NBME CBSE EXAM NEWEST 2026/2027 ACTUAL EXAM
TEST BANK | COMPLETE 200 REAL EXAM QUESTIONS
AND CORRECT DETAILED ANSWERS (VERIFIED
ANSWERS) | ALREADY GRADED A+ | NBME CBSE
EXAM PREP (BRAND NEW!!)
Section 1: Cardiovascular and Respiratory Systems
(Questions 1–35)
Question 1: A 56-year-old woman with restrictive
cardiomyopathy, proteinuria, and renal failure has a 35-year
history of rheumatoid arthritis. Renal biopsy shows glomerular
deposition of eosinophilic hyaline material with a birefringent
pattern under polarized light after Congo red staining. What is
the structure of this material?
A. Alpha-helical structure
B. Beta-pleated sheet structure
C. Cross-linked collagen
D. Fibrin mesh
Answer: B
Rationale: The combination of Congo red positivity with apple-green birefringence
under polarized light is diagnostic of amyloidosis. The eosinophilic hyaline material
represents amyloid deposits with a characteristic beta-pleated sheet structure. This
patient's amyloidosis is likely secondary to chronic rheumatoid arthritis.
,Question 2: A 63-year-old man has a 3-month history of difficulty
sleeping and reports that he sleeps better when upright. His heart
rate is 90 bpm and blood pressure is 110/60 mmHg. Physical
examination shows increased jugular venous pressure and mild
ankle edema. What is the most likely cause of this patient's
edema?
A. Decreased plasma oncotic pressure
B. Increased capillary hydrostatic pressure
C. Lymphatic obstruction
D. Sodium retention
Answer: B
Rationale: The patient's symptoms and signs (orthopnea, elevated JVP, peripheral
edema) indicate right-sided heart failure. In heart failure, impaired cardiac output leads
to venous congestion, which increases capillary hydrostatic pressure and causes fluid
extravasation into the interstitial space.
Question 3: A 54-year-old woman with hypertension and bilateral
renal artery stenosis starts taking NSAIDs for back pain. Her
creatinine concentration increases from 1.0 mg/dL to 5.0 mg/dL.
This is most likely due to inhibition of which of the following?
A. Vasoconstriction of the afferent arteriole
B. Vasodilation of the afferent arteriole
C. Vasoconstriction of the efferent arteriole
D. Vasodilation of the efferent arteriole
Answer: B
,Rationale: In patients with renal artery stenosis, glomerular filtration is maintained by
angiotensin II-mediated vasoconstriction of the efferent arteriole. NSAIDs inhibit
prostaglandin-mediated vasodilation of the afferent arteriole, reducing renal blood flow
and causing a precipitous rise in creatinine.
Question 4: A 35-year-old man who uses crack cocaine daily
presents with a 2-hour history of substernal chest pain. His
temperature is 37°C, heart rate is 110/min, and blood pressure is
160/100 mmHg. What is the most appropriate next step?
A. Admit the patient for possible myocardial ischemia
B. Discharge with cardiology follow-up
C. Administer oral pain medication
D. Perform a stress test
Answer: A
Rationale: This patient's chest pain in the setting of cocaine use and hypertensive
emergency requires hospital admission for possible myocardial ischemia. Cocaine-
induced vasospasm can cause myocardial infarction even in young patients without
traditional risk factors.
Question 5: A 70-year-old man dies in a motor vehicle collision.
He was undergoing evaluation for occult blood in the stool. Gross
examination of the transverse colon shows a polypoid lesion.
Which of the following is the most likely diagnosis?
A. Hyperplastic polyp
B. Inflammatory polyp
C. Tubular adenoma
D. Villous adenoma
, Answer: C
Rationale: The image described is consistent with a tubular adenoma, a common
precursor to colorectal carcinoma. These are typically found during screening
colonoscopy for occult blood. Villous adenomas are less common and have higher
malignant potential.
Question 6: A 34-year-old woman with pyelonephritis is treated
with a bactericidal antibiotic for 4 days without improvement. An
antibiotic is added that inhibits binding to the 30S ribosomal
subunit, blocking protein synthesis intracellularly. Which
antibiotic is most likely being added?
A. Ciprofloxacin
B. Gentamicin
C. Metronidazole
D. Vancomycin
Answer: B
Rationale: Gentamicin is an aminoglycoside that binds to the 30S ribosomal subunit,
inhibiting bacterial protein synthesis. It is often added to beta-lactam antibiotics for
synergistic effect against difficult-to-treat infections.
Question 7: A patient with sudden shortness of breath has a loud
P2 sound that is louder than A2 on cardiac auscultation. What is
the most specific indicator of pulmonary arterial hypertension in
this patient?
A. A2 sound louder than P2
B. P2 sound louder than A2
TEST BANK | COMPLETE 200 REAL EXAM QUESTIONS
AND CORRECT DETAILED ANSWERS (VERIFIED
ANSWERS) | ALREADY GRADED A+ | NBME CBSE
EXAM PREP (BRAND NEW!!)
Section 1: Cardiovascular and Respiratory Systems
(Questions 1–35)
Question 1: A 56-year-old woman with restrictive
cardiomyopathy, proteinuria, and renal failure has a 35-year
history of rheumatoid arthritis. Renal biopsy shows glomerular
deposition of eosinophilic hyaline material with a birefringent
pattern under polarized light after Congo red staining. What is
the structure of this material?
A. Alpha-helical structure
B. Beta-pleated sheet structure
C. Cross-linked collagen
D. Fibrin mesh
Answer: B
Rationale: The combination of Congo red positivity with apple-green birefringence
under polarized light is diagnostic of amyloidosis. The eosinophilic hyaline material
represents amyloid deposits with a characteristic beta-pleated sheet structure. This
patient's amyloidosis is likely secondary to chronic rheumatoid arthritis.
,Question 2: A 63-year-old man has a 3-month history of difficulty
sleeping and reports that he sleeps better when upright. His heart
rate is 90 bpm and blood pressure is 110/60 mmHg. Physical
examination shows increased jugular venous pressure and mild
ankle edema. What is the most likely cause of this patient's
edema?
A. Decreased plasma oncotic pressure
B. Increased capillary hydrostatic pressure
C. Lymphatic obstruction
D. Sodium retention
Answer: B
Rationale: The patient's symptoms and signs (orthopnea, elevated JVP, peripheral
edema) indicate right-sided heart failure. In heart failure, impaired cardiac output leads
to venous congestion, which increases capillary hydrostatic pressure and causes fluid
extravasation into the interstitial space.
Question 3: A 54-year-old woman with hypertension and bilateral
renal artery stenosis starts taking NSAIDs for back pain. Her
creatinine concentration increases from 1.0 mg/dL to 5.0 mg/dL.
This is most likely due to inhibition of which of the following?
A. Vasoconstriction of the afferent arteriole
B. Vasodilation of the afferent arteriole
C. Vasoconstriction of the efferent arteriole
D. Vasodilation of the efferent arteriole
Answer: B
,Rationale: In patients with renal artery stenosis, glomerular filtration is maintained by
angiotensin II-mediated vasoconstriction of the efferent arteriole. NSAIDs inhibit
prostaglandin-mediated vasodilation of the afferent arteriole, reducing renal blood flow
and causing a precipitous rise in creatinine.
Question 4: A 35-year-old man who uses crack cocaine daily
presents with a 2-hour history of substernal chest pain. His
temperature is 37°C, heart rate is 110/min, and blood pressure is
160/100 mmHg. What is the most appropriate next step?
A. Admit the patient for possible myocardial ischemia
B. Discharge with cardiology follow-up
C. Administer oral pain medication
D. Perform a stress test
Answer: A
Rationale: This patient's chest pain in the setting of cocaine use and hypertensive
emergency requires hospital admission for possible myocardial ischemia. Cocaine-
induced vasospasm can cause myocardial infarction even in young patients without
traditional risk factors.
Question 5: A 70-year-old man dies in a motor vehicle collision.
He was undergoing evaluation for occult blood in the stool. Gross
examination of the transverse colon shows a polypoid lesion.
Which of the following is the most likely diagnosis?
A. Hyperplastic polyp
B. Inflammatory polyp
C. Tubular adenoma
D. Villous adenoma
, Answer: C
Rationale: The image described is consistent with a tubular adenoma, a common
precursor to colorectal carcinoma. These are typically found during screening
colonoscopy for occult blood. Villous adenomas are less common and have higher
malignant potential.
Question 6: A 34-year-old woman with pyelonephritis is treated
with a bactericidal antibiotic for 4 days without improvement. An
antibiotic is added that inhibits binding to the 30S ribosomal
subunit, blocking protein synthesis intracellularly. Which
antibiotic is most likely being added?
A. Ciprofloxacin
B. Gentamicin
C. Metronidazole
D. Vancomycin
Answer: B
Rationale: Gentamicin is an aminoglycoside that binds to the 30S ribosomal subunit,
inhibiting bacterial protein synthesis. It is often added to beta-lactam antibiotics for
synergistic effect against difficult-to-treat infections.
Question 7: A patient with sudden shortness of breath has a loud
P2 sound that is louder than A2 on cardiac auscultation. What is
the most specific indicator of pulmonary arterial hypertension in
this patient?
A. A2 sound louder than P2
B. P2 sound louder than A2
