NBME PATHOLOGY EXAM 2025/2026 STUDY(500
QUESTIONS AND ANSWERS )
GRADED A+
67 YR M w/ 1 hours of vertigo, nausea, imbalance, small R pupil, mild R ptosis, nystagmus, weakness of R
palate, sensation to pinprick is decreased over R face and L extremities + incoordination of finger to
nose and heel-shin. where is occlusion?
R vertebral
77 YR F w/ cramping abdominal pain and distention w/ n/v. no hx of abdominal sx. afebrile, tachy.
distended abdomen w/ mild diffuse tenderness. BS are high pitched. x-ray of abdomen shows air fluid
levels in SB and liver but no gas in colon or free air. dx?
gallstone ileus --> air in billiary tree/liver even though all other signs sound like SBO
18 mo old has not used L arm since he fell while walking & holding hands w/ sister. he is holding LUE at
side w/ forearm pronated. no tenderness of LLE, restricted movement of elbow. next step?
passive hypersupination of forearm --> nurse maid elbow aka radial head dislocation (can also
hyperpronate)
asthmatic teen w/ asthma attack, she hast not been taking her meds. what is best way to get her to be
compliant
negotiate a contract regarding med compliance
,5 mo old w/ persistent wheezing since birth, well-nourished, wheezing w/ extension of neck. what is
cause?
compression of airway by vascular ring --> malformation of aorta so wraps around trachea, improves w/
neck extension --> sx
largyngomalacia improves in prone position not extension
heavy cigarette smoker w/ hiccups. Na+ 120. CXR w/ R hilar mass. next step?
fluid restriction --> SIADH from small cell lung CA
female w/ herberden's nodes, generalized weakness x2 weeks. BUN 41 and Cr 4. what is cause?
ATN --> from chronic NSAIDs
32 YR F brought to ED after MVC, agitated, SOB, tachy, RR30, hypotensive, breath sounds absent on R, L
sounds normal, CXR w/ opacification of R hemithorax. cause?
hemothorax
25 YR F at 27 weeks w/ severe contractions x6 hours, vaginal spotting, contractions every 2-3 mins w/
FHR 130 and no decels, cervic 1-2 cm and 70% effaced, GBS is positive. next step?
IM beclamethasone THEN later can give penicillin
,man w/ 15 yr hx of difficult relaxing hands after tightly gripping objects or shaking hands, difficulty
releasing after gripping w/ hands. dx?
mYRtonic muscular dystrophy
pt unable to see out of R eye since awakening 2 hrs ago. visual acuity 20/200 in R eye and 20/20 in L. R
pupil poorly reactive to light. where is site of lesion?
R optic nerve
6 mo old w/ poor feeding, labored breathing, to and fro murmur in 2nd L itnercostal space, loud S2,
bounding peripheral pulses, widened pulse pressure. dx?
patent ductus arteriosus
recurrent lymph node infxns w/ staph a in a kid. what is dx and mechanism?
chronic granulomatous dz --> impaired phagocytic oxidative metabolism
pt hyperkalemic bc missed 2 dialysis appointments. EKG w/ peaked t waves. next step?
IV calcium gluconate --> THEN can give insulin but this works within minutes
hyaline casts vs WBC casts?
-WBC casts: interstitial nephritis and pyelonephritis
-hyaline casts: AKI
, 4 YR M in MVC, RR 32 w/ grunting and restractions, hypoxic on ABG, CXR 4 hrs later shows diffuse
infiltrates on R side. dx?
pulmonary contusion
asymptomatic 57 YR M smoker, bruit in RUQ, no masses, BUN 23, Cr 1.4. what is cause of bruit?
accumulation of lipids in arterial wall --> renal artery stenosis
52 YR F w/ decreased libido, underwent TAH and bilateral salpingo-oophorectomy for leiomYRmata uteri
and menorrhagia. on hormone replacement + estrogen since sx. exam w/ moist, rugated vagina. what is
cause?
decreased androgens/testosterone --> due to oophoreectomy = decreased androstenedione and DHEA
= aka hypergonadotropic hypogonadism ant pituitary works ovaries don't
67 YR F w/ afib on warfarin, INR 6 so meds stopped, next day she had abdominal pain and vomiting x24
hours, Hgb 13 --> 7.8. cause?
intramural hematoma of proximal small bowel --> rare complication of warfarin
IVDU w/ papilledema, LP w/ high proteins, low glucose, 200 cells. dx?
fungal meningitis --> cryptococcal --> prolly has AIDS
QUESTIONS AND ANSWERS )
GRADED A+
67 YR M w/ 1 hours of vertigo, nausea, imbalance, small R pupil, mild R ptosis, nystagmus, weakness of R
palate, sensation to pinprick is decreased over R face and L extremities + incoordination of finger to
nose and heel-shin. where is occlusion?
R vertebral
77 YR F w/ cramping abdominal pain and distention w/ n/v. no hx of abdominal sx. afebrile, tachy.
distended abdomen w/ mild diffuse tenderness. BS are high pitched. x-ray of abdomen shows air fluid
levels in SB and liver but no gas in colon or free air. dx?
gallstone ileus --> air in billiary tree/liver even though all other signs sound like SBO
18 mo old has not used L arm since he fell while walking & holding hands w/ sister. he is holding LUE at
side w/ forearm pronated. no tenderness of LLE, restricted movement of elbow. next step?
passive hypersupination of forearm --> nurse maid elbow aka radial head dislocation (can also
hyperpronate)
asthmatic teen w/ asthma attack, she hast not been taking her meds. what is best way to get her to be
compliant
negotiate a contract regarding med compliance
,5 mo old w/ persistent wheezing since birth, well-nourished, wheezing w/ extension of neck. what is
cause?
compression of airway by vascular ring --> malformation of aorta so wraps around trachea, improves w/
neck extension --> sx
largyngomalacia improves in prone position not extension
heavy cigarette smoker w/ hiccups. Na+ 120. CXR w/ R hilar mass. next step?
fluid restriction --> SIADH from small cell lung CA
female w/ herberden's nodes, generalized weakness x2 weeks. BUN 41 and Cr 4. what is cause?
ATN --> from chronic NSAIDs
32 YR F brought to ED after MVC, agitated, SOB, tachy, RR30, hypotensive, breath sounds absent on R, L
sounds normal, CXR w/ opacification of R hemithorax. cause?
hemothorax
25 YR F at 27 weeks w/ severe contractions x6 hours, vaginal spotting, contractions every 2-3 mins w/
FHR 130 and no decels, cervic 1-2 cm and 70% effaced, GBS is positive. next step?
IM beclamethasone THEN later can give penicillin
,man w/ 15 yr hx of difficult relaxing hands after tightly gripping objects or shaking hands, difficulty
releasing after gripping w/ hands. dx?
mYRtonic muscular dystrophy
pt unable to see out of R eye since awakening 2 hrs ago. visual acuity 20/200 in R eye and 20/20 in L. R
pupil poorly reactive to light. where is site of lesion?
R optic nerve
6 mo old w/ poor feeding, labored breathing, to and fro murmur in 2nd L itnercostal space, loud S2,
bounding peripheral pulses, widened pulse pressure. dx?
patent ductus arteriosus
recurrent lymph node infxns w/ staph a in a kid. what is dx and mechanism?
chronic granulomatous dz --> impaired phagocytic oxidative metabolism
pt hyperkalemic bc missed 2 dialysis appointments. EKG w/ peaked t waves. next step?
IV calcium gluconate --> THEN can give insulin but this works within minutes
hyaline casts vs WBC casts?
-WBC casts: interstitial nephritis and pyelonephritis
-hyaline casts: AKI
, 4 YR M in MVC, RR 32 w/ grunting and restractions, hypoxic on ABG, CXR 4 hrs later shows diffuse
infiltrates on R side. dx?
pulmonary contusion
asymptomatic 57 YR M smoker, bruit in RUQ, no masses, BUN 23, Cr 1.4. what is cause of bruit?
accumulation of lipids in arterial wall --> renal artery stenosis
52 YR F w/ decreased libido, underwent TAH and bilateral salpingo-oophorectomy for leiomYRmata uteri
and menorrhagia. on hormone replacement + estrogen since sx. exam w/ moist, rugated vagina. what is
cause?
decreased androgens/testosterone --> due to oophoreectomy = decreased androstenedione and DHEA
= aka hypergonadotropic hypogonadism ant pituitary works ovaries don't
67 YR F w/ afib on warfarin, INR 6 so meds stopped, next day she had abdominal pain and vomiting x24
hours, Hgb 13 --> 7.8. cause?
intramural hematoma of proximal small bowel --> rare complication of warfarin
IVDU w/ papilledema, LP w/ high proteins, low glucose, 200 cells. dx?
fungal meningitis --> cryptococcal --> prolly has AIDS
