9/26/25, 5:58 PM NBME 25 <span style="color:#000;font-weight:bold;">200+</span> (2025-2026 A+ Graded) Exam-Style Questions | Verified Solutio…
NBME 25 TEST QUESTIONS & ANSWERS
Page 1 of 419
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,9/26/25, 5:58 PM NBME 25 <span style="color:#000;font-weight:bold;">200+</span> (2025-2026 A+ Graded) Exam-Style Questions | Verified Solutio…
Question 1
1
Exam Section 1: Item 1 of 50
National Board of Medical Examiners
Comprehensive Basic Science Self-Assessment
1. A75-year-old man has decreased exercise tolerance and occasional syncopal
episodes related to exertion. Left-heart catheterization discloses this pressure tracing
(Ao -aorta; LV -left ventricle; LA -
left atrium). The most frequently encountered mechanism underlying this disorder is
which of the following?
ЕCG
A) Amyloid deposition
150-
B) Calcification
C) Cystic medial necrosis
D) Pericardial effusion
100-
O E) Septal hypertrophy
Ao
50-
LV
LA
Time
Time-
Correct Answer: B.
The pressure tracing demonstrates a large pressure gradient between the left
ventricle and aorta during systole, which is consistent with the diagnosis of aortic
stenosis. In the setting of aortic stenosis, the left ventricle must generate higher
pressures in order to
overcome the opening resistance of the stenotic valve. This increased pressure is not
fully transmitted across the stenotic valve to the aorta, which causes a delay in the
aortic peak pressure. In a normal aortic valve, the pressure tracing in the left ventricle
and
aorta follow a similar curve during systole while the valve is open. Calcification of the
valve is a pathologic consequence of mechanical stresses on the heart valves, and
results from repetitive microtrauma from the opening and closing of valve leaflets
with
associated chronic inflammation. Many people will develop some degree of valve
stenosis because of chronic inflammation with resultant calcification and fibrosis over
time, with the aortic valve most commonly affected. Early-onset aortic stenosis can
occur in the
setting of bicuspid aortic valve or chronic rheumatic heart disease. Patients may
report fatigue, shortness of breath, cough, diminished exercise tolerance, or syncope
with exertion. Physical examination findings include a crescendo-decrescendo systolic
Page 2 of 419
2/419
,9/26/25, 5:58 PM NBME 25 <span style="color:#000;font-weight:bold;">200+</span> (2025-2026 A+ Graded) Exam-Style Questions | Verified Solutio…
murmur
best heard at the upper right sternal border, and pulsus parvus et tardus (weak and
delayed) may be noted on examination of peripheral pulses. As a result of the chronic
increased afterload from a fixed obstruction by the valve, left ventricular hypertrophy,
and resultant diastolic dysfunction can occur.
Incorrect Answers: A, C, D, and E.
Amyloid deposition (Choice A) occurs in cardiac amyloidosis, which is an infiltrative
cardiomyopathy caused by the deposition of amyloid protein throughout the
extracellular space of the heart. It does not directly cause aortic stenosis.
Cystic medial necrosis (Choice C) is a disorder of the large arteries (particularly the
aorta) which is associated with connective tissue diseases such as Marfan syndrome,
Ehlers-Danlos syndrome, and annuloaortic ectasia. It is characterized by basophilic
ground
substance deposition in the tunica media with cyst-like lesions. It increases the risk for
dissection, aneurysm, or rupture of the aorta, but it is not associated with aortic
stenosis.
Pericardial effusion (Choice D) refers to the presence of an abnormal amount of fluid
in the pericardium. If severe enough, it can potentially progress to cardiac tamponade
with compression of the cardiac chambers and obstructive shock. It typically causes
the
equalization of pressures amongst the four heart chambers.
Septal hypertrophy (Choice E) is present in hypertrophic cardiomyopathy. If there is
severe hypertrophy, the cardiac pressure tracing is like that seen in aortic stenosis
with a large pressure gradient between the left ventricle and the aorta. This is because
of left
ventricular outflow tract obstruction from the septal hypertrophy. However, aortic
stenosis is a far more common disorder, especially in older adults.
Educational Objective: Aortic stenosis can be identified on a cardiac pressure tracing
by the presence of a large pressure gradient between the left ventricle and the aorta.
It is most commonly caused by age-related fibrosis and calcification.
II
Next
Score Report
Lab Values
Calculator
Help
Pause
Pressure (mm Hg)
Correct Answer
Page 3 of 419
3/419
, 9/26/25, 5:58 PM NBME 25 <span style="color:#000;font-weight:bold;">200+</span> (2025-2026 A+ Graded) Exam-Style Questions | Verified Solutio…
Question 2
2
Exam Section 1: Item 2 of 50
National Board of Medical Examiners
Comprehensive Basic Science Self-Assessment
2. New reagents are being designed to treat graft-versus-host disease in HLA-
unrelated bone marrow transplant recipients. Reagents should be designed that
selectively deplete which of the following donor cells?
A) B lymphocytes
O B) Dendritic cells
C) Macrophages
D) Neutrophils
E) T lymphocytes
Correct Answer: E.
T lymphocytes, which are responsible for the immune attack against the recipient,
should be the target of agents used to treat graft-versus-host disease (GVHD) in HLA-
unrelated bone marrow transplant recipients. Prior to grafting of allogeneic stem cells
in a bone
marrow transplant, recipient native marrow must be completely ablated. It is then
replaced with donor marrow, which recolonizes the marrow cavity. Successful
transplantation results in reconstitution of the immune system with the donor's
immune cells. GVHD
occurs when the donor's immune system recognizes the host's tissues as foreign and
mounts an immune response against them. Manifestations of acute GVHD include
rash, ranging from maculopapular to blistering, diarrhea, abdominal pain, and
hepatitis with
hyperbilirubinemia. Diagnosis should be suspected in patients with any of these
symptoms and a recent bone marrow transplant. Medications that are used in the
treatment of GVHD act either by directly inhibiting the production of T lymphocytes
or by suppressing
the normal function of these cells. Examples include mycophenolate mofetil, which
inhibits the synthesis of nucleotides needed for lymphocyte proliferation; etanercept,
a TNF-alpha receptor inhibitor; pentostatin, a purine analog that inhibits Ť
lymphocyte
proliferation; sirolimus, which inhibits mTOR to suppress T lymphocyte proliferation;
and anti-thymocyte globulin, which directly targets T lymphocytes.
Incorrect Answers: A, B, C, and D.
B lymphocyte depletion (Choice A) is the result of several medications that target
CD20, a surface marker found on B lymphocytes. The most used monoclonal antibody
targeting this site is rituximab. It is currently used as a primary component of
chemotherapy
regimens to treat a variety of B-cell lymphomas. It is also used to treat vasculitis such
as granulomatosis with polyangiitis, microscopic polyangiitis, neurologic disorders
such as myasthenia gravis and autoimmune encephalitis, and refractory immune
Page 4 of 419
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NBME 25 TEST QUESTIONS & ANSWERS
Page 1 of 419
1/419
,9/26/25, 5:58 PM NBME 25 <span style="color:#000;font-weight:bold;">200+</span> (2025-2026 A+ Graded) Exam-Style Questions | Verified Solutio…
Question 1
1
Exam Section 1: Item 1 of 50
National Board of Medical Examiners
Comprehensive Basic Science Self-Assessment
1. A75-year-old man has decreased exercise tolerance and occasional syncopal
episodes related to exertion. Left-heart catheterization discloses this pressure tracing
(Ao -aorta; LV -left ventricle; LA -
left atrium). The most frequently encountered mechanism underlying this disorder is
which of the following?
ЕCG
A) Amyloid deposition
150-
B) Calcification
C) Cystic medial necrosis
D) Pericardial effusion
100-
O E) Septal hypertrophy
Ao
50-
LV
LA
Time
Time-
Correct Answer: B.
The pressure tracing demonstrates a large pressure gradient between the left
ventricle and aorta during systole, which is consistent with the diagnosis of aortic
stenosis. In the setting of aortic stenosis, the left ventricle must generate higher
pressures in order to
overcome the opening resistance of the stenotic valve. This increased pressure is not
fully transmitted across the stenotic valve to the aorta, which causes a delay in the
aortic peak pressure. In a normal aortic valve, the pressure tracing in the left ventricle
and
aorta follow a similar curve during systole while the valve is open. Calcification of the
valve is a pathologic consequence of mechanical stresses on the heart valves, and
results from repetitive microtrauma from the opening and closing of valve leaflets
with
associated chronic inflammation. Many people will develop some degree of valve
stenosis because of chronic inflammation with resultant calcification and fibrosis over
time, with the aortic valve most commonly affected. Early-onset aortic stenosis can
occur in the
setting of bicuspid aortic valve or chronic rheumatic heart disease. Patients may
report fatigue, shortness of breath, cough, diminished exercise tolerance, or syncope
with exertion. Physical examination findings include a crescendo-decrescendo systolic
Page 2 of 419
2/419
,9/26/25, 5:58 PM NBME 25 <span style="color:#000;font-weight:bold;">200+</span> (2025-2026 A+ Graded) Exam-Style Questions | Verified Solutio…
murmur
best heard at the upper right sternal border, and pulsus parvus et tardus (weak and
delayed) may be noted on examination of peripheral pulses. As a result of the chronic
increased afterload from a fixed obstruction by the valve, left ventricular hypertrophy,
and resultant diastolic dysfunction can occur.
Incorrect Answers: A, C, D, and E.
Amyloid deposition (Choice A) occurs in cardiac amyloidosis, which is an infiltrative
cardiomyopathy caused by the deposition of amyloid protein throughout the
extracellular space of the heart. It does not directly cause aortic stenosis.
Cystic medial necrosis (Choice C) is a disorder of the large arteries (particularly the
aorta) which is associated with connective tissue diseases such as Marfan syndrome,
Ehlers-Danlos syndrome, and annuloaortic ectasia. It is characterized by basophilic
ground
substance deposition in the tunica media with cyst-like lesions. It increases the risk for
dissection, aneurysm, or rupture of the aorta, but it is not associated with aortic
stenosis.
Pericardial effusion (Choice D) refers to the presence of an abnormal amount of fluid
in the pericardium. If severe enough, it can potentially progress to cardiac tamponade
with compression of the cardiac chambers and obstructive shock. It typically causes
the
equalization of pressures amongst the four heart chambers.
Septal hypertrophy (Choice E) is present in hypertrophic cardiomyopathy. If there is
severe hypertrophy, the cardiac pressure tracing is like that seen in aortic stenosis
with a large pressure gradient between the left ventricle and the aorta. This is because
of left
ventricular outflow tract obstruction from the septal hypertrophy. However, aortic
stenosis is a far more common disorder, especially in older adults.
Educational Objective: Aortic stenosis can be identified on a cardiac pressure tracing
by the presence of a large pressure gradient between the left ventricle and the aorta.
It is most commonly caused by age-related fibrosis and calcification.
II
Next
Score Report
Lab Values
Calculator
Help
Pause
Pressure (mm Hg)
Correct Answer
Page 3 of 419
3/419
, 9/26/25, 5:58 PM NBME 25 <span style="color:#000;font-weight:bold;">200+</span> (2025-2026 A+ Graded) Exam-Style Questions | Verified Solutio…
Question 2
2
Exam Section 1: Item 2 of 50
National Board of Medical Examiners
Comprehensive Basic Science Self-Assessment
2. New reagents are being designed to treat graft-versus-host disease in HLA-
unrelated bone marrow transplant recipients. Reagents should be designed that
selectively deplete which of the following donor cells?
A) B lymphocytes
O B) Dendritic cells
C) Macrophages
D) Neutrophils
E) T lymphocytes
Correct Answer: E.
T lymphocytes, which are responsible for the immune attack against the recipient,
should be the target of agents used to treat graft-versus-host disease (GVHD) in HLA-
unrelated bone marrow transplant recipients. Prior to grafting of allogeneic stem cells
in a bone
marrow transplant, recipient native marrow must be completely ablated. It is then
replaced with donor marrow, which recolonizes the marrow cavity. Successful
transplantation results in reconstitution of the immune system with the donor's
immune cells. GVHD
occurs when the donor's immune system recognizes the host's tissues as foreign and
mounts an immune response against them. Manifestations of acute GVHD include
rash, ranging from maculopapular to blistering, diarrhea, abdominal pain, and
hepatitis with
hyperbilirubinemia. Diagnosis should be suspected in patients with any of these
symptoms and a recent bone marrow transplant. Medications that are used in the
treatment of GVHD act either by directly inhibiting the production of T lymphocytes
or by suppressing
the normal function of these cells. Examples include mycophenolate mofetil, which
inhibits the synthesis of nucleotides needed for lymphocyte proliferation; etanercept,
a TNF-alpha receptor inhibitor; pentostatin, a purine analog that inhibits Ť
lymphocyte
proliferation; sirolimus, which inhibits mTOR to suppress T lymphocyte proliferation;
and anti-thymocyte globulin, which directly targets T lymphocytes.
Incorrect Answers: A, B, C, and D.
B lymphocyte depletion (Choice A) is the result of several medications that target
CD20, a surface marker found on B lymphocytes. The most used monoclonal antibody
targeting this site is rituximab. It is currently used as a primary component of
chemotherapy
regimens to treat a variety of B-cell lymphomas. It is also used to treat vasculitis such
as granulomatosis with polyangiitis, microscopic polyangiitis, neurologic disorders
such as myasthenia gravis and autoimmune encephalitis, and refractory immune
Page 4 of 419
4/419
