NBME 31 Practice Exam with All
Correct Answers 2025-2026 Updated.
Bisphosphonates = Alendronates Ibandronate, Risedronate, Zoledrontate pg 486 - Answer
MOA: pyrophosphate analog; bind hydroxyapatite in bone, inhibiting osteoclast activity
Use: osteoporosis, hypercalcemia, Paget disease of bone, metastatic bone disease, osteogenesis
imperfecta
AE: Esophagitis if taken orally, pts are advised to take w/ water and remain upright for 30 mins
-osteonecrosis of jaw
-atypical femoral stress fx
SERMs = selective estrogen receptor modulators pg 443
-Tamoxifen
-Raloxifene = - Answer MOA: receptor antagonists in breast, and agonists in bone
-block binding of estrogen to ER+ cells
Use: Tomxifen= breast CA tx only and prevention
Raloxifene= prevent osteoporosis by promoting osteoblast activity
AE: Tamoxifen= partial agonist in endometrium→ ↑risk of endometrial CA
-Raloxifene= no ↑ in endometrial CA [can relax] bc its an estrogen receptor antagonist to
endometrial tissue
both ↑ risk of thromboembolic events [DVT, PE] and "hot flashes"
Aortic dissection pg 303 - Answer -longitudinal intimal tear forming false lumen
-ass'd w/: HTN, bicuspid aortic valve, inherited connective tissue disorders [Marfan]
-present w/ tearing sudden onset CP radiating to back +/- unequal BP in amrs
CXR: mediastinal widening
-result in organ ischemia, aortic rupture, death
,2 types:
1. stanford A [proximal]:
involves Ascending Aorta
extend to aortic arch or descending aorta
result in acute aortic regurg or cardiac tamponade
2: standford B [distal]
-involves only descending aorta [Below left subclavian]
Tx: Beta blockers then vasodilators
MCQ: CT scan w/ dissection of descending aorta, gives rise to common hepatic artery extending
into celiac trunk
-celiac trunk = first major branch of descending aorta, and gives rise to common hepatic artery,
L gastric artery, and splenic artery at T12
-supplies liver, stomach, proximal duodenum, pancreas, inferior esophagus and spleen
1st initial management of all types of dissection= rapid reduction in blood pressure and pulse to
prevent further propagation of dissection
Colon blood supply - Answer receives blood from SMA and IMA
-SMA supplies:
cecum, ascending colon, proximal 2/3 of transverse colon
-IMA supplies:
distal 1/3 of transverse colon, and upper portion of rectum
kidney blood supply - Answer receives blood from renal artery which branches directly from
descending aorta
-although descending aortic dissection can compromise renal blood flow, it would be thru
involvement of renal arteries not celiac trunk
pancreas and small bowel blood supply: - Answer both get blood from the celiac trunk and
SMA
, - splenic artery= major division of celiac trunk whose branches supply a portion of the pancreas
-common hepatic artery= [another major branch of celiac trunk], gives rise to gastroduodenal
artery which branches into anterior and superior pancreaticoduodenal arteries and supply part
of the pancreas and proximal duodenum.
-SMA gives rise to anterior and posterior inferior pancreaticoduodenal arteries= supply distal
duodenum and part of pancreatic head
-superior and inferior pancreaticoduodenal arteries form an anastomosis
-2/2 dual blood supply, pancreas and small bowel would still get blood flow thru SMA if
dissection occurred thru celiac trunk
Systolic murmurs: pg 291 - Answer Aortic stenosis
Mitral/ tricuspid regurg
Mitral valve prolapse
Ventral Septal defect
Aortic stenosis: pg 291 - Answer -Crescendo decrescendo systolic ejection murmur
-soft S2
-LV >> aortic pressure during systole
-loudest at base; radiates to carotid
-"pulsus parvus et tardus"= pulses weak & delayed
-SAD= Syncope, Angina, Dyspnea
-MC 2/2 age related calcification in pt's>60 yo or younger pts w/ early-onset calcification of
bicuspid aortic valve
mitral/ tricuspid regurg pg 291 - Answer -holosystolic, high- pitched "blowing murmur"
-mitral= loudest at apex and radiates toward axilla
MR = 2/2 ischemic heart dz [post MI], MVP, LV dilation
-Tricuspid= loudest at tricuspid area
TR- MC 2/2 RV dilation
-Rheumatic fever mc causes TR but can cause MR
Mitral valve prolapse pg 291 - Answer -late systolic crescendo murmur w/ midsystolic click
2/2 sudden tensing of chordae tendinae as mitral leaflets prolapse into LA [Chordae cuase
Crescendo w/ Click]
-mc valve lesion
-best heard over apex
Correct Answers 2025-2026 Updated.
Bisphosphonates = Alendronates Ibandronate, Risedronate, Zoledrontate pg 486 - Answer
MOA: pyrophosphate analog; bind hydroxyapatite in bone, inhibiting osteoclast activity
Use: osteoporosis, hypercalcemia, Paget disease of bone, metastatic bone disease, osteogenesis
imperfecta
AE: Esophagitis if taken orally, pts are advised to take w/ water and remain upright for 30 mins
-osteonecrosis of jaw
-atypical femoral stress fx
SERMs = selective estrogen receptor modulators pg 443
-Tamoxifen
-Raloxifene = - Answer MOA: receptor antagonists in breast, and agonists in bone
-block binding of estrogen to ER+ cells
Use: Tomxifen= breast CA tx only and prevention
Raloxifene= prevent osteoporosis by promoting osteoblast activity
AE: Tamoxifen= partial agonist in endometrium→ ↑risk of endometrial CA
-Raloxifene= no ↑ in endometrial CA [can relax] bc its an estrogen receptor antagonist to
endometrial tissue
both ↑ risk of thromboembolic events [DVT, PE] and "hot flashes"
Aortic dissection pg 303 - Answer -longitudinal intimal tear forming false lumen
-ass'd w/: HTN, bicuspid aortic valve, inherited connective tissue disorders [Marfan]
-present w/ tearing sudden onset CP radiating to back +/- unequal BP in amrs
CXR: mediastinal widening
-result in organ ischemia, aortic rupture, death
,2 types:
1. stanford A [proximal]:
involves Ascending Aorta
extend to aortic arch or descending aorta
result in acute aortic regurg or cardiac tamponade
2: standford B [distal]
-involves only descending aorta [Below left subclavian]
Tx: Beta blockers then vasodilators
MCQ: CT scan w/ dissection of descending aorta, gives rise to common hepatic artery extending
into celiac trunk
-celiac trunk = first major branch of descending aorta, and gives rise to common hepatic artery,
L gastric artery, and splenic artery at T12
-supplies liver, stomach, proximal duodenum, pancreas, inferior esophagus and spleen
1st initial management of all types of dissection= rapid reduction in blood pressure and pulse to
prevent further propagation of dissection
Colon blood supply - Answer receives blood from SMA and IMA
-SMA supplies:
cecum, ascending colon, proximal 2/3 of transverse colon
-IMA supplies:
distal 1/3 of transverse colon, and upper portion of rectum
kidney blood supply - Answer receives blood from renal artery which branches directly from
descending aorta
-although descending aortic dissection can compromise renal blood flow, it would be thru
involvement of renal arteries not celiac trunk
pancreas and small bowel blood supply: - Answer both get blood from the celiac trunk and
SMA
, - splenic artery= major division of celiac trunk whose branches supply a portion of the pancreas
-common hepatic artery= [another major branch of celiac trunk], gives rise to gastroduodenal
artery which branches into anterior and superior pancreaticoduodenal arteries and supply part
of the pancreas and proximal duodenum.
-SMA gives rise to anterior and posterior inferior pancreaticoduodenal arteries= supply distal
duodenum and part of pancreatic head
-superior and inferior pancreaticoduodenal arteries form an anastomosis
-2/2 dual blood supply, pancreas and small bowel would still get blood flow thru SMA if
dissection occurred thru celiac trunk
Systolic murmurs: pg 291 - Answer Aortic stenosis
Mitral/ tricuspid regurg
Mitral valve prolapse
Ventral Septal defect
Aortic stenosis: pg 291 - Answer -Crescendo decrescendo systolic ejection murmur
-soft S2
-LV >> aortic pressure during systole
-loudest at base; radiates to carotid
-"pulsus parvus et tardus"= pulses weak & delayed
-SAD= Syncope, Angina, Dyspnea
-MC 2/2 age related calcification in pt's>60 yo or younger pts w/ early-onset calcification of
bicuspid aortic valve
mitral/ tricuspid regurg pg 291 - Answer -holosystolic, high- pitched "blowing murmur"
-mitral= loudest at apex and radiates toward axilla
MR = 2/2 ischemic heart dz [post MI], MVP, LV dilation
-Tricuspid= loudest at tricuspid area
TR- MC 2/2 RV dilation
-Rheumatic fever mc causes TR but can cause MR
Mitral valve prolapse pg 291 - Answer -late systolic crescendo murmur w/ midsystolic click
2/2 sudden tensing of chordae tendinae as mitral leaflets prolapse into LA [Chordae cuase
Crescendo w/ Click]
-mc valve lesion
-best heard over apex
