NBME CBSE ACTUAL TEST QUESTIONS AND
ANSWERS TEST BANK - COMPLETE SOLUTION
RATED A
Course
NBME CBSE
Question 1
A 25-year-old woman presents with acute abdominal pain and fever. Laboratory studies
reveal elevated white blood cell count and a CT scan shows an inflamed appendix. What is
the most appropriate next step in management?
A) Administer antibiotics
B) Perform laparoscopic appendectomy
C) Schedule for a follow-up in one week
D) Order a repeat CT scan
Answer: B) Perform laparoscopic appendectomy
Rationale: The clinical presentation is consistent with acute appendicitis, which is typically
treated with surgical intervention. Laparoscopic appendectomy is the standard approach and
should be performed promptly to prevent complications.
Question 2
A 60-year-old male smoker presents with a persistent cough and hemoptysis. A chest X-ray
shows a mass in the right lung. Which of the following is the most likely diagnosis?
A) Lung abscess
B) Pulmonary embolism
C) Lung cancer
D) Tuberculosis
Answer: C) Lung cancer
Rationale: Given the patient's age, smoking history, and symptoms (persistent cough and
hemoptysis), lung cancer is the most likely diagnosis. The presence of a lung mass on chest
X-ray further supports this.
Question 3
A 5-year-old boy is brought to the clinic for evaluation of failure to thrive. His mother reports
that he has difficulty swallowing and often coughs during meals. On examination, he has a
palpable mass in the neck. What is the most likely diagnosis?
,A) Zenker's diverticulum
B) Esophageal atresia
C) Laryngomalacia
D) Cervical esophageal obstruction
Answer: A) Zenker's diverticulum
Rationale: Zenker's diverticulum is a pharyngeal diverticulum that typically presents in older
adults but can occur in children. Symptoms include dysphagia, cough during meals, and a
neck mass due to the diverticulum.
Question 4
A 40-year-old woman presents with fatigue, weight gain, and cold intolerance. Physical
examination reveals bradycardia and a goiter. Which laboratory finding would most likely
confirm the diagnosis of hypothyroidism?
A) Elevated T3 levels
B) Elevated T4 levels
C) Elevated TSH levels
D) Low TSH levels
Answer: C) Elevated TSH levels
Rationale: In primary hypothyroidism, the thyroid gland fails to produce adequate thyroid
hormones (T3 and T4), leading to an increase in TSH levels as the pituitary gland attempts to
stimulate the thyroid.
Question 5
A 30-year-old woman presents with a history of irregular menstrual cycles and excessive hair
growth on her face and body. Which condition is she most likely suffering from?
A) Polycystic ovary syndrome (PCOS)
B) Hyperthyroidism
C) Cushing’s syndrome
D) Premature ovarian failure
Answer: A) Polycystic ovary syndrome (PCOS)
Rationale: The combination of irregular menstrual cycles and hirsutism is characteristic of
PCOS, a common endocrine disorder in women of reproductive age.
Question 6
,A patient presents with a sudden onset of severe headache described as "the worst headache
of my life," accompanied by nausea and photophobia. A CT scan of the head shows no acute
abnormalities. What is the most likely diagnosis?
A) Tension headache
B) Migraine headache
C) Subarachnoid hemorrhage
D) Cluster headache
Answer: C) Subarachnoid hemorrhage
Rationale: The description of a sudden, severe headache is classic for subarachnoid
hemorrhage. Even with a normal CT scan, this diagnosis must be considered, and further
evaluation (such as a lumbar puncture) may be necessary.
Question 7
A 50-year-old man presents with chest pain that radiates to his left arm and is associated with
shortness of breath. What is the most likely diagnosis?
A) Gastroesophageal reflux disease
B) Acute coronary syndrome
C) Pulmonary embolism
D) Aortic dissection
Answer: B) Acute coronary syndrome
Rationale: The combination of chest pain radiating to the left arm and shortness of breath is
highly suggestive of acute coronary syndrome, which encompasses conditions such as
myocardial infarction and unstable angina.
Question 8
A 22-year-old woman presents with increased thirst and urination. Laboratory tests reveal a
fasting blood glucose of 160 mg/dL. What is the most likely diagnosis?
A) Type 1 diabetes mellitus
B) Type 2 diabetes mellitus
C) Diabetes insipidus
D) Gestational diabetes
Answer: B) Type 2 diabetes mellitus
Rationale: The patient's age, symptoms, and fasting blood glucose level suggest Type 2
diabetes mellitus, which is characterized by insulin resistance and often occurs in adults.
Question 9
, A 70-year-old male presents with a history of worsening dyspnea on exertion. His vital signs
show elevated blood pressure and an oxygen saturation of 88% on room air. What is the most
appropriate initial management?
A) Oxygen supplementation
B) Diuretic therapy
C) Beta-blocker administration
D) Chest X-ray
Answer: A) Oxygen supplementation
Rationale: Given the patient's hypoxia (oxygen saturation of 88%), the most appropriate
initial management is to provide supplemental oxygen to improve oxygenation.
Question 10
A 45-year-old man presents with jaundice, dark urine, and pale stools. Laboratory tests show
elevated direct bilirubin levels. Which condition is most consistent with these findings?
A) Hemolytic anemia
B) Hepatitis
C) Cholestasis
D) Liver cirrhosis
Answer: C) Cholestasis
Rationale: The combination of jaundice, dark urine, pale stools, and elevated direct bilirubin
levels suggests cholestasis, which can occur due to bile duct obstruction or liver dysfunction.
Question 11
A 28-year-old woman presents with severe abdominal pain and nausea. An ultrasound reveals
the presence of gallstones. What is the most likely complication if the stones obstruct the
cystic duct?
A) Pancreatitis
B) Cholecystitis
C) Hepatitis
D) Perforation
Answer: B) Cholecystitis
Rationale: When gallstones obstruct the cystic duct, it can lead to acute cholecystitis due to
the accumulation of bile in the gallbladder, causing inflammation and infection.
Question 12
A 65-year-old man has difficulty breathing, especially when lying flat. He has a history of
heart failure. What is the most likely cause of his symptoms?
ANSWERS TEST BANK - COMPLETE SOLUTION
RATED A
Course
NBME CBSE
Question 1
A 25-year-old woman presents with acute abdominal pain and fever. Laboratory studies
reveal elevated white blood cell count and a CT scan shows an inflamed appendix. What is
the most appropriate next step in management?
A) Administer antibiotics
B) Perform laparoscopic appendectomy
C) Schedule for a follow-up in one week
D) Order a repeat CT scan
Answer: B) Perform laparoscopic appendectomy
Rationale: The clinical presentation is consistent with acute appendicitis, which is typically
treated with surgical intervention. Laparoscopic appendectomy is the standard approach and
should be performed promptly to prevent complications.
Question 2
A 60-year-old male smoker presents with a persistent cough and hemoptysis. A chest X-ray
shows a mass in the right lung. Which of the following is the most likely diagnosis?
A) Lung abscess
B) Pulmonary embolism
C) Lung cancer
D) Tuberculosis
Answer: C) Lung cancer
Rationale: Given the patient's age, smoking history, and symptoms (persistent cough and
hemoptysis), lung cancer is the most likely diagnosis. The presence of a lung mass on chest
X-ray further supports this.
Question 3
A 5-year-old boy is brought to the clinic for evaluation of failure to thrive. His mother reports
that he has difficulty swallowing and often coughs during meals. On examination, he has a
palpable mass in the neck. What is the most likely diagnosis?
,A) Zenker's diverticulum
B) Esophageal atresia
C) Laryngomalacia
D) Cervical esophageal obstruction
Answer: A) Zenker's diverticulum
Rationale: Zenker's diverticulum is a pharyngeal diverticulum that typically presents in older
adults but can occur in children. Symptoms include dysphagia, cough during meals, and a
neck mass due to the diverticulum.
Question 4
A 40-year-old woman presents with fatigue, weight gain, and cold intolerance. Physical
examination reveals bradycardia and a goiter. Which laboratory finding would most likely
confirm the diagnosis of hypothyroidism?
A) Elevated T3 levels
B) Elevated T4 levels
C) Elevated TSH levels
D) Low TSH levels
Answer: C) Elevated TSH levels
Rationale: In primary hypothyroidism, the thyroid gland fails to produce adequate thyroid
hormones (T3 and T4), leading to an increase in TSH levels as the pituitary gland attempts to
stimulate the thyroid.
Question 5
A 30-year-old woman presents with a history of irregular menstrual cycles and excessive hair
growth on her face and body. Which condition is she most likely suffering from?
A) Polycystic ovary syndrome (PCOS)
B) Hyperthyroidism
C) Cushing’s syndrome
D) Premature ovarian failure
Answer: A) Polycystic ovary syndrome (PCOS)
Rationale: The combination of irregular menstrual cycles and hirsutism is characteristic of
PCOS, a common endocrine disorder in women of reproductive age.
Question 6
,A patient presents with a sudden onset of severe headache described as "the worst headache
of my life," accompanied by nausea and photophobia. A CT scan of the head shows no acute
abnormalities. What is the most likely diagnosis?
A) Tension headache
B) Migraine headache
C) Subarachnoid hemorrhage
D) Cluster headache
Answer: C) Subarachnoid hemorrhage
Rationale: The description of a sudden, severe headache is classic for subarachnoid
hemorrhage. Even with a normal CT scan, this diagnosis must be considered, and further
evaluation (such as a lumbar puncture) may be necessary.
Question 7
A 50-year-old man presents with chest pain that radiates to his left arm and is associated with
shortness of breath. What is the most likely diagnosis?
A) Gastroesophageal reflux disease
B) Acute coronary syndrome
C) Pulmonary embolism
D) Aortic dissection
Answer: B) Acute coronary syndrome
Rationale: The combination of chest pain radiating to the left arm and shortness of breath is
highly suggestive of acute coronary syndrome, which encompasses conditions such as
myocardial infarction and unstable angina.
Question 8
A 22-year-old woman presents with increased thirst and urination. Laboratory tests reveal a
fasting blood glucose of 160 mg/dL. What is the most likely diagnosis?
A) Type 1 diabetes mellitus
B) Type 2 diabetes mellitus
C) Diabetes insipidus
D) Gestational diabetes
Answer: B) Type 2 diabetes mellitus
Rationale: The patient's age, symptoms, and fasting blood glucose level suggest Type 2
diabetes mellitus, which is characterized by insulin resistance and often occurs in adults.
Question 9
, A 70-year-old male presents with a history of worsening dyspnea on exertion. His vital signs
show elevated blood pressure and an oxygen saturation of 88% on room air. What is the most
appropriate initial management?
A) Oxygen supplementation
B) Diuretic therapy
C) Beta-blocker administration
D) Chest X-ray
Answer: A) Oxygen supplementation
Rationale: Given the patient's hypoxia (oxygen saturation of 88%), the most appropriate
initial management is to provide supplemental oxygen to improve oxygenation.
Question 10
A 45-year-old man presents with jaundice, dark urine, and pale stools. Laboratory tests show
elevated direct bilirubin levels. Which condition is most consistent with these findings?
A) Hemolytic anemia
B) Hepatitis
C) Cholestasis
D) Liver cirrhosis
Answer: C) Cholestasis
Rationale: The combination of jaundice, dark urine, pale stools, and elevated direct bilirubin
levels suggests cholestasis, which can occur due to bile duct obstruction or liver dysfunction.
Question 11
A 28-year-old woman presents with severe abdominal pain and nausea. An ultrasound reveals
the presence of gallstones. What is the most likely complication if the stones obstruct the
cystic duct?
A) Pancreatitis
B) Cholecystitis
C) Hepatitis
D) Perforation
Answer: B) Cholecystitis
Rationale: When gallstones obstruct the cystic duct, it can lead to acute cholecystitis due to
the accumulation of bile in the gallbladder, causing inflammation and infection.
Question 12
A 65-year-old man has difficulty breathing, especially when lying flat. He has a history of
heart failure. What is the most likely cause of his symptoms?
