NBME CBSE ACTUAL TEST PAPER 2026
QUESTIONS WITH SOLUTIONS GRADED A+
●● 38yo M truck driver with 1-week hx of watery, itchy eyes and a
runny nose. Physical shows inflamed nasal mucosa. No congestion in
lower lung. Pharmacotherapy? Answer: Loratadine--> less sedating
antihistamine
●● 16yo girl with 3-day hx of fever, nonproductive cough, and fatigue.
T 38.3, P 88/min, BP 102-70. PE shows pale conjunctivae. CXR shows
bilateral interstitial infiltrates. Blood spontaenously agglutinates while
awaiting transport to the laboratory. Antibody isotypes causing
agglutination? Answer: IgM (mono and mycoplasma)
●● 24yo M with small tender blisters on his penis 3 days after
unprotected sex. Photograph shown. Causal agent? Answer: HSV-2
●● 42yo F with 3-year hx of an intermittent facial rash, including the
forehead, eyelids, nose, and cheeks. Rash seems to be getting worse
since she moved from New York to Florida last year. Spicy foods
precipitate a flushing reaction that seems to exacerbate the rash. PE
shows erythema over the nose and cheeks, with scattered telangiectasias
and a few papules. Dx? Answer: Rosacea
,●● 53yo M returned from Africa, has fever, headache, and abdominal
discomfort. Received appropriate vaccinations prior to the trip. T 39.4C.
A wright-stained peripheral smear shown (ring forms in RBCs). Dx?
Answer: Malaria
●● 68yo F with T2DM and hypertension that has been poorly controlled
despite hydrochlorothiazide treatment. BP 150/96, Labs show serum
glucose concentration of 130 and proteinuria. In addition to current Rx,
which is most appropriate pharmacotherapy? Answer: ACE I (Lisinopril)
●● 66yo M with stage IV colon cancer with 3-day hx of severe diarrhea
after receiving chemotherapy with flourouracil, leucovorin, and
irinotecan. Prescribed opioid antidiarrheal agent with no CNS effects.
Which med? Answer: Loperamide
●● 35yo M in ED with 2-hour hx of sever fatigue and dizziness. Had
profuse, watery diarrhea for 8 hours despite a lack of oral intake.
Recently returned from a medical relief trip to a remove village in
Honduras. T 36.7 C, P 122/min, BP 90/50. PE shows dry skin and
decreased capillary refill. Stool for occult blood is negative; stool is gray
and turbid. Gram stain shows gram-negative, comma-shaped bacteria;
no erythrocytes of leukocytes. MOA of toxin? Answer: V. Cholerae-->
activates AC
●● 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 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
●● 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
QUESTIONS WITH SOLUTIONS GRADED A+
●● 38yo M truck driver with 1-week hx of watery, itchy eyes and a
runny nose. Physical shows inflamed nasal mucosa. No congestion in
lower lung. Pharmacotherapy? Answer: Loratadine--> less sedating
antihistamine
●● 16yo girl with 3-day hx of fever, nonproductive cough, and fatigue.
T 38.3, P 88/min, BP 102-70. PE shows pale conjunctivae. CXR shows
bilateral interstitial infiltrates. Blood spontaenously agglutinates while
awaiting transport to the laboratory. Antibody isotypes causing
agglutination? Answer: IgM (mono and mycoplasma)
●● 24yo M with small tender blisters on his penis 3 days after
unprotected sex. Photograph shown. Causal agent? Answer: HSV-2
●● 42yo F with 3-year hx of an intermittent facial rash, including the
forehead, eyelids, nose, and cheeks. Rash seems to be getting worse
since she moved from New York to Florida last year. Spicy foods
precipitate a flushing reaction that seems to exacerbate the rash. PE
shows erythema over the nose and cheeks, with scattered telangiectasias
and a few papules. Dx? Answer: Rosacea
,●● 53yo M returned from Africa, has fever, headache, and abdominal
discomfort. Received appropriate vaccinations prior to the trip. T 39.4C.
A wright-stained peripheral smear shown (ring forms in RBCs). Dx?
Answer: Malaria
●● 68yo F with T2DM and hypertension that has been poorly controlled
despite hydrochlorothiazide treatment. BP 150/96, Labs show serum
glucose concentration of 130 and proteinuria. In addition to current Rx,
which is most appropriate pharmacotherapy? Answer: ACE I (Lisinopril)
●● 66yo M with stage IV colon cancer with 3-day hx of severe diarrhea
after receiving chemotherapy with flourouracil, leucovorin, and
irinotecan. Prescribed opioid antidiarrheal agent with no CNS effects.
Which med? Answer: Loperamide
●● 35yo M in ED with 2-hour hx of sever fatigue and dizziness. Had
profuse, watery diarrhea for 8 hours despite a lack of oral intake.
Recently returned from a medical relief trip to a remove village in
Honduras. T 36.7 C, P 122/min, BP 90/50. PE shows dry skin and
decreased capillary refill. Stool for occult blood is negative; stool is gray
and turbid. Gram stain shows gram-negative, comma-shaped bacteria;
no erythrocytes of leukocytes. MOA of toxin? Answer: V. Cholerae-->
activates AC
●● 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 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
●● 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
