NBME SAMPLE COMPREHENSIVE STUDY
GUIDE 2026 FULL QUESTIONS AND
SOLUTIONS GRADED A+
◍ Non communicating hydrocephalus.
Answer: hydrocephalus caused by a something obstructing the normal flow
of CSF; Caused by stenosis of aqueduct of sylvian, colloid cyst blocking
foramen of monro or a tumor (often pediatric~ infratentorial: Pinealoma,
ependyoma, medulloblastoma)
◍ a 52 year old woman comes to the physician because of pain in her right
knee. the knee is red, warm and swollen. Serum uric acid concentrations is
11.4. Joint fluid aspirate shows negatively birefringent crystals.
Indomethacin therapy is started and she beings a purine restricted diet. One
week later, her 24 hour uric acid excretion is 800mg/day (norm is 300-600).
Which of the following drugs is most appropriate to decrease the serum uric
acid concentration in this patient?.
Answer: Allopurinol
◍ Breast cancer to vertebrae.
Answer: breast cancer to metastasize to the vertebra are the intercostal veins
(form both blastic and lytic lesions)
◍ a healthy 30 year old man is participating in a study of the effects of a
competitive inhibitor of endothelial nitric oxide synthase. After intravenous
injection of the inhibitor, blood pressure immediately increases.
Supplementation with which of the following amino acids is most
appropriate to reverse this increase?.
Answer: Arginine
◍ Annular pancreas.
, Answer: Abnormal migration of the ventral pancreatic budCan compress
duodenum, causing *billious vomitingNon bilous vomiting: esophageal
atresia (undigested), pyloric stenosis (nonbillious but darker)~ projectile
vomit, Extrahepatic biliary atresia: jaundice, dark urine and acholic=pale
(white~ lack bilirubin~ pigment) stools because bile backed up- seen in
babies
◍ The irreversibility of the pyruvate kinase reaction renders hepatic
gluconeogenesis dependent on which of the following two ATP- or GTP-
requiring enzymes?.
Answer: Pyruvate carboxylase and phosphoenolpyruvate carboxykinase
◍ TRALI (transfusion related acute lung injury).
Answer: pulmonary complications associated with blood component
transfusion due to leukocyte antibodies-> P-edema w/o Cardiac involvement
(6hrs post-transfusion)Sx: chills, cough, fever, cyanosis, hypotension,
respiratory distress, pulmonary failure~ hypoxemia: massive loss of
ventilation (shunting)
◍ Calcidiol vs Calcitriol.
Answer: Kidney makes 1-25, hydroxy vitamin D. (calcitriol-active)
25-hydroxy vit D (calcidiol) is made in the liver
◍ The absorption of calcium from the intestinal tract results principally from
the direct action of which of the following?.
Answer: 1,25- dihydroxycholecalciferol ---- a def. to this will cause a
decrease in calcium uptake - this is bc 1,25- dihydroxycholecalciferol is a
hormone that binds and activates the calcium receptor
◍ the sulfunylureas extert their hypoglycemic effect by blocking which of the
following channels?.
Answer: K+
◍ Neutrophils produce reactive oxygen compounds following phagocytosis of
bacteria. which of the following enzymes protects body tissues against these
highly reactive oxygen compounds?.
, Answer: Superoxide dismutase
◍ a 3 year old boy with cystic fibrosis is evaluated for the acute onset of an
uncontrollable nosebleed. There is no family history of a bleeding disorder.
A few large bruises are seen on the legs, no other abnormalities are noted.
Prothrombin and partial thromboplastin times are prolonged. The patients
abnormalities are likely to improve with treatment using a cofactor for
which process?.
Answer: carboxylation of prothrombin
◍ T1DM inheritance pattern.
Answer: Multifactorial ~ HLA-DR3 and 4
◍ Fructose 2,6-bisphosphate regulates which step in the diagram?.
Answer: C- glucose 6 phosphate conversion to pyruvate
◍ a 56 year old man who is right handed comes to the physician bc of a 2
month history of progressive clumsiness in the right hand and difficulty
finding words. Neurologic examination shows upper motoneuron weakness
of the right upper extremity, and difficulty naming and reptition. An MRI of
the brain shows an infiltrating left frontal mass. Analysis of a stereotacix
biopsy specimen shows a grade II astrocytoma. Impaired activity of which
of the following proteins is the most likely cause of this leasion?.
Answer: p53
◍ A 65 year old woman develops a proximal deep venous thrombosis 1 week
after an elective total hip replacement. What is the mechanism of
intravenous heparin in treating this disorder?.
Answer: inactivation of thrombin by antithrombin III
◍ A 33 year old woman comes to the physician for a follow up examination
after she was dianosted with hodgkin lymphoma. Chemotherapy, including
vinblastine, is started. The regimen is most likely to have which of the
following direct effects on the disease process in this patient?.
Answer: Blockage of microtubule assembly (that is the mechanism of action
for vinblastine)
, ◍ Autoregulation of GFR vs Endocrine.
Answer: Autoregulation~ local changes in BPMaintains GFR despite
changes in local blood pressure and blood flow By changing diameters of
afferent arterioles, efferent arterioles, and glomerular capillariesMyogenic:
afferent arteriole~ inc RBF-> reactive vasoconstriction (inc ca release from
SM cells)-> DEC RBF/GFRTubuloglomerular feedback: inc RBF~ inc
GFR-> inc Na/Cl delivery to JGA (in DCT)-> vasoconstrict afferent
arteriole and DEC RBF/GFREndocrine~ more systemic changes in BPAngII
(inc Na/H activity-(inc Na HCO3 absorb); constrict efferent arteriole-> inc
GFR) and inc aldosterone (inc Na and H+/K+ excretion~ contraction
alkalosis)ANP: ~ inc naturesis via Afferent arteriole dilation and dec Na
reabsorb in DCT Prostaglandins: PGE~ afferent arteriole dilation ~ inc GFR
(NSAIDs reduce GFR~ inc risk of renal injury/insufficiency)
◍ A 32 year old man is receiving cisplatin following surgical excision of
testicular carcinoma. interaction with which of the following cellular
components is most likely responsible for the antiproliferative effect of
cisplatin?.
Answer: DNA
◍ Sclerotomes.
Answer: Become the vertebrae and ribsFailure of fusion ~ spina bifida
(occulta) ~ lack of spinous process about SCNotochord (becomes IV
discs-nucleus pulposus)~ Neural plate development (CNS formation)NT->
matures into CNS from neural plate
◍ Vitamin E def anemia.
Answer: Hemolytic anemia~ red antioxidants vs B12 def (megaloblastic
macrocytic anemia)Hemolysis~ dec Hgb/hematocrit, inc LDH (normal
MCV), and neurologic symptomsvs B12 def: dec Hgb/hematocrit, inc MCV,
and neurologic symptoms (dorsal column)
◍ Pathologic dead space.
Answer: When part of the respiratory zone becomes unable to perform gas
exchange. Ventilated but not perfused =dead space (necrosis~ ischemia or
GUIDE 2026 FULL QUESTIONS AND
SOLUTIONS GRADED A+
◍ Non communicating hydrocephalus.
Answer: hydrocephalus caused by a something obstructing the normal flow
of CSF; Caused by stenosis of aqueduct of sylvian, colloid cyst blocking
foramen of monro or a tumor (often pediatric~ infratentorial: Pinealoma,
ependyoma, medulloblastoma)
◍ a 52 year old woman comes to the physician because of pain in her right
knee. the knee is red, warm and swollen. Serum uric acid concentrations is
11.4. Joint fluid aspirate shows negatively birefringent crystals.
Indomethacin therapy is started and she beings a purine restricted diet. One
week later, her 24 hour uric acid excretion is 800mg/day (norm is 300-600).
Which of the following drugs is most appropriate to decrease the serum uric
acid concentration in this patient?.
Answer: Allopurinol
◍ Breast cancer to vertebrae.
Answer: breast cancer to metastasize to the vertebra are the intercostal veins
(form both blastic and lytic lesions)
◍ a healthy 30 year old man is participating in a study of the effects of a
competitive inhibitor of endothelial nitric oxide synthase. After intravenous
injection of the inhibitor, blood pressure immediately increases.
Supplementation with which of the following amino acids is most
appropriate to reverse this increase?.
Answer: Arginine
◍ Annular pancreas.
, Answer: Abnormal migration of the ventral pancreatic budCan compress
duodenum, causing *billious vomitingNon bilous vomiting: esophageal
atresia (undigested), pyloric stenosis (nonbillious but darker)~ projectile
vomit, Extrahepatic biliary atresia: jaundice, dark urine and acholic=pale
(white~ lack bilirubin~ pigment) stools because bile backed up- seen in
babies
◍ The irreversibility of the pyruvate kinase reaction renders hepatic
gluconeogenesis dependent on which of the following two ATP- or GTP-
requiring enzymes?.
Answer: Pyruvate carboxylase and phosphoenolpyruvate carboxykinase
◍ TRALI (transfusion related acute lung injury).
Answer: pulmonary complications associated with blood component
transfusion due to leukocyte antibodies-> P-edema w/o Cardiac involvement
(6hrs post-transfusion)Sx: chills, cough, fever, cyanosis, hypotension,
respiratory distress, pulmonary failure~ hypoxemia: massive loss of
ventilation (shunting)
◍ Calcidiol vs Calcitriol.
Answer: Kidney makes 1-25, hydroxy vitamin D. (calcitriol-active)
25-hydroxy vit D (calcidiol) is made in the liver
◍ The absorption of calcium from the intestinal tract results principally from
the direct action of which of the following?.
Answer: 1,25- dihydroxycholecalciferol ---- a def. to this will cause a
decrease in calcium uptake - this is bc 1,25- dihydroxycholecalciferol is a
hormone that binds and activates the calcium receptor
◍ the sulfunylureas extert their hypoglycemic effect by blocking which of the
following channels?.
Answer: K+
◍ Neutrophils produce reactive oxygen compounds following phagocytosis of
bacteria. which of the following enzymes protects body tissues against these
highly reactive oxygen compounds?.
, Answer: Superoxide dismutase
◍ a 3 year old boy with cystic fibrosis is evaluated for the acute onset of an
uncontrollable nosebleed. There is no family history of a bleeding disorder.
A few large bruises are seen on the legs, no other abnormalities are noted.
Prothrombin and partial thromboplastin times are prolonged. The patients
abnormalities are likely to improve with treatment using a cofactor for
which process?.
Answer: carboxylation of prothrombin
◍ T1DM inheritance pattern.
Answer: Multifactorial ~ HLA-DR3 and 4
◍ Fructose 2,6-bisphosphate regulates which step in the diagram?.
Answer: C- glucose 6 phosphate conversion to pyruvate
◍ a 56 year old man who is right handed comes to the physician bc of a 2
month history of progressive clumsiness in the right hand and difficulty
finding words. Neurologic examination shows upper motoneuron weakness
of the right upper extremity, and difficulty naming and reptition. An MRI of
the brain shows an infiltrating left frontal mass. Analysis of a stereotacix
biopsy specimen shows a grade II astrocytoma. Impaired activity of which
of the following proteins is the most likely cause of this leasion?.
Answer: p53
◍ A 65 year old woman develops a proximal deep venous thrombosis 1 week
after an elective total hip replacement. What is the mechanism of
intravenous heparin in treating this disorder?.
Answer: inactivation of thrombin by antithrombin III
◍ A 33 year old woman comes to the physician for a follow up examination
after she was dianosted with hodgkin lymphoma. Chemotherapy, including
vinblastine, is started. The regimen is most likely to have which of the
following direct effects on the disease process in this patient?.
Answer: Blockage of microtubule assembly (that is the mechanism of action
for vinblastine)
, ◍ Autoregulation of GFR vs Endocrine.
Answer: Autoregulation~ local changes in BPMaintains GFR despite
changes in local blood pressure and blood flow By changing diameters of
afferent arterioles, efferent arterioles, and glomerular capillariesMyogenic:
afferent arteriole~ inc RBF-> reactive vasoconstriction (inc ca release from
SM cells)-> DEC RBF/GFRTubuloglomerular feedback: inc RBF~ inc
GFR-> inc Na/Cl delivery to JGA (in DCT)-> vasoconstrict afferent
arteriole and DEC RBF/GFREndocrine~ more systemic changes in BPAngII
(inc Na/H activity-(inc Na HCO3 absorb); constrict efferent arteriole-> inc
GFR) and inc aldosterone (inc Na and H+/K+ excretion~ contraction
alkalosis)ANP: ~ inc naturesis via Afferent arteriole dilation and dec Na
reabsorb in DCT Prostaglandins: PGE~ afferent arteriole dilation ~ inc GFR
(NSAIDs reduce GFR~ inc risk of renal injury/insufficiency)
◍ A 32 year old man is receiving cisplatin following surgical excision of
testicular carcinoma. interaction with which of the following cellular
components is most likely responsible for the antiproliferative effect of
cisplatin?.
Answer: DNA
◍ Sclerotomes.
Answer: Become the vertebrae and ribsFailure of fusion ~ spina bifida
(occulta) ~ lack of spinous process about SCNotochord (becomes IV
discs-nucleus pulposus)~ Neural plate development (CNS formation)NT->
matures into CNS from neural plate
◍ Vitamin E def anemia.
Answer: Hemolytic anemia~ red antioxidants vs B12 def (megaloblastic
macrocytic anemia)Hemolysis~ dec Hgb/hematocrit, inc LDH (normal
MCV), and neurologic symptomsvs B12 def: dec Hgb/hematocrit, inc MCV,
and neurologic symptoms (dorsal column)
◍ Pathologic dead space.
Answer: When part of the respiratory zone becomes unable to perform gas
exchange. Ventilated but not perfused =dead space (necrosis~ ischemia or
