NBME PRACTICE EXAMINATION 2026
QUESTIONS WITH ANSWERS GRADED A+
◍ Commonly present with melena (black, tarry stools) rather than bright red
blood..
Answer: duodenal ulcer and gastritis
◍ 91----------Exam Section 2: Item 41 of 50National Board of Medical
Examinersandive Rasic Sciencement* 41. A 75-year-old woman with
non-small cell carcinoma of the lung is brought to the physician because of a
2-day history of lethargy and cognitive impairment. One month ago, she
completed a 1-year regimen of chemotherapy and cranial irradiation. One
weekago, she received the diagnosis of major depressive disorder and began
therapy with a selective serotonin reuptake inhibitor. She speaks with a
blunted affect. Physical examination shows no abnormalities. Her
Mini-Mental State Examination score is 20/30.Serum studies show a sodium
concentration of 122 mEg/
L. The patient appears confused and falls asleep during the examination.
Which of the following is the most likely diagnosis?O A) DeliriumO B)
Dementia, Alzheimer typeO C) Dementia caused by Pick diseaseO D)
Serotonin syndromeO E) Vascular dementia.
Answer: A.Delirium is an acute confusional state typically associated with
acute medical illness in older patients. The pathogenesis of delirium is
poorly understood but may be related to deficient acetylcholine signaling in
the brain. Delirium presents with acute disturbances inawareness, attention,
and baseline cognition that fluctuate in severity over the course of the day
and appear related to a substance or acute medical condition. The cognitive
changes can include memory or language deficits, disorientation, or
perceptual disturbances(eg, visual hallucinations or paranoia). This patient
demonstrates clear disturbances in awareness and cognition, as well as
, severe hyponatremia (likely due to syndrome of inappropriate antidiuretic
hormone secretion associated with brain irradiation and selectiveserotonin
reuptake inhibitor initiation). Delirium prevention with cognitive stimulation
and avoidance of cognition-impairing medications is key. Delirium is
managed by addressing the underlying medical problem and supportive
management such as frequentreorientation and promoting sleep only at night
to re-establish the appropriate circadian rhythm. Antipsychotic medication
can manage symptoms of agitation or distressing hallucinations but does not
shorten the duration of delirium.Incorrect Answers: B, C, D, and
E.Dementia, Alzheimer type (Choice B) or caused by Pick disease (Choice
C) would present with insidious cognitive decline instead of acute
confusion. Fluctuations in the severity of cognitive deficits over the course
of the day would be atypical, unless a concomitantdelirium was also present.
Baseline dementia is a risk factor for developing acute delirium. Pick
disease (also known as frontotemporal dementia) typically develops when
patients are in their 50s and features personality changes in addition to
cognitive de
◍ What are hydatidiform moles?.
Answer: caused by: - fertilization of an empty egg by a single sperm,
followed by duplication of the paternal DNA resulting in 46 chromosomes
(complete)- dual fertilization of a normal ovum resulting in 69
chromosomes (partial)complete moles contain no fetal tissuepartial moles
contain some fetal tissueneither are viablelabs will reveal abnormally
increased b-hcg levels u/s will show bilateral multilocular ovarian cysts
(theca lutein cysts)
◍ 194----------Exam Section 4: Item 44 of 50Natjonal, Board pf Medical
Ęxaminersment.* 44. A healthy 21-year-old woman is concerned that her
son will develop a familial neurologic disorder. Her older brother died at the
age of 45 years after developing restlessness, forgetfulness, incoordination,
altered handwriting and speech, and subsequently,chorea. Autopsy showed
atrophy of the basal ganglia. Their mother died at the age of 55 years of a
similar disorder. Which of the following best approximates the risk of this
, woman's son for developing the disorder?O AJEssentially zeroO B) 25%O
G+33%O Đ)50%E) 100%.
Answer: B.The chance of this woman's son developing Huntington disease
(HD) is 25%. HD demonstrates an autosomal dominant pattern of
heritability. The woman's mother possessed HD symptoms and died early
and therefore presumably possesses one copy of the mutatedgene. This
woman has a 50% chance of inheriting the gene from her mother and a 50%
chance of passing on this mutated gene to her son (50% × 50% = 25%). HD
is a heritable progressive neurodegenerative disorder typically arising in the
third to sixth decades oflife associated with atrophy of the caudate nuclei in
the basal ganglia. The disease usually presents with an insidious onset of
psychiatric (irritability, depression, psychosis) and cognitive symptoms.
Motor symptoms (chorea, hypotonia, dystonia, loss of voluntarycontrol of
movements) typically appear later in the disease course. People with HD
typically die 10 to 40 years after disease onset. Chorea, a key HD symptom,
can be initially experienced as restlessness. Treatment is symptomatic and
can include tetrabenazine ordeutetrabenazine, which target chorea by
depleting dopamine stores. HD also demonstrates anticipation, a genetic
inheritance phenomenon in which future generations are affected at a
younger age or with more severe symptoms.Incorrect Answers: A, C, D, and
E.The son's risk would be essentially zero (Choice A) if the woman had
demonstrated a negative result on genetic testing for HD. Alternatively, if
the woman were older than 80 years old without any HD symptoms, the risk
that she would develop HD may be low enoughto assume she does not
possess the mutated HD gene and that her son's risk is therefore
negligible.Risks of 50% (Choice D) or 100% (Choice E) would signify that
either the woman or her son demonstrated the mutated HD gene on genetic
testing, respectively. The son's risk would be 50%
◍ Hemophilia A.
Answer: Factor VIII
◍ What disease process is the Philadelphia chromosome associated with?.
Answer: CML (required for diagnosis)however you can also see it in ALL
, and AML
◍ 196----------Exam Section 4: Item 46 of 50National Board of Medical
Examinersaive B A tancemont46. A healthy 28-year-old woman participates
in an exercise study. Several physiologic variables are measured as she runs
on a treadmill. The ambient room temperature is 75°
F. She reaches a steady state that increases her oxygen consumption
threefold. Shecontinues to exercise at that level for 20 minutes. During the
first 5 minutes of exercise, the vascular resistance of which of the following
is likely to show the greatest increase from resting values in this
volunteer?O A-GoronaryO B}GutaneousO G} Exercising-museleO Đ)
PulmonaryE) SplanchnicO F} Systemie.
Answer: E.Splanchnic vascular resistance is likely to show the greatest
increase when compared to its resting state. The splanchnic circulation
includes the celiac trunk and the superior and inferior mesenteric arteries,
which supply blood to the gastrointestinal system. Adequatesplanchnic
blood supply is critical to digestion and maintenance of the gastrointestinal
mucosal barrier. In the resting state, splanchnic circulation utilizes 25% to
30% of all cardiac output, but this can change drastically after meals
(increased blood flow) or duringperiods of physiologic stress such as
exercise or critical illness (decreased blood flow). Changes in splanchnic
blood flow are regulated by multiple mechanisms that are grouped into
intrinsic, extrinsic, and humoral control. Intrinsic regulatory mechanisms
includevasodilation (increased blood flow) in response to tissue hypoxia or
acidosis. Extrinsic control is exerted by the sympathetic and
parasympathetic nervous systems, with sympathetic innervation leading to
vasoconstriction and parasympathetic innervation leading tovasodilation.
Humoral mechanisms describe a response to the presence of hyperosmolar
contents within the lumen of the gastrointestinal tract and stimulate release
of nitric oxide to cause vasodilation and aid in digestion. During exercise, a
greater degree of cardiacoutput is required to supply oxygenated blood to
the coronary arteries and the skeletal muscles. Action of the sympathetic
nervous system leads to increased cardiac output via augmentation of the
QUESTIONS WITH ANSWERS GRADED A+
◍ Commonly present with melena (black, tarry stools) rather than bright red
blood..
Answer: duodenal ulcer and gastritis
◍ 91----------Exam Section 2: Item 41 of 50National Board of Medical
Examinersandive Rasic Sciencement* 41. A 75-year-old woman with
non-small cell carcinoma of the lung is brought to the physician because of a
2-day history of lethargy and cognitive impairment. One month ago, she
completed a 1-year regimen of chemotherapy and cranial irradiation. One
weekago, she received the diagnosis of major depressive disorder and began
therapy with a selective serotonin reuptake inhibitor. She speaks with a
blunted affect. Physical examination shows no abnormalities. Her
Mini-Mental State Examination score is 20/30.Serum studies show a sodium
concentration of 122 mEg/
L. The patient appears confused and falls asleep during the examination.
Which of the following is the most likely diagnosis?O A) DeliriumO B)
Dementia, Alzheimer typeO C) Dementia caused by Pick diseaseO D)
Serotonin syndromeO E) Vascular dementia.
Answer: A.Delirium is an acute confusional state typically associated with
acute medical illness in older patients. The pathogenesis of delirium is
poorly understood but may be related to deficient acetylcholine signaling in
the brain. Delirium presents with acute disturbances inawareness, attention,
and baseline cognition that fluctuate in severity over the course of the day
and appear related to a substance or acute medical condition. The cognitive
changes can include memory or language deficits, disorientation, or
perceptual disturbances(eg, visual hallucinations or paranoia). This patient
demonstrates clear disturbances in awareness and cognition, as well as
, severe hyponatremia (likely due to syndrome of inappropriate antidiuretic
hormone secretion associated with brain irradiation and selectiveserotonin
reuptake inhibitor initiation). Delirium prevention with cognitive stimulation
and avoidance of cognition-impairing medications is key. Delirium is
managed by addressing the underlying medical problem and supportive
management such as frequentreorientation and promoting sleep only at night
to re-establish the appropriate circadian rhythm. Antipsychotic medication
can manage symptoms of agitation or distressing hallucinations but does not
shorten the duration of delirium.Incorrect Answers: B, C, D, and
E.Dementia, Alzheimer type (Choice B) or caused by Pick disease (Choice
C) would present with insidious cognitive decline instead of acute
confusion. Fluctuations in the severity of cognitive deficits over the course
of the day would be atypical, unless a concomitantdelirium was also present.
Baseline dementia is a risk factor for developing acute delirium. Pick
disease (also known as frontotemporal dementia) typically develops when
patients are in their 50s and features personality changes in addition to
cognitive de
◍ What are hydatidiform moles?.
Answer: caused by: - fertilization of an empty egg by a single sperm,
followed by duplication of the paternal DNA resulting in 46 chromosomes
(complete)- dual fertilization of a normal ovum resulting in 69
chromosomes (partial)complete moles contain no fetal tissuepartial moles
contain some fetal tissueneither are viablelabs will reveal abnormally
increased b-hcg levels u/s will show bilateral multilocular ovarian cysts
(theca lutein cysts)
◍ 194----------Exam Section 4: Item 44 of 50Natjonal, Board pf Medical
Ęxaminersment.* 44. A healthy 21-year-old woman is concerned that her
son will develop a familial neurologic disorder. Her older brother died at the
age of 45 years after developing restlessness, forgetfulness, incoordination,
altered handwriting and speech, and subsequently,chorea. Autopsy showed
atrophy of the basal ganglia. Their mother died at the age of 55 years of a
similar disorder. Which of the following best approximates the risk of this
, woman's son for developing the disorder?O AJEssentially zeroO B) 25%O
G+33%O Đ)50%E) 100%.
Answer: B.The chance of this woman's son developing Huntington disease
(HD) is 25%. HD demonstrates an autosomal dominant pattern of
heritability. The woman's mother possessed HD symptoms and died early
and therefore presumably possesses one copy of the mutatedgene. This
woman has a 50% chance of inheriting the gene from her mother and a 50%
chance of passing on this mutated gene to her son (50% × 50% = 25%). HD
is a heritable progressive neurodegenerative disorder typically arising in the
third to sixth decades oflife associated with atrophy of the caudate nuclei in
the basal ganglia. The disease usually presents with an insidious onset of
psychiatric (irritability, depression, psychosis) and cognitive symptoms.
Motor symptoms (chorea, hypotonia, dystonia, loss of voluntarycontrol of
movements) typically appear later in the disease course. People with HD
typically die 10 to 40 years after disease onset. Chorea, a key HD symptom,
can be initially experienced as restlessness. Treatment is symptomatic and
can include tetrabenazine ordeutetrabenazine, which target chorea by
depleting dopamine stores. HD also demonstrates anticipation, a genetic
inheritance phenomenon in which future generations are affected at a
younger age or with more severe symptoms.Incorrect Answers: A, C, D, and
E.The son's risk would be essentially zero (Choice A) if the woman had
demonstrated a negative result on genetic testing for HD. Alternatively, if
the woman were older than 80 years old without any HD symptoms, the risk
that she would develop HD may be low enoughto assume she does not
possess the mutated HD gene and that her son's risk is therefore
negligible.Risks of 50% (Choice D) or 100% (Choice E) would signify that
either the woman or her son demonstrated the mutated HD gene on genetic
testing, respectively. The son's risk would be 50%
◍ Hemophilia A.
Answer: Factor VIII
◍ What disease process is the Philadelphia chromosome associated with?.
Answer: CML (required for diagnosis)however you can also see it in ALL
, and AML
◍ 196----------Exam Section 4: Item 46 of 50National Board of Medical
Examinersaive B A tancemont46. A healthy 28-year-old woman participates
in an exercise study. Several physiologic variables are measured as she runs
on a treadmill. The ambient room temperature is 75°
F. She reaches a steady state that increases her oxygen consumption
threefold. Shecontinues to exercise at that level for 20 minutes. During the
first 5 minutes of exercise, the vascular resistance of which of the following
is likely to show the greatest increase from resting values in this
volunteer?O A-GoronaryO B}GutaneousO G} Exercising-museleO Đ)
PulmonaryE) SplanchnicO F} Systemie.
Answer: E.Splanchnic vascular resistance is likely to show the greatest
increase when compared to its resting state. The splanchnic circulation
includes the celiac trunk and the superior and inferior mesenteric arteries,
which supply blood to the gastrointestinal system. Adequatesplanchnic
blood supply is critical to digestion and maintenance of the gastrointestinal
mucosal barrier. In the resting state, splanchnic circulation utilizes 25% to
30% of all cardiac output, but this can change drastically after meals
(increased blood flow) or duringperiods of physiologic stress such as
exercise or critical illness (decreased blood flow). Changes in splanchnic
blood flow are regulated by multiple mechanisms that are grouped into
intrinsic, extrinsic, and humoral control. Intrinsic regulatory mechanisms
includevasodilation (increased blood flow) in response to tissue hypoxia or
acidosis. Extrinsic control is exerted by the sympathetic and
parasympathetic nervous systems, with sympathetic innervation leading to
vasoconstriction and parasympathetic innervation leading tovasodilation.
Humoral mechanisms describe a response to the presence of hyperosmolar
contents within the lumen of the gastrointestinal tract and stimulate release
of nitric oxide to cause vasodilation and aid in digestion. During exercise, a
greater degree of cardiacoutput is required to supply oxygenated blood to
the coronary arteries and the skeletal muscles. Action of the sympathetic
nervous system leads to increased cardiac output via augmentation of the
