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NBME CBSE REAL EXAM 200 QUESTIONS AND ANSWERS
LATEST 2025 (usmle step 1) MEDICAL EXAMINATION
|ALREADY GRADED A+|
15yo girl emigrated from India and with several lesions on neck
for 2 weeks. Physical exam shows hypopigmented, hypoesthetic
area on left side of forehead and 4-cm lesions on neck. Biopsy
shows acid-fast bacilli. Best explanation why the organism results
in dermal rather than visceral infections? - ANSWER-
Temperature sensitivity
59yo man has total thyroidectomy for 4-cm follicular carcinoma of
thyroid. Twelve hours after procedure, has paresthesias of hands
and feet. Vitals stable, carpal spasm on inflamation of bp cuff. Lab
findings? - ANSWER-Low PTH and calcium; accidentally remove
parathyroid
41yo man with asthma and allergy to grass pollen wheezes and
difficulty breathing 10 min after mowing lawn. Drug for immediate
relief of acute symptoms? - ANSWER-Albuterol
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14yo boy daily headaches for 2 months. Headaches are bilateral
aching in temples. "Has not been himself" for months. Confused,
forgetting names, dates, places, clumsy, frequent falls. School
performance declined. Physical exam: broad-based ataxic gait.
Slow to answer questions. Chronic abuse of which substance? -
ANSWER-Inhaled glue
40yo African American woman 2-week hx fever, malaise,
dyspnea. Temperature 36.7 C (98 F), respirations 20. Physical
exam: erythema nodosum, parotid enlargement,
hepatosplenomegaly. Calcium 16. CT chest bilateral hilar
adenopathy. Increased in which in serum? - ANSWER-1,25-
Dihydroxycholecalciferol
56yo woman with restrictive cardiomyopathy, proteinuria, renal
failure. 35-year history of rheumatoid arthritis. Renal biopsy
shows glomerular deposition of eosinophilic hyaline material.
Congo red statin: birefringent pattern under polarized light.
Structure of material? - ANSWER-Beta-pleated sheet structure
63yo man 3-month hx difficulty sleeping. Sleeps better upright.
HR 90, bp 110/60. Physical exam: increased jugular venous
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pressure, mild ankle edema. Cause of edema? - ANSWER-
Increased capillary hydrostatic pressure
14yo boy come to ER 1 hour after colliding with teammate playing
soccer. Physical exam: edematous tissues of left eye, mild
depression of left zygomatic bone. Skin between eye and upper
lip numb. Double vision look upward. Nerve damaged causing
sensory loss? - ANSWER-Maxillary division of the trigeminal
nerve
35yo man increasingly depressed, impulsive and difficult over
past year. Grimaces intermittently with rapid, jerking, purposeless
movements of fingers. Historical factor relevant in dx? -
ANSWER-Family history
18yo man Crohn disease 1-day hx severe abdominal pain and
intermittent bloody diarrhea. Temperature 38 C (100.4 F), pulse
98, respirations 18. Physical exam: draining anal fisutla.
Treatment with antibiotics and prednisone over next 3 weeks
recovers. Mechanism of pharmacotherapy is suppression of
which? - ANSWER-T-lymphocytes
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34yo woman with pyelonephritis treated with bactericidal antibiotic
4 days no improvement. Antibiotic added that inhibits binding to
30S ribosome, blocking protein synthesis intracellularly.
Antibiotic? - ANSWER-Gentamicin
3yo boy and his 5yo brother with recurrent hemarthroses. Both
parents healthy, but mother with two younger brothers with same
sx and maternal uncle who died at 8 of mild head trauma. Partial
thromboplastin time is prolonged. Defect? - ANSWER-Factor VIII
6yo boy from Russia with unstable gait and incoordination for 2
weeks. Pale, bulky stools for 4 years and two episodes of
bacterial pneumonia and chronic cough since age 1 year. 3%ile
for height/weight. Neuro exam shows ataxia, no DTRs, loss of
proprioception. Stool shows inc fat concentration. Vitamin
deficient? - ANSWER-Vitamin E
54yo F 1 week after sudden loss of vision in left eye, returned
within 1 day. 3-month hx of progressive SOB with exertion.
Echocardiography shows mass in the left atrium of the heart.
NBME CBSE REAL EXAM 200 QUESTIONS AND ANSWERS
LATEST 2025 (usmle step 1) MEDICAL EXAMINATION
|ALREADY GRADED A+|
15yo girl emigrated from India and with several lesions on neck
for 2 weeks. Physical exam shows hypopigmented, hypoesthetic
area on left side of forehead and 4-cm lesions on neck. Biopsy
shows acid-fast bacilli. Best explanation why the organism results
in dermal rather than visceral infections? - ANSWER-
Temperature sensitivity
59yo man has total thyroidectomy for 4-cm follicular carcinoma of
thyroid. Twelve hours after procedure, has paresthesias of hands
and feet. Vitals stable, carpal spasm on inflamation of bp cuff. Lab
findings? - ANSWER-Low PTH and calcium; accidentally remove
parathyroid
41yo man with asthma and allergy to grass pollen wheezes and
difficulty breathing 10 min after mowing lawn. Drug for immediate
relief of acute symptoms? - ANSWER-Albuterol
,2|Page
14yo boy daily headaches for 2 months. Headaches are bilateral
aching in temples. "Has not been himself" for months. Confused,
forgetting names, dates, places, clumsy, frequent falls. School
performance declined. Physical exam: broad-based ataxic gait.
Slow to answer questions. Chronic abuse of which substance? -
ANSWER-Inhaled glue
40yo African American woman 2-week hx fever, malaise,
dyspnea. Temperature 36.7 C (98 F), respirations 20. Physical
exam: erythema nodosum, parotid enlargement,
hepatosplenomegaly. Calcium 16. CT chest bilateral hilar
adenopathy. Increased in which in serum? - ANSWER-1,25-
Dihydroxycholecalciferol
56yo woman with restrictive cardiomyopathy, proteinuria, renal
failure. 35-year history of rheumatoid arthritis. Renal biopsy
shows glomerular deposition of eosinophilic hyaline material.
Congo red statin: birefringent pattern under polarized light.
Structure of material? - ANSWER-Beta-pleated sheet structure
63yo man 3-month hx difficulty sleeping. Sleeps better upright.
HR 90, bp 110/60. Physical exam: increased jugular venous
,3|Page
pressure, mild ankle edema. Cause of edema? - ANSWER-
Increased capillary hydrostatic pressure
14yo boy come to ER 1 hour after colliding with teammate playing
soccer. Physical exam: edematous tissues of left eye, mild
depression of left zygomatic bone. Skin between eye and upper
lip numb. Double vision look upward. Nerve damaged causing
sensory loss? - ANSWER-Maxillary division of the trigeminal
nerve
35yo man increasingly depressed, impulsive and difficult over
past year. Grimaces intermittently with rapid, jerking, purposeless
movements of fingers. Historical factor relevant in dx? -
ANSWER-Family history
18yo man Crohn disease 1-day hx severe abdominal pain and
intermittent bloody diarrhea. Temperature 38 C (100.4 F), pulse
98, respirations 18. Physical exam: draining anal fisutla.
Treatment with antibiotics and prednisone over next 3 weeks
recovers. Mechanism of pharmacotherapy is suppression of
which? - ANSWER-T-lymphocytes
, 4|Page
34yo woman with pyelonephritis treated with bactericidal antibiotic
4 days no improvement. Antibiotic added that inhibits binding to
30S ribosome, blocking protein synthesis intracellularly.
Antibiotic? - ANSWER-Gentamicin
3yo boy and his 5yo brother with recurrent hemarthroses. Both
parents healthy, but mother with two younger brothers with same
sx and maternal uncle who died at 8 of mild head trauma. Partial
thromboplastin time is prolonged. Defect? - ANSWER-Factor VIII
6yo boy from Russia with unstable gait and incoordination for 2
weeks. Pale, bulky stools for 4 years and two episodes of
bacterial pneumonia and chronic cough since age 1 year. 3%ile
for height/weight. Neuro exam shows ataxia, no DTRs, loss of
proprioception. Stool shows inc fat concentration. Vitamin
deficient? - ANSWER-Vitamin E
54yo F 1 week after sudden loss of vision in left eye, returned
within 1 day. 3-month hx of progressive SOB with exertion.
Echocardiography shows mass in the left atrium of the heart.
