NBME CBSE REAL EXAM PRACTICE TESTS LATEST 2025 COMPLETE EXAM
NBME CBSE REAL EXAM PRACTICE TESTS LATEST 2025
COMPLETE EXAM WITH 400 QUESTIONS AND CORRECT
DETAILED ANSWERS |ALREADYGRADED A+
65 yo w/ painful gout requests a disabled parking permit. What does the physician
say? - ANSWER-"I will authorize the permit, but i recommend that you continue
w/ regular exercise and only use the permit when you are having severe pain"
- DMV will need doctor to verify condition
- usually for: Lung disease, Heart disease, impaired mobility, wheelchair, brace, or
cane, limited ability walk or to use your legs, Documented vision problems,
including low-vision or partial sightedness, Loss of one or both legs or loss of both
hands, or limited use of these parts
25 yo after MVA has low BP from ruptured spleen has surgery -> episodes of
hypotension. in next 24 hrs he has azotemia, and is fully colume restored, but
urine remains less than 20ml/h. What will his UA show? - ANSWER-fractional
excretion of sodium greater than 2%
- intrinsic renal azotemia -> decreased RBF = decreased GFR
- causes acute tubular necrosis as repleted water and he still has decreased urine
output -> no improvement of symptoms with hydration (prerenal azotemia will
improve with repletion of water)
- from prolonged ischemia
- urea absorption is impaired as tubules are no longer functioning -> decreased
BUN (<15)
- kidney can no longer concentrate urine = <350 osm
- no longer reabsorbing sodium (>40 excreted) making the FENa >2%
1|Page
, NBME CBSE REAL EXAM PRACTICE TESTS LATEST 2025 COMPLETE EXAM
A newborn male has a limb deformity. The woman's mother, sister, and husband
are in the room. How d you deliver the news? - ANSWER-Ask mother and sister to
leave room and inform the parents of the abnormality
54 yo w/ rheumatic heart disease come to ER w/ 45 mins of SOB. Pulse is 115, RR
24, BP 110/80, crackles over lower lungs bilaterally. has 2/6 systolic ejection
murmur radiating to right side of neck and diastolic murmur at apex. ECG shows
afib, and LA enlargement. No ischemia. What is causing her pulmonary
symptoms? - ANSWER-Intra-alveolar transudates
- increase pulmonary veinous pressure -> pulmonary veinous distention, and
transudation of fluid into alveoli
- presence of hemosiderin-laden macrophages (heart failure cells) in lung alveoli
20 yo woman w/ low grade fever, fatigue, joint pain for a year. A week ago these
got worse at the beach and got rash on areas not even in sun. temp is 101. PE
shows malar/trunk rash, oral ulcers, swollen lymph nodes. ANA AB 1:200. Gene
encoding what protein is mutated? - ANSWER-C1q
- SLE: autoimmune disease from type II and III rxns
- associated w/ deficiency of early complement proteins (C1q, C4, C2) ->
decreased clearance of immune complexes
32 yo has ruptured membrane at 39 weeks and umbilical cord compression is
suspected. What would explain the decrease in fetal heart rate due to
compression? - ANSWER-Increased fetal systemic vascular resistance
- increase in BP felt by babies carotid body -> increases firing to tell PNS vagus
nerve to kick on and slow HR
2|Page
, NBME CBSE REAL EXAM PRACTICE TESTS LATEST 2025 COMPLETE EXAM
- Compression of babies umbilical veins/arteries are part of their circulation and
will be felt as a increase in SVR
Rheumatoid arthritis is most similar to what other kind of immune reaction? -
ANSWER-Serum sickness
- both are type III hypersensitivity rxn = immune complexes (AG-AB mostly IgG)
activate complement -> attracts neutrophils that release lysosomal enzymes
- three things stuck together: AG-AB-complement
- others: SLE, polyarteritis nodosa, PSGN, some drugs (penicillin = haptens), and
hep B
- RA: HLA-DR4 (4 walled rheum)
- rheumatoid factor = IgM AB that targets IgG FC region
- most specific AB = anti-cyclic citrullinated peptide
24 yo has purple spots over legs. three months ago she has splenectomy for
immune thrombocytopenic purpura. Labs shows Hb 13.5, hct 40%, leukocyte
10,000, platelet 25,000, PTT 29 sec.
Her plt after operation were 20,000 -> 100,000 and she had howell-jolly bodies.
Today she has no howell-jolly bodies. What explains this? - ANSWER-accessory
spleen
- small nodule of splenic tissue found apart from main body of the spleen
- in 10% of the population and are 1 centimetre in diameter. They may resemble a
lymph node or a small spleen
- hence why she no longer has howel-jowell bodies, and why plts are still being
removed
3|Page
, NBME CBSE REAL EXAM PRACTICE TESTS LATEST 2025 COMPLETE EXAM
in a 62 yo male w/ BP 220/160 wants a drug to decrease HR and SVR. What can
you us? - ANSWER-Labetalol
- alpha and beta antagonist can be used in HTN emergency
- reduces afterload via vasodilation
- also can be used in pregnancy
- used IV
45 yo lifelong smoker quit 3 years prior has white patch on lateral border of
tongue. Bx shows carcinoma in situ. If this is left untreated what will occur next? -
ANSWER-Invasion of submucosa
- not dissemination to distant sites -> this would happen second
- tongue structure: stratified squamous epithelial layer, basement membrane,
lamina propria -> sumucosa w/ glands -> muscle core
Cyclophasphamide kill mitotic cells. What cells are most rapidly depleted? B
lymphocytes, granulocytes, T lymphocytes? - ANSWER-Granulocytes
- turnover faster than bone marrow cell types
- most likely to have neutropenia in chemo -> most pronounced
- total leukocyte count will be low with neutropenia is most prominent
78 yo has is on life support and neighbor who cooks for and cares for him tells you
he wouldn't want to be kept on life support. pt has poor prognosis and has no
relatives/children. What is the most appropriate thing to say at this time? -
ANSWER-"thank you for telling me this. your friends previous statements to you
can be helpful in making decisions for him"
4|Page
NBME CBSE REAL EXAM PRACTICE TESTS LATEST 2025
COMPLETE EXAM WITH 400 QUESTIONS AND CORRECT
DETAILED ANSWERS |ALREADYGRADED A+
65 yo w/ painful gout requests a disabled parking permit. What does the physician
say? - ANSWER-"I will authorize the permit, but i recommend that you continue
w/ regular exercise and only use the permit when you are having severe pain"
- DMV will need doctor to verify condition
- usually for: Lung disease, Heart disease, impaired mobility, wheelchair, brace, or
cane, limited ability walk or to use your legs, Documented vision problems,
including low-vision or partial sightedness, Loss of one or both legs or loss of both
hands, or limited use of these parts
25 yo after MVA has low BP from ruptured spleen has surgery -> episodes of
hypotension. in next 24 hrs he has azotemia, and is fully colume restored, but
urine remains less than 20ml/h. What will his UA show? - ANSWER-fractional
excretion of sodium greater than 2%
- intrinsic renal azotemia -> decreased RBF = decreased GFR
- causes acute tubular necrosis as repleted water and he still has decreased urine
output -> no improvement of symptoms with hydration (prerenal azotemia will
improve with repletion of water)
- from prolonged ischemia
- urea absorption is impaired as tubules are no longer functioning -> decreased
BUN (<15)
- kidney can no longer concentrate urine = <350 osm
- no longer reabsorbing sodium (>40 excreted) making the FENa >2%
1|Page
, NBME CBSE REAL EXAM PRACTICE TESTS LATEST 2025 COMPLETE EXAM
A newborn male has a limb deformity. The woman's mother, sister, and husband
are in the room. How d you deliver the news? - ANSWER-Ask mother and sister to
leave room and inform the parents of the abnormality
54 yo w/ rheumatic heart disease come to ER w/ 45 mins of SOB. Pulse is 115, RR
24, BP 110/80, crackles over lower lungs bilaterally. has 2/6 systolic ejection
murmur radiating to right side of neck and diastolic murmur at apex. ECG shows
afib, and LA enlargement. No ischemia. What is causing her pulmonary
symptoms? - ANSWER-Intra-alveolar transudates
- increase pulmonary veinous pressure -> pulmonary veinous distention, and
transudation of fluid into alveoli
- presence of hemosiderin-laden macrophages (heart failure cells) in lung alveoli
20 yo woman w/ low grade fever, fatigue, joint pain for a year. A week ago these
got worse at the beach and got rash on areas not even in sun. temp is 101. PE
shows malar/trunk rash, oral ulcers, swollen lymph nodes. ANA AB 1:200. Gene
encoding what protein is mutated? - ANSWER-C1q
- SLE: autoimmune disease from type II and III rxns
- associated w/ deficiency of early complement proteins (C1q, C4, C2) ->
decreased clearance of immune complexes
32 yo has ruptured membrane at 39 weeks and umbilical cord compression is
suspected. What would explain the decrease in fetal heart rate due to
compression? - ANSWER-Increased fetal systemic vascular resistance
- increase in BP felt by babies carotid body -> increases firing to tell PNS vagus
nerve to kick on and slow HR
2|Page
, NBME CBSE REAL EXAM PRACTICE TESTS LATEST 2025 COMPLETE EXAM
- Compression of babies umbilical veins/arteries are part of their circulation and
will be felt as a increase in SVR
Rheumatoid arthritis is most similar to what other kind of immune reaction? -
ANSWER-Serum sickness
- both are type III hypersensitivity rxn = immune complexes (AG-AB mostly IgG)
activate complement -> attracts neutrophils that release lysosomal enzymes
- three things stuck together: AG-AB-complement
- others: SLE, polyarteritis nodosa, PSGN, some drugs (penicillin = haptens), and
hep B
- RA: HLA-DR4 (4 walled rheum)
- rheumatoid factor = IgM AB that targets IgG FC region
- most specific AB = anti-cyclic citrullinated peptide
24 yo has purple spots over legs. three months ago she has splenectomy for
immune thrombocytopenic purpura. Labs shows Hb 13.5, hct 40%, leukocyte
10,000, platelet 25,000, PTT 29 sec.
Her plt after operation were 20,000 -> 100,000 and she had howell-jolly bodies.
Today she has no howell-jolly bodies. What explains this? - ANSWER-accessory
spleen
- small nodule of splenic tissue found apart from main body of the spleen
- in 10% of the population and are 1 centimetre in diameter. They may resemble a
lymph node or a small spleen
- hence why she no longer has howel-jowell bodies, and why plts are still being
removed
3|Page
, NBME CBSE REAL EXAM PRACTICE TESTS LATEST 2025 COMPLETE EXAM
in a 62 yo male w/ BP 220/160 wants a drug to decrease HR and SVR. What can
you us? - ANSWER-Labetalol
- alpha and beta antagonist can be used in HTN emergency
- reduces afterload via vasodilation
- also can be used in pregnancy
- used IV
45 yo lifelong smoker quit 3 years prior has white patch on lateral border of
tongue. Bx shows carcinoma in situ. If this is left untreated what will occur next? -
ANSWER-Invasion of submucosa
- not dissemination to distant sites -> this would happen second
- tongue structure: stratified squamous epithelial layer, basement membrane,
lamina propria -> sumucosa w/ glands -> muscle core
Cyclophasphamide kill mitotic cells. What cells are most rapidly depleted? B
lymphocytes, granulocytes, T lymphocytes? - ANSWER-Granulocytes
- turnover faster than bone marrow cell types
- most likely to have neutropenia in chemo -> most pronounced
- total leukocyte count will be low with neutropenia is most prominent
78 yo has is on life support and neighbor who cooks for and cares for him tells you
he wouldn't want to be kept on life support. pt has poor prognosis and has no
relatives/children. What is the most appropriate thing to say at this time? -
ANSWER-"thank you for telling me this. your friends previous statements to you
can be helpful in making decisions for him"
4|Page
