NBME CBSE REAL Final Exam
2025/2026
NBME CBSE REAL Final Exam 2025/2026
Complete All Verified Questions And Correct
Detailed Answers (Rationales) |Already
Graded A+||Brand New Updated Version
Neuro 1
An 84-year-old man is evaluated for a 5-year history of a gradually worsening gait and a 2-year
history of cognitive impairment and urinary incontinence. Twelve years ago, he sustained a
closed head injury that caused a mild traumatic subarachnoid hemorrhage and a 5-hour loss of
consciousness. Medications include zolpidem (when needed as a sleep aid) and a daily
multivitamin.
On physical examination, temperature is 36.2 °C (97.2 °F), blood pressure is 128/78 mm Hg,
pulse rate is 76/min, respiration rate is 14/min, and BMI is 27. The patient's gait is slow and
unsteady and is marked by small, shuffling steps. His level of alertness, speech, posture, arm
swing, and muscle tone are all normal, and he has no tremor. He scores 24/30 on the Folstein
Mini-Mental State Examination, losing one point in the orientation portion for incorrectly stating
today's date, three points in the serial calculation portion, and t
- Correct Answer :B
The triad of gait apraxia, dementia, and urinary incontinence, especially when accompanied by
enlarged ventricles, is suggestive of normal pressure hydrocephalus.
This patient exhibits the classic triad of gait impairment (specifically, gait apraxia), dementia, and
urinary incontinence that typifies the potentially reversible syndrome of normal pressure
hydrocephalus (NPH). This triad of symptoms eventually occurs in most patients with dementia,
and the diagnosis of NPH is often considered but much less often proved to be the correct
A+ TEST BANK 1
, NBME CBSE REAL Final Exam
2025/2026
diagnosis. In this patient, however, strong evidence supports a diagnosis of NPH, including the
MRI evidence of ventriculomegaly. Although Alzheimer dementia (AD) is also associated with
cognitive impairment and impaired gait, gait does not improve after removal of cerebrospinal
fluid in AD as it does in NPH. AD is so common in elderly patients with cognitive impairment that
excluding it as a cause can delay the diagnosis of NPH; this delay may help explain some of the
eventual shunt failures that occur even in patients with well-diagnosed NPH. Therefore,
recognizing reversible dementia syndromes as soon as possible is imperative because of the
therapeutic opportunity these syndromes represent.
The only symptom this patient has that is shared by patients with Parkinson disease is a shuffling
gait. Otherwise, his presentation—normal posture, arm swing, and muscle tone and the absence
of a tremor—is quite different.
Likewise, this patient has no history of or symptoms suggesting stroke or vascular disease, such
as sudden onset of neurologic signs or symptoms, which makes vascular dementia unlikely.
Although coincident vascular, Alzheimer-type, and Parkinson-type pathology is a common finding
in autopsy studies, even in neurologically unimpaired healthy elderly adults, this fact should
Neuro 2
An 18-year-old male college student is evaluated for a single generalized tonic-clonic seizure that
began when he was asleep in his dormitory and resolved uneventfully. He has no history of head
trauma, meningitis, or prior seizure and no family history of epilepsy. He takes no medications.
Results of physical examination, including a neurologic examination, are normal.
Results of laboratory studies, including a complete blood count, a serum electrolyte panel, and a
urine toxicology screen, are also normal.
An MRI of the brain and an electroencephalogram show no abnormalities.
A+ TEST BANK 2
, NBME CBSE REAL Final Exam
2025/2026
Which of the following is the most appropriate management of this patient's seizure?
A Initiate no drug therapy at this time
B Initiate therapy with carbamazepine
C Initiate therapy with lamotrigine
D Initiate therapy with valproic acid
E Refer for epilepsy surgery evaluation
- Correct Answer :A
Unless special circumstances exist, drug therapy is generally not started in patients with a single
unprovoked seizure.
Drug therapy should not be initiated in this patient at this time. After a single unprovoked
seizure, the risk of recurrence in the subsequent 2 years has been reported to be 30% to 40%.
The risk of recurrence is greatest in patients with status epilepticus on presentation, with an
identifiable underlying neurologic cause, or with abnormal results on an electroencephalogram
(EEG). Patients with a partial seizure who are age 65 years or older or who have a family history
of epilepsy may also be in a higher-risk category. The appropriate recommendation for this
young patient, who has experienced a single idiopathic seizure but has no personal or family
history of epilepsy, no identified neurologic cause of his seizure, and normal results on an EEG, is
that no medication be started. As with all medical treatment recommendations, patient
preference must be taken into account, and some patients in the low-risk group may elect to
start therapy after a single seizure, particularly if they have a high-risk occupation. If a second
seizure occurs in the future, the recurrence risk is greater than 60%, and antiepileptic medical
therapy should be recommended at that time.
Of note, driver's license privileges are restricted in every state in the United States for persons
who have experienced a seizure. Specific restrictions vary by state, with typical requirements of a
seizure-free period of 3 to 12 months in order to again operate a motor vehicle; a few states
make exceptions for a single seizure. Reinstatement of driving privileges depends on
A+ TEST BANK 3
, NBME CBSE REAL Final Exam
2025/2026
demonstrating freedom from seizures for the specified period and there being a reasonable
expectation of future seizure control. Initiation of antiepileptic medication
Neuro 3
A 36-year-old woman is evaluated in the office for a history of migraine, with and without aura,
since age 16 years. She has an average of three attacks each month and consistently experiences
an attack 2 days prior to menstruation; this headache is more difficult to treat than those not
associated with menstruation. Although she typically obtains pain relief within 2 hours of taking
sumatriptan, the headache recurs within 24 hours after each dose during the period of
menstrual flow. Sumatriptan, orally as needed, is her only medication.
Results of physical examination are unremarkable.
Which of the following is the most appropriate perimenstrual treatment for this patient's
headaches?
A Estrogen-progestin contraceptive pill
B Mefenamic acid
C Sumatriptan plus naproxen, orally
D Sumatriptan, subcutaneously
E Topiramate
- Correct Answer :B
Evidence supports the use of mefenamic acid for perimenstrual prophylaxis of menstrually
related migraines, with treatment starting 2 days prior to the onset of flow or 1 day prior to the
expected onset of the headache and continuing for the duration of menstruation.
A+ TEST BANK 4
2025/2026
NBME CBSE REAL Final Exam 2025/2026
Complete All Verified Questions And Correct
Detailed Answers (Rationales) |Already
Graded A+||Brand New Updated Version
Neuro 1
An 84-year-old man is evaluated for a 5-year history of a gradually worsening gait and a 2-year
history of cognitive impairment and urinary incontinence. Twelve years ago, he sustained a
closed head injury that caused a mild traumatic subarachnoid hemorrhage and a 5-hour loss of
consciousness. Medications include zolpidem (when needed as a sleep aid) and a daily
multivitamin.
On physical examination, temperature is 36.2 °C (97.2 °F), blood pressure is 128/78 mm Hg,
pulse rate is 76/min, respiration rate is 14/min, and BMI is 27. The patient's gait is slow and
unsteady and is marked by small, shuffling steps. His level of alertness, speech, posture, arm
swing, and muscle tone are all normal, and he has no tremor. He scores 24/30 on the Folstein
Mini-Mental State Examination, losing one point in the orientation portion for incorrectly stating
today's date, three points in the serial calculation portion, and t
- Correct Answer :B
The triad of gait apraxia, dementia, and urinary incontinence, especially when accompanied by
enlarged ventricles, is suggestive of normal pressure hydrocephalus.
This patient exhibits the classic triad of gait impairment (specifically, gait apraxia), dementia, and
urinary incontinence that typifies the potentially reversible syndrome of normal pressure
hydrocephalus (NPH). This triad of symptoms eventually occurs in most patients with dementia,
and the diagnosis of NPH is often considered but much less often proved to be the correct
A+ TEST BANK 1
, NBME CBSE REAL Final Exam
2025/2026
diagnosis. In this patient, however, strong evidence supports a diagnosis of NPH, including the
MRI evidence of ventriculomegaly. Although Alzheimer dementia (AD) is also associated with
cognitive impairment and impaired gait, gait does not improve after removal of cerebrospinal
fluid in AD as it does in NPH. AD is so common in elderly patients with cognitive impairment that
excluding it as a cause can delay the diagnosis of NPH; this delay may help explain some of the
eventual shunt failures that occur even in patients with well-diagnosed NPH. Therefore,
recognizing reversible dementia syndromes as soon as possible is imperative because of the
therapeutic opportunity these syndromes represent.
The only symptom this patient has that is shared by patients with Parkinson disease is a shuffling
gait. Otherwise, his presentation—normal posture, arm swing, and muscle tone and the absence
of a tremor—is quite different.
Likewise, this patient has no history of or symptoms suggesting stroke or vascular disease, such
as sudden onset of neurologic signs or symptoms, which makes vascular dementia unlikely.
Although coincident vascular, Alzheimer-type, and Parkinson-type pathology is a common finding
in autopsy studies, even in neurologically unimpaired healthy elderly adults, this fact should
Neuro 2
An 18-year-old male college student is evaluated for a single generalized tonic-clonic seizure that
began when he was asleep in his dormitory and resolved uneventfully. He has no history of head
trauma, meningitis, or prior seizure and no family history of epilepsy. He takes no medications.
Results of physical examination, including a neurologic examination, are normal.
Results of laboratory studies, including a complete blood count, a serum electrolyte panel, and a
urine toxicology screen, are also normal.
An MRI of the brain and an electroencephalogram show no abnormalities.
A+ TEST BANK 2
, NBME CBSE REAL Final Exam
2025/2026
Which of the following is the most appropriate management of this patient's seizure?
A Initiate no drug therapy at this time
B Initiate therapy with carbamazepine
C Initiate therapy with lamotrigine
D Initiate therapy with valproic acid
E Refer for epilepsy surgery evaluation
- Correct Answer :A
Unless special circumstances exist, drug therapy is generally not started in patients with a single
unprovoked seizure.
Drug therapy should not be initiated in this patient at this time. After a single unprovoked
seizure, the risk of recurrence in the subsequent 2 years has been reported to be 30% to 40%.
The risk of recurrence is greatest in patients with status epilepticus on presentation, with an
identifiable underlying neurologic cause, or with abnormal results on an electroencephalogram
(EEG). Patients with a partial seizure who are age 65 years or older or who have a family history
of epilepsy may also be in a higher-risk category. The appropriate recommendation for this
young patient, who has experienced a single idiopathic seizure but has no personal or family
history of epilepsy, no identified neurologic cause of his seizure, and normal results on an EEG, is
that no medication be started. As with all medical treatment recommendations, patient
preference must be taken into account, and some patients in the low-risk group may elect to
start therapy after a single seizure, particularly if they have a high-risk occupation. If a second
seizure occurs in the future, the recurrence risk is greater than 60%, and antiepileptic medical
therapy should be recommended at that time.
Of note, driver's license privileges are restricted in every state in the United States for persons
who have experienced a seizure. Specific restrictions vary by state, with typical requirements of a
seizure-free period of 3 to 12 months in order to again operate a motor vehicle; a few states
make exceptions for a single seizure. Reinstatement of driving privileges depends on
A+ TEST BANK 3
, NBME CBSE REAL Final Exam
2025/2026
demonstrating freedom from seizures for the specified period and there being a reasonable
expectation of future seizure control. Initiation of antiepileptic medication
Neuro 3
A 36-year-old woman is evaluated in the office for a history of migraine, with and without aura,
since age 16 years. She has an average of three attacks each month and consistently experiences
an attack 2 days prior to menstruation; this headache is more difficult to treat than those not
associated with menstruation. Although she typically obtains pain relief within 2 hours of taking
sumatriptan, the headache recurs within 24 hours after each dose during the period of
menstrual flow. Sumatriptan, orally as needed, is her only medication.
Results of physical examination are unremarkable.
Which of the following is the most appropriate perimenstrual treatment for this patient's
headaches?
A Estrogen-progestin contraceptive pill
B Mefenamic acid
C Sumatriptan plus naproxen, orally
D Sumatriptan, subcutaneously
E Topiramate
- Correct Answer :B
Evidence supports the use of mefenamic acid for perimenstrual prophylaxis of menstrually
related migraines, with treatment starting 2 days prior to the onset of flow or 1 day prior to the
expected onset of the headache and continuing for the duration of menstruation.
A+ TEST BANK 4
