NBME CBSE Question and Answer (2026)
| Newest Exam Questions with Explained
Answers and Rationales | Grade 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? -✓✓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? -✓✓IgM (mono and
mycoplasma)
• 24yo M with small tender blisters on his penis 3 days after unprotected sex.
Photograph shown. Causal agent? -✓✓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? -✓✓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? -✓✓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? -✓✓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? -✓✓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? -✓✓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? -✓✓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? -
✓✓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)? -✓✓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? -✓✓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? -✓✓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? -
✓✓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? -✓✓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? -✓✓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? -✓✓= 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. Which describes this mechanism of
transport? -✓✓Carrier-mediated diffusion
• Newborn has male genital ducts but female external genitalia. Cytogenetic
analysis shows a 46,XY karyotype, and genetic testing shows a mutation of the
gene encoding 5alpha-reductase. In absence of this mutation, labia majora would
have been? -✓✓Scrotum
• Corresponded to penis shaft? -✓✓Labia minora
• Study designed to evaluate the efficacy of coenzyme Q10 in improving cardiac
output in patients with CHF. Sixty patients with CHF are recruited. Each assigned
by coin toss to one of tw groups. Design? -✓✓RCT
• 12yo boy immersed up to his neck in 60F water for 20 minutes. Physiological
changes?
ADH:
Central Blood volume:
ANP: -✓✓ADH: decreased (VC leads to decreased ADH)
ANP: increased
Central blood volume: increased
• Randomized controlled study of 2000 patients with insomnia is conducted to
evaluate the efficacy of a new medication to treat this condition. Ten subjects from
both the control and treatment groups do not complete the study are are not
| Newest Exam Questions with Explained
Answers and Rationales | Grade 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? -✓✓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? -✓✓IgM (mono and
mycoplasma)
• 24yo M with small tender blisters on his penis 3 days after unprotected sex.
Photograph shown. Causal agent? -✓✓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? -✓✓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? -✓✓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? -✓✓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? -✓✓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? -✓✓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? -✓✓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? -
✓✓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)? -✓✓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? -✓✓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? -✓✓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? -
✓✓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? -✓✓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? -✓✓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? -✓✓= 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. Which describes this mechanism of
transport? -✓✓Carrier-mediated diffusion
• Newborn has male genital ducts but female external genitalia. Cytogenetic
analysis shows a 46,XY karyotype, and genetic testing shows a mutation of the
gene encoding 5alpha-reductase. In absence of this mutation, labia majora would
have been? -✓✓Scrotum
• Corresponded to penis shaft? -✓✓Labia minora
• Study designed to evaluate the efficacy of coenzyme Q10 in improving cardiac
output in patients with CHF. Sixty patients with CHF are recruited. Each assigned
by coin toss to one of tw groups. Design? -✓✓RCT
• 12yo boy immersed up to his neck in 60F water for 20 minutes. Physiological
changes?
ADH:
Central Blood volume:
ANP: -✓✓ADH: decreased (VC leads to decreased ADH)
ANP: increased
Central blood volume: increased
• Randomized controlled study of 2000 patients with insomnia is conducted to
evaluate the efficacy of a new medication to treat this condition. Ten subjects from
both the control and treatment groups do not complete the study are are not
