NBME CBSE ACTUAL TEST QUESTIONS AND
ANSWERS 2024/2025
SECTION 1: CARDIOVASCULAR & PULMONARY
1. A 55yearold man with a history of hypertension presents with sudden onset
of severe, tearing chest pain radiating to his back. His blood pressure is
180/100 mm Hg in the right arm and 140/80 mm Hg in the left arm. Which of
the following is the most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Correct Answer: C
Rationale: Aortic dissection classically presents with sudden, severe, tearing
chest pain that radiates to the back, along with asymmetric blood pressures
between arms. Risk factors include hypertension and connective tissue
disorders. Acute MI presents with pressurelike chest pain; pulmonary
embolism with dyspnea and pleuritic pain; pericarditis with positional chest
pain and friction rub.
,2. A 68yearold woman with a history of chronic heart failure presents with
worsening dyspnea, orthopnea, and peripheral edema. On examination, she
has jugular venous distention, crackles in both lung bases, and an S3 gallop.
Which of the following is the most appropriate firstline medication for this
patient?
A. Digoxin
B. Furosemide
C. Metoprolol
D. Lisinopril
Correct Answer: B
Rationale: This patient has acute decompensated heart failure with volume
overload. Furosemide, a loop diuretic, is the firstline treatment to reduce
preload and relieve pulmonary congestion. Digoxin is used for rate control in
atrial fibrillation; metoprolol and lisinopril are chronic management
medications.
3. A 62yearold man with a 40packyear smoking history presents with a
chronic cough, hemoptysis, and weight loss. Chest Xray shows a hilar mass.
Which of the following cell types is most likely associated with this
presentation?
A. Squamous cell carcinoma
B. Adenocarcinoma
C. Small cell carcinoma
D. Large cell carcinoma
,Correct Answer: A
Rationale: Squamous cell carcinoma of the lung is strongly associated with
smoking and often presents as a central/hilar mass with cavitation.
Hemoptysis is common due to central location. Adenocarcinoma is more
peripheral; small cell is aggressive with early metastasis; large cell is
undifferentiated.
4. A 45yearold man is brought to the emergency department after a motor
vehicle collision. He is tachypneic and hypoxic. Chest Xray shows multiple rib
fractures and a pleural effusion. Which of the following is the most likely
diagnosis?
A. Pneumothorax
B. Hemothorax
C. Pulmonary contusion
D. Flail chest
Correct Answer: B
Rationale: Multiple rib fractures can lacerate the lung or intercostal vessels,
leading to hemothorax. The combination of trauma, hypoxia, and pleural
effusion on imaging is most consistent with hemothorax. Pneumothorax
would show a pleural line without effusion; pulmonary contusion would show
parenchymal opacities; flail chest requires paradoxical movement of the chest
wall.
, 5. A 45yearold woman presents with dyspnea on exertion and fatigue. On
examination, she has a holosystolic murmur at the apex that radiates to the
axilla. Which of the following is the most likely diagnosis?
A. Mitral stenosis
B. Mitral regurgitation
C. Aortic stenosis
D. Aortic regurgitation
Correct Answer: B
Rationale: Mitral regurgitation presents with a holosystolic murmur at the
apex that radiates to the axilla. Mitral stenosis has a diastolic rumble; aortic
stenosis has a systolic ejection murmur at the right upper sternal border;
aortic regurgitation has a diastolic decrescendo murmur.
6. A 65yearold man with a history of diabetes presents with sudden onset of
severe, tearing chest pain radiating to his back. His blood pressure is 180/100
mm Hg in the right arm and 140/80 mm Hg in the left arm. Which of the
following is the most appropriate initial management?
A. Betablocker and surgical consultation
B. Aspirin and heparin
C. Fibrinolytics
D. Nitroglycerin
Correct Answer: A
Rationale: This patient has aortic dissection. Initial management includes
blood pressure control with betablockers (to reduce shear stress) and
ANSWERS 2024/2025
SECTION 1: CARDIOVASCULAR & PULMONARY
1. A 55yearold man with a history of hypertension presents with sudden onset
of severe, tearing chest pain radiating to his back. His blood pressure is
180/100 mm Hg in the right arm and 140/80 mm Hg in the left arm. Which of
the following is the most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Correct Answer: C
Rationale: Aortic dissection classically presents with sudden, severe, tearing
chest pain that radiates to the back, along with asymmetric blood pressures
between arms. Risk factors include hypertension and connective tissue
disorders. Acute MI presents with pressurelike chest pain; pulmonary
embolism with dyspnea and pleuritic pain; pericarditis with positional chest
pain and friction rub.
,2. A 68yearold woman with a history of chronic heart failure presents with
worsening dyspnea, orthopnea, and peripheral edema. On examination, she
has jugular venous distention, crackles in both lung bases, and an S3 gallop.
Which of the following is the most appropriate firstline medication for this
patient?
A. Digoxin
B. Furosemide
C. Metoprolol
D. Lisinopril
Correct Answer: B
Rationale: This patient has acute decompensated heart failure with volume
overload. Furosemide, a loop diuretic, is the firstline treatment to reduce
preload and relieve pulmonary congestion. Digoxin is used for rate control in
atrial fibrillation; metoprolol and lisinopril are chronic management
medications.
3. A 62yearold man with a 40packyear smoking history presents with a
chronic cough, hemoptysis, and weight loss. Chest Xray shows a hilar mass.
Which of the following cell types is most likely associated with this
presentation?
A. Squamous cell carcinoma
B. Adenocarcinoma
C. Small cell carcinoma
D. Large cell carcinoma
,Correct Answer: A
Rationale: Squamous cell carcinoma of the lung is strongly associated with
smoking and often presents as a central/hilar mass with cavitation.
Hemoptysis is common due to central location. Adenocarcinoma is more
peripheral; small cell is aggressive with early metastasis; large cell is
undifferentiated.
4. A 45yearold man is brought to the emergency department after a motor
vehicle collision. He is tachypneic and hypoxic. Chest Xray shows multiple rib
fractures and a pleural effusion. Which of the following is the most likely
diagnosis?
A. Pneumothorax
B. Hemothorax
C. Pulmonary contusion
D. Flail chest
Correct Answer: B
Rationale: Multiple rib fractures can lacerate the lung or intercostal vessels,
leading to hemothorax. The combination of trauma, hypoxia, and pleural
effusion on imaging is most consistent with hemothorax. Pneumothorax
would show a pleural line without effusion; pulmonary contusion would show
parenchymal opacities; flail chest requires paradoxical movement of the chest
wall.
, 5. A 45yearold woman presents with dyspnea on exertion and fatigue. On
examination, she has a holosystolic murmur at the apex that radiates to the
axilla. Which of the following is the most likely diagnosis?
A. Mitral stenosis
B. Mitral regurgitation
C. Aortic stenosis
D. Aortic regurgitation
Correct Answer: B
Rationale: Mitral regurgitation presents with a holosystolic murmur at the
apex that radiates to the axilla. Mitral stenosis has a diastolic rumble; aortic
stenosis has a systolic ejection murmur at the right upper sternal border;
aortic regurgitation has a diastolic decrescendo murmur.
6. A 65yearold man with a history of diabetes presents with sudden onset of
severe, tearing chest pain radiating to his back. His blood pressure is 180/100
mm Hg in the right arm and 140/80 mm Hg in the left arm. Which of the
following is the most appropriate initial management?
A. Betablocker and surgical consultation
B. Aspirin and heparin
C. Fibrinolytics
D. Nitroglycerin
Correct Answer: A
Rationale: This patient has aortic dissection. Initial management includes
blood pressure control with betablockers (to reduce shear stress) and
