/NBME CBSE (USMLE STEP
N
1)MEDICAL ACTUAL EXAM NEWEST
VERSION 2024-2025 TESTBANK
QUESTIONS AND CORRECT
DETAILEDANSWERS WITH
RATIONALES |ALREADYGRADED A+
70yonMndiesninnanmotornvehiclencollision.nWasnundergoingnevaluationnfornoccultnbloodninnthenstool
.nPhotonofntransversencolonnshown.nDx?n-nnCORRECTnANSWERSTubularnadenoma
38yonMnwithn1-
weeknhxnofnwatery,nitchyneyesnandnanrunnynnose.nPhysicalnshowsninflamednnasalnmucosa.nNoncong
estionninnlowernlung.nPharmacotherapy?n-nnCORRECTnANSWERSLoratadine
16yongirlnwithn3-daynhxnofnfever,nnonproductivencough,nandnfatigue.nTn38.3,nPn88/min,nBPn102-
70.nPEnshowsnpalenconjunctivae.nCXRnshowsnbilateralninterstitialninfiltrates.nBloodnspontaenouslyna
gglutinatesnwhilenawaitingntransportntonthenlaboratory.nAntibodynisotypesncausingnagglutination?n
-nnCORRECTnANSWERSIgM
24yonMnwithnsmallntendernblistersnonnhisnpenisn3ndaysnafternunprotectednsex.nPhotographnshown.n
Causalnagent?n-nnCORRECTnANSWERSHSV-2
42yonFnwithn3-
yearnhxnofnannintermittentnfacialnrash,nincludingnthenforehead,neyelids,nnose,nandncheeks.nRashnsee
msntonbengettingnworsensincenshenmovednfromnNewnYorkntonFloridanlastnyear.nSpicynfoodsnprecipita
tenanflushingnreactionnthatnseemsntonexacerbatenthenrash.nPEnshowsnerythemanovernthennosenandn
cheeks,nwithnscatteredntelangiectasiasnandnanfewnpapules.nDx?n-nnCORRECTnANSWERSRosacea
,53yonMnreturnednfromnAfrica,nhasnfever,nheadache,nandnabdominalndiscomfort.nReceivednappropr
iatenvaccinationsnpriorntonthentrip.nTn39.4C.nAnwright-stainednperipheralnsmearnshown.nDx?n-
nnCORRECTnANSWERSMalaria
68yonFnwithnT2DMnandnhypertensionnthatnhasnbeennpoorlyncontrolledndespitenhydrochlorothiazid
entreatment.nBPn150/96,nLabsnshownserumnglucosenconcentrationnofn130nandnproteinuria.nInnaddit
ionntoncurrentnRx,nwhichnisnmostnappropriatenpharmacotherapy?n-nnCORRECTnANSWERSLisinopril
66yonMnwithnstagenIVncolonncancernwithn3-
daynhxnofnseverendiarrheanafternreceivingnchemotherapynwithnfluorouracil,nleucovorin,nandnIrinote
can.nprescribednopioidnantidiarrhealnagentnwithnnonCNSneffects.nWhichnmed?n-
nnCORRECTnANSWERSLoperamide
35yonMninnEDnwithn2-
hournhxnofnsevernfatiguenandndizziness.nHadnprofuse,nwateryndiarrheanforn8nhoursndespitenanlacknof
noralnintake.nRecentlynreturnednfromnanmedicalnreliefntripntonanremovenvillageninnHonduras.nTn36.7n
C,nPn122/min,nBPn90/50.nPEnshowsndrynskinnandndecreasedncapillarynrefill.nStoolnfornoccultnbloodnisn
negative;nstoolnisngraynandnturbid.nGramnstainnshowsngram-negative,ncomma-
shapednbacteria;nnonerythrocytesnofnleukocytes.nMOAnofntoxin?n-
nnCORRECTnANSWERSActivationnofnadenylylncyclase
59yonFnwithngradualnonsetnofnlacknofnmusclencontrolninnhernleftnarmnandnleg.nSxn1nmonagonafterndxn
withnmetastaticnbreastncancer.nPEnshowsnataxianofnleftnuppernandnlowernextremities.nMusclenstren
gth,nDTR,nsensation,nproprioceptionnnormal.nMetastaticntumorninnwhichnlocation?n-
nnCORRECTnANSWERScerebellum
Newbornndeliverednatn38nweeks'ngestationnweighsn1800ng.nPEnshowsnpetechialnrash,nmicrocephaly
,nandnhepatosplenomegaly.nSerologicntestnfornCMV:nIgGn+ninnmother,n+ninnnewborn;nIGMn-
ninnmother,n+ninnnewborn.nExplanation?n-
nnCORRECTnANSWERSCongenitalncytomegalovirusninfection
,Femalennewbornnisndeliverednatn38nweeks'ngestation.nApgarn8nandn8natn1/5nmin.nPEnshowsnanbulgin
g,nfluod0fillednmassnapproximatelyn5ncmninndiameterninnthenmidlinenovernthenlumbosacralnregion.n
Nonspontaneousnmovementsnofnthenlowernextremities.nAbnormalitynmostnlikelynoccurrednbecause
nofnabnormalndevelopmentnduringnwhichnperiodsnofnpostconceptionn(inndays)?n-
nnCORRECTnANSWERS15nton40
64yonMninnEDn3nhoursnafternSOBnwithnexertionnandnextremenfatigue.nHasnischemicnheartndisease.nP
n125/min,nBPn105/60.nECGnshowsnatrialnfibrillation.nIntravenousnibutilidenisnadministered.nTennmin
utesnlater,nECGnshowsnnormalnsinusnrhythm.nRisknfornwhichndrugneffectninnthennextn6nhours?n-
nnCORRECTnANSWERStorsadesndenpointes
65yonFnwithn20-
yearnhxnofnosteoarthritisnofnthenhandsnnownhasnpainnradiatingndownnthendistalnanteriornthigh,nkne
e,nmedialnleg,nandnfood.nBonynoutgrowthnofnvertebraencompressingnonenofnthenspinalnnervesnisnsu
spected.nNervenrootninnwhichnintervertebralnforaminanisneffected?n-nnCORRECTnANSWERSL3ntonL4
38yonMnwithn3-
yearnhxnofnT2DM.nTakingnannoralnantihyperglycemicnagent,nhenhasntriedndietnandnexercise.nBMIn32.n
PEnnormal.nHbnA1cnisn10%.nPhysiciannrecommendsninitiationnofninsulinninjections.nResponds,n"Inkn
ownthatninsulinnwouldnhelpncontrolnmynbloodnsugar.nButnanlotnofnpeopleninnmynfamilynhavendiabete
s,nandninsulinnmadenthemnreallynsicknatntimes.nPatientnisnatnwhichnstagenofnchange?n-
nnCORRECTnANSWERScontemplation
24yonMnwithn2-
daynhistorynofnannitchynrashnonnhisnarmsnandnlegs.nReturnednfromnancampingntripninnthenwoodsn5nd
aysnago.nPEnshowsnedematous,nerythematousnrashnwithnlinearnvesicles.nCausenisnactivationnofnwhi
chncellntypes?n-nnCORRECTnANSWERSTnlymphocytes
70yonMnfromnchinanwithnpoorlyndifferentiatednmonoclonalncarcinomanofnthennasopharynx.nDNAnp
robesnofnneoplasticncellsnarenmostnlikelyntondetectngenomenofnwhichnvirus?n-
nnCORRECTnANSWERSEBV
, Epidemiologicnstudynofnanilinendye,n500nworkersnwithnbladderncancernandn200nworkersnwithout.nE
xposedntonanilinendyes/HavenBladderncancer:nYes/Yesn(250),nYes/Non(50),nNo/Yesn(250),nNo/Non(1
50).nOddsnratio?n-nnCORRECTnANSWERS3
24yonMnwithnhxnofnIVDAncouldnnotnbenaroused.nFriendnreportsnthatnthenpatientninjectednhimselfnwi
thnandrugn6nhoursnago.nLabsnshowndrugnconcentrationnofn0.3.nAssumingnfirst-ordernone-
compartmentnkinetics,nhasnanhalf-
lifenofn2nhours,nandnanvolumenofndistributionnofn200nLninnthisnpatient.nWhatnisnquantitynofndrugn(inn
mg)ninjected?n-nnCORRECTnANSWERS480
Compoundnisntakennupnbynbacterialncells.nNonenergynisnnecessarynfornuptake,nandnthencompoundni
snnotnconcentratedninnthencell.nWhichndescribesnthisnmechanismnofntransport?n-
nnCORRECTnANSWERScarrier-mediatedndiffusion
Newbornnhasnmalengenitalnductsnbutnfemalenexternalngenitalia.nCytogeneticnanalysisnshowsnan46,X
Ynkaryotype,nandngeneticntestingnshowsnanmutationnofnthengenenencodingn5alpha-
reductase.nInnabsencenofnthisnmutation,nlabianmajoranwouldnhavenbeen?n-
nnCORRECTnANSWERSscrotum
StudyndesignedntonevaluatenthenefficacynofncoenzymenQ10ninnimprovingncardiacnoutputninnpatients
nwithnCHF.nSixtynpatientsnwithnCHFnarenrecruited.nEachnassignednbyncoinntossntononenofntwongroups.
nDesign?n-nnCORRECTnANSWERSrandomizednclinicalntrial
12yonboynimmersednupntonhisnneckninn60Fnwaternforn20nminutes.nPhysiologicalnchanges?n-
nnCORRECTnANSWERSCentralnbloodnvolumenINCREASED,nADHn(vasopressin)nDECREASED,nAtrialnNa
triureticnPeptidenINCREASED?nCn(block3,nq23)
Randomizedncontrollednstudynofn2000npatientsnwithninsomnianisnconductedntonevaluatentheneffica
cynofnannewnmedicationntontreatnthisncondition.nTennsubjectsnfromnbothnthencontrolnandntreatment
ngroupsndonnotncompletenthenstudynarennotnincludedninnthenanalysis.nTreatmentngroupnablentonfalln
asleepn5nminutesnfasternthanncontroln(p=0.001).nNeitherngroupnreportnannimprovementninnqualityn
ofnlife.nConcludenthatnnewnmednisnefficaciousninntreatingninsomnia.nTypenofnerror?n-
N
1)MEDICAL ACTUAL EXAM NEWEST
VERSION 2024-2025 TESTBANK
QUESTIONS AND CORRECT
DETAILEDANSWERS WITH
RATIONALES |ALREADYGRADED A+
70yonMndiesninnanmotornvehiclencollision.nWasnundergoingnevaluationnfornoccultnbloodninnthenstool
.nPhotonofntransversencolonnshown.nDx?n-nnCORRECTnANSWERSTubularnadenoma
38yonMnwithn1-
weeknhxnofnwatery,nitchyneyesnandnanrunnynnose.nPhysicalnshowsninflamednnasalnmucosa.nNoncong
estionninnlowernlung.nPharmacotherapy?n-nnCORRECTnANSWERSLoratadine
16yongirlnwithn3-daynhxnofnfever,nnonproductivencough,nandnfatigue.nTn38.3,nPn88/min,nBPn102-
70.nPEnshowsnpalenconjunctivae.nCXRnshowsnbilateralninterstitialninfiltrates.nBloodnspontaenouslyna
gglutinatesnwhilenawaitingntransportntonthenlaboratory.nAntibodynisotypesncausingnagglutination?n
-nnCORRECTnANSWERSIgM
24yonMnwithnsmallntendernblistersnonnhisnpenisn3ndaysnafternunprotectednsex.nPhotographnshown.n
Causalnagent?n-nnCORRECTnANSWERSHSV-2
42yonFnwithn3-
yearnhxnofnannintermittentnfacialnrash,nincludingnthenforehead,neyelids,nnose,nandncheeks.nRashnsee
msntonbengettingnworsensincenshenmovednfromnNewnYorkntonFloridanlastnyear.nSpicynfoodsnprecipita
tenanflushingnreactionnthatnseemsntonexacerbatenthenrash.nPEnshowsnerythemanovernthennosenandn
cheeks,nwithnscatteredntelangiectasiasnandnanfewnpapules.nDx?n-nnCORRECTnANSWERSRosacea
,53yonMnreturnednfromnAfrica,nhasnfever,nheadache,nandnabdominalndiscomfort.nReceivednappropr
iatenvaccinationsnpriorntonthentrip.nTn39.4C.nAnwright-stainednperipheralnsmearnshown.nDx?n-
nnCORRECTnANSWERSMalaria
68yonFnwithnT2DMnandnhypertensionnthatnhasnbeennpoorlyncontrolledndespitenhydrochlorothiazid
entreatment.nBPn150/96,nLabsnshownserumnglucosenconcentrationnofn130nandnproteinuria.nInnaddit
ionntoncurrentnRx,nwhichnisnmostnappropriatenpharmacotherapy?n-nnCORRECTnANSWERSLisinopril
66yonMnwithnstagenIVncolonncancernwithn3-
daynhxnofnseverendiarrheanafternreceivingnchemotherapynwithnfluorouracil,nleucovorin,nandnIrinote
can.nprescribednopioidnantidiarrhealnagentnwithnnonCNSneffects.nWhichnmed?n-
nnCORRECTnANSWERSLoperamide
35yonMninnEDnwithn2-
hournhxnofnsevernfatiguenandndizziness.nHadnprofuse,nwateryndiarrheanforn8nhoursndespitenanlacknof
noralnintake.nRecentlynreturnednfromnanmedicalnreliefntripntonanremovenvillageninnHonduras.nTn36.7n
C,nPn122/min,nBPn90/50.nPEnshowsndrynskinnandndecreasedncapillarynrefill.nStoolnfornoccultnbloodnisn
negative;nstoolnisngraynandnturbid.nGramnstainnshowsngram-negative,ncomma-
shapednbacteria;nnonerythrocytesnofnleukocytes.nMOAnofntoxin?n-
nnCORRECTnANSWERSActivationnofnadenylylncyclase
59yonFnwithngradualnonsetnofnlacknofnmusclencontrolninnhernleftnarmnandnleg.nSxn1nmonagonafterndxn
withnmetastaticnbreastncancer.nPEnshowsnataxianofnleftnuppernandnlowernextremities.nMusclenstren
gth,nDTR,nsensation,nproprioceptionnnormal.nMetastaticntumorninnwhichnlocation?n-
nnCORRECTnANSWERScerebellum
Newbornndeliverednatn38nweeks'ngestationnweighsn1800ng.nPEnshowsnpetechialnrash,nmicrocephaly
,nandnhepatosplenomegaly.nSerologicntestnfornCMV:nIgGn+ninnmother,n+ninnnewborn;nIGMn-
ninnmother,n+ninnnewborn.nExplanation?n-
nnCORRECTnANSWERSCongenitalncytomegalovirusninfection
,Femalennewbornnisndeliverednatn38nweeks'ngestation.nApgarn8nandn8natn1/5nmin.nPEnshowsnanbulgin
g,nfluod0fillednmassnapproximatelyn5ncmninndiameterninnthenmidlinenovernthenlumbosacralnregion.n
Nonspontaneousnmovementsnofnthenlowernextremities.nAbnormalitynmostnlikelynoccurrednbecause
nofnabnormalndevelopmentnduringnwhichnperiodsnofnpostconceptionn(inndays)?n-
nnCORRECTnANSWERS15nton40
64yonMninnEDn3nhoursnafternSOBnwithnexertionnandnextremenfatigue.nHasnischemicnheartndisease.nP
n125/min,nBPn105/60.nECGnshowsnatrialnfibrillation.nIntravenousnibutilidenisnadministered.nTennmin
utesnlater,nECGnshowsnnormalnsinusnrhythm.nRisknfornwhichndrugneffectninnthennextn6nhours?n-
nnCORRECTnANSWERStorsadesndenpointes
65yonFnwithn20-
yearnhxnofnosteoarthritisnofnthenhandsnnownhasnpainnradiatingndownnthendistalnanteriornthigh,nkne
e,nmedialnleg,nandnfood.nBonynoutgrowthnofnvertebraencompressingnonenofnthenspinalnnervesnisnsu
spected.nNervenrootninnwhichnintervertebralnforaminanisneffected?n-nnCORRECTnANSWERSL3ntonL4
38yonMnwithn3-
yearnhxnofnT2DM.nTakingnannoralnantihyperglycemicnagent,nhenhasntriedndietnandnexercise.nBMIn32.n
PEnnormal.nHbnA1cnisn10%.nPhysiciannrecommendsninitiationnofninsulinninjections.nResponds,n"Inkn
ownthatninsulinnwouldnhelpncontrolnmynbloodnsugar.nButnanlotnofnpeopleninnmynfamilynhavendiabete
s,nandninsulinnmadenthemnreallynsicknatntimes.nPatientnisnatnwhichnstagenofnchange?n-
nnCORRECTnANSWERScontemplation
24yonMnwithn2-
daynhistorynofnannitchynrashnonnhisnarmsnandnlegs.nReturnednfromnancampingntripninnthenwoodsn5nd
aysnago.nPEnshowsnedematous,nerythematousnrashnwithnlinearnvesicles.nCausenisnactivationnofnwhi
chncellntypes?n-nnCORRECTnANSWERSTnlymphocytes
70yonMnfromnchinanwithnpoorlyndifferentiatednmonoclonalncarcinomanofnthennasopharynx.nDNAnp
robesnofnneoplasticncellsnarenmostnlikelyntondetectngenomenofnwhichnvirus?n-
nnCORRECTnANSWERSEBV
, Epidemiologicnstudynofnanilinendye,n500nworkersnwithnbladderncancernandn200nworkersnwithout.nE
xposedntonanilinendyes/HavenBladderncancer:nYes/Yesn(250),nYes/Non(50),nNo/Yesn(250),nNo/Non(1
50).nOddsnratio?n-nnCORRECTnANSWERS3
24yonMnwithnhxnofnIVDAncouldnnotnbenaroused.nFriendnreportsnthatnthenpatientninjectednhimselfnwi
thnandrugn6nhoursnago.nLabsnshowndrugnconcentrationnofn0.3.nAssumingnfirst-ordernone-
compartmentnkinetics,nhasnanhalf-
lifenofn2nhours,nandnanvolumenofndistributionnofn200nLninnthisnpatient.nWhatnisnquantitynofndrugn(inn
mg)ninjected?n-nnCORRECTnANSWERS480
Compoundnisntakennupnbynbacterialncells.nNonenergynisnnecessarynfornuptake,nandnthencompoundni
snnotnconcentratedninnthencell.nWhichndescribesnthisnmechanismnofntransport?n-
nnCORRECTnANSWERScarrier-mediatedndiffusion
Newbornnhasnmalengenitalnductsnbutnfemalenexternalngenitalia.nCytogeneticnanalysisnshowsnan46,X
Ynkaryotype,nandngeneticntestingnshowsnanmutationnofnthengenenencodingn5alpha-
reductase.nInnabsencenofnthisnmutation,nlabianmajoranwouldnhavenbeen?n-
nnCORRECTnANSWERSscrotum
StudyndesignedntonevaluatenthenefficacynofncoenzymenQ10ninnimprovingncardiacnoutputninnpatients
nwithnCHF.nSixtynpatientsnwithnCHFnarenrecruited.nEachnassignednbyncoinntossntononenofntwongroups.
nDesign?n-nnCORRECTnANSWERSrandomizednclinicalntrial
12yonboynimmersednupntonhisnneckninn60Fnwaternforn20nminutes.nPhysiologicalnchanges?n-
nnCORRECTnANSWERSCentralnbloodnvolumenINCREASED,nADHn(vasopressin)nDECREASED,nAtrialnNa
triureticnPeptidenINCREASED?nCn(block3,nq23)
Randomizedncontrollednstudynofn2000npatientsnwithninsomnianisnconductedntonevaluatentheneffica
cynofnannewnmedicationntontreatnthisncondition.nTennsubjectsnfromnbothnthencontrolnandntreatment
ngroupsndonnotncompletenthenstudynarennotnincludedninnthenanalysis.nTreatmentngroupnablentonfalln
asleepn5nminutesnfasternthanncontroln(p=0.001).nNeitherngroupnreportnannimprovementninnqualityn
ofnlife.nConcludenthatnnewnmednisnefficaciousninntreatingninsomnia.nTypenofnerror?n-
