NBME CBSE REAL Final Exam
2025/2026
NBME CBSE REAL Final Exam 2025/2026
Complete All Verified Questions And Correct
Detailed Answers (Rationales) |Already
Graded A+||Brand New Updated Version
52-year-old female with a history of breast cancer who received 4week course of radiations 6
months ago comes for followup. Exam shows no cancer recurrence. rr 26/min. CT chest shows
bilateral atelectasis in upper lung fields. Primary pathophysiological cause?
A. Compression
B. Consolidation
C. Contraction
D. Obstruction
E. Resorption
C. Contraction (secondary to radiation)
Atelectasis= loss of lung volume due to inadequate expansion of air space.
Contraction Atelectasis: radiation causes local or general fibrotic changes in lung or pleura which
makes full expansion not possibly and causes and increase in elastic recoil during expiration
(stiffer lungs).
35-year-old woman with infertile, receive injection of contrast material into cervix. On
hysterosalpingogram (shown), contrast material (indicated by arrows) also seen in peritoneal
cavity, which explain this finding?
A. Rupture of the fallopian tube
B. Rupture of the uterine body
C. Spillage of contrast which in an artifact
D. Spillage of contrast which is normal
D. Spillage of contrast which is normal
A+ TEST BANK 1
, NBME CBSE REAL Final Exam
2025/2026
48-year-old woman with gradual onset back pain past 2 weeks. No trauma. Doesn't smoke
cigarettes, drink alcohol or use drugs. Hemogram, serologic studies and urinalysis unremarkable.
Xray of spine shows two lytic lesions, in T-10 and L-1. Dx?
A. Avascular necrosis
B. Metastatic carcinoma of breast
C. Osteosarcoma
D. Renal osteodystrophy
E. Thyroid carcinoma
B. Metastatic carcinoma of breast
Bone Mets (most to least common): Prostate, breast>lung, thyroid, kidney
A 68-year-old man comes to the physician because of a 1-month history of light-headedness and
tightness in his chest with exertion. He adds that the pain is worse after arguing with his wife,
and the symptoms resolve with rest. He has a past history of lower gastrointestinal bleeding;
evaluation at that time was negative on upper endoscopy and colonoscopy. His temperature is
37°C (98.6°F), pulse is 85/min, respirations are 15/min, and blood pressure is 110/75 mm Hg.
Physical examination shows no abnormalities. His hemoglobin concentration is 8.2 g/dL, and
hematocrit is 24%. Test of the stool for occult blood is positive. An ECG shows no abnormalities.
Repeat colonoscopy shows no abnormalities. Which of the following is the most likely cause of
this patient's gastrointestinal symptoms?
A. Adenocarcinoma of the colon
B. Angiodysplasia
C. Diverticulitis
D. Peutz-Jeghers syndrome
B. Angiodysplasia
Tortuous dilation of vessels--> hematochezia. Most often found in cecum, terminal ileum,
ascending colon. More common in older patients. Confirmed by angiography
24-year-old man with 3-day progressive numbness of both feet that has ascended to thighs. Last
24 hours, numbness and tingling of hands. PE ataxic gait. Deep tendon reflexes diminished in
upper extremities and absent in knees and ankles. Vibration and joint position absent in
fingertips and feet bilaterally. Mild weakness distal upper extremities ad moderate weakness of
lower extremities. Structure involved in creating these sensory findings?
A+ TEST BANK 2
, NBME CBSE REAL Final Exam
2025/2026
A. Dorsal spinocerebellar tract
B. Fasciculus cuneatus
C. Fasiculus gracilisi
D. Myelinated primary afferents
E. Unmyelinated primary afferents
F. Ventral spinocerebellar tract
D. Myelinated primary afferents
Guillain-Barre syndrome: Ascending symmetric numbness and paralysis that begins in the lower
extremities. Due to autoimmune destruction of schwann cells--> inflammation and demylination
of peripheral nerves and motor fibers.
55-year-old man northern European descent with 2-month weakness, altered skin color, bilateral
knee pain. Siblings have type 2 diabetes and cirrhosis. His PE bronzed skin, hepatomegaly,
arthritis. Increased saturation of transferrin and ferritin. Liver biopsy increased iron content and
cirrhosis Greatest risk?
Hemochromatosis!
From multiple blood transfusions or hereditary HFE mutation (can result in heart failure, "bronze
diabetes," and increase risk of hepatocellular carcinoma
Classic triad= cirrhosis, DM, and skin pigmentation
45-year-old man bmi 26, total cholesterol 200(boderline high) , HDL 50, triglycerides 550 (high).
In addition to lifestyle changes. Which drug to prescribe?
A. Colestipol
B. Ezetimibe
C. Fenofibrate
D. Orlistat
E. Simvastatin
Main issue is high triglycerides!!
C. Fenofibrate
Upregulates LPL-> increase in triglyceride clearence and it will activate PPAR-A to induce HDL
synthesis
Colestipol= Bile acid resin which actually slightly increases triglycerides and predominately used
to decrease LDL by preventing intestinal reabsorption of bile acids; liver must use cholesterol to
make more
A+ TEST BANK 3
, NBME CBSE REAL Final Exam
2025/2026
47-year-old woman with irregular, raised, multicolored dark lesion on left forearm with frequent
sunlight exposure. Biopsy shows malignant pigmented cells. Worst prognosis with involvement
of which layer?
A. Basement membrane
B. Epidermis
C. Papillary dermis
D. Reticular dermis
E. Subcutaneous tissue
subcutaneous tissue
Deepest layer/ deeper the tissue involvement is the worse the prognosis
Layers of the skin:
EPIDERMIS (surface to base): Stratum Corneum (keratin), Stratum Lucidum, Stratum
Granulosum, Stratum Spinosum, Stratum Basale.
DERMIS
SUBCUTANEOUS FAT (hypodermis, subcutis)
Lab Workbench wiped down with alcohol, successfully inactivates viruses with which
characteristic?
A. DNA genome
B. Enveloped virion
C. Helical capsid
D. Icosahedral capsid
E. Naked virion
F. RNA genome
B. Enveloped virion
Alcohol's denature proteins and disrupts cell membrane.
82-year-old woman comes to the physician because of constant severe lower abdominal pain
and fever for 24 hours. Laproscopic examination shows severe diverticulosis and perforated
diverticulitis. In spite of appropriate therapy she dies 2 days later. Liver autopsy shown. Which of
the following is the primary component of the material shown on the hepatic surface?
A. Collagen Type I
B. Collagen Type III
C. Fibrin
D. Fibronectin
E. Proteoglycans
A+ TEST BANK 4
2025/2026
NBME CBSE REAL Final Exam 2025/2026
Complete All Verified Questions And Correct
Detailed Answers (Rationales) |Already
Graded A+||Brand New Updated Version
52-year-old female with a history of breast cancer who received 4week course of radiations 6
months ago comes for followup. Exam shows no cancer recurrence. rr 26/min. CT chest shows
bilateral atelectasis in upper lung fields. Primary pathophysiological cause?
A. Compression
B. Consolidation
C. Contraction
D. Obstruction
E. Resorption
C. Contraction (secondary to radiation)
Atelectasis= loss of lung volume due to inadequate expansion of air space.
Contraction Atelectasis: radiation causes local or general fibrotic changes in lung or pleura which
makes full expansion not possibly and causes and increase in elastic recoil during expiration
(stiffer lungs).
35-year-old woman with infertile, receive injection of contrast material into cervix. On
hysterosalpingogram (shown), contrast material (indicated by arrows) also seen in peritoneal
cavity, which explain this finding?
A. Rupture of the fallopian tube
B. Rupture of the uterine body
C. Spillage of contrast which in an artifact
D. Spillage of contrast which is normal
D. Spillage of contrast which is normal
A+ TEST BANK 1
, NBME CBSE REAL Final Exam
2025/2026
48-year-old woman with gradual onset back pain past 2 weeks. No trauma. Doesn't smoke
cigarettes, drink alcohol or use drugs. Hemogram, serologic studies and urinalysis unremarkable.
Xray of spine shows two lytic lesions, in T-10 and L-1. Dx?
A. Avascular necrosis
B. Metastatic carcinoma of breast
C. Osteosarcoma
D. Renal osteodystrophy
E. Thyroid carcinoma
B. Metastatic carcinoma of breast
Bone Mets (most to least common): Prostate, breast>lung, thyroid, kidney
A 68-year-old man comes to the physician because of a 1-month history of light-headedness and
tightness in his chest with exertion. He adds that the pain is worse after arguing with his wife,
and the symptoms resolve with rest. He has a past history of lower gastrointestinal bleeding;
evaluation at that time was negative on upper endoscopy and colonoscopy. His temperature is
37°C (98.6°F), pulse is 85/min, respirations are 15/min, and blood pressure is 110/75 mm Hg.
Physical examination shows no abnormalities. His hemoglobin concentration is 8.2 g/dL, and
hematocrit is 24%. Test of the stool for occult blood is positive. An ECG shows no abnormalities.
Repeat colonoscopy shows no abnormalities. Which of the following is the most likely cause of
this patient's gastrointestinal symptoms?
A. Adenocarcinoma of the colon
B. Angiodysplasia
C. Diverticulitis
D. Peutz-Jeghers syndrome
B. Angiodysplasia
Tortuous dilation of vessels--> hematochezia. Most often found in cecum, terminal ileum,
ascending colon. More common in older patients. Confirmed by angiography
24-year-old man with 3-day progressive numbness of both feet that has ascended to thighs. Last
24 hours, numbness and tingling of hands. PE ataxic gait. Deep tendon reflexes diminished in
upper extremities and absent in knees and ankles. Vibration and joint position absent in
fingertips and feet bilaterally. Mild weakness distal upper extremities ad moderate weakness of
lower extremities. Structure involved in creating these sensory findings?
A+ TEST BANK 2
, NBME CBSE REAL Final Exam
2025/2026
A. Dorsal spinocerebellar tract
B. Fasciculus cuneatus
C. Fasiculus gracilisi
D. Myelinated primary afferents
E. Unmyelinated primary afferents
F. Ventral spinocerebellar tract
D. Myelinated primary afferents
Guillain-Barre syndrome: Ascending symmetric numbness and paralysis that begins in the lower
extremities. Due to autoimmune destruction of schwann cells--> inflammation and demylination
of peripheral nerves and motor fibers.
55-year-old man northern European descent with 2-month weakness, altered skin color, bilateral
knee pain. Siblings have type 2 diabetes and cirrhosis. His PE bronzed skin, hepatomegaly,
arthritis. Increased saturation of transferrin and ferritin. Liver biopsy increased iron content and
cirrhosis Greatest risk?
Hemochromatosis!
From multiple blood transfusions or hereditary HFE mutation (can result in heart failure, "bronze
diabetes," and increase risk of hepatocellular carcinoma
Classic triad= cirrhosis, DM, and skin pigmentation
45-year-old man bmi 26, total cholesterol 200(boderline high) , HDL 50, triglycerides 550 (high).
In addition to lifestyle changes. Which drug to prescribe?
A. Colestipol
B. Ezetimibe
C. Fenofibrate
D. Orlistat
E. Simvastatin
Main issue is high triglycerides!!
C. Fenofibrate
Upregulates LPL-> increase in triglyceride clearence and it will activate PPAR-A to induce HDL
synthesis
Colestipol= Bile acid resin which actually slightly increases triglycerides and predominately used
to decrease LDL by preventing intestinal reabsorption of bile acids; liver must use cholesterol to
make more
A+ TEST BANK 3
, NBME CBSE REAL Final Exam
2025/2026
47-year-old woman with irregular, raised, multicolored dark lesion on left forearm with frequent
sunlight exposure. Biopsy shows malignant pigmented cells. Worst prognosis with involvement
of which layer?
A. Basement membrane
B. Epidermis
C. Papillary dermis
D. Reticular dermis
E. Subcutaneous tissue
subcutaneous tissue
Deepest layer/ deeper the tissue involvement is the worse the prognosis
Layers of the skin:
EPIDERMIS (surface to base): Stratum Corneum (keratin), Stratum Lucidum, Stratum
Granulosum, Stratum Spinosum, Stratum Basale.
DERMIS
SUBCUTANEOUS FAT (hypodermis, subcutis)
Lab Workbench wiped down with alcohol, successfully inactivates viruses with which
characteristic?
A. DNA genome
B. Enveloped virion
C. Helical capsid
D. Icosahedral capsid
E. Naked virion
F. RNA genome
B. Enveloped virion
Alcohol's denature proteins and disrupts cell membrane.
82-year-old woman comes to the physician because of constant severe lower abdominal pain
and fever for 24 hours. Laproscopic examination shows severe diverticulosis and perforated
diverticulitis. In spite of appropriate therapy she dies 2 days later. Liver autopsy shown. Which of
the following is the primary component of the material shown on the hepatic surface?
A. Collagen Type I
B. Collagen Type III
C. Fibrin
D. Fibronectin
E. Proteoglycans
A+ TEST BANK 4
