NBME SAMPLE FINAL TEST 2026
QUESTIONS WITH CORRECT ANSWERS
GRADED A+
◍ Your assessment of a mother in labor reveals that a fetal limb is protruding
from the vagina. Management of this situation should include:•
A:positioning the mother with her hips elevated, administering high-flow
oxygen, and providing transport.• B:applying gentle traction to the
protruding limb to remove pressure of the fetus from the umbilical cord.•
C:positioning the mother in a semi-Fowler's position, administering oxygen,
and providing transport.• D:giving the mother 100% oxygen and attempting
to manipulate the protruding limb so that delivery can occur..
Answer: The correct answer is A;Reason:Limb presentations represent a dire
emergency for the newborn and do not spontaneously deliver in the field.
You should position the mother in a manner so that her hips are elevated in
an attempt to slide the infant slightly back into the birth canal and remove
pressure from the umbilical cord. Administer high-flow oxygen to the
mother, cover the protruding limb with a sterile sheet (or any clean sheet, if
a sterile sheet is not available), and transport immediately. Do NOT pull on
the protruding limb as this may cause injury to the newborn.
◍ Why do you see gynecomastia in men with cirrhosis?.
Answer: Decreased inactivation of steroid hormones --> Increased estrogens
--> gynecomastia
◍ Which of the following BEST describes the mechanism of injury?• A:The
product of mass, force of gravity, and height• B:The energy of an object in
motion• C:Your concern for potentially serious injuries• D:The way in
which traumatic injuries occur.
Answer: You selected D; This is correct!Reason:The mechanism of injury
, (MOI) is the way in which traumatic injuries occur; it describes the forces
(or energy transmission) acting on the body that cause injury. Index of
suspicion is your concern for potentially serious underlying and unseen
(occult) injuries. A significant MOI (eg, fall from a significant height,
ejection from a motor vehicle) should increase your index of suspicion for
serious injuries. The energy of an object in motion is called kinetic injury.
Potential injury is the product of mass (weight), force of gravity, and height;
it is mostly associated with the energy of falling objects.
◍ MOA of main drugs used to treat ADHD?.
Answer: Increase catecholamines in synaptic cleft, esp. NE and dopamine
◍ Prevention of cardiac arrest in infants and small children should focus
primarily on:• A:providing immediate transport.• B:avoiding upsetting the
child.• C:ensuring adequate ventilation.• D:keeping the child warm..
Answer: You selected C; This is correct!Reason:The most common cause of
cardiac arrest in infants and children is failure of the respiratory system.
Their hearts generally are healthy, and they rarely go into ventricular
fibrillation (V-Fib). The key to preventing cardiac arrest in the majority of
infants and children is to ensure adequate ventilation and oxygenation.
◍ Functions of TGF-beta?.
Answer: Angiogenesis, fibrosis, cell cycle arrest(a tissue mediator in wound
healing)
◍ Which of the following signs or symptoms is indicative of cerebral
hypoxia?• A:Decreased level of consciousness• B:Heart rate greater than
120 beats/min• C:Diffuse wheezing on exhalation• D:Chief complaint of
dyspnea.
Answer: You selected A; This is correct!Reason:Dyspnea, a feeling of
shortness of breath, is a symptom of a condition that can cause cerebral
hypoxia (eg, CHF, COPD); however, dyspnea itself does not indicate
cerebral hypoxia. Wheezing, a whistling sound that indicates bronchospasm,
is a sign; like dyspnea, it indicates the presence of a condition that can cause
cerebral hypoxia (eg, asthma). Tachycardia can occur for many reasons;
, cerebral hypoxia is but one. Of the choices listed, a decreased level of
consciousness is most indicative of cerebral hypoxia. As oxygen levels in
the brain decrease and carbon dioxide levels increase, the patient's mental
status deteriorates.
◍ A previously healthy 72 year old man is brought to the physician because of
weakness and fatigue. His hemoglobin concentration is 9.2 g/dL, leukocyte
count is 5400/mm3, and platelet count is 350,000/mm3. A peripheral blood
smear is shown (many small RBCs with various shape and big central palor,
one WBC and its size is bigger than the RBC shown). Which of the
following is the most likely cause of these findings?A, aplastic anemiaB,
chronic myelogenous leukemiaC, gastrointestinal blood lossD,
beta-thalassemia major (wrong)E, Vit B12 deficiency.
Answer: very common cause of anemia is older person is GI blood loss.
Different sizes of RBCs would give a wide red cell distribution width
(RDW) which implies blood loss. The other answers do not make sense with
the rest of the question stem. (A) would have pancytopenia, (B) would likely
have a higher WBC and smear would have leukemia-looking cells, (D)
would be severe microcytic anemia and would not be presenting now at age
72, and (E) no history to correlate with B12 deficiency/ no megaloblastic
cells.
◍ An 83-year-old man is brought to the emergency department after being
found at home bedridden and confused. He takes no medications.
Temperature is 35.6°C (96°F), pulse is 100/min, and blood pressure is 85/50
mm Hg. Blood pressure is unchanged after intravenous infusion of 1 liter of
isotonic saline. A pulmonary artery catheter is inserted and the following
findings are obtained:Cardiac output highPulmonary capillary wedge
pressure lowSystemic vascular resistance lowWhich of the following is the
most likely cause of the hypotension?A) Early septic shockB)
Gastrointestinal bleedingC) HypothyroidismD) Massive pulmonary
embolism (Wrong)E) Silent myocardial infarction.
Answer: A) Early septic shock(possible to not have a fever in older people)
, ◍ After removing a patient from the water, your assessment reveals that he is
not breathing and is continuously regurgitating large amounts of water. You
should:• A:perform abdominal thrusts to remove the water.• B:begin rescue
breathing after he stops regurgitating.• C:alternate suctioning with artificial
ventilations.• D:place him on his side and press on his abdomen..
Answer: You selected C; This is correct!Reason:In cases where a patient is
not breathing and is regurgitating (passively vomiting) secretions at the
same time, you must address both issues. This is accomplished most
effectively by suctioning for 15 seconds and then ventilating for 2 minutes.
This alternating sequence should be repeated until all secretions are cleared
from the airway. You should turn the patient onto his side to facilitate
drainage of liquid, but do not apply pressure to his abdomen. Manual gastric
decompression, which involves applying pressure to the patient's abdomen,
is a dangerous maneuver because it will force more water from the stomach,
which the patient could potentially aspirate. Manual gastric decompression
should ONLY be performed if gastric distention is so severe that it is
impossible to ventilate a patient AND a paramedic is not present to insert a
gastric tube into the stomach. Abdominal thrusts are used to remove a solid
foreign body from the airway, not liquid.
◍ A 73-year-old male presents with confusion; cool, pale, clammy skin; absent
radial pulses; and a blood pressure of 70/40 mm Hg. The patient's wife tells
you that he has had abdominal pain for a week and began vomiting a
coffee-ground substance yesterday. His past medical history includes
hypertension and gastric ulcer disease. Your MOST immediate concern
should be that:• A:he is bleeding from his gastrointestinal tract.• B:he is in
shock and requires prompt transport.• C:his blood glucose level is probably
too high.• D:his condition requires surgery within 2 hours.
Answer: You selected B; This is correct!Reason:The patient is likely
bleeding from his gastrointestinal (GI) tract. Although this is a serious
condition, it is not a condition you can treat; internal bleeding cannot be
controlled in the field. You can, however, treat his signs and symptoms of
shock by administering high-flow oxygen and keeping him warm by
QUESTIONS WITH CORRECT ANSWERS
GRADED A+
◍ Your assessment of a mother in labor reveals that a fetal limb is protruding
from the vagina. Management of this situation should include:•
A:positioning the mother with her hips elevated, administering high-flow
oxygen, and providing transport.• B:applying gentle traction to the
protruding limb to remove pressure of the fetus from the umbilical cord.•
C:positioning the mother in a semi-Fowler's position, administering oxygen,
and providing transport.• D:giving the mother 100% oxygen and attempting
to manipulate the protruding limb so that delivery can occur..
Answer: The correct answer is A;Reason:Limb presentations represent a dire
emergency for the newborn and do not spontaneously deliver in the field.
You should position the mother in a manner so that her hips are elevated in
an attempt to slide the infant slightly back into the birth canal and remove
pressure from the umbilical cord. Administer high-flow oxygen to the
mother, cover the protruding limb with a sterile sheet (or any clean sheet, if
a sterile sheet is not available), and transport immediately. Do NOT pull on
the protruding limb as this may cause injury to the newborn.
◍ Why do you see gynecomastia in men with cirrhosis?.
Answer: Decreased inactivation of steroid hormones --> Increased estrogens
--> gynecomastia
◍ Which of the following BEST describes the mechanism of injury?• A:The
product of mass, force of gravity, and height• B:The energy of an object in
motion• C:Your concern for potentially serious injuries• D:The way in
which traumatic injuries occur.
Answer: You selected D; This is correct!Reason:The mechanism of injury
, (MOI) is the way in which traumatic injuries occur; it describes the forces
(or energy transmission) acting on the body that cause injury. Index of
suspicion is your concern for potentially serious underlying and unseen
(occult) injuries. A significant MOI (eg, fall from a significant height,
ejection from a motor vehicle) should increase your index of suspicion for
serious injuries. The energy of an object in motion is called kinetic injury.
Potential injury is the product of mass (weight), force of gravity, and height;
it is mostly associated with the energy of falling objects.
◍ MOA of main drugs used to treat ADHD?.
Answer: Increase catecholamines in synaptic cleft, esp. NE and dopamine
◍ Prevention of cardiac arrest in infants and small children should focus
primarily on:• A:providing immediate transport.• B:avoiding upsetting the
child.• C:ensuring adequate ventilation.• D:keeping the child warm..
Answer: You selected C; This is correct!Reason:The most common cause of
cardiac arrest in infants and children is failure of the respiratory system.
Their hearts generally are healthy, and they rarely go into ventricular
fibrillation (V-Fib). The key to preventing cardiac arrest in the majority of
infants and children is to ensure adequate ventilation and oxygenation.
◍ Functions of TGF-beta?.
Answer: Angiogenesis, fibrosis, cell cycle arrest(a tissue mediator in wound
healing)
◍ Which of the following signs or symptoms is indicative of cerebral
hypoxia?• A:Decreased level of consciousness• B:Heart rate greater than
120 beats/min• C:Diffuse wheezing on exhalation• D:Chief complaint of
dyspnea.
Answer: You selected A; This is correct!Reason:Dyspnea, a feeling of
shortness of breath, is a symptom of a condition that can cause cerebral
hypoxia (eg, CHF, COPD); however, dyspnea itself does not indicate
cerebral hypoxia. Wheezing, a whistling sound that indicates bronchospasm,
is a sign; like dyspnea, it indicates the presence of a condition that can cause
cerebral hypoxia (eg, asthma). Tachycardia can occur for many reasons;
, cerebral hypoxia is but one. Of the choices listed, a decreased level of
consciousness is most indicative of cerebral hypoxia. As oxygen levels in
the brain decrease and carbon dioxide levels increase, the patient's mental
status deteriorates.
◍ A previously healthy 72 year old man is brought to the physician because of
weakness and fatigue. His hemoglobin concentration is 9.2 g/dL, leukocyte
count is 5400/mm3, and platelet count is 350,000/mm3. A peripheral blood
smear is shown (many small RBCs with various shape and big central palor,
one WBC and its size is bigger than the RBC shown). Which of the
following is the most likely cause of these findings?A, aplastic anemiaB,
chronic myelogenous leukemiaC, gastrointestinal blood lossD,
beta-thalassemia major (wrong)E, Vit B12 deficiency.
Answer: very common cause of anemia is older person is GI blood loss.
Different sizes of RBCs would give a wide red cell distribution width
(RDW) which implies blood loss. The other answers do not make sense with
the rest of the question stem. (A) would have pancytopenia, (B) would likely
have a higher WBC and smear would have leukemia-looking cells, (D)
would be severe microcytic anemia and would not be presenting now at age
72, and (E) no history to correlate with B12 deficiency/ no megaloblastic
cells.
◍ An 83-year-old man is brought to the emergency department after being
found at home bedridden and confused. He takes no medications.
Temperature is 35.6°C (96°F), pulse is 100/min, and blood pressure is 85/50
mm Hg. Blood pressure is unchanged after intravenous infusion of 1 liter of
isotonic saline. A pulmonary artery catheter is inserted and the following
findings are obtained:Cardiac output highPulmonary capillary wedge
pressure lowSystemic vascular resistance lowWhich of the following is the
most likely cause of the hypotension?A) Early septic shockB)
Gastrointestinal bleedingC) HypothyroidismD) Massive pulmonary
embolism (Wrong)E) Silent myocardial infarction.
Answer: A) Early septic shock(possible to not have a fever in older people)
, ◍ After removing a patient from the water, your assessment reveals that he is
not breathing and is continuously regurgitating large amounts of water. You
should:• A:perform abdominal thrusts to remove the water.• B:begin rescue
breathing after he stops regurgitating.• C:alternate suctioning with artificial
ventilations.• D:place him on his side and press on his abdomen..
Answer: You selected C; This is correct!Reason:In cases where a patient is
not breathing and is regurgitating (passively vomiting) secretions at the
same time, you must address both issues. This is accomplished most
effectively by suctioning for 15 seconds and then ventilating for 2 minutes.
This alternating sequence should be repeated until all secretions are cleared
from the airway. You should turn the patient onto his side to facilitate
drainage of liquid, but do not apply pressure to his abdomen. Manual gastric
decompression, which involves applying pressure to the patient's abdomen,
is a dangerous maneuver because it will force more water from the stomach,
which the patient could potentially aspirate. Manual gastric decompression
should ONLY be performed if gastric distention is so severe that it is
impossible to ventilate a patient AND a paramedic is not present to insert a
gastric tube into the stomach. Abdominal thrusts are used to remove a solid
foreign body from the airway, not liquid.
◍ A 73-year-old male presents with confusion; cool, pale, clammy skin; absent
radial pulses; and a blood pressure of 70/40 mm Hg. The patient's wife tells
you that he has had abdominal pain for a week and began vomiting a
coffee-ground substance yesterday. His past medical history includes
hypertension and gastric ulcer disease. Your MOST immediate concern
should be that:• A:he is bleeding from his gastrointestinal tract.• B:he is in
shock and requires prompt transport.• C:his blood glucose level is probably
too high.• D:his condition requires surgery within 2 hours.
Answer: You selected B; This is correct!Reason:The patient is likely
bleeding from his gastrointestinal (GI) tract. Although this is a serious
condition, it is not a condition you can treat; internal bleeding cannot be
controlled in the field. You can, however, treat his signs and symptoms of
shock by administering high-flow oxygen and keeping him warm by
