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100+ Free NBME CBSSA Practice Questions

Pass your NBME Comprehensive Basic Science Self-Assessment exam on the first try — instant access, no signup required.

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A 10-year-old boy has a family history of early colon cancer. Genetic testing shows a germline mismatch repair mutation. Which molecular finding is expected in his tumors?

A
B
C
D
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2026 Statistics

Key Facts: NBME CBSSA Exam

200

Official Form Questions

NBME CBSSA page

4

Official Sections

NBME CBSSA page

75 min

Standard-Paced Section Time

NBME CBSSA page

5 h

Self-Paced Section Time

NBME CBSSA page

7

Available Forms Listed

NBME CBSSA page

$62

Official Form Price Listed

NBME CBSSA page

100

Free Practice Questions Here

Open Exam Prep

NBME CBSSA is the official Comprehensive Basic Science Self-Assessment for students preparing for USMLE Step 1. NBME lists seven available forms, each with four 50-question sections in standard-paced mode. This free bank provides 100 original CBSSA-style items focused on mechanism-driven basic science reasoning rather than copied or recalled official questions.

Sample NBME CBSSA Practice Questions

Try these sample questions to test your NBME CBSSA exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 23-year-old man develops dark urine and back pain 2 days after taking primaquine for malaria prophylaxis. Peripheral smear shows bite cells and Heinz bodies. Which biochemical abnormality most directly explains this reaction?
A.Impaired generation of NADPH in the pentose phosphate pathway
B.Defective conversion of pyruvate to acetyl-CoA
C.Decreased synthesis of heme from glycine and succinyl-CoA
D.Impaired reduction of methemoglobin by cytochrome b5 reductase
Explanation: Glucose-6-phosphate dehydrogenase deficiency reduces NADPH production, limiting regeneration of reduced glutathione. Oxidant stress from drugs such as primaquine then causes hemoglobin precipitation, Heinz bodies, membrane damage, and hemolysis.
2A newborn has bilious vomiting during the first day of life. Radiography shows air in the stomach and proximal duodenum with no distal bowel gas. Which embryologic process failed?
A.Physiologic herniation of the midgut into the umbilical cord
B.Recanalization of the duodenal lumen
C.Migration of neural crest cells into the distal colon
D.Rotation of the midgut around the superior mesenteric artery
Explanation: Duodenal atresia causes a double-bubble sign and bilious vomiting. It results from failure of the duodenal lumen to recanalize after epithelial proliferation temporarily occludes the gut tube.
3A 55-year-old man with exertional chest pressure has a fixed narrowing of the left anterior descending artery. During exercise, which local metabolic change primarily increases blood flow to the ischemic myocardium distal to the stenosis?
A.Increased adenosine concentration
B.Increased endothelin release
C.Decreased hydrogen ion concentration
D.Decreased extracellular potassium concentration
Explanation: Adenosine accumulates when myocardial oxygen demand exceeds supply. It is a potent local vasodilator that helps match coronary blood flow to myocardial metabolic activity.
4A 7-year-old boy has recurrent skin abscesses and pneumonia caused by Staphylococcus aureus. Neutrophils fail to reduce nitroblue tetrazolium after stimulation. Which organism would create a similar clinical risk because it is catalase positive?
A.Streptococcus pyogenes
B.Enterococcus faecalis
C.Aspergillus fumigatus
D.Clostridium tetani
Explanation: Chronic granulomatous disease causes defective NADPH oxidase and impaired respiratory burst. Catalase-positive organisms such as Aspergillus, Staphylococcus aureus, Serratia, Burkholderia, and Nocardia degrade their own hydrogen peroxide, preventing host myeloperoxidase from using it for killing.
5A 49-year-old woman has episodic burning pain in her hands and feet with redness. Laboratory studies show platelets of 950,000/mm3 and a JAK2 mutation. Which mechanism best explains her painful episodes?
A.Immune complex deposition in small vessels
B.Platelet-mediated microvascular occlusion
C.Defective collagen cross-linking in vessel walls
D.Antibody-mediated destruction of peripheral nerves
Explanation: Essential thrombocythemia can cause erythromelalgia from platelet activation and microvascular thrombi. Low-dose aspirin often relieves symptoms by inhibiting platelet thromboxane A2 production.
6A 64-year-old man with benign prostatic hyperplasia develops dizziness when standing after starting tamsulosin. The drug most directly relaxes smooth muscle by blocking which receptor?
A.Alpha-1 adrenergic receptor
B.Beta-1 adrenergic receptor
C.Muscarinic M3 receptor
D.Dopamine D2 receptor
Explanation: Tamsulosin blocks alpha-1 adrenergic receptors in prostatic and bladder neck smooth muscle. Vascular alpha-1 blockade can also cause orthostatic hypotension, especially when therapy is initiated.
7A screening test for a cancer has 95% sensitivity and 80% specificity. In a population where disease prevalence decreases substantially, which test characteristic will decrease most directly?
A.Sensitivity
B.Specificity
C.Positive predictive value
D.Likelihood ratio positive
Explanation: Positive predictive value depends strongly on disease prevalence. When prevalence decreases, a positive result is more likely to be false positive, so positive predictive value falls even if sensitivity and specificity are unchanged.
8A 4-year-old boy has severe recurrent sinopulmonary infections. Flow cytometry shows absent mature B cells with normal T-cell counts. His maternal uncle had similar infections. Which gene product is most likely defective?
A.Common gamma chain of cytokine receptors
B.Bruton tyrosine kinase
C.CD40 ligand
D.Adenosine deaminase
Explanation: X-linked agammaglobulinemia is caused by Bruton tyrosine kinase mutations, blocking B-cell maturation. Affected boys have absent mature B cells and recurrent infections after maternal IgG wanes.
9A 38-year-old woman with ulcerative colitis has progressive jaundice and pruritus. Cholangiography shows multifocal strictures and dilation of intrahepatic and extrahepatic bile ducts. Which pathologic process is most likely?
A.Granulomatous destruction of small intrahepatic bile ducts
B.Fibro-obliterative inflammation around bile ducts
C.Cholesterol stone obstruction of the cystic duct
D.Copper accumulation from impaired biliary excretion
Explanation: Primary sclerosing cholangitis is associated with ulcerative colitis and causes concentric, fibro-obliterative inflammation of bile ducts, producing beading on cholangiography.
10A 6-month-old infant has recurrent vomiting, seizures, lactic acidosis, and failure to thrive. Serum alanine is elevated. Which enzyme complex is most likely deficient?
A.Pyruvate carboxylase
B.Pyruvate dehydrogenase
C.Phosphofructokinase-1
D.Fructose-1,6-bisphosphatase
Explanation: Pyruvate dehydrogenase deficiency prevents conversion of pyruvate to acetyl-CoA. Pyruvate is shunted to lactate and alanine, causing lactic acidosis and neurologic dysfunction.

About the NBME CBSSA Exam

The NBME Comprehensive Basic Science Self-Assessment is a Step 1 readiness tool that tests integrated basic science content through clinical vignettes. Official CBSSA score reports emphasize equated percent correct performance, content-area feedback, longitudinal performance, answer rationales, and an estimated probability of passing USMLE Step 1.

Assessment

Free 100-question practice bank modeled on Step 1 basic science reasoning; official CBSSA forms use four 50-question sections

Time Limit

Official standard-paced CBSSA: 4 sections x 1 hour 15 minutes; self-paced: 5 hours per section

Passing Score

No CBSSA pass score; reports estimate Step 1 passing probability

Exam Fee

$62 per official form listed by NBME (National Board of Medical Examiners (NBME))

NBME CBSSA Exam Content Outline

44-52%

Pathology

Cell injury, inflammation, hemodynamics, neoplasia, and organ-system disease mechanisms.

25-35%

Physiology

Cardiovascular, renal, respiratory, endocrine, gastrointestinal, and neurophysiology mechanisms.

16-26%

Microbiology and Immunology

Pathogens, vaccines, immune cells, antibodies, complement, hypersensitivity, and immune deficiency.

14-24%

Biochemistry and Nutrition

Enzymes, metabolism, vitamins, molecular biology, nutrition, and inherited metabolic disorders.

15-22%

Pharmacology

Drug mechanisms, toxicities, autonomic effects, chemotherapy, antimicrobials, and pharmacokinetics.

11-15%

Gross Anatomy and Embryology

Anatomic lesions, nerve injury, congenital defects, vascular supply, and embryologic origins.

8-13%

Behavioral Sciences

Ethics, communication, study design, bias, screening tests, and population-health interpretation.

8-13%

Histology and Cell Biology

Cellular organization, organelles, epithelial and connective tissue, signaling, and microscopy.

5-9%

Genetics

Inheritance, imprinting, repeat expansion, population genetics, and mutation mechanisms.

How to Pass the NBME CBSSA Exam

What You Need to Know

  • Passing score: No CBSSA pass score; reports estimate Step 1 passing probability
  • Assessment: Free 100-question practice bank modeled on Step 1 basic science reasoning; official CBSSA forms use four 50-question sections
  • Time limit: Official standard-paced CBSSA: 4 sections x 1 hour 15 minutes; self-paced: 5 hours per section
  • Exam fee: $62 per official form listed by NBME

Keys to Passing

  • Complete 500+ practice questions
  • Score 80%+ consistently before scheduling
  • Focus on highest-weighted sections
  • Use our AI tutor for tough concepts

NBME CBSSA Study Tips from Top Performers

1Use timed mixed blocks because CBSSA rewards flexible switching across disciplines and organ systems.
2For each missed question, write the tested mechanism in one sentence before reviewing facts.
3Treat pathology and physiology as the backbone of review; many pharmacology, microbiology, and biochemistry questions hinge on those mechanisms.
4Review wrong answer choices deliberately. Distractors often represent nearby mechanisms, lesions, or drug classes.
5Use official NBME CBSSA forms near the readiness decision because only official forms provide NBME EPC reporting and Step 1 probability estimates.
6Avoid memorizing recalled questions. Readiness improves more reliably from mechanism-based practice and score-report-driven remediation.

Frequently Asked Questions

What is the NBME CBSSA?

CBSSA stands for Comprehensive Basic Science Self-Assessment. It is NBME's self-assessment for students preparing for USMLE Step 1 and is designed to gauge basic science readiness.

How many questions are on an official CBSSA form?

NBME describes the standard-paced CBSSA as four sections of 50 questions each, for 200 questions per official form.

How is CBSSA timed?

The official standard-paced option allows 1 hour and 15 minutes per 50-question section. NBME also lists a self-paced option with 5 hours per section.

Does CBSSA give a Step 1 passing prediction?

NBME reports an estimated probability of passing USMLE Step 1, along with equated percent correct scores and content-area feedback. The estimate is not a guarantee of future Step 1 performance.

Are these questions copied from NBME forms?

No. This bank contains original educational questions written to practice the same basic science reasoning style without reproducing official, recalled, or copyrighted NBME items.

What should I review after a CBSSA-style block?

Review the mechanism behind each missed item, then group misses by discipline and system. CBSSA readiness depends on integrating pathology, physiology, pharmacology, microbiology, biochemistry, genetics, anatomy, and biostatistics.