NBME CBSE REAL EXAM QUESTIONS AND
ANSWERS LATEST UPDATE 202 5 (USMLE STEP 1)
MEDICAL EXAMINATION CORRECTLY
VERIFIED
NBME CBSE REAL EXAM
1. 70yoM diesin a motorvehiclecollision.Was undergoingevaluationfor occultbloodin thestool. Photo
of transverse colon shown. Dx?
- Tubular adenoma
2. 38yoM with1-weekhx of watery,itchy eyesand a runny nose.Physicalshowsinflamednasal
mucosa. No congestion in lower lung. Pharmacotherapy?
- Loratadine
3. 16yogirl with3-day hx of fever,nonproductivecough,and fatigue.T 38.3,P 88/min,BP 102-70. PE shows
pale conjunctivae.CXR shows bilateral interstitial infiltrates. Blood spontaenouslyagglutinates while
awaiting transport to the laboratory. Antibody isotypes causing agglutination?
- IgM
4. 24yoM withsmalltenderblisterson his penis3 daysafterunprotectedsex.Photographshown. Causal
agent?
- Herpessimplexvirus type2
5. 42yoF with3-yearhx of an intermittentfacialrash,including theforehead,eyelids,nose,and cheeks. Rash
seems to be getting worse since she moved from New York to Florida last year. Spicy foods precipitate
a
flushingreactionthatseemsto exacerbatetherash.PE showserythemaoverthenoseand cheeks, with scattered
telangiectasias and a few papules. Dx?
- Rosacea
6. 53yoM returnedfrom Africa, has fever,headache,and abdominaldiscomfort.Receivedappropriate
vaccinations prior to the trip. T 39.4C. A wright
-stained peripheral smear shown. Dx?
- Malaria
7. 68yo F with T2DM and hypertension that has eben poorly controlled despite hydrochlorothiazide
treatment.BP 150/96,Labs showserumglucoseconcentrationof 130 and proteinuria.In additionto current
Rx, which is most appropriate pharmacotherapy?
,- Lisinopril
, 8. 66yoM withstageIV coloncancerwith3-dayhx of severediarrhea afterreceivingchemotherapywith
flourouracil, leucovorin, and irinotecan. perscribed opioid antidiarrheal agent with no CNS effects.
Which
med?
- Loperamide
9. 35yoM in ED with2-hour hx of severfatigueand dizziness.Had profuse,waterydiarrheafor 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 -negative,
gram comma -shaped bacteria; no erythrocytes
of leukocytes. MOA of toxin?
- Activationof adenylylcyclase
10. 59yoF withgradualonsetof lack of musclecontrolin her leftarm andleg.Sx 1 mo agoafterdx with
metastatic breast cancer. PE shows ataxia of left upper and lower extremities. Muscle strength, DTR, sensation,
proprioception normal. Metastatic tumor in which location?
- Cerebellum
11. Newborn delivered at 38 weeks' gestation weighs 1800 g. PE shows petechial rash, microcephaly, and
hepatosplenomegaly.
Serologictestfor CMV: IgG + in mother,+ in newborn;IGM - in mother,+ in newborn.
Explanation?
- Congenitalcytomegalovirusinfection
12. Femalenewbornis deliveredat 38 weeks'gestation.Apgar 8 and 8 at 1/5min. PE showsa 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)?
- 15 to 40
13. 64yo M in ED 3 hours after SOB with exertionand extremefatigue.Has ischemic heart disease.P
125/min,BP 105/60.ECG showsatrialfibrillation.Intravenousibutilideis administered.Ten minutes later,
ECG shows normal sinus rhythm. Risk for which drug effect in the next 6 hours?
- Torsadesde pointes
14. 65yoF with20-yearhx of osteoarthritisof thehandsnow haspain radiatingdownthedistalanterior 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?
- L-3 to 4
15. 38yo M with -3year 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
thatinsulin wouldhelpcontrolmy bloodsugar.But a lot of peoplein my familyhave diabetes, and insulin
made them really sick at times. Patient is at which stage of change?
ANSWERS LATEST UPDATE 202 5 (USMLE STEP 1)
MEDICAL EXAMINATION CORRECTLY
VERIFIED
NBME CBSE REAL EXAM
1. 70yoM diesin a motorvehiclecollision.Was undergoingevaluationfor occultbloodin thestool. Photo
of transverse colon shown. Dx?
- Tubular adenoma
2. 38yoM with1-weekhx of watery,itchy eyesand a runny nose.Physicalshowsinflamednasal
mucosa. No congestion in lower lung. Pharmacotherapy?
- Loratadine
3. 16yogirl with3-day hx of fever,nonproductivecough,and fatigue.T 38.3,P 88/min,BP 102-70. PE shows
pale conjunctivae.CXR shows bilateral interstitial infiltrates. Blood spontaenouslyagglutinates while
awaiting transport to the laboratory. Antibody isotypes causing agglutination?
- IgM
4. 24yoM withsmalltenderblisterson his penis3 daysafterunprotectedsex.Photographshown. Causal
agent?
- Herpessimplexvirus type2
5. 42yoF with3-yearhx of an intermittentfacialrash,including theforehead,eyelids,nose,and cheeks. Rash
seems to be getting worse since she moved from New York to Florida last year. Spicy foods precipitate
a
flushingreactionthatseemsto exacerbatetherash.PE showserythemaoverthenoseand cheeks, with scattered
telangiectasias and a few papules. Dx?
- Rosacea
6. 53yoM returnedfrom Africa, has fever,headache,and abdominaldiscomfort.Receivedappropriate
vaccinations prior to the trip. T 39.4C. A wright
-stained peripheral smear shown. Dx?
- Malaria
7. 68yo F with T2DM and hypertension that has eben poorly controlled despite hydrochlorothiazide
treatment.BP 150/96,Labs showserumglucoseconcentrationof 130 and proteinuria.In additionto current
Rx, which is most appropriate pharmacotherapy?
,- Lisinopril
, 8. 66yoM withstageIV coloncancerwith3-dayhx of severediarrhea afterreceivingchemotherapywith
flourouracil, leucovorin, and irinotecan. perscribed opioid antidiarrheal agent with no CNS effects.
Which
med?
- Loperamide
9. 35yoM in ED with2-hour hx of severfatigueand dizziness.Had profuse,waterydiarrheafor 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 -negative,
gram comma -shaped bacteria; no erythrocytes
of leukocytes. MOA of toxin?
- Activationof adenylylcyclase
10. 59yoF withgradualonsetof lack of musclecontrolin her leftarm andleg.Sx 1 mo agoafterdx with
metastatic breast cancer. PE shows ataxia of left upper and lower extremities. Muscle strength, DTR, sensation,
proprioception normal. Metastatic tumor in which location?
- Cerebellum
11. Newborn delivered at 38 weeks' gestation weighs 1800 g. PE shows petechial rash, microcephaly, and
hepatosplenomegaly.
Serologictestfor CMV: IgG + in mother,+ in newborn;IGM - in mother,+ in newborn.
Explanation?
- Congenitalcytomegalovirusinfection
12. Femalenewbornis deliveredat 38 weeks'gestation.Apgar 8 and 8 at 1/5min. PE showsa 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)?
- 15 to 40
13. 64yo M in ED 3 hours after SOB with exertionand extremefatigue.Has ischemic heart disease.P
125/min,BP 105/60.ECG showsatrialfibrillation.Intravenousibutilideis administered.Ten minutes later,
ECG shows normal sinus rhythm. Risk for which drug effect in the next 6 hours?
- Torsadesde pointes
14. 65yoF with20-yearhx of osteoarthritisof thehandsnow haspain radiatingdownthedistalanterior 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?
- L-3 to 4
15. 38yo M with -3year 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
thatinsulin wouldhelpcontrolmy bloodsugar.But a lot of peoplein my familyhave diabetes, and insulin
made them really sick at times. Patient is at which stage of change?
