NBME CBSE|VERIFIED QUESTIONS AND CORRECT DETAILED ANSWERS|RATED
AND GRADED A+ NEW UPDATE| 2026/2027
A 35-year-old man who is an undocumented immigrant is diagnosed with tuberculosis. Despite feeling
ill, he did not previously seek medical care because he could not afford to lose time at work. He pleads
with the physician not to report the diagnosis to anyone because he is afraid he will be deported. After
empathizing with the patient, it is most appropriate for the physician to take which of the following
actions? - ANSWER✔ Report the case to the health department to ensure that family members and
work site contacts are identified and evaluated.
TB is a reportable disease.
After an emergency landing in the wilderness, a 25-year-old pilot goes 3 days without food until she is
rescued. Adipocytes play an important role in maintaining homeostasis in this woman because of which
of the following effects? - ANSWER✔ Glucagon activates hormone-sensitive lipase.
When blood sugar is low, glucagon signals the adipocytes to activate hormone-sensitive lipase, and to
convert
triglycerides into free fatty acids
A 60-year-old man develops pain, erythema, and swelling of the right great toe. Serum uric acid
concentration is three times normal. Which of the following findings is most common in patients with
this condition? - ANSWER✔ No specific enzyme or renal defect.
Gout can be caused by underexcretion, overproduction, or overconsumption of purines.
In rare cases, overproduction of uric acid can be genetic. These disorders include hypoxanthine-guanine
phosphoribosyltransferase deficiency (Lesch-Nyhan syndrome), glucose-6-phosphatase deficiency (von
Gierke disease), fructose 1-phosphate aldolase deficiency, and PP-ribose-P synthetase variants.
It can also be linked to thyroid issues, renal insufficancy, or chronic alcohol abuse.
,A 27-year-old woman comes to the physician because of a 5-day history of a moderate vaginal
discharge. Physical examination shows a thin, white, vaginal discharge that has a foul-smelling fishy
odor. Vaginal pH is 6. A Pap smear shows clumps of bacteria on the squamous cells. There are no
leukocytes. Culture of the discharge is most likely to show an increased amount of which of the
following? - ANSWER✔ Gardnerella vaginalis
Gardnerella vaginalis causes vaginosis. (overgrowth of bacteria in vagina)
Symptoms:
- white/gray vaginal discharge
- fishy smell
- non-painful
- Vaginal epithelial cells are covered with bacteria
Treatment: Metronidazole
A 20-year-old man comes to the physician because of a 1-year history of progressive numbness of his
arms. He recently burned his right thumb while cooking, but he felt no pain. Sensation to pain and
temperature is decreased throughout both upper extremities and across the shoulders to the neck.
Sensation is intact elsewhere. The most likely cause of his condition is a lesion in which of the following
spinal cord structures? - ANSWER✔ Anterior white commissure
Sounds like syringomyelia (central dilatation of cord with resultant injury to gray horn and ant white
commissure) which mostly affects the cervical spinal cord.
Crossing fibers of spinothalamic tract are typically damaged first. Bilateral loss of pain and temperature
sensation in upper extremities (fine touch sensation is preserved)
A 40-year-old man comes to the physician for a routine health maintenance examination. There is a
strong family history of myocardial infarctions occurring at the ages of 40 to 50 years. Physical
examination shows no abnormalities.
Serum studies show:
, - Cholesterol, total:
increased
- HDL-cholesterol:
normal
- LDL-cholesterol:
increased
- Triglycerides:
normal
Following treatment with lovastatin, his serum total cholesterol and serum LDL-cholesterol
concentrations decrease. The beneficial effect of lovastatin most likely occurs as a result of which of the
following mechanisms? - ANSWER✔ Increases LDL-receptors
Lovastatin is a HMG-CoA reductase inhibitor - these decrease LDL (aka bad cholesterol) by inhibiting the
cholesterol precursor mevalonate and synthesizing LDL receptors.
A 60-year-old man comes to the physician for a routine health maintenance examination.
Physical examination shows no abnormalities. Urinalysis shows:
- pH: 6.0
- Specific gravity: 1.018
- Blood: 3+
- Glucose: negative
- Protein: 1+
Microscopic examination of the urine shows atypical cells. A CT scan of the abdomen discloses a lesion
of the right kidney as shown in the photograph. Which of the following compounds is the most
significant predisposing risk factor for this patient's condition? - ANSWER✔ 2-Naphthylamine
AND GRADED A+ NEW UPDATE| 2026/2027
A 35-year-old man who is an undocumented immigrant is diagnosed with tuberculosis. Despite feeling
ill, he did not previously seek medical care because he could not afford to lose time at work. He pleads
with the physician not to report the diagnosis to anyone because he is afraid he will be deported. After
empathizing with the patient, it is most appropriate for the physician to take which of the following
actions? - ANSWER✔ Report the case to the health department to ensure that family members and
work site contacts are identified and evaluated.
TB is a reportable disease.
After an emergency landing in the wilderness, a 25-year-old pilot goes 3 days without food until she is
rescued. Adipocytes play an important role in maintaining homeostasis in this woman because of which
of the following effects? - ANSWER✔ Glucagon activates hormone-sensitive lipase.
When blood sugar is low, glucagon signals the adipocytes to activate hormone-sensitive lipase, and to
convert
triglycerides into free fatty acids
A 60-year-old man develops pain, erythema, and swelling of the right great toe. Serum uric acid
concentration is three times normal. Which of the following findings is most common in patients with
this condition? - ANSWER✔ No specific enzyme or renal defect.
Gout can be caused by underexcretion, overproduction, or overconsumption of purines.
In rare cases, overproduction of uric acid can be genetic. These disorders include hypoxanthine-guanine
phosphoribosyltransferase deficiency (Lesch-Nyhan syndrome), glucose-6-phosphatase deficiency (von
Gierke disease), fructose 1-phosphate aldolase deficiency, and PP-ribose-P synthetase variants.
It can also be linked to thyroid issues, renal insufficancy, or chronic alcohol abuse.
,A 27-year-old woman comes to the physician because of a 5-day history of a moderate vaginal
discharge. Physical examination shows a thin, white, vaginal discharge that has a foul-smelling fishy
odor. Vaginal pH is 6. A Pap smear shows clumps of bacteria on the squamous cells. There are no
leukocytes. Culture of the discharge is most likely to show an increased amount of which of the
following? - ANSWER✔ Gardnerella vaginalis
Gardnerella vaginalis causes vaginosis. (overgrowth of bacteria in vagina)
Symptoms:
- white/gray vaginal discharge
- fishy smell
- non-painful
- Vaginal epithelial cells are covered with bacteria
Treatment: Metronidazole
A 20-year-old man comes to the physician because of a 1-year history of progressive numbness of his
arms. He recently burned his right thumb while cooking, but he felt no pain. Sensation to pain and
temperature is decreased throughout both upper extremities and across the shoulders to the neck.
Sensation is intact elsewhere. The most likely cause of his condition is a lesion in which of the following
spinal cord structures? - ANSWER✔ Anterior white commissure
Sounds like syringomyelia (central dilatation of cord with resultant injury to gray horn and ant white
commissure) which mostly affects the cervical spinal cord.
Crossing fibers of spinothalamic tract are typically damaged first. Bilateral loss of pain and temperature
sensation in upper extremities (fine touch sensation is preserved)
A 40-year-old man comes to the physician for a routine health maintenance examination. There is a
strong family history of myocardial infarctions occurring at the ages of 40 to 50 years. Physical
examination shows no abnormalities.
Serum studies show:
, - Cholesterol, total:
increased
- HDL-cholesterol:
normal
- LDL-cholesterol:
increased
- Triglycerides:
normal
Following treatment with lovastatin, his serum total cholesterol and serum LDL-cholesterol
concentrations decrease. The beneficial effect of lovastatin most likely occurs as a result of which of the
following mechanisms? - ANSWER✔ Increases LDL-receptors
Lovastatin is a HMG-CoA reductase inhibitor - these decrease LDL (aka bad cholesterol) by inhibiting the
cholesterol precursor mevalonate and synthesizing LDL receptors.
A 60-year-old man comes to the physician for a routine health maintenance examination.
Physical examination shows no abnormalities. Urinalysis shows:
- pH: 6.0
- Specific gravity: 1.018
- Blood: 3+
- Glucose: negative
- Protein: 1+
Microscopic examination of the urine shows atypical cells. A CT scan of the abdomen discloses a lesion
of the right kidney as shown in the photograph. Which of the following compounds is the most
significant predisposing risk factor for this patient's condition? - ANSWER✔ 2-Naphthylamine
