NBME 16 | Practice Questions & Answers
An animal study is conducted to assess the effects of Mucus secretion: increases
smoking on pulmonary defense and maintenance Macrophage activity: decreases
mechanisms. For 1 week, normal male rats are exposed to Mucociliary action: decreases
levels of cigarette smoke comparable to those
encountered by humans who smoke cigarettes. Results of
pulmonary testing are compared with baseline levels
obtained the week before the smoke exposure. Which of
the following sets of changes is most likely to be
observed?
20-year-old F secretary with 8yr history of intermittent Migraine
headaches. Flashing lights in her right visual field, followed
20 minutes later by a unilateral throbbing headache
accompanied by nausea and vomiting. occur around time
of menses. Dx?
57-year-old M with 6mo hx of progressive constipation and Inferior mesenteric
a feeling of rectal fullness. Digital rectal examination shows
no palpable lesion. Occult blood positive. Coolonoscopy
shows mass in sigmoid colon. Adenocarcinoma. Mets
spread via which of the following lymph nodes?
70 yr old african american women come to physician after Gender
1 day onset of back pain. She's a part time cashier, low
income, and smoked 1/2 a pack for 50 years and drinks 3
caffeinated beverages a day. X-ray shows vertebral
compression fracture of L3 and she has decreased bone
mineral density. Biggest risk factor?
5-year-old-boy with mental retardedation is grossly obese Check for two maternal copies of chromosome 15
and has facial features of Prader-Willi syndrome.
Karytoyping and flourescent in situ hybridization studies do
not show deletion in the usual site. Which to confirm PWS?
83yo M from Puerto Rico with weight loss and abdominal Use a Spanish-speaking interpreter to determine how much the patient wishes to
pain and blood in his stool for 1 month. Possible colon know about his diagnosis and treatment
cancer. Poor english. Needs colonoscopy but family
doesn't want to hear bad news and wants to make
decision for about his treatment. Next step?
38-year-old F undergoes laparoscopic cholecystecomy Ondansetron
with general anesthesia. After she awakens
postoperatively, she is nauseated and vomits three times
in 20 minutes. Treatment for N/V?
During an experimental study of oxygen consumption in PCT
the kidney, experimental animals are ventilated with 100%
nitrogen. Cells from which of the following areas of the
kidney first show signs of anoxic injury?
7-year-old girl 30 minutes after being hit in the mouth with Right lower lobe
basketball. Something stuck in her throat. Part of one tooth
is missing. Lateral x-ray of the neck and chest is shown;
arrow shows part of the tooth. Greatest risk for aspiration
into which lobes?
Poliovirus mRNA lacks a 5' m7G cap but is translated Presence of an internal ribosome entry site
efficiently by cellular ribosomes. Which of the following
additional structural features of poliovirus mRNA is the
most likely cause of its ability to be translated in the
absence of a cap?
67-year-old F brother and mother have history of colon Low sensitivity
cancer. Physician recommends colonoscopy, but patent
only wants her stool to be tested for blood. Most likely
concerned about which of the following regarding this test?
Stuvia 2026-2027
, NBME 16 | Practice Questions & Answers
69-year-old African American woman has moderate ACEI or ARB (Irbesartan)
hypertension and type 2 DM. BMI 31. On
hydrohlorothiazide. Labs show microalbuminuria. Most
appropriate to add which drugs?
36-year-old man with 2-hour history of pain and swelling of Activation of AT III (heparin)
his right calf. No shortness of breath or chest pain. 18-hour
airplane trip 4 hours ago. Noninvasive vascular studies
show an occlusion of right femoral vein. Immediate therapy
has which mechanisms of action?
64 yr old alcoholic man with 1 day of confusion. Killing of bacteria in the gut that generate ammonia
Disoriented, disheveled. Dehydrated, jaundiced. and has
spider angiomata over face and chest. Has flapping up
and down of the hands when his arms are outstretched.
Abdominal distention and bulging flanks. He is
administered oral neomycin. Question asks which of the
following primary mechanisms of action is most likely to
occur in this patient as a result of the drug treatment?
1 year old boy is brought in. Has white, pale hair that Inability to make melanin (tyrosinase deficiency)
hasn't changed color since birth. His eyes are blue. During
ophthalmic examination, the patient turns away from the
flashlight and starts crying. Which of the following is the
most likely cause of the pale skin color?
2-year-old boy with developmental delay. Hx of hearing MELAS
loss in mother and delayed speech in older sister. Maternal Heteroplasmy
uncle had stroke-like episodes at the age of 25 years.
Physical shows ophthalmoplegia and hypotonia. Lactic
acid concentration increased. Explanation?
Male newborn at 28 weeks' is tachypneic and hypoxemic. Decreased number of lamellar bodies (used to secrete surfactant)
Which altered structure changes in the type II
pneumocytes is the most likely cause?
16-year-old girl with cystic fibrosis with 3-week history of Vitamin E
generalized weakness, numbness and tingling of her arms
and legs, and difficulty walking. Not adhered to
medications. Bilateral weakness and decreased deep
tendon reflexes in the upper and lower extremities. Walks
with an ataxic gait. Cause is deficiency of which?
48-year-old woman with 6-month hx of irregular menstrual Menopause (increased FSH)
periods and hot flashes. LMP 35 days ago, and had scant
blood flow. Menses had previously occurred at regular 28-
day cycles. Mild thinning of the vaginal tissue. Labs most
likely to show which of the following serum concentrations?
62-year-old M with unstable angina pectoris undergoes Left coronary artery
coronary catheterization. To visualize the anterior
interventricular (left anterior descending) artery, the tip of
the catheter would need to be placed into the orifice of
which arteries?
35-year-old F with intermittent sharp chest pain Pericarditis
exacerbated by deep breathing, and can be decreased by
leaning forward. 2-month hx of pain and swelling in her
hands and knees accompanied by morning stiffness that
lasts 1 hour. Pulsus paradoxus less than 10 mm Hg. Harsh
scratchy sound present in systole and diastole. Warmth,
swelling, and tenderness of the metacarphophalangeal
joints and knees. Cause?
60-year-old M with a systolic murmur is heard, which is AS
loudest at the R second intercostal space. Which cardiac
abnormality is the cause?
Stuvia 2026-2027
, NBME 16 | Practice Questions & Answers
31-year-old woman with invasive squamous cell carcinoma T-lymphocytes (CD8+ will present to MHC I)
of the cervix. Biopsy shows tumor cells express human
papillomavirus, type 16 antigens. Which cell types plays a
role in recognizing and killing these virus-infected tumor
cells?
An 85-year-old woman is diagnosed with a fracture of the Morphine is metabolized to active metabolites that accumulate
right femur and begins treatment with morphine by patient-
controlled analgesic pump. Three days later, her
respirations are 6/min. Physical examination shows
pinpoint pupils. Her serum creatinine concentration is 1.8
mg/dL. Which of the following best explains this patient's
clinical deterioration after the initiation of morphine
therapy?
35 y/o man with 3 yr history of enlarging nose, coarse adenylyl cyclase
facies, muscle weakness, increased hand/foot size. Large
fleshy nose and prognathism on exam. High IGF-1 in
serum. MRI shows pituitary adenoma. Morphologic
analysis of the tumor shows a densely granulated
somatotroph adenoma. Further studies show that the G
alpha-s subunit of the tumor G proteins lack GTPase
activity. The tumor cells most likely have an increased
activity of which enzyme?
30-year-old woman with Li-Fraumeni syndrome found to Impaired regulation of apoptosis
have adenocarcinoma of the breast. Family history
includes osteosarcoma. Which mechanisms underlies this
condition?
56-year-old with palpable hard nodule on prstate has Pelvis parasympathetic nerves
increased serum prostate-specific antigen concentration.
Fine-needle biopsy specimen shows adenocarcinoma.
Patient undergoes radical prostatectomy. Which structure
is at greatest risk for injury during removal of prostate?
56-year-old woman frequently burned herself while Syrinx of the central region of the spinal cord from C4 to T5
cooking. Loss of pain and temperature sensation in both
upper extremities and portion of her trunk from clavicles to
just below the nipples. Touch, vibratory sensation, and
proprioception normal. Findings on MRI of head and
spine?
66-year-old man surgical excision of a brain mass; RCC
photomicrograph of excised tissue shown. Smoked 1 pack Kidney
daily for 50 years. Labs show polycythemia,
hypercalcemia, and microscopic hematuria.
Immunostaining of the tissue is positive for epithelial
membrane antigen and negative for carcinoembryonic
antigen. Site of primary neoplasm?
25-year-old man comes to the physician 8 hours after the Rupture of an intervertebral disc
onset of severe pain of his low back that radiates down his
left leg. He started a weight-lifting regimen earlier in the
day during which he tried to lift a bar loaded with 91 kg
(200 lb) from the ground to over his head. The pain began
almost immediately after this attempt Which of the
following is the most likely cause of this patients pain?
43-year-old man with 6-week hx of sharp, stabbing pain on V2 branch of trigeminal-- foramen rotundum
the left side of his face that occurs when he touches it.
Pain when shaving. Pain just lateral to the left nasal ala
reproduces the pain. Nerve supplying this area exits the
skull through which foramina?
Where does V3 exit? Foramen ovale
Stuvia 2026-2027
An animal study is conducted to assess the effects of Mucus secretion: increases
smoking on pulmonary defense and maintenance Macrophage activity: decreases
mechanisms. For 1 week, normal male rats are exposed to Mucociliary action: decreases
levels of cigarette smoke comparable to those
encountered by humans who smoke cigarettes. Results of
pulmonary testing are compared with baseline levels
obtained the week before the smoke exposure. Which of
the following sets of changes is most likely to be
observed?
20-year-old F secretary with 8yr history of intermittent Migraine
headaches. Flashing lights in her right visual field, followed
20 minutes later by a unilateral throbbing headache
accompanied by nausea and vomiting. occur around time
of menses. Dx?
57-year-old M with 6mo hx of progressive constipation and Inferior mesenteric
a feeling of rectal fullness. Digital rectal examination shows
no palpable lesion. Occult blood positive. Coolonoscopy
shows mass in sigmoid colon. Adenocarcinoma. Mets
spread via which of the following lymph nodes?
70 yr old african american women come to physician after Gender
1 day onset of back pain. She's a part time cashier, low
income, and smoked 1/2 a pack for 50 years and drinks 3
caffeinated beverages a day. X-ray shows vertebral
compression fracture of L3 and she has decreased bone
mineral density. Biggest risk factor?
5-year-old-boy with mental retardedation is grossly obese Check for two maternal copies of chromosome 15
and has facial features of Prader-Willi syndrome.
Karytoyping and flourescent in situ hybridization studies do
not show deletion in the usual site. Which to confirm PWS?
83yo M from Puerto Rico with weight loss and abdominal Use a Spanish-speaking interpreter to determine how much the patient wishes to
pain and blood in his stool for 1 month. Possible colon know about his diagnosis and treatment
cancer. Poor english. Needs colonoscopy but family
doesn't want to hear bad news and wants to make
decision for about his treatment. Next step?
38-year-old F undergoes laparoscopic cholecystecomy Ondansetron
with general anesthesia. After she awakens
postoperatively, she is nauseated and vomits three times
in 20 minutes. Treatment for N/V?
During an experimental study of oxygen consumption in PCT
the kidney, experimental animals are ventilated with 100%
nitrogen. Cells from which of the following areas of the
kidney first show signs of anoxic injury?
7-year-old girl 30 minutes after being hit in the mouth with Right lower lobe
basketball. Something stuck in her throat. Part of one tooth
is missing. Lateral x-ray of the neck and chest is shown;
arrow shows part of the tooth. Greatest risk for aspiration
into which lobes?
Poliovirus mRNA lacks a 5' m7G cap but is translated Presence of an internal ribosome entry site
efficiently by cellular ribosomes. Which of the following
additional structural features of poliovirus mRNA is the
most likely cause of its ability to be translated in the
absence of a cap?
67-year-old F brother and mother have history of colon Low sensitivity
cancer. Physician recommends colonoscopy, but patent
only wants her stool to be tested for blood. Most likely
concerned about which of the following regarding this test?
Stuvia 2026-2027
, NBME 16 | Practice Questions & Answers
69-year-old African American woman has moderate ACEI or ARB (Irbesartan)
hypertension and type 2 DM. BMI 31. On
hydrohlorothiazide. Labs show microalbuminuria. Most
appropriate to add which drugs?
36-year-old man with 2-hour history of pain and swelling of Activation of AT III (heparin)
his right calf. No shortness of breath or chest pain. 18-hour
airplane trip 4 hours ago. Noninvasive vascular studies
show an occlusion of right femoral vein. Immediate therapy
has which mechanisms of action?
64 yr old alcoholic man with 1 day of confusion. Killing of bacteria in the gut that generate ammonia
Disoriented, disheveled. Dehydrated, jaundiced. and has
spider angiomata over face and chest. Has flapping up
and down of the hands when his arms are outstretched.
Abdominal distention and bulging flanks. He is
administered oral neomycin. Question asks which of the
following primary mechanisms of action is most likely to
occur in this patient as a result of the drug treatment?
1 year old boy is brought in. Has white, pale hair that Inability to make melanin (tyrosinase deficiency)
hasn't changed color since birth. His eyes are blue. During
ophthalmic examination, the patient turns away from the
flashlight and starts crying. Which of the following is the
most likely cause of the pale skin color?
2-year-old boy with developmental delay. Hx of hearing MELAS
loss in mother and delayed speech in older sister. Maternal Heteroplasmy
uncle had stroke-like episodes at the age of 25 years.
Physical shows ophthalmoplegia and hypotonia. Lactic
acid concentration increased. Explanation?
Male newborn at 28 weeks' is tachypneic and hypoxemic. Decreased number of lamellar bodies (used to secrete surfactant)
Which altered structure changes in the type II
pneumocytes is the most likely cause?
16-year-old girl with cystic fibrosis with 3-week history of Vitamin E
generalized weakness, numbness and tingling of her arms
and legs, and difficulty walking. Not adhered to
medications. Bilateral weakness and decreased deep
tendon reflexes in the upper and lower extremities. Walks
with an ataxic gait. Cause is deficiency of which?
48-year-old woman with 6-month hx of irregular menstrual Menopause (increased FSH)
periods and hot flashes. LMP 35 days ago, and had scant
blood flow. Menses had previously occurred at regular 28-
day cycles. Mild thinning of the vaginal tissue. Labs most
likely to show which of the following serum concentrations?
62-year-old M with unstable angina pectoris undergoes Left coronary artery
coronary catheterization. To visualize the anterior
interventricular (left anterior descending) artery, the tip of
the catheter would need to be placed into the orifice of
which arteries?
35-year-old F with intermittent sharp chest pain Pericarditis
exacerbated by deep breathing, and can be decreased by
leaning forward. 2-month hx of pain and swelling in her
hands and knees accompanied by morning stiffness that
lasts 1 hour. Pulsus paradoxus less than 10 mm Hg. Harsh
scratchy sound present in systole and diastole. Warmth,
swelling, and tenderness of the metacarphophalangeal
joints and knees. Cause?
60-year-old M with a systolic murmur is heard, which is AS
loudest at the R second intercostal space. Which cardiac
abnormality is the cause?
Stuvia 2026-2027
, NBME 16 | Practice Questions & Answers
31-year-old woman with invasive squamous cell carcinoma T-lymphocytes (CD8+ will present to MHC I)
of the cervix. Biopsy shows tumor cells express human
papillomavirus, type 16 antigens. Which cell types plays a
role in recognizing and killing these virus-infected tumor
cells?
An 85-year-old woman is diagnosed with a fracture of the Morphine is metabolized to active metabolites that accumulate
right femur and begins treatment with morphine by patient-
controlled analgesic pump. Three days later, her
respirations are 6/min. Physical examination shows
pinpoint pupils. Her serum creatinine concentration is 1.8
mg/dL. Which of the following best explains this patient's
clinical deterioration after the initiation of morphine
therapy?
35 y/o man with 3 yr history of enlarging nose, coarse adenylyl cyclase
facies, muscle weakness, increased hand/foot size. Large
fleshy nose and prognathism on exam. High IGF-1 in
serum. MRI shows pituitary adenoma. Morphologic
analysis of the tumor shows a densely granulated
somatotroph adenoma. Further studies show that the G
alpha-s subunit of the tumor G proteins lack GTPase
activity. The tumor cells most likely have an increased
activity of which enzyme?
30-year-old woman with Li-Fraumeni syndrome found to Impaired regulation of apoptosis
have adenocarcinoma of the breast. Family history
includes osteosarcoma. Which mechanisms underlies this
condition?
56-year-old with palpable hard nodule on prstate has Pelvis parasympathetic nerves
increased serum prostate-specific antigen concentration.
Fine-needle biopsy specimen shows adenocarcinoma.
Patient undergoes radical prostatectomy. Which structure
is at greatest risk for injury during removal of prostate?
56-year-old woman frequently burned herself while Syrinx of the central region of the spinal cord from C4 to T5
cooking. Loss of pain and temperature sensation in both
upper extremities and portion of her trunk from clavicles to
just below the nipples. Touch, vibratory sensation, and
proprioception normal. Findings on MRI of head and
spine?
66-year-old man surgical excision of a brain mass; RCC
photomicrograph of excised tissue shown. Smoked 1 pack Kidney
daily for 50 years. Labs show polycythemia,
hypercalcemia, and microscopic hematuria.
Immunostaining of the tissue is positive for epithelial
membrane antigen and negative for carcinoembryonic
antigen. Site of primary neoplasm?
25-year-old man comes to the physician 8 hours after the Rupture of an intervertebral disc
onset of severe pain of his low back that radiates down his
left leg. He started a weight-lifting regimen earlier in the
day during which he tried to lift a bar loaded with 91 kg
(200 lb) from the ground to over his head. The pain began
almost immediately after this attempt Which of the
following is the most likely cause of this patients pain?
43-year-old man with 6-week hx of sharp, stabbing pain on V2 branch of trigeminal-- foramen rotundum
the left side of his face that occurs when he touches it.
Pain when shaving. Pain just lateral to the left nasal ala
reproduces the pain. Nerve supplying this area exits the
skull through which foramina?
Where does V3 exit? Foramen ovale
Stuvia 2026-2027
