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NBME CBSE REAL EXAM 200 QUESTIONS AND ANSWERS
LATEST 2025 COMPLETE EXAM (usmle step 1)MEDICAL
EXAMINATION
0yo M in ED 15 minutes after found unconscious. Comatose, pupils 4
mm in diameter, not reactive to light. CT head shown. Cause of coma is
bleeding from which structures? - ANSWER-MMA
1-week-old girl. screening showed a possible defect in fatty acid
oxidation. PE normal. Next step? - ANSWER-Measurement of serum
acylcarnitine concentrations
10yo boy has had anemia since birth. Spleen is five times normal.
Splenectomy is indicated if anemia is caused by which? - ANSWER-
Hereditary spherocytosis
10yo girl well-child examination. No menstrual period. 50th percentile
height and weight. Physical exam absence of breast bud development
and no pubic or axillary hair. It is most appropriate to tell mother that
first objective sign of puberty will be which? - ANSWER-Breast bud
development
12yo boy immersed up to his neck in 60F water for 20 minutes.
Physiological changes?
ADH:
Central Blood volume:
ANP: - ANSWER-ADH: decreased (VC leads to decreased ADH)
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ANP: increased
Central blood volume: increased
13yo girl 2/6, holosystolic murmur heard best over left fifth intercostal
space adjacent to the sternum; it increases with inspiration.
Abnormality of which valves? - ANSWER-Tricuspid
14yo boy come to ER 1 hour after colliding with teammate playing
soccer. Physical exam: edematous tissues of left eye, mild depression of
left zygomatic bone. Skin between eye and upper lip numb. Double
vision look upward. Nerve damaged causing sensory loss? - ANSWER-
Maxillary division of the trigeminal nerve
14yo boy daily headaches for 2 months. Headaches are bilateral aching
in temples. "Has not been himself" for months. Confused, forgetting
names, dates, places, clumsy, frequent falls. School performance
declined. Physical exam: broad-based ataxic gait. Slow to answer
questions. Chronic abuse of which substance? - ANSWER-Inhaled glue
15yo girl 1-day hx redness and painful skin following sunbathing. She
used sunblock. No medications. Physical exam: severe erythema of
back and extremities, no blisters. Dx? - ANSWER-1st-degree burn
15yo girl emigrated from India and with several lesions on neck for 2
weeks. Physical exam shows hypopigmented, hypoesthetic area on left
side of forehead and 4-cm lesions on neck. Biopsy shows acid-fast
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bacilli. Best explanation why the organism results in dermal rather than
visceral infections? - ANSWER-Temperature sensitivity
15yo girl health maintenance exam. Mother dx squamous cell
carcinoma face, maternal grandfather died of metastatic melanoma. In
patient this age, which factor most predicts compliance with
photoprotection? - ANSWER-Use of sunscreen by peers
16yo boy with no signs of puberty. Sex development Tanner stage 2.
Physical exam: circumcised penis, soft small tests 5 mL, prostate firm,
nontender, no discharge or lesions. Testosterone low. Which hormone
is cause of decreased serum testosterone and lack of pituitary hormone
stimulus? - ANSWER-LH
16yo girl with 2-year hx of fainting; increased in frequency during past 6
months. BP 110/80 supine and 60/40 standing. Neuro exam normal.
Plasma shows undetectable noreipinephrine and marked increase in
dopamine concentration when standing. Deficiency of which? -
ANSWER-DA-B-hydroxylase
16yo girl with 3-day hx of fever, nonproductive cough, and fatigue. T
38.3, P 88/min, BP 102-70. PE shows pale conjunctivae. CXR shows
bilateral interstitial infiltrates. Blood spontaenously agglutinates while
awaiting transport to the laboratory. Antibody isotypes causing
agglutination? - ANSWER-IgM (mono and mycoplasma)
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17yo boy with 8-kg weight gain during the past year. No medical illness.
BMI is 32. He asks, "Do you think that my weight gain is inherited from
my father?" Appropriate response? - ANSWER-"Yes, your weight gain
can be caused by genes and environment combined."
17yo girl 1-day shortness of breath, weakness and muscle tenderness.
Did triathlon previous day. BMI 19. Temperature 38 C (100.4 F),
respirations 20, bp 150/90. Physical bilateral crackles lower lobes,
muscle tenderness. Creatinine 4. Urinalysis 3+ protein, 4+ hemoglobin.
Patient's condition is from increased release of which substance? -
ANSWER-Myoglobin--> rhabdo
18-yo F with sepsis after an abortion. Within 24 hours she becomes
dyspneic, oliguric, and develops petechiae, ecchymoses, and bleeding
from venipuncture sites. Which lab finding? - ANSWER-DIC-->
decreased fibrinogen
18mo girl. Separation of the umbilical cord was delayed after birth. Has
had four severe skin infections Staphylococcus aureus; No pus
formation at infection sites. Persistent leukocytosis in absence of
infection. Mechanisms impaired? - ANSWER-LAD
18yo M with yellow nodules on achilles tendons of his feet and
extensor tendons of his hands. Exam shows collection of foamy
histiocytes within the dermis. Serum cholesterol is 980, and lipoprotein
electrophoresis shows a selective increase in LDL. Underlying disorder?
- ANSWER-Absence of functional LDL R's in hepatocytes
NBME CBSE REAL EXAM 200 QUESTIONS AND ANSWERS
LATEST 2025 COMPLETE EXAM (usmle step 1)MEDICAL
EXAMINATION
0yo M in ED 15 minutes after found unconscious. Comatose, pupils 4
mm in diameter, not reactive to light. CT head shown. Cause of coma is
bleeding from which structures? - ANSWER-MMA
1-week-old girl. screening showed a possible defect in fatty acid
oxidation. PE normal. Next step? - ANSWER-Measurement of serum
acylcarnitine concentrations
10yo boy has had anemia since birth. Spleen is five times normal.
Splenectomy is indicated if anemia is caused by which? - ANSWER-
Hereditary spherocytosis
10yo girl well-child examination. No menstrual period. 50th percentile
height and weight. Physical exam absence of breast bud development
and no pubic or axillary hair. It is most appropriate to tell mother that
first objective sign of puberty will be which? - ANSWER-Breast bud
development
12yo boy immersed up to his neck in 60F water for 20 minutes.
Physiological changes?
ADH:
Central Blood volume:
ANP: - ANSWER-ADH: decreased (VC leads to decreased ADH)
,2|Page
ANP: increased
Central blood volume: increased
13yo girl 2/6, holosystolic murmur heard best over left fifth intercostal
space adjacent to the sternum; it increases with inspiration.
Abnormality of which valves? - ANSWER-Tricuspid
14yo boy come to ER 1 hour after colliding with teammate playing
soccer. Physical exam: edematous tissues of left eye, mild depression of
left zygomatic bone. Skin between eye and upper lip numb. Double
vision look upward. Nerve damaged causing sensory loss? - ANSWER-
Maxillary division of the trigeminal nerve
14yo boy daily headaches for 2 months. Headaches are bilateral aching
in temples. "Has not been himself" for months. Confused, forgetting
names, dates, places, clumsy, frequent falls. School performance
declined. Physical exam: broad-based ataxic gait. Slow to answer
questions. Chronic abuse of which substance? - ANSWER-Inhaled glue
15yo girl 1-day hx redness and painful skin following sunbathing. She
used sunblock. No medications. Physical exam: severe erythema of
back and extremities, no blisters. Dx? - ANSWER-1st-degree burn
15yo girl emigrated from India and with several lesions on neck for 2
weeks. Physical exam shows hypopigmented, hypoesthetic area on left
side of forehead and 4-cm lesions on neck. Biopsy shows acid-fast
,3|Page
bacilli. Best explanation why the organism results in dermal rather than
visceral infections? - ANSWER-Temperature sensitivity
15yo girl health maintenance exam. Mother dx squamous cell
carcinoma face, maternal grandfather died of metastatic melanoma. In
patient this age, which factor most predicts compliance with
photoprotection? - ANSWER-Use of sunscreen by peers
16yo boy with no signs of puberty. Sex development Tanner stage 2.
Physical exam: circumcised penis, soft small tests 5 mL, prostate firm,
nontender, no discharge or lesions. Testosterone low. Which hormone
is cause of decreased serum testosterone and lack of pituitary hormone
stimulus? - ANSWER-LH
16yo girl with 2-year hx of fainting; increased in frequency during past 6
months. BP 110/80 supine and 60/40 standing. Neuro exam normal.
Plasma shows undetectable noreipinephrine and marked increase in
dopamine concentration when standing. Deficiency of which? -
ANSWER-DA-B-hydroxylase
16yo girl with 3-day hx of fever, nonproductive cough, and fatigue. T
38.3, P 88/min, BP 102-70. PE shows pale conjunctivae. CXR shows
bilateral interstitial infiltrates. Blood spontaenously agglutinates while
awaiting transport to the laboratory. Antibody isotypes causing
agglutination? - ANSWER-IgM (mono and mycoplasma)
, 4|Page
17yo boy with 8-kg weight gain during the past year. No medical illness.
BMI is 32. He asks, "Do you think that my weight gain is inherited from
my father?" Appropriate response? - ANSWER-"Yes, your weight gain
can be caused by genes and environment combined."
17yo girl 1-day shortness of breath, weakness and muscle tenderness.
Did triathlon previous day. BMI 19. Temperature 38 C (100.4 F),
respirations 20, bp 150/90. Physical bilateral crackles lower lobes,
muscle tenderness. Creatinine 4. Urinalysis 3+ protein, 4+ hemoglobin.
Patient's condition is from increased release of which substance? -
ANSWER-Myoglobin--> rhabdo
18-yo F with sepsis after an abortion. Within 24 hours she becomes
dyspneic, oliguric, and develops petechiae, ecchymoses, and bleeding
from venipuncture sites. Which lab finding? - ANSWER-DIC-->
decreased fibrinogen
18mo girl. Separation of the umbilical cord was delayed after birth. Has
had four severe skin infections Staphylococcus aureus; No pus
formation at infection sites. Persistent leukocytosis in absence of
infection. Mechanisms impaired? - ANSWER-LAD
18yo M with yellow nodules on achilles tendons of his feet and
extensor tendons of his hands. Exam shows collection of foamy
histiocytes within the dermis. Serum cholesterol is 980, and lipoprotein
electrophoresis shows a selective increase in LDL. Underlying disorder?
- ANSWER-Absence of functional LDL R's in hepatocytes
