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NBME CBSE REAL EXAM (USMLE STEP 1) MEDICAL EXAMINATION
NEWEST 2026 ACTUAL EXAM WITH COMPLETE QUESTIONS AND
CORRECT DETAILED ANSWERS (100% VERIFIED ANSWERS)
|ALREADY GRADED A+| ||PROFESSOR VERIFIED||
35yo M with recurrent sinusitis and bronchitis. Cardiac
examination shows PMI at fourth intercostal space within the
midclavicular line on the right. Hepatic margin is palpable on the
left. Endoscopy shows nasal polyps. Biopsy shows thickened,
ciliated, pseudostratified epithelium with small patches of
squamous metaplasia and mild lymphoid infiltration. Which
structure most likely to be absent on electron microscopic exam of
epithelium? - ANSWER-Kartageners
Dynein arms
30yo primi at 22 weeks' gestation with 1-day hx of fever, chills,
and muscle aches. T 39.4, P 114/min, resp 15/min, BP 104/72.
PE shows uterus consistent with 22-week gestation. Fetahl heart
sounds are heard. WBC 12K, Blood cultures grow gram-positive
rods. Causal organism? - ANSWER-Listeria
42yo M with multiple lesions over his body. PE shows flaccid
bullous erosions involving upper and lower extremities and torso.
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Biopsy shows extensive epidermal acantholysis resulting in the
formation of intraepidermal blister. Intact basal layer of
keratinocytes adherent to basement membrane is identified.
Which is related to pathogenesis? - ANSWER-Pemphigus;
antibodies against desmosomal proteins
59yo F with gradual onset of lack of muscle control in her left arm
and leg. Sx 1 mo ago after dx with metastatic breast cancer. PE
shows ataxia of left upper and lower extremities. Muscle strength,
DTR, sensation, proprioception normal. Metastatic tumor in which
location? - ANSWER-Cerebellum
Newborn delivered at 38 weeks' gestation weighs 1800 g. PE
shows petechial rash, microcephaly, and hepatosplenomegaly.
Serologic test for CMV: IgG + in mother, + in newborn; IGM - in
mother, + in newborn. Explanation? - ANSWER-Congenital CMV
infection
Female newborn is delivered at 38 weeks' gestation. Apgar 8 and
8 at 1/5 min. PE shows a bulging, fluod0filled mass approximately
5 cm in diameter in the midline over the lumbosacral region. No
spontaneous movements of the lower extremities. Abnormality
most likely occurred because of abnormal development during
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which periods of postconception (in days)? - ANSWER-15-40;
neutral tube closes at about 4 weeks
64yo M in ED 3 hours after SOB with exertion and extreme
fatigue. Has ischemic heart disease. P 125/min, BP 105/60. ECG
shows atrial fibrillation. Intravenous ibutilide is administered. Ten
minutes later, ECG shows normal sinus rhythm. Risk for which
drug effect in the next 6 hours? - ANSWER-Torsades de pointes
65yo F with 20-year hx of osteoarthritis of the hands now has pain
radiating down the distal anterior thigh, knee, medial leg, and
food. Bony outgrowth of vertebrae compressing one of the spinal
nerves is suspected. Nerve root in which intervertebral foramina is
effected? - ANSWER-L3 to L4
38yo M with 3-year hx of T2DM. Taking an oral antihyperglycemic
agent, he has tried diet and exercise. BMI 32. PE normal. Hb A1c
is 10%. Physician recommends initiation of insulin injections.
Responds, "I know that insulin would help control my blood sugar.
But a lot of people in my family have diabetes, and insulin made
them really sick at times. Patient is at which stage of change? -
ANSWER-Contemplation
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24yo M with 2-day history of an itchy rash on his arms and legs.
Returned from a camping trip in the woods 5 days ago. PE shows
edematous, erythematous rash with linear vesicles. Cause is
activation of which cell types? - ANSWER-T-lymphocytes (type IV
HS)
70yo M from china with poorly differentiated monoclonal
carcinoma of the nasopharynx. DNA probes of neoplastic cells are
most likely to detect genome of which virus? - ANSWER-EBV
24yo M with hx of IVDA could not be aroused. Friend reports that
the patient injected himself with a drug 6 hours ago. Labs show
drug concentration of 0.3. Assuming first-order one-compartment
kinetics, has a half-life of 2 hours, and a volume of distribution of
200 L in this patient. What is quantity of drug (in mg) injected? -
ANSWER-= 200 (0.3) =60
3 half-lives = 120, 240, 480
Compound is taken up by bacterial cells. No energy is necessary
for uptake, and the compound is not concentrated in the cell.
NBME CBSE REAL EXAM (USMLE STEP 1) MEDICAL EXAMINATION
NEWEST 2026 ACTUAL EXAM WITH COMPLETE QUESTIONS AND
CORRECT DETAILED ANSWERS (100% VERIFIED ANSWERS)
|ALREADY GRADED A+| ||PROFESSOR VERIFIED||
35yo M with recurrent sinusitis and bronchitis. Cardiac
examination shows PMI at fourth intercostal space within the
midclavicular line on the right. Hepatic margin is palpable on the
left. Endoscopy shows nasal polyps. Biopsy shows thickened,
ciliated, pseudostratified epithelium with small patches of
squamous metaplasia and mild lymphoid infiltration. Which
structure most likely to be absent on electron microscopic exam of
epithelium? - ANSWER-Kartageners
Dynein arms
30yo primi at 22 weeks' gestation with 1-day hx of fever, chills,
and muscle aches. T 39.4, P 114/min, resp 15/min, BP 104/72.
PE shows uterus consistent with 22-week gestation. Fetahl heart
sounds are heard. WBC 12K, Blood cultures grow gram-positive
rods. Causal organism? - ANSWER-Listeria
42yo M with multiple lesions over his body. PE shows flaccid
bullous erosions involving upper and lower extremities and torso.
,2|Page
Biopsy shows extensive epidermal acantholysis resulting in the
formation of intraepidermal blister. Intact basal layer of
keratinocytes adherent to basement membrane is identified.
Which is related to pathogenesis? - ANSWER-Pemphigus;
antibodies against desmosomal proteins
59yo F with gradual onset of lack of muscle control in her left arm
and leg. Sx 1 mo ago after dx with metastatic breast cancer. PE
shows ataxia of left upper and lower extremities. Muscle strength,
DTR, sensation, proprioception normal. Metastatic tumor in which
location? - ANSWER-Cerebellum
Newborn delivered at 38 weeks' gestation weighs 1800 g. PE
shows petechial rash, microcephaly, and hepatosplenomegaly.
Serologic test for CMV: IgG + in mother, + in newborn; IGM - in
mother, + in newborn. Explanation? - ANSWER-Congenital CMV
infection
Female newborn is delivered at 38 weeks' gestation. Apgar 8 and
8 at 1/5 min. PE shows a bulging, fluod0filled mass approximately
5 cm in diameter in the midline over the lumbosacral region. No
spontaneous movements of the lower extremities. Abnormality
most likely occurred because of abnormal development during
,3|Page
which periods of postconception (in days)? - ANSWER-15-40;
neutral tube closes at about 4 weeks
64yo M in ED 3 hours after SOB with exertion and extreme
fatigue. Has ischemic heart disease. P 125/min, BP 105/60. ECG
shows atrial fibrillation. Intravenous ibutilide is administered. Ten
minutes later, ECG shows normal sinus rhythm. Risk for which
drug effect in the next 6 hours? - ANSWER-Torsades de pointes
65yo F with 20-year hx of osteoarthritis of the hands now has pain
radiating down the distal anterior thigh, knee, medial leg, and
food. Bony outgrowth of vertebrae compressing one of the spinal
nerves is suspected. Nerve root in which intervertebral foramina is
effected? - ANSWER-L3 to L4
38yo M with 3-year hx of T2DM. Taking an oral antihyperglycemic
agent, he has tried diet and exercise. BMI 32. PE normal. Hb A1c
is 10%. Physician recommends initiation of insulin injections.
Responds, "I know that insulin would help control my blood sugar.
But a lot of people in my family have diabetes, and insulin made
them really sick at times. Patient is at which stage of change? -
ANSWER-Contemplation
, 4|Page
24yo M with 2-day history of an itchy rash on his arms and legs.
Returned from a camping trip in the woods 5 days ago. PE shows
edematous, erythematous rash with linear vesicles. Cause is
activation of which cell types? - ANSWER-T-lymphocytes (type IV
HS)
70yo M from china with poorly differentiated monoclonal
carcinoma of the nasopharynx. DNA probes of neoplastic cells are
most likely to detect genome of which virus? - ANSWER-EBV
24yo M with hx of IVDA could not be aroused. Friend reports that
the patient injected himself with a drug 6 hours ago. Labs show
drug concentration of 0.3. Assuming first-order one-compartment
kinetics, has a half-life of 2 hours, and a volume of distribution of
200 L in this patient. What is quantity of drug (in mg) injected? -
ANSWER-= 200 (0.3) =60
3 half-lives = 120, 240, 480
Compound is taken up by bacterial cells. No energy is necessary
for uptake, and the compound is not concentrated in the cell.
