07-15-2010, 04:11 PM
45. A 20-year-old woman feels sad, cries occasionally, and doubts her ability to take care of her healthy 3-day-old
newborn. She has started to breastfeed, and her sleep and appetite are normal. Which of the following is the
most likely explanation for her feelings?
A) Adjustment disorder with depressed mood
B) Brief reactive psychosis
C) Major depressive episode
D) Normal reaction to birth
E) Postpartum pituitary necrosis
42. A 30-year-old woman comes to the emergency department because of acute sharp flank pain and blood in her
urine. An intravenous pyelogram obtained at 30 minutes is shown. Which of the following is the most likely
diagnosis?
A) Appendicitis
B) Bladder tumor
C) Cystitis
D) Kidney tumor
E) Pyelonephritis
F) Right ureteral obstruction
(please see the picture if u have offline nbme 4 block 2 Q 42)
38. A 65-year-old woman with chronic constipation comes to the emergency department because of a 3-day history
of abdominal pain. Abdominal examination shows distention with tenderness in the left lower quadrant.
Sigmoidoscopy shows no tumors, but the scope cannot be inserted beyond 15 cm because of abrupt luminal
narrowing. Which of the following is the most likely diagnosis?
A) Appendicitis
B) Diverticulosis
C) Small-bowel obstruction
D) Volvulus of the cecum
E) Volvulus of the sigmoid colon
29. A 12-year-old boy has had persistent pain in the arm since he fell while playing basketball 2 weeks ago. His left
deltoid muscle is paralyzed, and he is unable to hold his left arm in abduction against resistance. Which of the
following bones is the most likely site of a fracture?
A) Acromion
B) Clavicle
C) Coracoid process
D) Deltoid tuberosity
E) Radius
F) Shaft of the humerus
G) Surgical neck of the humerus
H) Ulna
28. A 21-year-old man develops wristdrop after sustaining a complete fracture of the upper arm associated with
extensive tissue damage. The fracture was reduced successfully, and the ends of vessels and damaged nelVes
were apposed and surgically rejoined. Despite physical therapy, the extensor muscles have a decreased
volume and can contract only weakly. Wound healing and flexion are good. The most likely cause of this
condition is abnormal function of which of the following?
A) Circulation
B) Glucose transporters
C) Lymphatic drainage
D) Neurotrophic input
E) Tendon stretch receptors
26. A 15-year-old boy comes to the physician because of nelVousness. He tells the physician that he is afraid he is
"going crazy." He describes brief episodes when colors have appeared especially bright and sounds have
seemed louder than usual. He says that several times while sitting in class, the desks appeared to move. When
asked, he adds that he frequently skipped school last term and had bad grades. He says, "But now I've changed
and I'm attending regularly." Physical examination and laboratory studies show no abnormalities. Which of the
following is the most likely cause of this patient's condition?
A) Alcohol use
B) Bipolar disorder
C) Hallucinogen use
D) Migraine
E) Schizophrenia
25. A 45-year-old man has had four episodes of involuntary twitching of the right foot. Following the last episodes,
he had a tonic-clonic seizure. Which of the following structures on the left is the most likely origin of the
seizure?
A) Inferior frontal cortex
B) Inferior temporal cortex
C) Insular cortex
D) Primary motor cortex
E) Supplementary motor cortex
newborn. She has started to breastfeed, and her sleep and appetite are normal. Which of the following is the
most likely explanation for her feelings?
A) Adjustment disorder with depressed mood
B) Brief reactive psychosis
C) Major depressive episode
D) Normal reaction to birth
E) Postpartum pituitary necrosis
42. A 30-year-old woman comes to the emergency department because of acute sharp flank pain and blood in her
urine. An intravenous pyelogram obtained at 30 minutes is shown. Which of the following is the most likely
diagnosis?
A) Appendicitis
B) Bladder tumor
C) Cystitis
D) Kidney tumor
E) Pyelonephritis
F) Right ureteral obstruction
(please see the picture if u have offline nbme 4 block 2 Q 42)
38. A 65-year-old woman with chronic constipation comes to the emergency department because of a 3-day history
of abdominal pain. Abdominal examination shows distention with tenderness in the left lower quadrant.
Sigmoidoscopy shows no tumors, but the scope cannot be inserted beyond 15 cm because of abrupt luminal
narrowing. Which of the following is the most likely diagnosis?
A) Appendicitis
B) Diverticulosis
C) Small-bowel obstruction
D) Volvulus of the cecum
E) Volvulus of the sigmoid colon
29. A 12-year-old boy has had persistent pain in the arm since he fell while playing basketball 2 weeks ago. His left
deltoid muscle is paralyzed, and he is unable to hold his left arm in abduction against resistance. Which of the
following bones is the most likely site of a fracture?
A) Acromion
B) Clavicle
C) Coracoid process
D) Deltoid tuberosity
E) Radius
F) Shaft of the humerus
G) Surgical neck of the humerus
H) Ulna
28. A 21-year-old man develops wristdrop after sustaining a complete fracture of the upper arm associated with
extensive tissue damage. The fracture was reduced successfully, and the ends of vessels and damaged nelVes
were apposed and surgically rejoined. Despite physical therapy, the extensor muscles have a decreased
volume and can contract only weakly. Wound healing and flexion are good. The most likely cause of this
condition is abnormal function of which of the following?
A) Circulation
B) Glucose transporters
C) Lymphatic drainage
D) Neurotrophic input
E) Tendon stretch receptors
26. A 15-year-old boy comes to the physician because of nelVousness. He tells the physician that he is afraid he is
"going crazy." He describes brief episodes when colors have appeared especially bright and sounds have
seemed louder than usual. He says that several times while sitting in class, the desks appeared to move. When
asked, he adds that he frequently skipped school last term and had bad grades. He says, "But now I've changed
and I'm attending regularly." Physical examination and laboratory studies show no abnormalities. Which of the
following is the most likely cause of this patient's condition?
A) Alcohol use
B) Bipolar disorder
C) Hallucinogen use
D) Migraine
E) Schizophrenia
25. A 45-year-old man has had four episodes of involuntary twitching of the right foot. Following the last episodes,
he had a tonic-clonic seizure. Which of the following structures on the left is the most likely origin of the
seizure?
A) Inferior frontal cortex
B) Inferior temporal cortex
C) Insular cortex
D) Primary motor cortex
E) Supplementary motor cortex