NBME 3&4 Exam Questions and
Answers 100% PASS
A 32-year-old man comes to a medical clinic in Santiago, Chile, because of a 6-week history
of persistent pain and swelling of his right arm that began after he fell while hiking. Two
months ago, he began an extended solo backpacking trip through a remote part of the
Andes Mountains. He splinted the arm with a stick. His food supply has been limited to
saltine crackers, peanut butter, and processed cheese spread. Today, an x-ray of the right
upper extremity shows a poorly formed callus and nonunion of the fracture ends. This
patient most likely has decreased function of which of the following proteins?WH—
ANSWER-A) Alkaline phosphatase
B) Histidine deaminase
C) Matrix metalloproteinase
D) Neutrophil elastase
E) Prolyl 4-hydroxylaseRationale:
Correct Answer: E.
,Vitamin C (ascorbic acid) is an antioxidant and coenzyme in the synthesis of collagen via
prolyl hydroxylase. Deficiency is common in persons having diets poor in fruits and
vegetables, and results in scurvy, which presents with blood vessel fragility (ie, easy bruising,
petechiae, perifollicular hemorrhage), impaired wound and bone healing, and disordered
hair growth.
Two randomized, double-blind studies (Study X and Study Y) are conducted to assess the
efficacy of a new chemotherapeutic agent. For each study, patients are randomized to
receive either placebo or the new experimental chemotherapy; all subjects are then
followed for a mean of 5 years. Follow-up rates are 92% in Study X and 91% in Study Y.
Results show: The relative risk of dying of cancer is 0.7 in Study X (95% confidence interval of
0.2 to 2.4) and 0.6 in Study Y (95% confidence interval of 0.5 to 0.7). Which of the following
best accounts for this difference in confidence intervals?—ANSWER-A) Bias
B) Difference in follow-up rates
C) Difference in number of patients
D) Different population
E) Randomization error Rationale:
Correct Answer: C.
A confidence interval (CI) proposes a range of values within which a true value is likely to fall.
A CI that includes a value of 1.0 indicates the absence of significant difference between two
groups. A broad CI, or a CI that includes a value of 1.0, is commonly caused by inadequate
statistical power. Statistical power is often limited by an inadequate number of study
© 2026 Copyright. All Rights Reserved. This document is
protected by copyright law, Copyrighted By Brittie Donald
,participants. The power of a study can be increased through a larger sample size and
improved precision in measurements.Q
A 70-year-old man comes to the physician because of a 1-month history of heavy, pressing
substernal chest pain that occurs when he walks up a flight of stairs. The symptoms are
relieved by rest. The physician prescribes a drug to alleviate the symptoms. Within the cell,
the drug acts by breaking down into a compound that binds to a protein to increase
intracellular concentrations of cGMP, resulting in vasodilation. This binding most likely occurs
in which of the following cell locations?—ANSWER-A) Cytosol
B) Golgi complex
C) Mitochondria
D) Nucleus
E) Peroxisome
F) Plasma membraneRationale:
Correct Answer: A.
Nitroglycerin is a potent vasodilator used in the acute management of angina pectoris. It
acts by stimulating guanylate cyclase in the cytosol of vascular smooth muscle cells, leading
to increased cGMP formation and smooth muscle relaxation.
A 27-year-old man comes to the physician because of a 3-week history of pain in his back
and flanks. His blood pressure is 153/87 mm Hg. Palpation of the abdomen and flanks shows
enlarged kidneys bilaterally. Renal ultrasound shows multiple cysts in the cortex and medulla
, of each kidney. Cysts are also likely to be found in which of the following organs?—ANSWER-
A) Adrenal glands
B) Colon
C) Liver
D) Lungs
E) Testicles
answer C
Polycystic kidney disease is caused by genetic mutations that result in the development of
multiple cysts in the kidney as a result of structural abnormalities of the renal tubules.
Aneurysmal vascular disease and hepatic cysts are often present in the autosomal dominant
form of polycystic kidney disease.
A 53-year-old woman having an acute inferior myocardial infarction develops sinus
bradycardia and hypotension. Administration of which of the following is the most
appropriate next step to increase this patient's heart rate?—ANSWER-A) Amiodarone
B) Atenolol
C) Atropine
D) Phenylephrine
E) VerapamilRationale:
Correct Answer: C.
© 2026 Copyright. All Rights Reserved. This document is
protected by copyright law, Copyrighted By Brittie Donald
Answers 100% PASS
A 32-year-old man comes to a medical clinic in Santiago, Chile, because of a 6-week history
of persistent pain and swelling of his right arm that began after he fell while hiking. Two
months ago, he began an extended solo backpacking trip through a remote part of the
Andes Mountains. He splinted the arm with a stick. His food supply has been limited to
saltine crackers, peanut butter, and processed cheese spread. Today, an x-ray of the right
upper extremity shows a poorly formed callus and nonunion of the fracture ends. This
patient most likely has decreased function of which of the following proteins?WH—
ANSWER-A) Alkaline phosphatase
B) Histidine deaminase
C) Matrix metalloproteinase
D) Neutrophil elastase
E) Prolyl 4-hydroxylaseRationale:
Correct Answer: E.
,Vitamin C (ascorbic acid) is an antioxidant and coenzyme in the synthesis of collagen via
prolyl hydroxylase. Deficiency is common in persons having diets poor in fruits and
vegetables, and results in scurvy, which presents with blood vessel fragility (ie, easy bruising,
petechiae, perifollicular hemorrhage), impaired wound and bone healing, and disordered
hair growth.
Two randomized, double-blind studies (Study X and Study Y) are conducted to assess the
efficacy of a new chemotherapeutic agent. For each study, patients are randomized to
receive either placebo or the new experimental chemotherapy; all subjects are then
followed for a mean of 5 years. Follow-up rates are 92% in Study X and 91% in Study Y.
Results show: The relative risk of dying of cancer is 0.7 in Study X (95% confidence interval of
0.2 to 2.4) and 0.6 in Study Y (95% confidence interval of 0.5 to 0.7). Which of the following
best accounts for this difference in confidence intervals?—ANSWER-A) Bias
B) Difference in follow-up rates
C) Difference in number of patients
D) Different population
E) Randomization error Rationale:
Correct Answer: C.
A confidence interval (CI) proposes a range of values within which a true value is likely to fall.
A CI that includes a value of 1.0 indicates the absence of significant difference between two
groups. A broad CI, or a CI that includes a value of 1.0, is commonly caused by inadequate
statistical power. Statistical power is often limited by an inadequate number of study
© 2026 Copyright. All Rights Reserved. This document is
protected by copyright law, Copyrighted By Brittie Donald
,participants. The power of a study can be increased through a larger sample size and
improved precision in measurements.Q
A 70-year-old man comes to the physician because of a 1-month history of heavy, pressing
substernal chest pain that occurs when he walks up a flight of stairs. The symptoms are
relieved by rest. The physician prescribes a drug to alleviate the symptoms. Within the cell,
the drug acts by breaking down into a compound that binds to a protein to increase
intracellular concentrations of cGMP, resulting in vasodilation. This binding most likely occurs
in which of the following cell locations?—ANSWER-A) Cytosol
B) Golgi complex
C) Mitochondria
D) Nucleus
E) Peroxisome
F) Plasma membraneRationale:
Correct Answer: A.
Nitroglycerin is a potent vasodilator used in the acute management of angina pectoris. It
acts by stimulating guanylate cyclase in the cytosol of vascular smooth muscle cells, leading
to increased cGMP formation and smooth muscle relaxation.
A 27-year-old man comes to the physician because of a 3-week history of pain in his back
and flanks. His blood pressure is 153/87 mm Hg. Palpation of the abdomen and flanks shows
enlarged kidneys bilaterally. Renal ultrasound shows multiple cysts in the cortex and medulla
, of each kidney. Cysts are also likely to be found in which of the following organs?—ANSWER-
A) Adrenal glands
B) Colon
C) Liver
D) Lungs
E) Testicles
answer C
Polycystic kidney disease is caused by genetic mutations that result in the development of
multiple cysts in the kidney as a result of structural abnormalities of the renal tubules.
Aneurysmal vascular disease and hepatic cysts are often present in the autosomal dominant
form of polycystic kidney disease.
A 53-year-old woman having an acute inferior myocardial infarction develops sinus
bradycardia and hypotension. Administration of which of the following is the most
appropriate next step to increase this patient's heart rate?—ANSWER-A) Amiodarone
B) Atenolol
C) Atropine
D) Phenylephrine
E) VerapamilRationale:
Correct Answer: C.
© 2026 Copyright. All Rights Reserved. This document is
protected by copyright law, Copyrighted By Brittie Donald
