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NBME CBSE REAL EXAM (USMLE STEP 1) MEDICAL EXAMINATION
NEWEST 2026-2027 ACTUAL EXAM WITH COMPLETE QUESTIONS
AND CORRECT DETAILED ANSWERS (100% VERIFIED ANSWERS)
|ALREADY GRADED A+| ||PROFESSOR VERIFIED||
42yo M in ED for 5-hour hx of fever, chills, and severe pain and
swelling of his left arm. Scratched his arm on a nail yesterday.
Appears confused, T 40C, BP 71/38. Labs show Hb 14, HCt 42%,
WBC 15K (35% PMNs, 40% bands, 25% lymphos), Platelets 50K,
Serum BUN 28, Cr 2.8. Symptoms due to systematic release of
which cytokines? - ANSWER-Septic shock--> IL-1 and TNF-alpha
62yo M dies suddenly while playing tennis. No cardiac risk
factors, no hx of CAD. Autopsy, cardiac valve defect and
concentric LVH. Which valve abrnomalities is most likely
involved? - ANSWER-AS
67yo M has urinary urgency after placement of urinary bladder
catheter during transurethral resection of the prostate. Most
appropriate Rx has which MOA? - ANSWER-Urinary urge
incontinence--> Oxybutinin--> M3 R antagonist
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Mouse embryos are produced with two pronuclei, both of same
parental origin. When the pronuclei are maternal, produces have
poorly developed extraembryonic structures. When both pronuclei
are paternal, produces have poorly developed embryonic tissue.
Which genetic mechnanisms? - ANSWER-Imprinting
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
63yo M with 6-month hx of exertional chest pain relieved by rest.
smoked for 45 years. Mild HTN, no meds. Which lesion in LAD is
most likely cause? - ANSWER-Calcified 80% stenosis
65yo F with ovarian cancer treated with cyclophosphamide and
other chemotherapeutic agents. Cyclophosphamide affects which
target? - ANSWER-DNA replication
Pharm co trying to develop a long-acting weight-loss agent that
mimics activity of a naturally occurring peptide originates in
,3|Page
adipose tissue, signals brain about stored fat, and suppresses
appetite by its action in the CNS. Which chemical mediator? -
ANSWER-Leptin
45yo F has thyroidectomy because of asymmetric enlargement of
thyroid noticed 6 weeks ago. Underwent adrenalectomy for
pheochromocytoma 3 years ago. Bilateral thyroid lesions with
spindle cells arranged in small clusters. Amyloid deposits b/w
neoplastic cells. C-cell hyperplasia, malignant. Which marker to
monitor? - ANSWER-Calcitonin (MEN 2A)
45yo F intubated, mechanically ventilated with fungemia with
Candida albicans. Rx with caspofungin is started. Feature of
causal organism targeted by this drug? - ANSWER-B-glucan
carbohydrates in the cell wall
56yo M 4 hours after sudden onset of uncontrollable irregular
movements of the left side of the body. PE shows flailing
movements of the proximal appendicular muscles on the left.
Nuclei damaged? - ANSWER-Right subthalamic (contralateral
lesion)
, 4|Page
60yo M 1-month Hx of progressive SOB with exertion.
Breath sounds: Dec on right lung base, normal on left lung base
Percussion note dull on right lung base, nml on left lung base
Tactile fremitus decreased on right lung base, nml on left lung
base
Adventitious sounds none on right lung base, crackles on left lung
base
Dx? - ANSWER-Pleural effusion
68yo M with difficulty swallowing solids for 2 months. Hx of dilated
cardiomyopathy. X-rays of esophagus w/ barium contrast show
indentation and posterior displacement of the esophagus.
Enlargement of what caused dysphagia? - ANSWER-LA
40yo woman hx of 6 month episodic sinusitis with 2-week
intermittent headaches, fatigue, and generalized joint pain,
worsening cough productive of blood-tinged sputum. Failed
antibiotics, decongestants and nasal corticosteroids. Physical
exam: erythema nasal mucosa, two small ulceration. Lungs
NBME CBSE REAL EXAM (USMLE STEP 1) MEDICAL EXAMINATION
NEWEST 2026-2027 ACTUAL EXAM WITH COMPLETE QUESTIONS
AND CORRECT DETAILED ANSWERS (100% VERIFIED ANSWERS)
|ALREADY GRADED A+| ||PROFESSOR VERIFIED||
42yo M in ED for 5-hour hx of fever, chills, and severe pain and
swelling of his left arm. Scratched his arm on a nail yesterday.
Appears confused, T 40C, BP 71/38. Labs show Hb 14, HCt 42%,
WBC 15K (35% PMNs, 40% bands, 25% lymphos), Platelets 50K,
Serum BUN 28, Cr 2.8. Symptoms due to systematic release of
which cytokines? - ANSWER-Septic shock--> IL-1 and TNF-alpha
62yo M dies suddenly while playing tennis. No cardiac risk
factors, no hx of CAD. Autopsy, cardiac valve defect and
concentric LVH. Which valve abrnomalities is most likely
involved? - ANSWER-AS
67yo M has urinary urgency after placement of urinary bladder
catheter during transurethral resection of the prostate. Most
appropriate Rx has which MOA? - ANSWER-Urinary urge
incontinence--> Oxybutinin--> M3 R antagonist
,2|Page
Mouse embryos are produced with two pronuclei, both of same
parental origin. When the pronuclei are maternal, produces have
poorly developed extraembryonic structures. When both pronuclei
are paternal, produces have poorly developed embryonic tissue.
Which genetic mechnanisms? - ANSWER-Imprinting
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
63yo M with 6-month hx of exertional chest pain relieved by rest.
smoked for 45 years. Mild HTN, no meds. Which lesion in LAD is
most likely cause? - ANSWER-Calcified 80% stenosis
65yo F with ovarian cancer treated with cyclophosphamide and
other chemotherapeutic agents. Cyclophosphamide affects which
target? - ANSWER-DNA replication
Pharm co trying to develop a long-acting weight-loss agent that
mimics activity of a naturally occurring peptide originates in
,3|Page
adipose tissue, signals brain about stored fat, and suppresses
appetite by its action in the CNS. Which chemical mediator? -
ANSWER-Leptin
45yo F has thyroidectomy because of asymmetric enlargement of
thyroid noticed 6 weeks ago. Underwent adrenalectomy for
pheochromocytoma 3 years ago. Bilateral thyroid lesions with
spindle cells arranged in small clusters. Amyloid deposits b/w
neoplastic cells. C-cell hyperplasia, malignant. Which marker to
monitor? - ANSWER-Calcitonin (MEN 2A)
45yo F intubated, mechanically ventilated with fungemia with
Candida albicans. Rx with caspofungin is started. Feature of
causal organism targeted by this drug? - ANSWER-B-glucan
carbohydrates in the cell wall
56yo M 4 hours after sudden onset of uncontrollable irregular
movements of the left side of the body. PE shows flailing
movements of the proximal appendicular muscles on the left.
Nuclei damaged? - ANSWER-Right subthalamic (contralateral
lesion)
, 4|Page
60yo M 1-month Hx of progressive SOB with exertion.
Breath sounds: Dec on right lung base, normal on left lung base
Percussion note dull on right lung base, nml on left lung base
Tactile fremitus decreased on right lung base, nml on left lung
base
Adventitious sounds none on right lung base, crackles on left lung
base
Dx? - ANSWER-Pleural effusion
68yo M with difficulty swallowing solids for 2 months. Hx of dilated
cardiomyopathy. X-rays of esophagus w/ barium contrast show
indentation and posterior displacement of the esophagus.
Enlargement of what caused dysphagia? - ANSWER-LA
40yo woman hx of 6 month episodic sinusitis with 2-week
intermittent headaches, fatigue, and generalized joint pain,
worsening cough productive of blood-tinged sputum. Failed
antibiotics, decongestants and nasal corticosteroids. Physical
exam: erythema nasal mucosa, two small ulceration. Lungs
