Federation of State Medical Boards (FSMB) &
National Board of Medical Examiners (NBME)
NBME USMLE (United States Medical Licensing
Examination): USMLE Step 1, 2 and 3
NBME CBSSA & NBME CBSE Comprehensive Basic
Science Self- Assessment and Examination
Course Title and Number: NBME CBSSA, NBME CBSE, and
NBME USMLE Exam
Exam Title: NBME
Exam Date: Exam 2025- 2026
Instructor: ____ [Insert Instructor’s Name] _______
Student Name: ___ [Insert Student’s Name] _____
Student ID: ____ [Insert Student ID] _____________
Examination
Time: - ____ Hours: ___ Minutes
Instructions:
1. Read each question carefully.
2. Answer all questions.
3. Use the provided answer sheet to mark your responses.
4. Ensure all answers are final before submitting the exam.
5. Please answer each question below and click Submit when you
have completed the Exam.
6. This test has a time limit, The test will save and submit
automatically when the time expires
7. This is Exam which will assess your knowledge on the course
Learning Resources.
Good Luck……...!
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USMLE Step 2 CK (Clinical Knowledge) Exam Review NBME
USMLE United States Medical Licensing Examination Questions
and Answers | 100% Pass Guaranteed | Graded A+ |
2025- 2026
NBME USMLE (United States Medical Licensing Examination)
USMLE Step 1, Step 2 CK (Clinical Knowledge), Step 2 CS
(Clinical Skills - discontinued), & Step 3
NBME CBSSA & NBME CBSE Comprehensive Basic Science Self-
Assessment and Examination
National Board of Medical Examiners (NBME)
Read All Instructions Carefully and Answer All the
Questions Correctly Good Luck: -
Question 1
A 6-year-old boy is brought to the emergency
department by his mother because of the acute onset 1
hour ago of severe right-sided lumbar pain and three
episodes of emesis….
Answer: B. CT Scan of Abdomen Pelvis
1. Why the correct answer is right:
o In acute lumbar pain, vomiting, hematuria,
and unilateral hydronephrosis with
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hydroureter, the child likely has a ureteral
stone.
o For USMLE/NBME, recognize that CT of the
abdomen and pelvis is the gold standard for
detecting and localizing ureteral stones.
2. Illness script/Test-taking strategy:
o Ureteral stones can present with colicky pain
and hematuria, often showing radiographic
evidence of hydronephrosis.
o Associate sudden flank pain with hematuria to
ureteral stones.
3. Why other answers are wrong:
o A. Captopril renography: For renal artery
stenosis.
o C. MAG-3 renal scan: Differentiates
obstructive vs. non-obstructive dilatation.
o D-E. Radionuclide cystography &
Retrograde pyelography: Evaluates
vesicoureteral reflux and urinary tract,
respectively, but not ideal for stone detection.
o F. Ultrasonography of the spinal column:
For spinal dysraphism.
o G. Voiding cystourethrography: Assesses
vesicoureteral reflux.
Test-taking tip: On USMLE, the clinical scenario’s
specifics guide the test choice. Here, pain + hematuria
+ hydronephrosis screams “stone,” and CT is the top
for stone detection.
Reference:
Le, T., Bhushan, V., & Sochat, M. (2023). First Aid
for the USMLE Step 1 (p. 67, 207). McGraw-Hill
Education.
Le, T., Bhushan, V., Ascha, M., Bhardwaj, A.,
Boushra, M., & Griffin, D. (2023). First Aid for the
USMLE Step 2 CK, eleventh edition (11th ed.). (p.
227, 694 – 697). McGraw-Hill Education.
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Question 2
An 82-year-old woman comes to the office because of a
1-month history of increasing numbness in her feet.
She has no history of serious illness…..
Answer: F. Vitamin B12 (cyanocobalamin)
supplementation
1. Why the correct answer is right:
o The patient’s symptoms—numbness, absent
deep tendon reflexes, decreased vibration,
and proprioception—indicate peripheral
neuropathy, and given the prolonged intake of
calcium carbonate, vitamin B12 malabsorption
is suggested.
o For USMLE/NBME, calcium can bind to vitamin
B12 in the stomach, leading to decreased
absorption and deficiency.
2. Illness script/Test-taking strategy:
o Peripheral neuropathy with sensory deficits
combined with a history of prolonged calcium
carbonate intake should raise suspicion for
vitamin B12 deficiency.
o Always assess for dietary and medication
histories which may influence vitamin B12
levels.
3. Why other answers are wrong:
o A. Alcohol cessation: Chronic alcohol use
can cause neuropathy and cerebellar, and gait
abnormalities.
o B. Calcium carbonate cessation: May
reduce B12 depletion but will not replace
already depleted stores.
o C. Folic acid supplementation: Deficiency
can cause megaloblastic anemia but not
neuropathy.
o D. Niacin supplementation: Niacin
deficiency causes pellagra presenting with
diarrhea, dermatitis, and dementia.
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o E. Vitamin B (thiamine) supplementation:
Deficiency leads to Wernicke-Korsakoff
syndrome or beriberi.
Test-taking tip: For neurologic findings combined with
a specific dietary or medication history, think about the
potential nutritional deficiencies. In this case,
peripheral neuropathy with calcium carbonate use
leads to B12 deficiency.
Reference:
Le, T., Bhushan, V., & Sochat, M. (2023). First Aid
for the USMLE Step 1 (p. 66, 67, 157, 158).
McGraw-Hill Education.
Le, T., Bhushan, V., Ascha, M., Bhardwaj, A.,
Boushra, M., & Griffin, D. (2023). First Aid for the
USMLE Step 2 CK, eleventh edition (11th ed.). (p.
293 – 294). McGraw-Hill Education.
Question 3
A 2-year-old girl is brought to the emergency
department because of loud breathing, harsh cough,
and a hoarse cry since she awoke 1 hour ago. Her
parents state that yesterday she had a runny nose.
Medical history is unremarkable and she receives no
medications…..
Answer: D. Nebulized epinephrine
1. Why the correct answer is right:
o The clinical presentation of the 2-year-old girl,
characterized by loud breathing, harsh cough,
hoarse cry, runny nose, fever, and inspiratory
stridor, strongly suggests acute viral croup.
Croup is a common pediatric respiratory illness
that primarily affects the larynx and trachea,
often caused by parainfluenza virus. The key
features of croup include a “barking” cough,
hoarseness, and inspiratory stridor, especially
in the context of a recent upper respiratory
tract infection.
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o Nebulized epinephrine is the most appropriate
initial pharmacotherapy for moderate to
severe croup, which is indicated by the
presence of significant stridor at rest and the
use of accessory muscles for breathing
(evidenced by suprasternal and subcostal
retractions). Nebulized epinephrine works by
causing vasoconstriction and reducing upper
airway edema, thereby relieving the airway
obstruction and improving breathing.
2. Illness script/Test-taking strategy:
o In cases of pediatric respiratory distress with a
clinical picture consistent with croup, it’s
crucial to assess the severity based on
symptoms like stridor, retractions, and general
respiratory status. The choice of therapy
hinges on the severity of these symptoms,
with nebulized epinephrine being a first-line
treatment for more severe cases.
3. Why other answers are wrong:
o A. Intravenous dexamethasone: While
dexamethasone is used in the treatment of
croup, it’s generally not the first-line for
immediate relief of severe symptoms.
o B. Nebulized albuterol: More appropriate for
bronchospasm associated with asthma or
bronchiolitis, not croup.
o C. Nebulized budesonide: A corticosteroid
used for long-term management of asthma,
not acute relief of croup symptoms.
o E. Oral albuterol: Typically not utilized
clinically.
o F.Oral prednisone: While oral steroids are
used in croup, they do not provide the
immediate relief of severe symptoms like
nebulized epinephrine.
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o G.Subcutaneous epinephrine: Used in
refractory status asthmaticus, not croup.
Test-taking tip: When tackling clinical vignettes,
especially in pediatrics, it’s important to closely
evaluate the presenting symptoms and their severity.
Stridor typically is an upper airway, inspiratory noise,
wheezing is a lower airway, expiratory noise.
Reference:
Le, T., Bhushan, V., & Sochat, M. (2023). First Aid
for the USMLE Step 1 (p. 67, 592). McGraw-Hill
Education.
Le, T., Bhushan, V., Ascha, M., Bhardwaj, A.,
Boushra, M., & Griffin, D. (2023). First Aid for the
USMLE Step 2 CK, eleventh edition (11th ed.). (p.
611 – 614). McGraw-Hill Education.
Question 4
A 67-year-old man is evaluated in the intensive care
unit. He has end-stage pancreatic cancer and was
hospitalized three days ago for treatment of
pneumonia….
Answer: D Provide palliative therapy only
1. Why the correct answer is right:
o The patient is at the end-stage of a terminal
illness and presents with acute respiratory
failure.
o He did not formalize his wishes in an advanced
directive but verbally expressed his desire to
avoid mechanical ventilation to his wife.
o The USMLE/NBME emphasizes the importance
of prioritizing the patient’s expressed wishes,
even verbal, over other considerations when
no legal document is present.
2. Illness script/Test-taking strategy:
o When presented with an ethical scenario on
the USMLE, always prioritize the patient’s
known wishes.
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o Remember that verbalizing wishes to a close
family member often carries significant
weight, especially without a formalized
document.
3. Why other answers are wrong:
o A. Perform endotracheal intubation and
begin mechanical ventilation: This goes
against the patient’s wishes.
o B. Perform endotracheal intubation and
then consult the hospital ethics
committee: Consulting ethics is valid in many
cases, but the patient’s wishes are clear here.
o C. Perform endotracheal intubation only:
This goes against the patient’s wishes.
o E. Seek a court order to assign a legal
guardian: A prolonged process, and the
situation requires immediate decision-making.
Test-taking tip: The USMLE often tests ethical
scenarios where the best decision respects the
autonomy and wishes of the patient. It is important to
differentiate between expressed patient wishes and
surrogate or family preferences.
Reference:
Le, T., Bhushan, V., Ascha, M., Bhardwaj, A.,
Boushra, M., & Griffin, D. (2023). First Aid for the
USMLE Step 2 CK, eleventh edition (11th ed.). (p.
637 – 642). McGraw-Hill Education.
Question 5
A 6-year-old boy is brought to the office by his parents
as a new patient. Three months ago, he and his 3-year-
old sister and 4-year-old brother were adopted from a
Russian orphanage …………… is unable to read, even in
Russian. Results of receptive language testing are
consistent with an average IQ……..
Answer: D Learning disorder
1. Why the correct answer is right:
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o The child shows specific difficulties in reading
(despite average IQ and age-appropriate daily
living skills), characteristic of a learning
disorder.
o The USMLE/NBME expects students to
recognize that learning disorders can manifest
as specific academic challenges even when a
general intellectual ability is within normal
limits.
2. Illness script/Test-taking strategy:
o A history of institutionalization can lead to
various developmental issues.
o When there is a specific deficit like reading
difficulty in the presence of normal intellectual
functioning and appropriate daily living skills,
think of learning disorders.
3. Why other answers are wrong:
o A. Autism spectrum disorder: Involve
persistent deficits in social communication and
interaction.
o B. Fetal alcohol syndrome: Involves
characteristic facial features, growth
problems, and CNS abnormalities
o C. Intellectual developmental disorder:
The child has an average IQ, making this
diagnosis less likely.
o E. Post-traumatic stress disorder: Trauma
might be suspected, but symptoms do not
highlight re-experiencing, avoidance, or
increased arousal.
o F. Reactive attachment disorder: Involves
inhibited, emotionally withdrawn behavior
toward adult caregivers.
Test-taking tip: Focus on the primary deficits
presented in the vignette. The main issue was the
reading difficulty in the setting of average IQ and age-
appropriate skills, directing towards a learning disorder.
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Reference:
Le, T., Bhushan, V., Ascha, M., Bhardwaj, A.,
Boushra, M., & Griffin, D. (2023). First Aid for the
USMLE Step 2 CK, eleventh edition (11th ed.). (p.
588, 513t). McGraw-Hill Education.
Question 6
A 77-year-old woman residing in a skilled nursing care
facility is examined by the physician one day after staff
noticed blood on her bedsheets. She sustained a
cerebral infarction eight years ago……
Answer: F. Biopsy of the vulva
1. Why the correct answer is right:
o The presentation of a raised, fleshy lesion on
the vulva in an elderly woman is concerning
for vulvar cancer, and the most definitive way
to diagnose it is through histological
examination.
o The USMLE/NBME expects students to
prioritize biopsy for suspicious lesions to
establish a diagnosis.
2. Illness script/Test-taking strategy:
o The presentation of a raised, fleshy lesion on
the vulva in an elderly woman is concerning
for vulvar cancer, and the most definitive way
to diagnose it is through histological
examination.
o The USMLE/NBME expects students to
prioritize biopsy for suspicious lesions to
establish a diagnosis.
3. Why other answers are wrong:
o A. Cytologic evaluation of the vulva: Not
the primary method for diagnosing vulvar
cancer.
o B. CT scan of the abdomen and pelvis:
Imaging is not the initial step.
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National Board of Medical Examiners (NBME)
NBME USMLE (United States Medical Licensing
Examination): USMLE Step 1, 2 and 3
NBME CBSSA & NBME CBSE Comprehensive Basic
Science Self- Assessment and Examination
Course Title and Number: NBME CBSSA, NBME CBSE, and
NBME USMLE Exam
Exam Title: NBME
Exam Date: Exam 2025- 2026
Instructor: ____ [Insert Instructor’s Name] _______
Student Name: ___ [Insert Student’s Name] _____
Student ID: ____ [Insert Student ID] _____________
Examination
Time: - ____ Hours: ___ Minutes
Instructions:
1. Read each question carefully.
2. Answer all questions.
3. Use the provided answer sheet to mark your responses.
4. Ensure all answers are final before submitting the exam.
5. Please answer each question below and click Submit when you
have completed the Exam.
6. This test has a time limit, The test will save and submit
automatically when the time expires
7. This is Exam which will assess your knowledge on the course
Learning Resources.
Good Luck……...!
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USMLE Step 2 CK (Clinical Knowledge) Exam Review NBME
USMLE United States Medical Licensing Examination Questions
and Answers | 100% Pass Guaranteed | Graded A+ |
2025- 2026
NBME USMLE (United States Medical Licensing Examination)
USMLE Step 1, Step 2 CK (Clinical Knowledge), Step 2 CS
(Clinical Skills - discontinued), & Step 3
NBME CBSSA & NBME CBSE Comprehensive Basic Science Self-
Assessment and Examination
National Board of Medical Examiners (NBME)
Read All Instructions Carefully and Answer All the
Questions Correctly Good Luck: -
Question 1
A 6-year-old boy is brought to the emergency
department by his mother because of the acute onset 1
hour ago of severe right-sided lumbar pain and three
episodes of emesis….
Answer: B. CT Scan of Abdomen Pelvis
1. Why the correct answer is right:
o In acute lumbar pain, vomiting, hematuria,
and unilateral hydronephrosis with
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hydroureter, the child likely has a ureteral
stone.
o For USMLE/NBME, recognize that CT of the
abdomen and pelvis is the gold standard for
detecting and localizing ureteral stones.
2. Illness script/Test-taking strategy:
o Ureteral stones can present with colicky pain
and hematuria, often showing radiographic
evidence of hydronephrosis.
o Associate sudden flank pain with hematuria to
ureteral stones.
3. Why other answers are wrong:
o A. Captopril renography: For renal artery
stenosis.
o C. MAG-3 renal scan: Differentiates
obstructive vs. non-obstructive dilatation.
o D-E. Radionuclide cystography &
Retrograde pyelography: Evaluates
vesicoureteral reflux and urinary tract,
respectively, but not ideal for stone detection.
o F. Ultrasonography of the spinal column:
For spinal dysraphism.
o G. Voiding cystourethrography: Assesses
vesicoureteral reflux.
Test-taking tip: On USMLE, the clinical scenario’s
specifics guide the test choice. Here, pain + hematuria
+ hydronephrosis screams “stone,” and CT is the top
for stone detection.
Reference:
Le, T., Bhushan, V., & Sochat, M. (2023). First Aid
for the USMLE Step 1 (p. 67, 207). McGraw-Hill
Education.
Le, T., Bhushan, V., Ascha, M., Bhardwaj, A.,
Boushra, M., & Griffin, D. (2023). First Aid for the
USMLE Step 2 CK, eleventh edition (11th ed.). (p.
227, 694 – 697). McGraw-Hill Education.
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Question 2
An 82-year-old woman comes to the office because of a
1-month history of increasing numbness in her feet.
She has no history of serious illness…..
Answer: F. Vitamin B12 (cyanocobalamin)
supplementation
1. Why the correct answer is right:
o The patient’s symptoms—numbness, absent
deep tendon reflexes, decreased vibration,
and proprioception—indicate peripheral
neuropathy, and given the prolonged intake of
calcium carbonate, vitamin B12 malabsorption
is suggested.
o For USMLE/NBME, calcium can bind to vitamin
B12 in the stomach, leading to decreased
absorption and deficiency.
2. Illness script/Test-taking strategy:
o Peripheral neuropathy with sensory deficits
combined with a history of prolonged calcium
carbonate intake should raise suspicion for
vitamin B12 deficiency.
o Always assess for dietary and medication
histories which may influence vitamin B12
levels.
3. Why other answers are wrong:
o A. Alcohol cessation: Chronic alcohol use
can cause neuropathy and cerebellar, and gait
abnormalities.
o B. Calcium carbonate cessation: May
reduce B12 depletion but will not replace
already depleted stores.
o C. Folic acid supplementation: Deficiency
can cause megaloblastic anemia but not
neuropathy.
o D. Niacin supplementation: Niacin
deficiency causes pellagra presenting with
diarrhea, dermatitis, and dementia.
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o E. Vitamin B (thiamine) supplementation:
Deficiency leads to Wernicke-Korsakoff
syndrome or beriberi.
Test-taking tip: For neurologic findings combined with
a specific dietary or medication history, think about the
potential nutritional deficiencies. In this case,
peripheral neuropathy with calcium carbonate use
leads to B12 deficiency.
Reference:
Le, T., Bhushan, V., & Sochat, M. (2023). First Aid
for the USMLE Step 1 (p. 66, 67, 157, 158).
McGraw-Hill Education.
Le, T., Bhushan, V., Ascha, M., Bhardwaj, A.,
Boushra, M., & Griffin, D. (2023). First Aid for the
USMLE Step 2 CK, eleventh edition (11th ed.). (p.
293 – 294). McGraw-Hill Education.
Question 3
A 2-year-old girl is brought to the emergency
department because of loud breathing, harsh cough,
and a hoarse cry since she awoke 1 hour ago. Her
parents state that yesterday she had a runny nose.
Medical history is unremarkable and she receives no
medications…..
Answer: D. Nebulized epinephrine
1. Why the correct answer is right:
o The clinical presentation of the 2-year-old girl,
characterized by loud breathing, harsh cough,
hoarse cry, runny nose, fever, and inspiratory
stridor, strongly suggests acute viral croup.
Croup is a common pediatric respiratory illness
that primarily affects the larynx and trachea,
often caused by parainfluenza virus. The key
features of croup include a “barking” cough,
hoarseness, and inspiratory stridor, especially
in the context of a recent upper respiratory
tract infection.
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o Nebulized epinephrine is the most appropriate
initial pharmacotherapy for moderate to
severe croup, which is indicated by the
presence of significant stridor at rest and the
use of accessory muscles for breathing
(evidenced by suprasternal and subcostal
retractions). Nebulized epinephrine works by
causing vasoconstriction and reducing upper
airway edema, thereby relieving the airway
obstruction and improving breathing.
2. Illness script/Test-taking strategy:
o In cases of pediatric respiratory distress with a
clinical picture consistent with croup, it’s
crucial to assess the severity based on
symptoms like stridor, retractions, and general
respiratory status. The choice of therapy
hinges on the severity of these symptoms,
with nebulized epinephrine being a first-line
treatment for more severe cases.
3. Why other answers are wrong:
o A. Intravenous dexamethasone: While
dexamethasone is used in the treatment of
croup, it’s generally not the first-line for
immediate relief of severe symptoms.
o B. Nebulized albuterol: More appropriate for
bronchospasm associated with asthma or
bronchiolitis, not croup.
o C. Nebulized budesonide: A corticosteroid
used for long-term management of asthma,
not acute relief of croup symptoms.
o E. Oral albuterol: Typically not utilized
clinically.
o F.Oral prednisone: While oral steroids are
used in croup, they do not provide the
immediate relief of severe symptoms like
nebulized epinephrine.
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o G.Subcutaneous epinephrine: Used in
refractory status asthmaticus, not croup.
Test-taking tip: When tackling clinical vignettes,
especially in pediatrics, it’s important to closely
evaluate the presenting symptoms and their severity.
Stridor typically is an upper airway, inspiratory noise,
wheezing is a lower airway, expiratory noise.
Reference:
Le, T., Bhushan, V., & Sochat, M. (2023). First Aid
for the USMLE Step 1 (p. 67, 592). McGraw-Hill
Education.
Le, T., Bhushan, V., Ascha, M., Bhardwaj, A.,
Boushra, M., & Griffin, D. (2023). First Aid for the
USMLE Step 2 CK, eleventh edition (11th ed.). (p.
611 – 614). McGraw-Hill Education.
Question 4
A 67-year-old man is evaluated in the intensive care
unit. He has end-stage pancreatic cancer and was
hospitalized three days ago for treatment of
pneumonia….
Answer: D Provide palliative therapy only
1. Why the correct answer is right:
o The patient is at the end-stage of a terminal
illness and presents with acute respiratory
failure.
o He did not formalize his wishes in an advanced
directive but verbally expressed his desire to
avoid mechanical ventilation to his wife.
o The USMLE/NBME emphasizes the importance
of prioritizing the patient’s expressed wishes,
even verbal, over other considerations when
no legal document is present.
2. Illness script/Test-taking strategy:
o When presented with an ethical scenario on
the USMLE, always prioritize the patient’s
known wishes.
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o Remember that verbalizing wishes to a close
family member often carries significant
weight, especially without a formalized
document.
3. Why other answers are wrong:
o A. Perform endotracheal intubation and
begin mechanical ventilation: This goes
against the patient’s wishes.
o B. Perform endotracheal intubation and
then consult the hospital ethics
committee: Consulting ethics is valid in many
cases, but the patient’s wishes are clear here.
o C. Perform endotracheal intubation only:
This goes against the patient’s wishes.
o E. Seek a court order to assign a legal
guardian: A prolonged process, and the
situation requires immediate decision-making.
Test-taking tip: The USMLE often tests ethical
scenarios where the best decision respects the
autonomy and wishes of the patient. It is important to
differentiate between expressed patient wishes and
surrogate or family preferences.
Reference:
Le, T., Bhushan, V., Ascha, M., Bhardwaj, A.,
Boushra, M., & Griffin, D. (2023). First Aid for the
USMLE Step 2 CK, eleventh edition (11th ed.). (p.
637 – 642). McGraw-Hill Education.
Question 5
A 6-year-old boy is brought to the office by his parents
as a new patient. Three months ago, he and his 3-year-
old sister and 4-year-old brother were adopted from a
Russian orphanage …………… is unable to read, even in
Russian. Results of receptive language testing are
consistent with an average IQ……..
Answer: D Learning disorder
1. Why the correct answer is right:
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o The child shows specific difficulties in reading
(despite average IQ and age-appropriate daily
living skills), characteristic of a learning
disorder.
o The USMLE/NBME expects students to
recognize that learning disorders can manifest
as specific academic challenges even when a
general intellectual ability is within normal
limits.
2. Illness script/Test-taking strategy:
o A history of institutionalization can lead to
various developmental issues.
o When there is a specific deficit like reading
difficulty in the presence of normal intellectual
functioning and appropriate daily living skills,
think of learning disorders.
3. Why other answers are wrong:
o A. Autism spectrum disorder: Involve
persistent deficits in social communication and
interaction.
o B. Fetal alcohol syndrome: Involves
characteristic facial features, growth
problems, and CNS abnormalities
o C. Intellectual developmental disorder:
The child has an average IQ, making this
diagnosis less likely.
o E. Post-traumatic stress disorder: Trauma
might be suspected, but symptoms do not
highlight re-experiencing, avoidance, or
increased arousal.
o F. Reactive attachment disorder: Involves
inhibited, emotionally withdrawn behavior
toward adult caregivers.
Test-taking tip: Focus on the primary deficits
presented in the vignette. The main issue was the
reading difficulty in the setting of average IQ and age-
appropriate skills, directing towards a learning disorder.
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Reference:
Le, T., Bhushan, V., Ascha, M., Bhardwaj, A.,
Boushra, M., & Griffin, D. (2023). First Aid for the
USMLE Step 2 CK, eleventh edition (11th ed.). (p.
588, 513t). McGraw-Hill Education.
Question 6
A 77-year-old woman residing in a skilled nursing care
facility is examined by the physician one day after staff
noticed blood on her bedsheets. She sustained a
cerebral infarction eight years ago……
Answer: F. Biopsy of the vulva
1. Why the correct answer is right:
o The presentation of a raised, fleshy lesion on
the vulva in an elderly woman is concerning
for vulvar cancer, and the most definitive way
to diagnose it is through histological
examination.
o The USMLE/NBME expects students to
prioritize biopsy for suspicious lesions to
establish a diagnosis.
2. Illness script/Test-taking strategy:
o The presentation of a raised, fleshy lesion on
the vulva in an elderly woman is concerning
for vulvar cancer, and the most definitive way
to diagnose it is through histological
examination.
o The USMLE/NBME expects students to
prioritize biopsy for suspicious lesions to
establish a diagnosis.
3. Why other answers are wrong:
o A. Cytologic evaluation of the vulva: Not
the primary method for diagnosing vulvar
cancer.
o B. CT scan of the abdomen and pelvis:
Imaging is not the initial step.
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