NBME Comprehensive Clinical Science
Form 190 Exam With Actual 120
Questions & Verified Answers,Plus
Rationales/Expert Verified For
Guaranteed Pass Graded A+/
2025/2026 /Latest Update/Instant
Download Pdf
1. A 56-year-old man presents with fatigue and pallor. Lab results show Hb 9.2 g/dL,
MCV 68 fL, ferritin 8 ng/mL. What is the most likely diagnosis?
A) Anemia of chronic disease
B) Iron deficiency anemia
C) Vitamin B12 deficiency
D) Thalassemia
B) Iron deficiency anemia
Rationale: Microcytic anemia with low ferritin indicates iron deficiency anemia,
often due to chronic blood loss or dietary deficiency.
2. A 24-year-old woman presents with a 2-week history of fever, sore throat, and
lymphadenopathy. Monospot test is positive. Which virus is most likely responsible?
A) CMV
B) EBV
C) HIV
D) Adenovirus
B) EBV
Rationale: Infectious mononucleosis is caused by Epstein-Barr virus, presenting
with fever, pharyngitis, and lymphadenopathy.
3. A 65-year-old man presents with exertional dyspnea. Echocardiogram shows EF 30%
and dilated ventricles. Which is the most likely diagnosis?
A) Restrictive cardiomyopathy
B) Hypertrophic cardiomyopathy
, C) Dilated cardiomyopathy
D) Constrictive pericarditis
C) Dilated cardiomyopathy
Rationale: Dilated cardiomyopathy presents with systolic dysfunction, dilated
ventricles, and reduced ejection fraction.
4. A 32-year-old woman has recurrent episodes of palpitations, sweating, and
headache. Labs show elevated plasma metanephrines. Which is the next best step?
A) ECG
B) 24-hour urine catecholamines
C) Abdominal MRI
D) Echocardiogram
C) Abdominal MRI
Rationale: Elevated metanephrines suggest pheochromocytoma. MRI is preferred
to localize the adrenal tumor.
5. A 45-year-old man presents with jaundice and pruritus. Labs show elevated direct
bilirubin and ALP. Which is the most likely pattern of liver injury?
A) Hepatocellular
B) Cholestatic
C) Mixed
D) Hemolytic
B) Cholestatic
Rationale: Elevated ALP and direct bilirubin indicate cholestatic liver injury,
commonly due to bile duct obstruction.
6. A 70-year-old woman has acute onset of severe chest pain radiating to the back. BP is
unequal in both arms. What is the most likely diagnosis?
A) Myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
C) Aortic dissection
Rationale: Sudden tearing chest pain with unequal BP suggests an aortic dissection.
7. A 23-year-old man presents with dysuria and urethral discharge. Gram stain shows
gram-negative intracellular diplococci. Which organism is responsible?
A) Chlamydia trachomatis
B) Neisseria gonorrhoeae
C) Treponema pallidum
D) Mycoplasma genitalium
B) Neisseria gonorrhoeae
, Rationale: Gram-negative intracellular diplococci on urethral smear is
characteristic of gonococcal infection.
8. A 40-year-old woman presents with fatigue and cold intolerance. TSH is 8.5 mIU/L
(high), free T4 is low. Which is the most likely cause?
A) Graves disease
B) Hashimoto thyroiditis
C) Subacute thyroiditis
D) Iodine-induced hyperthyroidism
B) Hashimoto thyroiditis
Rationale: Hypothyroidism with elevated TSH and low free T4, often with
autoimmune etiology, indicates Hashimoto thyroiditis.
9. A 60-year-old man presents with tremor at rest, bradykinesia, and rigidity. Which
neurotransmitter is most likely deficient?
A) Serotonin
B) Dopamine
C) Acetylcholine
D) Norepinephrine
B) Dopamine
Rationale: Parkinson disease is due to loss of dopaminergic neurons in the
substantia nigra.
10. A 28-year-old woman presents with acute onset right lower quadrant pain, nausea,
and vomiting. She is afebrile. Which imaging is most appropriate initially?
A) Abdominal X-ray
B) CT abdomen/pelvis with contrast
C) Ultrasound
D) MRI abdomen
C) Ultrasound
Rationale: Ultrasound is first-line in suspected appendicitis in young adults,
especially women to rule out gynecologic causes.
11. A 55-year-old man with chronic alcohol use presents with epigastric pain radiating to
the back and elevated serum amylase and lipase. What is the most likely diagnosis?
A) Acute pancreatitis
B) Cholecystitis
C) Peptic ulcer disease
D) Gastritis
A) Acute pancreatitis
Rationale: Epigastric pain radiating to the back with elevated pancreatic enzymes
indicates acute pancreatitis, commonly alcohol-related.
Form 190 Exam With Actual 120
Questions & Verified Answers,Plus
Rationales/Expert Verified For
Guaranteed Pass Graded A+/
2025/2026 /Latest Update/Instant
Download Pdf
1. A 56-year-old man presents with fatigue and pallor. Lab results show Hb 9.2 g/dL,
MCV 68 fL, ferritin 8 ng/mL. What is the most likely diagnosis?
A) Anemia of chronic disease
B) Iron deficiency anemia
C) Vitamin B12 deficiency
D) Thalassemia
B) Iron deficiency anemia
Rationale: Microcytic anemia with low ferritin indicates iron deficiency anemia,
often due to chronic blood loss or dietary deficiency.
2. A 24-year-old woman presents with a 2-week history of fever, sore throat, and
lymphadenopathy. Monospot test is positive. Which virus is most likely responsible?
A) CMV
B) EBV
C) HIV
D) Adenovirus
B) EBV
Rationale: Infectious mononucleosis is caused by Epstein-Barr virus, presenting
with fever, pharyngitis, and lymphadenopathy.
3. A 65-year-old man presents with exertional dyspnea. Echocardiogram shows EF 30%
and dilated ventricles. Which is the most likely diagnosis?
A) Restrictive cardiomyopathy
B) Hypertrophic cardiomyopathy
, C) Dilated cardiomyopathy
D) Constrictive pericarditis
C) Dilated cardiomyopathy
Rationale: Dilated cardiomyopathy presents with systolic dysfunction, dilated
ventricles, and reduced ejection fraction.
4. A 32-year-old woman has recurrent episodes of palpitations, sweating, and
headache. Labs show elevated plasma metanephrines. Which is the next best step?
A) ECG
B) 24-hour urine catecholamines
C) Abdominal MRI
D) Echocardiogram
C) Abdominal MRI
Rationale: Elevated metanephrines suggest pheochromocytoma. MRI is preferred
to localize the adrenal tumor.
5. A 45-year-old man presents with jaundice and pruritus. Labs show elevated direct
bilirubin and ALP. Which is the most likely pattern of liver injury?
A) Hepatocellular
B) Cholestatic
C) Mixed
D) Hemolytic
B) Cholestatic
Rationale: Elevated ALP and direct bilirubin indicate cholestatic liver injury,
commonly due to bile duct obstruction.
6. A 70-year-old woman has acute onset of severe chest pain radiating to the back. BP is
unequal in both arms. What is the most likely diagnosis?
A) Myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
C) Aortic dissection
Rationale: Sudden tearing chest pain with unequal BP suggests an aortic dissection.
7. A 23-year-old man presents with dysuria and urethral discharge. Gram stain shows
gram-negative intracellular diplococci. Which organism is responsible?
A) Chlamydia trachomatis
B) Neisseria gonorrhoeae
C) Treponema pallidum
D) Mycoplasma genitalium
B) Neisseria gonorrhoeae
, Rationale: Gram-negative intracellular diplococci on urethral smear is
characteristic of gonococcal infection.
8. A 40-year-old woman presents with fatigue and cold intolerance. TSH is 8.5 mIU/L
(high), free T4 is low. Which is the most likely cause?
A) Graves disease
B) Hashimoto thyroiditis
C) Subacute thyroiditis
D) Iodine-induced hyperthyroidism
B) Hashimoto thyroiditis
Rationale: Hypothyroidism with elevated TSH and low free T4, often with
autoimmune etiology, indicates Hashimoto thyroiditis.
9. A 60-year-old man presents with tremor at rest, bradykinesia, and rigidity. Which
neurotransmitter is most likely deficient?
A) Serotonin
B) Dopamine
C) Acetylcholine
D) Norepinephrine
B) Dopamine
Rationale: Parkinson disease is due to loss of dopaminergic neurons in the
substantia nigra.
10. A 28-year-old woman presents with acute onset right lower quadrant pain, nausea,
and vomiting. She is afebrile. Which imaging is most appropriate initially?
A) Abdominal X-ray
B) CT abdomen/pelvis with contrast
C) Ultrasound
D) MRI abdomen
C) Ultrasound
Rationale: Ultrasound is first-line in suspected appendicitis in young adults,
especially women to rule out gynecologic causes.
11. A 55-year-old man with chronic alcohol use presents with epigastric pain radiating to
the back and elevated serum amylase and lipase. What is the most likely diagnosis?
A) Acute pancreatitis
B) Cholecystitis
C) Peptic ulcer disease
D) Gastritis
A) Acute pancreatitis
Rationale: Epigastric pain radiating to the back with elevated pancreatic enzymes
indicates acute pancreatitis, commonly alcohol-related.
