NBME CBSE ACTUAL TEST QUESTIONS AND ANSWERS
2024/2025(QUIZ BANK WITH ALL THE CORRECT
ANSWERS)(USMLE STEP 1)MEDICAL EXAMINATION
1) 62 year old woman - osteoporosis - a bisphosphonate is prescribed. The expected
g g g g g g g g g g g g
beneficial effect of the drug is due to which of the following? -Answer- Decreased
g g g g g g g g g g g g g g
Osteoclast Activity
g g
2) Cohot Study of elderly women - relative risk ratio for hip fractures among those who
g g g g g g g g g g g g g g
exercise regularly is 1.2 (95% confidence interval of 1.1 to 1.8). Which of the
g g g g g g g g g g g g g g
following is the conclusion about the effect of exercise on the risk of hip fracture? -
g g g g g g g g g g g g g g g g
Answer- Statistically Significant Overall Increase Risk
g g g g g
3) 52 year old man goes to ER with chest pain radiating to his jaw while shoveling
g g g g g g g g g g g g g g g
snow. Pulse is 80/min and blood pressure is 130/70. The most immediate
g g g g g g g g g g g g
treatment mechanism of action? -Answer- Increased nitric oxide concentration
g g g g g g g g g
4) 24 year old woman - spilled hot grease on her left leg while working at a fast-food
g g g g g g g g g g g g g g g g
restaurant. Exam of leg shows 7cm pink, soft, granular, edematous wound. The
g g g g g g g g g g g g
formation of this tissue was most likely caused by increased activity of which? -
g g g g g g g g g g g g g g
Answer-
5) Vascular Endothelial Growth g g
Factor VEGF - stimulates
g g g g
angiogenesiss.
g
TYPE III Collagen = Blood Vessels - early wound repair
g g g g g g g g g
6) 27 year old man- MVC - skull x-ray shows a linear, nondepressed basal skull
g g g g g g g g g g g g g
fracture - increased serum osm and decreased urin osm. Following
g g g g g g g g g g
desmopressin urine osm increases. Desmopressin's effect is due to the
g g g g g g g g g g
activation of which of the following? - Answer- a. Adenylyl Cyclase
g g g g g g g g g g g
Adenylate Cyclase - ATP - CAMP -- PROTEKINASE A -- g g g g g g g g g
Ca v2
g g
7) A 10 month old boy - 4 day history of fever and cough. He attends day care center.
g g g g g g g g g g g g g g g g g
Chest exam shows intercostal retractions along with bilateral, diffuse wheezes
g g g g g g g g g g
and expiratory rhonchi. The infectious agent most likely has which of the following
g g g g g g g g g g g g g
properties? -Answer- Mediation of Cell Entry via a fusion protein
g g g g g g g g g g
8) A 17 year old girl in ED - 15 minutes after being stung by a bee. Mild light
g g g g g g g g g g g g g g g g g
headedness but no difficulty swallowing- Bilateral wheezing - Which is most
g g g g g g g g g g g
appropriate pharmacotherapy for this patient? -Answer- B2- Agonist
g g g g g g g g
9) 14 year old boy - 2 day history of sore throat and fever that peaks in late afternoon. 1
g g g g g g g g g g g g g g g g g g
week of fatigue. He recentaly had sex with one partner. Physical exam show
g g g g g g g g g g g g g
cervical lymphadenopathy and pharyngeal erythema with a creamy exudate. DX?
g g g g g g g g g g
,g -Answer- Infectious Mononucleosis
g g
,10) 57 year old man - radiation therapy for squamous cell carcinoma of the lung.
g g g g g g g g g g g g g
gDespite therapy, tumor increases in size and he dies 6 months later. The
g g g g g g g g g g g g
gprogressive tumor growth is due to a defect in cell cycle arrest in which of the g g g g g g g g g g g g g g g
gfollowing phases of cell cycle? -Answer- G1 g g g g g g
11) 28 year old - lived in sub-Saharan Africa - until he came to the US. Temp of 100.4 -
g g g g g g g g g g g g g g g g g g
gimaging shows bilateral hydroureter and hydronephrosis. Biopsy shows marked
g g g g g g g g
gfibrosis and scattered granulomas. DX? -Answer- Schistosomiasis
g g g g g g
12) A couple with a family history of a-thalassemia. Woman has one gene deletion and
g g g g g g g g g g g g g
gman has two gene deletion. If the two gene is trans - what percentage of offspring
g g g g g g g g g g g g g g g
gwill have a two gene deletion? -Answer- 50%
g g g g g g g
13) previously healthy 40 year brought to emergency department by her husband - 2
g g g g g g g g g g g g
gday history of fever, lethargy, confusion. PE shows scattered petechiae and
g g g g g g g g g g
gecchymoses over the lower extremities - 3+ polychromasia and 3+ schistocytes g g g g g g g g g g
gand Low platelets Dx? -Answer- Thrombotic Thrombocytopenia Purpura
g g g g g g g
14) 16 year old boy - is admitted to the ER because of a knife wound to the left side of
g g g g g g g g g g g g g g g g g g g
ghis chest. An X-ray of the chest shows an air-fluid level in the left side of the
g g g g g g g g g g g g g g g g
gchest, partial collapse of the left lung, and the elevation of the stomach bubble.
g g g g g g g g g g g g g
gThe mediastinum is midline. DX? -Answer- Hemopneumpothorax under tension
g g g g g g g g
15) 49 year old woman - coronary artery disease - BP 140/90 - High Cholesterol, High
g g g g g g g g g g g g g g
gLDL (190), High triglycerides (350) - TX with atorvastatin and losartan. What are
g g g g g g g g g g g g
gthe effects on HDL and Triglycerides? -Answer- HDL increased
g g g g g g g g
Triglycerides Decreased g
16) 73 yeare old - diffuse weakness and tingling of her arms and legs. Sensation and
g g g g g g g g g g g g g g
gvibration and position is decreased in all extremities. What vitamin deficiency? -
g g g g g g g g g g g
Answer- Vitamin B12 - (cyanocobalamin) g g g g
Tea and Toast - low B12 in diet
g g g g g g g
17) 15 year old girl - 3 month history of acne - which is the underlying cause of the
g g g g g g g g g g g g g g g g g
gpatients acne? -Answer- Stimulation of Sebaceous Glands by androgens
g g g g g g g g
ACNE = Propionibacterium ACNE g g g
18) 4 year old from Brazil - PE shows single 12x10cm lesion in the right side of jaw with
g g g g g g g g g g g g g g g g g
gdiffuse regular edges. Photomicrographs of an incisional biopsy (looks like Burkitts
g g g g g g g g g g
gLymphoma/ Starry night) - which of the processes most likely to occur in the region g g g g g g g g g g g g g g
gindicated by the arrow? -Answer- Apoptosis g g g g g
19) b. Endemic Burkitt lymphoma can happen in Brazil as well as Africa (jaw lesion,
g g g g g g g g g g g g g
gpuffy face). g
, 20) 51 year old - lump on tongue - 1 pack smoking history for 30 years. 1.5 cm mass
g g g g g g g g g g g g g g g g g
gon apex of tongue. It is most appropriate to evaluate which lymph nodes first for
g g g g g g g g g g g g g g
gevidence of metastasis? -Answer- Submental g g g g
21) 15 year old boy - ER - 2 hour history of confusion and agitation - fever, headache,
g g g g g g g g g g g g g g g g
gstiff neck, and vomiting - since returned from summer camp - patient is
g g g g g g g g g g g g
ghallucinating - lumbar puncture - shows cysts and trophozoites- most likely g g g g g g g g g g
gpathogen? -Answer- a. g g
22) Olfactory
gNerve
gNaegleria
gfowleri
23) 17 year old - ED - 30 minutes after being found with a blank stare. Physical exam
g g g g g g g g g g g g g g g g
gshows rigidity. During exam he becomes hostile and assaults physician - Pt
g g g g g g g g g g g
gingested which drug? -Answer- PCP g g g g
24) Placebo controlled clinical trial - 5000 pts with essential hypertension. 2500
g g g g g g g g g g
gpatients receive new drug and 2500 patients receive placebo. If alpha is set at 0.01
g g g g g g g g g g g g g g
ginstead of 0.05, which of the following is most likely result? -Answer- Significant
g g g g g g g g g g g g
gfindings can be reported with greater confidence
g g g g g g
25) 17 year old - gymnast - comes to hospital because of lack of menstrual period for 6
g g g g g g g g g g g g g g g g
gmonths. BMI 15 Which is the cause of the amenorrhea? -Answer-
g g g g g g g g g g
gHypogonadotropic Hypogonadism g
26) A male stillborn is delivered at 32 weeks - Oligohydramnios - absence of a urethral
g g g g g g g g g g g g g g
gopening. Which is most likely finding? -Answer- Pulmonary Hypoplasia
g g g g g g g g
27) A 6 day old - breast fed boy in ED - poor weight gain and irritability since delivery -
g g g g g g g g g g g g g g g g g g
gPhysical exam shows jaundice and hepatomegaly. The concentration of which of
g g g g g g g g g g
gthe following metabolites is most likely increased? -Answer- a. Galactose - 1 -
g g g g g g g g g g g g
gphosphate
28) b. Congenital intolerance to breast milk
g g g g g
29) A 25-year-old man - comes to ED - severe muscle pain, diffuse, painful swelling of
g g g g g g g g g g g g g g
ghis neck, underarms, and groin after camping in New Mexico Generalized
g g g g g g g g g g
gscattered black maculae. Examination of the right upper extremity shows
g g g g g g g g g
gerythematous, solid, tender mass. Mass is draining blood and necrotic material. g g g g g g g g g g
gThe most effective antibiotic for patient disorder will interfere with which of the
g g g g g g g g g g g g
gfollowing processes? -Answer- a. g g g
30) Ribosomal Assembly g
31) b. Yersenia Pestis
g g
32) 45 year old - progressive weakness - muscle fasciculations of the upper extremities
g g g g g g g g g g g g
gand weakness of the lower extremity - What additional findings? -Answer- Atrophy
g g g g g g g g g g g
33) b. ALS = Lou Gherig
g g g g
34) A new severe respiratory illness - Why use a killed vaccine vs a live vaccine? -Answer-
g g g g g g g g g g g g g g g
35) Avoids Concerns of reversion to virulence
g g g g g
36) b. Killed vaccines - avoids reversion to virulence
g g g g g g g
2024/2025(QUIZ BANK WITH ALL THE CORRECT
ANSWERS)(USMLE STEP 1)MEDICAL EXAMINATION
1) 62 year old woman - osteoporosis - a bisphosphonate is prescribed. The expected
g g g g g g g g g g g g
beneficial effect of the drug is due to which of the following? -Answer- Decreased
g g g g g g g g g g g g g g
Osteoclast Activity
g g
2) Cohot Study of elderly women - relative risk ratio for hip fractures among those who
g g g g g g g g g g g g g g
exercise regularly is 1.2 (95% confidence interval of 1.1 to 1.8). Which of the
g g g g g g g g g g g g g g
following is the conclusion about the effect of exercise on the risk of hip fracture? -
g g g g g g g g g g g g g g g g
Answer- Statistically Significant Overall Increase Risk
g g g g g
3) 52 year old man goes to ER with chest pain radiating to his jaw while shoveling
g g g g g g g g g g g g g g g
snow. Pulse is 80/min and blood pressure is 130/70. The most immediate
g g g g g g g g g g g g
treatment mechanism of action? -Answer- Increased nitric oxide concentration
g g g g g g g g g
4) 24 year old woman - spilled hot grease on her left leg while working at a fast-food
g g g g g g g g g g g g g g g g
restaurant. Exam of leg shows 7cm pink, soft, granular, edematous wound. The
g g g g g g g g g g g g
formation of this tissue was most likely caused by increased activity of which? -
g g g g g g g g g g g g g g
Answer-
5) Vascular Endothelial Growth g g
Factor VEGF - stimulates
g g g g
angiogenesiss.
g
TYPE III Collagen = Blood Vessels - early wound repair
g g g g g g g g g
6) 27 year old man- MVC - skull x-ray shows a linear, nondepressed basal skull
g g g g g g g g g g g g g
fracture - increased serum osm and decreased urin osm. Following
g g g g g g g g g g
desmopressin urine osm increases. Desmopressin's effect is due to the
g g g g g g g g g g
activation of which of the following? - Answer- a. Adenylyl Cyclase
g g g g g g g g g g g
Adenylate Cyclase - ATP - CAMP -- PROTEKINASE A -- g g g g g g g g g
Ca v2
g g
7) A 10 month old boy - 4 day history of fever and cough. He attends day care center.
g g g g g g g g g g g g g g g g g
Chest exam shows intercostal retractions along with bilateral, diffuse wheezes
g g g g g g g g g g
and expiratory rhonchi. The infectious agent most likely has which of the following
g g g g g g g g g g g g g
properties? -Answer- Mediation of Cell Entry via a fusion protein
g g g g g g g g g g
8) A 17 year old girl in ED - 15 minutes after being stung by a bee. Mild light
g g g g g g g g g g g g g g g g g
headedness but no difficulty swallowing- Bilateral wheezing - Which is most
g g g g g g g g g g g
appropriate pharmacotherapy for this patient? -Answer- B2- Agonist
g g g g g g g g
9) 14 year old boy - 2 day history of sore throat and fever that peaks in late afternoon. 1
g g g g g g g g g g g g g g g g g g
week of fatigue. He recentaly had sex with one partner. Physical exam show
g g g g g g g g g g g g g
cervical lymphadenopathy and pharyngeal erythema with a creamy exudate. DX?
g g g g g g g g g g
,g -Answer- Infectious Mononucleosis
g g
,10) 57 year old man - radiation therapy for squamous cell carcinoma of the lung.
g g g g g g g g g g g g g
gDespite therapy, tumor increases in size and he dies 6 months later. The
g g g g g g g g g g g g
gprogressive tumor growth is due to a defect in cell cycle arrest in which of the g g g g g g g g g g g g g g g
gfollowing phases of cell cycle? -Answer- G1 g g g g g g
11) 28 year old - lived in sub-Saharan Africa - until he came to the US. Temp of 100.4 -
g g g g g g g g g g g g g g g g g g
gimaging shows bilateral hydroureter and hydronephrosis. Biopsy shows marked
g g g g g g g g
gfibrosis and scattered granulomas. DX? -Answer- Schistosomiasis
g g g g g g
12) A couple with a family history of a-thalassemia. Woman has one gene deletion and
g g g g g g g g g g g g g
gman has two gene deletion. If the two gene is trans - what percentage of offspring
g g g g g g g g g g g g g g g
gwill have a two gene deletion? -Answer- 50%
g g g g g g g
13) previously healthy 40 year brought to emergency department by her husband - 2
g g g g g g g g g g g g
gday history of fever, lethargy, confusion. PE shows scattered petechiae and
g g g g g g g g g g
gecchymoses over the lower extremities - 3+ polychromasia and 3+ schistocytes g g g g g g g g g g
gand Low platelets Dx? -Answer- Thrombotic Thrombocytopenia Purpura
g g g g g g g
14) 16 year old boy - is admitted to the ER because of a knife wound to the left side of
g g g g g g g g g g g g g g g g g g g
ghis chest. An X-ray of the chest shows an air-fluid level in the left side of the
g g g g g g g g g g g g g g g g
gchest, partial collapse of the left lung, and the elevation of the stomach bubble.
g g g g g g g g g g g g g
gThe mediastinum is midline. DX? -Answer- Hemopneumpothorax under tension
g g g g g g g g
15) 49 year old woman - coronary artery disease - BP 140/90 - High Cholesterol, High
g g g g g g g g g g g g g g
gLDL (190), High triglycerides (350) - TX with atorvastatin and losartan. What are
g g g g g g g g g g g g
gthe effects on HDL and Triglycerides? -Answer- HDL increased
g g g g g g g g
Triglycerides Decreased g
16) 73 yeare old - diffuse weakness and tingling of her arms and legs. Sensation and
g g g g g g g g g g g g g g
gvibration and position is decreased in all extremities. What vitamin deficiency? -
g g g g g g g g g g g
Answer- Vitamin B12 - (cyanocobalamin) g g g g
Tea and Toast - low B12 in diet
g g g g g g g
17) 15 year old girl - 3 month history of acne - which is the underlying cause of the
g g g g g g g g g g g g g g g g g
gpatients acne? -Answer- Stimulation of Sebaceous Glands by androgens
g g g g g g g g
ACNE = Propionibacterium ACNE g g g
18) 4 year old from Brazil - PE shows single 12x10cm lesion in the right side of jaw with
g g g g g g g g g g g g g g g g g
gdiffuse regular edges. Photomicrographs of an incisional biopsy (looks like Burkitts
g g g g g g g g g g
gLymphoma/ Starry night) - which of the processes most likely to occur in the region g g g g g g g g g g g g g g
gindicated by the arrow? -Answer- Apoptosis g g g g g
19) b. Endemic Burkitt lymphoma can happen in Brazil as well as Africa (jaw lesion,
g g g g g g g g g g g g g
gpuffy face). g
, 20) 51 year old - lump on tongue - 1 pack smoking history for 30 years. 1.5 cm mass
g g g g g g g g g g g g g g g g g
gon apex of tongue. It is most appropriate to evaluate which lymph nodes first for
g g g g g g g g g g g g g g
gevidence of metastasis? -Answer- Submental g g g g
21) 15 year old boy - ER - 2 hour history of confusion and agitation - fever, headache,
g g g g g g g g g g g g g g g g
gstiff neck, and vomiting - since returned from summer camp - patient is
g g g g g g g g g g g g
ghallucinating - lumbar puncture - shows cysts and trophozoites- most likely g g g g g g g g g g
gpathogen? -Answer- a. g g
22) Olfactory
gNerve
gNaegleria
gfowleri
23) 17 year old - ED - 30 minutes after being found with a blank stare. Physical exam
g g g g g g g g g g g g g g g g
gshows rigidity. During exam he becomes hostile and assaults physician - Pt
g g g g g g g g g g g
gingested which drug? -Answer- PCP g g g g
24) Placebo controlled clinical trial - 5000 pts with essential hypertension. 2500
g g g g g g g g g g
gpatients receive new drug and 2500 patients receive placebo. If alpha is set at 0.01
g g g g g g g g g g g g g g
ginstead of 0.05, which of the following is most likely result? -Answer- Significant
g g g g g g g g g g g g
gfindings can be reported with greater confidence
g g g g g g
25) 17 year old - gymnast - comes to hospital because of lack of menstrual period for 6
g g g g g g g g g g g g g g g g
gmonths. BMI 15 Which is the cause of the amenorrhea? -Answer-
g g g g g g g g g g
gHypogonadotropic Hypogonadism g
26) A male stillborn is delivered at 32 weeks - Oligohydramnios - absence of a urethral
g g g g g g g g g g g g g g
gopening. Which is most likely finding? -Answer- Pulmonary Hypoplasia
g g g g g g g g
27) A 6 day old - breast fed boy in ED - poor weight gain and irritability since delivery -
g g g g g g g g g g g g g g g g g g
gPhysical exam shows jaundice and hepatomegaly. The concentration of which of
g g g g g g g g g g
gthe following metabolites is most likely increased? -Answer- a. Galactose - 1 -
g g g g g g g g g g g g
gphosphate
28) b. Congenital intolerance to breast milk
g g g g g
29) A 25-year-old man - comes to ED - severe muscle pain, diffuse, painful swelling of
g g g g g g g g g g g g g g
ghis neck, underarms, and groin after camping in New Mexico Generalized
g g g g g g g g g g
gscattered black maculae. Examination of the right upper extremity shows
g g g g g g g g g
gerythematous, solid, tender mass. Mass is draining blood and necrotic material. g g g g g g g g g g
gThe most effective antibiotic for patient disorder will interfere with which of the
g g g g g g g g g g g g
gfollowing processes? -Answer- a. g g g
30) Ribosomal Assembly g
31) b. Yersenia Pestis
g g
32) 45 year old - progressive weakness - muscle fasciculations of the upper extremities
g g g g g g g g g g g g
gand weakness of the lower extremity - What additional findings? -Answer- Atrophy
g g g g g g g g g g g
33) b. ALS = Lou Gherig
g g g g
34) A new severe respiratory illness - Why use a killed vaccine vs a live vaccine? -Answer-
g g g g g g g g g g g g g g g
35) Avoids Concerns of reversion to virulence
g g g g g
36) b. Killed vaccines - avoids reversion to virulence
g g g g g g g
