NBME FINAL PAPER 2026 FULL SOLUTION
WITH COMPLETE QUESTIONS AND
VERIFIED ANSWERS
⫸ Olanazepine Answer:
⫸ The elderly and dementia related psychosis with antipsychotics
Answer: DO not give antipsychotics to the elderly with dementia as
there is an increased risk of death as shown in short term controlled trials
: increased risk of death - cardiovascular heart failure, sudden death or
infections
⫸ AA with previously controlled Diabetes was started on olanzapine
prior to discharge and recently has gained 25 lb what test should be
tested Answer: SERUM glucose levels - No olanazpine ( as even at
normal levels it causes metabolic abnormalities)
increased risk of diabetes and hyperglycemia
* always monitor blood glucose*
⫸ Addison's disease Answer: Hyperpigmentation of skin and mucous
membranes - 1st symptoms - most prominent in sun exposed skin areas
Myalgias- hypokalemia
Fatigue, weigh loss, poor appetite
* random symptoms - heightened sense of smell taste and hearing and
salt craving *
Females have amenorrhea d/t weight loss and chronic illness
,⫸ Pt presents with dizziness while sitting and standing but no
orthostatic changes - 96/60 and only is not dizzy while running
Sodium is 134
Potassium 3.4 Answer: ADDISONS disease
-exercise is a natural way to increase cortisol
⫸ Acute addison's disease Answer: prominant nausea vomting and
vascular colaapse - may have an acute abdomein with hyperpyrexia ( >
105 )
⫸ intention to treat Answer: Intention to treat (ITT) analysis means all
patients who were enrolled and randomly allocated to treatment are
included in the analysis and are analysed in the groups to which they
were randomized. i.e. "once randomized, always analyzed"
⫸ Seroma Answer: us a collection of fluid under the suture line and
may occur in regions of extensive undermining or dead space
⫸ A fib Answer: Irregularly irregular rhythm
NO P Waves
Variable ventricular rate
QRS are narrow < 120 ms unless pre-exisiting bundle branch ( if right
called ashman's phenomenon)
,⫸ A flutter Answer: regular atrial activity at ~300 bpm giving a saw
tooth appearance best seen in leads 2,3, AVF
⫸ Work up for carotid artery stenosis Answer: Ultrasound is the
screening test of choice
Arteriography - comes with 1-2% risk of stroke
⫸ Viral bronchitis Answer: inflammation of the trachea, bronchi, and
bronchioles
Hacking cough with phlegm production and often follows an upper
respiratory infection
caused by: adenovirus, influenza, parainfluenze
Manefests as the common cold - mucoid phelgm that esolved in 7-10
days
⫸ Viral bronchiolitis Answer: Inflammation of the bronchioles that is
normally caused by a viral infection -- RSV
low grade fever
*apnea maybe the first symptoms in early disease*
Coryza, fine rales and wheezes
⫸ who gets palivizumab Answer: infants born at less then 29 weeks
should recieve palivizumab or those under 1 year with heart disease and
lung disease
, ⫸ Acute laryngotracheobronchitis Answer: CROUP
It is the most common etiology for hoarseness, cough, and onset of acute
stridor in febrile children.
Croup usually begins with nonspecific respiratory symptoms (ie,
rhinorrhea, sore throat, cough). Fever is generally low grade (38-39°C)
but can exceed 40°C. Within 1-2 days, the characteristic signs of
hoarseness, barking cough, and inspiratory stridor develop, often
suddenly, along with a variable degree of respiratory distress. Symptoms
are perceived as worsening at night, with most ED visits occurring
between 10 pm and 4 am.
⫸ exercise programs improve the ability to do what for nursing home
residents Answer: complete the activities of daily living
⫸ What vitamin is commonly low in the elderly d/t natural gastric
achlorhydria Answer: Vitamine B12
leading to macrocytosis and balence problems
⫸ Adverse effects of echinacea Answer: Abdominal pain
Allergic reactions
Altered fertility
Diarrhea
WITH COMPLETE QUESTIONS AND
VERIFIED ANSWERS
⫸ Olanazepine Answer:
⫸ The elderly and dementia related psychosis with antipsychotics
Answer: DO not give antipsychotics to the elderly with dementia as
there is an increased risk of death as shown in short term controlled trials
: increased risk of death - cardiovascular heart failure, sudden death or
infections
⫸ AA with previously controlled Diabetes was started on olanzapine
prior to discharge and recently has gained 25 lb what test should be
tested Answer: SERUM glucose levels - No olanazpine ( as even at
normal levels it causes metabolic abnormalities)
increased risk of diabetes and hyperglycemia
* always monitor blood glucose*
⫸ Addison's disease Answer: Hyperpigmentation of skin and mucous
membranes - 1st symptoms - most prominent in sun exposed skin areas
Myalgias- hypokalemia
Fatigue, weigh loss, poor appetite
* random symptoms - heightened sense of smell taste and hearing and
salt craving *
Females have amenorrhea d/t weight loss and chronic illness
,⫸ Pt presents with dizziness while sitting and standing but no
orthostatic changes - 96/60 and only is not dizzy while running
Sodium is 134
Potassium 3.4 Answer: ADDISONS disease
-exercise is a natural way to increase cortisol
⫸ Acute addison's disease Answer: prominant nausea vomting and
vascular colaapse - may have an acute abdomein with hyperpyrexia ( >
105 )
⫸ intention to treat Answer: Intention to treat (ITT) analysis means all
patients who were enrolled and randomly allocated to treatment are
included in the analysis and are analysed in the groups to which they
were randomized. i.e. "once randomized, always analyzed"
⫸ Seroma Answer: us a collection of fluid under the suture line and
may occur in regions of extensive undermining or dead space
⫸ A fib Answer: Irregularly irregular rhythm
NO P Waves
Variable ventricular rate
QRS are narrow < 120 ms unless pre-exisiting bundle branch ( if right
called ashman's phenomenon)
,⫸ A flutter Answer: regular atrial activity at ~300 bpm giving a saw
tooth appearance best seen in leads 2,3, AVF
⫸ Work up for carotid artery stenosis Answer: Ultrasound is the
screening test of choice
Arteriography - comes with 1-2% risk of stroke
⫸ Viral bronchitis Answer: inflammation of the trachea, bronchi, and
bronchioles
Hacking cough with phlegm production and often follows an upper
respiratory infection
caused by: adenovirus, influenza, parainfluenze
Manefests as the common cold - mucoid phelgm that esolved in 7-10
days
⫸ Viral bronchiolitis Answer: Inflammation of the bronchioles that is
normally caused by a viral infection -- RSV
low grade fever
*apnea maybe the first symptoms in early disease*
Coryza, fine rales and wheezes
⫸ who gets palivizumab Answer: infants born at less then 29 weeks
should recieve palivizumab or those under 1 year with heart disease and
lung disease
, ⫸ Acute laryngotracheobronchitis Answer: CROUP
It is the most common etiology for hoarseness, cough, and onset of acute
stridor in febrile children.
Croup usually begins with nonspecific respiratory symptoms (ie,
rhinorrhea, sore throat, cough). Fever is generally low grade (38-39°C)
but can exceed 40°C. Within 1-2 days, the characteristic signs of
hoarseness, barking cough, and inspiratory stridor develop, often
suddenly, along with a variable degree of respiratory distress. Symptoms
are perceived as worsening at night, with most ED visits occurring
between 10 pm and 4 am.
⫸ exercise programs improve the ability to do what for nursing home
residents Answer: complete the activities of daily living
⫸ What vitamin is commonly low in the elderly d/t natural gastric
achlorhydria Answer: Vitamine B12
leading to macrocytosis and balence problems
⫸ Adverse effects of echinacea Answer: Abdominal pain
Allergic reactions
Altered fertility
Diarrhea
