NBME CBSE COMPREHENSIVE TEST BANK REAL
EXAM 200 QUESTIONS AND ANSWERS LATEST
2026 COMPLETE EXAM (usmle step 2) MEDICAL
EXAMINATION
37yo M with 4-day hx of diarrhea and abdominal pain, worse in past 24h,
with watery-brown stools. Completed a 10-day course of amoxicillin for a
sinus infection 5 days ago. Stool shows: Fecal fat negative; ova and
parasites negative; Cx for infx negative; C. Diff toxin positive. Which
pathologic findings present in intestinal tract?
ANSWERS: Pseudomembranes of fibrin and inflammatory debris
28yo M in ED 30 minutes after SOB. 3-year hx of cocaine abuse. T 38.1, P
100/min, BP 150/45. PE: diminished pulses in left upper extremity. Crackles
heard over all lung fields. 2/6 diastolic murmur at left sternal border. CXr
shows a widened aortic arch. Dx?
ANSWERS: Dissecting aneurysm
1-week-old girl. screening showed a possible defect in fatty acid oxidation.
PE normal. Next step?
ANSWERS: Measurement of serum acylcarnitine concentrations
,79yoM 30 minutes after LOC for 30 seconds. Alert, but dizzy. No urinary
or fecal incontinence. Pulse 40/min, BP 92/56. PE shows no tongue biting.
Lungs clear, Variable intensity S1. Oriented X3. ECG shows a third-degree
atrioventricular block. Next step?
ANSWERS: Insertion of transvenous pacemaker
55yo M with chronic bronchitis in ED after being unresponsive. Found
bottles of albuterol, ampicillin, codeine, and theophylline bedside. T 37.2 C,
p 112/min, respirations are 6/min, BP 95/60. Acute Rx should include?
ANSWERS: Naloxone
50yo man has persistent cough for 2 months. He has had a 5 kg (11 lb)
weight loss. He is a farmer and on itraconazole 4 weeks for
histoplasmosis from chicken coops. Medications: hydrochlorothiazide,
enalapril, atenolol, omeprazole, and metoclopramide for hypertension and
gastroesophageal reflux. Thin. Physical exam otherwise normal.
Itraconazole interacts with which drug and account for lack of effect of
itraconazole?
ANSWERS: Omeprazole (CYP P450 inhibitor)
,20yo man with 6-hour difficulty breathing and vomiting. 10-year history of
type 1 diabetes on insulin. Pulse 90, respirations 30 and deep, bp 90/60.
Physical shows dehydration. Labs: Na+ 130, K+ 6.5, HCO3 5, glucose 500, pH
7.2, pCO2 25 mm Hg. Which compound stimulated hormone-sensitive
lipase in adipocytes causing accumulation of metabolites causing
acidosis?
ANSWERS: Epinephrine/ glucagon--> triggers FA breakdown to create
glucose
Physician sad to inform patient of progression of carcinoma to the terminal
phase. Physician's face makes patient cry and ask, "It's bad news, isn't it?"
Which is best response?
ANSWERS: "Yes, it is."
75yo man 2-year history of decreased force of urinary stream, urinate
several times throughout night. BUN 55, Cr 5.0. Ultrasound shows bilateral
hydronephrosis and dilated ureter. Mechanism of renal failure?
ANSWERS: Increased hydrostatic pressure in Bowman's space
4yo boy two bacterial urinary tract infections past year. Physical exam
normal. Radiologic studies show dilation of left ureter and renal pelvis,
minimal left-sided renal function. Left nephrectomy done. Photo: dilated
renal pelvis and ureter. Which is cause of renal disease?
ANSWERS: Congenital urethral obstruction
, 45yo man poorly controlled type 2 diabetes 1-month low-grade fever.
Getting hemodialysis for end-stage renal disease. T 37 C (98.6 F), pulse
72, bp 144/92. Physical subclavian catheter below right clavicle. Lungs
clear. Cardiac exam no murmurs. Blood cultures grow nonhemolytic,
catalase-negative, gram-positive cocci in pairs and chains. Which
organism?
ANSWERS: Enterococcus faecalis
3yo boy sickle cell disease with fever and pain over left foot 3 weeks.
Hematocrit stable. Leukocyte count 15,000 predominance of neutrophils.
Which is most likely explanation for findings?
ANSWERS: Osteomyelitis
10yo girl well-child examination. No menstrual period. 50th percentile
height and weight. Physical exam absence of breast bud development and
no pubic or axillary hair. It is most appropriate to tell mother that first
objective sign of puberty will be which?
ANSWERS: Breast bud development
45yo woman follow-up exam after 8 weeks tamoxifen therapy for
estrogen- and progesterone-positive invasive ductal carcinoma of
breast. 50yo sister also hormone-sensitive breast cancer. Physical
exam normal. Serum decreased concentrations of endoxifen, active
metabolite of prodrug tamoxifen. Genetic analysis shows homozygous
cytochrome P450 2D6*4 alleles. Likelihood patient's sisters has same
alleles?
ANSWERS: 25%
EXAM 200 QUESTIONS AND ANSWERS LATEST
2026 COMPLETE EXAM (usmle step 2) MEDICAL
EXAMINATION
37yo M with 4-day hx of diarrhea and abdominal pain, worse in past 24h,
with watery-brown stools. Completed a 10-day course of amoxicillin for a
sinus infection 5 days ago. Stool shows: Fecal fat negative; ova and
parasites negative; Cx for infx negative; C. Diff toxin positive. Which
pathologic findings present in intestinal tract?
ANSWERS: Pseudomembranes of fibrin and inflammatory debris
28yo M in ED 30 minutes after SOB. 3-year hx of cocaine abuse. T 38.1, P
100/min, BP 150/45. PE: diminished pulses in left upper extremity. Crackles
heard over all lung fields. 2/6 diastolic murmur at left sternal border. CXr
shows a widened aortic arch. Dx?
ANSWERS: Dissecting aneurysm
1-week-old girl. screening showed a possible defect in fatty acid oxidation.
PE normal. Next step?
ANSWERS: Measurement of serum acylcarnitine concentrations
,79yoM 30 minutes after LOC for 30 seconds. Alert, but dizzy. No urinary
or fecal incontinence. Pulse 40/min, BP 92/56. PE shows no tongue biting.
Lungs clear, Variable intensity S1. Oriented X3. ECG shows a third-degree
atrioventricular block. Next step?
ANSWERS: Insertion of transvenous pacemaker
55yo M with chronic bronchitis in ED after being unresponsive. Found
bottles of albuterol, ampicillin, codeine, and theophylline bedside. T 37.2 C,
p 112/min, respirations are 6/min, BP 95/60. Acute Rx should include?
ANSWERS: Naloxone
50yo man has persistent cough for 2 months. He has had a 5 kg (11 lb)
weight loss. He is a farmer and on itraconazole 4 weeks for
histoplasmosis from chicken coops. Medications: hydrochlorothiazide,
enalapril, atenolol, omeprazole, and metoclopramide for hypertension and
gastroesophageal reflux. Thin. Physical exam otherwise normal.
Itraconazole interacts with which drug and account for lack of effect of
itraconazole?
ANSWERS: Omeprazole (CYP P450 inhibitor)
,20yo man with 6-hour difficulty breathing and vomiting. 10-year history of
type 1 diabetes on insulin. Pulse 90, respirations 30 and deep, bp 90/60.
Physical shows dehydration. Labs: Na+ 130, K+ 6.5, HCO3 5, glucose 500, pH
7.2, pCO2 25 mm Hg. Which compound stimulated hormone-sensitive
lipase in adipocytes causing accumulation of metabolites causing
acidosis?
ANSWERS: Epinephrine/ glucagon--> triggers FA breakdown to create
glucose
Physician sad to inform patient of progression of carcinoma to the terminal
phase. Physician's face makes patient cry and ask, "It's bad news, isn't it?"
Which is best response?
ANSWERS: "Yes, it is."
75yo man 2-year history of decreased force of urinary stream, urinate
several times throughout night. BUN 55, Cr 5.0. Ultrasound shows bilateral
hydronephrosis and dilated ureter. Mechanism of renal failure?
ANSWERS: Increased hydrostatic pressure in Bowman's space
4yo boy two bacterial urinary tract infections past year. Physical exam
normal. Radiologic studies show dilation of left ureter and renal pelvis,
minimal left-sided renal function. Left nephrectomy done. Photo: dilated
renal pelvis and ureter. Which is cause of renal disease?
ANSWERS: Congenital urethral obstruction
, 45yo man poorly controlled type 2 diabetes 1-month low-grade fever.
Getting hemodialysis for end-stage renal disease. T 37 C (98.6 F), pulse
72, bp 144/92. Physical subclavian catheter below right clavicle. Lungs
clear. Cardiac exam no murmurs. Blood cultures grow nonhemolytic,
catalase-negative, gram-positive cocci in pairs and chains. Which
organism?
ANSWERS: Enterococcus faecalis
3yo boy sickle cell disease with fever and pain over left foot 3 weeks.
Hematocrit stable. Leukocyte count 15,000 predominance of neutrophils.
Which is most likely explanation for findings?
ANSWERS: Osteomyelitis
10yo girl well-child examination. No menstrual period. 50th percentile
height and weight. Physical exam absence of breast bud development and
no pubic or axillary hair. It is most appropriate to tell mother that first
objective sign of puberty will be which?
ANSWERS: Breast bud development
45yo woman follow-up exam after 8 weeks tamoxifen therapy for
estrogen- and progesterone-positive invasive ductal carcinoma of
breast. 50yo sister also hormone-sensitive breast cancer. Physical
exam normal. Serum decreased concentrations of endoxifen, active
metabolite of prodrug tamoxifen. Genetic analysis shows homozygous
cytochrome P450 2D6*4 alleles. Likelihood patient's sisters has same
alleles?
ANSWERS: 25%
