NBME CERTIFICATION SCRIPT 2026
QUESTIONS WITH SOLUTIONS GRADED A+
◍ How does hypokalemia worsens metabolic alkalosis?.
Answer: Hypokalemia further worsens metabolic alkalosis via trans-cellular
exchange or extracellular sodium and protons in for potassium ions
◍ Patient with breast cancer status post chest radiation now has bilateral
atelectasis on imaging. What is the primary pathophysiologic process?.
Answer: Radiation pneumonitis, late stageFibrosis and contraction of lung
tissue -> increased elastic recoil and reduced compliance -> alveolar
collapse and impaired gas exchanged = atelectasis
◍ What is the classic presentation of pyloric stenosis?.
Answer: Male infant 3-6 weeks of age with repeated vomiting after feeds,
dehydration, and hypochloremic, hypokalemic metabolic alkalosis
◍ parvovirus causes anemia in who.
Answer: aplastic crisis with people with sickle cell
◍ What is the mechanism of action of Bosentan?.
Answer: Competitive antagonist of endothelin-1 to both ETA and ETB
receptors and causes vasodilation & reduced pulmonary vascular
resistance(Effective tx for pulmonary arterial hypertension; side effect:
hepatotoxic)
◍ What part of the nephron is ischemic acute tubular necrosis (ATN) more
likely to occur?.
Answer: Proximal Convoluted Tubule
◍ loop diuretics cause.
Answer: metabolic alkalosis and volume contraction (increased bicarb)
◍ imprinting is a/w.
, Answer: dna methylation (example is beckwith wiedman)
◍ adenocarcinoma of the lung is the most common in whomst.
Answer: NONSMOKERS/women
◍ if you overcorrect Na+ too fast what part of the body will you risk
damaging.
Answer: the brainstem
◍ AD polycystic kidney disease vs AR polycystic kidney DZ proteins.
Answer: polycystin vs fibrocystin
◍ Guillan Barre other name.
Answer: acute inflammatory demyelinating polyradiculopathy
◍ How does infliximab work?.
Answer: Monoclonal antibody which targets TNF-a to prevent effective
binding with the TNF-a receptor which leads to macrophage depletion
◍ Patient had an abdominal aortic aneurysm repaired now with dark
purple-to-black necrotic lesions on toes and biopsy of lesion shows occluded
small arteries with needle-shaped clefts. What is the cause of the lesions?.
Answer: Cholesterol embolization (aortic atheroembolism)
◍ What regulates the cortical collecting tubule? (2).
Answer: AldosteroneADH
◍ What lung cancer is associated with hypercalcemia and why?.
Answer: Squamous Cell CarcinomaBecause of paraneoplastic parathyroid
hormone-related peptide (PTHrP) production
◍ What cardiac structure does rheumatic fever commonly affect?.
Answer: Mitral valve -> mitral stenosis & left atrial enlargement
◍ graft vs host disease HS.
Answer: type 4
◍ What is the mechanism of action of Albendazole?.
Answer: Anti-helminthic drug that binds to B-tubulin, which inhibits
, microtubule polymerization, decreases parasite glucose utilization, and
decreases energy production.
◍ petechiae are caused by.
Answer: defecit in production of platelets
◍ what allows the release of extravascular fluid when there is a bee sting?.
Answer: gap formation bn endothelial cells
◍ If a patient comes in with something major and then <1 week later gets
tachypneic w/ sx of resp failure. (fluffy infiltrates and bilateral opacities).
Answer: ARDS
◍ Aedes aegypti mosquito + short viral prodrome + acute hepatitis + liver
dysfunction + Councilman bodies within hepatocytes, what is the causal
organism?.
Answer: Yellow FeverPositive-sense RNA flavivirus
◍ How does reperfusion injury cause injury to an affected organ?.
Answer: Restoration of perfusion leads to a rapid increase free radicals ->
free radicals damage cells through membrane lipid peroxidation, oxidative
damage to intracellular proteins, and DNA strand breaks -> cellular necrosis
and lysis = red infarct with increase troponin I and CK-MB
◍ dark skin individuals will get melanoma where.
Answer: palm
◍ high dose dopamine can act on what receptor.
Answer: alpha-1 which can help with septic shock
◍ in a patient with central diabetes insipidus what will the proximal tubule,
juxtaglom apparatus, medullary collecting duct TUBULAR osmolality look
like.
Answer: proximal tubule= isotonicjuxtaglom (this gets info from the DCT
so itll be the same) = hypotonicmedullary CD= hypotonic
◍ the ureter passes over what at the sacroiliac joint.
Answer: external iliac vessels
, ◍ watery diarrhea, hypokalemia and achloryhdria.
Answer: VIPoma
◍ ritonavir/lopinavir MOA.
Answer: protease inhibitor
◍ What is Type IV hypersensitivity?.
Answer: Cell-mediatedT-cell mediated tissue injury from (1) CD8+ T cell
directly killing a target cell or (2) CD4+ T cell releasing cytokines to
activate macrophage and incite inflammation Slowest, takes several days to
manifest
◍ gag reflex efferent.
Answer: vagus nerve which innervates the soft palate and pharyngeal
muscles
◍ thickened cortex and trabeculae.
Answer: pagets
◍ pioglitazone moa.
Answer: stimulation of the peroxisome proliferator-activated receptor
gamma
◍ What are causes of early-onset aortic stenosis?.
Answer: Bicuspid aortic valve Chronic rheumatic heart disease
◍ IV drug user presents with tricuspid regurgitation and signs and symptoms
of right-sided heart failure. Diagnosis?.
Answer: Tricuspid valve endocarditis
◍ if the left testicular artery is ligated then what is the back up?.
Answer: artery of ductus deferens
◍ what protein helps adhesion of leukocytes.
Answer: selectin
◍ What regulates intestinal absorption of calcium and what is its FIRST
precursor?.
QUESTIONS WITH SOLUTIONS GRADED A+
◍ How does hypokalemia worsens metabolic alkalosis?.
Answer: Hypokalemia further worsens metabolic alkalosis via trans-cellular
exchange or extracellular sodium and protons in for potassium ions
◍ Patient with breast cancer status post chest radiation now has bilateral
atelectasis on imaging. What is the primary pathophysiologic process?.
Answer: Radiation pneumonitis, late stageFibrosis and contraction of lung
tissue -> increased elastic recoil and reduced compliance -> alveolar
collapse and impaired gas exchanged = atelectasis
◍ What is the classic presentation of pyloric stenosis?.
Answer: Male infant 3-6 weeks of age with repeated vomiting after feeds,
dehydration, and hypochloremic, hypokalemic metabolic alkalosis
◍ parvovirus causes anemia in who.
Answer: aplastic crisis with people with sickle cell
◍ What is the mechanism of action of Bosentan?.
Answer: Competitive antagonist of endothelin-1 to both ETA and ETB
receptors and causes vasodilation & reduced pulmonary vascular
resistance(Effective tx for pulmonary arterial hypertension; side effect:
hepatotoxic)
◍ What part of the nephron is ischemic acute tubular necrosis (ATN) more
likely to occur?.
Answer: Proximal Convoluted Tubule
◍ loop diuretics cause.
Answer: metabolic alkalosis and volume contraction (increased bicarb)
◍ imprinting is a/w.
, Answer: dna methylation (example is beckwith wiedman)
◍ adenocarcinoma of the lung is the most common in whomst.
Answer: NONSMOKERS/women
◍ if you overcorrect Na+ too fast what part of the body will you risk
damaging.
Answer: the brainstem
◍ AD polycystic kidney disease vs AR polycystic kidney DZ proteins.
Answer: polycystin vs fibrocystin
◍ Guillan Barre other name.
Answer: acute inflammatory demyelinating polyradiculopathy
◍ How does infliximab work?.
Answer: Monoclonal antibody which targets TNF-a to prevent effective
binding with the TNF-a receptor which leads to macrophage depletion
◍ Patient had an abdominal aortic aneurysm repaired now with dark
purple-to-black necrotic lesions on toes and biopsy of lesion shows occluded
small arteries with needle-shaped clefts. What is the cause of the lesions?.
Answer: Cholesterol embolization (aortic atheroembolism)
◍ What regulates the cortical collecting tubule? (2).
Answer: AldosteroneADH
◍ What lung cancer is associated with hypercalcemia and why?.
Answer: Squamous Cell CarcinomaBecause of paraneoplastic parathyroid
hormone-related peptide (PTHrP) production
◍ What cardiac structure does rheumatic fever commonly affect?.
Answer: Mitral valve -> mitral stenosis & left atrial enlargement
◍ graft vs host disease HS.
Answer: type 4
◍ What is the mechanism of action of Albendazole?.
Answer: Anti-helminthic drug that binds to B-tubulin, which inhibits
, microtubule polymerization, decreases parasite glucose utilization, and
decreases energy production.
◍ petechiae are caused by.
Answer: defecit in production of platelets
◍ what allows the release of extravascular fluid when there is a bee sting?.
Answer: gap formation bn endothelial cells
◍ If a patient comes in with something major and then <1 week later gets
tachypneic w/ sx of resp failure. (fluffy infiltrates and bilateral opacities).
Answer: ARDS
◍ Aedes aegypti mosquito + short viral prodrome + acute hepatitis + liver
dysfunction + Councilman bodies within hepatocytes, what is the causal
organism?.
Answer: Yellow FeverPositive-sense RNA flavivirus
◍ How does reperfusion injury cause injury to an affected organ?.
Answer: Restoration of perfusion leads to a rapid increase free radicals ->
free radicals damage cells through membrane lipid peroxidation, oxidative
damage to intracellular proteins, and DNA strand breaks -> cellular necrosis
and lysis = red infarct with increase troponin I and CK-MB
◍ dark skin individuals will get melanoma where.
Answer: palm
◍ high dose dopamine can act on what receptor.
Answer: alpha-1 which can help with septic shock
◍ in a patient with central diabetes insipidus what will the proximal tubule,
juxtaglom apparatus, medullary collecting duct TUBULAR osmolality look
like.
Answer: proximal tubule= isotonicjuxtaglom (this gets info from the DCT
so itll be the same) = hypotonicmedullary CD= hypotonic
◍ the ureter passes over what at the sacroiliac joint.
Answer: external iliac vessels
, ◍ watery diarrhea, hypokalemia and achloryhdria.
Answer: VIPoma
◍ ritonavir/lopinavir MOA.
Answer: protease inhibitor
◍ What is Type IV hypersensitivity?.
Answer: Cell-mediatedT-cell mediated tissue injury from (1) CD8+ T cell
directly killing a target cell or (2) CD4+ T cell releasing cytokines to
activate macrophage and incite inflammation Slowest, takes several days to
manifest
◍ gag reflex efferent.
Answer: vagus nerve which innervates the soft palate and pharyngeal
muscles
◍ thickened cortex and trabeculae.
Answer: pagets
◍ pioglitazone moa.
Answer: stimulation of the peroxisome proliferator-activated receptor
gamma
◍ What are causes of early-onset aortic stenosis?.
Answer: Bicuspid aortic valve Chronic rheumatic heart disease
◍ IV drug user presents with tricuspid regurgitation and signs and symptoms
of right-sided heart failure. Diagnosis?.
Answer: Tricuspid valve endocarditis
◍ if the left testicular artery is ligated then what is the back up?.
Answer: artery of ductus deferens
◍ what protein helps adhesion of leukocytes.
Answer: selectin
◍ What regulates intestinal absorption of calcium and what is its FIRST
precursor?.
