NBME 25 TEST PAPER 2025/2026 QUESTIONS WITH
ANSWERS GRADED A+
✔✔subscapularis injury - ✔✔limit of function or pain elicited on passive external rotation
or resisted internal rotation
✔✔What does the dermis contain? Pathologic proliferation of these can cause what? -
✔✔Fibrous connective tissue with blood vessels, sensory nerve endings, hair follicles
and glands' dermatofibromas, hemangiomas, neurofibromas
✔✔What is extrinsic apoptosis? What can cause it? - ✔✔apoptosis caused by activation
of the death receptor extrinsic pathway; dependent on external cellular signals as with
the binding of Fas and Fas L; in hep A, there is a release of perforin and granzyme B
from cytotoxic CD8+ T lymphocytes responding to intracellular viral pathogens -->
stimulates apoptosis
✔✔what is intrinsic apoptosis? - ✔✔apoptosis caused by the activation of
mitochondria...triggered by cellular damage such as radiation, oxidation, ischemia, or
toxin exposure --> release of cytochrome C from mitochondria --> activation of caspase
✔✔apoptosis pathway - ✔✔
✔✔nuchal translucency, pregnancy associated plasma protein, and bHCG in mom
pregnant with baby with down syndrome? - ✔✔nuchal translucency is increased,
pregnancy plasma protein is decreased, bHCG is increased
✔✔lymph node histology bartonella? - ✔✔granulomas containing stellate
microabscesses; multinucleated giant cells may or may not be present
✔✔where does the break down of di and tripepides to free amino acids take place? -
✔✔intestinal mucosa
✔✔function of duodenum regarding proteins - ✔✔contains trypin and chymotrypsin
which aid in the digestion of complex polypeptides
✔✔amylase does what? - ✔✔digestion of carbohydrates
✔✔lipase does what? - ✔✔digestion of triglycerides
✔✔patient has work related stress, epigastric pain, and a normal endoscopic
exam...diagnosis? - ✔✔nonuclear (functional) dyspepsia...dyspepsia = epigastric pain
variably accompanies by multiple symptoms including nausea, bloating, or early satiety;
patients with nonuclear dyspepsia commonly have psychiatric conditions including GAD
or MDD and stressful life circumstances
, ✔✔describe the pathogenesis of reperfusion injury in heart - ✔✔rapid increase in the
production of free radicals...free radicals damage cells through membrane lipid
peroxidation (oxidatvie damage to intracellular proteins) and DNA strand breaks -->
cellular necrosis and lysis (red infarct)
✔✔what should be given to a patient taking insulin with symptoms of hypoglycemia? -
✔✔immediate administration of oral or IV glucose OR intramuscular glucagon
(stimulates hepatic glucose production via gluconeogenesis and glycogenolysis)
✔✔bifid carotid pulse; other names for this? - ✔✔double systolic peak (one sharp, one
more broad) --> aortic regurg, combined aortic regurg and stenosis, HCM (less
common); aka pulsus bisferiens and biphasic pulse
✔✔jugular cannon waves - ✔✔large amplitude waves which can be present in certain
cardiac arrhythmia (complete HB and V tach); desynchronized contractions of the atria
and ventricles lead to increased right atrial pressure and an exaggerated atrial wave
✔✔Pulsus parvus et tardus? What is another name for it? - ✔✔aortic stenosis; aka
anacrotic pulse
✔✔what is the main modality of resistance to B lactam antibiotics in gram negative
bacteria? how does it do this? - ✔✔production of beta lactamases (aka penicillinases);
gene encoding beta lactamase enzymes are transferred on plasmids between bacteria
✔✔elaboration of new PBP is a mechanism of resistance in what organism? -
✔✔staphylococci
✔✔alteration of existing PBP is a mode of resistance frequently found in what
organisms? - ✔✔gram positive organisms such as strep pneumo, step viridans
✔✔what organisms use mutation in porin genes for antibiotic resistance? - ✔✔gram
negatives like pseudomonas, klebsiella, serratia marcenscens
✔✔name a classic example of efflux pump resistance - ✔✔e coli resistance to
tetracycline
✔✔bigeminal pulse? - ✔✔normal beat followed rapidly by a premature ventricular
contraction (second beat has a reduced amplitude because of decreased stroke volume
from shortened diastolic filling time)
✔✔adenosine in brain is excitatory or inhibitory? - ✔✔inhibitory
ANSWERS GRADED A+
✔✔subscapularis injury - ✔✔limit of function or pain elicited on passive external rotation
or resisted internal rotation
✔✔What does the dermis contain? Pathologic proliferation of these can cause what? -
✔✔Fibrous connective tissue with blood vessels, sensory nerve endings, hair follicles
and glands' dermatofibromas, hemangiomas, neurofibromas
✔✔What is extrinsic apoptosis? What can cause it? - ✔✔apoptosis caused by activation
of the death receptor extrinsic pathway; dependent on external cellular signals as with
the binding of Fas and Fas L; in hep A, there is a release of perforin and granzyme B
from cytotoxic CD8+ T lymphocytes responding to intracellular viral pathogens -->
stimulates apoptosis
✔✔what is intrinsic apoptosis? - ✔✔apoptosis caused by the activation of
mitochondria...triggered by cellular damage such as radiation, oxidation, ischemia, or
toxin exposure --> release of cytochrome C from mitochondria --> activation of caspase
✔✔apoptosis pathway - ✔✔
✔✔nuchal translucency, pregnancy associated plasma protein, and bHCG in mom
pregnant with baby with down syndrome? - ✔✔nuchal translucency is increased,
pregnancy plasma protein is decreased, bHCG is increased
✔✔lymph node histology bartonella? - ✔✔granulomas containing stellate
microabscesses; multinucleated giant cells may or may not be present
✔✔where does the break down of di and tripepides to free amino acids take place? -
✔✔intestinal mucosa
✔✔function of duodenum regarding proteins - ✔✔contains trypin and chymotrypsin
which aid in the digestion of complex polypeptides
✔✔amylase does what? - ✔✔digestion of carbohydrates
✔✔lipase does what? - ✔✔digestion of triglycerides
✔✔patient has work related stress, epigastric pain, and a normal endoscopic
exam...diagnosis? - ✔✔nonuclear (functional) dyspepsia...dyspepsia = epigastric pain
variably accompanies by multiple symptoms including nausea, bloating, or early satiety;
patients with nonuclear dyspepsia commonly have psychiatric conditions including GAD
or MDD and stressful life circumstances
, ✔✔describe the pathogenesis of reperfusion injury in heart - ✔✔rapid increase in the
production of free radicals...free radicals damage cells through membrane lipid
peroxidation (oxidatvie damage to intracellular proteins) and DNA strand breaks -->
cellular necrosis and lysis (red infarct)
✔✔what should be given to a patient taking insulin with symptoms of hypoglycemia? -
✔✔immediate administration of oral or IV glucose OR intramuscular glucagon
(stimulates hepatic glucose production via gluconeogenesis and glycogenolysis)
✔✔bifid carotid pulse; other names for this? - ✔✔double systolic peak (one sharp, one
more broad) --> aortic regurg, combined aortic regurg and stenosis, HCM (less
common); aka pulsus bisferiens and biphasic pulse
✔✔jugular cannon waves - ✔✔large amplitude waves which can be present in certain
cardiac arrhythmia (complete HB and V tach); desynchronized contractions of the atria
and ventricles lead to increased right atrial pressure and an exaggerated atrial wave
✔✔Pulsus parvus et tardus? What is another name for it? - ✔✔aortic stenosis; aka
anacrotic pulse
✔✔what is the main modality of resistance to B lactam antibiotics in gram negative
bacteria? how does it do this? - ✔✔production of beta lactamases (aka penicillinases);
gene encoding beta lactamase enzymes are transferred on plasmids between bacteria
✔✔elaboration of new PBP is a mechanism of resistance in what organism? -
✔✔staphylococci
✔✔alteration of existing PBP is a mode of resistance frequently found in what
organisms? - ✔✔gram positive organisms such as strep pneumo, step viridans
✔✔what organisms use mutation in porin genes for antibiotic resistance? - ✔✔gram
negatives like pseudomonas, klebsiella, serratia marcenscens
✔✔name a classic example of efflux pump resistance - ✔✔e coli resistance to
tetracycline
✔✔bigeminal pulse? - ✔✔normal beat followed rapidly by a premature ventricular
contraction (second beat has a reduced amplitude because of decreased stroke volume
from shortened diastolic filling time)
✔✔adenosine in brain is excitatory or inhibitory? - ✔✔inhibitory
