1 of 39
NBME CBSE REAL EXAM 200 QUESTIONS AND ANSWERS LATEST 2025/2026
COMPLETE EXAM (usmle step 1) MEDICAL EXAMINATION
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?
- ......ANSWER........Insertion of transvenous pacemaker
80yo F in ED for 2-day hx of "feeling funny." "Lost my pep." Hx of poorly controlled
hypertension. Just started medication 2 weeks ago. BP 130/85. Pe normal. Serum
potassium is 3. Which drug? - ......ANSWER........HCTZ
80yo F with suspected temporal arteritis (TA). ESR is 100, Pretest probability for TA is 50%
in this patient. In the evaluation of TA, ESR has a sensitivity of 99% and specificity of 60%.
Based on the results of the ESR testing, most appropriate next step?
- ......ANSWER........ESR is not sensitive; need additional testing like a biopsy to confirm the
diagnosis
80yo man type 2 diabetes 2-month history severe constipation. Laxatives haven't relieved
symptoms. Abdominal exam shows distention. Colonoscopy shows no abnormalities.
Patient has dysfunction of which nerve? - ......ANSWER........Pelvic splanchnic
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
,2 of 39
83yo M brought to ED after being found at home bedridden and confused. No meds. P
100/min, BP 85/50. BP unchanged after 1L IV saline. Pulmonary artery catheter shows:
Cardiac output high, PCWP low, systemic vascular resistance low. Cause of hypotension?
- ......ANSWER........Early septic shock (only form with decreased SVR)
8yo boy with disruptive behavior, interrupts, always moving, trouble completing tasks.
Drug with which mechanism is appropriate? - ......ANSWER........Increased release of DA
and NE
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 hemi anoia. Labs show GH
deficiency. MRI shows calcified cystic mass in suprasellar region. Tumor derived from?
- ......ANSWER........Craniopharyngioma--> diverticulum of the rood of the embryonic oral
cavity
A study conducted to assess effectiveness of injections of lidocaine into "trigger points" of
pain symptoms in patients with fibromyalgia. Fifty patients randomly assigned - 0.9%
saline only or saline plus lidocaine. Graph shows self-reported pain scores. Explanation?
- ......ANSWER........Placebo effect
Compound is taken up by bacterial cells. No energy is necessary for uptake, and the
compound is not concentrated in the cell. Which describes this mechanism of transport?
- ......ANSWER........Carrier-mediated diffusion
Corresponded to penis shaft? - ......ANSWER........Labia minora
,3 of 39
Exam scaled so scores are normally distributed with mean of 500 and SD of 100. Which %
are between 400 and 600? - ......ANSWER........67%
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)
Female newborn is delivered at 38 weeks' gestation. Apgar 8 and 8 at 1/5 min. PE shows a
bulging, fluod0filled mass approximately 5 cm in diameter in the midline over the
lumbosacral region. No spontaneous movements of the lower extremities. Abnormality
most likely occurred because of abnormal development during which periods of
postconception (in days)? - ......ANSWER........15-40; neutral tube closes at about 4 weeks
Girl for well-child exam. Normal development includes pincer grasp, finger feeding,
standing while holding onto a table, and playing peekaboo. Age (in months)?
- ......ANSWER........9 months
In a survey of 100 households (average three residents per household), 45 with asthma are
detected. Prevalence? - ......ANSWER........45/ (100*3) = 15%
, 4 of 39
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? - ......ANSWER........Type II pneumocytes (large cell with round shape in the airways)
Male newborn has macrocephaly with poor skull mineralization, shortened extremities
with misshaped long bones, and several fx. Defect in which? - ......ANSWER........Collagen
Mouse embryos are produced with two pronuclei, both of same parental origin. When the
pronuclei are maternal, produces have poorly developed extraembryonic structures. When
both pronuclei are paternal, produces have poorly developed embryonic tissue. Which
genetic mechanisms? - ......ANSWER........Imprinting
Newborn delivered at 38 weeks' gestation weighs 1800 g. PE shows petechial rash,
microcephaly, and hepatosplenomegaly. Serologic test for CMV: IgG + in mother, + in
newborn; IGM - in mother, + in newborn. Explanation? - ......ANSWER........Congenital CMV
infection
Newborn has male genital ducts but female external genitalia. Cytogenetic analysis shows
a 46, XY karyotype, and genetic testing shows a mutation of the gene encoding 5alpha-
reductase. In absence of this mutation, labia majora would have been?
- ......ANSWER........Scrotum
Pharm co trying to develop a long-acting weight-loss agent that mimics activity of a
naturally occurring peptide originates in adipose tissue, signals brain about stored fat and
suppresses appetite by its action in the CNS. Which chemical mediator?
- ......ANSWER........Leptin
NBME CBSE REAL EXAM 200 QUESTIONS AND ANSWERS LATEST 2025/2026
COMPLETE EXAM (usmle step 1) MEDICAL EXAMINATION
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?
- ......ANSWER........Insertion of transvenous pacemaker
80yo F in ED for 2-day hx of "feeling funny." "Lost my pep." Hx of poorly controlled
hypertension. Just started medication 2 weeks ago. BP 130/85. Pe normal. Serum
potassium is 3. Which drug? - ......ANSWER........HCTZ
80yo F with suspected temporal arteritis (TA). ESR is 100, Pretest probability for TA is 50%
in this patient. In the evaluation of TA, ESR has a sensitivity of 99% and specificity of 60%.
Based on the results of the ESR testing, most appropriate next step?
- ......ANSWER........ESR is not sensitive; need additional testing like a biopsy to confirm the
diagnosis
80yo man type 2 diabetes 2-month history severe constipation. Laxatives haven't relieved
symptoms. Abdominal exam shows distention. Colonoscopy shows no abnormalities.
Patient has dysfunction of which nerve? - ......ANSWER........Pelvic splanchnic
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
,2 of 39
83yo M brought to ED after being found at home bedridden and confused. No meds. P
100/min, BP 85/50. BP unchanged after 1L IV saline. Pulmonary artery catheter shows:
Cardiac output high, PCWP low, systemic vascular resistance low. Cause of hypotension?
- ......ANSWER........Early septic shock (only form with decreased SVR)
8yo boy with disruptive behavior, interrupts, always moving, trouble completing tasks.
Drug with which mechanism is appropriate? - ......ANSWER........Increased release of DA
and NE
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 hemi anoia. Labs show GH
deficiency. MRI shows calcified cystic mass in suprasellar region. Tumor derived from?
- ......ANSWER........Craniopharyngioma--> diverticulum of the rood of the embryonic oral
cavity
A study conducted to assess effectiveness of injections of lidocaine into "trigger points" of
pain symptoms in patients with fibromyalgia. Fifty patients randomly assigned - 0.9%
saline only or saline plus lidocaine. Graph shows self-reported pain scores. Explanation?
- ......ANSWER........Placebo effect
Compound is taken up by bacterial cells. No energy is necessary for uptake, and the
compound is not concentrated in the cell. Which describes this mechanism of transport?
- ......ANSWER........Carrier-mediated diffusion
Corresponded to penis shaft? - ......ANSWER........Labia minora
,3 of 39
Exam scaled so scores are normally distributed with mean of 500 and SD of 100. Which %
are between 400 and 600? - ......ANSWER........67%
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)
Female newborn is delivered at 38 weeks' gestation. Apgar 8 and 8 at 1/5 min. PE shows a
bulging, fluod0filled mass approximately 5 cm in diameter in the midline over the
lumbosacral region. No spontaneous movements of the lower extremities. Abnormality
most likely occurred because of abnormal development during which periods of
postconception (in days)? - ......ANSWER........15-40; neutral tube closes at about 4 weeks
Girl for well-child exam. Normal development includes pincer grasp, finger feeding,
standing while holding onto a table, and playing peekaboo. Age (in months)?
- ......ANSWER........9 months
In a survey of 100 households (average three residents per household), 45 with asthma are
detected. Prevalence? - ......ANSWER........45/ (100*3) = 15%
, 4 of 39
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? - ......ANSWER........Type II pneumocytes (large cell with round shape in the airways)
Male newborn has macrocephaly with poor skull mineralization, shortened extremities
with misshaped long bones, and several fx. Defect in which? - ......ANSWER........Collagen
Mouse embryos are produced with two pronuclei, both of same parental origin. When the
pronuclei are maternal, produces have poorly developed extraembryonic structures. When
both pronuclei are paternal, produces have poorly developed embryonic tissue. Which
genetic mechanisms? - ......ANSWER........Imprinting
Newborn delivered at 38 weeks' gestation weighs 1800 g. PE shows petechial rash,
microcephaly, and hepatosplenomegaly. Serologic test for CMV: IgG + in mother, + in
newborn; IGM - in mother, + in newborn. Explanation? - ......ANSWER........Congenital CMV
infection
Newborn has male genital ducts but female external genitalia. Cytogenetic analysis shows
a 46, XY karyotype, and genetic testing shows a mutation of the gene encoding 5alpha-
reductase. In absence of this mutation, labia majora would have been?
- ......ANSWER........Scrotum
Pharm co trying to develop a long-acting weight-loss agent that mimics activity of a
naturally occurring peptide originates in adipose tissue, signals brain about stored fat and
suppresses appetite by its action in the CNS. Which chemical mediator?
- ......ANSWER........Leptin
