Step 2 CK NBME Form 4 (Offline) Answer Key


Step 2 CK NBME Form 4

Block 1

1. D (recurrent candidal infections >> impaired cell mediated immunity)
2. A (reassuring pattern)
3. E (normal pressure hydrocephalus >> impairment of the higher mental control of the bladder which basically inhibits the voiding reflex)
4. A (post-streptococcal acute glomerulonephritis)
5. D (hostility towards authority without gross moral violations)
6. B (high BP plus papilledema)
7. E (Multiple sclerosis)
8. C (the patient is psychotic so her demand for an abortion cannot be allowed. Haloperidol can be used in pregnancy if the benefit to the mother clearly outweighs the potential fetal risk
9. D (Crohn's disease predisposes to fibrotic strictures)
10. D (Slipped capital femoral epiphysis)
11. E (RSV infection)
12. A (facial edema + linked with history of food intake)
13. E (hint: irregular mobile mass in the right upper quadrant)
14. B (blood cultures to confirm endocarditis. Blood cultures should always be collected before antibiotic treatment begins.)
15. D (chronic pancreatitis. amylase and lipase may or may not be elevated. pancreatic enzyme replacement therapy to relieve steatorrhea.)
16. B (increased intracranial pressure plus growth retardation plus visual difficulty >> craniopharyngioma fits)
17. F (joint aspiration >> first step in management of a swollen, tender joint)
18. C (Osgood – Schlatter Disease: Osteochondrosis of the tibial tubercle Tx: Kaplan notes say immobilization of the knee in an extension (or ) Cylinder cast for 4 – 6 weeks. Books also mention NSAIDs as part of treatment. Apparently the correct answer on online NBME, informed by a commenter, is C - NSAIDs)
19. A (pulmonary embolism, Spiral CT scan preferred over pulmonary angiography)
20. E (restrictive pattern on PFTs)
21. B (Intussception >> contrast enema is diagnostic and therapeutic)
22. D (oral-esophageal candidiasis in HIV >> Fluconazole)
23. G (Diabetes mellitus)
24. B (Febrile neutropenia)
25. D
26. A (only 40% of original participants remain)
27. F (patient was well-controlled on Paroxetine >> best option is to resume it)
28. G (hint: masses vary in size with her menstrual cycle)
29. C
30. A
31. B (Systolic murmur radiating to carotids is classic for aortic stenosis.)
32. D (Metronidazole for pseudomembranous colitis)
33. D
34. A (L to R shunt >> increased pulmonary blood flow)
35. A (subarachnoid haemorrhage can lead to diabetes insipidus)
36. F (vitamin D supplementation is recommended for all breastfed infants)
37. D (patient fulfills criteria of Major Depression. Note the marked anhedonia >> no longer enjoys the taste of food)
38. A (von Willibrand disease)
39. A (specific trigger, doesn't fulfill criteria of Major Depression)
40. A (Urge incontinence)
41. D (N0 M0 indicates that the tumor removal was most likely complete, therefore metastatic diseases is unlikely. Plus patient's smoking history also is risk factor for primary lung cancer.)
42. A (Hemochromatosis)
43. D
44. C (Dementia)
45. B (Postal worker >> high risk for bioterrorism. Cutaneous anthrax)
46. E (ankle edema >> well known side effect of Nifedipine)

Block 2

1. E (positive ANA and dsDNA)
2. C (ST elevation on ECG)
3. G (Tension pneumothorax)
4. B
5. C (Naproxen >> nephrotoxicity)
6. E
7. C (looks like alcohol withdrawal)
8. D (Hydatidiform mole)
9. B (obesity, papilledema, bifrontal headaches)
10. B (hyperkalemia with ECG changes >> Ca Gluconate)
11. D (GI obstruction, first step NG decompression)
12. B
13. A
14. A (2 year h/o productive cough >> Chronic Bronchitis. O2 sat: 90% >> Blue Bloater)
15. A (smoking is a contraindication for OCPs)
16. C (Foreign body ingestion >> bronchoscopy)
17. M
18. C (Isoniazid neurotoxicity preventable by administration of B6)
19. B (hyperglycemia can cause hyponatremia)
20. E (elderly patient, hematocrit too low, transfuse RBC. We don't use 5% Dextrose water or 0.45% saline for resuscitation, we use 0.9% Saline, which isn't given among options)
21. A (oral & genital ulcers plus erythema nodosum)
22. C (Erysipelas)
23. D (MRI shows a mass obstructing CSF outflow from the ventricles. Choice E is wrong. Choroid plexus papilloma most commonly occurs in Children, and even Choroid plexus papilloma itself can cause obstruction to CSF flow depending on its location)
24. E (cystic fibrosis)
25. B (Endometriosis. Clues >> infertility, dysparunea)
26. C
27. A
28. C (typical position of venous ulcers)
29. B (NSAID induced (pseudo)allergic reaction. Avoid aspirin)
30. C (best option)
31. A (peripheral arterial disease makes atherosclerotic process most likely)
32. E (essential tremor >> propranolol)
33. C (poorly controlled HTN >> increased risk of MI)
34. B (CA of head of pancreas)
35. D
36. E
37. C (long-standing lymphedema >> lymphangiosarcoma)
38. A (avoid permanent/prolonged catheterization wherever possible)
39. D
40. B (Nursemaid's elbow)
41. D
42. I
43. B
44. A (diffuse enlarged uterus >> adenomyosis)
45. E (pneumocystis shows bilateral infiltrates on x ray)
46. A (warm compresses would provide most quick symptomatic benefit. Compression stockings and enoxaparin therapy are valid options but would not help with the pain.)

Block 3

1.B (Fragile X syndrome)
2. E (Neuroleptic Malignant Syndrome)
3. C (small cell carcinoma >> SIADH)
4. E
5. B
6. D (clue: she comes in the fall)
7. A
8. B (The most common cause of lymphangitis in humans is Streptococcus pyogenes)
9. B
10. A (neonatal tetanus)
11. D (Dextrose water is not used for resuscitation; use normal saline or ringer lactate)
12. C (selenium sulfide shampoo can be used for treatment of tinea versicolor)
13. B
14. B
15. E
16. A (look for air under the diaphragm)
17. D (It cannot be excessive Vitamin D because serum phosphorus is below normal)
18. B
19. B
20. Q (rings on Prussian blue)
21. H
22. E
23. J (macular rash involving palms and soles >> think Syphilis)
24. E (referred pain to left shoulder)
25. C (blood at urethral meatus >> look for urethral injury)
26. B (Tinea capitis. Can be transmitted by direct contact or through sharing of combs, hats and clothing.)
27. A
28. B (septic shock)
29. C
30. A (pale mucosa, cobblestoning)
31. D (contrast nephropathy can be decreased with proper hydration)
32. E (Hirschsprung disease)
33. C
34. A (passive smoking increases the incidence of ear and throat infections in children)
35. A
36. E
37. D
38. A (Normal aging. She doesn't have dementia. MMSE score of 27 is normal.)
39. A
40. D
41. C (Juvenile rheumatoid arthritis)
42. G
43. C
44. C (Ambulatory ECG monitoring is not used to diagnose angina)
45. F (Epiglottitis)
46. B (Febrile seizure)

Block 4

1. D
2. E (Mitral Stensis >> Increased pulmonary venous pressure)
3. D (Late decelerations >> fetal hypoxia, placental insufficiency)
4. D
5. C (Start HAART with CD4 below 350 and Pneumocystis prophylaxis with CD4 below 200)
6. B (Patient fulfills criteria of Major Depression. Start antidepressants.)
7. C (Polycythemia Vera)
8. E
9. C (suspicion of Mastoiditis)
10. E (clues >> pharmacist, advised to lose weight)
11. B (Epididymo-orchitis in a sexually active young male)
12. D (Acne vulgaris)
13. C
14. D (Abdominal angina. Widespread atherosclerosis makes it likely.)
15. C
16. E
17. C (Granulosa cell tumor >> excess estrogen)
18. C (Acute poststreptococcal glomerulonephritis >> low C3)
19. A (Hereditary Angioedema. C4 is also decreased in Hereditary Angioedema, but C1 Estrase Inhibitor's deficiency is the primary pathophysiology. So while C4 is also the correct answer, I believe we should prefer C1 Estrase Inhibitor given the causative role it plays in the disease. )
20. E
21. A (Alzheimer's dementia >> decreased acetylcholine)
22. A (dry mucous membrances, dilated pupils, flushed appearance)
23. A (Doxorubicin >> cardiotoxicity)
24. E
25. B (patient most likely stopped taking prednisone)
26. G
27. F
28. B
29. B
30. E
31. B
32. E (her rising PCO2 indicates impending respiratory failure)
33. B
34. D
35. C (Pelvic Inflammatory Disease)
36. F
37. A
38. G (Myasthenia gravis)
39. F (obstructive sleep apnea)
40. E
41. A (vegetarian diet predisposes her to B12 deficiency)
42. D
43. B
44. G (buzzword: bag of worms)
45. C (embolism of cardiac myxoma)
46. B


Step 2 CK NBME Form 3 (Offline) Answer Key

Step 2 CK NBME Form 3


Block 1

1. A (Platelet count normal, Bleeding time prolonged)
2. B (hints: continues to work productively, sleeps 8-10 hours, no suicidal ideation, duration < 2 months)
3. A (Heat stroke is defined as a body temperature of greater than 40.6 °C (105.1 °F) due to environmental heat exposure with lack of thermoregulation. This patient has a temperature of 38 C only. Murmur points towards option A.)
4. A
5. A (oliguria with increased BUN & Creatinine [ratio < 20] following an episode of 30 min hypotension]
6. D
7. C
8. C (eosinophils in urine sediment plus generalized rash)
9. E
10. C (Salmonella enteritidis is not transmitted by feco-oral transmission; the main source of its infection is infected eggs, especially when they are eaten raw and undercooked)
11. D (uncontrolled diabetes with obesity)
12. D
13. F (hint: dog's bark like cough)
14. E (reflexes are depressed in elderly, vibratory sense is reduced in toes and ankles, not knees. tremor of outstretched hands may be seen in otherwise healthy elderly.)
15. B (answer provided by a commenter: "the answer isnt A, as A means the pt has ANION GAP ACIDOSIS..which he obviously doesn't as acidosis is due to diarrhea. I wud say its B, as his pCO2 should b low in case of metabolic acidosis, he's retaining it despite acidosis, means its a resp prob as well.")
16. E
17. C (incontinence is not a part of normal aging; diabetes lose the sensation of full bladder, making C most likely)
18. D (malignant otitis externa)
19. A
20. E (Alcoholic hepatitis. Reticulocyte count should be normal, so option C is out. ALT has to be elevated, so it has be either D or E. Since hepatic ducts are normal, ALP can't be raised as much as 800, ruling out option D. Therefore E is the answer.)
21. D
22. I
23. A (Buspirone for GAD)
24. E (only option that gives a restrictive pattern on PFTs)
25. C
26. E (Angioedema)
27. B
28. C (atypical lymphocytes >> Infectious Mononucleosis)
29. C (hypermobility [Ehlers-Danlos syndrome] >>  recurrent patellar dislocation >> Tx: Quadriceps strengthening exercises]
30. E (severe osteoarthritis affecting patient's quality of life >> total knee replacement)
31. D (April, not the right time for Influenza vaccine. Pneumococcal indicated.)
32. E (Pseudomembranous colitis)
33. C (Genital warts)
34. A
35. E (Polymyositis >> proximal muscle weakness. In scleroderma there is loss of peristaltic movement in the lower 2/3rd of esophagus, including LES. While in polymyositis there are absent pharyngeal contractions and decreased upper esophageal sphincter pressures [http://www.myositis.org/pdf/Gastrointestinal%20Ebert.pdf])
36. I (Hypertensive emergency >> Sodium nitroprusside. Other options: Nicardipine, Fenoldopam, Hydralazine, Labetalol)
37. A (the girl immediately coughs and breathes spontaneously without resuscitation >> good prognosis)
38. A
39. B (history of trauma + murmur & thrill + tinnitus + vericose veins)
40. B (prevalence affects positive predictive value)
41. D (calcitonin represents the classical clinical marker for medullary thyroid carcinoma)
42. A/B/E (This question is up for debate it appears. I thought: absent gag reflex is no more considered a reliable indicators of aspiration risk. Dentures increased the risk of aspiration pneumonia. A commenter gave his feedback: I think the right answer might be E. There are studies out there about aspiration prevention by jejunostomy tube placement. At the same time, aspiration risk is increased with poorly fitted dentures or missing teeth. This patient has false teeth, which by itself do not predispose to aspiration. I think A might be a distractor. Another commenter thinks it is B: the most commonly used method used to prevent aspiration that ive seen in hospitals is GIVING ANTACIDS, the dentures r not unhygienic or ill fitting, so dats out..)
43. A (TIA >> aspirin)
44. C
45. D (Anemia in elderly >> Colon cancer. Mets in Liver.)
46. B (split fixed S2)

Block 2

1. E (long history of a strict diet)
2. B (lisinopril side-effect)
3. F
4. D (hyphema: blood in anterior chamber of eye)
5. D (DVT. It cannot be Compartment syndrome because that requires a prolonged period of ischema and in this patient distal pulses were always palpable.)
6. C
7. E (testicular cancer can have metastasis to anterior mediastinum)
8. C (No waiting is necessary after MI to resume sex, but it is not for the reason that is stated in option E. That leaves C as the best answer. D is wrong.)
9. E
10. B
11. A (determine fetal lie by US if examination doesn't reveal)
12. B
13. A (flat-topped red papules over knuckles >> "Gottron's papules")
14. A
15. A
16. C (Hep B, raised AFP)
17. E (MEN II. It causes Parathyroid adenoma/hyperplasia, not carcinoma.)
18. B (Doxorubicin >> cardiotoxicity)
19. C (Ectopic pregnancy. Normal HCG level at 7-8 weeks LMP is: 7, 650 - 229,000 mIU/ml, therefore this patients HCG is not excessive. Transvaginal US shows Empty uterus (if it was Gestational Trophoblastic Disease, it would have shown homogenous intrauterine echoes or snow-storm appearance) Absence of adnexal mass does not rule out ectopic pregnancy. Patient has a previous history of ectopic pregnancy, which makes her high risk.)
20. B (description of cervical os points towards cervicitis. For threatened abortion, it is crucial to know whether the cervix is closed or not, information which the question doesn't give.)
21. N
22. B
23. B
24. M [subcutaneous epinephrine is the treatment for anaphylaxis/angioedema. Source: UW, step up to medicine]
25. L (tinnitus, increased respiration, suicide threat >> aspirin toxicity. diagnose with serum aspirin level.)
26. O (positive PPD, follow with chest X ray)
27. D
28. B
29. E (febrile neutropenia)
30. E
31. D
32. E (very high FSH and LH)
33. D (fever and joint pain with history of a course of dicloxacillin + urticarial rash, generalized lymphadenopathy >> serum sickness. A is a distractor because Infectious Mononuclesis treated with Ampicillin/Amoxicillin may develop a red, diffuse rash)
34. A
35. C (Hepatitis A vaccine or IG should be given to a previously unvaccinated household and sexual contacts of persons with serologically confirmed hepatitis A)
36. B (ECG changes due to hyperkalemia >> Ca Gluconate)
37. B
38. C
39. C (Patient already had a high serum cholesterol level in past, so confirm now with fasting lipid studies. LDL is a more specific cardiac risk factor than total serum cholestrol.)
40. K
41. A (normal, normal)
42. G
43. A (Congenital adrenal hyperplasia)
44. B
45. A
46. B

Block 3

1. C (Atypical depression with a history of bulemia >> drug of choice is Fluoxetine. Phenelzine is more effective for atypical, but has more side-effects so 2nd line, plus this patient has history of bulemia, which makes Fluoxetine better option. Some people think it is a case of Fibromyalgia and Imipramine should be the answer, but without the mention of tender points, I consider it doubtful.)
2. E
3. A
4. E
5. C (suspicion of Pancreatic Cancer)
6. E
7. D (Tx of hypercalcemia >> infusion of 0.9% saline +/- loop diuretic)
8. B (looks like the rational choice, also given that the question is meant to be about Medical Ethics. Some people think that D is correct answer, to test for ADPKD.)
9. D
10. E
11. A
12. B
13. F
14. F
15. E
16. E
17. B (In prolonged or arrested active phase if contractions are inadequate (adequate: every 2-3 min. this patient has every 8 min) Tx is augmentation with oxytocin. If uterine contractions are inadequate >> C section)
18. B (Gallstones most likely cause of acute pancreatitis)
19. C (insecticide poisoning. opiates would cause pinpoint pupils but also respiratory depression.)
20. B
21. C (Patient has no history of bleeding problems and takes no medications which rules out all choices except C >> surgical bleeding)
22. D
23. E
24. E
25. B
26. A (Exercise reduces future muscle spasms and sprains. Back brace would limit his spine movements, but there is nothing wrong with his spine.)
27. B (In the early stage of septic shock, cardiac contractility increases and preload & afterload decrease)
28. D
29. B
30. D
31. A
32. E (hint >> the month November)
33. B
34. E
35. B (asymmetry in radical pulses)
36. B
37. C
38. F (Seborrheic keratosis >> stuck on appearance)
39. D
40. D
41. C (Chondrocalcinosis >> pseudogout)
42. C
43. H (Syndenham Chorea)
44. B (Patient's Magnesium level is below normal 1.5 - 2.5 mg/dL)
45. A
46. D

Block 4

1. A
2. D (Before starting a vigorous excercise program, individuals over the age of 45 years with two or more risk factors and those between 35 years to 44 years with more than two risk factors for coronary artery disease must undergo a maximal exercise stress test after a thorough physical examination, even if they feel normal and have no symptoms.)
3. C
4. E
5. B (Infants are very commonly prone to anal fissures)
6. D
7. A (follow ABC)
8. B (chronic analgesic use)
9. D
10. C
11. E
12. E
13. F (retinal artery embolism)
14. A (pre-ductal or ductal coarctation of aorta)
15. C
16. A
17. A (hyperkalemia, hyperpigmentation of palmar creases)
18. B
19. B (best explanation)
20. E
21. E
22. D
23. E (tropical sprue)
24. A
25. A (Parkinson's disease)
26. C
27. C (lucid interval)
28. B (febrile neutropenia >> Aminogycoside + [AntiPseudomonal penicillin or AP cephalosporin])
29. B
30. A
31. C
32. D
33. A
34. C (learning disability commonly associated with ADHD)
35. B (emergency contraception >> high dose OCP)
36. D
37. M
38. G
39. C (Cystic fibrosis patients have decreased sperm count)
40. C
41. A
42. B (Polycystic Ovarian Syndrome)
43. A (hint for Lyme Disease: Long Island)
44. E
45. B (subclavian steal syndrome)
46. A

Step 2 CK NBME Form 2 (Offline) Answer Key


Step 2 CK NBME Form 2


Block 1

1. B (well-fitted shoes to avoid trauma. prophylactic antibiotics not indicated.)
2. A (clue from the stem: hyperthyroidism, irregularly irregular pulse, variation in intensity of S1)
3. C
4. E (hereditary spherocytosis)
5. B
6. E (NSAID papillary necrosis doesn't happen so fast. History of trauma makes E best answer)
7. C (DT boosters indicated after every 10 years. She has all 5 doses of DTP already, so now booster is with adult DT even if she is 16 year old.)
8. C (SIADH can happen secondary to meningitis)
9. D (Hemochromatosis)
10. A (identifiable stressor)
11. J
12. H
13. D (renal artery stenosis)
14. A (HTN with hypokalemia >> Conn's syndrome)
15. D
16. B (fixed splitting of S2)
17.
18. D (refractile body at bifurcation of retinal artery >> cholesterol emboli from the internal carotid artery atherosclerotic disease >> duplex scan of carotid artery)
19. A
20. C
21. A
22. B
23. A
24. B
25. A [Pt has a crude pincer grasp- This should have been mastered by 9-14 months to be normal]
26. E
27. C
28. C (only option that goes with restrictive disease)
29. D
30. G
31. D
32. B (fat soluble vitamin)
33. E
34. A
35. C
36. A (antibiotic prophylaxis for Chronic bacterial prostatitis)
37. F
38. A (Huntington's disease)
39. G
40. A (cyclosporine-induced hypertension)
41. E
42. B
43. E (obesity >> increased estrogen)
44. C (crossed hemiplegia)
45. B
46. F

BLOCK 2

1. D (pin-point pupils >> opiates)
2. B
3. A (Lyme disease)
4. D (Granulosa cells produce excessive amounts of estrogen)
5. C
6. D
7. B (Elevating the left testicle relieves the pain >> Epidodymitis)
8. D (side effect of enalapril)
9. D (Heparin-induced thrombocytopenia. As explained by a commenter: the reason there is thrombocytopenia in HIT is because the Heparin-Platelet4 complex are attacked by IgG in the human bodies that essentially activate the platelet and thus form clots. These clots are the reason free platelets are low.)
10. C
11. B (pulsus paradoxus)
12. D
13. C (biliary colic)
14. C (Oral isotretinoin is never the first option for acne, only used when topical treatments have failed)
15. B
16. C
17. B (screening of lipid profil routinly done for every HTN patient)
18. A
19. B
20. E
21. F
22. D
23. D
24. E (white patches over the skin that become more distinct with Wood's lamp examination "ash leaf spots" >> Tuberous sclerosis)
25. D
26. I
27. B
28. E
29. B
30. D
31. E
32. B
33. B (question stem says that mother applies sunscreen 'just before she goes swimming', which is incorrect way. It should be applied at least 15-30 min before sun exposure)
34. A (Botulism)
35. A
36. D (VSD)
37. E
38. D
39. D
40. B
41. C
42. E
43. D
44. E
45. C
46. D

Block 3

1. D
2. A
3. C
4. B
5. A
6. A (aldolase-B deficiency)
7. B
8. D
9. D (risk of repeated falls)
10. B (Xanthelasma >> high cholestrol)
11. E
12. B
13. D (Prinzmetal angina)
14. A
15. C (Diabetes Inspidus)
16. E
17. C (I am confused between Conversion and Malingering, because there is possibly a motive [she doesn't want to move] but it isn't clearly stated either. So on revising the question, I am now more tilted towards Conversion.)
18. G
19. C (Patient has febrile neutropenia >> IV antibiotics)
20. B
21. E (Surgery to relieve obstruction)
22. B
23. C
24. B
25. H
26. E
27. C
28. D
29. G (Cardiac tamponade)
30. A
31. D (CMV infection)
32. D
33. C (Herpes zoster)
34. C (adrenal crisis)
35. B
36. C
37. B
38. F (Isoniazid >> B6 deficiency)
39. E
40. D (Warfarin contraindicated in pregnancy)
41. E
42. F
43. D
44. B
45. C
46. D (tension pneumothorax >> decreased venous return)

Block 4

1. A (breath holding spell >> reassurance)
2. A (RR shows a relationship but p value is statistically insignificant)
3. B
4. E (anaphylaxis)
5. E (high clinical suspicion with low-probability VQ scan >> angiography)
6. F
7. C (multiple areas of increased and decreased uptake >> MNG)
8. G
9. C (acute presentation makes aortic valve rupture more likely than congestive heart failure)
10. B (in a terminally ill patient, the priority is pain control)
11. A (erythema toxicum >> self-limiting condition)
12. C (MR, large testes >> fragile X syndrome)
13. E (Digoxin toxicity)
14. E
15. F (previous episodes of a sudden decline of cognitive functioning >> multi-infarct dementia)
16. C
17. E (delirium tremens)
18. D
19. J (proximal muscle weakness, polymyositis is one of the causes)
20. E
21. E
22. D (Mitral stenosis; most common cause RHD)
23. E (Mastitis: antibiotics, continue breast feeding)
24. A (Ephedrine is a sympathomimetic drug. For the treatment of hypotension during spinal anesthesia.)
25. B (Metoprolol improves mortality in heart disease)
26. F
27. D (Chronic Granulomatous disease)
28. D (S4 points towards MI)
29. D
30. A
31. C (thiazide diuretic >> gout)
32. B
33. D (GI obstruction >> NG tube first step)
34. D (HTN in young patient >> look for renal artery stenosis)
35. A (Malignancy related hypercalcemia fits best: Depression, Muscle weakness and fatigue, decreased tendon reflex, weight loss. Hypothyroidism wouldn't account for the weight loss.)
36. A
37. C (insulin and glucose >> fastest way to lower down serum K)
38. E (she is asymptomatic, no treatment at this point is indicated)
39. D (intussusception >> contrast enema both diagnostic and therapeutic)
40. C (ectopic pregnancy)
41. D
42. D
43. C
44. A (Hepatic artery complications are very common following liver transplant in children.)
45. A (http://pediatrics.aappublications.org/content/65/6/1125.abstract)
46. C

Step 2 CK NBME Form 1 (Offline) Answer Key

Step 2 CK NBME 1


Block 1

1. C (none of other options provides evidence of peritonitis)
2. B
3. B
4. B (increase in reticulocyte count, with African American patient using TMP-SMX >> probably hemolytic anemia secondary to G6PD deficiency)
5. C (Dementia, decreased gag reflex, increase risk of aspiration pneumonia)
6. F
7. D
8. C (epidural + increased postvoid residual urine >> overflow incontinence)
9. I (Pseudodementia secondary to Major Depression. Hints: trouble sleeping, decreased appetite, psychomotor retardation, a flat affect, past history of treatment response.)
10. H
11. C (hint: relief of wheezing with neck extension >> vascular ring)
12. A (Nursemaid's elbow, subluxation of radial head)
13. G (probably secondary to Arnold Chiari malformation)
14. C (always do US to confirm gestational age when there is abnormal MSAFP level)
15. F
16. C (low protein diet >> low BUN)
17. B (CT is investigation of choice for Diverticulitis)
18. F (DiGeorge syndrome)
19. E
20. D (Eaton Lambert syndrome)
21. B
22. D (suspect sexual abuse)
23. B
24. E
25. D
26. D
27. No picture with offline NBME. Other keys say A.
28. A (Aortic regurgitation, Marfan syndrome)
29. B
30. B
31. E (Coarctation of Aorta)
32. C (Gallstone ileus, hints: the pattern of air in X ray)
33. C (Epidural also causes Bradycardia. Patient is Tachycardic, so A option is out.)
34. A
35. B
36. D (a hematoma [E] would have resolved by now. Tumors are often noticed after injury.)
37. E (buzz-word: macro-orchidism)
38. B
39. E*
40. D
41. C
42. A (Eczema herpeticum: numerous umbilicated vescicles superimposed on healing atopic dermatitis)43. C
44. C (patient has resistent depression and a very high risk of another suicide attempt >> contraindication for transplant)
45. A
46. D

Block 2


1. D (decreased reflex and decreased vibration sense are part of normal aging.)
2. D (diabetic ketoacidosis)
3. A
4. D (Erythema nodosum, extraintestinal manifestation of IBD)5. D
6. E
7. F
8. E
9. G
10. C (Osteoblastic lesions >> prostate mets)
11. E (Patient-controlled analgesia is the treatment of choice for moderate to severe postop pain)
12. D
13. B (wikipedia: "GGT is elevated by large quantities of alcohol ingestion. Isolated elevation or disproportionate elevation compared to other liver enzymes (such as ALP or ALT) may indicate alcohol abuse or alcoholic liver disease.")
14. E (thoughts of suicide and infanticide >> indications for hospitalization)
15. C (COPD and Peripheral arterial disease >> contraindications for Beta-Blockers)
16. D (typical description of murmur)
17. G
18. A (Echo to diagnose cardiac tamponade. There is some controversy whether the term Paracentesis can be used synonymously with Pericardiocentesis. If it can be, then E might be the answer given the hemodynamic instability.)
19. H
20. N
21. B
22. B (MMSE score less than 24 indicates dementia)
23. E
24. E
25. E (Both Influenza and DT are indicated in this person. however, as they do not mention the time of the year [influenza given only at the start of flu season] so DT looks more likely answer)
26. C ((thrombocytopenia >> thrombocytopenia)
27. D (hint: anaphylactic reaction to blood transfusion)
28. E
29. A
30. A
31. A
32. D (Mycoplasma pneumonia)
33. B
34. F (hints: calcifications anterior to the vertebral bodies+ BP 105/65 mm Hg)
35. E
36. E
37. D
38. D
39. No picture with offline NBME
40. E (only option that is employed for acne)
41. D (pap-smear is only done up till age 65, mammography up till 70)
42. D
43. B (hint: multiple tender spots over the neck, shoulders, and lumbar spine)44. B (ACEI show mortality benefit, ARBs do not)
45. B
46. B (ECG changes with hyperkalemia >> immediate IV calcium gluconate)


Block 3

1. F (Addison's disease)
2. C (dilated cardiomyopathy secondary to viral myocarditis)
3. B (persistent vomiting: low Cl, high HCO3)
4. B (mastoiditis)
5. E
6. C
7. A (simple uncomplicated lumber disk herniaton)
8. C
9. A
10. E (Imaging studies are not sensitive for the diagnosis of endometriosis)
11. C
12. C
13. A (+ive Progestin challenge test >> anovulation)
14. E
15. D
16. A (septic emboli from infectious endocarditis)
17. B
18. G
19. C (IV drug abuse >> HIV)
20. D
21. C (Its PE so heparin. In fat embolism there is petechial rash in the axilla and neck ans also bilateral patchy infiltrates on CXR.)
22. A
23. A
24. C
25. C (depressive patient >> rule out suicidal ideation)
26. C (scurvy)
27. A
28. E
29. A
30. B (intussusception)
31. B
32. B (Pica >> Fe deficiency anemia)
33. E (Lithium >> thyroid dysfunction)
34. B (milk is low in Fe)
35. A
36. D (Type II diabetes may have increased levels of insulin due to insulin resistance)
37. A (Heparin induced thrombocytopenia)
38. B (TMP-SMX)
39. A (All other are contraindicated in pregnancy)
40. A (there is no reason to examine the patient or do any tests)
41. D (temporal arteritis)
42. C ( LDL is calculated indirectly using the formula C = H+ L + kT
where H is HDL cholesterol, L is LDL cholesterol, C is total cholesterol, T are triglycerides, and k is 0.20 if the quantities are measured in mg/dl and 0.45 if in mmol/l. Because LDL is normal, correct answer is to repeat about five years.)
43. E
44. D (inconsistent condom use >> screen for STDs)
45. B
46. G



Block 4

1. H (Chronic hyponatremia >> fluid restriction)
2. E (Thymoma associated with Myasthenia gravis)
3. D (Immunosuppression with typical X ray pattern)
4. D
5. D
6. G (optic  neuritis)
7. F (carpal tunnel syndrome)
8. P
9. B (Pompe's disease >> floppy infant appearance, feeding difficulties, macroglossia, hepatomegaly, and heart failure from a progressively hypertrophic cardiomyopathy)
10. A (Pheochromocytoma)
11. H
12. A (estrogen can increase sex hormone binding protein, cause testosterone unavailable, cause decreased libido)
13. I (Vitamin K deficiency)
14. B
15. B (if the patient was middle aged, it could be Berger's, option D)
16. D
17. C
18. E (too late for any prophylaxis now)
19. C (adrenoleukodystrophy)
20. B (hint: lung mets)
21. A
22. C (hyaline casts can be seen in setting of dehydration)
23. E
24. D (Crohn's disease)
25. A
26. E
27. B (negative strep test in children needs to be confirmed by Throat culture because Strep A is common and carries dangerous sequlae and needs to be excluded)
28. B
29. E
30. A
31. D
32. D (analgesic nephropathy)
33. B
34. D
35. A (yogurt and cottage cheese are low in lactose. Probably a case of irritable bowel syndrome)
36. G
37. F
38. E
39. E
40. B
41. B
42. C (HIV seems more likely compared to other options)
43. B
44. E
45. F
46. C (Haloperidol decanoate for non compliant patients in depot form. Fluphenazine can also be given as a depot form but as fluphenazine decanoate but not fluphenazine hydrochloride.)



Step 1 NBME Form 6 (Offline) Answer Key


Step 1 NBME Form 6

Block 1

1. B
2. C
3. C
4. B
5. B 
6. D
7. C 
8. B
9. A
10. F
11. B
12. E
13. A
14. D
15. E
16. B
17. B
18. A
19. B
20. A
21. E
22. A
23. E
24. A
25. B
26. E
27. B
28. D
29. B
30. A
31. C
32. C
33. A
34. A
35. B
36. C
37. D
38. E
39. E
40. D
41. A
42. E
43. E
44. A
45. A
46. A
47. E
48. C
49. A
50. B

Block 2

1. A
2. H
3. J
4. E
5. C
6. D
7. B
8. C
9. E
10. E
11. A
12. C
13. A
14. E
15. A
16. C
17. E
18. C
19. B
20. C
21. E
22. A 
23. A
24. A
25. D
26. F
27. E
28. E
29. B
30. D
31. D
32. C
33. E
34. E
35. A
36. C
37. A
38. E
39. A
40. A
41. B
42. B
43. B
44. C
45. B
46. E
47. A
48. C
49. C
50. B

Block 3

1. B
2. C
3. E
4. B
5. A
6. B
7. C
8. E
9. B
10. D
11. C
12. F
13. E
14. B
15. C
16. B
17. B
18. B
19. D
20. C
21. D
22. B
23. C
24. B
25. A
26. E
27. C
28. A
29. A
30. D
31. E
32. D
33. C
34. E
35. A
36. H
37. D
38. E
39. D
40. A
41. B
42. E
43. A
44. E
45. C
46. E
47. D
48. B
49. H
50. E

Block 4

1. E
2. A
3. C
4. B
5. D
6. B
7. E
8. A
9. D
10. E
11. C
12. C
13. C
14. A
15. D
16. A
17. F
18. E
19. D
20. H
21. C
22. C
23. B
24. B
25. C
26. D
27. B
28. D
29. A
30. B
31. A
32. C
33. D
34. C
35. C
36. A
37. B
38. A
39. F
40. C
41. E
42. B
43. B
44. E
45. B
46. F
47. D
48. D
49. D
50. I

Step 1 NBME Form 5 (Offline) Answer Key



Step 1 NBME Form 5

Block 1

1. A
2. B
3. E
4. A
5. B
6. E
7. B
8. B
9. A
10. E
11. B
12. B
13. B
14. B
15. A
16. A
17. B
18. A
19. F
20. D
21. B
22. D
23. B
24. C
25. A
26. E
27. A
28. D
29. E
30. B
31. B
32. D
33. F
34. C
35. D
36. E
37. B
38. G
39. C 
40. B
41. E
42. A
43. A
44. C
45. C
46. B (Sarcoidosis)
47. D
48. D
49. B
50. C

Block 2

1. E
2. D
3. F
4. D
5. D
6. B
7. D
8. D
9. B
10. C
11. E
12. E
13. A
14. B
15. A
16. E
17. F
18. C
19. C
20. A
21. D
22. G
23. F
24. C
25. A
26. E
27. D
28. C
29. D
30. E
31. A
32. A
33. B
34. E
35. A
36. B
37. E
38. E
39. F
40. E
41. A
42. A
43. A
44. E
45. D
46. E
47. D
48. F
49. A
50. E

Block 3

1. D
2. C
3. D
4. A (Alcohol increases toxicity of statins)
5. E
6. A
7. A
8. D
9. D
10. C
11. C
12. D
13. D
14. C
15. C
16. A
17. E
18. C
19. B
20. C
21. E
22. E
23. B
24. E
25. B
26. D
27. A
28. C
29. C
30. A
31. A
32. B
33. D
34. E
35. E
36. C
37. B
38. C
39. D
40. E
41. D
42. E /B?
43. B
44. A
45. D
46. H
47. E
48. D
49. E
50. C

Block 4

1. A
2. A
3. E
4. C
5. D
6. F
7. D
8. B
9. C
10. B
11. E
12. E
13. F
14. C
15. C
16. B
17. D
18. A
19. B
20. D
21. A
22. D
23. D
24. C
25. A
26. D
27. C
28. F
29. D
30. A
31. C
32. B
33. C
34. C
35. G
36. B
37. C
38. E
39. C 
40. A
41. E
42. D
43. D
44. D
45. C
46. D
47. A
48. D
49. E
50. C

Step 1 NBME Form 4 (Offline) Answer Key


Step 1 NBME 4

Block 1

1. A
2. D
3. B
4. E
5. D
6. B
7. E
8. B
9. D
10. D
11. C
12. E
13. G
14. B
15. E
16. E
17. D
18. C
19. I
20. B
21. H
22. B
23. A
24. A
25. B
26. C
27. D
28. B
29. E
30. B
31. C
32. B
33. A
34. A
35. E
36. D
37. J
38. C
39. B
40. A
41. E
42. F
43. C
44. C
45. B
46. C
47. G
48. E
49. B
50. E

Block 2

1. B
2. C
3. A
4. D
5. C
6. D
7. A
8. D
9. A
10. D
11. E
12. B
13. A
14. A
15. B
16. D
17. C
18. D
19. C
20. A
21. F
22. C
23. D
24. B
25. D
26. C
27. B
28. D /A (doubtful)
29. G
30. A
31. D
32. E
33. C
34. C
35. D
36. F
37. C
38. E
39. F
40. C
41. D
42. F
43. B
44. A
45. D
46. E
47. B
48. D
49. C
50. C

Block 3

1. C
2. C
3. C
4. F
5. E
6. B
7. B
8. A
9. E
10. G
11. E
12. A
13. A
14. D
15. C
16. E
17. E
18. A
19. A
20. A
21. B
22. F
23. A
24. E
25. E
26. C
27. A
28. F
29. B
30. A
31. E
32. B
33. A
34. A
35. B
36. D
37. C
38. F
39. A
40. D
41. B
42. F
43. A
44. B
45. E
46. D
47. B
48. D
49. D
50. D

Block 4

1. A
2. D
3. C
4. A
5. A
6. B
7. A
8. B
9. A
10. F
11. A
12. E
13. A
14. B
15. E
16. F /E (confusion)
17. A
18. D
19. E
20. A
21. A
22. D
23. E
24. B
25. E
26. B
27. B
28. D
29. A
30. H
31. E
32. G
33. E
34. D
35. A
36. A
37. A
38. G
39. B
40. C
41. C
42. E
43. D
44. B
45. E
46. E
47. C
48. C
49. C
50. B

Step 1 NBME Form 3 (Offline) Answer Key


Step 1 NBME Form 3

Block 1

1. B
2. D
3. E
4. A
5. E
6. H
7. C
8. A
9. F
10. A
11. B
12. D
13. C
14. E
15. D
16. C
17. E
18. B
19. Infectious Mononucleosis
20. B
21. C
22. A
23. A
24. A
25. E
26. C
27. C
28. D
29. A
30. C
31. B
32. E
33. D
34. E
35. C
36. A
37. C
38. D
39. C
40. E
41. B
42. A
43. J
44. D
45. D
46. B
47. C
48. B
49. D
50. C

Block 2

1. A
2. A
3. D
4. C
5. C
6. E
7. E
8. C
9. D
10. B
11. G
12. A
13. G
14. D
15. C
16. D
17. C
18. B
19. D
20. E
21. C
22. C
23. C
24. B
25. C
26. D
27. B
28. C
29. C
30. A
31. C
32. F
33. A
34. C
35. C
36. A
37. B
38. A
39. C
40. E
41. D
42. D
43. D
44. E
45. B
46. F
47. B
48. A
49. A
50. C

Block 3

1. C
2. C
3. A
4. C
5. E
6. B
7. C
8. J
9. C
10. C
11. C
12. A
13. D
14. B
15. C
16. E
17. C
18. E
19. E
20. D
21. E
22. B
23. D
24. A
25. F
26. E
27. C
28. F
29. E
30. D
31. D
32. C
33. C
34. A
35. A
36. D
37. C
38. E
39. B
40. E
41. E
42. A
43. D
44. E
45. D
46. G
47. D
48. E
49. A
50. B

Block 4

1. C
2. B
3. C
4. C
5. E
6. C
7. A
8. A
9. C
10. B
11. C
12. C
13. A
14. F
15. E
16. D
17. C
18. E
19. A
20. D
21. B
22. B
23. E
24. A
25. C
26. D
27. A
28. D
29. B
30. E
31. B
32. E
33. B
34. A
35. D
36. E
37. A
38. E /A (doubtful)
39. C
40. E
41. F
42. C
43. D
44. A
45. E
46. C
47. A
48. B
49. C
50. B

Step 1 NBME Form 2 (Offline) Answer Key


Step 1 NBME Form 2

Block 1

1. B
2. G
3. B
4. A
5. D
6. A
7. C
8. A
9. C
10. E
11. A
12. H
13. D
14. B
15. C
16. E
17. C
18. B
19. B
20. C
21. D
22. A
23. A
24. B
25. A
26. A
27. C
28. D
29. B
30. E
31. D
32. A
33. B
34. C
35. C
36. C
37. E
38. D
39. D
40. E
41. C
42. C
43. B
44. B
45. B
46. G
47. E
48. A
49. E
50. C

Block 2

1. C
2. A
3. D
4. C
5. C
6. C
7. D
8. A
9. B
10. E
11. C
12. E
13. B
14. A
15. A
16. D
17. B
18. B
19. D
20. A
21. E
22. A
23. E
24. A
25. G
26. A
27. F
28. B
29. C
30. A
31. A
32. B
33. E
34. D
35. E
36. D
37. D
38. F
39. E
40. B
41. C
42. D
43. D
44. E
45. D
46. D
47. E
48. C
49. C
50. C

Block 3

1. C
2. B
3. E /B/D?
4. C
5. F
6. A
7. B
8. E
9. E
10. E
11. C
12. D
13. A
14. D
15. E
16. B
17. D
18. A
19. B
20. D
21. D
22. B
23. D
24. E
25. B
26. C
27. D
28. C
29. A
30. B
31. A
32. F
33. B
34. A
35. B
36. F
37. D
38. E
39. B
40. C
41. C
42. A
43. B
44. E
45. D
46. E
47. D
48. D
49. C
50. B

Block 4

1. D
2. D
3. D
4. E
5. B
6. A
7. D
8. E
9. C
10. D
11. C
12. A
13. B
14. C
15. A
16. C
17. C
18. B
19. A
20. E
21. D
22. E
23. C
24. C
25. B
26. I
27. C
28. D
29. A
30. D
31. E
32. F
33. A
34. B
35. D
36. D
37. C
38. B
39. A
40. B
41. A
42. B
43. D
44. C
45. A
46. E
47. D
48. C
49. B
50. C

Step 1 NBME Form 1 (Offline) Answer Key

Step 1 NBME Form 1

Block 1

1. B
2. C
3. B
4. E
5. B
6. A
7. I
8. E
9. A
10. E
11. D
12. E
13. B
14. B
15. B
16. D
17. A
18. B
19. C
20. B
21. C
22. C
23. E
24. C
25. A
26. E
27. F
28. A
29. D
30. D
31. D
32. D
33. A
34. H
35. A
36. E
37. E
38. D
39. B
40. B
41. E
42. D
43. B
44. B
45. A
46. D
47. C
48. C
49. D
50. A


Block 2

1. E
2. A
3. A
4. C
5. C
6. B
7. F
8. D
9. D
10. A
11. A
12. D
13. A
14. C
15. D
16. H
17. A
18. C
19. G
20. B
21. B
22. C
23. D
24. C
25. C
26. D
27. D
28. C
29. C
30. B
31. A
32. C /F ?
33. B
34. C
35. D
36. B
37. E
38. C 
39. C
40. A
41. D
42. F
43. A
44. B
45. C
46. A
47. D
48. C
49. D
50. C

Block 3

1. B
2. C
3. D
4. C
5. A
6. B
7. E
8. D
9. B
10. A
11. C
12. E
13. A
14. E
15. E
16. C
17. E
18. E
19. D
20. B
21. B
22. B
23. G
24. D
25. E
26. D
27. E
28. A
29. E
30. B
31. B
32. B
33. A
34. A
35. D
36. D
37. B
38. B
39. D
40. A
41. A
42. D
43. C
44. C
45. D
46. A
47. D
48. B
49. C
50. A

Block 4

1. A
2. B
3. A
4. F
5. C
6. H
7. C
8. A
9. E
10. D
11. E
12. B
13. B
14. A
15. B
16. E
17. c
18. D
19. C
20. A
21. I
22. B
23. E
24. D
25. B
26. C
27. C
28. A
29. D
30. G
31. B
32. E
33. E
34. E
35. D
36. E
37. A
38. C
39. E
40. D
41. D
42. A
43. E
44. C
45. B
46. A
47. H
48. C
49. C
50. E