Page 1 of 215
NCCAOM Biomedicine Board EXAM LATEST
UPDATE THIS YEAR (2026-2027) ALL 300
QUESTIONS AND CORRECT ANSWERS WITH
RATIONALES
1. A 55-year-old patient presents with chest pain radiating to the left arm, shortness of breath,
and diaphoresis. Which structure is most likely involved in the pain pathway?
A) Vagus nerve
B) Phrenic nerve
C) Sympathetic chain ganglia
D) Intercostal nerves
Answer: C
Cardiac pain (angina/MI) is transmitted via visceral afferent fibers that travel with sympathetic
nerves. Pain from the heart is referred to the left arm and jaw because these visceral afferents
enter the same spinal cord segments (T1-T4) as somatic afferents from those areas.
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, Page 2 of 215
2. A 45-year-old woman presents with drooping of her left eyelid (ptosis), a constricted left
pupil (miosis), and lack of sweating on the left side of her face. This triad of symptoms is known
as:
A) Bell's palsy
B) Horner's syndrome
C) Myasthenia gravis
D) Trigeminal neuralgia
Answer: B
Horner's syndrome (ptosis, miosis, anhidrosis) results from disruption of the sympathetic
innervation to the head and neck. The sympathetic pathway originates in the hypothalamus,
descends through the brainstem and spinal cord, and synapses in the superior cervical ganglion.
3. A patient with a history of smoking presents with a non-healing ulcer on the lower lip. Which
layer of the skin is most directly involved in this condition?
A) Stratum corneum
B) Epidermis
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, Page 3 of 215
C) Dermis
D) Subcutaneous tissue
Answer: C
Squamous cell carcinoma, which often presents as a non-healing ulcer on sun-exposed areas,
arises from keratinocytes in the epidermis but invades the dermis as it progresses. The epidermis
is the outermost layer, but the dermis is involved in ulceration.
4. A patient reports dizziness and lightheadedness when standing up quickly. This is most likely
due to dysfunction of which system?
A) Vestibular system
B) Autonomic nervous system
C) Cerebellum
D) Somatosensory system
Answer: B
Orthostatic hypotension, characterized by dizziness upon standing, results from a failure of the
autonomic nervous system to appropriately constrict blood vessels and increase heart rate in
response to gravity-induced blood pooling in the lower extremities.
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, Page 4 of 215
5. A 60-year-old patient with a history of diabetes presents with a loss of sensation in a
"stocking-glove" distribution in both feet. This pattern of sensory loss indicates involvement of
which type of nerve fibers?
A) Motor neurons
B) Sensory neurons (small-diameter unmyelinated and myelinated fibers)
C) Autonomic fibers
D) Cranial nerves
Answer: B
Diabetic peripheral neuropathy typically affects small-diameter sensory fibers (pain and
temperature) and large-diameter fibers (vibration and proprioception) in a symmetric, distal-to-
proximal pattern (stocking-glove distribution). This is due to metabolic and microvascular
damage to peripheral nerves.
6. The parasympathetic nervous system is responsible for which of the following effects?
4
NCCAOM Biomedicine Board EXAM LATEST
UPDATE THIS YEAR (2026-2027) ALL 300
QUESTIONS AND CORRECT ANSWERS WITH
RATIONALES
1. A 55-year-old patient presents with chest pain radiating to the left arm, shortness of breath,
and diaphoresis. Which structure is most likely involved in the pain pathway?
A) Vagus nerve
B) Phrenic nerve
C) Sympathetic chain ganglia
D) Intercostal nerves
Answer: C
Cardiac pain (angina/MI) is transmitted via visceral afferent fibers that travel with sympathetic
nerves. Pain from the heart is referred to the left arm and jaw because these visceral afferents
enter the same spinal cord segments (T1-T4) as somatic afferents from those areas.
1
, Page 2 of 215
2. A 45-year-old woman presents with drooping of her left eyelid (ptosis), a constricted left
pupil (miosis), and lack of sweating on the left side of her face. This triad of symptoms is known
as:
A) Bell's palsy
B) Horner's syndrome
C) Myasthenia gravis
D) Trigeminal neuralgia
Answer: B
Horner's syndrome (ptosis, miosis, anhidrosis) results from disruption of the sympathetic
innervation to the head and neck. The sympathetic pathway originates in the hypothalamus,
descends through the brainstem and spinal cord, and synapses in the superior cervical ganglion.
3. A patient with a history of smoking presents with a non-healing ulcer on the lower lip. Which
layer of the skin is most directly involved in this condition?
A) Stratum corneum
B) Epidermis
2
, Page 3 of 215
C) Dermis
D) Subcutaneous tissue
Answer: C
Squamous cell carcinoma, which often presents as a non-healing ulcer on sun-exposed areas,
arises from keratinocytes in the epidermis but invades the dermis as it progresses. The epidermis
is the outermost layer, but the dermis is involved in ulceration.
4. A patient reports dizziness and lightheadedness when standing up quickly. This is most likely
due to dysfunction of which system?
A) Vestibular system
B) Autonomic nervous system
C) Cerebellum
D) Somatosensory system
Answer: B
Orthostatic hypotension, characterized by dizziness upon standing, results from a failure of the
autonomic nervous system to appropriately constrict blood vessels and increase heart rate in
response to gravity-induced blood pooling in the lower extremities.
3
, Page 4 of 215
5. A 60-year-old patient with a history of diabetes presents with a loss of sensation in a
"stocking-glove" distribution in both feet. This pattern of sensory loss indicates involvement of
which type of nerve fibers?
A) Motor neurons
B) Sensory neurons (small-diameter unmyelinated and myelinated fibers)
C) Autonomic fibers
D) Cranial nerves
Answer: B
Diabetic peripheral neuropathy typically affects small-diameter sensory fibers (pain and
temperature) and large-diameter fibers (vibration and proprioception) in a symmetric, distal-to-
proximal pattern (stocking-glove distribution). This is due to metabolic and microvascular
damage to peripheral nerves.
6. The parasympathetic nervous system is responsible for which of the following effects?
4
