NBME CBSE REAL EXAM 200 QUESTIONS AND ANSWERS LATEST 2025 COMPLETE EXAM (usmle step 1)MEDICAL EXAMINATION

NBME CBSE REAL EXAM 200 QUESTIONS AND
ANSWERS LATEST 2025 COMPLETE EXAM (usmle
step 1)MEDICAL EXAMINATION




1. 70yo M dies in a motor vehicle collision. Was undergoing evaluation for occult
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blood in the stool. Photo of transverse colon shown. Dx? -
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- Tubular adenoma - g g




2. 38yo M with 1-week hx of watery, itchy eyes and a runny nose. Physical shows
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inflamed nasal mucosa. No congestion in lower lung. Pharmacotherapy? -
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- Loratadine - g




3. 16yo girl with 3-day hx of fever, nonproductive cough, and fatigue. T 38.3, P
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88/min, BP 102-70. PE shows pale conjunctivae. CXR shows bilateral interstitial
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infiltrates. Blood spontaenously agglutinates while awaiting transport to the
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laboratory. Antibody isotypes causing agglutination? -
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- IgM - g




4. 24yo M with small tender blisters on his penis 3 days after unprotected sex.
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Photograph shown. Causal agent? -
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- Herpes simplex virus type 2 -
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5. 42yo F with 3-year hx of an intermittent facial rash, including the forehead,
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eyelids, nose, and cheeks. Rash seems to be getting worse since she moved from
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New York to Florida last year. Spicy foods precipitate a flushing reaction that
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seems to exacerbate the rash. PE shows erythema over the nose and cheeks, with
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scattered telangiectasias and a few papules. Dx? -
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,- Rosacea -
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,6. 53yo M returned from Africa, has fever, headache, and abdominal discomfort.
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Received appropriate vaccinations prior to the trip. T 39.4C. A wright-stained
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peripheral smear shown. Dx? -
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- Malaria - g




7. 68yo F with T2DM and hypertension that has eben poorly controlled despite
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hydrochlorothiazide treatment. BP 150/96, Labs show serum glucose concentration
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of 130 and proteinuria. In addition to current Rx, which is most appropriate
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pharmacotherapy? -
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- Lisinopril - g




8. 66yo M with stage IV colon cancer with 3-day hx of severe diarrhea after
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receiving chemotherapy with flourouracil, leucovorin, and irinotecan. perscribed
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opioid antidiarrheal agent with no CNS effects. Which med? -
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- Loperamide - g




9. 35yo M in ED with 2-hour hx of sever fatigue and dizziness. Had profuse, watery
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diarrhea for 8 hours despite a lack of oral intake. Recently returned from a medical
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relief trip to a remove village in Honduras. T 36.7 C, P 122/min, BP 90/50. PE shows
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dry skin and decreased capillary refill. Stool for occult blood is negative; stool is gray
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and turbid. Gram stain shows gram-negative, comma-shaped bacteria; no
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erythrocytes of leukocytes. MOA of toxin? -
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- Activation of adenylyl cyclase - g g g g




10. 59yo F with gradual onset of lack of muscle control in her left arm and leg. Sx 1
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mo ago after dx with metastatic breast cancer. PE shows ataxia of left upper and
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lower extremities. Muscle strength, DTR, sensation, proprioception normal.
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Metastatic tumor in which location? -
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- Cerebellum - g

, 11. Newborn delivered at 38 weeks' gestation weighs 1800 g. PE shows petechial g g g g g g g g g g g




rash, microcephaly, and hepatosplenomegaly. Serologic test for CMV: IgG + in
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mother, + in newborn; IGM - in mother, + in newborn. Explanation? -
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- Congenital cytomegalovirus infection - g g g




12. Female newborn is delivered at 38 weeks' gestation. Apgar 8 and 8 at 1/5 min. PE
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shows a bulging, fluod0filled mass approximately 5 cm in diameter in the midline
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over the lumbosacral region. No spontaneous movements of the lower extremities.
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Abnormality most likely occurred because of abnormal development during which
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periods of postconception (in days)? -
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- 15 to 40 -
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13. 64yo M in ED 3 hours after SOB with exertion and extreme fatigue. Has
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ischemic heart disease. P 125/min, BP 105/60. ECG shows atrial fibrillation.
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Intravenous ibutilide is administered. Ten minutes later, ECG shows normal sinus
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rhythm. Risk for which drug effect in the next 6 hours? -
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- Torsades de pointes - g g g




14. 65yo F with 20-year hx of osteoarthritis of the hands now has pain radiating
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down the distal anterior thigh, knee, medial leg, and food. Bony outgrowth of
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vertebrae compressing one of the spinal nerves is suspected. Nerve root in which
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intervertebral foramina is effected? -
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- L-3 to 4 -
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15. 38yo M with 3-year hx of T2DM. Taking an oral antihyperglycemic agent, he
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has tried diet and exercise. BMI 32. PE normal. Hb A1c is 10%. Physician
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recommends initiation of insulin injections. Responds, "I know that insulin would
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help control my blood sugar. But a lot of people in my family have diabetes, and
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insulin made them really sick at times. Patient is at which stage of change? -
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- Contemplation - g