Page 1 of 391
NBME 26 EXAM NEWEST WITH 350 QUESTIONS
AND CORRECT VERIFIED WELL EXPLAINED
ANSWERS JUST RELEASED THIS YEAR
Question 1 :A 42-year-old man is struck by a motor vehicle. His only injury is a closed fracture of
the proximal tibia. Initial neurovascular examination shows no deficits. Twenty-four hours later,
he has increased leg pain and paresthesias in the dorsal space between his
first and second toes. The patient begins to pass dark red urine and becomes oliguric. Urinalysis
is positive for blood but no erythrocytes are seen on microscopic examination. Which of the
following acute disorders is the most likely cause of the renal
failure?
A) Glomerulonephritis
B) Hemolytic-uremic syndrome
C) Interstitial nephritis
D) Nephrotic syndrome
E) Tubular necrosis - CORRECT ANSWER✔✔E.
Tibial fractures present a high risk for compartment syndrome. The fracture results in blood
vessel injury and muscle injury, inflammation, and edema. Because the fascia containing the
anterior compartment of the leg does not stretch, bleeding and swelling can
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cause increased pressure in the compartment. This increased pressure in turn inhibits venous
drainage, further increasing pressure in the compartment. Eventually the nerve supply and
associated arteries are compromised, leading to the classic signs and
symptoms of compartment syndrome. Signs and symptoms of compartment syndrome include
pain out of proportion to examination findings, pain with passive movement of the muscles,
paresthesia, pallor, pulselessness, and paralysis. Compromised blood supply
deprives muscle and tissue of oxygen and glucose, leading to tissue ischemia and necrosis.
Muscle necrosis leads to rhabdomyolysis, myoglobinuria, and acute renal failure. Evaluation of
rhabdomyolysis reveals red or brown urine and urinalysis is typically positive
for blood due to the presence of myoglobinuria without microscopic evidence of red blood cells.
A complication of rhabdomyolysis is acute kidney injury from acute tubular necrosis secondary
to the release of nephrotoxic myoglobin and nonprotein heme pigments.
Acute tubular necrosis typically occurs following an ischemic or nephrotoxic insult to the
kidneys, which results in loss of the tubular epithelium. Granular, muddy brown casts are
common on urinalysis. Compartment syndrome is treated by immediate fasciotomy to
decrease compartment pressure and support tissue perfusion.
Incorrect Answers: A, B, C, and D.
Glomerulonephritis (Choice A) refers to a variety of glomerular diseases, including nephritic and
nephrotic syndromes. Nephritic syndromes typically present with acute renal failure associated
with h
Question:
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Exam Section 1: Item 5 of 50
National, Board of Medical Examiners
Comprehensive Basic Science Self-Assessment
5. A 65-year-old woman has ascites. Which of the following additional findings indicates a
diagnosis of constrictive pericarditis rather than cirrhosis?
O A) Edema of the lower extremities
B) Esophageal varices
C) Hypoalbuminemia
D) Hyponatremia
E) Increased jugular venous pressure
F) Splenomegaly - CORRECT ANSWER✔✔E.
Increased jugular venous pressure (JVP) is an expected finding in constrictive pericarditis (CP)
and would not be found in patients with volume overload secondary to cirrhosis. CP describes a
pathologic state whereby the pericardium, which encases the entirety of
the heart and the origins of the great vessels, loses its elasticity. This can occur in patients with
viral infections, connective tissue disease, tuberculosis, or as a result of cardiac surgery or
radiation. During the normal cardiac cycle, increased venous return to the
right atrium (RA) and right ventricle (RV) during inspiration leads to transient expansion of the
RV with slight bowing of the interventricular septum into the left ventricle (LV). This increased
RV preload does not impair LV filling as the pericardial sac expands to
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accommodate the increased RV volume. In constrictive pericarditis, the pericardial sac loses its
elasticity. When venous return to the right heart increases, the pericardial sac is unable to
expand, which exacerbates movement of the interventricular septum into the
LV. This impairs diastolic filling of the LV and reduces cardiac output. LV diastolic filling is further
reduced by a reduction in preload from the pulmonary veins. The constricted pericardium does
not respond to normal changes in intrathoracic pressure during
inspiration, but the pulmonary venous system, which lies outside of the pericardium,
experiences a normal drop in pressure during inspiration. This difference creates an abnormal
pressure gradient that reduces LV preload and leads to reduced cardiac output. The
RV and LV develop interventricular dependence whereby increased pressure in each ventricle
begins to affect the other ventricle. CP ultimately results in equalization of pressures in all four
chambers, with clinical evidence of right heart failure exhib
Question: 4
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Exam Section 1: Item 4 of 50
National Board of Medical Examiners
Comprehensive Basic Science Self-Assessment
4. A male newborn is found to have a defect in anchoring fibrils. Which of the following skin
findings is most likely in this patient?
A) Blisters
B) Easy bruising
4
SUCCESS!
NBME 26 EXAM NEWEST WITH 350 QUESTIONS
AND CORRECT VERIFIED WELL EXPLAINED
ANSWERS JUST RELEASED THIS YEAR
Question 1 :A 42-year-old man is struck by a motor vehicle. His only injury is a closed fracture of
the proximal tibia. Initial neurovascular examination shows no deficits. Twenty-four hours later,
he has increased leg pain and paresthesias in the dorsal space between his
first and second toes. The patient begins to pass dark red urine and becomes oliguric. Urinalysis
is positive for blood but no erythrocytes are seen on microscopic examination. Which of the
following acute disorders is the most likely cause of the renal
failure?
A) Glomerulonephritis
B) Hemolytic-uremic syndrome
C) Interstitial nephritis
D) Nephrotic syndrome
E) Tubular necrosis - CORRECT ANSWER✔✔E.
Tibial fractures present a high risk for compartment syndrome. The fracture results in blood
vessel injury and muscle injury, inflammation, and edema. Because the fascia containing the
anterior compartment of the leg does not stretch, bleeding and swelling can
1
SUCCESS!
,Page 2 of 391
cause increased pressure in the compartment. This increased pressure in turn inhibits venous
drainage, further increasing pressure in the compartment. Eventually the nerve supply and
associated arteries are compromised, leading to the classic signs and
symptoms of compartment syndrome. Signs and symptoms of compartment syndrome include
pain out of proportion to examination findings, pain with passive movement of the muscles,
paresthesia, pallor, pulselessness, and paralysis. Compromised blood supply
deprives muscle and tissue of oxygen and glucose, leading to tissue ischemia and necrosis.
Muscle necrosis leads to rhabdomyolysis, myoglobinuria, and acute renal failure. Evaluation of
rhabdomyolysis reveals red or brown urine and urinalysis is typically positive
for blood due to the presence of myoglobinuria without microscopic evidence of red blood cells.
A complication of rhabdomyolysis is acute kidney injury from acute tubular necrosis secondary
to the release of nephrotoxic myoglobin and nonprotein heme pigments.
Acute tubular necrosis typically occurs following an ischemic or nephrotoxic insult to the
kidneys, which results in loss of the tubular epithelium. Granular, muddy brown casts are
common on urinalysis. Compartment syndrome is treated by immediate fasciotomy to
decrease compartment pressure and support tissue perfusion.
Incorrect Answers: A, B, C, and D.
Glomerulonephritis (Choice A) refers to a variety of glomerular diseases, including nephritic and
nephrotic syndromes. Nephritic syndromes typically present with acute renal failure associated
with h
Question:
----------
2
SUCCESS!
,Page 3 of 391
Exam Section 1: Item 5 of 50
National, Board of Medical Examiners
Comprehensive Basic Science Self-Assessment
5. A 65-year-old woman has ascites. Which of the following additional findings indicates a
diagnosis of constrictive pericarditis rather than cirrhosis?
O A) Edema of the lower extremities
B) Esophageal varices
C) Hypoalbuminemia
D) Hyponatremia
E) Increased jugular venous pressure
F) Splenomegaly - CORRECT ANSWER✔✔E.
Increased jugular venous pressure (JVP) is an expected finding in constrictive pericarditis (CP)
and would not be found in patients with volume overload secondary to cirrhosis. CP describes a
pathologic state whereby the pericardium, which encases the entirety of
the heart and the origins of the great vessels, loses its elasticity. This can occur in patients with
viral infections, connective tissue disease, tuberculosis, or as a result of cardiac surgery or
radiation. During the normal cardiac cycle, increased venous return to the
right atrium (RA) and right ventricle (RV) during inspiration leads to transient expansion of the
RV with slight bowing of the interventricular septum into the left ventricle (LV). This increased
RV preload does not impair LV filling as the pericardial sac expands to
3
SUCCESS!
, Page 4 of 391
accommodate the increased RV volume. In constrictive pericarditis, the pericardial sac loses its
elasticity. When venous return to the right heart increases, the pericardial sac is unable to
expand, which exacerbates movement of the interventricular septum into the
LV. This impairs diastolic filling of the LV and reduces cardiac output. LV diastolic filling is further
reduced by a reduction in preload from the pulmonary veins. The constricted pericardium does
not respond to normal changes in intrathoracic pressure during
inspiration, but the pulmonary venous system, which lies outside of the pericardium,
experiences a normal drop in pressure during inspiration. This difference creates an abnormal
pressure gradient that reduces LV preload and leads to reduced cardiac output. The
RV and LV develop interventricular dependence whereby increased pressure in each ventricle
begins to affect the other ventricle. CP ultimately results in equalization of pressures in all four
chambers, with clinical evidence of right heart failure exhib
Question: 4
----------
Exam Section 1: Item 4 of 50
National Board of Medical Examiners
Comprehensive Basic Science Self-Assessment
4. A male newborn is found to have a defect in anchoring fibrils. Which of the following skin
findings is most likely in this patient?
A) Blisters
B) Easy bruising
4
SUCCESS!
