Page 1 of 381
NBME 26 EXAM NEWEST VERSION THIS YEAR
WITH 300 QUESTIONS AND WELL ELABORATED
ANSWERS
A 78-year-old man comes to the physician with his daughter because of low back pain for 3
months. He underwent a bilateral orchiectomy 2 years ago for prostate cancer. He speaks
French fluently, but he knows only a few English words. His daughter offers
to serve as an interpreter. After thanking the daughter for her offer, it is most appropriate for
the physician to state which of the following?
O A) "Have you interpreted for your father before in a medical capacity?"
O B) "I believe it would be awkward for a daughter to interpret for her father."
C) "It is best that I use a professional French interpreter."
O D) "Please ask your father if he's ready to begin the examination."
E) "That would be fine. I'll just ask you to step out of the room for the physical examination."
C.
Professional interpreters can provide high-quality translations that maintain patient safety.
Credentialed interpreters are trained in medical knowledge and vocabulary, ethics, and cultural
sensitivity. Relying on a family member for interpreting increases the risk of
miscommunication about medical or culturally relevant details and can jeopardize informed
consent for treatment and patient safety.
Incorrect Answers: A, B, D, and E.
, Page 2 of 381
Having past experience translating for a family member (Choice A) is suboptimal compared to
the rigorous training professional interpreters receive. Irrespective of interpersonal
awkwardness or the physician's personal beliefs (Choice B), family members should not
act as interpreters for patients (Choices D and E). The nuances of a medical situation may be
misunderstood by an untrained interpreter and therefore miscommunicated to the patient. The
only situation in which interpretation by a family member is acceptable is an
emergency when no other option exists.
Educational Objective: Physicians should utilize professional interpreters instead of family
members to translate for patients. Professional interpreters are trained to accurately
communicate in medical settings and are therefore crucial for patient safety and informed
consent to treatment.
79
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Exam Section 2: Item 29 of 50
National, Board pf Medical Examiners
ment
* 29. A 15-year-old girl is brought to the physician by her mother because of a 1-year history of
increasingly severe abdominal pain that occurs periodically, but not regularly. Physical
examination shows abdominal tenderness that is most acute around the umbilicus.
The physician suspects ectopic endometrial tissue, and an operation is scheduled. During the
operation, an 8-cm piece of tissue is removed from the ileal region on the antimesenteric side
of the bowel approximately 90 cm proximal to the ileocecal junction.
, Page 3 of 381
The patient's pain resolves postoperatively. The ectopic tissue was most likely located in which
of the following structures?
O A) Ascending colon
B) Falciform ligament
C) lleal polyp
O D) Meckel diverticulum
O E) Vermiform appendix D.
Meckel diverticulum results from persistence of the vitelline duct and can demonstrate ectopic,
functional gastric, pancreatic, or, rarely, endometrial tissue. It can present with acute or chronic
hematochezia or melena. It is often painless but may also present with
abdominal pain. It typically presents in childhood, most commonly before age 2 years, although
because of its indolent nature, it may not be diag
length. In children, it may serve as a potential lead-point for intussusception. A technetium 99m
pertechnetate scan demonstrates uptake in the right lower quadrant, corresponding with
ectopic gastric mucosa within the Meckel diverticulum. Treatment of symptomatic
cases is through surgical resection.
sed until later in life. It is co
only located two feet proximal to the ileocecal valve and is approxir
ately two inches in
Incorrect Answers: A, B, C, and E.
The ascending colon (Choice A) is a common site of colon polyps. The ascending colon is distal
to the ileocecal valve and is not consistent with the location of the excised tissue.
, Page 4 of 381
The falciform ligament (Choice B) is a peritoneal fold that divides the liver; it is anatomically
distant from the described location of resection in this case.
lleal polyps (Choice C) are less common than their counterparts in the colon, and may be
associated with hereditary polyposis syndromes, such as Peutz-Jeghers syndrome or familial
adenomatous polyposis. The length of the removed tissue and its presentation with
intermittent abdominal pain is more suggestive of a Meckel diverticulum.
The vermiform appendix (Choice E) is the site of acute appendicitis, which presents with
periumbilical pain that migrates to the right lower quadrant, fever, anorexia, nausea, vomiting,
diarrhea, and leukocytosis.
Educational Objective: Meckel diverticulum results from persistence of the vitell
80
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Exam Section 2: Item 30 of 50
National, Board pf Medical Examiners
ent
30. A 14-year-old girl is brought to the physician by her mother because of episodes of
increasingly severe facial blemishes during the past 6 months. She says that she does not eat
high-fat foods or use makeup. Use of an astringent soap has not resolved her
symptoms. Menarche occurred at the age of 12 years. A photograph of her face is shown.
Which of the following best describes the pathologic mechanism of this patient's condition?
O A) Acceleration of the proliferation of cells in the dermis by increased estrogen production
O B) Colonization of apocrine sweat glands by fungi
NBME 26 EXAM NEWEST VERSION THIS YEAR
WITH 300 QUESTIONS AND WELL ELABORATED
ANSWERS
A 78-year-old man comes to the physician with his daughter because of low back pain for 3
months. He underwent a bilateral orchiectomy 2 years ago for prostate cancer. He speaks
French fluently, but he knows only a few English words. His daughter offers
to serve as an interpreter. After thanking the daughter for her offer, it is most appropriate for
the physician to state which of the following?
O A) "Have you interpreted for your father before in a medical capacity?"
O B) "I believe it would be awkward for a daughter to interpret for her father."
C) "It is best that I use a professional French interpreter."
O D) "Please ask your father if he's ready to begin the examination."
E) "That would be fine. I'll just ask you to step out of the room for the physical examination."
C.
Professional interpreters can provide high-quality translations that maintain patient safety.
Credentialed interpreters are trained in medical knowledge and vocabulary, ethics, and cultural
sensitivity. Relying on a family member for interpreting increases the risk of
miscommunication about medical or culturally relevant details and can jeopardize informed
consent for treatment and patient safety.
Incorrect Answers: A, B, D, and E.
, Page 2 of 381
Having past experience translating for a family member (Choice A) is suboptimal compared to
the rigorous training professional interpreters receive. Irrespective of interpersonal
awkwardness or the physician's personal beliefs (Choice B), family members should not
act as interpreters for patients (Choices D and E). The nuances of a medical situation may be
misunderstood by an untrained interpreter and therefore miscommunicated to the patient. The
only situation in which interpretation by a family member is acceptable is an
emergency when no other option exists.
Educational Objective: Physicians should utilize professional interpreters instead of family
members to translate for patients. Professional interpreters are trained to accurately
communicate in medical settings and are therefore crucial for patient safety and informed
consent to treatment.
79
----------
Exam Section 2: Item 29 of 50
National, Board pf Medical Examiners
ment
* 29. A 15-year-old girl is brought to the physician by her mother because of a 1-year history of
increasingly severe abdominal pain that occurs periodically, but not regularly. Physical
examination shows abdominal tenderness that is most acute around the umbilicus.
The physician suspects ectopic endometrial tissue, and an operation is scheduled. During the
operation, an 8-cm piece of tissue is removed from the ileal region on the antimesenteric side
of the bowel approximately 90 cm proximal to the ileocecal junction.
, Page 3 of 381
The patient's pain resolves postoperatively. The ectopic tissue was most likely located in which
of the following structures?
O A) Ascending colon
B) Falciform ligament
C) lleal polyp
O D) Meckel diverticulum
O E) Vermiform appendix D.
Meckel diverticulum results from persistence of the vitelline duct and can demonstrate ectopic,
functional gastric, pancreatic, or, rarely, endometrial tissue. It can present with acute or chronic
hematochezia or melena. It is often painless but may also present with
abdominal pain. It typically presents in childhood, most commonly before age 2 years, although
because of its indolent nature, it may not be diag
length. In children, it may serve as a potential lead-point for intussusception. A technetium 99m
pertechnetate scan demonstrates uptake in the right lower quadrant, corresponding with
ectopic gastric mucosa within the Meckel diverticulum. Treatment of symptomatic
cases is through surgical resection.
sed until later in life. It is co
only located two feet proximal to the ileocecal valve and is approxir
ately two inches in
Incorrect Answers: A, B, C, and E.
The ascending colon (Choice A) is a common site of colon polyps. The ascending colon is distal
to the ileocecal valve and is not consistent with the location of the excised tissue.
, Page 4 of 381
The falciform ligament (Choice B) is a peritoneal fold that divides the liver; it is anatomically
distant from the described location of resection in this case.
lleal polyps (Choice C) are less common than their counterparts in the colon, and may be
associated with hereditary polyposis syndromes, such as Peutz-Jeghers syndrome or familial
adenomatous polyposis. The length of the removed tissue and its presentation with
intermittent abdominal pain is more suggestive of a Meckel diverticulum.
The vermiform appendix (Choice E) is the site of acute appendicitis, which presents with
periumbilical pain that migrates to the right lower quadrant, fever, anorexia, nausea, vomiting,
diarrhea, and leukocytosis.
Educational Objective: Meckel diverticulum results from persistence of the vitell
80
----------
Exam Section 2: Item 30 of 50
National, Board pf Medical Examiners
ent
30. A 14-year-old girl is brought to the physician by her mother because of episodes of
increasingly severe facial blemishes during the past 6 months. She says that she does not eat
high-fat foods or use makeup. Use of an astringent soap has not resolved her
symptoms. Menarche occurred at the age of 12 years. A photograph of her face is shown.
Which of the following best describes the pathologic mechanism of this patient's condition?
O A) Acceleration of the proliferation of cells in the dermis by increased estrogen production
O B) Colonization of apocrine sweat glands by fungi
