NBME HIGH YIELD EXAM 2025
QUESTIONS AND ANSWERS
What are sentinel lymph nodes? - ....ANSWER ...-First group of lymph
nodes draining a specific organ
Describe the lymph node drainage of the GI tract - ....ANSWER ...-
*Trachea and esophagus => Mediastinal
*Liver, spleen, pancreas, stomach, upper duodenum => Celiac
*Lower duodenum, jejunum, ilecum, colon to splenic flexure => SMA
*Colon from splenic flexure to upper rectum => IMA
*Lower rectum to anal canal (above pectinate line) =>Internal Iliac
Anal rectum (below pectinate line) =>Superficial inguinal
What is the mechanism by which Lactulose is used to treat Hepatic
Encephalopathy? - ....ANSWER ...-*Lactulose is resistant to intestinal
disaccharides
*Metabolized by gut flora into lactic and formic acid.
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,*These acids have an osmotic/laxative effect and cause an acidifying effect
*Acids also cause NH3 to be trapped as NH4+ and cannot cross intestinal wall;
excreted into feces
What antimuscarinics are used to prevent postprandial abdominal pain of IBS
patient - ....ANSWER ...-Hyoscyamine,dicyclomine
Which drugs are contraindicated in patients with glaucoma? -
....ANSWER ...-Drugs that cause mydriasis: A1 agonists or M3 antagonists
(antimuscarinics)
A1 agonists: Epinephrine
M3 antagonists:Atropine and other antimuscarinics
Mydriasis pulls the iris to it's base, making the angle narrow
What is the treatment of Atropione poisoning?
What is the treatment of Organophosphate poisoning? - ....ANSWER ...-
Atropine poisoning: Physostigmine (crosses BBB)
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,Organophosphate poisoning: Atropine first and then PAM
*Important to distinguish between atropine overdose and TCA overdose. Both
have symptoms of anticholinergic excess; TCA also has
Which receptor is associated with the following
*Pupillary dilator muscle contraction -> mydriasis
*Pupillary sphinctor muscle contraction -> miosis
*Ciliary muscle contraction ->accommodation
*Increase aqueous humor production
*Decrease aqueous humor production - ....ANSWER ...-*Pupillary dilator
muscle contraction -> mydriasis: A1
*Pupillary sphinctor muscle contraction -> miosis: M3
*Ciliary muscle contraction ->accommodation: M3
*Increase aqueous humor production: B2
*Decrease aqueous humor production: A2
Hemicholinium - ....ANSWER ...-MOA: blocks the sodium-dependent
reuptake of choline into presynaptic terminals.
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, *Because reuptake of choline is the rate-limiting step in acetylcholine synthesis,
hemicholinium reduces presynaptic stores of acetylcholine
Which of the following below will deplete "presynaptic ACh" stores?
a) botulinum toxin
b) curare
c) neostigmine
d) hemicholinium
e) atropine - ....ANSWER ...-d) hemicholinium
A 47-year-old woman comes to the physician for a routine health maintenance
examination. She has a 2-year history of venous insufficiency and notes daily
swelling of her ankles that worsesn in the evening. She takes no medications. Her
pulse is 80/min, and BP is 160/100 mm Hg. Cardiopulmonary examination shows
no abnormalities. Examination of the lower extermities show 2+ edema and
increased pigmentation. Which of the following hypertensive drugs would most
likely exacerbate this patient's swelling?
A) Atenolol
B) Clonidine
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 4
QUESTIONS AND ANSWERS
What are sentinel lymph nodes? - ....ANSWER ...-First group of lymph
nodes draining a specific organ
Describe the lymph node drainage of the GI tract - ....ANSWER ...-
*Trachea and esophagus => Mediastinal
*Liver, spleen, pancreas, stomach, upper duodenum => Celiac
*Lower duodenum, jejunum, ilecum, colon to splenic flexure => SMA
*Colon from splenic flexure to upper rectum => IMA
*Lower rectum to anal canal (above pectinate line) =>Internal Iliac
Anal rectum (below pectinate line) =>Superficial inguinal
What is the mechanism by which Lactulose is used to treat Hepatic
Encephalopathy? - ....ANSWER ...-*Lactulose is resistant to intestinal
disaccharides
*Metabolized by gut flora into lactic and formic acid.
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 1
,*These acids have an osmotic/laxative effect and cause an acidifying effect
*Acids also cause NH3 to be trapped as NH4+ and cannot cross intestinal wall;
excreted into feces
What antimuscarinics are used to prevent postprandial abdominal pain of IBS
patient - ....ANSWER ...-Hyoscyamine,dicyclomine
Which drugs are contraindicated in patients with glaucoma? -
....ANSWER ...-Drugs that cause mydriasis: A1 agonists or M3 antagonists
(antimuscarinics)
A1 agonists: Epinephrine
M3 antagonists:Atropine and other antimuscarinics
Mydriasis pulls the iris to it's base, making the angle narrow
What is the treatment of Atropione poisoning?
What is the treatment of Organophosphate poisoning? - ....ANSWER ...-
Atropine poisoning: Physostigmine (crosses BBB)
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 2
,Organophosphate poisoning: Atropine first and then PAM
*Important to distinguish between atropine overdose and TCA overdose. Both
have symptoms of anticholinergic excess; TCA also has
Which receptor is associated with the following
*Pupillary dilator muscle contraction -> mydriasis
*Pupillary sphinctor muscle contraction -> miosis
*Ciliary muscle contraction ->accommodation
*Increase aqueous humor production
*Decrease aqueous humor production - ....ANSWER ...-*Pupillary dilator
muscle contraction -> mydriasis: A1
*Pupillary sphinctor muscle contraction -> miosis: M3
*Ciliary muscle contraction ->accommodation: M3
*Increase aqueous humor production: B2
*Decrease aqueous humor production: A2
Hemicholinium - ....ANSWER ...-MOA: blocks the sodium-dependent
reuptake of choline into presynaptic terminals.
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 3
, *Because reuptake of choline is the rate-limiting step in acetylcholine synthesis,
hemicholinium reduces presynaptic stores of acetylcholine
Which of the following below will deplete "presynaptic ACh" stores?
a) botulinum toxin
b) curare
c) neostigmine
d) hemicholinium
e) atropine - ....ANSWER ...-d) hemicholinium
A 47-year-old woman comes to the physician for a routine health maintenance
examination. She has a 2-year history of venous insufficiency and notes daily
swelling of her ankles that worsesn in the evening. She takes no medications. Her
pulse is 80/min, and BP is 160/100 mm Hg. Cardiopulmonary examination shows
no abnormalities. Examination of the lower extermities show 2+ edema and
increased pigmentation. Which of the following hypertensive drugs would most
likely exacerbate this patient's swelling?
A) Atenolol
B) Clonidine
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 4
