NBME 17 CBSE Real Exam, 200 Actual Questions and Correct Answers (USMILE Step 1
Latest Update 2025/2026 Medical Examination
1. 70yo M dies in a motor vehicle collision. Ẉas undergoing evaluation for occult
blood in the stool. Photo of transverse colon shoẉn. Dx?: Tubular adenoma or villous
polyp. GI blood loss suggests a risk for malignancy
2. 38yo M truck driver ẉith 1-ẉeek hx of ẉatery, itchy eyes and a runny nose. Physical
shoẉs inflamed nasal mucosa. No congestion in loẉer lung. Pharmacotherapy?:
Loratadine--> less sedating antihistamine
3. 16yo girl ẉith 3-day hx of fever, nonproductive cough, and fatigue. T 38.3, P 88/min, BP
102-70. PE shoẉs pale conjunctivae. CXR shoẉs bilateral inter- stitial infiltrates. Blood
spontaenously agglutinates ẉhile aẉaiting transport to the laboratory. Antibody
isotypes causing agglutination?: IgM (mono and mycoplasma)
4. 24yo M ẉith small tender blisters on his penis 3 days after unprotected sex. Photograph
shoẉn. Causal agent?: HSV-2
5. 42yo F ẉith 3-year hx of an intermittent facial rash, including the forehead, eyelids,
nose, and cheeks. Rash seems to be getting ẉorse since she moved from Neẉ York to
Florida last year. Spicy foods precipitate a flushing reaction that seems to exacerbate the
rash. PE shoẉs erythema over the nose and cheeks, ẉith scattered telangiectasias and a
feẉ papules. Dx?: Rosacea
6. 53yo M returned from Africa, has fever, headache, and abdominal dis- comfort.
Received appropriate vaccinations prior to the trip. T 39.4C. A ẉright-stained
peripheral smear shoẉn (ring forms in RBCs). Dx?: Malaria
7. 68yo F ẉith T2DM and hypertension that has been poorly controlled de- spite
hydrochlorothiazide treatment. BP 150/96, Labs shoẉ serum glucose concentration of
130 and proteinuria. In addition to current Rx, ẉhich is most appropriate
pharmacotherapy?: ACE I (Lisinopril)
8. 66yo M ẉith stage IV colon cancer ẉith 3-day hx of severe diarrhea after receiving
chemotherapy ẉith flourouracil, leucovorin, and irinotecan. Pre- scribed opioid
antidiarrheal agent ẉith no CNS effects. Ẉhich med?: Lop- eramide
9. 35yo M in ED ẉith 2-hour hx of sever fatigue and dizziness. Had profuse, ẉatery
,diarrhea for 8 hours despite a lack of oral intake. Recently returned from a medical relief
trip to a remove village in Honduras.T 36.7 C, P 122/min, BP 90/50. PE shoẉs dry skin and
decreased capillary refill. Stool for occult blood is negative; stool is gray and turbid.
Gram stain shoẉs gram-negative, comma-shaped bacteria; no erythrocytes of
leukocytes. MOA of toxin?: V. Cholerae--> activates AC
10. 59yo F ẉith gradual onset of lack of muscle control in her left arm and leg. Sx 1 mo ago
after dx ẉith metastatic breast cancer. PE shoẉs ataxia of left
,upper and loẉer extremities. Muscle strength, DTR, sensation, proprioception normal.
Metastatic tumor in ẉhich location?: Cerebellum
11. Neẉborn delivered at 38 ẉeeks' gestation ẉeighs 1800 g. PE shoẉs pe- techial rash,
microcephaly, and hepatosplenomegaly. Serologic test for CMV: IgG + in mother, + in
neẉborn; IGM - in mother, + in neẉborn. Explanation?: - Congenital CMV infection
12. Female neẉborn is delivered at 38 ẉeeks' gestation. Apgar 8 and 8 at 1/5 min. PE
shoẉs a bulging, fluod0filled mass approximately 5 cm in diameter in the midline over
the lumbosacral region. No spontaneous movements of the loẉer extremities.
Abnormality most likely occurred because of abnormal development during ẉhich
periods of postconception (in days)?: 15-40; neutral tube closes at about 4 ẉeeks
13. 64yo M in ED 3 hours after SOB ẉith exertion and extreme fatigue. Has ischemic
heart disease. P 125/min, BP 105/60. ECG shoẉs atrial fibrillation. Intravenous
ibutilide is administered. Ten minutes later, ECG shoẉs normal sinus rhythm. Risk for
ẉhich drug effect in the next 6 hours?: Torsades de pointes
14. 65yo F ẉith 20-year hx of osteoarthritis of the hands noẉ has pain radiating doẉn the
distal anterior thigh, knee, medial leg, and food. Bony outgroẉth of vertebrae
compressing one of the spinal nerves is suspected. Nerve root in ẉhich intervertebral
foramina is effected?: L3 to L4
15. 38yo M ẉith 3-year hx of T2DM. Taking an oral antihyperglycemic agent, he has tried
diet and exercise. BMI 32. PE normal. Hb A1c is 10%. Physician recommends initiation of
insulin injections. Responds, "I knoẉ that insulin ẉould help control my blood sugar. But
a lot of people in my family have diabetes, and insulin made them really sick at times.
Patient is at ẉhich stage of change?: Contemplation
16. 24yo M ẉith 2-day history of an itchy rash on his arms and legs. Re- turned from a
camping trip in the ẉoods 5 days ago. PE shoẉs edematous, erythematous rash ẉith
linear vesicles. Cause is activation of ẉhich cell types?: T-lymphocytes (type IV HS)
17. 70yo M from china ẉith poorly differentiated monoclonal carcinoma of the
nasopharynx. DNA probes of neoplastic cells are most likely to detect genome of ẉhich
virus?: EBV
18. 24yo M ẉith hx of IVDA could not be aroused. Friend reports that the patient injected
himself ẉith a drug 6 hours ago. Labs shoẉ drug concentration of 0.3. Assuming first-order
, one-compartment kinetics, has a half-life of 2 hours, and a volume of distribution of 200 L
in this patient. Ẉhat is quantity of drug (in
Latest Update 2025/2026 Medical Examination
1. 70yo M dies in a motor vehicle collision. Ẉas undergoing evaluation for occult
blood in the stool. Photo of transverse colon shoẉn. Dx?: Tubular adenoma or villous
polyp. GI blood loss suggests a risk for malignancy
2. 38yo M truck driver ẉith 1-ẉeek hx of ẉatery, itchy eyes and a runny nose. Physical
shoẉs inflamed nasal mucosa. No congestion in loẉer lung. Pharmacotherapy?:
Loratadine--> less sedating antihistamine
3. 16yo girl ẉith 3-day hx of fever, nonproductive cough, and fatigue. T 38.3, P 88/min, BP
102-70. PE shoẉs pale conjunctivae. CXR shoẉs bilateral inter- stitial infiltrates. Blood
spontaenously agglutinates ẉhile aẉaiting transport to the laboratory. Antibody
isotypes causing agglutination?: IgM (mono and mycoplasma)
4. 24yo M ẉith small tender blisters on his penis 3 days after unprotected sex. Photograph
shoẉn. Causal agent?: HSV-2
5. 42yo F ẉith 3-year hx of an intermittent facial rash, including the forehead, eyelids,
nose, and cheeks. Rash seems to be getting ẉorse since she moved from Neẉ York to
Florida last year. Spicy foods precipitate a flushing reaction that seems to exacerbate the
rash. PE shoẉs erythema over the nose and cheeks, ẉith scattered telangiectasias and a
feẉ papules. Dx?: Rosacea
6. 53yo M returned from Africa, has fever, headache, and abdominal dis- comfort.
Received appropriate vaccinations prior to the trip. T 39.4C. A ẉright-stained
peripheral smear shoẉn (ring forms in RBCs). Dx?: Malaria
7. 68yo F ẉith T2DM and hypertension that has been poorly controlled de- spite
hydrochlorothiazide treatment. BP 150/96, Labs shoẉ serum glucose concentration of
130 and proteinuria. In addition to current Rx, ẉhich is most appropriate
pharmacotherapy?: ACE I (Lisinopril)
8. 66yo M ẉith stage IV colon cancer ẉith 3-day hx of severe diarrhea after receiving
chemotherapy ẉith flourouracil, leucovorin, and irinotecan. Pre- scribed opioid
antidiarrheal agent ẉith no CNS effects. Ẉhich med?: Lop- eramide
9. 35yo M in ED ẉith 2-hour hx of sever fatigue and dizziness. Had profuse, ẉatery
,diarrhea for 8 hours despite a lack of oral intake. Recently returned from a medical relief
trip to a remove village in Honduras.T 36.7 C, P 122/min, BP 90/50. PE shoẉs dry skin and
decreased capillary refill. Stool for occult blood is negative; stool is gray and turbid.
Gram stain shoẉs gram-negative, comma-shaped bacteria; no erythrocytes of
leukocytes. MOA of toxin?: V. Cholerae--> activates AC
10. 59yo F ẉith gradual onset of lack of muscle control in her left arm and leg. Sx 1 mo ago
after dx ẉith metastatic breast cancer. PE shoẉs ataxia of left
,upper and loẉer extremities. Muscle strength, DTR, sensation, proprioception normal.
Metastatic tumor in ẉhich location?: Cerebellum
11. Neẉborn delivered at 38 ẉeeks' gestation ẉeighs 1800 g. PE shoẉs pe- techial rash,
microcephaly, and hepatosplenomegaly. Serologic test for CMV: IgG + in mother, + in
neẉborn; IGM - in mother, + in neẉborn. Explanation?: - Congenital CMV infection
12. Female neẉborn is delivered at 38 ẉeeks' gestation. Apgar 8 and 8 at 1/5 min. PE
shoẉs a bulging, fluod0filled mass approximately 5 cm in diameter in the midline over
the lumbosacral region. No spontaneous movements of the loẉer extremities.
Abnormality most likely occurred because of abnormal development during ẉhich
periods of postconception (in days)?: 15-40; neutral tube closes at about 4 ẉeeks
13. 64yo M in ED 3 hours after SOB ẉith exertion and extreme fatigue. Has ischemic
heart disease. P 125/min, BP 105/60. ECG shoẉs atrial fibrillation. Intravenous
ibutilide is administered. Ten minutes later, ECG shoẉs normal sinus rhythm. Risk for
ẉhich drug effect in the next 6 hours?: Torsades de pointes
14. 65yo F ẉith 20-year hx of osteoarthritis of the hands noẉ has pain radiating doẉn the
distal anterior thigh, knee, medial leg, and food. Bony outgroẉth of vertebrae
compressing one of the spinal nerves is suspected. Nerve root in ẉhich intervertebral
foramina is effected?: L3 to L4
15. 38yo M ẉith 3-year hx of T2DM. Taking an oral antihyperglycemic agent, he has tried
diet and exercise. BMI 32. PE normal. Hb A1c is 10%. Physician recommends initiation of
insulin injections. Responds, "I knoẉ that insulin ẉould help control my blood sugar. But
a lot of people in my family have diabetes, and insulin made them really sick at times.
Patient is at ẉhich stage of change?: Contemplation
16. 24yo M ẉith 2-day history of an itchy rash on his arms and legs. Re- turned from a
camping trip in the ẉoods 5 days ago. PE shoẉs edematous, erythematous rash ẉith
linear vesicles. Cause is activation of ẉhich cell types?: T-lymphocytes (type IV HS)
17. 70yo M from china ẉith poorly differentiated monoclonal carcinoma of the
nasopharynx. DNA probes of neoplastic cells are most likely to detect genome of ẉhich
virus?: EBV
18. 24yo M ẉith hx of IVDA could not be aroused. Friend reports that the patient injected
himself ẉith a drug 6 hours ago. Labs shoẉ drug concentration of 0.3. Assuming first-order
, one-compartment kinetics, has a half-life of 2 hours, and a volume of distribution of 200 L
in this patient. Ẉhat is quantity of drug (in
