NBME CBSE MEDICAL ACTUAL EXAM/STUDY GUIDE
NBME CBSE MEDICAL ACTUAL EXAM/STUDY GUIDE NEWEST
VERSION 2025-2026 TESTBANK QUESTIONS AND CORRECT
DETAILED ANSWERS |ALREADYGRADED A+
45yo F has thyroidectomy because of asymmetric enlargement of thyroid noticed
6 weeks ago. Underwent adrenalectomy for pheochromocytoma 3 years ago.
Bilateral thyroid lesions with spindle cells arranged in small clusters. Amyloid
deposits b/w neoplastic cells. C-cell hyperplasia, malignant. Which marker to
monitor? - ANSWER-Calcitonin
45yo F intubated, mechanically ventilated with fungemia with Candida albicans.
Rx with caspofungin is started. Feature of causal organism targeted by this drug? -
ANSWER-Beta-Glucan carbohydrates in the cell wall
56yo M 4 hours after sudden onset of uncontrollable irregular movements of the
left side of the body. PE shows flailing movements of the proximal appendicular
muscles on the left. Nuclei damaged? - ANSWER-Right subthalamic
60yo M 1-month Hx of progressive SOB with exertion. Breath sounds: Decreased
on right lung base, normal on left lung base. Percussion note dull on right lung
base, normal on left lung base. Tactile fremitus decreased on right lung base,
normal on left lung base. Adventitious sounds none on right lung base, crackles on
left lung base. Dx? - ANSWER-Pleural effusion
68yo M with difficulty swallowing solids for 2 months. Hx of dilated
cardiomyopathy. X-rays of esophagus w/ barium contrast show indentation and
posterior displacement of the esophagus. Enlargement of what caused dysphagia?
- ANSWER-Left atrium
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, NBME CBSE MEDICAL ACTUAL EXAM/STUDY GUIDE
25yo F with 3-year hx of irregular menses. Menarche was at age of 14 years. BP
116/62. PE shows increased hair growth on the face and chest. Pelvic exam shows
clitoromegaly and a normal-appearing uterus. Serum shows increased 17-
hydroxyprogesterone and androstenedione. Deficiency of? - ANSWER-21-
hydroxylase
60yo M in ED for sudden onset of acute abdominal pain and tenderness, nausea,
vomiting, and bloody diarrhea 2 hours ago. He has a Hx of cirrhosis and
hepatocellular carcinoma. BP 99/50. Loss of bowel sounds. Surgery shows small
intestine with dark purple-red hemorrhagic appearance. Cause? - ANSWER-
Mesenteric venous thrombosis
38yo M in ED 30 min after unable to stand upright. Lethargic, pulse 110/min, BP
90/62. PE shows dry mucosa and poor skin turgor. Mid-epigastric tenderness. Labs
show:
Serum: Na 143, K 3.2, Cl 101, HCO3 11. ABG: pH 7.28, Pco2 23, Po2 98. Acid-base
status in this patient? - ANSWER-Metabolic acidosis
2mo boy given vaccine to convert T-independent antigens to T-dependent forms
to enhance protection in young children. Which vaccine given? - ANSWER-
Haemophilus influenzae type b
A study conducted to assess effectiveness of injections of lidocaine into "trigger
points" of pain symptoms in patients with fibromyalgia. Fifty patients randomly
assigned - 0.9% saline only or saline plus lidocaine. Graph shows self-reported
pain scores. Explanation? - ANSWER-Placebo effect
2|Page
, NBME CBSE MEDICAL ACTUAL EXAM/STUDY GUIDE
58yo F in ED for 2-hour hx of SOB and chest pain radiates to her back between the
shoulder blades. Resp 28/min, PE shows diaphoresis. ECG normal. Coronary
angiography shows occlusion of marginal branch of LAD coronary artery.
Revascularization done with stent placement. CK-MB and troponin I increased.
Mechanism of these lab findings? - ANSWER-membrane lipid peroxidation?
In a clinical study, a polymorphic marker with three alleles, 1, 2, and 3, is found to
be tightly linked to the gene for polycystic kidney disease. Pedigree shown. If III, 1
is unaffected by this disease, patient is most likely carrier of? - ANSWER-2, 3
6yo girl with 4-day hx of round shiny bumps in areas where she has eczema. Her
mother saw similar bumps on a playmate at pool party 3 weeks ago. No other Sx.
PE shows firm, smooth, umbilicated papules 2 to 4 mm diameter in clusters.
Causal organism? - ANSWER-Poxvirus
80yo F in ED for 2-day hx of "feeling funny." "Lost my pep." Hx of poorly controlled
hypertension. Just started medication 2 weeks ago. BP 130/85. Pe normal. Serum
potassium is 3. Which drug? - ANSWER-Hydrochlorothiazide
69yo F with weakness of left leg since awakening. PE shows weakness. Babinski
present on left. Decreased somatic sensation in left foot, agraphesthesia on
plantar surfaces of the toes, and decreased position sense in the toes. MRI shows
edematous area in cerebral cortex of right hemisphere. Lesion? - ANSWER-G
(cingulate gyrus - ACA territory)
68yo M in for a hemiorrhaphy. Surgeon gives info of risks and benefits. Patient
says that he understands what he has been told, and his family will be able to
3|Page
, NBME CBSE MEDICAL ACTUAL EXAM/STUDY GUIDE
discuss later. In this patient, which combination of components fulfill the criteria
for fully informed consent? - ANSWER-Information, competence, voluntariness
47yo F with psoriasis for follow-up. Was given several topical creams, to be used in
specified sequence twice daily. No improvements apparent at this appointment.
How to begin discussion of compliance? - ANSWER-"most people find it difficult to
adhere to a routine, how did you do"
Male newborn has macrocephaly with poor skull mineralization, shortened
extremities with misshaped long bones, and several fractures. Defect in which? -
ANSWER-Collagen
27yo F in ED 30 min after being ejected through windshield during collision.
Unrestrained front-seat passenger. PE shows marked edema and tenderness of
the jaw. Panorex x-ray of mouth shown. Which is injured? - ANSWER-Inferior
alveolar nerve?
Girl for well-child exam. Normal development includes pincer grasp, finger
feeding, standing while holding onto a table, and playing peekaboo. Age (in
months)? - ANSWER-9 months
60yo M exam prior to employment. PE normal. Labs show
Hb 14, HCT 42%, WBC 12k (PMN 45%, lymphos 50%, Monos 5%), platelets 250k.
Flow cytometry analysis of peripheral lymphocytes shows: CD3 50%, CD4 40%,
CD8 10%, Kappa 47%, lambda 3%. Which is most predictive of a clonal lymphoid
proliferation? - ANSWER-Surface kappa:surface lambda ratio
4|Page
NBME CBSE MEDICAL ACTUAL EXAM/STUDY GUIDE NEWEST
VERSION 2025-2026 TESTBANK QUESTIONS AND CORRECT
DETAILED ANSWERS |ALREADYGRADED A+
45yo F has thyroidectomy because of asymmetric enlargement of thyroid noticed
6 weeks ago. Underwent adrenalectomy for pheochromocytoma 3 years ago.
Bilateral thyroid lesions with spindle cells arranged in small clusters. Amyloid
deposits b/w neoplastic cells. C-cell hyperplasia, malignant. Which marker to
monitor? - ANSWER-Calcitonin
45yo F intubated, mechanically ventilated with fungemia with Candida albicans.
Rx with caspofungin is started. Feature of causal organism targeted by this drug? -
ANSWER-Beta-Glucan carbohydrates in the cell wall
56yo M 4 hours after sudden onset of uncontrollable irregular movements of the
left side of the body. PE shows flailing movements of the proximal appendicular
muscles on the left. Nuclei damaged? - ANSWER-Right subthalamic
60yo M 1-month Hx of progressive SOB with exertion. Breath sounds: Decreased
on right lung base, normal on left lung base. Percussion note dull on right lung
base, normal on left lung base. Tactile fremitus decreased on right lung base,
normal on left lung base. Adventitious sounds none on right lung base, crackles on
left lung base. Dx? - ANSWER-Pleural effusion
68yo M with difficulty swallowing solids for 2 months. Hx of dilated
cardiomyopathy. X-rays of esophagus w/ barium contrast show indentation and
posterior displacement of the esophagus. Enlargement of what caused dysphagia?
- ANSWER-Left atrium
1|Page
, NBME CBSE MEDICAL ACTUAL EXAM/STUDY GUIDE
25yo F with 3-year hx of irregular menses. Menarche was at age of 14 years. BP
116/62. PE shows increased hair growth on the face and chest. Pelvic exam shows
clitoromegaly and a normal-appearing uterus. Serum shows increased 17-
hydroxyprogesterone and androstenedione. Deficiency of? - ANSWER-21-
hydroxylase
60yo M in ED for sudden onset of acute abdominal pain and tenderness, nausea,
vomiting, and bloody diarrhea 2 hours ago. He has a Hx of cirrhosis and
hepatocellular carcinoma. BP 99/50. Loss of bowel sounds. Surgery shows small
intestine with dark purple-red hemorrhagic appearance. Cause? - ANSWER-
Mesenteric venous thrombosis
38yo M in ED 30 min after unable to stand upright. Lethargic, pulse 110/min, BP
90/62. PE shows dry mucosa and poor skin turgor. Mid-epigastric tenderness. Labs
show:
Serum: Na 143, K 3.2, Cl 101, HCO3 11. ABG: pH 7.28, Pco2 23, Po2 98. Acid-base
status in this patient? - ANSWER-Metabolic acidosis
2mo boy given vaccine to convert T-independent antigens to T-dependent forms
to enhance protection in young children. Which vaccine given? - ANSWER-
Haemophilus influenzae type b
A study conducted to assess effectiveness of injections of lidocaine into "trigger
points" of pain symptoms in patients with fibromyalgia. Fifty patients randomly
assigned - 0.9% saline only or saline plus lidocaine. Graph shows self-reported
pain scores. Explanation? - ANSWER-Placebo effect
2|Page
, NBME CBSE MEDICAL ACTUAL EXAM/STUDY GUIDE
58yo F in ED for 2-hour hx of SOB and chest pain radiates to her back between the
shoulder blades. Resp 28/min, PE shows diaphoresis. ECG normal. Coronary
angiography shows occlusion of marginal branch of LAD coronary artery.
Revascularization done with stent placement. CK-MB and troponin I increased.
Mechanism of these lab findings? - ANSWER-membrane lipid peroxidation?
In a clinical study, a polymorphic marker with three alleles, 1, 2, and 3, is found to
be tightly linked to the gene for polycystic kidney disease. Pedigree shown. If III, 1
is unaffected by this disease, patient is most likely carrier of? - ANSWER-2, 3
6yo girl with 4-day hx of round shiny bumps in areas where she has eczema. Her
mother saw similar bumps on a playmate at pool party 3 weeks ago. No other Sx.
PE shows firm, smooth, umbilicated papules 2 to 4 mm diameter in clusters.
Causal organism? - ANSWER-Poxvirus
80yo F in ED for 2-day hx of "feeling funny." "Lost my pep." Hx of poorly controlled
hypertension. Just started medication 2 weeks ago. BP 130/85. Pe normal. Serum
potassium is 3. Which drug? - ANSWER-Hydrochlorothiazide
69yo F with weakness of left leg since awakening. PE shows weakness. Babinski
present on left. Decreased somatic sensation in left foot, agraphesthesia on
plantar surfaces of the toes, and decreased position sense in the toes. MRI shows
edematous area in cerebral cortex of right hemisphere. Lesion? - ANSWER-G
(cingulate gyrus - ACA territory)
68yo M in for a hemiorrhaphy. Surgeon gives info of risks and benefits. Patient
says that he understands what he has been told, and his family will be able to
3|Page
, NBME CBSE MEDICAL ACTUAL EXAM/STUDY GUIDE
discuss later. In this patient, which combination of components fulfill the criteria
for fully informed consent? - ANSWER-Information, competence, voluntariness
47yo F with psoriasis for follow-up. Was given several topical creams, to be used in
specified sequence twice daily. No improvements apparent at this appointment.
How to begin discussion of compliance? - ANSWER-"most people find it difficult to
adhere to a routine, how did you do"
Male newborn has macrocephaly with poor skull mineralization, shortened
extremities with misshaped long bones, and several fractures. Defect in which? -
ANSWER-Collagen
27yo F in ED 30 min after being ejected through windshield during collision.
Unrestrained front-seat passenger. PE shows marked edema and tenderness of
the jaw. Panorex x-ray of mouth shown. Which is injured? - ANSWER-Inferior
alveolar nerve?
Girl for well-child exam. Normal development includes pincer grasp, finger
feeding, standing while holding onto a table, and playing peekaboo. Age (in
months)? - ANSWER-9 months
60yo M exam prior to employment. PE normal. Labs show
Hb 14, HCT 42%, WBC 12k (PMN 45%, lymphos 50%, Monos 5%), platelets 250k.
Flow cytometry analysis of peripheral lymphocytes shows: CD3 50%, CD4 40%,
CD8 10%, Kappa 47%, lambda 3%. Which is most predictive of a clonal lymphoid
proliferation? - ANSWER-Surface kappa:surface lambda ratio
4|Page
