1 | Page
NBME CBSE REAL EXAM 400 QUESTIONS AND
ANSWERS LATEST (usmle step 1) MEDICAL
EXAMINATION 2025/2026
12. Female newborn is delivered at 38 weeks' gestation. Apgar 8 and 8
at 1/5 min. PE shows a bulging, fluod0filled mass approximately 5 cm in
diameter in the midline over the lumbosacral region. No spontaneous
movements of the lower extremities. Abnormality most likely occurred
because of abnormal development during which periods of post
conception (in days)?
- 15 to 40
13. 64yo M in ED 3 hours after SOB with exertion and extreme fatigue.
Has ischemic heart disease. P 125/min, BP 105/60. ECG shows atrial
fibrillation. Intravenous ibutilide is administered. Ten minutes later,
ECG shows normal sinus rhythm. Risk for which drug effect in the next 6
hours?
- Torsades de pointes
14. 65yo F with 20-year hx of osteoarthritis of the hands now has pain
radiating down the distal anterior thigh, knee, medial leg, and food.
Bony outgrowth of vertebrae compressing one of the spinal nerves is
suspected. Nerve root in which intervertebral foramina is effected?
- L-3 to 4
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15. 38yo M with 3-year hx of T2DM. Taking an oral antihyperglycemic
agent, he has tried diet and exercise. BMI 32. PE normal. Hb A1c is 10%.
Physician recommends initiation of insulin injections. Responds, "I
know that insulin would help control my blood sugar. But a lot of
people in my family have diabetes, and insulin made them really sick at
times. Patient is at which stage of change?
- Contemplation
16. 24yo M with 2-day history of an itchy rash on his arms and legs.
Returned from a camping trip in the woods 5 days ago. PE shows
edematous, erythematous rash with linear vesicles. Cause is activation
of which cell types?
- T lymphocytes
17. 70yo M from china with poorly differentiated monoclonal
carcinoma of the nasopharynx. DNA probes of neoplastic cells are most
likely to detect genome of which virus?
- Epstein-Barr virus
18. Epidemiologic study of aniline dye, 500 workers with bladder
cancer and 200 workers without. Exposed to aniline dyes/Have Bladder
cancer: Yes/Yes (250), Yes/No (50), No/Yes (250), No/No (150). Odds
ratio?
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-3
19. 24yo M with hx of IVDA could not be aroused. Friend reports that
the patient injected himself with a drug 6 hours ago. Labs show drug
concentration of 0.3. Assuming first-order one-compartment kinetics,
has a half-life of 2 hours, and a volume of distribution of 200 L in this
patient. What is quantity of drug (in mg) injected?
- 480
20. Compound is taken up by bacterial cells. No energy is necessary for
uptake, and the compound is not concentrated in the cell. Which
describes this mechanism of transport?
- Carrier-mediated diffusion
21. Newborn has male genital ducts but female external genitalia.
Cytogenetic analysis shows a 46,XY karyotype, and genetic testing
shows a mutation of the gene encoding 5alpha-reductase. In absence of
this mutation, labia majora would have been?
- Scrotum
22. Study designed to evaluate the efficacy of coenzyme Q10 in
improving cardiac output in patients with CHF. Sixty patients with CHF
are recruited. Each assigned by coin toss to one of tw groups. Design?
- Candomized clinical trial
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23. 12yo boy immersed up to his neck in 60F water for 20 minutes.
Physiological changes?
- Central blood volume INCREASED, ADH (vasopressin) DECREASED,
Atrial Natriuretic Peptide INCREASED??
24. Rndomized controlled study of 2000 patients with insomnia is
conducted to evaluate the efficacy of a new medication to treat this
condition. Ten subjects from both the control and treatment groups do
not complete the study are are not included in the analysis. Treatment
group able to fall asleep 5 minutes faster than control (p=0.001).
Neither group report an improvement in quality of life.
Conclude that new med is efficacious in treating insomnia. Type of
error?
- Failure to distinguish between statistical significance and clinical
significance
25. 50yo M with increasing cough for 6 month and hemoptysis for 1
week. Smoked 1 pack per day for 32 years. Plays squash, swims. CXR
shows a 3 x 4-cm hilar mass. Cytologic examination of sputum shows a
non-small cell carcinoma. Tells patient he has lung cancer. The patient
reponds, "How can this be happening to m? I eat right and exercise."
Appropriate resposne?
- "It must be difficult for you to accept this diagnosis when you feel
healthy."
NBME CBSE REAL EXAM 400 QUESTIONS AND
ANSWERS LATEST (usmle step 1) MEDICAL
EXAMINATION 2025/2026
12. Female newborn is delivered at 38 weeks' gestation. Apgar 8 and 8
at 1/5 min. PE shows a bulging, fluod0filled mass approximately 5 cm in
diameter in the midline over the lumbosacral region. No spontaneous
movements of the lower extremities. Abnormality most likely occurred
because of abnormal development during which periods of post
conception (in days)?
- 15 to 40
13. 64yo M in ED 3 hours after SOB with exertion and extreme fatigue.
Has ischemic heart disease. P 125/min, BP 105/60. ECG shows atrial
fibrillation. Intravenous ibutilide is administered. Ten minutes later,
ECG shows normal sinus rhythm. Risk for which drug effect in the next 6
hours?
- Torsades de pointes
14. 65yo F with 20-year hx of osteoarthritis of the hands now has pain
radiating down the distal anterior thigh, knee, medial leg, and food.
Bony outgrowth of vertebrae compressing one of the spinal nerves is
suspected. Nerve root in which intervertebral foramina is effected?
- L-3 to 4
,2 | Page
15. 38yo M with 3-year hx of T2DM. Taking an oral antihyperglycemic
agent, he has tried diet and exercise. BMI 32. PE normal. Hb A1c is 10%.
Physician recommends initiation of insulin injections. Responds, "I
know that insulin would help control my blood sugar. But a lot of
people in my family have diabetes, and insulin made them really sick at
times. Patient is at which stage of change?
- Contemplation
16. 24yo M with 2-day history of an itchy rash on his arms and legs.
Returned from a camping trip in the woods 5 days ago. PE shows
edematous, erythematous rash with linear vesicles. Cause is activation
of which cell types?
- T lymphocytes
17. 70yo M from china with poorly differentiated monoclonal
carcinoma of the nasopharynx. DNA probes of neoplastic cells are most
likely to detect genome of which virus?
- Epstein-Barr virus
18. Epidemiologic study of aniline dye, 500 workers with bladder
cancer and 200 workers without. Exposed to aniline dyes/Have Bladder
cancer: Yes/Yes (250), Yes/No (50), No/Yes (250), No/No (150). Odds
ratio?
,3 | Page
-3
19. 24yo M with hx of IVDA could not be aroused. Friend reports that
the patient injected himself with a drug 6 hours ago. Labs show drug
concentration of 0.3. Assuming first-order one-compartment kinetics,
has a half-life of 2 hours, and a volume of distribution of 200 L in this
patient. What is quantity of drug (in mg) injected?
- 480
20. Compound is taken up by bacterial cells. No energy is necessary for
uptake, and the compound is not concentrated in the cell. Which
describes this mechanism of transport?
- Carrier-mediated diffusion
21. Newborn has male genital ducts but female external genitalia.
Cytogenetic analysis shows a 46,XY karyotype, and genetic testing
shows a mutation of the gene encoding 5alpha-reductase. In absence of
this mutation, labia majora would have been?
- Scrotum
22. Study designed to evaluate the efficacy of coenzyme Q10 in
improving cardiac output in patients with CHF. Sixty patients with CHF
are recruited. Each assigned by coin toss to one of tw groups. Design?
- Candomized clinical trial
, 4 | Page
23. 12yo boy immersed up to his neck in 60F water for 20 minutes.
Physiological changes?
- Central blood volume INCREASED, ADH (vasopressin) DECREASED,
Atrial Natriuretic Peptide INCREASED??
24. Rndomized controlled study of 2000 patients with insomnia is
conducted to evaluate the efficacy of a new medication to treat this
condition. Ten subjects from both the control and treatment groups do
not complete the study are are not included in the analysis. Treatment
group able to fall asleep 5 minutes faster than control (p=0.001).
Neither group report an improvement in quality of life.
Conclude that new med is efficacious in treating insomnia. Type of
error?
- Failure to distinguish between statistical significance and clinical
significance
25. 50yo M with increasing cough for 6 month and hemoptysis for 1
week. Smoked 1 pack per day for 32 years. Plays squash, swims. CXR
shows a 3 x 4-cm hilar mass. Cytologic examination of sputum shows a
non-small cell carcinoma. Tells patient he has lung cancer. The patient
reponds, "How can this be happening to m? I eat right and exercise."
Appropriate resposne?
- "It must be difficult for you to accept this diagnosis when you feel
healthy."
