": "A", "text": "Epstein-Barr virus"}, {"letter": "B", "text": "Human herpesvirus 6"}, {"letter": "C", "text": "Parvovirus B19"}, {"letter": "D", "text": "Rubella virus"}, {"letter": "E", "text": "Varicella-zoster virus"}] | 2 | Human herpesvirus 6 (HHV-6) is the cause of roseola infantum, or exanthem subitum. In a minority of cases, this viral syndrome may also be caused by human herpesvirus 7, enteroviruses, and adenoviruses, though HHV-6 is the most frequent cause. This viral syndrome is characterized by several days of high fevers sometime... | true | images_crop/nbme27_page-70.webp | ||
nbme27_page-107 | NBME 27 | Nephrology | 0 | The initial therapeutic effect of hydrochlorothiazide in patients with hypertension is a result of decreased sodium reabsorption in which of the following parts of the nephron? | [{"letter": "A", "text": "Ascending limb of the loop of Henle"}, {"letter": "B", "text": "Descending limb of the loop of Henle"}, {"letter": "C", "text": "Collecting duct"}, {"letter": "D", "text": "Distal tubule"}, {"letter": "E", "text": "Proximal tubule"}] | 4 | The distal convoluted tubule (DCT) is the main site for sodium and chloride reabsorption in the nephron, allowing for production of dilute, hypotonic filtrate. Hydrochlorothiazide (HCTZ) and other thiazide diuretics (eg, chlorthalidone, metolazone) inhibit sodium and chloride reabsorption in the DCT by inhibiting the a... | true | images_crop/nbme27_page-107.webp | ||
nbme27_page-161 | NBME 27 | Neurology | 0 | A 40-year-old woman comes to the physician for genetic counseling because of a family history of muscle weakness. She says that she has not sought treatment because her symptoms are not severe, but her children have profound muscle weakness and fatigue. Sequence analysis of mitochondrial DNA shows a mutation in 50% of ... | [{"letter": "A", "text": "Anticipation"}, {"letter": "B", "text": "Genetic drift"}, {"letter": "C", "text": "Heteroplasmy"}, {"letter": "D", "text": "Imprinting"}, {"letter": "E", "text": "Pseudodominant inheritance"}] | 3 | Mitochondria are the cellular organelles that produce ATP via oxidative phosphorylation, a process that requires four enzyme complexes to produce a transmembrane potential that is ultimately used to produce ATP via ATP synthase. Mitochondrial DNA is separate from somatic nuclear DNA, and mutations in genes encoding any... | true | images_crop/nbme27_page-161.webp | ||
nbme27_page-88 | NBME 27 | Cardiology | 0 | A 70-year-old woman comes to the physician for advice after her husband of 45 years suddenly dies of cardiac arrest. She wants to donate $1,000,000 to a small city's department of public health to decrease the number of sudden cardiac deaths. She asks the physician to recommend the most effective way to put this money ... | [{"letter": "A", "text": "Creation of an antismoking campaign"}, {"letter": "B", "text": "Creation of a citywide aerobic exercise program"}, {"letter": "C", "text": "Fortification of the water supply with aspirin"}, {"letter": "D", "text": "Placement of external automatic defibrillators in public spaces throughout the ... | 4 | Cardiac arrests in public places (nonhealthcare settings) affect thousands of persons in the United States every year. The effectiveness of defibrillation is greatest at the earliest possible time after cardiac arrest. Easy to use, battery-powered automatic external defibrillators (AEDs) placed in public areas have bee... | false | |||
nbme27_page-144 | NBME 27 | Cardiology | 0 | An 82-year-old woman is brought to the physician because of a 1-week history of episodes of light-headedness and fainting. She has hypertension currently treated with propranolol. Her pulse is 45/min, and blood pressure is 90/50 mm Hg. Physical examination shows no other abnormalities. An ECG shows normal, regular P wa... | [{"letter": "A", "text": "Decreased activation of fast sodium channels"}, {"letter": "B", "text": "Decreased rate of repolarization phase"}, {"letter": "C", "text": "Decreased slope of diastolic depolarization"}, {"letter": "D", "text": "Increased calcium influx during late phase of slow depolarization"}, {"letter": "E... | 3 | Propranolol is a nonselective β-adrenergic blocker that is used in the treatment of hypertension. β-adrenergic blockers are also classified as class II antiarrhythmic agents because of their ability to modulate the electrophysiology of the heart. For this indication, propranolol may also be used in the treatment of sup... | true | images_crop/nbme27_page-144.webp | ||
nbme27_page-125 | NBME 27 | Infectious Disease | 0 | The graph shows the plasma concentration of an antibiotic as a function of time after an intravenous bolus. If the antibiotic is administered continuously by intravenous infusion, approximately how many hours will it take for the plasma concentration of the drug to first achieve almost 97% of its steady-state concentra... | [{"letter": "A", "text": "3"}, {"letter": "B", "text": "6"}, {"letter": "C", "text": "9"}, {"letter": "D", "text": "15"}, {"letter": "E", "text": "24"}] | 4 | A steady-state concentration of a drug occurs when the rate of elimination of a drug is equal to the rate of drug administration. Because of this, the time to steady-state concentration is dependent on the rate of elimination. Rate of elimination can be quantified by the half-life of the drug, or the time required for ... | true | images_crop/nbme27_page-125.webp | ||
nbme27_page-89 | NBME 27 | Nephrology | 0 | 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"}] | 4 | 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... | false | |||
nbme27_page-71 | NBME 27 | Dermatology | 0 | A previously healthy 6-year-old boy is brought to the physician by his mother because of a 1-week history of an itchy rash in his armpits, both hands and feet, and groin. The itching is most intense at night and keeps him awake. His vital signs are within normal limits. Examination of the skin shows multiple erythemato... | [{"letter": "A", "text": "\"Do you have any pets at home?\""}, {"letter": "B", "text": "\"Does anyone else in the family have an itchy rash like this?\""}, {"letter": "C", "text": "\"Does your child take any medications?\""}, {"letter": "D", "text": "\"Has there been any recent travel?\""}, {"letter": "E", "text": "\"H... | 2 | Scabies is a skin infestation by the mite Sarcoptes scabiei that is transmissible by skin-to-skin contact, as in family members or sexual partners. The skin infestation typically occurs on the sides or webs of the fingers, wrists, axillae, areolae, or genitalia and leads to intense pruritus, as in this patient. Physica... | true | images_crop/nbme27_page-71.webp | ||
nbme27_page-181 | NBME 27 | Infectious Disease | 0 | A screening program is instituted for detection of vaginal Chlamydia trachomatis infection among first-year women college students. At the initial screening, evidence of C. trachomatis infection is found in 500 of 2500 students. One year later, screening shows vaginal C. trachomatis infection in an additional 200 stude... | [{"letter": "A", "text": "8%"}, {"letter": "B", "text": "10%"}, {"letter": "C", "text": "16%"}, {"letter": "D", "text": "20%"}, {"letter": "E", "text": "28%"}] | 2 | Incidence is an important epidemiological measure that assesses the rate of occurrence of new disease in a population at risk. Incidence is the number of new cases expressed as a percentage of the total population at risk over a specified period of time. In this study, the total population is 2500 students. At the begi... | true | images_crop/nbme27_page-181.webp | ||
nbme27_page-182 | NBME 27 | Gastroenterology | 0 | The photomicrograph is of a stained stool smear. Chronic infection with this organism is most likely to cause which of the following? | [{"letter": "A", "text": "Bloody diarrhea"}, {"letter": "B", "text": "Constipation"}, {"letter": "C", "text": "Intestinal obstruction"}, {"letter": "D", "text": "Intestinal malabsorption"}, {"letter": "E", "text": "Iron deficiency"}] | 4 | The photomicrograph displays a flagellated, pear-shaped trophozoite with two large, central nuclei and a median axostyle, consistent with the appearance of Giardia lamblia. G. lamblia is a flagellated, parasitic organism that causes giardiasis. Giardiasis is usually acquired through the ingestion of cysts in contaminat... | true | images_crop/nbme27_page-182.webp | ||
nbme27_page-52 | NBME 27 | Psychiatry | 0 | A 20-year-old woman is brought to the emergency department by her roommate 30 minutes after she ingested a large quantity of acetaminophen tablets during a suicide attempt. The physician asks her why she tried to kill herself. She replies tearfully, "My boyfriend told me that he doesn't want to see me again, and he won... | [{"letter": "A", "text": "Borderline"}, {"letter": "B", "text": "Dependent"}, {"letter": "C", "text": "Histrionic"}, {"letter": "D", "text": "Narcissistic"}, {"letter": "E", "text": "Obsessive-compulsive"}] | 1 | Borderline personality disorder (BPD) is a cluster B personality disorder, the emotional or dramatic cluster, that features an unstable sense of self and tumultuous relationships. Likely caused by a combination of genetic polymorphisms in serotonin and dopamine receptors and emotional invalidation during childhood, pat... | false | |||
nbme27_page-192 | NBME 27 | Pulmonology | 0 | A 24-year-old woman is brought to the emergency department 30 minutes after sustaining abdominal trauma in a motor vehicle collision. She is hypotensive. Rupture of the spleen is suspected. Several attempts to insert a catheter in the left subclavian vein for a blood transfusion are unsuccessful, and she develops worse... | [{"letter": "A", "text": "Parietal pleura"}, {"letter": "B", "text": "Phrenic nerve"}, {"letter": "C", "text": "Pulmonary artery"}, {"letter": "D", "text": "Thoracic duct"}, {"letter": "E", "text": "Visceral pleura"}] | 5 | Placement of a central venous catheter (CVC) is frequently performed at any of three sites: the internal jugular vein, subclavian vein, and femoral vein. Indications for central venous access include volume resuscitation, emergency vascular access, and administration of vasopressors or caustic medications. Complication... | true | images_crop/nbme27_page-192.webp | ||
nbme27_page-162 | NBME 27 | Cardiology | 0 | A 47-year-old man is admitted to the hospital because of acute pulmonary edema. Treatment is started with nesiritide, a drug that is structurally identical to endogenous human B-type natriuretic peptide. Which of the following is most likely to occur in this patient? | [{"letter": "A", "text": "Arterial hypertension"}, {"letter": "B", "text": "Arteriolar vasoconstriction"}, {"letter": "C", "text": "Decreased cardiac output"}, {"letter": "D", "text": "Exaggerated orthostatic hypotension"}, {"letter": "E", "text": "Increased urine flow"}] | 5 | Brain-type natriuretic peptide (BNP) is produced primarily by cardiomyocytes of the ventricles in response to mechanical distension and neurohormonal signaling (mediated by angiotensin II, endothelin, and β-adrenergic stimulation). BNP originates as prepro-BNP which is enzymatically cleaved to pro-BNP within the cardio... | true | images_crop/nbme27_page-162.webp | ||
nbme27_page-145 | NBME 27 | Musculoskeletal | 0 | A 58-year-old woman comes to the physician because of a 3-month history of mild urine leakage when she washes her hands or when she hears water running. The leakage does not occur with coughing or sneezing. There is no nocturia, urinary hesitancy, or straining with urination. Her vital signs are within normal limits. P... | [{"letter": "A", "text": "Incomplete emptying"}, {"letter": "B", "text": "Increased intra-abdominal pressure"}, {"letter": "C", "text": "Polyuria"}, {"letter": "D", "text": "Uninhibited bladder contractions"}, {"letter": "E", "text": "Urinary tract infection"}] | 4 | An overactive bladder is caused by detrusor muscle instability and uninhibited bladder contractions. It commonly results in urge incontinence, which presents with the urge to void followed by the leakage of urine. Treatment of urge incontinence includes pelvic floor strengthening exercises, timed voiding, techniques fo... | false | |||
nbme27_page-126 | NBME 27 | Nephrology | 0 | An investigator is studying the human immune response to tumor cell antigens in malignancies. Which of the following sets of cancer types and tumor antigens is most likely to produce the highest antibody titer? | [{"letter": "A", "text": "B-cell lymphoma - CD19"}, {"letter": "B", "text": "Breast cancer - HER2/neu"}, {"letter": "C", "text": "Cervical cancer - human papillomavirus type 16 E6 protein"}, {"letter": "D", "text": "Melanoma - tyrosinase"}, {"letter": "E", "text": "Prostate cancer - prostatic acid phosphatase"}] | 3 | Of the options presented, E6 protein produced by human papillomavirus (HPV) is the only nonhuman antigen and will likely produce the highest antibody titer. Immunogenicity refers to the ability of an antigen to invoke a humoral and cell-mediated immune response. Cervical cancer is a common malignancy. Risk factors for ... | true | images_crop/nbme27_page-126.webp | ||
nbme27_page-90 | NBME 27 | Other | 0 | A 1-year-old girl is admitted to the hospital because of failure to thrive. She has had frequent, loose stools for 6 months. She has not gained weight satisfactorily during this period. She is at the 3rd percentile for length and weight. Physical examination shows facial edema. Laboratory studies show hypoalbuminemia. ... | [{"letter": "A", "text": "Aminopeptidase"}, {"letter": "B", "text": "Carboxypeptidase A"}, {"letter": "C", "text": "Chymotrypsin"}, {"letter": "D", "text": "Enteropeptidase"}, {"letter": "E", "text": "Trypsin"}] | 4 | This infant's findings of failure to thrive, diarrhea, edema, hypoalbuminemia, and increased concentrations of luminal proenzymes are suggestive of enteropeptidase deficiency. This rare disorder is caused by an inactivating mutation in the gene encoding enteropeptidase. In the absence of functional enteropeptidase, pan... | false |
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