NBME 26 EXAM PREP
NBME 26 EXAM PREP LATEST 2025/2026 ACTUAL
EXAM COMPLETE 200 QUESTIONS AND CORRECT
ANSWERS WITH DETAILED RATIONALES GRADED A+
GUARANTEED PASS- ACE YOUR EXAM
1
----------
Exam Section 1: Item 2 of 50
National Board of Medical Examiners
Comprehensive Basic Science Self-Assessment
2. A 62-year-old man is being evaluated for rectal bleeding. An x-ray of the
gastrointestinal tract with contrast material is shown. Which of the following is the
most likely explanation for the feathery appearance
in the portion of the gastrointestinal tract indicated by X when compared with the
portion indicated by Y?
O A) Absence of circular muscle
B) Fewer villi
C) Greater bowel motility
D) Greater mucosal surface area
E) Less circular and longitudinal smooth muscle - Correct Answer-D.
The jejunum (X) can be distinguished from the ileum (Y) by several characteristic
features. The inner mucosal folds, or plicae circulares, are more prominent, more
1|Page
, NBME 26 EXAM PREP
numerous, and taller in the jejunum compared to the ileum. This leads to an
increased mucosal
surface area and an associated feathered appearance after the administration of
oral contrast material. The jejunum also demonstrates a larger caliber, thicker
muscular walls, longer vasa rectae, and fewer arcades. The ileum is notable for the
presence of Peyer
patches and mucosal lymphoid follicles, which can be identified histologically.
Incorrect Answers: A, B, C, and E.
Absence of circular muscle (Choice A) is not a feature of either the jejunum or the
ileum. The muscularis externa, which is organized into circular and longitudinal
layers, extends through all segments of the small intestine.
Fewer villi (Choice B) is not a feature of the jejunum. Both the jejunum and the
ileum contain villi. However, the plicae circulares are much more prominent and
numerous in the jejunum, leading to an increased overall surface area and an
associated increased
number of mucosal villi compared to the ileum.
Greater bowel motility (Choice C) is not a distinguishing characteristic of the
jejunum as compared to the ileum. Bowel motility is controlled by peristaltic
contractions and migrating motor complexes that are under the control of the
enteric and central nervous
systems.
Less circular and longitudinal smooth muscle (Choice E) is a feature of the ileum
(Y) rather than the jejunum (X). The jejunum has a thicker muscular wall in
comparison to the ileum, but its feathered appearance with oral contrast material
is primarily due to its
prominent plicae circulares and increased mucosal surface area.
Educational Objective: The jejunum possesses several characteristic features, in
2|Page
, NBME 26 EXAM PREP
2
----------
Exam Section 1: Item 3 of 50
National Board of Medical Examiners
Comprehensive Basic Science Self-Assessment
3. A 65-year-old man who has chronic lymphocytic leukemia has the sudden onset
of fatigue and shortness of breath. Laboratory studies show:
Hemoglobin
Hematocrit
Leukocyte count
Platelet count
6.5 g/dL
19%
50,000/mm3
170,000/mm3
8%
Reticulocyte count
Serum bilirubin
4 mg/dL
0.5 mg/dL
Total
Conjugated
3|Page
, NBME 26 EXAM PREP
A peripheral blood smear is shown. Which of the following is the most likely cause
of the anemia?
A) Aplastic anemia
B) Autoimmune hemolysis
C) Hereditary spherocytosis
D) Microangiopathic hemolysis
E}Monoclonal gammopathy - Correct Answer-B.
Autoimmune hemolysis explains this patient's anemia, unconjugated
hyperbilirubinemia, reticulocytosis (large blue-colored erythrocytes), and
spherocytes on the peripheral smear. Autoimmune hemolytic anemia (AIHA)
occurs due to production of antibodies
targeting circulating red blood cell (RBC) surface antigens, marking them for
removal in the reticuloendothelial system (RES) or fixing complement leading to
intravascular hemolysis. IgG antibodies are active at the physiologic temperature
of the human body
(called "warm AIHA"); these do not routinely activate complement. Instead, they
mark the cells for removal. Phagocytosis of the IgG antibody along with a
component of the erythrocyte membrane creates sphere-shaped RBCS seen on
peripheral smear. In
contrast, IgM antibodies bind and fix complement at lower temperatures and
result in intravascular hemolysis (called "cold AIHA"). IgG antibodies are known as
"warm" antibodies, and IgM antibodies are known as "cold" antibodies.
Regardless of the type of
antibody, laboratory findings demonstrate a normocytic anemia, an increased
reticulocyte count indicating hematopoiesis, and unconjugated hyperbilirubinemia
from hemoglobin released from lysed erythrocytes. Diagnosis is made by
laboratory analysis, a
4|Page
NBME 26 EXAM PREP LATEST 2025/2026 ACTUAL
EXAM COMPLETE 200 QUESTIONS AND CORRECT
ANSWERS WITH DETAILED RATIONALES GRADED A+
GUARANTEED PASS- ACE YOUR EXAM
1
----------
Exam Section 1: Item 2 of 50
National Board of Medical Examiners
Comprehensive Basic Science Self-Assessment
2. A 62-year-old man is being evaluated for rectal bleeding. An x-ray of the
gastrointestinal tract with contrast material is shown. Which of the following is the
most likely explanation for the feathery appearance
in the portion of the gastrointestinal tract indicated by X when compared with the
portion indicated by Y?
O A) Absence of circular muscle
B) Fewer villi
C) Greater bowel motility
D) Greater mucosal surface area
E) Less circular and longitudinal smooth muscle - Correct Answer-D.
The jejunum (X) can be distinguished from the ileum (Y) by several characteristic
features. The inner mucosal folds, or plicae circulares, are more prominent, more
1|Page
, NBME 26 EXAM PREP
numerous, and taller in the jejunum compared to the ileum. This leads to an
increased mucosal
surface area and an associated feathered appearance after the administration of
oral contrast material. The jejunum also demonstrates a larger caliber, thicker
muscular walls, longer vasa rectae, and fewer arcades. The ileum is notable for the
presence of Peyer
patches and mucosal lymphoid follicles, which can be identified histologically.
Incorrect Answers: A, B, C, and E.
Absence of circular muscle (Choice A) is not a feature of either the jejunum or the
ileum. The muscularis externa, which is organized into circular and longitudinal
layers, extends through all segments of the small intestine.
Fewer villi (Choice B) is not a feature of the jejunum. Both the jejunum and the
ileum contain villi. However, the plicae circulares are much more prominent and
numerous in the jejunum, leading to an increased overall surface area and an
associated increased
number of mucosal villi compared to the ileum.
Greater bowel motility (Choice C) is not a distinguishing characteristic of the
jejunum as compared to the ileum. Bowel motility is controlled by peristaltic
contractions and migrating motor complexes that are under the control of the
enteric and central nervous
systems.
Less circular and longitudinal smooth muscle (Choice E) is a feature of the ileum
(Y) rather than the jejunum (X). The jejunum has a thicker muscular wall in
comparison to the ileum, but its feathered appearance with oral contrast material
is primarily due to its
prominent plicae circulares and increased mucosal surface area.
Educational Objective: The jejunum possesses several characteristic features, in
2|Page
, NBME 26 EXAM PREP
2
----------
Exam Section 1: Item 3 of 50
National Board of Medical Examiners
Comprehensive Basic Science Self-Assessment
3. A 65-year-old man who has chronic lymphocytic leukemia has the sudden onset
of fatigue and shortness of breath. Laboratory studies show:
Hemoglobin
Hematocrit
Leukocyte count
Platelet count
6.5 g/dL
19%
50,000/mm3
170,000/mm3
8%
Reticulocyte count
Serum bilirubin
4 mg/dL
0.5 mg/dL
Total
Conjugated
3|Page
, NBME 26 EXAM PREP
A peripheral blood smear is shown. Which of the following is the most likely cause
of the anemia?
A) Aplastic anemia
B) Autoimmune hemolysis
C) Hereditary spherocytosis
D) Microangiopathic hemolysis
E}Monoclonal gammopathy - Correct Answer-B.
Autoimmune hemolysis explains this patient's anemia, unconjugated
hyperbilirubinemia, reticulocytosis (large blue-colored erythrocytes), and
spherocytes on the peripheral smear. Autoimmune hemolytic anemia (AIHA)
occurs due to production of antibodies
targeting circulating red blood cell (RBC) surface antigens, marking them for
removal in the reticuloendothelial system (RES) or fixing complement leading to
intravascular hemolysis. IgG antibodies are active at the physiologic temperature
of the human body
(called "warm AIHA"); these do not routinely activate complement. Instead, they
mark the cells for removal. Phagocytosis of the IgG antibody along with a
component of the erythrocyte membrane creates sphere-shaped RBCS seen on
peripheral smear. In
contrast, IgM antibodies bind and fix complement at lower temperatures and
result in intravascular hemolysis (called "cold AIHA"). IgG antibodies are known as
"warm" antibodies, and IgM antibodies are known as "cold" antibodies.
Regardless of the type of
antibody, laboratory findings demonstrate a normocytic anemia, an increased
reticulocyte count indicating hematopoiesis, and unconjugated hyperbilirubinemia
from hemoglobin released from lysed erythrocytes. Diagnosis is made by
laboratory analysis, a
4|Page
