1|Page
2025 NBME Final Exam And Practice Exam with 1000
accurate questions and verified answers covering
clinical knowledge, diagnostic reasoning, pathology,
pharmacology, and medical decision-making.
An 18-year-old woman develops sepsis after an abortion. Within
24 hours she becomes dyspneic, oliguric, and develops
petechiae, ecchymoses, and bleeding from venipuncture sites.
Which of the following is the laboratory finding most consistent
with this disease process? - ANSWER-Decreased plasma
fibrinogen concentration
A 27-year-old primigravid woman at 34 weeks' gestation is
admitted to the hospital because of nausea and vomiting, and
abdominal pain for 12 hours. Her pregnancy has been otherwise
unremarkable. Prior laboratory studies, including a complete
blood count and serologic tests for HIV and hepatitis, have
shown no abnormalities. Her blood pressure now is 164/102 mm
Hg. Abdominal examination shows right upper quadrant
tenderness. Laboratory studies show: Hemoglobin 7.4 g/dL;
Hematocrit 24%; Platelet count 72,000; Serum Creatinine 1.2
mg/dL; Total bilirubin 2.3 mg/dL; AST 112 U/L; ALT 116 U/L.
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Examination of a peripheral blood smear is most likely to show
a predominance of which of the following in this patient? -
ANSWER-Schistocytes
A 44-year-old man with a 1-year history of angina pectoris
comes to the emergency department because of increasingly
severe chest pain during the past 2 days. He has had five
previous similar episodes, which required treatment with
increasing doses of nitroglycerin to resolve. His temperature is
37°C (98.6°F), pulse is 105/min , respirations are 16/min, and
blood pressure is 150/90 mm Hg. Cardiac examination shows an
S4. An ECG shows ST-segment depression in the precordial
leads. In addition to aspirin, heparin, and nitroglycerin, he is
given a dose of a monoclonal antibody against the platelet
lib/Illa receptor. This antibody will most likely prevent binding
of which of the following substances to platelets? - ANSWER-
Fibrinogen
"A 4-year-old boy is brought to the emergency department
because of a 1-hour history of headache, nausea and vomiting,
and dizziness. Physical examination shows severe lethargy. His
venous blood is bright red; carboxyhemoglobin saturation is
30°/c, (reference range < 5°/c,). Which of the following steps in
the electron transport pathway is primarily affected in this
patient? - ANSWER-
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Reduced A B substrate ., NAO+ ., - ANSWER-
Flavin C D E - ANSWER-
-• coa-• Cyt b • Cyt c-• Cyt aa3 • 0mononucleotide 2 -
ANSWER-
0 A)" - ANSWER-(cyta + a3)
A 25-year-old woman undergoes a radical mastectomy with
removal of the axillary lymph nodes on the left side. After the
operation, she develops painful edema of the left upper
extremity. Which of the following therapies is most likely to
decrease the swelling in this patient? - ANSWER-Compression
sleeve
A 60-year-old man comes to the physician because of weakness
and lightheadedness for 3 months. His diet consists of a healthy
balance of fruits, vegetables, whole grains, and lean chicken and
fish. He has a 10-year history of chronic autoimmune
(Hashimoto) thyroiditis treated with thyroxine. Physical
examination shows pallor. Serum studies show increased
, 4|Page
concentrations of methylmalonic acid and total homocysteine. A
peripheral blood smear shows megaloblastic anemia. Which of
the following is the most likely cause of the findings in this
patient? - ANSWER-Failure of intrinsic factor production
A 22-year-old woman comes to the physician for a follow-up
examination. One year ago, she was diagnosed with a
pulmonary embolism. Two years ago, she delivered a female
stillborn at 23 weeks gestation. Physical examination today
shows no abnormalities. Laboratory studies show a platelet
count of 250,000/mm3, a prothrombin time within the reference
range, and an increased partial thromboplastin time. The
findings in this patient are most consistent with which of the
following conditions? - ANSWER-Antiphospholipid antibody
syndrome
A 12-year-old African American girl is brought to the emergency
department by her mother because of a 6-hour history of fever
and severe rib pain. She has had numerous episodes in the past.
Her paternal aunt and uncle have had similar symptoms since
youth (autosomal recessive). Her temperature is 39°C (102.2°F).
The lungs are clear to auscultation. Abdominal examination
shows tenderness to palpation. A peripheral blood smear is
shown in the photomicrograph. Which of the following is the
most likely underlying cause (molecular/genetic cause) of this
2025 NBME Final Exam And Practice Exam with 1000
accurate questions and verified answers covering
clinical knowledge, diagnostic reasoning, pathology,
pharmacology, and medical decision-making.
An 18-year-old woman develops sepsis after an abortion. Within
24 hours she becomes dyspneic, oliguric, and develops
petechiae, ecchymoses, and bleeding from venipuncture sites.
Which of the following is the laboratory finding most consistent
with this disease process? - ANSWER-Decreased plasma
fibrinogen concentration
A 27-year-old primigravid woman at 34 weeks' gestation is
admitted to the hospital because of nausea and vomiting, and
abdominal pain for 12 hours. Her pregnancy has been otherwise
unremarkable. Prior laboratory studies, including a complete
blood count and serologic tests for HIV and hepatitis, have
shown no abnormalities. Her blood pressure now is 164/102 mm
Hg. Abdominal examination shows right upper quadrant
tenderness. Laboratory studies show: Hemoglobin 7.4 g/dL;
Hematocrit 24%; Platelet count 72,000; Serum Creatinine 1.2
mg/dL; Total bilirubin 2.3 mg/dL; AST 112 U/L; ALT 116 U/L.
,2|Page
Examination of a peripheral blood smear is most likely to show
a predominance of which of the following in this patient? -
ANSWER-Schistocytes
A 44-year-old man with a 1-year history of angina pectoris
comes to the emergency department because of increasingly
severe chest pain during the past 2 days. He has had five
previous similar episodes, which required treatment with
increasing doses of nitroglycerin to resolve. His temperature is
37°C (98.6°F), pulse is 105/min , respirations are 16/min, and
blood pressure is 150/90 mm Hg. Cardiac examination shows an
S4. An ECG shows ST-segment depression in the precordial
leads. In addition to aspirin, heparin, and nitroglycerin, he is
given a dose of a monoclonal antibody against the platelet
lib/Illa receptor. This antibody will most likely prevent binding
of which of the following substances to platelets? - ANSWER-
Fibrinogen
"A 4-year-old boy is brought to the emergency department
because of a 1-hour history of headache, nausea and vomiting,
and dizziness. Physical examination shows severe lethargy. His
venous blood is bright red; carboxyhemoglobin saturation is
30°/c, (reference range < 5°/c,). Which of the following steps in
the electron transport pathway is primarily affected in this
patient? - ANSWER-
,3|Page
Reduced A B substrate ., NAO+ ., - ANSWER-
Flavin C D E - ANSWER-
-• coa-• Cyt b • Cyt c-• Cyt aa3 • 0mononucleotide 2 -
ANSWER-
0 A)" - ANSWER-(cyta + a3)
A 25-year-old woman undergoes a radical mastectomy with
removal of the axillary lymph nodes on the left side. After the
operation, she develops painful edema of the left upper
extremity. Which of the following therapies is most likely to
decrease the swelling in this patient? - ANSWER-Compression
sleeve
A 60-year-old man comes to the physician because of weakness
and lightheadedness for 3 months. His diet consists of a healthy
balance of fruits, vegetables, whole grains, and lean chicken and
fish. He has a 10-year history of chronic autoimmune
(Hashimoto) thyroiditis treated with thyroxine. Physical
examination shows pallor. Serum studies show increased
, 4|Page
concentrations of methylmalonic acid and total homocysteine. A
peripheral blood smear shows megaloblastic anemia. Which of
the following is the most likely cause of the findings in this
patient? - ANSWER-Failure of intrinsic factor production
A 22-year-old woman comes to the physician for a follow-up
examination. One year ago, she was diagnosed with a
pulmonary embolism. Two years ago, she delivered a female
stillborn at 23 weeks gestation. Physical examination today
shows no abnormalities. Laboratory studies show a platelet
count of 250,000/mm3, a prothrombin time within the reference
range, and an increased partial thromboplastin time. The
findings in this patient are most consistent with which of the
following conditions? - ANSWER-Antiphospholipid antibody
syndrome
A 12-year-old African American girl is brought to the emergency
department by her mother because of a 6-hour history of fever
and severe rib pain. She has had numerous episodes in the past.
Her paternal aunt and uncle have had similar symptoms since
youth (autosomal recessive). Her temperature is 39°C (102.2°F).
The lungs are clear to auscultation. Abdominal examination
shows tenderness to palpation. A peripheral blood smear is
shown in the photomicrograph. Which of the following is the
most likely underlying cause (molecular/genetic cause) of this
