NBME FORM 30 EXAM QUESTIONS WITH VERIFIED ANSWERS || A VERIFIED A+ PASS. (2025)

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NBME FORM 30 EXAM
QUESTIONS WITH VERIFIED ANSWERS || A VERIFIED A+ PASS.
Exam Section 1: Item 1 of 50
National Board of Medical Examiners®
Comprehensive Basic Science Self-Assessment

"1
Exam Section 1: Item 1 of 50
National Board of Medical Examiners®
Comprehensive Basic Science Self-Assessment
41. A 14-year-old boy is brought to the physician by his parents because of increasingly
severe left knee pain during the past week. The pain is exacerbated by running or kneeling.
He plays multiple sports and is currently in the middle of soccer season. There
has been no recent trauma to the area or related sports injuries. Physical examination
shows full range of motion of both lower extremities. There is a discrete area of swelling
just below the left patella over the proximal portion of the tibia. Palpation of the
area produces pain. Pain is also reproduced when he does a full squat. Examination of the
right knee shows no abnormalities. Which of the following is the most likely cause of this
patient's condition?
A) Chondromalacia
B) Ligamental tear
C) Osgood-Schlatter disease
D) Osteochondritis
E) St - CORRECT ANSWER C.
Osgood-Schlatter disease refers to osteochondrosis or traction apophysitis of the tibial
tubercle that typically occurs in adolescent, athletic children. Repetitive tension via the
patellar tendon transmits to the tibial tubercle, presenting as pain reported during
activities
that increase the stress on the tubercle, such as kneeling, squatting, kicking, or similar
activities that increase the extensor force transmitted by the quadriceps. Patients localize
pain to the anterior aspect of the proximal tibia and knee. Physical examination typically
discloses tenderness over an enlarged tibial tubercle. The condition is diagnosed clinically;
x-rays, if obtained, may show increased lucency in the area of the tibial tubercle. Treatment
is through rest, cryotherapy, and non-steroidal anti-inflammatory medications, as
the condition resolves with time and unloading.
Incorrect Answers: A, B, D, and E.
Chondromalacia (Choice A) as related to the knee refers to deterioration of cartilage along
the posterior aspect of the patella. It is common in young athletes, especially runners, and
presents with knee pain that is worse with bending. It can be differentiated from

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,Osgood-Schlatter disease by the location of pain, whereas chondromalacia will not present
with pain at the tibial tuberosity.
Ligamental tear (Choice B) is a broad term that in the context of the knee could describe
damage to any of the collateral ligaments, such as the anterior or posterior cruciate or the
medial or lateral collateral ligaments. Tear or rupture of these ligaments presents with
pain which is worse when placing the affected ligament under strain, tenderness in the
area of the injury, and laxity when evoking the motion restricted by the ligament itself.
Osteochondritis (Choice D) describes the inflammation of bone or cartilage within a joint; it
may al"

"2
Exam Section 1: Item 2 of 50
National Board of Medical Examiners®
Comprehensive Basic Science Self-Assessment
42. A 40-year-old man is evaluated because his skin is extremely sensitive to sunlight.
Exposure to the sun causes the formation of vesicles and blisters on the skin, which
frequently take weeks to heal. He is diagnosed with a disorder caused by the increased
synthesis of compounds in the skin that are subject to excitation by visible light. Which of
the following biochemical pathways is most likely defective in this patient?
A) Bile acid synthesis
B) Bilirubin degradation
C) Heme synthesis
D) Melanin synthesis
E) Riboflavin metabolism - CORRECT ANSWER C.
Porphyria cutanea tarda is characterized by severe cutaneous photosensitivity with
blistering and hyperpigmentation after exposure to sunlight and is the most common of the
porphyrias. It is caused by decreased activity of uroporphyrinogen decarboxylase, an
enzyme used to in the production of heme. The initial substrates for heme are glycine and
succinyl-CoA. Their conversion to heme begins in the mitochondria with a rate limiting step
catalyzed by aminolevulinate synthase. A series of additional steps then occurs
which take place in the cellular cytoplasm. In one of these intermediate steps,
uroporphyrinogen decarboxylase catalyzes the conversion of uroporphyrinogen III to
coproporphyrinogen III. Not only will a deficiency in uroporphyrinogen decarboxylase
prevent correct
heme synthesis, it will also cause uroporphyrinogen III to accumulate. Accumulated
uroporphyrinogen IIl is then deposited in the skin. Upon exposure to light of wavelength
400nm, the molecule enters an excited state and releases photons which in turn create
reactive oxygen species within the skin. These reactive oxygen species damage the
basement membrane, lipids, and proteins nearby resulting in dermoepidermal separation
and blister formation.
Incorrect Answers: A, B, D, and E.

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,Bile acid synthesis (Choice A) uses cholesterol as the initial substrate. Cholesterol 7a-
hydroxylase is the rate-limiting step in the creation of bile acids. Porphyrins are not
intermediate byproducts of this pathway. Impaired bile acid production will lead to
decreased
intestinal absorption of lipids and fat-soluble vitamins, but not photosensitivity and blister
formation.
Bilirubin forms as a result of the degradation of heme. Bilirubin degradation (Choice B) is
the process by which bilirubin is first conjugated in the liver to become water soluble and
then excreted into"

"3
Exam Section 1: Item 3 of 50
National Board of Medical Examiners®
Comprehensive Basic Science Self-Assessment
43. A 70-year-old man with metastatic prostate cancer has been taking leuprolide for the
past 3 months. Which of the following best describes this patient's current serum
luteinizing hormone (LH) and testosterone concentrations compared with concentrations
before treatment?
LH
Testosterone
A)
↑
↑
B)
↑
C)
No change
↑
D)
no change
E) - CORRECT ANSWER E.
Leuprolide is a gonadotropin-releasing hormone (GNRH) analog. If given in a pulsatile
fashion, mimicking the physiologic secretion of GNRH, it will act as a GNRH receptor
agonist and increase follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
When leuprolide is initially started in a patient, the hypothalamus reacts as if it were an
agonist and there is a transient rise in LH and FSH for the first week of treatment. However,
with continued use in a non-pulsatile fashion, as in this case, it will act as a GNRH
receptor antagonist and subsequently decrease FSH and LH. By decreasing the production
of LH and the stimulation of Leydig cells, leuprolide indirectly lowers testosterone. Prostate
cancer is a hormonally sensitive cancer; androgens play a critical role in its

Page 3 of 209

, growth. Thus, by inhibiting testosterone production, this driver of cancer growth is
removed, and sensitive tumors begin to shrink. This approach to treating prostate cancer is
termed medical castration. Some tumors may become castration-resistant, in which
mutations develop that allow the cancer to continue growing without hormonal
stimulation.
Incorrect Answers: A, B, C, and D.
While there is a transient increase in LH and testosterone (Choice A) for the first week of
treatment, after three months of treatment leuprolide will be exerting GNRH antagonist
effects. This will lead to decreased LH and testosterone concentrations.
Because LH stimulates the Leydig cells to produce testosterone, when LH concentration is
decreased, testosterone concentrations will also decrease (Choice B). A medication which
continuously increases testosterone would not be appropriate for use in prostate
cancer as it is an androgen-dependent malignancy and would continue to grow under
androgen stimulation.
LH decreases rather than showing no change (Choice C) when"

"4
Exam Section 1: Item 4 of 50
National Board of Medical Examiners®
Comprehensive Basic Science Self-Assessment
44. A 34-year-old woman comes to the physician because of a 10-year history of
constipation. She usually has fewer than three bowel movements weekly. She often has
bloating and cramping, and she has to strain and apply perineal pressure to defecate. She
says that she does not have problems with sleep, appetite, or energy. Palpation of the
abdomen produces diffuse discomfort; bowel sounds are present. Which of the following is
the most likely cause of this patient's gastrointestinal symptoms?
A) Colon polyps
B) Congenital megacolon (Hirschsprung disease)
C) Factitious disorder
D) Gluten enteropathy
E) Irritable bowel syndrome
F) Major depressive disorder - CORRECT ANSWER E.
Irritable bowel syndrome (IBS) is characterized by recurrent, intermittent abdominal pain
and alteration of bowel habits as either a change in stool frequency or consistency. The
abdominal pain may be either exacerbated or relieved by defecation and can vary
widely in location and character. IBS commonly presents with intermittent episodes of
diarrhea and/or constipation, often which alternate. When diarrhea does occur, it usually
does so during waking hours which serves to differentiate it from other causes of
diarrhea. It is most common in middle-aged women and the pathogenesis is unknown. It is
not caused by a structural abnormality, and physical examination will show nonspecific
abdominal discomfort rather than localized pain. Stress management may improve

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