NBME 27 Test Review | Questions and Verified Answers | Latest Update 2025/2026 | GRADED A | 100% Correct

NBME 27 Test Review | Questions and Verified Answers | Latest Update 2025/2026 | GRADED A | 100% Correct. QUESTION: AV fistulas result in what change to the heart dynamics? This is an abnormal connection between the atria and ventricles, resulting in increased blood flowing from the atria to the ventricles. increased CO results (until high output heart failure ensues, but that takes time) QUESTION: Pierre Robin Sequence Mandibular hypoplasia, glossoptosis, cleft soft palate. W/ FAS or Edwards. QUESTION: What is the main regulator of serum osmolality? ADH (vasopressin) responsiveness to this decreases with age QUESTION: This is a neoplasm of endothelial cells; presents as spindle cells with slit-like blood filled sections Kaposi's sarcoma QUESTION: Hurler syndrome mucopolysaccharidosis, deficient a L iduronidase, accumulations of heparin sulfate and dermatan sulfate in heart, brain, liver, and other organs, progressive, hepatosplenomagaly, dwarfism, gargoyle-like facies, stubby fingers, corneal clouding, mental retardation, death by 10 years of age p57 QUESTION: Hunter syndrome similar to Hurler, deficient L iduronosulfate sulfatase, accumulations of heparin sulfate and dermatan sulfate, hepatospenomegaly, micrognathia, retinal degeneration, joint stiffness, mental retardation, cardiac lesions p59 QUESTION: Who is at risk for iron deficiency anemia? - Chronic blood loss - Pregnant women - Infants, children, adolescents - Vegetarians QUESTION: Gastrin induces secretion of HCl from what? parietal cells; are large w/ central round nucleus and strongly acidophilic cytoplasm QUESTION: This is an important step in phagocytosis as it involves surrounding of the cell membrane around the pathogen, allowing for encapsulation and internalization polymerization of actin QUESTION: Receptor-mediated endocytosis The movement of specific molecules into a cell by the inward budding of membranous vesicles containing proteins with receptor sites specific to the molecules being taken in; enables a cell to acquire bulk quantities of specific substances. Clathrin-coated pits is a type QUESTION: Effects of botulism on neuromuscular junction decreases release of AcH, decreases end-plate motor potential; does NOT significantly change the mini end plate potential, does not change the actual RESPONSE to AcH QUESTION: Cerebellar vermis Truncal ataxia, dysarthria Vermis is centrally located - affects central body QUESTION: IkappaB inhibitor that is boudn to NF-KB; releases it when phosphorylated QUESTION: May see irrational behavior and abdominal pain, hx of abnormally colored wine, (port wine colored) s/p tx with a drug; diaphoresis with this enzyme deficiency porphobinologen deaminase -> acute intermittent porphyria QUESTION: How do PDE5 inhibitors work? Inhibit PDE5 therefore breakdown of cGMP doesn't occur and cGMP can act as a second messenger to decrease calcium levels and cause muscle relaxation block sympathetic activity QUESTION: Four y/o boy comes in with hematuria and RBC casts in his urine. 2-3 weeks ago, he recovered from a viral infection. Protein is 2+. What does he have? proliferative glomerulonephritis QUESTION: Labeled CT of heart see QUESTION: Tricuspid valve CT see QUESTION: Newborn with female phenotype but male genital ducts; has clitoromegaly indicates 5-alpha reductase deficiency 5-alpha reductase converts testosterone to DHT QUESTION: To access the renal arteries from the femoral artery, stent should be placed - just above the testicular arteries (in a male) QUESTION: Having a more difficult time reading things that are near instead of far, due to loss of accomodative power of the lens presbyopia - normal age-related change QUESTION: Circle of willis angiogram they love angiograms QUESTION: In which genes from the chromosomes of only one parent is expressed (other is methylated) genomic imprinting QUESTION: After bumping his elbow on a table, a 55 year old man complains of a swollen, fluctuant mass that is mildly tender on the elbow. He has no fever or other sx. olecranon bursitis QUESTION: Infection inside the joint capsule septic arthritis QUESTION: What can homocysteine become? homocysteine -> methionine (via methionine synthase, B6) or homocysteine -> cystathionine -> cysteine (via cystathionine synthase, B6, serine) QUESTION: Substance P A neurotransmitter that is involved in the transmission of pain messages to the brain. QUESTION: What activates trypsinogen? Is from duodenal/jejunal mucosa enteropeptidase (enterokinase) QUESTION: Best way to address sudden cardiac death through public health measure place defibrillators in public spaces throughout the area you are interested in providing free drugs to everyone over a certain age group is not targeted to those who the drug is actually for, and can cause adverse effects in the rest of the population QUESTION: TX of neonatal conjunctivitis erythromycin ointment on eyes QUESTION: Primary mediators of immune vasodilation in innate immunity bradykinin PGE2 histamine QUESTION: Where is the anticodon located? bottom of tRNA QUESTION: Vertical sequence at the top of the tRNA is the - acceptor stem QUESTION: Biggest risk factor for pancreatic cancer smoking QUESTION: Source of energy after glucose sources are depleted gluconeogenesis - in the liver, as well as the kidney and the intestinal epithelium (have glucose-6-phosphatase) QUESTION: Do females have Sertoli-Leydig cells? yes. point blank period. QUESTION: People with this personality disorder make suicidal gestures, praise or devalue people, are often in tumultuous relationships, and desparately avoid abandonment borderline personality disorder QUESTION: People with this personality disorder are often clingy and submissive in relationships, are desperate not to be alone, and can be more prone to being in abusive relationships dependent personality disorder QUESTION: A newborn baby born prematurely with hyaline membrane disease is oxygenated and ventilated, but has her oxygenation status and level checked continuously to avoid retinopathy intraventricular hemorrhage bronchopulmonary dysplasia QUESTION: CREST syndrome Calcinosis, Raynaud's, esophageal dysmotility, Sclerodactyly, Telangiectasia QUESTION: path to uterine artery from femoral artery femoral external iliac internal iliac uterine QUESTION: Where does the femoral artery enter the thigh? from posterior to the inguinal ligament as continuation of external iliac artery QUESTION: What changes occur with the ductus arteriosus once a newborn is born normally? pulmonary vascular resistance dramatically falls pulmonary blood flow is increased towards the pulmonary vein -> left side of heart QUESTION: Other changes: venous return decreases after umbilical cord is cut RAP: LAP gradient decreases because of increased LAP due to the increase from pulmonary blood flow QUESTION: Signs of graft vs host disease maculopapular rash, hepatosplenomegaly, jaundice, diarrhea QUESTION: Signs of acute transplant rejection within weeks to about 6 months dense lymphocytic infiltrate found in transplanted tissue caused by CD8+ or CD4+ cell of the host being activated against the donor's MHCs QUESTION: This is used for the reversal of the neuromuscular junctional blockade after surgery neostigmine (an acetylcholinesterase inhibitor) QUESTION: This is a large intestinal roundworm; can cause small bowel obstruction Ascaris lumbricoides QUESTION: ADRs of Beta-2 Agonists tremor, arrhythmia, hypokalemia QUESTION: C1-C2 joint atlantoaxial joint QUESTION: Responsible for the conversion of cortisol to cortisone; can be inhibited by licorice 11-beta-hydroxysteroid dehydrogenase type II QUESTION: Initiation of apoptosis intrinsic pathway: after trigger -> bax and bak form mitochondiral membrane poires -> release of cytochrome c into cytoplasm -> activates caspases extrinsic pathway: triggering of Fas/Fas-L binding or immune cell cytotoxic T-cell release of perforin and granzyme QUESTION: Most common cause of ATN ischemia QUESTION: Infection of p. falciparum invades the host cell's cytoplasm and induces processing of malaria proteins and presentation by MHC I cells QUESTION: Pupils with opioids constrict QUESTION: Positive Skew (mean, median, mode) mode < median< mean QUESTION: Negative Skew (mean, median, mode) mean < median < mode QUESTION: This has the classic triad of cirrhosis, diabetes mellitus, and skin hyperpigmentation hemochromatosis QUESTION: ATP hydrolysation leads to how many H+ ions across the intestinal cell? 1 ATP for 1 H+ QUESTION: Adipose tissue in PCOS produces what estrone has aromatase, which converts testosterone to estrone QUESTION: deficiency of bicarbonate in the blood causes increased chloride QUESTION: What hormones induce the axial growth of a growth plate IGF-1, GH also testosterone and estrogen QUESTION: Where is DNA polymerase used? DNA replication QUESTION: Where is RNA polymerase found? DNA transcription QUESTION: Flexion of the wrist is controlled by what nerve roots? C6, 7, and 8 QUESTION: Abduction of the shoulder and elbow flexion are controlled by what nerve roots C5-6 QUESTION: Biggest risk factor for urothelial cancer cigarette smoking QUESTION: Why is hyperventilation common in pregnancy? to eliminate fetal CO2 (gets into the blood) QUESTION: ADRs of fluoroquinolones Neurotoxicity Allergies Photosensitivity Tendon rupture QTc prolongation Dysglycemias QUESTION: Baby with poor feeding, hyptonia, facial hypoplasia; increased levels of very long chain fatty acids and phytanic acids Zelleweger syndrome absence of peroxisomes QUESTION: beta blockers lower heart rate by decreasing the slope of phase 4 depolarization prolonging the repolarization phase at the AV node QUESTION: Mechanism of toxoplasma gondii infection (primary) ingestion QUESTION: Effects of inadequate insulin in Type I diabetics leads to increased breakdown of stores 9glycogenolysis, lipolysis, etc.) to produce glucose -> weight loss increased glycosylation of RBCs QUESTION: Cigarette smoking effects on respiratory clearance smoking increases the prodcution of mucus, but this paralyzes the cilia; alveolar macrophages are distorted (picking up too much debris) and thus their function is disturbed QUESTION: What type of antigen would generate the highest antibodies? a foreign antigen (ie. HPV vs Her-2 neu) QUESTION: diarrhea causes what kind of acid-base imbalance? a non-anion gap metabolic acidosis QUESTION: What glial cells protect the brain from glutamate excitotoxicity (and from damage in general) astrocytes QUESTION: In what settings can early-onset aortic stenosis occur 40-60 y/o congenital bicuspid valve or chronic rheumatic heart disease QUESTION: Angiodysplasia is associated with.. von Willebrand's disease calcific aortic stenosis Hematochezia (2nd MCC) QUESTION: Role of Vitamin C in collagen synthesis hydroxylation of proline and lysine in procollagen QUESTION: Clomiphene Estrogen partial agonist: synthetic used in infertility to induce ovulation action on pituitary: antiestrogenic, so it does NOT block the FSH and LH to promote more FSH and LH QUESTION: What cells are key in the fracture repair process? periosteal cells endosteal cells QUESTION: Most common cause of inherited intellectual disability; also see hyperextensible joints, long head w/ prominent jaw and wide forehead Fragile X syndrome QUESTION: What drugs cause hemolysis in G6PD deficiency? Isoniazid Sulfonamides Dapsone Primaquine Aspirin Ibuprofen Nitrofurantoin QUESTION: Oxidative Burst (respiratory burst) Increased O2 consumption and glycogenolysis of leukocyte that follows degranulation. QUESTION: When is a pleural biopsy indicated? to evaluate pleural effusion, a pleural mass QUESTION: Recurrent PNA involving the same region of hte lung indicates a possible mass; best investigated w/ bronchoscopy QUESTION: What typically induces testicular atrophy and azoospermia exogenous testosterone use QUESTION: What type of collagen is involved in osteoarthritis? Type II collagen QUESTION: Secretory phase of uterine cycle coincides with the luteal phase of the ovarian cycle QUESTION: Proliferative phase The second phase of the uterine (endometrial) cycle, during which the endometrium (shed off during menstruation is rebuilt). QUESTION: Necrotizing enterocolitis Pre-term infants have lower immune function, bacteria proliferate in bowel and cause ischemia and air in the bowel. Dx: thin curvilinear lines of lucency see abdominal tenderness, distension, vomiting QUESTION: Failure of fusion of these lead to cleft lip nasal and maxillary prominences QUESTION: What can lead to hyperchloremia metabolic acidosis - due to loss of potassium and bicarb in stool (diarrhea for example); chloride increased to compensate QUESTION: Where is the parietal pleura? lines the thoracic cavity (attached) QUESTION: location of sphenoethmodial recess superior to superior concha QUESTION: Inflammatory mediators release what to kill organisms like Strep pnemoniae? reactive oxygen species (think of the O2 burst) that can damage the respiratory endothelial cells QUESTION: Branchial cleft cyst a congenital lesion due to the incomplete involution of the branchial cleft which is usually located in the lateral neck. anterior to the SCM does NOT move with swallowing (unlike thyroglossal duct cyst) QUESTION: Intention to treat analysis Individual outcomes in a clinical trial are analyzed according to the group to which they have been randomized, regardless of whether they dropped out - everybody gets analyzed QUESTION: Cecum the cavity in which the large intestine begins and into which the ileum opens QUESTION: Lesions of the lateral medullary pyramid lead to c/l UMN sx of the upper and lower limb QUESTION: First pass effect The initial metabolism in the liver of a drug absorbed from the gastrointestinal tract QUESTION: What happens to the liver during aging decreases in size and blood flow -> decreased metabolism -> decreased first pass effect QUESTION: This is a 1st line therapy for claudication cilostazol has vasodilatory and antiplatelet properties