NBME 28 Exam Questions and
Answers 100% PASS
1
Exam Section 1: Item 1 of 50
National Board of Medical Examiners'
Comprehensive Basic Science Self-Assessment
1. A 25-year-old man is brought to the emergency department because of severe abdominal
pain, nausea, and vomiting for 1 hour. The pain originates in the left flank and radiates to his
groin. His pulse is 100/min, respirations are 18/min, and blood pressure is
150/100 mm Hg. Physical examination shows tenderness of the left flank and the left lower
quadrant of the abdomen. Bowel sounds are mildly hypoactive. Test of the stool for occult
blood is negative. Which of the following best explains these findings?
A) Colon neoplasm
B) Diverticulitis
C) Epididymitis
D) Renal infarction
E) Torsion of the testis
,F) Ureteral calculus—ANSWER-F.
Ureteral calculus typically presents with colicky, unilateral flank pain radiating to the groin,
and with gross or microscopic hematuria. Pain may be significant enough to trigger nausea,
as in this case. The common types of urinary tract calculi are calcium oxalate or
phosphate, ammonium magnesium phosphate, uric acid, and cystine. On urinalysis, red
blood cells without casts are common. Fever, dysuria, and pyuria would not be expected
unless there was a concomitant infection. Treatment for ureteral calculus is
symptomatic with pain control and nausea relief. Most ureteral calculi pass spontaneously
after a period of observation for patients with well-controlled pain and no signs of sepsis or
infection. Stone removal by shock wave lithotripsy or endoscopic removal is an
option for patients requiring emergency therapy. It is also an option for patients with
persistent obstruction, uncontrolled symptoms, or failure of stone progression. In general,
stones smaller than 5 mm will pass without operative assistance. Obstructing stones may
require temporary placement of a ureteral stent to prevent hydronephrosis and renal
parenchymal injury.
Incorrect Answers: A, B, C, D, and E.
Colon neoplasm (Choice A) would be unlikely in an otherwise healthy young patient with no
family history of polyposis syndromes and acute, severe, flank pain. It would typically
present with insidious weight loss, anemia, constipation, or blood per rectum. In
addition, test for stool for occult blood is negative, making this diagnosis unlikely.
© 2026 Copyright. All Rights Reserved. This document is
protected by copyright law, Copyrighted By Brittie Donald
,Diverticulitis (Choice B) can present with left lower quadrant abdominal pain and tenderness
but would be less abrupt in presentation and typically present with fever, diarrhea, and
hyperactive bowel sounds. It would be unlikely to cause flank pain.
Epididymitis (Choice C) is a common cause of painful scrotal swelling and refers to acute
infection and inflammation of the epididymis. In younger males, this is commonly secondary
to sexually transmitted infections such as Chlamydia trachomatis or Neisseria
gonorrhoeae. In older males, Escherichia coli is more common.
Renal infarction (Choice D) can cause flank pain, nausea, and vomiting, and can be due to
thromboembolic disease, renal artery dissection, or a hypercoagulable state. However, it is
rare and ureteral calculus is more common and likely in this patient.
Torsion of the testis (Choice E) occurs when the testicle twists on the spermatic cord
resulting in subsequent loss of testicular blood supply. Patients typically present with acute,
severe testicular pain, swelling, and erythema. On physical examination, the testicle
typically demonstrates an abnormal lie (eg, transverse), extreme tenderness to palpation,
absent cremasteric reflex, and pain that does not improve with elevation of the scrotum (as
it does in epididymitis).
Educational Objective: Ureteral calculus typically presents with colicky, unilateral flank pain
radiating to the groin, along with gross or microscopic hematuria.
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2
Exam Section 1: Item 2 of 50
National Board of Medical Examiners'
Comprehensive Basic Science Self-Assessment
2. Which of the following types of sensory information is compromised by lesions of the
structure at site X in the photograph shown?
A) Conscious proprioception
B) Pain sensation
C) Two-point discrimination
D) Unconscious proprioception
E) Vibration sense—ANSWER-D.
The anterior lobe of the cerebellum (labeled X, pictured in cross-section as an arborized
brain area posterior to the brainstem and anterior to the primary fissure of the cerebellum)
mediates unconscious proprioception. The anterior lobe of the cerebellum receives
© 2026 Copyright. All Rights Reserved. This document is
protected by copyright law, Copyrighted By Brittie Donald
Answers 100% PASS
1
Exam Section 1: Item 1 of 50
National Board of Medical Examiners'
Comprehensive Basic Science Self-Assessment
1. A 25-year-old man is brought to the emergency department because of severe abdominal
pain, nausea, and vomiting for 1 hour. The pain originates in the left flank and radiates to his
groin. His pulse is 100/min, respirations are 18/min, and blood pressure is
150/100 mm Hg. Physical examination shows tenderness of the left flank and the left lower
quadrant of the abdomen. Bowel sounds are mildly hypoactive. Test of the stool for occult
blood is negative. Which of the following best explains these findings?
A) Colon neoplasm
B) Diverticulitis
C) Epididymitis
D) Renal infarction
E) Torsion of the testis
,F) Ureteral calculus—ANSWER-F.
Ureteral calculus typically presents with colicky, unilateral flank pain radiating to the groin,
and with gross or microscopic hematuria. Pain may be significant enough to trigger nausea,
as in this case. The common types of urinary tract calculi are calcium oxalate or
phosphate, ammonium magnesium phosphate, uric acid, and cystine. On urinalysis, red
blood cells without casts are common. Fever, dysuria, and pyuria would not be expected
unless there was a concomitant infection. Treatment for ureteral calculus is
symptomatic with pain control and nausea relief. Most ureteral calculi pass spontaneously
after a period of observation for patients with well-controlled pain and no signs of sepsis or
infection. Stone removal by shock wave lithotripsy or endoscopic removal is an
option for patients requiring emergency therapy. It is also an option for patients with
persistent obstruction, uncontrolled symptoms, or failure of stone progression. In general,
stones smaller than 5 mm will pass without operative assistance. Obstructing stones may
require temporary placement of a ureteral stent to prevent hydronephrosis and renal
parenchymal injury.
Incorrect Answers: A, B, C, D, and E.
Colon neoplasm (Choice A) would be unlikely in an otherwise healthy young patient with no
family history of polyposis syndromes and acute, severe, flank pain. It would typically
present with insidious weight loss, anemia, constipation, or blood per rectum. In
addition, test for stool for occult blood is negative, making this diagnosis unlikely.
© 2026 Copyright. All Rights Reserved. This document is
protected by copyright law, Copyrighted By Brittie Donald
,Diverticulitis (Choice B) can present with left lower quadrant abdominal pain and tenderness
but would be less abrupt in presentation and typically present with fever, diarrhea, and
hyperactive bowel sounds. It would be unlikely to cause flank pain.
Epididymitis (Choice C) is a common cause of painful scrotal swelling and refers to acute
infection and inflammation of the epididymis. In younger males, this is commonly secondary
to sexually transmitted infections such as Chlamydia trachomatis or Neisseria
gonorrhoeae. In older males, Escherichia coli is more common.
Renal infarction (Choice D) can cause flank pain, nausea, and vomiting, and can be due to
thromboembolic disease, renal artery dissection, or a hypercoagulable state. However, it is
rare and ureteral calculus is more common and likely in this patient.
Torsion of the testis (Choice E) occurs when the testicle twists on the spermatic cord
resulting in subsequent loss of testicular blood supply. Patients typically present with acute,
severe testicular pain, swelling, and erythema. On physical examination, the testicle
typically demonstrates an abnormal lie (eg, transverse), extreme tenderness to palpation,
absent cremasteric reflex, and pain that does not improve with elevation of the scrotum (as
it does in epididymitis).
Educational Objective: Ureteral calculus typically presents with colicky, unilateral flank pain
radiating to the groin, along with gross or microscopic hematuria.
%3D
Next
Score Report
, Lab Values
Calculator
Help
Pause
2
Exam Section 1: Item 2 of 50
National Board of Medical Examiners'
Comprehensive Basic Science Self-Assessment
2. Which of the following types of sensory information is compromised by lesions of the
structure at site X in the photograph shown?
A) Conscious proprioception
B) Pain sensation
C) Two-point discrimination
D) Unconscious proprioception
E) Vibration sense—ANSWER-D.
The anterior lobe of the cerebellum (labeled X, pictured in cross-section as an arborized
brain area posterior to the brainstem and anterior to the primary fissure of the cerebellum)
mediates unconscious proprioception. The anterior lobe of the cerebellum receives
© 2026 Copyright. All Rights Reserved. This document is
protected by copyright law, Copyrighted By Brittie Donald
