NBME Practice Tests 2025-2026 Question
and Correct answer GRADED A+
What antiretroviral prevents entry into a CD4+ t-cell - ANSWERSEnfuvirtide
Severe pain after meals (better when she doesn't eat), unintentional weight loss, hx of atherosclerosis +
abdominal bruit and absent pedal pulses. What artery could be atherosclerotic? - ANSWERSSuperior
Mesenteric
What is the inheritance pattern of Fragile X? How does transmission change if the mother has fragile X
vs. the father? - ANSWERSIt is X linked dominant (like hypophosphatemic rickets and Alports)
Mothers w/ disease: give it to 50% of daughters and sons
Fathers w/ disease: give it to all daughters and no sons
What medication could be used for watery nasal decongestion during an allergy attack? -
ANSWERSAlpha-adrenergic agonist (phenylephrine alpha 1 > alpha 2) in Sudafed and most OTC
decongestants
Newborn baby with hypothyroidism (no thyroid) has no symptoms. What can the mom transfer to the
baby allowing for normal development? - ANSWERSThyroxine (T4) is transferred in late gestation
through the placenta preventing the initial symptoms of congenital hypothyroidism
How does enterococcus faecalis develop resistance from vancomycin? - ANSWERSSubstitution of d-
lactate for d-alanine in peptidoglycan wall
2 days following an acute MI, a pt becomes short of breath and diaphoretic, high HR and pressure. What
murmur would be heard? - ANSWERS4/6 holosystolic murmur heard best over the lower left sternal
border and the cardiac apex
,- from posteromedial papillary muscle rupture (has single blood supply from posterior descending
artery) -> severe mitral regurgitation occurs 2-7 days after an MI
18 month old who has not eaten in 24 hrs has high pulse, increase respirations, hepatomegaly. His
glucose, ketones, and carnitine are decreased in serum, and urine ketones are decreased, and
dicarboxylic acids are present. He is given medium chain triglycerides for 6 months which helps. What is
deficient? - ANSWERSVery long-chain acyl-Coa dehydrogenase deficiency
- hypoketonic hypoglycemia
- fat deposits in liver = hepatomegaly
- cardiorespiratory distress
3 yo with constant fractures of bones, and blue sclera and normal teeth. What biochemical process is
altered? - ANSWERSProcollagen synthesis
- Osteogenesis imperfecta
- AD
- glycosylation of residues and then forms disulfide/hydrogen bonds -> triple helix (will not occur in this
disease)
- no normal type ONE collagen (bone)
-treat with bisphosphanates to prevents fractures
Cross sections area of an aneurysm is 2cm^2, and the velocity of blood flow is 20cm/sec. What is the
flow rate (L/min) through the aneurysm? - ANSWERSFlow rate (Q) = Flow velocity X cross sectional area
- 2X20 = 40cm^3/sec
- 40X60s = 24000 mm/sec (1cm^3 = 1 mm)
- 2.4L/min
severe bleed from gunshot wound to abdomen -> 3L blood in peritoneum. Cells in liver/kidney =
centrilobular pallor and swelling. Why is this occurring? - ANSWERSdecreased function of Na+/K+
ATPase
,- reversible injury from blood loss
What does fish oil do? - ANSWERSfish oil/omega 3 fatty acids antagonize VLDL-cholesterol secretion
- increase LDL/HDL slightly
- decrease FFA delivery to liver
60 yo man with no hx of bleeding problems has elevated PTT what molecule in the kinin cascade can be
deficient? - ANSWERSKallikrein -> leads to a build up of high molecular weight kininogen that activates
the intrinsic pathway -> elevated PTT
23 yo with sjogren and burning pain in feet is relieved with capsaicin. what neurotransmitter is causing
pain? - ANSWERSSubstance P
18 yo w/ ALL on chemo and low neutrophil count has lung infiltrate with PAS stain of budding fungus.
How do you treat him? - ANSWERSamphotericin B
- most likely cryptoccocus neoformans
12 yo with 6 months of difficulty walking and leg pain. Atrophy of LE and hammer toes with a high
stepping gait. What will a bc show? - ANSWERSAbnormal Myelin sheath
- AD
- pes cavus, hammer toe
- CMT1A/PMP22
mass in ovaries (CA 125 positive cancer) needs to be removed. What structure passing inferior to ovary
is at risk of injury? - ANSWERSureter
- passes behind ovary, round ligament, and ovarian vein and artery
52 yo male w/ no past hx come in w/ progressive issues swallowing, double vision, slurred speech,
ptosis, and waddling gait. He has fatigable weakness. What is the mechanism of disease? -
ANSWERSbinding of autoantibodies to the acetylcholine receptor
, 27 yo being treated for hodgkin lymphoma receives bone marrow tx from his cousin. 2 weeks after, he
has general erythematous, maculopapular rash, diarrhea, and increased liver enzymes and bilirubin.
What is the mechanism causing this reaction? - ANSWERSDonor T lymphocytes reacting against host cell
- Graft vs. Host disease
- grafted immunocompetent T-cells proliferate in immunocompromised host rejecting host cells ->
severe organ dysfunction
5 yo who was given aspirin for the flu presents with 16 hrs of severe vomiting, increased sleepiness,
prolonged prothrombin time, high ammonia, transaminase, and lactate and goes into a coma. What
caused this coma? - ANSWERScerebral edema from Reye's syndrome
- never give child aspirin except in kawasaki
woman with type 1 DM, recurrent episodes of fainting when she is hypoglycemic. What is the
mechanism of an injection drug that can be used to help these episodes? - ANSWERSstimulation of
hepatic glucose production
Young boy with fanconi syndrome. Will his reabsorption be increased/decreased of the following: amino
acids, glucose, phosphate, HCO3- - ANSWERSall decreased
- generalized reabsorption defect in PCT
24 yo african american male, red bumps on face, chin, neck that are itchy and painful. What does he
have? - ANSWERSpseudofolliculitis barbae
- "razor bumps" to the extreme
6 month old w/ recurrent URI, hypocalcemia, repair of coarctation of aorta, broad nasal bridge,
dysplastic pinnae. What is causing his recurrent infection? - ANSWERST-lymphocyte deficiency
- DiGeorge Syndrome
-22q11 deletion
- failure of 3 and 4th pharyngeal pouch (no thymus and parathyroid)
and Correct answer GRADED A+
What antiretroviral prevents entry into a CD4+ t-cell - ANSWERSEnfuvirtide
Severe pain after meals (better when she doesn't eat), unintentional weight loss, hx of atherosclerosis +
abdominal bruit and absent pedal pulses. What artery could be atherosclerotic? - ANSWERSSuperior
Mesenteric
What is the inheritance pattern of Fragile X? How does transmission change if the mother has fragile X
vs. the father? - ANSWERSIt is X linked dominant (like hypophosphatemic rickets and Alports)
Mothers w/ disease: give it to 50% of daughters and sons
Fathers w/ disease: give it to all daughters and no sons
What medication could be used for watery nasal decongestion during an allergy attack? -
ANSWERSAlpha-adrenergic agonist (phenylephrine alpha 1 > alpha 2) in Sudafed and most OTC
decongestants
Newborn baby with hypothyroidism (no thyroid) has no symptoms. What can the mom transfer to the
baby allowing for normal development? - ANSWERSThyroxine (T4) is transferred in late gestation
through the placenta preventing the initial symptoms of congenital hypothyroidism
How does enterococcus faecalis develop resistance from vancomycin? - ANSWERSSubstitution of d-
lactate for d-alanine in peptidoglycan wall
2 days following an acute MI, a pt becomes short of breath and diaphoretic, high HR and pressure. What
murmur would be heard? - ANSWERS4/6 holosystolic murmur heard best over the lower left sternal
border and the cardiac apex
,- from posteromedial papillary muscle rupture (has single blood supply from posterior descending
artery) -> severe mitral regurgitation occurs 2-7 days after an MI
18 month old who has not eaten in 24 hrs has high pulse, increase respirations, hepatomegaly. His
glucose, ketones, and carnitine are decreased in serum, and urine ketones are decreased, and
dicarboxylic acids are present. He is given medium chain triglycerides for 6 months which helps. What is
deficient? - ANSWERSVery long-chain acyl-Coa dehydrogenase deficiency
- hypoketonic hypoglycemia
- fat deposits in liver = hepatomegaly
- cardiorespiratory distress
3 yo with constant fractures of bones, and blue sclera and normal teeth. What biochemical process is
altered? - ANSWERSProcollagen synthesis
- Osteogenesis imperfecta
- AD
- glycosylation of residues and then forms disulfide/hydrogen bonds -> triple helix (will not occur in this
disease)
- no normal type ONE collagen (bone)
-treat with bisphosphanates to prevents fractures
Cross sections area of an aneurysm is 2cm^2, and the velocity of blood flow is 20cm/sec. What is the
flow rate (L/min) through the aneurysm? - ANSWERSFlow rate (Q) = Flow velocity X cross sectional area
- 2X20 = 40cm^3/sec
- 40X60s = 24000 mm/sec (1cm^3 = 1 mm)
- 2.4L/min
severe bleed from gunshot wound to abdomen -> 3L blood in peritoneum. Cells in liver/kidney =
centrilobular pallor and swelling. Why is this occurring? - ANSWERSdecreased function of Na+/K+
ATPase
,- reversible injury from blood loss
What does fish oil do? - ANSWERSfish oil/omega 3 fatty acids antagonize VLDL-cholesterol secretion
- increase LDL/HDL slightly
- decrease FFA delivery to liver
60 yo man with no hx of bleeding problems has elevated PTT what molecule in the kinin cascade can be
deficient? - ANSWERSKallikrein -> leads to a build up of high molecular weight kininogen that activates
the intrinsic pathway -> elevated PTT
23 yo with sjogren and burning pain in feet is relieved with capsaicin. what neurotransmitter is causing
pain? - ANSWERSSubstance P
18 yo w/ ALL on chemo and low neutrophil count has lung infiltrate with PAS stain of budding fungus.
How do you treat him? - ANSWERSamphotericin B
- most likely cryptoccocus neoformans
12 yo with 6 months of difficulty walking and leg pain. Atrophy of LE and hammer toes with a high
stepping gait. What will a bc show? - ANSWERSAbnormal Myelin sheath
- AD
- pes cavus, hammer toe
- CMT1A/PMP22
mass in ovaries (CA 125 positive cancer) needs to be removed. What structure passing inferior to ovary
is at risk of injury? - ANSWERSureter
- passes behind ovary, round ligament, and ovarian vein and artery
52 yo male w/ no past hx come in w/ progressive issues swallowing, double vision, slurred speech,
ptosis, and waddling gait. He has fatigable weakness. What is the mechanism of disease? -
ANSWERSbinding of autoantibodies to the acetylcholine receptor
, 27 yo being treated for hodgkin lymphoma receives bone marrow tx from his cousin. 2 weeks after, he
has general erythematous, maculopapular rash, diarrhea, and increased liver enzymes and bilirubin.
What is the mechanism causing this reaction? - ANSWERSDonor T lymphocytes reacting against host cell
- Graft vs. Host disease
- grafted immunocompetent T-cells proliferate in immunocompromised host rejecting host cells ->
severe organ dysfunction
5 yo who was given aspirin for the flu presents with 16 hrs of severe vomiting, increased sleepiness,
prolonged prothrombin time, high ammonia, transaminase, and lactate and goes into a coma. What
caused this coma? - ANSWERScerebral edema from Reye's syndrome
- never give child aspirin except in kawasaki
woman with type 1 DM, recurrent episodes of fainting when she is hypoglycemic. What is the
mechanism of an injection drug that can be used to help these episodes? - ANSWERSstimulation of
hepatic glucose production
Young boy with fanconi syndrome. Will his reabsorption be increased/decreased of the following: amino
acids, glucose, phosphate, HCO3- - ANSWERSall decreased
- generalized reabsorption defect in PCT
24 yo african american male, red bumps on face, chin, neck that are itchy and painful. What does he
have? - ANSWERSpseudofolliculitis barbae
- "razor bumps" to the extreme
6 month old w/ recurrent URI, hypocalcemia, repair of coarctation of aorta, broad nasal bridge,
dysplastic pinnae. What is causing his recurrent infection? - ANSWERST-lymphocyte deficiency
- DiGeorge Syndrome
-22q11 deletion
- failure of 3 and 4th pharyngeal pouch (no thymus and parathyroid)
