NBME CBSE (USMLE Step 1)
National Board of Medical
Examiners
2026/2027 Academic Year
Practice Questions & Correct
Answers Plus Rationales
Latest 2026 PDF
THIS DOCUMENT CONTAINS:
✓ Practice Questions & Correct Answers 2026/27
✓ Verified Correct Answers & Rationales
✓ Instant Pdf Download
,1
Section I: Cell Injury, Adaptation & Death (Questions 1-10)
1. A 68-year-old male with long-standing hypertension dies
of a myocardial infarction. Autopsy reveals left ventricular
hypertrophy. Which cellular adaptation best describes this
finding?
a) Hyperplasia
b) Metaplasia
c) Hypertrophy
d) Dysplasia
Correct Answer: c — Hypertrophy is an increase in cell size, not
number. Left ventricular thickening in response to pressure
overload (hypertension) is the classic example of pathologic
hypertrophy. Hyperplasia is an increase in cell number;
metaplasia is a reversible change in cell type; dysplasia is
disordered growth with atypia.
2. A 55-year-old female with chronic gastroesophageal reflux
disease undergoes upper endoscopy revealing intestinal-type
columnar epithelium in the distal esophagus. This finding
represents which cellular adaptation?
a) Hyperplasia
b) Metaplasia
c) Dysplasia
d) Atrophy
Correct Answer: b — Barrett esophagus is a classic example of
,2
metaplasia: the normal squamous epithelium of the esophagus is
replaced by intestinal-type columnar epithelium as an adaptive
response to chronic acid exposure. This is a reversible change, but
persistent stress can progress to dysplasia and adenocarcinoma.
3. A child with acetaminophen overdose develops
centrilobular hepatic necrosis. What is the underlying
mechanism of hepatocellular injury?
a) Activation of complement
b) Free radical formation and glutathione depletion
c) Direct membrane lysis
d) Immune complex deposition
Correct Answer: b — Acetaminophen overdose leads to
accumulation of a toxic metabolite (NAPQI) that causes free
radical–mediated centrilobular necrosis. Glutathione depletion is
the key predisposing factor. Treatment with N-acetylcysteine
replenishes glutathione stores.
4. A 45-year-old male with chronic alcoholism presents with
tender, subcutaneous nodules over the extensor surfaces of
his forearms. Biopsy reveals necrotic fat with saponification.
What type of necrosis is present?
a) Coagulative necrosis
b) Liquefactive necrosis
c) Caseous necrosis
d) Fat necrosis
, 3
Correct Answer: d — Fat necrosis occurs when lipases break
down triglycerides into free fatty acids, which then combine with
calcium (saponification). This is the classic pathologic process in
acute pancreatitis and in subcutaneous nodules associated with
alcoholic pancreatitis.
5. A 35-year-old female with systemic lupus erythematosus
develops progressive renal failure. Renal biopsy shows
extensive deposition of amorphous eosinophilic material in
the glomeruli. This material exhibits apple-green
birefringence under polarized light after Congo red staining.
What is the most likely diagnosis?
a) Dystrophic calcification
b) Metastatic calcification
c) Amyloidosis
d) Fibrinoid necrosis
Correct Answer: c — Amyloidosis is characterized by
extracellular deposition of misfolded proteins in a β-pleated sheet
configuration. AL (amyloid light chain) amyloidosis is associated
with plasma cell dyscrasias; AA amyloidosis is seen in chronic
inflammatory conditions such as SLE, rheumatoid arthritis, and
inflammatory bowel disease.
6. A 62-year-old male with end-stage renal disease on long-
term hemodialysis develops carpal tunnel syndrome. Biopsy
of the flexor retinaculum reveals amyloid deposition. Which
National Board of Medical
Examiners
2026/2027 Academic Year
Practice Questions & Correct
Answers Plus Rationales
Latest 2026 PDF
THIS DOCUMENT CONTAINS:
✓ Practice Questions & Correct Answers 2026/27
✓ Verified Correct Answers & Rationales
✓ Instant Pdf Download
,1
Section I: Cell Injury, Adaptation & Death (Questions 1-10)
1. A 68-year-old male with long-standing hypertension dies
of a myocardial infarction. Autopsy reveals left ventricular
hypertrophy. Which cellular adaptation best describes this
finding?
a) Hyperplasia
b) Metaplasia
c) Hypertrophy
d) Dysplasia
Correct Answer: c — Hypertrophy is an increase in cell size, not
number. Left ventricular thickening in response to pressure
overload (hypertension) is the classic example of pathologic
hypertrophy. Hyperplasia is an increase in cell number;
metaplasia is a reversible change in cell type; dysplasia is
disordered growth with atypia.
2. A 55-year-old female with chronic gastroesophageal reflux
disease undergoes upper endoscopy revealing intestinal-type
columnar epithelium in the distal esophagus. This finding
represents which cellular adaptation?
a) Hyperplasia
b) Metaplasia
c) Dysplasia
d) Atrophy
Correct Answer: b — Barrett esophagus is a classic example of
,2
metaplasia: the normal squamous epithelium of the esophagus is
replaced by intestinal-type columnar epithelium as an adaptive
response to chronic acid exposure. This is a reversible change, but
persistent stress can progress to dysplasia and adenocarcinoma.
3. A child with acetaminophen overdose develops
centrilobular hepatic necrosis. What is the underlying
mechanism of hepatocellular injury?
a) Activation of complement
b) Free radical formation and glutathione depletion
c) Direct membrane lysis
d) Immune complex deposition
Correct Answer: b — Acetaminophen overdose leads to
accumulation of a toxic metabolite (NAPQI) that causes free
radical–mediated centrilobular necrosis. Glutathione depletion is
the key predisposing factor. Treatment with N-acetylcysteine
replenishes glutathione stores.
4. A 45-year-old male with chronic alcoholism presents with
tender, subcutaneous nodules over the extensor surfaces of
his forearms. Biopsy reveals necrotic fat with saponification.
What type of necrosis is present?
a) Coagulative necrosis
b) Liquefactive necrosis
c) Caseous necrosis
d) Fat necrosis
, 3
Correct Answer: d — Fat necrosis occurs when lipases break
down triglycerides into free fatty acids, which then combine with
calcium (saponification). This is the classic pathologic process in
acute pancreatitis and in subcutaneous nodules associated with
alcoholic pancreatitis.
5. A 35-year-old female with systemic lupus erythematosus
develops progressive renal failure. Renal biopsy shows
extensive deposition of amorphous eosinophilic material in
the glomeruli. This material exhibits apple-green
birefringence under polarized light after Congo red staining.
What is the most likely diagnosis?
a) Dystrophic calcification
b) Metastatic calcification
c) Amyloidosis
d) Fibrinoid necrosis
Correct Answer: c — Amyloidosis is characterized by
extracellular deposition of misfolded proteins in a β-pleated sheet
configuration. AL (amyloid light chain) amyloidosis is associated
with plasma cell dyscrasias; AA amyloidosis is seen in chronic
inflammatory conditions such as SLE, rheumatoid arthritis, and
inflammatory bowel disease.
6. A 62-year-old male with end-stage renal disease on long-
term hemodialysis develops carpal tunnel syndrome. Biopsy
of the flexor retinaculum reveals amyloid deposition. Which
