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NBME PICTURES ROCKS
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HIGH-YIELD NBME
PICTURES By ROCKS2018
NBME PICTURES ROCKS
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NBME PICTURES ROCKS
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TABLE OF CONTENTS
NBME 1 ............................................................................................................................................. 4
NBME 2 ............................................................................................................................................. 8
NBME 3 ........................................................................................................................................... 12
NBME 4 ........................................................................................................................................... 18
NBME 5 ........................................................................................................................................... 24
NBME 6 ........................................................................................................................................... 30
NBME 7 ........................................................................................................................................... 35
NBME 11.......................................................................................................................................... 40
NBME 12.......................................................................................................................................... 44
NBME 13.......................................................................................................................................... 49
NBME 15.......................................................................................................................................... 53
NBME 16.......................................................................................................................................... 56
NBME 17.......................................................................................................................................... 58
NBME 18.......................................................................................................................................... 61
NBME 19.......................................................................................................................................... 64
NBME 20.......................................................................................................................................... 67
NBME 21.......................................................................................................................................... 70
NBME 22.......................................................................................................................................... 73
NBME 23.......................................................................................................................................... 77
NBME 24.......................................................................................................................................... 81
NBME PICTURES ROCKS
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NBME 1
Toxoplasma gondii
Cleft lip and palate
(Multifactorial inheritance)
NBME PICTURES ROCKS
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5
Candida (Vignette mentions
vaginal discharge)
Esophageal varices
Abnormality X will cause ataxic
limb movements. Something to
do with cerebellar vessels,
probably related to
telangiectasias or the Osler-
Weber-Rendu syndrome
NBME PICTURES ROCKS
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Infantile hemangioma
Actinic keratosis. Prevent by
sunscreen
Neurofibromatosis (NF-1)
NBME PICTURES ROCKS
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Angiofibroma. Case of
Tuberous Sclerosis
Gap Junction
Aplastic Anemia
NBME PICTURES ROCKS
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NBME 2
Asbestosis
Pulmonary infarct
NBME PICTURES ROCKS
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HPV Wart (Thickened stratum
corneum and epidermis and
vacuolated squamous cells)
CMV
Renal Infarct
NBME PICTURES ROCKS
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Dementia -> Alzheimer’s dz
Horseshoe kidney. Associated
with NORMAL renal function
(Asymptomatic)
PSGN
NBME PICTURES ROCKS
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Opening into parotid
duct gland
Pneumocystis Jirovecii
NBME PICTURES ROCKS
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NBME 3
Q was testing pernicious
anemia
Infectious mononucleosis
NBME PICTURES ROCKS
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Nerve injured in X ->
Dorsiflexion of the foot
impaired
Girl with chronic renal
insufficiency -> what is
the cause of that
insufficiency from the
picture ->
Vesicoureteral reflux.
(Tbh I hate this pic !!!)
Psoriasis = hyperplasia
of epidermis
NBME PICTURES ROCKS
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Enterobius Vermicularis
pinworm. This is from
cellophane tape test from
perirectal region. You
treat by mebendazole
Cystic fibrosis ->> bronchiectasis
Cryptococcus neoformans
NBME PICTURES ROCKS
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15
Lenticulostriate artery
hemorrhage
Medial meniscus
NBME PICTURES ROCKS
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16
Multiple Myeloma
Neisseria gonorrhoeae
NBME PICTURES ROCKS
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3rd degree AV
Block
Intraluminal mass in
transverse colon -> most
likely adenocarcinoma.
Vignette helps, because it
can also look like adenoma
NBME PICTURES ROCKS
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NBME 4
Macular degeneration
Trichophyton rubrum ->>
tinea pedis ->> treat by
miconazole
NBME PICTURES ROCKS
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Solid cystic mass in right
kidney ->> RCC
CMV
NBME PICTURES ROCKS
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Disease that will
affect the primary
function of this tissue
in the pic ->> lobar
pneumonia
Renal insufficiency
and this structure on
urinalysis ->> PSGN
NBME PICTURES ROCKS
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Right ureteral obstruction
Bloodborne metastasis
to liver
Burkitt’s Lymphoma
NBME PICTURES ROCKS
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Subdural Hematoma
Staghorn calculus
NBME PICTURES ROCKS
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Thymus in 3-yr-old. Can
be seen in Wilms tumor
NBME PICTURES ROCKS
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NBME 5
Osteomyelitis in right
thumb (arrow) -> Affect
Flexor Pollicis Longus
tendon
Axillary nerve injured in this picture
NBME PICTURES ROCKS
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Pinealoma
HHV-8 in HIV (lesion
biopsy from forehead
lesion)
Cutaneous Sarcoidosis
manifestation. Vignette
gives you hilar
lymphadenopathy
NBME PICTURES ROCKS
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Granulomatous
inflammation
Gap junctions
Lab that will show
earliest response
after treatment
for this ->
reticulocyte count
NBME PICTURES ROCKS
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The legendary photo
of Coxsackie virus
infection (HFMD).
Pottery Syndrome
Crohn’s dz
NBME PICTURES ROCKS
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Atrial flutter
Pseudomonas aeruginosa
(Culture at autopsy of this
bronchiectasis)
Pulmonary infarct
NBME PICTURES ROCKS
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Emphysema
Monochorionic
monoamniotic
NBME PICTURES ROCKS
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NBME 6
Mass resected from
head of pancreas ->>
the patient has
gastrinoma
And here is the
legendary NBME
picture, which everyone
loves
Ureteral obstruction
(autopsy of 69-yr-old)
Nodular glomerulosclerosis
(Diabetic)
NBME PICTURES ROCKS
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From esophagus ->>
adenocarcinoma
Crohn’s dz
Caused by
systemic HTN
NBME PICTURES ROCKS
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Coagulative necrosis
Malaria
Problem with collagen
synthesis (man with
bleeding gums, loose
teeth, bruises on legs).
Vit C deficiency
NBME PICTURES ROCKS
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Invasion of submucosa
and muscular layer by
malignant neoplasm in
colon
Epidural hematoma.
This pic sucks, but
vignette helps
NBME PICTURES ROCKS
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Molluscum Bodies
Papilledema
Radial nerve at greatest risk
of injury here
NBME PICTURES ROCKS
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NBME 7
Primordial germ cell
migration defect. This is the
legendary pic of
sacrococcygeal teratoma
Parvovirus B19. This is from
BM smear.
NBME PICTURES ROCKS
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Left Pneumothorax
Neonatal respiratory
distress syndrome
Membranous nephropathy
(Spike and dome)
NBME PICTURES ROCKS
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Ossification of MCL
Molluscum Contagiosum
This mass will be
causing hearing loss.
NBME PICTURES ROCKS
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Patient at risk of
choriocarcinoma.
Complete Hydatidiform
mole
Acute Pyelonephritis
NBME PICTURES ROCKS
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Strep Pneumonia
Diabetic Glomerulosclerosis
NBME PICTURES ROCKS
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NBME 11
Urothelial cancer
Oral Thrush -> Candida
Kernicterus from
unconjugated
hyperbilirubinemia
NBME PICTURES ROCKS
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External
Hemorrhoids.
Vignette tells
patient feels pain
Coccidioides immitis
Subdural hematoma
NBME PICTURES ROCKS
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Liver cirrhosis
Lyme disease and
leptospirosis
(Spirochete infections)
Spleen is damaged from
gun shot
NBME PICTURES ROCKS
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Which valve is
replaced here ->
Tricuspid
Chancre -> Syphilis
Defect in fibrillar
collagen synthesis
NBME PICTURES ROCKS
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NBME 12
Neisseria Meningitidis/gonorrhea
Uterine Leiomyoma
NBME PICTURES ROCKS
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Malrotation
RCC
Cutaneous larva migrans
-> Ancylostoma sp,
Necator americanus
(hookworms)
NBME PICTURES ROCKS
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Cryptococcus
SLE
NBME PICTURES ROCKS
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Lesion in vocal
cords ->
Squamous cell
carcinoma
Chronic Graft rejection
Perforated viscus -> causing
pneumoperitoneum
NBME PICTURES ROCKS
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1-week history of fever -
> So you guys already
know -> Kawasaki
disease or
mucocutaneous lymph
node syndrome
Chest tube inserted
through serratus
anterior
NBME PICTURES ROCKS
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NBME 13
Scleroderma/CREST
Vascular malformation
(AVMs)
Malformation of
paramesonephric ducts -
> Unicornuate uterus
NBME PICTURES ROCKS
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Listeria. Vignette about
pregnant woman
Multiple myeloma
NBME PICTURES ROCKS
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Subarachnoid hemorrhage
Paraganglioma -> In
bifurcation of carotid
arteries
Pneumocystis Jirovecii
NBME PICTURES ROCKS
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Dermatitis Herpetiformis
Sickle cell dz
NBME PICTURES ROCKS
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NBME 15
Contact Dermatitis
Multiple myeloma
NBME PICTURES ROCKS
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Action of pancreatic
enzymes on adipose
tissue
Ectopic pregnancy
NBME PICTURES ROCKS
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The legendary external
hemorrhoid picture (with
thrombosis)
Same exact picture as in
NBME 3, but different
vignette. Now this is
hydronephrosis. Can’t
they even afford to have
better pictures !!!
NBME PICTURES ROCKS
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NBME 16
Candida (budding)
Schistosoma mansoni
NBME PICTURES ROCKS
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Peutz-Jeghers Syndrome
Klinefelter’s
syndrome (testicular
atrophy) -> you can’t
visualize any
spermatogonia
Cryptococcus
NBME PICTURES ROCKS
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NBME 17
Epidural Hematoma
These ferruginous bodies react
with alveolar macrophages
Congenital diaphragmatic
hernia = incomplete formation
of pleuroperitoneal
membrane
NBME PICTURES ROCKS
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Actinic Keratosis
Here comes the legendary
picture again !!! But what
could it be this time
around??
Congenital Ureteral
obstruction. Phew !! Not
that different from the last
one (NBME 4)
HSV-2
NBME PICTURES ROCKS
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Inferior alveolar
nerve. Look at that
fracture !!!
Myxoma in left
atrium, NOT
MITRAL VALVE !!!
Strangulation
NBME PICTURES ROCKS
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NBME 18
This is gout. Believe it or
not !!! Because of that
crystal in the middle there
Oh no !! What now??
Now the answer is diffuse
cortical necrosis lol. Vignette
goes with tubular atrophy
because of posterior urethral
valves
Amyloid infiltration in
heart
NBME PICTURES ROCKS
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Ancylostoma/Necator.
Vignette helps by saying
patient is barefoot.
Expect to see microcytic
anemia
Kaposi Sarcoma
Parkinson’s Dz
NBME PICTURES ROCKS
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You get Axillary
nerve damage
Osler-Weber-
Rendu Syndrome
NBME PICTURES ROCKS
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NBME 19
Granuloma
Legendary H. pylori Peptic
ulcer disease
NBME PICTURES ROCKS
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Herpes
Gout
Familial Adenomatous
Polyposis
NBME PICTURES ROCKS
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Cholesterol Emboli
Osteogenesis Imperfecta
Those eyes sure look blue !!!
Problem with scar formation, NOT
GRANULATION TISSUE
DEPOSITION (REMEMBER IT’S A
COLLAGE 1 PROBLEM)
NBME PICTURES ROCKS
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NBME 20
Mass of meningeal
origin
Tumor in Rectus
Femoris muscle
NBME PICTURES ROCKS
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AGAIN ????
Ok what is it now??
Ok I guess now it is
urothelial cancer. Thank
you, biopsy, I love you
so much.
Schistosoma mansoni
NBME PICTURES ROCKS
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Infantile hemangioma
NBME PICTURES ROCKS
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NBME 21
Chondrosarcoma
Diverticulitis
NBME PICTURES ROCKS
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Squamous cell carcinoma of
the lung
Giardia Lamblia
NBME PICTURES ROCKS
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PCOS
Actinic Keratosis
Trichotillomania
NBME PICTURES ROCKS
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NBME 22
Avascular Necrosis
Cleft lip/palate -> Failure of fusion
of maxillary and medial nasal
prominences
NBME PICTURES ROCKS
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ADPKD
Jejunal intussusception
NBME PICTURES ROCKS
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EXCUSE ME???
CAN YOU STOP??
Anyway, answer this time around is interstitial
inflammation
Vesicouteric Reflux (VR) can lead to Reflux
Nephropathy, which is characterized by chronic
tubulointerstitial inflammation
Transmitted by Reduviid
bug. This is Trypanosoma
cruzi
Pott’s fracture, from
forced eversion
NBME PICTURES ROCKS
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Scabies
NBME PICTURES ROCKS
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NBME 23
Bed bugs serve
as carriers of
MRSA. WOW !!!
Metastasis to the liver
NBME PICTURES ROCKS
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Staghorn calculi
Renal angiogram showing
fibromuscular dysplasia
Capillary Hemangioma
NBME PICTURES ROCKS
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Painless transilluminating
mass -> Ganglion cyst ->
resolves on its own
Entrapment of inferior
rectus muscle
This is Malaria. Believe it or
not, it will put you at greatest
risk of hypoglycemia. Malaria
can impair hepatic
gluconeogenesis and can also
consume glucose for its own
metabolic demands. This is
one of the hardest NBME Qs in
history btw. Truly legendary
don’t you guys think??
NBME PICTURES ROCKS
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The cystic structure
is a yolk sac
Seminoma is the most
common testicular tumor. It's
a germ cell tumor. Commonly
see "fried egg cells".
NBME PICTURES ROCKS
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NBME 24
Monosodium urate
crystals
Granulation tissue
NBME PICTURES ROCKS
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Niacin deficiency
Aphthous ulcers
NBME PICTURES ROCKS
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Abdominal Aortic
Aneurysm (Crescent
sign)
Cryptococcus
NBME PICTURES ROCKS
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Lunate
dislocation
Strongyloides infection
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