NBME FULL SOLUTION PACK EXAM 2026
ACTUAL EXAM PAPER COMPLETE
QUESTIONS AND ANSWERS
⩥ 23 yo AA man - 2 months of inc pain and swelling above R.knee
> no trauma, recent fever
PMHx: retinoblastoma (infancy - tx w/ enucleation)
98.6F
PE: mod swelling of distal femur; mild tenderness to palp w/ mod
discomfort on weight bearing
labs: alk phos 1350
x-ray of R.femur: lytic lesion w/ periosteal new bone at margins
most likely dx? Answer: osteosarcoma
osteoSarComa = Sunburst + Codman's triangle
> periosteal bone rx (from elevation of periosteum) = Codman's triangle
RF: Paget dz of bone, bone infarcts, radiation, familial retinoblastoma,
Li-Fraumeni syndrome
> homeboy had retinoblastoma as an infant
commonly affects metaphysis of long bones (esp knees)
presents as painful enlarging mass or path features
peak incidence of primary tumor in males < 20 yo
,⩥ 27 yo AA woman - 1 wk of tight sensation in chest and nonproductive
cough
> cough freq at night
> breathing txs in ED for acute SOB twice during past 3 months
~ told to stop smoking
PMHx: freq URIs
no meds
SHx: smokes 1 pack qd for 10 yrs
vitals: stable
PE: end-exp wheezes BL
CXR: gucci
most likely underlying cause of symptoms? Answer: activation of mast
cells
asthma exacerbated by smoke
bronchodilator therapy reversing the SOB is the key finding here
> this is how you differentiate bet asthma and COPD
symptoms typically worse at night
features: SOB, wheezing, chest tightness, cough
associated triggers include tobacco smoke
⩥ 27 yo - 3 hrs of muscle swelling/tenderness of L.thigh
> minimal trauma
,PMHx: severe hemophilia A
> tx factor VIII replacement for bleeding episodes since childhood
over recent months: bleeding poorly controlled
> inc doses of factor VIII have been req to stop bleeding episodes
labs: dec plt 125,000; aPTT > 120 sec
next step in dx of pt's inc bleeding? Answer: test for factor VIII inhibitor
during mixing study: normal plasma is added to plasma from
hemophiliac pt
> clotting def should correct - PTT returns to normal
> factor inhibitors won't correct - PTT will fail to normalize if factor
VIII inh is present
idiopathic development of inh
will require larger infusions of factor VIII in the future due to this inh
think hemophilia when you see "boys w/ hemarthrosis"
⩥ 27 yo man - inc freq episodes of int vomiting over last 3 wks
> occurs w/in 1 hr after eating
> partially digested food
> no blood noted
> appetite seems unaffected
> stops eating before completes meal
> 8 lb weight loss - last 6 months ago
PMHx: mod mental retardation; seizure disorder (phenytoin)
, vitals: stable
PE: speech not intelligible
PE: 3x4 cm of alopecia in R.occipitoparietal area of scalp; bowel sounds
present; abd musculature voluntarily contracts w/ palp; no
organomegaly/masses palp; minimal contractors in upper/lower ext; inc
muscle tone
most likely dx? Answer: gastric bezoar
mental retardation + area of alopecia + frequent vomiting > gastric
bezoar
bezoar = mass trapped in the GI system
pt is pulling his hair out and ingesting it > accumulation of foreign
materials in stomach and impaired gastric emptying - gastroparesis
stupid ass question since I've literally never seen this word before
⩥ 27 yo - total serum chol 190
no FHx of HTN or premature CAD
> grandma dx w/ T2DM at 65 yo
general dietary advice + education concerning RFs + what else for
mgnt? Answer: repeat measurement of serum cholesterol concentration
in 5 years
chol < 200 is normal
another answer choice talks about recommending a chol-lowering diet -
but you talking about dietary advice is basically that already
LOVE THIS SHITTY QUESTION
ACTUAL EXAM PAPER COMPLETE
QUESTIONS AND ANSWERS
⩥ 23 yo AA man - 2 months of inc pain and swelling above R.knee
> no trauma, recent fever
PMHx: retinoblastoma (infancy - tx w/ enucleation)
98.6F
PE: mod swelling of distal femur; mild tenderness to palp w/ mod
discomfort on weight bearing
labs: alk phos 1350
x-ray of R.femur: lytic lesion w/ periosteal new bone at margins
most likely dx? Answer: osteosarcoma
osteoSarComa = Sunburst + Codman's triangle
> periosteal bone rx (from elevation of periosteum) = Codman's triangle
RF: Paget dz of bone, bone infarcts, radiation, familial retinoblastoma,
Li-Fraumeni syndrome
> homeboy had retinoblastoma as an infant
commonly affects metaphysis of long bones (esp knees)
presents as painful enlarging mass or path features
peak incidence of primary tumor in males < 20 yo
,⩥ 27 yo AA woman - 1 wk of tight sensation in chest and nonproductive
cough
> cough freq at night
> breathing txs in ED for acute SOB twice during past 3 months
~ told to stop smoking
PMHx: freq URIs
no meds
SHx: smokes 1 pack qd for 10 yrs
vitals: stable
PE: end-exp wheezes BL
CXR: gucci
most likely underlying cause of symptoms? Answer: activation of mast
cells
asthma exacerbated by smoke
bronchodilator therapy reversing the SOB is the key finding here
> this is how you differentiate bet asthma and COPD
symptoms typically worse at night
features: SOB, wheezing, chest tightness, cough
associated triggers include tobacco smoke
⩥ 27 yo - 3 hrs of muscle swelling/tenderness of L.thigh
> minimal trauma
,PMHx: severe hemophilia A
> tx factor VIII replacement for bleeding episodes since childhood
over recent months: bleeding poorly controlled
> inc doses of factor VIII have been req to stop bleeding episodes
labs: dec plt 125,000; aPTT > 120 sec
next step in dx of pt's inc bleeding? Answer: test for factor VIII inhibitor
during mixing study: normal plasma is added to plasma from
hemophiliac pt
> clotting def should correct - PTT returns to normal
> factor inhibitors won't correct - PTT will fail to normalize if factor
VIII inh is present
idiopathic development of inh
will require larger infusions of factor VIII in the future due to this inh
think hemophilia when you see "boys w/ hemarthrosis"
⩥ 27 yo man - inc freq episodes of int vomiting over last 3 wks
> occurs w/in 1 hr after eating
> partially digested food
> no blood noted
> appetite seems unaffected
> stops eating before completes meal
> 8 lb weight loss - last 6 months ago
PMHx: mod mental retardation; seizure disorder (phenytoin)
, vitals: stable
PE: speech not intelligible
PE: 3x4 cm of alopecia in R.occipitoparietal area of scalp; bowel sounds
present; abd musculature voluntarily contracts w/ palp; no
organomegaly/masses palp; minimal contractors in upper/lower ext; inc
muscle tone
most likely dx? Answer: gastric bezoar
mental retardation + area of alopecia + frequent vomiting > gastric
bezoar
bezoar = mass trapped in the GI system
pt is pulling his hair out and ingesting it > accumulation of foreign
materials in stomach and impaired gastric emptying - gastroparesis
stupid ass question since I've literally never seen this word before
⩥ 27 yo - total serum chol 190
no FHx of HTN or premature CAD
> grandma dx w/ T2DM at 65 yo
general dietary advice + education concerning RFs + what else for
mgnt? Answer: repeat measurement of serum cholesterol concentration
in 5 years
chol < 200 is normal
another answer choice talks about recommending a chol-lowering diet -
but you talking about dietary advice is basically that already
LOVE THIS SHITTY QUESTION
