NBME CBSE COMPREHENSIVE PRACTICE
EXAMINATION NEWEST EDITION 2026\2027
PRACTICE EXAM – 200+ EXAM TYPE HIGH YIELD
QUESTIONS AND CORRECT ANSWERS WITH
DETAILED RATIONALES | CURRENTLY UPDATED |
100% APPROVED MEDICAL- NURSING EXAM, STUDY
GUIDE| GUARANTEED PASS GRADE A+ | LATEST
EDITION
SECTION 1: CARDIOVASCULAR SYSTEM (Questions 1-25)
Question 1
A 65-year-old man presents with crushing chest pain radiating to his left
arm. ECG shows ST-segment elevation in leads II, III, and if. Which
coronary artery is most likely occluded?
A) Left anterior descending artery
B) Right coronary artery
C) Left circumflex artery
D) Left main coronary artery
Rationale: ST-segment elevation in leads II, III, and aVF indicates an
inferior wall myocardial infarction, which is most commonly caused by
,occlusion of the right coronary artery (RCA). The RCA supplies the
inferior wall of the left ventricle in approximately 80% of individuals
(right-dominant circulation).
Question 2
A 72-year-old woman with a history of hypertension and diabetes
presents with acute shortness of breath. Auscultation reveals a new
holosystolic murmur at the apex radiating to the axilla. What is the
most likely diagnosis?
A) Aortic stenosis
B) Mitral stenosis
C) Mitral regurgitation
D) Tricuspid regurgitation
Rationale: A holosystolic murmur at the apex radiating to the axilla is
classic for mitral regurgitation. Acute mitral regurgitation can present
with acute shortness of breath due to sudden volume overload of the
left atrium. Common causes include papillary muscle dysfunction or
rupture following myocardial infarction, or infective endocarditis.
,Question 3
A 28-year-old man is found to have a blood pressure of 160/100 mmHg
in both arms. He reports episodes of headache, palpitations, and
sweating. Plasma metanephrines are elevated. Which of the following
is the most likely diagnosis?
A) Primary hyperaldosteronism
B) Pheochromocytoma
C) Cushing syndrome
D) Renovascular hypertension
Rationale: The triad of episodic headache, palpitations, and sweating
combined with elevated plasma metanephrines is highly suggestive of
pheochromocytoma, a catecholamine-secreting tumor of the adrenal
medulla. The paroxysmal release of catecholamines causes episodic
hypertension and the associated symptoms.
Question 4
A 55-year-old man presents with progressive dyspnea on exertion.
Echocardiography reveals concentric left ventricular hypertrophy with a
reduced ejection fraction. Which of the following is the most likely
underlying mechanism?
, A) Volume overload
B) Pressure overload
C) Loss of myocardial contractility
D) Pericardial constriction
Rationale: Concentric left ventricular hypertrophy occurs as a
compensatory response to pressure overload (increased afterload),
commonly seen in chronic hypertension or aortic stenosis. The
sarcomeres are added in parallel, leading to increased wall thickness
without chamber dilation. This differs from eccentric hypertrophy seen
in volume overload states.
Question 5
A 45-year-old woman presents with fatigue and dyspnea. Physical
examination reveals a fixed split S2 and a systolic ejection murmur at
the left upper sternal border. What is the most likely diagnosis?
A) Ventricular septal defect
B) Atrial septal defect
C) Patent ductus arteriosus
D) Tetralogy of Fallot
Rationale: A fixed split S2 is pathognomonic for atrial septal defect
(ASD). The fixed splitting occurs because the delay in right ventricular
EXAMINATION NEWEST EDITION 2026\2027
PRACTICE EXAM – 200+ EXAM TYPE HIGH YIELD
QUESTIONS AND CORRECT ANSWERS WITH
DETAILED RATIONALES | CURRENTLY UPDATED |
100% APPROVED MEDICAL- NURSING EXAM, STUDY
GUIDE| GUARANTEED PASS GRADE A+ | LATEST
EDITION
SECTION 1: CARDIOVASCULAR SYSTEM (Questions 1-25)
Question 1
A 65-year-old man presents with crushing chest pain radiating to his left
arm. ECG shows ST-segment elevation in leads II, III, and if. Which
coronary artery is most likely occluded?
A) Left anterior descending artery
B) Right coronary artery
C) Left circumflex artery
D) Left main coronary artery
Rationale: ST-segment elevation in leads II, III, and aVF indicates an
inferior wall myocardial infarction, which is most commonly caused by
,occlusion of the right coronary artery (RCA). The RCA supplies the
inferior wall of the left ventricle in approximately 80% of individuals
(right-dominant circulation).
Question 2
A 72-year-old woman with a history of hypertension and diabetes
presents with acute shortness of breath. Auscultation reveals a new
holosystolic murmur at the apex radiating to the axilla. What is the
most likely diagnosis?
A) Aortic stenosis
B) Mitral stenosis
C) Mitral regurgitation
D) Tricuspid regurgitation
Rationale: A holosystolic murmur at the apex radiating to the axilla is
classic for mitral regurgitation. Acute mitral regurgitation can present
with acute shortness of breath due to sudden volume overload of the
left atrium. Common causes include papillary muscle dysfunction or
rupture following myocardial infarction, or infective endocarditis.
,Question 3
A 28-year-old man is found to have a blood pressure of 160/100 mmHg
in both arms. He reports episodes of headache, palpitations, and
sweating. Plasma metanephrines are elevated. Which of the following
is the most likely diagnosis?
A) Primary hyperaldosteronism
B) Pheochromocytoma
C) Cushing syndrome
D) Renovascular hypertension
Rationale: The triad of episodic headache, palpitations, and sweating
combined with elevated plasma metanephrines is highly suggestive of
pheochromocytoma, a catecholamine-secreting tumor of the adrenal
medulla. The paroxysmal release of catecholamines causes episodic
hypertension and the associated symptoms.
Question 4
A 55-year-old man presents with progressive dyspnea on exertion.
Echocardiography reveals concentric left ventricular hypertrophy with a
reduced ejection fraction. Which of the following is the most likely
underlying mechanism?
, A) Volume overload
B) Pressure overload
C) Loss of myocardial contractility
D) Pericardial constriction
Rationale: Concentric left ventricular hypertrophy occurs as a
compensatory response to pressure overload (increased afterload),
commonly seen in chronic hypertension or aortic stenosis. The
sarcomeres are added in parallel, leading to increased wall thickness
without chamber dilation. This differs from eccentric hypertrophy seen
in volume overload states.
Question 5
A 45-year-old woman presents with fatigue and dyspnea. Physical
examination reveals a fixed split S2 and a systolic ejection murmur at
the left upper sternal border. What is the most likely diagnosis?
A) Ventricular septal defect
B) Atrial septal defect
C) Patent ductus arteriosus
D) Tetralogy of Fallot
Rationale: A fixed split S2 is pathognomonic for atrial septal defect
(ASD). The fixed splitting occurs because the delay in right ventricular
