NBME CBSE REAL EXAMPREP COMPREHENSIVE
REVIEW GUIDE WITH FULLY SOLVED
QUESTIONS AND VERIFIED SOLUTIONS 2026
◉ Severe pain after meals (better when she doesn't eat), unintentional
weight loss, hx of atherosclerosis + abdominal bruit and absent pedal
pulses. What artery could be atherosclerotic? Answer:Superior
Mesenteric
◉ What is the inheritance pattern of Fragile X? How does transmission
change if the mother has fragile X vs. the father? Answer:It is X linked
dominant (like hypophosphatemic rickets and Alports)
Mothers w/ disease: give it to 50% of daughters and sons
Fathers w/ disease: give it to all daughters and no sons
◉ What medication could be used for watery nasal decongestion during
an allergy attack? Answer:Alpha-adrenergic agonist (phenylephrine
alpha 1 > alpha 2) in Sudafed and most OTC decongestants
,◉ Newborn baby with hypothyroidism (no thyroid) has no symptoms.
What can the mom transfer to the baby allowing for normal
development? Answer:Thyroxine (T4) is transferred in late gestation
through the placenta preventing the initial symptoms of congenital
hypothyroidism
◉ How does enterococcus faecalis develop resistance from
vancomycin? Answer:Substitution of d-lactate for d-alanine in
peptidoglycan wall
◉ 2 days following an acute MI, a pt becomes short of breath and
diaphoretic, high HR and pressure. What murmur would be heard?
Answer:4/6 holosystolic murmur heard best over the lower left sternal
border and the cardiac apex
- from posteromedial papillary muscle rupture (has single blood supply
from posterior descending artery) -> severe mitral regurgitation occurs
2-7 days after an MI
◉ 18 month old who has not eaten in 24 hrs has high pulse, increase
respirations, hepatomegaly. His glucose, ketones, and carnitine are
decreased in serum, and urine ketones are decreased, and dicarboxylic
acids are present. He is given medium chain triglycerides for 6 months
which helps. What is deficient? Answer:Very long-chain acyl-Coa
dehydrogenase deficiency
,- hypoketonic hypoglycemia
- fat deposits in liver = hepatomegaly
- cardiorespiratory distress
◉ 3 yo with constant fractures of bones, and blue sclera and normal
teeth. What biochemical process is altered? Answer:Procollagen
synthesis
- Osteogenesis imperfecta
- AD
- glycosylation of residues and then forms disulfide/hydrogen bonds ->
triple helix (will not occur in this disease)
- no normal type ONE collagen (bone)
-treat with bisphosphanates to prevents fractures
◉ Cross sections area of an aneurysm is 2cm^2, and the velocity of
blood flow is 20cm/sec. What is the flow rate (L/min) through the
aneurysm? Answer:Flow rate (Q) = Flow velocity X cross sectional area
- 2X20 = 40cm^3/sec
- 40X60s = 24000 mm/sec (1cm^3 = 1 mm)
- 2.4L/min
, ◉ severe bleed from gunshot wound to abdomen -> 3L blood in
peritoneum. Cells in liver/kidney = centrilobular pallor and swelling.
Why is this occurring? Answer:decreased function of Na+/K+ ATPase
- reversible injury from blood loss
◉ What does fish oil do? Answer:fish oil/omega 3 fatty acids antagonize
VLDL-cholesterol secretion
- increase LDL/HDL slightly
- decrease FFA delivery to liver
◉ 60 yo man with no hx of bleeding problems has elevated PTT what
molecule in the kinin cascade can be deficient? Answer:Kallikrein ->
leads to a build up of high molecular weight kininogen that activates the
intrinsic pathway -> elevated PTT
◉ 23 yo with sjogren and burning pain in feet is relieved with capsaicin.
what neurotransmitter is causing pain? Answer:Substance P
◉ 18 yo w/ ALL on chemo and low neutrophil count has lung infiltrate
with PAS stain of budding fungus. How do you treat him?
Answer:amphotericin B
REVIEW GUIDE WITH FULLY SOLVED
QUESTIONS AND VERIFIED SOLUTIONS 2026
◉ Severe pain after meals (better when she doesn't eat), unintentional
weight loss, hx of atherosclerosis + abdominal bruit and absent pedal
pulses. What artery could be atherosclerotic? Answer:Superior
Mesenteric
◉ What is the inheritance pattern of Fragile X? How does transmission
change if the mother has fragile X vs. the father? Answer:It is X linked
dominant (like hypophosphatemic rickets and Alports)
Mothers w/ disease: give it to 50% of daughters and sons
Fathers w/ disease: give it to all daughters and no sons
◉ What medication could be used for watery nasal decongestion during
an allergy attack? Answer:Alpha-adrenergic agonist (phenylephrine
alpha 1 > alpha 2) in Sudafed and most OTC decongestants
,◉ Newborn baby with hypothyroidism (no thyroid) has no symptoms.
What can the mom transfer to the baby allowing for normal
development? Answer:Thyroxine (T4) is transferred in late gestation
through the placenta preventing the initial symptoms of congenital
hypothyroidism
◉ How does enterococcus faecalis develop resistance from
vancomycin? Answer:Substitution of d-lactate for d-alanine in
peptidoglycan wall
◉ 2 days following an acute MI, a pt becomes short of breath and
diaphoretic, high HR and pressure. What murmur would be heard?
Answer:4/6 holosystolic murmur heard best over the lower left sternal
border and the cardiac apex
- from posteromedial papillary muscle rupture (has single blood supply
from posterior descending artery) -> severe mitral regurgitation occurs
2-7 days after an MI
◉ 18 month old who has not eaten in 24 hrs has high pulse, increase
respirations, hepatomegaly. His glucose, ketones, and carnitine are
decreased in serum, and urine ketones are decreased, and dicarboxylic
acids are present. He is given medium chain triglycerides for 6 months
which helps. What is deficient? Answer:Very long-chain acyl-Coa
dehydrogenase deficiency
,- hypoketonic hypoglycemia
- fat deposits in liver = hepatomegaly
- cardiorespiratory distress
◉ 3 yo with constant fractures of bones, and blue sclera and normal
teeth. What biochemical process is altered? Answer:Procollagen
synthesis
- Osteogenesis imperfecta
- AD
- glycosylation of residues and then forms disulfide/hydrogen bonds ->
triple helix (will not occur in this disease)
- no normal type ONE collagen (bone)
-treat with bisphosphanates to prevents fractures
◉ Cross sections area of an aneurysm is 2cm^2, and the velocity of
blood flow is 20cm/sec. What is the flow rate (L/min) through the
aneurysm? Answer:Flow rate (Q) = Flow velocity X cross sectional area
- 2X20 = 40cm^3/sec
- 40X60s = 24000 mm/sec (1cm^3 = 1 mm)
- 2.4L/min
, ◉ severe bleed from gunshot wound to abdomen -> 3L blood in
peritoneum. Cells in liver/kidney = centrilobular pallor and swelling.
Why is this occurring? Answer:decreased function of Na+/K+ ATPase
- reversible injury from blood loss
◉ What does fish oil do? Answer:fish oil/omega 3 fatty acids antagonize
VLDL-cholesterol secretion
- increase LDL/HDL slightly
- decrease FFA delivery to liver
◉ 60 yo man with no hx of bleeding problems has elevated PTT what
molecule in the kinin cascade can be deficient? Answer:Kallikrein ->
leads to a build up of high molecular weight kininogen that activates the
intrinsic pathway -> elevated PTT
◉ 23 yo with sjogren and burning pain in feet is relieved with capsaicin.
what neurotransmitter is causing pain? Answer:Substance P
◉ 18 yo w/ ALL on chemo and low neutrophil count has lung infiltrate
with PAS stain of budding fungus. How do you treat him?
Answer:amphotericin B
