NBME ASSESSMENTS | VERIFIED QUESTIONS AND
ANSWERS |GRADED A+ | GUARANTEED PASS |
LATEST UPDATE 2026
Question 1
A 24-year-old man presents with a 3-day history of fever, sore throat, and fatigue. Examination
shows posterior cervical lymphadenopathy and tonsillar exudates. A heterophile antibody test is
positive. Which of the following cells is primarily responsible for producing the antibodies
detected by this test?
A. CD4+ T lymphocytes
B. Plasma cells
C. Natural killer cells
D. Neutrophils
E. Macrophages
Answer: B. Plasma cells
Rationale: Plasma cells are terminally differentiated B lymphocytes that produce antibodies.
Infectious mononucleosis caused by Epstein-Barr virus results in polyclonal B-cell activation
and production of heterophile antibodies.
Question 2
A 6-year-old boy develops periorbital edema and frothy urine. Urinalysis shows heavy
proteinuria without hematuria. Serum creatinine is normal. Renal biopsy is normal by light
microscopy. Which of the following is most likely seen on electron microscopy?
A. Subepithelial immune complex deposits
B. Mesangial immune complex deposits
C. Diffuse podocyte foot-process effacement
D. Glomerular basement membrane splitting
E. Fibrinoid necrosis
Answer: C. Diffuse podocyte foot-process effacement
Rationale: Minimal change disease is the most common cause of nephrotic syndrome in children.
Light microscopy is usually normal, while electron microscopy shows diffuse effacement of
podocyte foot processes.
,Question 3
A 58-year-old man with a history of smoking presents with painless hematuria. Cystoscopy
reveals a papillary bladder mass. Histology demonstrates malignant cells arising from the
urothelium. Which exposure is most strongly associated with this malignancy?
A. Vinyl chloride
B. Benzene
C. Aromatic amines
D. Asbestos
E. Radon
Answer: C. Aromatic amines
Rationale: Transitional cell carcinoma of the bladder is strongly associated with cigarette
smoking and occupational exposure to aromatic amines such as aniline dyes.
Question 4
A 19-year-old woman develops severe abdominal pain several hours after taking aspirin. She has
a history of asthma and recurrent nasal polyps. Which mediator is most responsible for her
symptoms?
A. Histamine
B. Leukotriene C4
C. Prostaglandin E2
D. Thromboxane A2
E. Bradykinin
Answer: B. Leukotriene C4
Rationale: Aspirin inhibits cyclooxygenase, diverting arachidonic acid metabolism toward the
lipoxygenase pathway. Increased leukotrienes cause bronchoconstriction in aspirin-exacerbated
respiratory disease.
Question 5
A 45-year-old woman presents with fatigue, weight loss, and hyperpigmentation. Laboratory
studies show hyponatremia, hyperkalemia, and low cortisol with elevated ACTH. Which adrenal
zone is primarily affected?
A. Zona glomerulosa only
B. Zona fasciculata only
,C. Zona reticularis only
D. All cortical zones
E. Adrenal medulla
Answer: D. All cortical zones
Rationale: Primary adrenal insufficiency causes destruction of the adrenal cortex, resulting in
deficiencies of cortisol and aldosterone and increased ACTH. Hyperpigmentation occurs
because ACTH is derived from POMC, which also produces melanocyte-stimulating activity.
Question 6
A 72-year-old man develops sudden weakness of the right face and right arm. He also has
expressive aphasia. Which cerebral artery is most likely affected?
A. Right anterior cerebral artery
B. Left anterior cerebral artery
C. Right middle cerebral artery
D. Left middle cerebral artery
E. Left posterior cerebral artery
Answer: D. Left middle cerebral artery
Rationale: The dominant middle cerebral artery supplies the lateral frontal lobe, including
Broca area. A dominant-hemisphere MCA lesion can cause contralateral face/arm weakness and
expressive aphasia.
Question 7
A newborn develops respiratory distress shortly after birth. The infant was born at 30 weeks'
gestation. Chest x-ray shows diffuse reticulogranular opacities and air bronchograms. Which
substance is deficient?
A. Elastin
B. Surfactant
C. Collagen type I
D. Alpha-1 antitrypsin
E. Pulmonary IgA
Answer: B. Surfactant
, Rationale: Premature infants are at risk for neonatal respiratory distress syndrome due to
inadequate surfactant production by type II pneumocytes. Surfactant deficiency increases
alveolar surface tension and promotes atelectasis.
Question 8
A 34-year-old woman has recurrent episodes of abdominal pain, psychiatric symptoms, and dark-
colored urine. Her symptoms worsen after starting a new medication. Which enzyme deficiency
is most likely responsible?
A. Porphobilinogen deaminase
B. Ferrochelatase
C. ALA dehydratase
D. Uroporphyrinogen decarboxylase
E. Glucose-6-phosphate dehydrogenase
Answer: A. Porphobilinogen deaminase
Rationale: Acute intermittent porphyria is caused by porphobilinogen deaminase deficiency.
Attacks cause abdominal pain, neuropsychiatric symptoms, and increased urinary
porphobilinogen. Certain drugs can precipitate attacks.
Question 9
A 63-year-old man with long-standing hypertension develops progressive kidney dysfunction.
Renal biopsy shows hyaline thickening of the walls of small arteries and arterioles. Which
process is responsible?
A. Immune complex deposition
B. Lipid accumulation
C. Plasma protein leakage
D. Fibrinoid necrosis
E. Amyloid deposition
Answer: C. Plasma protein leakage
Rationale: Hyaline arteriolosclerosis is associated with chronic hypertension and diabetes.
Increased vascular permeability allows plasma proteins to enter the vessel wall, producing
hyaline thickening and luminal narrowing.
Question 10
ANSWERS |GRADED A+ | GUARANTEED PASS |
LATEST UPDATE 2026
Question 1
A 24-year-old man presents with a 3-day history of fever, sore throat, and fatigue. Examination
shows posterior cervical lymphadenopathy and tonsillar exudates. A heterophile antibody test is
positive. Which of the following cells is primarily responsible for producing the antibodies
detected by this test?
A. CD4+ T lymphocytes
B. Plasma cells
C. Natural killer cells
D. Neutrophils
E. Macrophages
Answer: B. Plasma cells
Rationale: Plasma cells are terminally differentiated B lymphocytes that produce antibodies.
Infectious mononucleosis caused by Epstein-Barr virus results in polyclonal B-cell activation
and production of heterophile antibodies.
Question 2
A 6-year-old boy develops periorbital edema and frothy urine. Urinalysis shows heavy
proteinuria without hematuria. Serum creatinine is normal. Renal biopsy is normal by light
microscopy. Which of the following is most likely seen on electron microscopy?
A. Subepithelial immune complex deposits
B. Mesangial immune complex deposits
C. Diffuse podocyte foot-process effacement
D. Glomerular basement membrane splitting
E. Fibrinoid necrosis
Answer: C. Diffuse podocyte foot-process effacement
Rationale: Minimal change disease is the most common cause of nephrotic syndrome in children.
Light microscopy is usually normal, while electron microscopy shows diffuse effacement of
podocyte foot processes.
,Question 3
A 58-year-old man with a history of smoking presents with painless hematuria. Cystoscopy
reveals a papillary bladder mass. Histology demonstrates malignant cells arising from the
urothelium. Which exposure is most strongly associated with this malignancy?
A. Vinyl chloride
B. Benzene
C. Aromatic amines
D. Asbestos
E. Radon
Answer: C. Aromatic amines
Rationale: Transitional cell carcinoma of the bladder is strongly associated with cigarette
smoking and occupational exposure to aromatic amines such as aniline dyes.
Question 4
A 19-year-old woman develops severe abdominal pain several hours after taking aspirin. She has
a history of asthma and recurrent nasal polyps. Which mediator is most responsible for her
symptoms?
A. Histamine
B. Leukotriene C4
C. Prostaglandin E2
D. Thromboxane A2
E. Bradykinin
Answer: B. Leukotriene C4
Rationale: Aspirin inhibits cyclooxygenase, diverting arachidonic acid metabolism toward the
lipoxygenase pathway. Increased leukotrienes cause bronchoconstriction in aspirin-exacerbated
respiratory disease.
Question 5
A 45-year-old woman presents with fatigue, weight loss, and hyperpigmentation. Laboratory
studies show hyponatremia, hyperkalemia, and low cortisol with elevated ACTH. Which adrenal
zone is primarily affected?
A. Zona glomerulosa only
B. Zona fasciculata only
,C. Zona reticularis only
D. All cortical zones
E. Adrenal medulla
Answer: D. All cortical zones
Rationale: Primary adrenal insufficiency causes destruction of the adrenal cortex, resulting in
deficiencies of cortisol and aldosterone and increased ACTH. Hyperpigmentation occurs
because ACTH is derived from POMC, which also produces melanocyte-stimulating activity.
Question 6
A 72-year-old man develops sudden weakness of the right face and right arm. He also has
expressive aphasia. Which cerebral artery is most likely affected?
A. Right anterior cerebral artery
B. Left anterior cerebral artery
C. Right middle cerebral artery
D. Left middle cerebral artery
E. Left posterior cerebral artery
Answer: D. Left middle cerebral artery
Rationale: The dominant middle cerebral artery supplies the lateral frontal lobe, including
Broca area. A dominant-hemisphere MCA lesion can cause contralateral face/arm weakness and
expressive aphasia.
Question 7
A newborn develops respiratory distress shortly after birth. The infant was born at 30 weeks'
gestation. Chest x-ray shows diffuse reticulogranular opacities and air bronchograms. Which
substance is deficient?
A. Elastin
B. Surfactant
C. Collagen type I
D. Alpha-1 antitrypsin
E. Pulmonary IgA
Answer: B. Surfactant
, Rationale: Premature infants are at risk for neonatal respiratory distress syndrome due to
inadequate surfactant production by type II pneumocytes. Surfactant deficiency increases
alveolar surface tension and promotes atelectasis.
Question 8
A 34-year-old woman has recurrent episodes of abdominal pain, psychiatric symptoms, and dark-
colored urine. Her symptoms worsen after starting a new medication. Which enzyme deficiency
is most likely responsible?
A. Porphobilinogen deaminase
B. Ferrochelatase
C. ALA dehydratase
D. Uroporphyrinogen decarboxylase
E. Glucose-6-phosphate dehydrogenase
Answer: A. Porphobilinogen deaminase
Rationale: Acute intermittent porphyria is caused by porphobilinogen deaminase deficiency.
Attacks cause abdominal pain, neuropsychiatric symptoms, and increased urinary
porphobilinogen. Certain drugs can precipitate attacks.
Question 9
A 63-year-old man with long-standing hypertension develops progressive kidney dysfunction.
Renal biopsy shows hyaline thickening of the walls of small arteries and arterioles. Which
process is responsible?
A. Immune complex deposition
B. Lipid accumulation
C. Plasma protein leakage
D. Fibrinoid necrosis
E. Amyloid deposition
Answer: C. Plasma protein leakage
Rationale: Hyaline arteriolosclerosis is associated with chronic hypertension and diabetes.
Increased vascular permeability allows plasma proteins to enter the vessel wall, producing
hyaline thickening and luminal narrowing.
Question 10
