NBME CBSE MEDICAL ACTUAL EXAM NEWEST VERSION 2024-2025
TESTBANK QUESTIONS AND CORRECT DETAILED ANSWERS
42yo M in ED because of a 10-day history of progressive fever, SOB, and
nonproductive cough. 20-kg weight loss. Immigrated to USA from the Ivory Coast 4
years ago. Temp 38C. Lungs clear, CXr shows diffuse interstitial infiltrate. Silver stain
obtained via bronchoscopy shows Pneumocystis jiroveci (formerly P. carinii). High dose
prednisone and trimethoprim-sulfamethoxazole is initiated, and workup for HIV infection
is done. HIV ELISA positive, HIV western blot positive, CD4 22; HIV viral load <50.
Explanation? - CORRECT ANSWER Infection with HIV-2
27yo F with vaginal bleeding for 3 weeks. First pregnancy ended with a spontaneous
abortion 8 months ago. No Rx since dilatation and curettage at that time. PE shows
enlarged uterus, beta-hCG markedly increased. Ultrasonagraphy of pelvis shows
material within the endometrial cavity and no intrauterine pregnancy. CT scan shows a
necrotic intrauterine mass and metastatic nodules in the lungs. Site of Origin? -
CORRECT ANSWER trophoblastic tissue
65yo M emigrated from Brazil with 8-month history of shortness of breath and fatigue,
edema of lower ext. CXR shows cardiomegaly. endomyocardial biopsy specimen shows
myofiber necrosis with a mixed inflammatory infiltrate of PMNs, T lymphos, m.phages,
and eosinophils. Causal org? - CORRECT ANSWER Trypanosoma cruzi
40yo F with mole on her back that has increased in size during past 4 months. PE
shows raised irregular lesion with variegated black-tan pigmentation and ill-defined
margins. Pleomorphic, hyperchromatic cells within clear islands that tend to collapse.
Extends from epidermis into papillary dermis. Dx? - CORRECT ANSWER
melanoma
42yo farmer has a 7-mm red scaly plaque on helical rim of left ear. Photomicrograph
shown. Dx? - CORRECT ANSWER actinic keratosis
30yo F training for a marathon, running 20 miles/day. Fasting glucose is 60. After her
glucose stores have been depleted, which organ, in addition to liver, releases glucose?
- CORRECT ANSWER kidney
Male newborn at 28 weeks'. Given ventilatory support with up to 80% oxygen for the
next 72 hours, but dies of resp. failure. Cause is inadequate secretion from which
labeled cell types? - CORRECT ANSWER D. type II pneumocyte (produces
surfactant)
9yo girl with poor growth during the past year. < 3rd %ile for height and at 10th
percentile for weight. PE normal. Visual field testing shows bitemporal hemianopia.
Labs show GH deficiency. MRI shows calcified cystic mass in suprasellar region. Tumor
,derived from? - CORRECT ANSWER Diverticulum of the roof of the embryonic oral
cavity
28yo F G1P1 with 2-day history of a painful mass in her right breast. Delivered healthy
female newborn 3 weeks ago, and been breast-feeding since. T 37C, PE shows 3-cm
tender mass surrounded by an area of erythema beneath the right areola. Causal org? -
CORRECT ANSWER staph aureus
3yo boy with bacterial colitis caused by Salmonella enterica serovar arizonae. Which
factor accounts for recruitment of PMNS to inflammatory site by intestinal epithelial
cells? - CORRECT ANSWER IL-8
27yo F with fever, malaise, abdominal pain, and vaginal d/c for 4 days. LMP 5 days ago.
Had ectopic 1 year ago. T 38.3 C, bilateral lower quadrant tenderness with rebound and
guarding. Pelvic exam with cervical motion tenderness and bilateral adnexal tenderness
WBC 18k. Pregnancy test neg. Dx? - CORRECT ANSWER Gonorrhea (PID)
20M with 3-month hx of progressive thirst (drinking a lot of fluids) and urinary frequency
during past 3 days. U/A shows specific gravity less than 1.006. Most likely has
dysfunction of which endocrine structure? - CORRECT ANSWER posterior pituitary
gland (ADH)
21yo M in ED with excruciating anal pain for 4 hours. Exam shows 15-mm, blue tinged
rounded mass at anal margin. Represents thrombus in a tributary of which blood
vessel? - CORRECT ANSWER inferior rectal vein
6-week-old girl with 6-day hx of vomiting small amount of milk 2 to 3 times daily. 50%ile
for length and weight. Cause? - CORRECT ANSWER Immature lower esophageal
sphincter
37yo M with 4-day hx of diarrhea and abdominal pain, worse in past 24h, with watery-
brown stools. Completed a 10-day course of amoxicillin for a sinus infection 5 days ago.
Stool shows: Fecal fat negative; ova and parasites negative; Cx for infx negative; C. Diff
toxin positive. Which pathologic findings present in intestinal tract? - CORRECT
ANSWER Pseudomemnbranes of fibrin and inflammatory debris
28yo M in ED 30 minutes after SOB. 3-year hx of cocaine abuse. T 38.1, P 100/min, BP
150/45. PE: diminished pulses in left upper extremity. Crackles heard over all lung
fields. 2/6 diastolic murmur at left sternal border. CXr shows a widened aortic arch. Dx?
- CORRECT ANSWER Dissecting aneurysm
1-week-old girl. screening showed a possible defect in fatty acid oxidation. PE normal.
Next step? - CORRECT ANSWER Measurement of serum acylcarnitine
concentrations
,79yoM 30 minutes after LOC for 30 seconds. Alert, but dizzy. No urinary or fecal
incontinence. Pulse 40/min, BP 92/56. PE shows no tongue biting. Lungs clear, Variable
intensity S1. Oriented X3. ECG shows a third-degree atrioventricular block. Next step? -
CORRECT ANSWER Insertion of transvenous pacemaker
55yo M with chronic bronchitis in ED after being unresponsive. Found bottles of
albuterol, ampicillin, codeine, and theophylline bedside. T 37.2 C, p 112/min,
respirations are 6/min, BP 95/60. Acute Rx should include? - CORRECT ANSWER
naloxone
50yo man has persistent cough for 2 months. He has had a 5 kg (11 lb) weight loss. He
is a farmer and on itraconazole 4 weeks for histoplasmosis from chicken coops.
Medications: hydrochlorothiazide, enalapril, atenolol, omeprazole, and metoclopramide
for hypertension and gastroesophageal reflux. Thin. Physical exam otherwise normal.
Itraconazole interacts with which drug and account for lack of effect of itraconazole? -
CORRECT ANSWER omeprazole
20yo man with 6-hour difficulty breathing and vomiting. 10-year history of type 1
diabetes on insulin. Pulse 90, respirations 30 and deep, bp 90/60. Physical shows
dehydration. Labs: Na+ 130, K+ 6.5, HCO3 5, glucose 500, pH 7.2, pCO2 25 mm Hg.
Which compound stimulated hormone-sensitive lipase in adipocytes causing
accumulation of metabolites causing acidosis? - CORRECT ANSWER epinephrine
Physician sad to inform patient of progression of carcinoma to the terminal phase.
Physician's face makes patient cry and ask, "It's bad news, isn't it?" Which is best
response? - CORRECT ANSWER "Yes, it is."
75yo man 2-year history of decreased force of urinary stream, urinate several times
throughout night. BUN 55, Cr 5.0. Ultrasound shows bilateral hydronephrosis and
dilated ureter. Mechanism of renal failure? - CORRECT ANSWER Increased
hydrostatic pressure in Bowman space
4yo boy two bacterial urinary tract infections past year. Physical exam normal.
Radiologic studies show dilation of left ureter and renal pelvis, minimal left-sided renal
function. Left nephrectomy done. Photo: dilated renal pelvis and ureter. Which is cause
of renal disease? - CORRECT ANSWER congenital urethral obstruction
45yo man poorly controlled type 2 diabetes 1-month low-grade fever. Getting
hemodialysis for end-stage renal disease. T 37 C (98.6 F), pulse 72, bp 144/92.
Physical subclavian catheter below right clavicle. Lungs clear. Cardiac exam no
murmurs. Blood cultures grow nonhemolytic, catalase-negative, gram-positive cocci in
pairs and chains. Which organism? - CORRECT ANSWER Enterococcus faecalis
, 3yo boy sickle cell disease with fever and pain over left foot 3 weeks. Hematocrit stable.
Leukocyte count 15,000 predominance of neutrophils. Which is most likely explanation
for findings? - CORRECT ANSWER osteomyelitis
10yo girl well-child examination. No menstrual period. 50th percentile height and weight.
Physical exam absence of breast bud development and no pubic or axillary hair. It is
most appropriate to tell mother that first objective sign of puberty will be which? -
CORRECT ANSWER Breast bud development
45yo woman follow-up exam after 8 weeks tamoxifen therapy for estrogen and
progesterone positive invasive ductal carcinoma of breast. 50yo sister also hormone-
sensitive breast cancer. Physical exam normal. Serum decreased concentrations of
endoxifen, active metabolite of prodrug tamoxifen. Genetic analysis shows homozygous
cytochrome P450 2D6*4 alleles. Likelihood patient's sisters has same alleles? -
CORRECT ANSWER 25%
60yo man progressive shortness of breath past 3 months. Worked in shipyard.
Respirations 25. Bilateral basilar crepitant crackles. Xray chest reticulonodular
pulmonary infiltrates consistent with interstitial fibrosis. Picture: sputum sample of
elongate structures (ferruginous body). Fibrosis initiated by interaction of structures with
which cell? - CORRECT ANSWER Alveolar macrophages
30yo woman 20 weeks gestation, uncomplicated pregnancy. Fundal height is greater
than expected for gestational age. Ultrasound shows increased amniotic fluid. Which
abnormality is cause? - CORRECT ANSWER Tracheoesophageal atresia
43yo woman for health maintenance exam. Physician 30 minutes late for appointment
because of emergency, when enters, patients checks watch. Which is best initial
response? - CORRECT ANSWER "I'm sorry I got delayed. I hope I haven't made
you late somewhere else."
27yo woman 12-hour history of fever and abdominal pain. History of recurrent urinary
tract infections. Temperature is 39 C (102.2 F). Physical exam tenderness of right flank.
Abdominal xrays bilateral staghorn renal calculi. Urinalysis pH 8, many RBCs, WBC,
bacteria. Calculi composed of? - CORRECT ANSWER struvite
48yo nulligravid woman with excessive uterine bleeding for 3 months. Bleeding during
menses and at irregular intervals. Menses were regular before. BMI 27. Pelvic exam:
adnexae are nonpalpable. Endometrial curettage shows abundant tissue. Which is
cause of symptoms? - CORRECT ANSWER Endometrial hyperplasia
65yo woman surgical repair of aneurysm right internal carotid artery in cavernous sinus.
Three days later on physical exam, right pupil larger than left pupil. Weakness of eye
TESTBANK QUESTIONS AND CORRECT DETAILED ANSWERS
42yo M in ED because of a 10-day history of progressive fever, SOB, and
nonproductive cough. 20-kg weight loss. Immigrated to USA from the Ivory Coast 4
years ago. Temp 38C. Lungs clear, CXr shows diffuse interstitial infiltrate. Silver stain
obtained via bronchoscopy shows Pneumocystis jiroveci (formerly P. carinii). High dose
prednisone and trimethoprim-sulfamethoxazole is initiated, and workup for HIV infection
is done. HIV ELISA positive, HIV western blot positive, CD4 22; HIV viral load <50.
Explanation? - CORRECT ANSWER Infection with HIV-2
27yo F with vaginal bleeding for 3 weeks. First pregnancy ended with a spontaneous
abortion 8 months ago. No Rx since dilatation and curettage at that time. PE shows
enlarged uterus, beta-hCG markedly increased. Ultrasonagraphy of pelvis shows
material within the endometrial cavity and no intrauterine pregnancy. CT scan shows a
necrotic intrauterine mass and metastatic nodules in the lungs. Site of Origin? -
CORRECT ANSWER trophoblastic tissue
65yo M emigrated from Brazil with 8-month history of shortness of breath and fatigue,
edema of lower ext. CXR shows cardiomegaly. endomyocardial biopsy specimen shows
myofiber necrosis with a mixed inflammatory infiltrate of PMNs, T lymphos, m.phages,
and eosinophils. Causal org? - CORRECT ANSWER Trypanosoma cruzi
40yo F with mole on her back that has increased in size during past 4 months. PE
shows raised irregular lesion with variegated black-tan pigmentation and ill-defined
margins. Pleomorphic, hyperchromatic cells within clear islands that tend to collapse.
Extends from epidermis into papillary dermis. Dx? - CORRECT ANSWER
melanoma
42yo farmer has a 7-mm red scaly plaque on helical rim of left ear. Photomicrograph
shown. Dx? - CORRECT ANSWER actinic keratosis
30yo F training for a marathon, running 20 miles/day. Fasting glucose is 60. After her
glucose stores have been depleted, which organ, in addition to liver, releases glucose?
- CORRECT ANSWER kidney
Male newborn at 28 weeks'. Given ventilatory support with up to 80% oxygen for the
next 72 hours, but dies of resp. failure. Cause is inadequate secretion from which
labeled cell types? - CORRECT ANSWER D. type II pneumocyte (produces
surfactant)
9yo girl with poor growth during the past year. < 3rd %ile for height and at 10th
percentile for weight. PE normal. Visual field testing shows bitemporal hemianopia.
Labs show GH deficiency. MRI shows calcified cystic mass in suprasellar region. Tumor
,derived from? - CORRECT ANSWER Diverticulum of the roof of the embryonic oral
cavity
28yo F G1P1 with 2-day history of a painful mass in her right breast. Delivered healthy
female newborn 3 weeks ago, and been breast-feeding since. T 37C, PE shows 3-cm
tender mass surrounded by an area of erythema beneath the right areola. Causal org? -
CORRECT ANSWER staph aureus
3yo boy with bacterial colitis caused by Salmonella enterica serovar arizonae. Which
factor accounts for recruitment of PMNS to inflammatory site by intestinal epithelial
cells? - CORRECT ANSWER IL-8
27yo F with fever, malaise, abdominal pain, and vaginal d/c for 4 days. LMP 5 days ago.
Had ectopic 1 year ago. T 38.3 C, bilateral lower quadrant tenderness with rebound and
guarding. Pelvic exam with cervical motion tenderness and bilateral adnexal tenderness
WBC 18k. Pregnancy test neg. Dx? - CORRECT ANSWER Gonorrhea (PID)
20M with 3-month hx of progressive thirst (drinking a lot of fluids) and urinary frequency
during past 3 days. U/A shows specific gravity less than 1.006. Most likely has
dysfunction of which endocrine structure? - CORRECT ANSWER posterior pituitary
gland (ADH)
21yo M in ED with excruciating anal pain for 4 hours. Exam shows 15-mm, blue tinged
rounded mass at anal margin. Represents thrombus in a tributary of which blood
vessel? - CORRECT ANSWER inferior rectal vein
6-week-old girl with 6-day hx of vomiting small amount of milk 2 to 3 times daily. 50%ile
for length and weight. Cause? - CORRECT ANSWER Immature lower esophageal
sphincter
37yo M with 4-day hx of diarrhea and abdominal pain, worse in past 24h, with watery-
brown stools. Completed a 10-day course of amoxicillin for a sinus infection 5 days ago.
Stool shows: Fecal fat negative; ova and parasites negative; Cx for infx negative; C. Diff
toxin positive. Which pathologic findings present in intestinal tract? - CORRECT
ANSWER Pseudomemnbranes of fibrin and inflammatory debris
28yo M in ED 30 minutes after SOB. 3-year hx of cocaine abuse. T 38.1, P 100/min, BP
150/45. PE: diminished pulses in left upper extremity. Crackles heard over all lung
fields. 2/6 diastolic murmur at left sternal border. CXr shows a widened aortic arch. Dx?
- CORRECT ANSWER Dissecting aneurysm
1-week-old girl. screening showed a possible defect in fatty acid oxidation. PE normal.
Next step? - CORRECT ANSWER Measurement of serum acylcarnitine
concentrations
,79yoM 30 minutes after LOC for 30 seconds. Alert, but dizzy. No urinary or fecal
incontinence. Pulse 40/min, BP 92/56. PE shows no tongue biting. Lungs clear, Variable
intensity S1. Oriented X3. ECG shows a third-degree atrioventricular block. Next step? -
CORRECT ANSWER Insertion of transvenous pacemaker
55yo M with chronic bronchitis in ED after being unresponsive. Found bottles of
albuterol, ampicillin, codeine, and theophylline bedside. T 37.2 C, p 112/min,
respirations are 6/min, BP 95/60. Acute Rx should include? - CORRECT ANSWER
naloxone
50yo man has persistent cough for 2 months. He has had a 5 kg (11 lb) weight loss. He
is a farmer and on itraconazole 4 weeks for histoplasmosis from chicken coops.
Medications: hydrochlorothiazide, enalapril, atenolol, omeprazole, and metoclopramide
for hypertension and gastroesophageal reflux. Thin. Physical exam otherwise normal.
Itraconazole interacts with which drug and account for lack of effect of itraconazole? -
CORRECT ANSWER omeprazole
20yo man with 6-hour difficulty breathing and vomiting. 10-year history of type 1
diabetes on insulin. Pulse 90, respirations 30 and deep, bp 90/60. Physical shows
dehydration. Labs: Na+ 130, K+ 6.5, HCO3 5, glucose 500, pH 7.2, pCO2 25 mm Hg.
Which compound stimulated hormone-sensitive lipase in adipocytes causing
accumulation of metabolites causing acidosis? - CORRECT ANSWER epinephrine
Physician sad to inform patient of progression of carcinoma to the terminal phase.
Physician's face makes patient cry and ask, "It's bad news, isn't it?" Which is best
response? - CORRECT ANSWER "Yes, it is."
75yo man 2-year history of decreased force of urinary stream, urinate several times
throughout night. BUN 55, Cr 5.0. Ultrasound shows bilateral hydronephrosis and
dilated ureter. Mechanism of renal failure? - CORRECT ANSWER Increased
hydrostatic pressure in Bowman space
4yo boy two bacterial urinary tract infections past year. Physical exam normal.
Radiologic studies show dilation of left ureter and renal pelvis, minimal left-sided renal
function. Left nephrectomy done. Photo: dilated renal pelvis and ureter. Which is cause
of renal disease? - CORRECT ANSWER congenital urethral obstruction
45yo man poorly controlled type 2 diabetes 1-month low-grade fever. Getting
hemodialysis for end-stage renal disease. T 37 C (98.6 F), pulse 72, bp 144/92.
Physical subclavian catheter below right clavicle. Lungs clear. Cardiac exam no
murmurs. Blood cultures grow nonhemolytic, catalase-negative, gram-positive cocci in
pairs and chains. Which organism? - CORRECT ANSWER Enterococcus faecalis
, 3yo boy sickle cell disease with fever and pain over left foot 3 weeks. Hematocrit stable.
Leukocyte count 15,000 predominance of neutrophils. Which is most likely explanation
for findings? - CORRECT ANSWER osteomyelitis
10yo girl well-child examination. No menstrual period. 50th percentile height and weight.
Physical exam absence of breast bud development and no pubic or axillary hair. It is
most appropriate to tell mother that first objective sign of puberty will be which? -
CORRECT ANSWER Breast bud development
45yo woman follow-up exam after 8 weeks tamoxifen therapy for estrogen and
progesterone positive invasive ductal carcinoma of breast. 50yo sister also hormone-
sensitive breast cancer. Physical exam normal. Serum decreased concentrations of
endoxifen, active metabolite of prodrug tamoxifen. Genetic analysis shows homozygous
cytochrome P450 2D6*4 alleles. Likelihood patient's sisters has same alleles? -
CORRECT ANSWER 25%
60yo man progressive shortness of breath past 3 months. Worked in shipyard.
Respirations 25. Bilateral basilar crepitant crackles. Xray chest reticulonodular
pulmonary infiltrates consistent with interstitial fibrosis. Picture: sputum sample of
elongate structures (ferruginous body). Fibrosis initiated by interaction of structures with
which cell? - CORRECT ANSWER Alveolar macrophages
30yo woman 20 weeks gestation, uncomplicated pregnancy. Fundal height is greater
than expected for gestational age. Ultrasound shows increased amniotic fluid. Which
abnormality is cause? - CORRECT ANSWER Tracheoesophageal atresia
43yo woman for health maintenance exam. Physician 30 minutes late for appointment
because of emergency, when enters, patients checks watch. Which is best initial
response? - CORRECT ANSWER "I'm sorry I got delayed. I hope I haven't made
you late somewhere else."
27yo woman 12-hour history of fever and abdominal pain. History of recurrent urinary
tract infections. Temperature is 39 C (102.2 F). Physical exam tenderness of right flank.
Abdominal xrays bilateral staghorn renal calculi. Urinalysis pH 8, many RBCs, WBC,
bacteria. Calculi composed of? - CORRECT ANSWER struvite
48yo nulligravid woman with excessive uterine bleeding for 3 months. Bleeding during
menses and at irregular intervals. Menses were regular before. BMI 27. Pelvic exam:
adnexae are nonpalpable. Endometrial curettage shows abundant tissue. Which is
cause of symptoms? - CORRECT ANSWER Endometrial hyperplasia
65yo woman surgical repair of aneurysm right internal carotid artery in cavernous sinus.
Three days later on physical exam, right pupil larger than left pupil. Weakness of eye
