NBME CBSE CERTIFICATION EVALUATION
2026 SOLVED QUESTION SET GRADED A+
◉ 6-Mercaptopurine (6-MP) used to treat acute lymphoblastic
leukemia (ALL). 6-MP acted on by enzymes to make 6-thioguanine
nucleotides (6-TGN). Efficacy and toxicity of 6-MP correlated with 6-
TGN. 6-MP acted on by xanthine oxidase (XO), thiopurine
methyltransferase (TPMT), leading to inactive metabolites. Which
are clinical consequences of ALL patients homozygous for low-
activity alleles of TPMT?
Answer: Give decreased doses of 6-MP--> slow metabolizer
◉ Ten human subjects given new oral drug to monitor drug effect
and toxicity. Blood analyzed for human pharmacokinetics of drug for
first time. Which trial type?
Answer: Type I
◉ 15yo girl health maintenance exam. Mother dx squamous cell
carcinoma face, maternal grandfather died of metastatic melanoma.
In patient this age, which factor most predicts compliance with
photoprotection?
Answer: Use of sunscreen by peers
,◉ 34yo AIDS patient with pulmonary tuberculosis. No CD4+ T
lymphocytes in peripheral blood. Which cellular components most
likely to have deficient function in tuberculous lesions in lungs?
Answer: Macrophages
◉ 44yo woman follow-up after two Pap smears showing atypical
squamous cells of undetermined significant. Test shows viral E6
protein of human papillomavirus. This protein promotes cell growth
and malignancy by causing cellular p53 protein degradation. This
degradation beings when p53 protein targeted to which type of cell
enzymes?
Answer: Ubiquitin ligase
◉ 40yo woman hx of 6 month episodic sinusitis with 2-week
intermittent headaches, fatigue, and generalized joint pain,
worsening cough productive of blood-tinged sputum. Failed
antibiotics, decongestants and nasal corticosteroids. Physical exam:
erythema nasal mucosa, two small ulceration. Lungs scattered
crackles. Xray patchy bilateral opacicites. Labs: Hemoglobin 13, ESR
70, leukocyte 10,500, antineutrophil cytoplasmic antibody
increased. Dx?
Answer: GPA
◉ 25yo woman 6-month history of joint pain poorly responsive to
aspirin. Physical exam: bilateral swelling of proximal
interphalangeal joints, metacarpophalangeal joints, and wrists;
,weakness of grasp. Small nodules palpated beneath skin around
joints of fingers. Dx?
Answer: RA
◉ 50yo woman 1-year hx of hot flashes and irregular menses.
Decreased bone mineral density. Alendronate prescribed.
Mechanism of drug?
Answer: Inhibits osteoclasts
◉ Female newborn at 36 weeks gestation has respiratory distress.
Apgar 3 and 5 at 1 and 5 minutes. Physical shows cyanosis.
Endotracheal and NG tubes placed. Xray shows nasogastric tube in
left hemithorax, mediastinum displacement to right, absence bowel
gas in abdomen. Which embryological event led to these findings?
Answer: Incomplete formation of pleuroperitoneal membrane
(diaphragmatic hernia)
◉ 65yo women progressive vulvar itching past 2 months;
miconazole for yeast infections ineffective. Exam: atrophy of labia
minora and thin, parchment-like skin over vulva and anus. Dx?
Answer: Lichen sclerosis
◉ 75yo man 2-day ear ringing, nausea, fatigue. Temp 37 C (98.6 F),
pulse 100, respirations 24, bp 140/85. Physical: mild epigastic
tenderness. ABG pH 7.42 pCO2 30 pO2 95 HCO3 19. Dx?
, Answer: Respiratory alkalosis; salicylate poisoning
◉ 15yo girl 1-day hx redness and painful skin following sunbathing.
She used sunblock. No medications. Physical exam: severe erythema
of back and extremities, no blisters. Dx?
Answer: 1st-degree burn
◉ 58yo man supraventricular tachyarrhythmia refractory to
pharmacotherapy gets ablation of accessory excitatory pathway in
atrial endocardium. Which area should be avoided to leave sinoatrial
(pacemaker) node intact?
Answer: The junction of t he SVC and RA
◉ 81yo woman massive pulmonary embolism from deep venous
thrombosis. Platelet count 160,000. Appropriate pharmacotherapy
is started. One week later, platelets 55,000. Thrombocytopenia most
likely caused by a drug with which of the following mechanism of
action?
Answer: Potentiates the action of AT III
◉ 22yo woman, g1p1, 2-day hx of fever, severe vaginal bleeding. four
days ago delivered healthy male newborn. Temp 38.1 C (100.6 F).
Pelvic exam: open cervix, heavy vaginal bleeding. US shows uterus
with no placental tissue or thrombi. If operation required to control
bleeding, ligation of branch of which artery required?
2026 SOLVED QUESTION SET GRADED A+
◉ 6-Mercaptopurine (6-MP) used to treat acute lymphoblastic
leukemia (ALL). 6-MP acted on by enzymes to make 6-thioguanine
nucleotides (6-TGN). Efficacy and toxicity of 6-MP correlated with 6-
TGN. 6-MP acted on by xanthine oxidase (XO), thiopurine
methyltransferase (TPMT), leading to inactive metabolites. Which
are clinical consequences of ALL patients homozygous for low-
activity alleles of TPMT?
Answer: Give decreased doses of 6-MP--> slow metabolizer
◉ Ten human subjects given new oral drug to monitor drug effect
and toxicity. Blood analyzed for human pharmacokinetics of drug for
first time. Which trial type?
Answer: Type I
◉ 15yo girl health maintenance exam. Mother dx squamous cell
carcinoma face, maternal grandfather died of metastatic melanoma.
In patient this age, which factor most predicts compliance with
photoprotection?
Answer: Use of sunscreen by peers
,◉ 34yo AIDS patient with pulmonary tuberculosis. No CD4+ T
lymphocytes in peripheral blood. Which cellular components most
likely to have deficient function in tuberculous lesions in lungs?
Answer: Macrophages
◉ 44yo woman follow-up after two Pap smears showing atypical
squamous cells of undetermined significant. Test shows viral E6
protein of human papillomavirus. This protein promotes cell growth
and malignancy by causing cellular p53 protein degradation. This
degradation beings when p53 protein targeted to which type of cell
enzymes?
Answer: Ubiquitin ligase
◉ 40yo woman hx of 6 month episodic sinusitis with 2-week
intermittent headaches, fatigue, and generalized joint pain,
worsening cough productive of blood-tinged sputum. Failed
antibiotics, decongestants and nasal corticosteroids. Physical exam:
erythema nasal mucosa, two small ulceration. Lungs scattered
crackles. Xray patchy bilateral opacicites. Labs: Hemoglobin 13, ESR
70, leukocyte 10,500, antineutrophil cytoplasmic antibody
increased. Dx?
Answer: GPA
◉ 25yo woman 6-month history of joint pain poorly responsive to
aspirin. Physical exam: bilateral swelling of proximal
interphalangeal joints, metacarpophalangeal joints, and wrists;
,weakness of grasp. Small nodules palpated beneath skin around
joints of fingers. Dx?
Answer: RA
◉ 50yo woman 1-year hx of hot flashes and irregular menses.
Decreased bone mineral density. Alendronate prescribed.
Mechanism of drug?
Answer: Inhibits osteoclasts
◉ Female newborn at 36 weeks gestation has respiratory distress.
Apgar 3 and 5 at 1 and 5 minutes. Physical shows cyanosis.
Endotracheal and NG tubes placed. Xray shows nasogastric tube in
left hemithorax, mediastinum displacement to right, absence bowel
gas in abdomen. Which embryological event led to these findings?
Answer: Incomplete formation of pleuroperitoneal membrane
(diaphragmatic hernia)
◉ 65yo women progressive vulvar itching past 2 months;
miconazole for yeast infections ineffective. Exam: atrophy of labia
minora and thin, parchment-like skin over vulva and anus. Dx?
Answer: Lichen sclerosis
◉ 75yo man 2-day ear ringing, nausea, fatigue. Temp 37 C (98.6 F),
pulse 100, respirations 24, bp 140/85. Physical: mild epigastic
tenderness. ABG pH 7.42 pCO2 30 pO2 95 HCO3 19. Dx?
, Answer: Respiratory alkalosis; salicylate poisoning
◉ 15yo girl 1-day hx redness and painful skin following sunbathing.
She used sunblock. No medications. Physical exam: severe erythema
of back and extremities, no blisters. Dx?
Answer: 1st-degree burn
◉ 58yo man supraventricular tachyarrhythmia refractory to
pharmacotherapy gets ablation of accessory excitatory pathway in
atrial endocardium. Which area should be avoided to leave sinoatrial
(pacemaker) node intact?
Answer: The junction of t he SVC and RA
◉ 81yo woman massive pulmonary embolism from deep venous
thrombosis. Platelet count 160,000. Appropriate pharmacotherapy
is started. One week later, platelets 55,000. Thrombocytopenia most
likely caused by a drug with which of the following mechanism of
action?
Answer: Potentiates the action of AT III
◉ 22yo woman, g1p1, 2-day hx of fever, severe vaginal bleeding. four
days ago delivered healthy male newborn. Temp 38.1 C (100.6 F).
Pelvic exam: open cervix, heavy vaginal bleeding. US shows uterus
with no placental tissue or thrombi. If operation required to control
bleeding, ligation of branch of which artery required?
