NBME CBSE (usmle step 1)MEDICAL ACTUAL EXAM LATEST
VERSION [1600 QUESTIONS AND ANSWERS] WITH STUDY
GUIDE DETAILED AND VERIFIED FOR GUARANTEED PASS-
LATEST UPDATE 2025 GRADED A
16yo girl with 3-day hx of fever, nonproductive cough, and fatigue. T 38.3, P 88/min, BP
102-70. PE shows pale conjunctivae. CXR shows bilateral interstitial infiltrates. Blood
spontaenously agglutinates while awaiting transport to the laboratory. Antibody isotypes
causing agglutination? - CORRECT ANSWER IgM
24yo M with small tender blisters on his penis 3 days after unprotected sex. Photograph
shown. Causal agent? - CORRECT ANSWER HSV-2
42yo F with 3-year hx of an intermittent facial rash, including the forehead, eyelids,
nose, and cheeks. Rash seems to be getting worse since she moved from New York to
Florida last year. Spicy foods precipitate a flushing reaction that seems to exacerbate
the rash. PE shows erythema over the nose and cheeks, with scattered telangiectasias
and a few papules. Dx? - CORRECT ANSWER Rosacea
53yo M returned from Africa, has fever, headache, and abdominal discomfort. Received
appropriate vaccinations prior to the trip. T 39.4C. A wright-stained peripheral smear
shown. Dx? - CORRECT ANSWER Malaria
68yo F with T2DM and hypertension that has been poorly controlled despite
hydrochlorothiazide treatment. BP 150/96, Labs show serum glucose concentration of
130 and proteinuria. In addition to current Rx, which is most appropriate
pharmacotherapy? - CORRECT ANSWER Lisinopril
66yo M with stage IV colon cancer with 3-day hx of severe diarrhea after receiving
chemotherapy with fluorouracil, leucovorin, and Irinotecan. prescribed opioid
antidiarrheal agent with no CNS effects. Which med? - CORRECT ANSWER
Loperamide
35yo M in ED with 2-hour hx of sever fatigue and dizziness. Had profuse, watery
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 shows dry skin
and decreased capillary refill. Stool for occult blood is negative; stool is gray and turbid.
Gram stain shows gram-negative, comma-shaped bacteria; no erythrocytes of
leukocytes. MOA of toxin? - CORRECT ANSWER Activation of adenylyl cyclase
,59yo F with gradual onset of lack of muscle control in her left arm and leg. Sx 1 mo ago
after dx with metastatic breast cancer. PE shows ataxia of left upper and lower
extremities. Muscle strength, DTR, sensation, proprioception normal. Metastatic tumor
in which location? - CORRECT ANSWER cerebellum
Newborn delivered at 38 weeks' gestation weighs 1800 g. PE shows petechial rash,
microcephaly, and hepatosplenomegaly. Serologic test for CMV: IgG + in mother, + in
newborn; IGM - in mother, + in newborn. Explanation? - CORRECT ANSWER
Congenital cytomegalovirus infection
Female newborn is delivered at 38 weeks' gestation. Apgar 8 and 8 at 1/5 min. PE
shows a bulging, fluod0filled mass approximately 5 cm in diameter in the midline over
the lumbosacral region. No spontaneous movements of the lower extremities.
Abnormality most likely occurred because of abnormal development during which
periods of postconception (in days)? - CORRECT ANSWER 15 to 40
64yo M in ED 3 hours after SOB with exertion and extreme fatigue. Has ischemic heart
disease. P 125/min, BP 105/60. ECG shows atrial fibrillation. Intravenous ibutilide is
administered. Ten minutes later, ECG shows normal sinus rhythm. Risk for which drug
effect in the next 6 hours? - CORRECT ANSWER torsades de pointes
65yo F with 20-year hx of osteoarthritis of the hands now has pain radiating down the
distal anterior thigh, knee, medial leg, and food. Bony outgrowth of vertebrae
compressing one of the spinal nerves is suspected. Nerve root in which intervertebral
foramina is effected? - CORRECT ANSWER L3 to L4
38yo M with 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 know that insulin would 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 which stage of change? - CORRECT ANSWER contemplation
24yo M with 2-day history of an itchy rash on his arms and legs. Returned from a
camping trip in the woods 5 days ago. PE shows edematous, erythematous rash with
linear vesicles. Cause is activation of which cell types? - CORRECT ANSWER T
lymphocytes
70yo M from china with poorly differentiated monoclonal carcinoma of the nasopharynx.
DNA probes of neoplastic cells are most likely to detect genome of which virus? -
CORRECT ANSWER EBV
Epidemiologic study of aniline dye, 500 workers with bladder cancer and 200 workers
without. Exposed to aniline dyes/Have Bladder cancer: Yes/Yes (250), Yes/No (50),
No/Yes (250), No/No (150). Odds ratio? - CORRECT ANSWER 3
,24yo M with hx of IVDA could not be aroused. Friend reports that the patient injected
himself with a drug 6 hours ago. Labs show 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. What is quantity of drug (in mg) injected? - CORRECT
ANSWER 480
Compound is taken up by bacterial cells. No energy is necessary for uptake, and the
compound is not concentrated in the cell. Which describes this mechanism of transport?
- CORRECT ANSWER carrier-mediated diffusion
Newborn has male genital ducts but female external genitalia. Cytogenetic analysis
shows a 46,XY karyotype, and genetic testing shows a mutation of the gene encoding
5alpha-reductase. In absence of this mutation, labia majora would have been? -
CORRECT ANSWER scrotum
Study designed to evaluate the efficacy of coenzyme Q10 in improving cardiac output in
patients with CHF. Sixty patients with CHF are recruited. Each assigned by coin toss to
one of two groups. Design? - CORRECT ANSWER randomized clinical trial
12yo boy immersed up to his neck in 60F water for 20 minutes. Physiological changes?
- CORRECT ANSWER Central blood volume INCREASED, ADH (vasopressin)
DECREASED, Atrial Natriuretic Peptide INCREASED? C (block3, q23)
Randomized controlled study of 2000 patients with insomnia is conducted to evaluate
the efficacy of a new medication to treat this condition. Ten subjects from both the
control and treatment groups do not complete the study are not included in the analysis.
Treatment group able to fall asleep 5 minutes faster than control (p=0.001). Neither
group report an improvement in quality of life. Conclude that new med is efficacious in
treating insomnia. Type of error? - CORRECT ANSWER Failure to distinguish
between statistical significance and clinical significance
18mo girl. Separation of the umbilical cord was delayed after birth. Has had four severe
skin infections Staphylococcus aureus; No pus formation at infection sites. Persistent
leukocytosis in absence of infection. Mechanisms impaired? - CORRECT ANSWER
leukocyte adhesion and transmigration
50yo M with increasing cough for 6 month and hemoptysis for 1 week. Smoked 1 pack
per day for 32 years. Plays squash, swims. CXR shows a 3 x 4-cm hilar mass. Cytologic
examination of sputum shows a non-small cell carcinoma. Tells patient he has lung
cancer. The patient responds, "How can this be happening to m? I eat right and
exercise." Appropriate response? - CORRECT ANSWER "It must be difficult for
you to accept this diagnosis when you feel healthy."
, 32yo M with 6-month hx of low back pain and stiffness, worse in morning and improve
during the day; the pain radiates to his buttocks but not down his legs. Back stiffness if
he sits for prolonged periods. Which to confirm diagnosis? - CORRECT ANSWER
X-rays of the sacroiliac joints
17yo boy with 8-kg weight gain during the past year. No medical illness. BMI is 32. He
asks, "Do you think that my weight gain is inherited from my father?" Appropriate
response? - CORRECT ANSWER "Yes, your weight gain can be caused by genes
and environment combined."
52yo M neighbors have reported that he has been confused and not taking care of
himself. 4-mo Hx of diarrhea. PE shows extreme muscle wasting, stomatitis, and a
diffuse rash that is worse in sun-exposed areas. Diagnosis? - CORRECT ANSWER
pellagra
80yo F with suspected temporal arteritis (TA). ESR is 100, Pretest probability for TA is
50% in this patient. In the evaluation of TA, ESR has a sensitivity of 99% and specificity
of 60%. Based on the results of the ESR testing, most appropriate next step? -
CORRECT ANSWER Additional testing to confirm the diagnosis of TA
Sequence surrounding the first two exons of the human beta-globin gene shown, with
exons in bold. Translation start codon is underlined. A mutation from G-->A at position
355 is most likely to lead to beta-thalassemia by which mechanism? - CORRECT
ANSWER Disruption of normal splicing by creation of a new 3' splice site?
42yo M in ED because of a 10-day history of progressive fever, SOB, and
nonproductive cough. 20-kg weight loss. Immigrated to USA from the Ivory Coast 4
years ago. Temp 38C. Lungs clear, CXr shows diffuse interstitial infiltrate. Silver stain
obtained via bronchoscopy shows Pneumocystis jiroveci (formerly P. carinii). High dose
prednisone and trimethoprim-sulfamethoxazole is initiated, and workup for HIV infection
is done. HIV ELISA positive, HIV western blot positive, CD4 22; HIV viral load <50.
Explanation? - CORRECT ANSWER Infection with HIV-2
27yo F with vaginal bleeding for 3 weeks. First pregnancy ended with a spontaneous
abortion 8 months ago. No Rx since dilatation and curettage at that time. PE shows
enlarged uterus, beta-hCG markedly increased. Ultrasonagraphy of pelvis shows
material within the endometrial cavity and no intrauterine pregnancy. CT scan shows a
necrotic intrauterine mass and metastatic nodules in the lungs. Site of Origin? -
CORRECT ANSWER trophoblastic tissue
65yo M emigrated from Brazil with 8-month history of shortness of breath and fatigue,
edema of lower ext. CXR shows cardiomegaly. endomyocardial biopsy specimen shows
myofiber necrosis with a mixed inflammatory infiltrate of PMNs, T lymphos, m.phages,
and eosinophils. Causal org? - CORRECT ANSWER Trypanosoma cruzi
VERSION [1600 QUESTIONS AND ANSWERS] WITH STUDY
GUIDE DETAILED AND VERIFIED FOR GUARANTEED PASS-
LATEST UPDATE 2025 GRADED A
16yo girl with 3-day hx of fever, nonproductive cough, and fatigue. T 38.3, P 88/min, BP
102-70. PE shows pale conjunctivae. CXR shows bilateral interstitial infiltrates. Blood
spontaenously agglutinates while awaiting transport to the laboratory. Antibody isotypes
causing agglutination? - CORRECT ANSWER IgM
24yo M with small tender blisters on his penis 3 days after unprotected sex. Photograph
shown. Causal agent? - CORRECT ANSWER HSV-2
42yo F with 3-year hx of an intermittent facial rash, including the forehead, eyelids,
nose, and cheeks. Rash seems to be getting worse since she moved from New York to
Florida last year. Spicy foods precipitate a flushing reaction that seems to exacerbate
the rash. PE shows erythema over the nose and cheeks, with scattered telangiectasias
and a few papules. Dx? - CORRECT ANSWER Rosacea
53yo M returned from Africa, has fever, headache, and abdominal discomfort. Received
appropriate vaccinations prior to the trip. T 39.4C. A wright-stained peripheral smear
shown. Dx? - CORRECT ANSWER Malaria
68yo F with T2DM and hypertension that has been poorly controlled despite
hydrochlorothiazide treatment. BP 150/96, Labs show serum glucose concentration of
130 and proteinuria. In addition to current Rx, which is most appropriate
pharmacotherapy? - CORRECT ANSWER Lisinopril
66yo M with stage IV colon cancer with 3-day hx of severe diarrhea after receiving
chemotherapy with fluorouracil, leucovorin, and Irinotecan. prescribed opioid
antidiarrheal agent with no CNS effects. Which med? - CORRECT ANSWER
Loperamide
35yo M in ED with 2-hour hx of sever fatigue and dizziness. Had profuse, watery
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 shows dry skin
and decreased capillary refill. Stool for occult blood is negative; stool is gray and turbid.
Gram stain shows gram-negative, comma-shaped bacteria; no erythrocytes of
leukocytes. MOA of toxin? - CORRECT ANSWER Activation of adenylyl cyclase
,59yo F with gradual onset of lack of muscle control in her left arm and leg. Sx 1 mo ago
after dx with metastatic breast cancer. PE shows ataxia of left upper and lower
extremities. Muscle strength, DTR, sensation, proprioception normal. Metastatic tumor
in which location? - CORRECT ANSWER cerebellum
Newborn delivered at 38 weeks' gestation weighs 1800 g. PE shows petechial rash,
microcephaly, and hepatosplenomegaly. Serologic test for CMV: IgG + in mother, + in
newborn; IGM - in mother, + in newborn. Explanation? - CORRECT ANSWER
Congenital cytomegalovirus infection
Female newborn is delivered at 38 weeks' gestation. Apgar 8 and 8 at 1/5 min. PE
shows a bulging, fluod0filled mass approximately 5 cm in diameter in the midline over
the lumbosacral region. No spontaneous movements of the lower extremities.
Abnormality most likely occurred because of abnormal development during which
periods of postconception (in days)? - CORRECT ANSWER 15 to 40
64yo M in ED 3 hours after SOB with exertion and extreme fatigue. Has ischemic heart
disease. P 125/min, BP 105/60. ECG shows atrial fibrillation. Intravenous ibutilide is
administered. Ten minutes later, ECG shows normal sinus rhythm. Risk for which drug
effect in the next 6 hours? - CORRECT ANSWER torsades de pointes
65yo F with 20-year hx of osteoarthritis of the hands now has pain radiating down the
distal anterior thigh, knee, medial leg, and food. Bony outgrowth of vertebrae
compressing one of the spinal nerves is suspected. Nerve root in which intervertebral
foramina is effected? - CORRECT ANSWER L3 to L4
38yo M with 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 know that insulin would 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 which stage of change? - CORRECT ANSWER contemplation
24yo M with 2-day history of an itchy rash on his arms and legs. Returned from a
camping trip in the woods 5 days ago. PE shows edematous, erythematous rash with
linear vesicles. Cause is activation of which cell types? - CORRECT ANSWER T
lymphocytes
70yo M from china with poorly differentiated monoclonal carcinoma of the nasopharynx.
DNA probes of neoplastic cells are most likely to detect genome of which virus? -
CORRECT ANSWER EBV
Epidemiologic study of aniline dye, 500 workers with bladder cancer and 200 workers
without. Exposed to aniline dyes/Have Bladder cancer: Yes/Yes (250), Yes/No (50),
No/Yes (250), No/No (150). Odds ratio? - CORRECT ANSWER 3
,24yo M with hx of IVDA could not be aroused. Friend reports that the patient injected
himself with a drug 6 hours ago. Labs show 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. What is quantity of drug (in mg) injected? - CORRECT
ANSWER 480
Compound is taken up by bacterial cells. No energy is necessary for uptake, and the
compound is not concentrated in the cell. Which describes this mechanism of transport?
- CORRECT ANSWER carrier-mediated diffusion
Newborn has male genital ducts but female external genitalia. Cytogenetic analysis
shows a 46,XY karyotype, and genetic testing shows a mutation of the gene encoding
5alpha-reductase. In absence of this mutation, labia majora would have been? -
CORRECT ANSWER scrotum
Study designed to evaluate the efficacy of coenzyme Q10 in improving cardiac output in
patients with CHF. Sixty patients with CHF are recruited. Each assigned by coin toss to
one of two groups. Design? - CORRECT ANSWER randomized clinical trial
12yo boy immersed up to his neck in 60F water for 20 minutes. Physiological changes?
- CORRECT ANSWER Central blood volume INCREASED, ADH (vasopressin)
DECREASED, Atrial Natriuretic Peptide INCREASED? C (block3, q23)
Randomized controlled study of 2000 patients with insomnia is conducted to evaluate
the efficacy of a new medication to treat this condition. Ten subjects from both the
control and treatment groups do not complete the study are not included in the analysis.
Treatment group able to fall asleep 5 minutes faster than control (p=0.001). Neither
group report an improvement in quality of life. Conclude that new med is efficacious in
treating insomnia. Type of error? - CORRECT ANSWER Failure to distinguish
between statistical significance and clinical significance
18mo girl. Separation of the umbilical cord was delayed after birth. Has had four severe
skin infections Staphylococcus aureus; No pus formation at infection sites. Persistent
leukocytosis in absence of infection. Mechanisms impaired? - CORRECT ANSWER
leukocyte adhesion and transmigration
50yo M with increasing cough for 6 month and hemoptysis for 1 week. Smoked 1 pack
per day for 32 years. Plays squash, swims. CXR shows a 3 x 4-cm hilar mass. Cytologic
examination of sputum shows a non-small cell carcinoma. Tells patient he has lung
cancer. The patient responds, "How can this be happening to m? I eat right and
exercise." Appropriate response? - CORRECT ANSWER "It must be difficult for
you to accept this diagnosis when you feel healthy."
, 32yo M with 6-month hx of low back pain and stiffness, worse in morning and improve
during the day; the pain radiates to his buttocks but not down his legs. Back stiffness if
he sits for prolonged periods. Which to confirm diagnosis? - CORRECT ANSWER
X-rays of the sacroiliac joints
17yo boy with 8-kg weight gain during the past year. No medical illness. BMI is 32. He
asks, "Do you think that my weight gain is inherited from my father?" Appropriate
response? - CORRECT ANSWER "Yes, your weight gain can be caused by genes
and environment combined."
52yo M neighbors have reported that he has been confused and not taking care of
himself. 4-mo Hx of diarrhea. PE shows extreme muscle wasting, stomatitis, and a
diffuse rash that is worse in sun-exposed areas. Diagnosis? - CORRECT ANSWER
pellagra
80yo F with suspected temporal arteritis (TA). ESR is 100, Pretest probability for TA is
50% in this patient. In the evaluation of TA, ESR has a sensitivity of 99% and specificity
of 60%. Based on the results of the ESR testing, most appropriate next step? -
CORRECT ANSWER Additional testing to confirm the diagnosis of TA
Sequence surrounding the first two exons of the human beta-globin gene shown, with
exons in bold. Translation start codon is underlined. A mutation from G-->A at position
355 is most likely to lead to beta-thalassemia by which mechanism? - CORRECT
ANSWER Disruption of normal splicing by creation of a new 3' splice site?
42yo M in ED because of a 10-day history of progressive fever, SOB, and
nonproductive cough. 20-kg weight loss. Immigrated to USA from the Ivory Coast 4
years ago. Temp 38C. Lungs clear, CXr shows diffuse interstitial infiltrate. Silver stain
obtained via bronchoscopy shows Pneumocystis jiroveci (formerly P. carinii). High dose
prednisone and trimethoprim-sulfamethoxazole is initiated, and workup for HIV infection
is done. HIV ELISA positive, HIV western blot positive, CD4 22; HIV viral load <50.
Explanation? - CORRECT ANSWER Infection with HIV-2
27yo F with vaginal bleeding for 3 weeks. First pregnancy ended with a spontaneous
abortion 8 months ago. No Rx since dilatation and curettage at that time. PE shows
enlarged uterus, beta-hCG markedly increased. Ultrasonagraphy of pelvis shows
material within the endometrial cavity and no intrauterine pregnancy. CT scan shows a
necrotic intrauterine mass and metastatic nodules in the lungs. Site of Origin? -
CORRECT ANSWER trophoblastic tissue
65yo M emigrated from Brazil with 8-month history of shortness of breath and fatigue,
edema of lower ext. CXR shows cardiomegaly. endomyocardial biopsy specimen shows
myofiber necrosis with a mixed inflammatory infiltrate of PMNs, T lymphos, m.phages,
and eosinophils. Causal org? - CORRECT ANSWER Trypanosoma cruzi
