National Board of Medical Examiners (NBME)
NBME USMLE (United States Medical Licensing
Examination): USMLE Step 1, 2 and 3
NBME CBSSA & NBME CBSE Comprehensive Basic
Science Self- Assessment and Examination
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NBME USMLE Exam
Exam Title: NBME
Exam Date: Exam 2025- 2026
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2025- 2026
NBME CBSSA & NBME CBSE Comprehensive
Basic Science Self- Assessment and Examination
NBME USMLE (United States Medical Licensing
Examination): USMLE Step 1, 2 and 3
Read All Instructions Carefully and Answer All the
Questions Correctly Good Luck: -
National Board of Medical Examiners®
Comprehensive Basic Science Self- Assessment
1. Exam Section 1: Item 1 of 50
National Board of Medical Examiners® Comprehensive
Basic Science Self-Assessment
Shortly after delivery, a full-term male newborn is found
to have black hair with a white forelock. His mother, a
brunette, also has a white forelock
and wears hearing aids. Physical examination shows
heterochromia of irides.
Otoacoustic emissions testing and
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brain stem auditory evoked responses show bilateral
sensorineural hearing loss. Which of the following is the
most likely cause of the findings in this patient?
A) Abnormal neural crest development
B) Abnormality of connexins
C) Deficiency of homogentisic acid oxidase activity
D) Deficiency of tyrosinase activity
E) Failure of internalization of melanin granules by
keratinocytes
F) Failure of melanosome transportation along
dendrites: A.
Abnormal neural crest development leads to Waardenburg
syndrome. Waardenburg syndrome is a syndrome of patchy
depigmentation of the skin, hair, irises, and cochlear
dysfunction that primarily illustrates an autosomal dominant
inheritance pattern. Because of
genetic mutations of genes encoding transcription factors,
neural crest cells do not properly differentiate into
melanoblasts (melanocyte precursors), or melanoblasts do not
migrate to their appropriate location. Patients typically have a
white forelock and eyelashes,
depigmented skin patches, iridic heterochromia, and
sensorineural deafness. The eyes may also be laterally
displaced. The clinical diagnosis may be confirmed with genetic
testing. Treatment includes audiologic evaluation and genetic
consultation. Incorrect Answers: B, C, D, E, and F.
An abnormality of connexins (Choice B) would lead to abnormal
formation of the plasma membrane channels of diverse cell
types. Different combinations of sen- sorineural hearing loss,
ichthyosis, alopecia, and peripheral neuropathy may occur.
Depigmentation would be atypical.
Deficiency of homogentisic acid oxidase activity (Choice C)
would lead to decreased metabolism of the amino acids
phenylalanine and tyrosine, which instead degrade into
homogentisic acid. Homogentisic acid accumulates in the skin
and joints, causing increased
pigmentation and arthritis, respectively. Depigmentation would
be atypical.
Deficiency of tyrosinase activity (Choice D) occurs in
oculocutaneous albinism, which presents with uniformly
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hypopigmented hair and skin (versus the patchy
depigmentation of Waardenburg syndrome) and eye
abnormalities (eg, iris hypopig- mentation, refractive
errors, nystagmus). In tyrosinase deficiency, melanocytes are
unable to synthesize melanin from the amino acid tyrosine.
Iridic heterochromia and sensorineural deaf- nes
2. 2
Exam Section 1: Item 2 of 50
National Board of Medical Examiners® Comprehensive
Basic Science Self-Assessment
2. During an experiment, a solution of mixed fatty acids
is injected into the duodenum of an experimental
animal. Under these conditions, the clearance rate of
an intravenous glucose load from the circulation is
doubled. In contrast, an injection of an equal
volume amount of 0.9% saline into the duodenum has
much less effect on the plasma clearance rate of
glucose. These findings are most likely caused by the
secretion of which of the following hormones?
A) Gastrin
B) Glucose-dependent insulinotropic peptide
C) Motilin
D) Secretin
E) Somatostatin: B.
Glucose-dependent insulinotropic peptide (GIP) is secreted by K
cells in the duode- num and jejunum and functions to decrease
gastric acid production and stimulate insulin release from the
pancreas. Its secretion is promoted by the presence of fatty
acids, amino
acids, and intestinal glucose. While serum glucose also
stimulates insulin secretion by the pancreas, the effect of
intraluminal glucose on GIP and subsequent insulin secretion
leads to increased concentrations of insulin compared to
parenteral glu- cose
administration. Insulin promotes peripheral tissue uptake of
glucose, glycolysis, glycogen synthesis, protein synthesis, and
fatty acid synthesis, resulting in de- creased glucose
concentration in the serum.
Incorrect Answers: A, C, D, and E.
Gastrin (Choice A) is produced by G cells in the gastric antrum
and stimulates parietal cells within the gastric body to produce
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