NBME HIGH YIELD EXAM 2025
QUESTIONS AND ANSWERS
What are sentinel lymph nodes? - ANS First group of lymph nodes draining a specific organ
Describe the lymph node drainage of the GI tract - ANS *Trachea and esophagus =>
Mediastinal
*Liver, spleen, pancreas, stomach, upper duodenum => Celiac
*Lower duodenum, jejunum, ilecum, colon to splenic flexure => SMA
*Colon from splenic flexure to upper rectum => IMA
*Lower rectum to anal canal (above pectinate line) =>Internal Iliac
Anal rectum (below pectinate line) =>Superficial inguinal
What is the mechanism by which Lactulose is used to treat Hepatic Encephalopathy? -
ANS *Lactulose is resistant to intestinal disaccharides
*Metabolized by gut flora into lactic and formic acid.
*These acids have an osmotic/laxative effect and cause an acidifying effect
*Acids also cause NH3 to be trapped as NH4+ and cannot cross intestinal wall; excreted into
feces
What antimuscarinics are used to prevent postprandial abdominal pain of IBS patient -
ANS Hyoscyamine,dicyclomine
1
Page
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, Which drugs are contraindicated in patients with glaucoma? - ANS Drugs that cause
mydriasis: A1 agonists or M3 antagonists (antimuscarinics)
A1 agonists: Epinephrine
M3 antagonists:Atropine and other antimuscarinics
Mydriasis pulls the iris to it's base, making the angle narrow
What is the treatment of Atropione poisoning?
What is the treatment of Organophosphate poisoning? - ANS Atropine poisoning:
Physostigmine (crosses BBB)
Organophosphate poisoning: Atropine first and then PAM
*Important to distinguish between atropine overdose and TCA overdose. Both have symptoms
of anticholinergic excess; TCA also has
Which receptor is associated with the following
*Pupillary dilator muscle contraction -> mydriasis
*Pupillary sphinctor muscle contraction -> miosis
*Ciliary muscle contraction ->accommodation
*Increase aqueous humor production
*Decrease aqueous humor production - ANS *Pupillary dilator muscle contraction ->
mydriasis: A1
*Pupillary sphinctor muscle contraction -> miosis: M3
*Ciliary muscle contraction ->accommodation: M3
2
*Increase aqueous humor production: B2
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*Decrease aqueous humor production: A2
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, Hemicholinium - ANS MOA: blocks the sodium-dependent reuptake of choline into
presynaptic terminals.
*Because reuptake of choline is the rate-limiting step in acetylcholine synthesis, hemicholinium
reduces presynaptic stores of acetylcholine
Which of the following below will deplete "presynaptic ACh" stores?
a) botulinum toxin
b) curare
c) neostigmine
d) hemicholinium
e) atropine - ANS d) hemicholinium
A 47-year-old woman comes to the physician for a routine health maintenance examination.
She has a 2-year history of venous insufficiency and notes daily swelling of her ankles that
worsesn in the evening. She takes no medications. Her pulse is 80/min, and BP is 160/100 mm
Hg. Cardiopulmonary examination shows no abnormalities. Examination of the lower
extermities show 2+ edema and increased pigmentation. Which of the following hypertensive
drugs would most likely exacerbate this patient's swelling?
A) Atenolol
B) Clonidine
C) Lisniopril
D) Losartan
E) Nifedipine - ANS E) Nifedipine
Bilateral edema of the lower limbs is one of the most common adverse effects of DHPs and is
likely related to the vasodilatory mechanism of action of these drugs.
3
Page
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, A 51 year old woman receives the diagnosis of pheochromocytoma. preoperatine treatment
with propranolol is prescribed to decrease excessive tachycardia. which of the following drugs
should be administered before starting propranolol therapy in the patient?
A- atenolol
B clonidine
C nifedipine
D- phenoxybenzamine
E sildenafil - ANS
What two effects do antimuscarinic drugs have on the eye? - ANS mydriasis(M3 receptor
mediates pupillary constriction)
cycloplegia(M3 receptor mediates ciliary constriction and accomodation)
Which chromosome is affected in Huntington's disease? - ANS 4
*HUNT*
What two diseases does the mnemonic frat brother with a big sweet heart help us remember
about Freidrich Ataxia? - ANS Diabetes mellitus
Hypertrophic cardiomyopathy
A 26 year old woman with pain and stiffness of both hands. Physical exam shows swelling and
redness of PIP joints. Xray shows joint space narrowing and marginal erosions of PIP joints. DIP
joints spared. Biopsy show?
4
A. Necrotizing granulomas
Page
@COPYRIGHT SIRJOEL 2025/2026
QUESTIONS AND ANSWERS
What are sentinel lymph nodes? - ANS First group of lymph nodes draining a specific organ
Describe the lymph node drainage of the GI tract - ANS *Trachea and esophagus =>
Mediastinal
*Liver, spleen, pancreas, stomach, upper duodenum => Celiac
*Lower duodenum, jejunum, ilecum, colon to splenic flexure => SMA
*Colon from splenic flexure to upper rectum => IMA
*Lower rectum to anal canal (above pectinate line) =>Internal Iliac
Anal rectum (below pectinate line) =>Superficial inguinal
What is the mechanism by which Lactulose is used to treat Hepatic Encephalopathy? -
ANS *Lactulose is resistant to intestinal disaccharides
*Metabolized by gut flora into lactic and formic acid.
*These acids have an osmotic/laxative effect and cause an acidifying effect
*Acids also cause NH3 to be trapped as NH4+ and cannot cross intestinal wall; excreted into
feces
What antimuscarinics are used to prevent postprandial abdominal pain of IBS patient -
ANS Hyoscyamine,dicyclomine
1
Page
@COPYRIGHT SIRJOEL 2025/2026
, Which drugs are contraindicated in patients with glaucoma? - ANS Drugs that cause
mydriasis: A1 agonists or M3 antagonists (antimuscarinics)
A1 agonists: Epinephrine
M3 antagonists:Atropine and other antimuscarinics
Mydriasis pulls the iris to it's base, making the angle narrow
What is the treatment of Atropione poisoning?
What is the treatment of Organophosphate poisoning? - ANS Atropine poisoning:
Physostigmine (crosses BBB)
Organophosphate poisoning: Atropine first and then PAM
*Important to distinguish between atropine overdose and TCA overdose. Both have symptoms
of anticholinergic excess; TCA also has
Which receptor is associated with the following
*Pupillary dilator muscle contraction -> mydriasis
*Pupillary sphinctor muscle contraction -> miosis
*Ciliary muscle contraction ->accommodation
*Increase aqueous humor production
*Decrease aqueous humor production - ANS *Pupillary dilator muscle contraction ->
mydriasis: A1
*Pupillary sphinctor muscle contraction -> miosis: M3
*Ciliary muscle contraction ->accommodation: M3
2
*Increase aqueous humor production: B2
Page
*Decrease aqueous humor production: A2
@COPYRIGHT SIRJOEL 2025/2026
, Hemicholinium - ANS MOA: blocks the sodium-dependent reuptake of choline into
presynaptic terminals.
*Because reuptake of choline is the rate-limiting step in acetylcholine synthesis, hemicholinium
reduces presynaptic stores of acetylcholine
Which of the following below will deplete "presynaptic ACh" stores?
a) botulinum toxin
b) curare
c) neostigmine
d) hemicholinium
e) atropine - ANS d) hemicholinium
A 47-year-old woman comes to the physician for a routine health maintenance examination.
She has a 2-year history of venous insufficiency and notes daily swelling of her ankles that
worsesn in the evening. She takes no medications. Her pulse is 80/min, and BP is 160/100 mm
Hg. Cardiopulmonary examination shows no abnormalities. Examination of the lower
extermities show 2+ edema and increased pigmentation. Which of the following hypertensive
drugs would most likely exacerbate this patient's swelling?
A) Atenolol
B) Clonidine
C) Lisniopril
D) Losartan
E) Nifedipine - ANS E) Nifedipine
Bilateral edema of the lower limbs is one of the most common adverse effects of DHPs and is
likely related to the vasodilatory mechanism of action of these drugs.
3
Page
@COPYRIGHT SIRJOEL 2025/2026
, A 51 year old woman receives the diagnosis of pheochromocytoma. preoperatine treatment
with propranolol is prescribed to decrease excessive tachycardia. which of the following drugs
should be administered before starting propranolol therapy in the patient?
A- atenolol
B clonidine
C nifedipine
D- phenoxybenzamine
E sildenafil - ANS
What two effects do antimuscarinic drugs have on the eye? - ANS mydriasis(M3 receptor
mediates pupillary constriction)
cycloplegia(M3 receptor mediates ciliary constriction and accomodation)
Which chromosome is affected in Huntington's disease? - ANS 4
*HUNT*
What two diseases does the mnemonic frat brother with a big sweet heart help us remember
about Freidrich Ataxia? - ANS Diabetes mellitus
Hypertrophic cardiomyopathy
A 26 year old woman with pain and stiffness of both hands. Physical exam shows swelling and
redness of PIP joints. Xray shows joint space narrowing and marginal erosions of PIP joints. DIP
joints spared. Biopsy show?
4
A. Necrotizing granulomas
Page
@COPYRIGHT SIRJOEL 2025/2026
