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NBME Free 120 Answers

medicine
Question#1 (reveal difficulty score)
A 28-year-old man comes to the physician ...
Schistosomiasis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#2 (reveal difficulty score)
A 14-year-old boy is brought to the emergency ...
Common fibular (peroneal) ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#3 (reveal difficulty score)
A 24-year-old man comes to the office because ...
Hair follicle ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#4 (reveal difficulty score)
A 14-year-old girl is brought to the ...
Acting out ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#6 (reveal difficulty score)
A 63-year-old woman comes to the physician 1 ...
Calcium pyrophosphate ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#7 (reveal difficulty score)
A 55-year-old woman with small cell carcinoma ...
Filgrastim ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ





Question#12 (reveal difficulty score)
A 17-year-old boy is brought to the emergency ...
PCP (phencyclidine) ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#15 (reveal difficulty score)
A 40-year-old woman comes to the physician ...
Sertoli-Leydig tumor ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ








Question#23 (reveal difficulty score)
A 4-year-old boy from Brazil is brought to ...
Apoptosis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#25 (reveal difficulty score)
A 27-year-old man is admitted to the hospital ...
Adenylyl cyclase ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#26 (reveal difficulty score)
A 30-year-old man is admitted to the hospital ...
Crohn disease ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#27 (reveal difficulty score)
A couple comes for preconceptional genetic ...
50% ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#29 (reveal difficulty score)
A 63-year-old homeless man is brought to the ...
C5a ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#30 (reveal difficulty score)
A 16-year-old boy is brought to the physician ...
Escherichia coli ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Question#34 (reveal difficulty score)
A 31-year-old woman with type 2 diabetes ...
ฮฑ-Toxin ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Question#38 (reveal difficulty score)
A 52-year-old woman begins pharmacotherapy ...
Metformin ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ





Question#3 (reveal difficulty score)
A previously healthy 40-year-old man is ...
Pericardium ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


ribosomal
Question#6 (reveal difficulty score)
A 14-year-old girl with a 9-year history of ...
Countertransference ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#8 (reveal difficulty score)
A 25-year-old man is brought to the emergency ...
Ribosomal assembly ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Question#12 (reveal difficulty score)
A 64-year-old man with non-Hodgkin lymphoma ...
Vincristine ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#15 (reveal difficulty score)
A 72-year-old woman comes to the physician ...
Echocardiography ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#16 (reveal difficulty score)
A 14-year-old boy is brought to the physician ...
Normal development ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Question#20 (reveal difficulty score)
A 45-year-old man comes to the physician ...
Infraspinatus ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#21 (reveal difficulty score)
A 54-year-old man comes to the physician for ...
Amygdala ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#23 (reveal difficulty score)
A male stillborn is delivered at 32 weeks' ...
Pulmonary hypoplasia ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#26 (reveal difficulty score)
A 55-year-old man comes to the physician ...
Basement membrane ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#27 (reveal difficulty score)
A 24-year-old man is brought to the emergency ...
Foramen ovale ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#28 (reveal difficulty score)
A 55-year-old man who is a business executive ...
Splitting ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#29 (reveal difficulty score)
A 3-year-old boy with chronic granulomatous ...
Vancomycin ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#31 (reveal difficulty score)
A 10-year-old girl is brought to the office ...
It is a polymorphism ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#33 (reveal difficulty score)
A 17-year-old girl has never had a menstrual ...
Androgen insensitivity ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#35 (reveal difficulty score)
A 47-year-old woman comes to the emergency ...
Annular pancreas ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#36 (reveal difficulty score)
An 8-year-old boy is brought to the office by ...
Adenovirus ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ





biochem metabolism
Question#1 (reveal difficulty score)
Six healthy subjects participate in a study ...
Fatty acid oxidation ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#2 (reveal difficulty score)
A 72-year-old woman who has smoked 20 ...
Timolol ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#4 (reveal difficulty score)
A 15-year-old boy is brought to the emergency ...
Olfactory nerve ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#5 (reveal difficulty score)
A 42-year-old woman comes to the physician ...
Parathyroid gland ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#7 (reveal difficulty score)
A 72-year-old woman comes to the physician ...
Aspiration ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Question#11 (reveal difficulty score)
A 42-year-old woman is brought to the ...
Infraorbital ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#12 (reveal difficulty score)
A previously healthy 24-year-old woman who is ...
Lubiprostone ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#13 (reveal difficulty score)
A 32-year-old man is brought to the emergency ...
Membranous ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#14 (reveal difficulty score)
A 2-year-old boy is brought to the office by ...
DNA virus ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ





Question#19 (reveal difficulty score)
A randomized controlled trial is conducted to ...
0.2 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#21 (reveal difficulty score)
A 6-day-old breast-fed boy is brought to the ...
Galactose 1-phosphate ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#22 (reveal difficulty score)
A 14-year-old boy is brought to the physician ...
Infectious mononucleosis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#24 (reveal difficulty score)
A 12-year-old boy is brought to the physician ...
Patellar ligament ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#25 (reveal difficulty score)
A 22-year-old woman comes to the office ...
BK virus ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#26 (reveal difficulty score)
A new test to detect the presence of malarial ...
95% ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Question#30 (reveal difficulty score)
A 16-year-old boy comes to the physician ...
Carditis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#32 (reveal difficulty score)
A 51-year-old man comes to the office because ...
Submental ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#34 (reveal difficulty score)
A 57-year-old man receives radiation therapy ...
G1 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#37 (reveal difficulty score)
A 59-year-old man is brought to the emergency ...
Hypovolemic ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#39 (reveal difficulty score)
A 14-year-old boy is brought to the office ...
Normal findings ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#40 (reveal difficulty score)
A 65-year-old man is brought to the physician ...
Substantia nigra ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Question#17 (reveal difficulty score)
A 6-year-old girl is admitted to the hospital ...
Myeloperoxidase ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#19 (reveal difficulty score)
A 7-year-old boy who lives in Kentucky is ...
Ingestion of soil ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#31 (reveal difficulty score)
A 23-year-old woman is brought to the medical ...
Orthostatic hypotension ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#18 (reveal difficulty score)
A 51-year-old man comes to the office because ...
Submental ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#37 (reveal difficulty score)
A 50-year-old woman comes to the physician ...
baroreceptor output ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#32 (reveal difficulty score)
A 27-year-old man comes to the emergency ...
gastric mucosa ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#7 (reveal difficulty score)
An asymptomatic 44-year-old man is found to ...
Petechiae ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Question#16 (reveal difficulty score)
A 12-year-old boy is brought to the physician ...
Upward gaze ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#14 (reveal difficulty score)
A 46-year-old woman with 2 months of fatigue ...
Adverse drug event ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#27 (reveal difficulty score)
An 18-year-old is brought to the ED with 1 ...
Tampon ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#39 (reveal difficulty score)
A 32-year-old with 2 years of abnormal hand ...
Basal Ganglia ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#35 (reveal difficulty score)
A 65-years-old woman with asthma is brought ...
Leukotrienes ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



micro antibiotics


Question#24 (reveal difficulty score)
A 47-year old man is brought to the emergency ...
Atropine ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#34 (reveal difficulty score)
A 38-year old woman, gravida 3, para 2, at ...
ACE inhibitors ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Crohn
Question#38 (reveal difficulty score)
A 30-year-old man is admitted to the hospital ...
Chron Disease ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#26 (reveal difficulty score)
A 45-year-old man is brought to the clinic by ...
Atrophy ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Question#26 (reveal difficulty score)
A 45-year-old man is brought to the clinic by ...
Atrophy ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Question#67 (reveal difficulty score)
An 18-year-old woman is brought to the ...
Tampons ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

development
Question#38 (reveal difficulty score)
A 9-month-old boy is brought to the office by ...
Normal development ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Recent comments ...

... โˆ—sugaplum made a comment (free120)
 +23  submitted by sugaplum(469)

Incase anyone else was thinking the same:
I was stuck between this and variant of unknown significance. However, variant of unknown significance is a sequence not a single nucleotide

nbme4unme  Thank you for explaining, I selected the unknown significance answer as well! +5
dhkahat  lol fuck this test +19
chaosawaits  Because knowing this will definitely make me a better doctor /s +1
... โˆ—bwdc made a comment (free120)
 +22  submitted by bwdc(675)

As always, itโ€™s almost better to ignore the pictures when possible. This gentleman has a peptic ulcer, which we know is caused predominately by H. pylori infection. H. pylori produces proteases and particularly urease, which allow it to increase the pH of its local environment by cleaving urea into ammonia, which is toxic to gastric mucosa. The picture demonstrates H pylori, which are evident with silver staining.

joonam  Hey bro, thank you so much for your contributions on these free 120 questions. Your advice on test taking strategies for step 1 have been very helpful. +25
luciana  "Elaborated enzymes by H. pylori may also contribute directly to epithelial cell injury. Ammonia produced through urease activity may be toxic to gastric epithelial cells. H. pylori protease and lipase degrade gastric mucus and disrupt the phospholipid-rich layer at the apical epithelial cell surface, allowing for cell injury from back diffusion of gastric acid." https://www.ncbi.nlm.nih.gov/pubmed/9394757 +4
luciana  I got tricked :( Thought the damage was due to destruction of local somatostatin cells with increased gastrin and acid production... but this is actually the mechanism of duodenal ulcers development related to H. pylori But makes sense, so thats how the somatostatin producing cells are destroyed lol +6
drpee  "Hyperacidity and gastric ulcer development" is also sort of true, but this is hinting at the mechanism for DUODENAL ulcer development from H Pylori. Irritation in the stomach leads to G Cell hyperplasia, increasing acid secrection which causes downstream ulceration. +7
itsalwayslupus  Did anyone else pick the hyperacidity answer just because the correct answer had "local tissue destruction" in it? I figured that H. Pylori was non-invasive, so would not directly damage the tissue it is localized too +8
cbreland  @itsalwayslupus exact same thoughts over here +1
... โˆ—bwdc made a comment (free120)
 +17  submitted by bwdc(675)

Donโ€™t let them blind you with this patientโ€™s misery. The issue of the day is that he has a DVT. Thatโ€™s why he came to the ER in the first sentence and what the ultrasound shows at the end. Patients with cancer are hypercoagulable.

focus  LOL best explanation possible. +3
... โˆ—bwdc made a comment (free120)
 +16  submitted by bwdc(675)

When people go camping, you should be thinking of zoonotic infections. Fun fact, New Mexico leads the country in cases of plague. Yes, that plague: Yersinia pestis. The โ€œbubonicโ€ part of bubonic plague refers to the swollen infected nodes (โ€œbuboesโ€) characteristic of the disease, which often involve the groin (bubo is the Greek word for groin, who knew?). In this case, theyโ€™re also describing a necrotic epitrochlear node. Classic treatment is with aminoglycosides, which bind to the 30s ribosomal subunit. (Note that Tularemia, caused by another gram-negative bacteria Francisella tularensis can present similarly but is more common in the midwest. Regardless, the two are often lumped together, the antimicrobial treatment is similar, and the answer in this case would be the same).

(Free 120, 2019 Update)

jbrito718  my dumbass didnt even think of the plague. This silly rabit actually thought francisella from the presentation and it was from there I came to the same answer. Thank god the mechanism for this answer was the same +1
chaosawaits  Sketchy for life! Saved my ass thinking of the guy cleaning up dog poo with the sai +1


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