1
NBME17 ACTUAL FINAL EXAM
QUESTIONS AND ANSWERS
(COMPLETE SOLUTIONS AND RESOURCES FOR THE COURSE EXAM FOR 2025/26)
A 25-year-old woman comes to the physician because of a 3-year history of irregular menses.
Menarche was at the age of 14 years. Puberty began at the age of 12 years and progressed normally.
Her blood pressure is 116/62 mmHg. Physical examination shows increased hair growth on the face
and chest. Pelvic examination shows clitoromegaly and a normal-appearing uterus. Serum studies
show increased concentrations of 17-hydroxyprogesterone and androstenedione. This patient most
likely has a deficiency of which of the following enzyme activities?
A) 11β-Hydroxylase
B) 17a-Hydroxylase
C) 21-Hydroxylase
D) 3β-Hydroxysteroid dehydrogenase
E) 5a-Reductase
A 15-year-old girl comes to the physician's office for a health maintenance examination Her mother
was recently diagnosed with squamous cell carcinoma of the face and her maternal grandfather died
of metastatic melanoma. During the visit, the physician advises her about methods of
photoprotection including daily use of a sunscreen. In a patient of this age which of the following
factors is most likely to predict compliance with photoprotection?
a Ability to tan
b Advice of the physician to wear sunscreen
c Concern about premature aging of skin
d Desire to prevent sunburn
e Family history of skin cancer
f Use of sunscreen by her peers
A 40-year-old African American woman comes to the physician because of a 2-week history of fever,
malaise, and dyspnea. Her temperature is 36.7°C (98°F), and respirations are 20/min. Physical
examination shows erythema nodosum, parotid enlargement, and hepatosplenomegaly. Her serum
calcium concentration is 16 mg/dL. A CT scan of the chest shows bilateral hilar adenopathy. Serum
studies are most likely to show an increased concentration of which of the following?
A Calcitonin
B Cholecalciferol
C 1,25-Dihydroxycholecalciferol
D 24,25-Dihydroxycholecalciferol
E Parathyroid hormone
1 a 55 year old woman has left flank pain and gross hematuria. a mass is palpable in the left upper
quadran of the abdomen. abdominal ultrasonography shows a 12 cm solid mass on the lower pole of
the left kidney. angiogram shows hypervasc mass.
a nephrobastoma
, 2
b papillary transitional cell ca
c renal cell adenocarc
d renal cell adenoma
e squamous cell ca
a 53 year old man who recently returned from africa, has fever, headache and abdominal disconfort.
he received appropiate vaccinations prior to the trip. his temp is 39. physical exam no abnorm. a
peripheral blood smears is shown (cant show the image). dx?
a babesiosis
b leishmaniasis
c malaria
d toxop
e trypanosomiasis
2 a 40 year old woman comes to the physician because of a 1 year history of episodes of crampy
abdominal pain, intermittent diarrhea, and rectal bleeding with passage of mocus. she is 173 cm tall
and weighs 55kg. BMI 18. abdominal exam shows diffuse tenderness with no rebound tenderness.
sigmoidoscopi shows diffuse ulcers, initial tx?
a amoxicillin
b bismuth subsalicylate
c loperamide
d octeotide
e sulfasalazine (maybe?)
3 a 50 year old man comes tot he physician because of a persistent cough for the past 2 months. he
has had a 5 kg weight loss during this period. he is a farmer and started itraconazole or 4 weeks ago
for histoplasmosis. current med hydrochlorothiazide, enalapril, atenolol, omeprazole and metoclop.
he appears thin. physical exam shows no other abdn. an interaction betwn itraconazole and which of
the following accounts for the lack of effect of itraconazole?
a atenolol
b enalapril
c hydroclorot
d metoclopramide
e omeprazole
4 a previously healthy 17 year oldgirl is brought tot he emergency department because of a 1 day
hsitory of shortness of breath, weakness, and muscle tenderness. she completed a triathlon the
previous day, appears restless. bmi 19, tem 38, bp 150.90. bilateral crackless at lower lungs, muscle
tenderness. creat 4 mg/dl. urinalisis 3 protein and 4 hemog. inc realease of?
a aldolase
b ck
c hemogl
NBME17 ACTUAL FINAL EXAM
QUESTIONS AND ANSWERS
(COMPLETE SOLUTIONS AND RESOURCES FOR THE COURSE EXAM FOR 2025/26)
A 25-year-old woman comes to the physician because of a 3-year history of irregular menses.
Menarche was at the age of 14 years. Puberty began at the age of 12 years and progressed normally.
Her blood pressure is 116/62 mmHg. Physical examination shows increased hair growth on the face
and chest. Pelvic examination shows clitoromegaly and a normal-appearing uterus. Serum studies
show increased concentrations of 17-hydroxyprogesterone and androstenedione. This patient most
likely has a deficiency of which of the following enzyme activities?
A) 11β-Hydroxylase
B) 17a-Hydroxylase
C) 21-Hydroxylase
D) 3β-Hydroxysteroid dehydrogenase
E) 5a-Reductase
A 15-year-old girl comes to the physician's office for a health maintenance examination Her mother
was recently diagnosed with squamous cell carcinoma of the face and her maternal grandfather died
of metastatic melanoma. During the visit, the physician advises her about methods of
photoprotection including daily use of a sunscreen. In a patient of this age which of the following
factors is most likely to predict compliance with photoprotection?
a Ability to tan
b Advice of the physician to wear sunscreen
c Concern about premature aging of skin
d Desire to prevent sunburn
e Family history of skin cancer
f Use of sunscreen by her peers
A 40-year-old African American woman comes to the physician because of a 2-week history of fever,
malaise, and dyspnea. Her temperature is 36.7°C (98°F), and respirations are 20/min. Physical
examination shows erythema nodosum, parotid enlargement, and hepatosplenomegaly. Her serum
calcium concentration is 16 mg/dL. A CT scan of the chest shows bilateral hilar adenopathy. Serum
studies are most likely to show an increased concentration of which of the following?
A Calcitonin
B Cholecalciferol
C 1,25-Dihydroxycholecalciferol
D 24,25-Dihydroxycholecalciferol
E Parathyroid hormone
1 a 55 year old woman has left flank pain and gross hematuria. a mass is palpable in the left upper
quadran of the abdomen. abdominal ultrasonography shows a 12 cm solid mass on the lower pole of
the left kidney. angiogram shows hypervasc mass.
a nephrobastoma
, 2
b papillary transitional cell ca
c renal cell adenocarc
d renal cell adenoma
e squamous cell ca
a 53 year old man who recently returned from africa, has fever, headache and abdominal disconfort.
he received appropiate vaccinations prior to the trip. his temp is 39. physical exam no abnorm. a
peripheral blood smears is shown (cant show the image). dx?
a babesiosis
b leishmaniasis
c malaria
d toxop
e trypanosomiasis
2 a 40 year old woman comes to the physician because of a 1 year history of episodes of crampy
abdominal pain, intermittent diarrhea, and rectal bleeding with passage of mocus. she is 173 cm tall
and weighs 55kg. BMI 18. abdominal exam shows diffuse tenderness with no rebound tenderness.
sigmoidoscopi shows diffuse ulcers, initial tx?
a amoxicillin
b bismuth subsalicylate
c loperamide
d octeotide
e sulfasalazine (maybe?)
3 a 50 year old man comes tot he physician because of a persistent cough for the past 2 months. he
has had a 5 kg weight loss during this period. he is a farmer and started itraconazole or 4 weeks ago
for histoplasmosis. current med hydrochlorothiazide, enalapril, atenolol, omeprazole and metoclop.
he appears thin. physical exam shows no other abdn. an interaction betwn itraconazole and which of
the following accounts for the lack of effect of itraconazole?
a atenolol
b enalapril
c hydroclorot
d metoclopramide
e omeprazole
4 a previously healthy 17 year oldgirl is brought tot he emergency department because of a 1 day
hsitory of shortness of breath, weakness, and muscle tenderness. she completed a triathlon the
previous day, appears restless. bmi 19, tem 38, bp 150.90. bilateral crackless at lower lungs, muscle
tenderness. creat 4 mg/dl. urinalisis 3 protein and 4 hemog. inc realease of?
a aldolase
b ck
c hemogl
