21-year-old with asthma - comes to the physician because her current medication regime is not relieving her
symptoms. The physician tells the patient about a clinical trial of a new drug for asthma. The trial is a large,
randomized, prospective, double blinded study of volunteers with asthma. The trial is most likely occurring at
which of the following phases of drug development? - Answer= Phase 3 large number random assignment, with
placebo, any Improvement
The pedigrees of patients with schizophrenia most closely resemble those of patients with which of the following? -
Answer= Diabetes Mellitus, Type 1 Schizophrenia doesn't have a clear pattern of inheritance. only Type 1 DM
doesn't have a clear inheritance pattern
Hox genes play a role in embryogenesis through which of the following processes? -Answer= Regulation of
Transcription
Homebox genes are transcription factors
A 1 month old - male newborn is brought to the physician for a routine examination. Parents have dark skin and
eyes. PE shows hypopigmentation of the skin, light blonde hair, and translucent irises. The inherited disorder
causes this phenotypic expression is most likely due to a defect in the metabolism of which? -Answer= Tyrosine
albinism, which is due to decreased tyrosinase activity.
If he has a problem metabolizing Phenylalanine, he would be presenting with the PKU sx like intellectual disability,
musty body odor, etc., in addition to his fair complexion
A 55-year-old - 2 weeks history of palpitations and anxiety. He has primary hypothyroidism and treated with
Levothyroxine. Pt is taking 2x dosage of
Levothyroxine for 2 months. Which are most likely set of findings? -Answer=
Increased Free T4
Increased Free T3
Decreased Thyroid Iodine Uptake
the patient has been taking excess of his levothyroxine medication.
Levothyroxine is the exogenous form of T4. Therefore, free T4 must be elevated.
T4 is converted to T3 at most peripheral tissues, so T3 will also be elevated.
,NBME CBSE ACTUAL TEST QUESTIONS AND
ANSWERS (Quiz bank with all the correct answers) (usmle
step 1) Medical examination new Update 2022/2023
12-year-old boy - brought to the physician by his mother for a well-child exam. His mother has outgrown the
clothes that she bought him 6 months ago. 50th percentile for height and weight. Pt shows growth of 2.3 in/year.
PE shows mild acne. Pubic hair and testes development are Tanner stage 2. Cause of onset of physical changes in
this patient? -Answer= Nocturnal Luteinizing Hormone
Pulses
Gonadotropin pulses occur only during sleep, but as puberty progresses they can be detected during the day.
By the end of puberty, there is little day-night difference in the amplitude and frequency of gonadotropin
pulses.
A 23-year-old primgravid woman at 22 weeks gestation is brought to a small rural hospital by her husband becase
of intermittent bleeding during past week. Pt woke up in copius amounts of blood and BP 90/60 mm/Hg. Her
female obstetrician is a woman who practices 2 hours away. Pt is a conservative muslin and dressed in a burka, and
she doesn't want a male physician. Only physician available is a male. Which of the following is the most
appropriate action by the physician? - Answer= Ask the patient if she would allow the examination if her husband is
present at all times Patient needs medical attention immediately, which eliminates obtaining a court order, or
transferring her. A nurse does not have the same training and qualifications as a physician best option among
those given is to ask the patient if she will allow with her husband present.
A 43 year old woman - nonproductive cough for 3 weeks. She has 6.8 kg (15 lb) weight loss. A CXR shows 3 nodules
in right lung. FNA suggest a malignant neoplasm. A photograph in the patient is shown. Which of the following is
most likely diagnosis -Answer= Metastatic Carcinoma metastasis was the best option here because there are
multiple malignant neoplasms
,NBME CBSE ACTUAL TEST QUESTIONS AND
step 1) Medical
ANSWERS 2023-2024 COMPLETE
examination new
NBME CBSE ACTUAL TEST QUESTIONS AND Update 2022/2023
ANSWERS 2023-2024 COMPLETE A 62-year-old man -
comes to physician for a
follow-up exam. One month ago, he was prescribed a proton pump inhibitor (PPI) for epigastric pain that relieved
when he easts. Pt states that the symptoms are still present and cause discomfort. Serum studies shows gastrin 4x
reference range. Physician discontinues the PPI therapy in this patient. 3 weeks later, most appropriate to measure
the concentration of which? -Answer= Serum Gastrin The use of any agent that inhibits gastric secretion of acid
rule out Zollinger-Ellison syndrome you need to stop the PPIs first, then measure Gastrin to make that your intial
measure of elevated Gastrin was not due to your drug rather than the patients disease.
62 year old woman - osteoporosis - a bisphosphonate is prescribed. The expected beneficial effect of the drug is due
to which of the following? -Answer= Decreased Osteoclast Activity
Cohot Study of elderly women - relative risk ratio for hip fractures among those who exercise regularly is 1.2 (95%
confidence interval of 1.1 to 1.8). Which of the following is the conclusion about the effect of exercise on the risk of
hip fracture? -Answer= Statistically Significant Overall Increase Risk
52 year old man goes to ER with chest pain radiating to his jaw while shoveling snow. Pulse is 80/min and blood
pressure is 130/70. The most immediate treatment mechanism of action? - Answer= Increased nitric oxide
concentration
24 year old woman - spilled hot grease on her left leg while working at a fastfood restaurant. Exam of leg shows 7cm
pink, soft, granular, edematous wound. The formation of this tissue was most likely caused by increased activity of
which? -Answer= a. Vascular Endothelial Growth Factor VEGF - stimulates angiogenesiss.
TYPE III Collagen = Blood Vessels - early wound repair
27 year old man- MVC - skull x-ray shows a linear, nondepressed basal skull fracture - increased serum osm and
decreased urin osm. Following desmopressin urine osm increases. Desmopressin's effect is due to the activation of
which of the following? -Answer= a. Adenylyl Cyclase
Adenylate Cyclase - ATP - CAMP --
PROTEKINASE A -- Ca v2
, NBME CBSE ACTUAL TEST QUESTIONS AND
A 10 month old boy - 4
ANSWERS 2023-2024 COMPLETE
day history of fever and
cough. He attends day care center. Chest exam shows intercostal retractions along with bilateral, diffuse wheezes
and expiratory rhonchi. The infectious agent most likely has which of the following properties? -Answer= Mediation
of Cell Entry via a fusion protein
A 17 year old girl in ED - 15 minutes after being stung by a bee. Mild light headedness but no difficulty swallowing-
Bilateral wheezing - Which is most appropriate pharmacotherapy for this patient? -Answer= B2- Agonist
14 year old boy - 2 day history of sore throat and fever that peaks in late afternoon. 1 week of fatigue. He recentaly
had sex with one partner. Physical exam show cervical lymphadenopathy and pharyngeal erythema with a creamy
exudate. DX? -Answer= Infectious Mononucleosis
57 year old man - radiation therapy for squamous cell carcinoma of the lung. Despite therapy, tumor increases in
size and he dies 6 months later. The progressive tumor growth is due to a defect in cell cycle arrest in which of the
following phases of cell cycle? -Answer= G1
28 year old - lived in sub-Saharan Africa - until he came to the US. Temp of 100.4 - imaging shows bilateral
hydroureter and hydronephrosis. Biopsy shows marked fibrosis and scattered granulomas. DX? -Answer=
Schistosomiasis
A couple with a family history of a-thalassemia. Woman has one gene deletion and man has two gene deletion. If
the two gene is trans - what percentage of offspring will have a two gene deletion?
-Answer= 50%
previously healthy 40 year brought to emergency department by her husband - 2 day history of fever, lethargy,
confusion. PE shows scattered petechiae and ecchymoses over the lower extremities - 3+ polychromasia and 3+
schistocytes and Low platelets Dx? -Answer= Thrombotic Thrombocytopenia Purpura
16 year old boy - is admitted to the ER because of a knife wound to the left side of his chest. An X- ray of the chest
shows an air-fluid level in the left side of the chest, partial collapse of the left lung, and the elevation of the stomach
bubble. The mediastinum is midline. DX? -Answer= Hemopneumpothorax under tension
symptoms. The physician tells the patient about a clinical trial of a new drug for asthma. The trial is a large,
randomized, prospective, double blinded study of volunteers with asthma. The trial is most likely occurring at
which of the following phases of drug development? - Answer= Phase 3 large number random assignment, with
placebo, any Improvement
The pedigrees of patients with schizophrenia most closely resemble those of patients with which of the following? -
Answer= Diabetes Mellitus, Type 1 Schizophrenia doesn't have a clear pattern of inheritance. only Type 1 DM
doesn't have a clear inheritance pattern
Hox genes play a role in embryogenesis through which of the following processes? -Answer= Regulation of
Transcription
Homebox genes are transcription factors
A 1 month old - male newborn is brought to the physician for a routine examination. Parents have dark skin and
eyes. PE shows hypopigmentation of the skin, light blonde hair, and translucent irises. The inherited disorder
causes this phenotypic expression is most likely due to a defect in the metabolism of which? -Answer= Tyrosine
albinism, which is due to decreased tyrosinase activity.
If he has a problem metabolizing Phenylalanine, he would be presenting with the PKU sx like intellectual disability,
musty body odor, etc., in addition to his fair complexion
A 55-year-old - 2 weeks history of palpitations and anxiety. He has primary hypothyroidism and treated with
Levothyroxine. Pt is taking 2x dosage of
Levothyroxine for 2 months. Which are most likely set of findings? -Answer=
Increased Free T4
Increased Free T3
Decreased Thyroid Iodine Uptake
the patient has been taking excess of his levothyroxine medication.
Levothyroxine is the exogenous form of T4. Therefore, free T4 must be elevated.
T4 is converted to T3 at most peripheral tissues, so T3 will also be elevated.
,NBME CBSE ACTUAL TEST QUESTIONS AND
ANSWERS (Quiz bank with all the correct answers) (usmle
step 1) Medical examination new Update 2022/2023
12-year-old boy - brought to the physician by his mother for a well-child exam. His mother has outgrown the
clothes that she bought him 6 months ago. 50th percentile for height and weight. Pt shows growth of 2.3 in/year.
PE shows mild acne. Pubic hair and testes development are Tanner stage 2. Cause of onset of physical changes in
this patient? -Answer= Nocturnal Luteinizing Hormone
Pulses
Gonadotropin pulses occur only during sleep, but as puberty progresses they can be detected during the day.
By the end of puberty, there is little day-night difference in the amplitude and frequency of gonadotropin
pulses.
A 23-year-old primgravid woman at 22 weeks gestation is brought to a small rural hospital by her husband becase
of intermittent bleeding during past week. Pt woke up in copius amounts of blood and BP 90/60 mm/Hg. Her
female obstetrician is a woman who practices 2 hours away. Pt is a conservative muslin and dressed in a burka, and
she doesn't want a male physician. Only physician available is a male. Which of the following is the most
appropriate action by the physician? - Answer= Ask the patient if she would allow the examination if her husband is
present at all times Patient needs medical attention immediately, which eliminates obtaining a court order, or
transferring her. A nurse does not have the same training and qualifications as a physician best option among
those given is to ask the patient if she will allow with her husband present.
A 43 year old woman - nonproductive cough for 3 weeks. She has 6.8 kg (15 lb) weight loss. A CXR shows 3 nodules
in right lung. FNA suggest a malignant neoplasm. A photograph in the patient is shown. Which of the following is
most likely diagnosis -Answer= Metastatic Carcinoma metastasis was the best option here because there are
multiple malignant neoplasms
,NBME CBSE ACTUAL TEST QUESTIONS AND
step 1) Medical
ANSWERS 2023-2024 COMPLETE
examination new
NBME CBSE ACTUAL TEST QUESTIONS AND Update 2022/2023
ANSWERS 2023-2024 COMPLETE A 62-year-old man -
comes to physician for a
follow-up exam. One month ago, he was prescribed a proton pump inhibitor (PPI) for epigastric pain that relieved
when he easts. Pt states that the symptoms are still present and cause discomfort. Serum studies shows gastrin 4x
reference range. Physician discontinues the PPI therapy in this patient. 3 weeks later, most appropriate to measure
the concentration of which? -Answer= Serum Gastrin The use of any agent that inhibits gastric secretion of acid
rule out Zollinger-Ellison syndrome you need to stop the PPIs first, then measure Gastrin to make that your intial
measure of elevated Gastrin was not due to your drug rather than the patients disease.
62 year old woman - osteoporosis - a bisphosphonate is prescribed. The expected beneficial effect of the drug is due
to which of the following? -Answer= Decreased Osteoclast Activity
Cohot Study of elderly women - relative risk ratio for hip fractures among those who exercise regularly is 1.2 (95%
confidence interval of 1.1 to 1.8). Which of the following is the conclusion about the effect of exercise on the risk of
hip fracture? -Answer= Statistically Significant Overall Increase Risk
52 year old man goes to ER with chest pain radiating to his jaw while shoveling snow. Pulse is 80/min and blood
pressure is 130/70. The most immediate treatment mechanism of action? - Answer= Increased nitric oxide
concentration
24 year old woman - spilled hot grease on her left leg while working at a fastfood restaurant. Exam of leg shows 7cm
pink, soft, granular, edematous wound. The formation of this tissue was most likely caused by increased activity of
which? -Answer= a. Vascular Endothelial Growth Factor VEGF - stimulates angiogenesiss.
TYPE III Collagen = Blood Vessels - early wound repair
27 year old man- MVC - skull x-ray shows a linear, nondepressed basal skull fracture - increased serum osm and
decreased urin osm. Following desmopressin urine osm increases. Desmopressin's effect is due to the activation of
which of the following? -Answer= a. Adenylyl Cyclase
Adenylate Cyclase - ATP - CAMP --
PROTEKINASE A -- Ca v2
, NBME CBSE ACTUAL TEST QUESTIONS AND
A 10 month old boy - 4
ANSWERS 2023-2024 COMPLETE
day history of fever and
cough. He attends day care center. Chest exam shows intercostal retractions along with bilateral, diffuse wheezes
and expiratory rhonchi. The infectious agent most likely has which of the following properties? -Answer= Mediation
of Cell Entry via a fusion protein
A 17 year old girl in ED - 15 minutes after being stung by a bee. Mild light headedness but no difficulty swallowing-
Bilateral wheezing - Which is most appropriate pharmacotherapy for this patient? -Answer= B2- Agonist
14 year old boy - 2 day history of sore throat and fever that peaks in late afternoon. 1 week of fatigue. He recentaly
had sex with one partner. Physical exam show cervical lymphadenopathy and pharyngeal erythema with a creamy
exudate. DX? -Answer= Infectious Mononucleosis
57 year old man - radiation therapy for squamous cell carcinoma of the lung. Despite therapy, tumor increases in
size and he dies 6 months later. The progressive tumor growth is due to a defect in cell cycle arrest in which of the
following phases of cell cycle? -Answer= G1
28 year old - lived in sub-Saharan Africa - until he came to the US. Temp of 100.4 - imaging shows bilateral
hydroureter and hydronephrosis. Biopsy shows marked fibrosis and scattered granulomas. DX? -Answer=
Schistosomiasis
A couple with a family history of a-thalassemia. Woman has one gene deletion and man has two gene deletion. If
the two gene is trans - what percentage of offspring will have a two gene deletion?
-Answer= 50%
previously healthy 40 year brought to emergency department by her husband - 2 day history of fever, lethargy,
confusion. PE shows scattered petechiae and ecchymoses over the lower extremities - 3+ polychromasia and 3+
schistocytes and Low platelets Dx? -Answer= Thrombotic Thrombocytopenia Purpura
16 year old boy - is admitted to the ER because of a knife wound to the left side of his chest. An X- ray of the chest
shows an air-fluid level in the left side of the chest, partial collapse of the left lung, and the elevation of the stomach
bubble. The mediastinum is midline. DX? -Answer= Hemopneumpothorax under tension
