NBME Practice Test
Updated for November 2026
Prepare for your NBME exam with our comprehensive study materials. Whether you are taking Step 1, Step 2, or a subject shelf exam, practicing with realistic questions is crucial for success. The NBME examination series assesses the knowledge required for safe and effective patient care.
Our NBME test resources include hundreds of practice questions covering pathology, pharmacology, and clinical sciences. Use this guide to understand the exam format, review essential topics, and boost your confidence before test day.
The NBME examination is a critical milestone for medical students worldwide. Success on the NBME exam (Steps 1, 2, and 3) determines residency placement and future career opportunities. Start your preparation early with targeted NBME practice questions. Also explore our nclex practice test. Practice with the free NBME practice test on PracticeTestGeeks (550+ questions with answer explanations).
- Each NBME Clinical Science Mastery Series self-assessment form has 50 multiple-choice questions.[1]
- The NBME Clinical Science Mastery Series self-assessments are available for $21.[1]
- The price of the NBME Comprehensive Basic Science Self-Assessment (CBSSA) starts at $62.[2]
- An NBME Clinical Science Mastery Series self-assessment must be completed within one year, and it can be paused and resumed at any time during that period.[1]
- After completing the NBME CBSSA, the performance profile can be reviewed and printed for 2 years.[2]
- NBME Clinical Science Mastery Series self-assessments are delivered online through the MyNBME Examinee Portal.[1]
- The NBME CBSSA can be taken online from any location with a suitable computer and internet connectivity.[2]
- The NBME Clinical Science Mastery Series is designed for students taking an NBME Clinical Science Subject Exam.[1]
- The NBME CBSSA is available at any time to any person who wishes to purchase one.[2]
Numbers in brackets link to the official sources listed under Sources & last verified. Dates that have passed are removed automatically.
NBME Exam at a Glance
| Item | Detail | Source · Verified |
|---|
| Number of questions (Clinical Science Mastery Series self-assessment) | 50 multiple-choice questions per form[1] | National Board of Medical Examiners · Oct 25, 2026 |
| Exam fee (Clinical Science Mastery Series self-assessment) | $21 per self-assessment[1] | National Board of Medical Examiners · Oct 25, 2026 |
| Exam fee (Comprehensive Basic Science Self-Assessment (CBSSA)) | Starts at $62[2] | National Board of Medical Examiners · Oct 25, 2026 |
| Validity (Clinical Science Mastery Series self-assessment) | Complete within one year of purchase; can pause and resume during that period[1] | National Board of Medical Examiners · Oct 25, 2026 |
| Validity (Comprehensive Basic Science Self-Assessment (CBSSA)) | Performance profile available for 2 years[2] | National Board of Medical Examiners · Oct 25, 2026 |
| Delivery (Clinical Science Mastery Series self-assessment) | Online via the MyNBME Examinee Portal[1] | National Board of Medical Examiners · Oct 25, 2026 |
| Delivery (Comprehensive Basic Science Self-Assessment (CBSSA)) | Online, from any location with a suitable computer and internet[2] | National Board of Medical Examiners · Oct 25, 2026 |
| Eligibility (Clinical Science Mastery Series self-assessment) | Designed for students taking an NBME Clinical Science Subject Exam[1] | National Board of Medical Examiners · Oct 25, 2026 |
| Eligibility (Comprehensive Basic Science Self-Assessment (CBSSA)) | Available to anyone who wishes to purchase one[2] | National Board of Medical Examiners · Oct 25, 2026 |
| Score release (Comprehensive Basic Science Self-Assessment (CBSSA)) | Score report available after completion via MyNBME portal and INSIGHTS[2] | National Board of Medical Examiners · Oct 25, 2026 |
What changed for NBME in 2026
- Oct 25, 2026: Exam fee (Clinical Science Mastery Series self-assessment) changed to $21 per self-assessment (previously $21 per form).[1]
- Oct 25, 2026: Number of questions (Clinical Science Mastery Series self-assessment) changed to 50 multiple-choice questions per form (previously 50 questions per form).[1]
- Oct 25, 2026: Delivery (Clinical Science Mastery Series self-assessment) changed to Online via the MyNBME Examinee Portal (previously Online via MyNBME Examinee Portal).[1]
- Oct 25, 2026: Validity (Clinical Science Mastery Series self-assessment) changed to Complete within one year of purchase; can pause and resume during that period (previously Complete within one year of purchase).[1]
- Oct 25, 2026: Exam fee (Comprehensive Basic Science Self-Assessment (CBSSA)) changed to Starts at $62 (previously From $62 per form).[2]
- Oct 25, 2026: Delivery (Comprehensive Basic Science Self-Assessment (CBSSA)) changed to Online, from any location with a suitable computer and internet (previously Online, any location with a computer and internet).[2]
- Oct 25, 2026: Validity (Comprehensive Basic Science Self-Assessment (CBSSA)) changed to Performance profile available for 2 years (previously Performance profile available 2 years).[2]
Free NBME Study Tools
Interactive NBME resources on PracticeTestGeeks, free to start:
- Pathology Test 1 — 20 questions with instant scoring and answer explanations
- NBME flashcards — review key terms and concepts card by card
- NBME study guide — topic-by-topic overview of what the exam covers
- NBME cheat sheet — one-page printable summary for last-minute review
According to National Board of Medical Examiners, “designed for students taking an NBME Clinical Science Subject Exam”[1]
NBME Practice Test Questions
Prepare for the NBME - National Board of Medical Examiners exam with our free practice test modules. Each quiz covers key topics to help you pass on your first try.
Worked examples: how to reason through NBME questions
These are practice questions written for this site, not questions from the real exam. Each explanation shows why the right answer is right and why the others are wrong.
Example 1
Question: A 32-year-old woman, gravida 2, para 2, develops fever and left lower abdominal pain 3 days after delivery of a full-term male newborn. Abdominal examination shows a tender, palpable mass. Ultrasonography of the mass shows an ovarian vein thrombosis. The thrombus is most likely to extend into which of the following veins?
- Hemiazygos vein
- Inferior vena cava
- Left internal iliac vein
- Left internal pudendal vein
- Left renal vein
Answer: E. Left renal vein
Explanation:
The correct answer is the left renal vein. The left ovarian vein drains into the left renal vein, so a thrombus that grows along the vessel extends in that direction.
The inferior vena cava is where the right ovarian vein drains directly, so it would suit a right-sided thrombus, not this left-sided one. The hemiazygos vein drains the posterior chest wall and has no link to the gonadal veins. The left internal iliac vein carries pelvic drainage, not ovarian drainage. The left internal pudendal vein serves the perineum and is a tributary of the internal iliac system, so it is also the wrong territory.
The rule to remember: gonadal veins do not follow the arteries' pattern on both sides. The right drains into the inferior vena cava and the left drains into the left renal vein. Ask which side the vessel is on before you choose.
Example 2
Question: A 72-year-old patient develops confusion, bradycardia, and yellow-green visual disturbances while on a drug for atrial fibrillation. Toxicity from which drug best explains these findings?
- Amiodarone
- Digoxin
- Metoprolol
- Diltiazem
Answer: B. Digoxin
Explanation:
The correct answer is digoxin. Confusion, a slow heart rate and yellow-green visual disturbance (xanthopsia) in an older patient being treated for atrial fibrillation is the classic digoxin toxicity picture.
Amiodarone can slow the heart rate, but its typical problems involve the thyroid, lungs, liver and corneal deposits, not yellow-green vision. Metoprolol causes bradycardia through beta blockade, but it does not produce visual colour change. Diltiazem can also slow the rate and lower blood pressure, yet it does not cause xanthopsia.
The rule to remember: when a rate-control drug stem includes a colour vision change, think of digoxin first. Then look for supporting clues such as nausea, older age or reduced kidney function, which make toxicity more likely.
Example 3
Question: A 60-year-old man has tenderness in the region distally between the tendons of the extensor pollicis longus and extensor pollicis brevis (anatomical snuffbox) after falling on the palm of his right hand. A fracture of which of the following carpal bones is most likely in this patient?
- Hamate
- Lunate
- Scaphoid
- Trapezium
- Triquetrum
Answer: C. Scaphoid
Explanation:
The correct answer is the scaphoid. A fall onto an outstretched palm with tenderness in the anatomical snuffbox points to a scaphoid fracture. The scaphoid forms part of the floor of the snuffbox, between the extensor pollicis longus and extensor pollicis brevis tendons.
The hamate sits on the ulnar side of the wrist, away from the snuffbox. The lunate lies in the centre of the proximal row and is tender in the middle of the dorsal wrist. The trapezium is at the base of the thumb and is deeper and more distal. The triquetrum is on the ulnar side as well, so tenderness there would not be in the snuffbox.
The rule to remember: snuffbox tenderness after a fall on the hand is a scaphoid fracture until imaging shows otherwise. This bone has a vulnerable blood supply, so it matters clinically.
How to use these practice tests
Start by working out which official product fits you. If you are preparing for a Clinical Science Subject Exam, read the NBME Clinical Science self-assessment page. If you want a broad basic science check, read the CBSSA page. Decide on a date to sit the paid assessment and work backwards from it.
Before you pay for a self-assessment, use the free sets here to find weak subjects. Pick a single subject set, such as Pathology, Pharmacology or Microbiology, and answer every question before you look at any explanation. Then read each explanation, including those for the options you got right, and write down the rule behind each miss.
Once a subject feels steady, move to a mixed set such as the Basic Science test or the Clinical Science test, so you practise switching between topics as the real exam requires. Keep a running list of missed topics and review it before each session.
Take the official self-assessment only when you can sit through it undisturbed. Afterwards, use the score report and performance profile to decide what to review in the time you have left. Because the Clinical Science self-assessments allow one year to finish, you can pause, but a steady pace usually beats a long break.
NBME Exam Study Guide
Use this comprehensive guide to understand the NBME examination structure, registration, and scoring. Whether you are taking Step 1, Step 2, or a shelf exam, preparation is key.
- What is the NBME exam?
- The NBME develops the USMLE Step exams and subject-specific shelf exams to assess medical students' readiness for licensure and clinical practice.
- Who takes the NBME examination?
- Medical students (MD and DO) and graduates take NBME exams, including Step 1, Step 2 CK, and Step 3, as part of their licensure requirements.
- What are NBME shelf exams?
- NBME shelf exams are subject-specific tests taken after clinical rotations (e.g., Surgery, Pediatrics) to evaluate knowledge in that specialty.
- What is the NBME Free 120?
- The NBME Free 120 is a set of free practice questions provided by the NBME to help examinees familiarize themselves with the software and question format.
- How many questions are on the NBME Step 1?
- The USMLE Step 1 exam typically consists of approximately 280 multiple-choice questions divided into seven 60-minute blocks.
- How long is the NBME Step 2 exam?
- The USMLE Step 2 CK exam is a one-day examination that takes approximately 9 hours, including break time.
- What is the format of NBME practice exams?
- NBME practice exams (Self-Assessments) usually contain 200 multiple-choice questions presented in a computer-based format similar to the actual test.
- What topics does the NBME exam cover?
- NBME exams cover basic sciences (Pathology, Pharmacology), clinical knowledge (Medicine, Surgery), and patient safety principles.
- How do I register for an NBME exam?
- You can register for USMLE Step exams through the NBE website or ECFMG (for international students) and schedule via Prometric.
- What is the NBME exam fee?
- Fees vary; Step 1 and Step 2 CK cost over $660 each, while self-assessments typically cost around $60 per exam.
- Where can I take the NBME exam?
- Most NBME exams are administered at Prometric testing centers worldwide, though some shelf exams may be taken at medical schools.
- Can I reschedule my NBME test date?
- Yes, you can reschedule your exam through Prometric, but fees may apply depending on how close to the test date you make the change.
- How is the NBME exam scored?
- Scores are reported on a 3-digit scale (e.g., 1-300). Step 1 is now Pass/Fail, while Step 2 CK and shelf exams receive numeric scores.
- What is a good NBME score?
- For Step 2 CK, a score above 240 is generally considered competitive. For shelf exams, schools often set their own passing percentiles.
- When do NBME exam results come out?
- Scores for USMLE Step exams are typically released 3-4 weeks after the test date, while shelf exam scores may be available sooner.
- What is an NBME self-assessment score?
- Self-assessments provide an estimated 3-digit score or a probability of passing Step 1, helping you gauge your readiness.
- How should I study for the NBME exam?
- Use a combination of question banks (like UWorld), review books (First Aid), and NBME practice tests to assess your progress.
- Are NBME practice exams accurate?
- Yes, NBME practice exams (CBSSA, CCSSA) are highly predictive of actual performance on USMLE Step exams.
- How many NBME practice tests should I take?
- Most students take 3-5 self-assessments leading up to their exam date to track improvement and build endurance.
- What is the best resource for NBME prep?
- Official NBME self-assessments and high-quality question banks are the most effective resources for mastering exam content.
NBME Exam Timeline
The NBME examination series (USMLE) follows the medical education curriculum. Here is the typical timeline for taking these exams. Also explore our socra practice test.
- Complete Basic Sciences - Finish first two years of medical school curriculum covering anatomy, pathology, and pharmacology.
- Pass USMLE Step 1 - Take the NBME Step 1 exam (Pass/Fail) typically after the second year.
- Clinical Rotations - Complete core rotations (Internal Medicine, Surgery, etc.) and pass NBME shelf exams.
- Take USMLE Step 2 CK - Assess clinical knowledge and skills application, usually early in the fourth year.
- Graduate Medical School - Earn your MD or DO degree.
- Begin Residency - Start your residency training program.
- Pass USMLE Step 3 - Complete the final NBME exam for independent medical licensure, usually during intern year.
PLAB and NBME: How These Medical Licensing Exams Compare
The PLAB (Professional and Linguistic Assessments Board) exam is the UK equivalent of the USMLE, and many international medical graduates prepare for both PLAB and NBME-style assessments simultaneously. NBME shelf exams and self-assessments use a similar multiple-choice clinical vignette format that builds the same diagnostic reasoning skills tested on PLAB Part 1. Practicing with NBME question banks strengthens the clinical knowledge base needed for both US and UK licensing pathways.
NBME Subject Exam Score Prediction with SSPO
The SSPO (Subject Score Performance Overview) is a diagnostic tool provided by the NBME that breaks down your shelf exam performance by discipline and content area. Reviewing your SSPO report after each NBME subject exam helps identify specific weak areas in pathophysiology, pharmacology, or clinical management that need targeted review. Students who systematically track their SSPO results across multiple shelf exams can measure improvement over time and adjust their study plans before Step 2 CK.
For a fuller set of questions on this topic, see our nbme practice exams resource.
For a fuller set of questions on this topic, see our free nbme practice exams resource.
For a fuller set of questions on this topic, see our nbme questions and answers pdf resource.
For a fuller set of questions on this topic, see our nbme test resource.
Expect to spend over $2,500 on exam fees alone, not including study resources like UWorld, First Aid, or NBME practice tests.
NBME Test Day Checklist
Valid Photo ID (Passport/License) Scheduling Permit (Printed/Digital) Comfortable Clothing (Layers) Ready to Pass Your NBME Exam?
Start practicing with our free questions today. Get comfortable with the format, identify your weak areas, and boost your score.
NBME: Pros and Cons
Pros
- NBME exam preparation strengthens your knowledge across all domains
- Passing the exam proves competency to employers and clients
- Study materials and practice tests are widely available
- Exam-based credentials are portable across states and employers
- Clear exam objectives help focus your study plan effectively
Cons
- Exam anxiety can affect performance — practice tests help reduce it
- Registration fees are non-refundable if you miss your test date
- Limited retake opportunities may apply with waiting periods
- Exam content updates periodically — use current study materials
- Testing center availability may require advance scheduling
Pros and Cons at a Glance
| Pros | Cons |
|---|
| NBME exam preparation strengthens your knowledge across all domains | Exam anxiety can affect performance — practice tests help reduce it |
| Passing the exam proves competency to employers and clients | Registration fees are non-refundable if you miss your test date |
| Study materials and practice tests are widely available | Limited retake opportunities may apply with waiting periods |
| Exam-based credentials are portable across states and employers | Exam content updates periodically — use current study materials |
| Clear exam objectives help focus your study plan effectively | Testing center availability may require advance scheduling |
Sample NBME Practice Questions
Try these questions from our free NBME practice tests. The correct answer and an explanation follow each question.
A 16-year-old boy is undergoing evaluation for jaundice. Laboratory studies show normal hepatic enzyme activities, a negative direct antiglobulin (Coombs) test, increased mean corpuscular hemoglobin concentration, and increased osmotic fragility of erythrocytes. Which of the following types of erythrocyte is most likely to be seen on a peripheral blood smear?
- A. Ovalocyte
- B. Schistocyte
- C. Spherocyte
- D. Target cell
- E. Teardrop cell
Answer: C. Spherocyte
The combination of jaundice, normal hepatic enzymes, negative Coombs test, increased mean corpuscular hemoglobin concentration (MCHC), and increased osmotic fragility is highly characteristic of hereditary spherocytosis. This genetic disorder causes red blood cells to be spherical, rigid, and more fragile, leading to their premature destruction in the spleen. Spherocytes are the hallmark finding on a peripheral blood smear in this condition.
A laboratory test reveals that an organism's cell wall lacks peptidoglycan and instead contains mycolic acids. This organism would be expected to stain positive with which technique?
- A. Acid-fast stain
- B. Gram stain
- C. India ink
- D. Silver stain
Answer: A. Acid-fast stain
Mycobacteria contain mycolic acids that bind carbol-fuchsin and resist decolorization with acid-alcohol, making them acid-fast positive.
A 22-year-old college student develops fever, pharyngitis, and posterior cervical lymphadenopathy. A peripheral blood smear shows atypical lymphocytes. The heterophile antibody test is positive. Which cell type is the primary reservoir for the causative virus?
- A. B lymphocytes
- B. T lymphocytes
- C. Monocytes
- D. Epithelial cells
Answer: A. B lymphocytes
Epstein-Barr virus (EBV) infects B lymphocytes via CD21 (complement receptor 2); the atypical lymphocytes seen on smear are reactive cytotoxic T cells responding to infected B cells.
A 25-year-old woman presents with fatigue and jaundice. CBC shows Hgb 8.5, reticulocyte count 9%, and spherocytes on peripheral smear. Direct Coombs test is positive. What is the most likely diagnosis?
- A. Hereditary spherocytosis
- B. Autoimmune hemolytic anemia
- C. G6PD deficiency
- D. Microangiopathic hemolytic anemia
Answer: B. Autoimmune hemolytic anemia
A positive direct Coombs test confirms autoantibodies coating the red cells, consistent with autoimmune hemolytic anemia.
Take the full NBME practice test
📋 📋 What is the NBME and what exams does it make?
The NBME (National Board of Medical Examiners) is a nonprofit founded in 1915 that develops standardized medical assessments. It co-sponsors the USMLE Step exams and creates the clinical subject (shelf) exams used at the end of core clerkships in U.S. medical schools.
📝 📝 What is an NBME shelf exam?
An NBME shelf exam is a standardized subject test taken at the end of a core clerkship such as medicine, surgery, pediatrics, or psychiatry. Each is a timed multiple-choice exam of roughly 110 clinical vignette questions, and your score is reported on a scaled percentile basis.
🎯 🎯 How accurate are NBME self-assessments at predicting Step scores?
NBME Self-Assessments are the most reliable predictors of actual USMLE performance. Most students score within 10 to 15 points of their most recent self-assessment on the real exam. Taking several assessments over weeks gives a more accurate prediction than a single practice test.
💰 💰 How much do NBME practice exams cost?
Each official NBME Self-Assessment typically costs about $60 through the NBME website. Students usually take several during a dedicated study block, so total spending often ranges from $120 to $300. Some medical schools provide vouchers or reimburse students for these practice tests.
🧠 🧠 Which subjects do NBME exams cover?
NBME subject exams span the full medical curriculum: anatomy, biochemistry, physiology, pharmacology, microbiology, pathology, behavioral science, and the clinical disciplines of medicine, surgery, pediatrics, psychiatry, and obstetrics and gynecology. Practicing by subject helps you target your weakest areas before test day.
⏱️ ⏱️ How long is an NBME shelf exam?
Most NBME clinical subject exams give you about 2 hours and 45 minutes to answer roughly 110 questions. That works out to under 90 seconds per question, so timed practice is essential for building the reading speed you need to finish every clinical vignette.
📊 📊 How are NBME exam scores reported?
NBME Self-Assessments report a three-digit score similar to the USMLE scale, while shelf exams are reported as a scaled score and a percentile comparing you to a national cohort. Your medical school sets the threshold that counts as honors, high pass, or pass.
📅 📅 When should I take NBME practice exams?
Take your first self-assessment at the start of a dedicated study period to set a baseline, then one every one to two weeks. Schedule your final practice test about a week before the real exam so you have time to fix weak areas without last-minute anxiety.
🩺 🩺 How is the NBME different from the USMLE?
The NBME is the organization that writes the questions, while the USMLE (United States Medical Licensing Examination) is the three-Step licensing exam. The NBME co-sponsors the USMLE with the Federation of State Medical Boards and also produces the separate subject and self-assessment exams.
📈 📈 How can I improve my NBME shelf exam score?
Do large volumes of timed practice questions, review every explanation including the wrong answers, and focus on high-yield clinical reasoning rather than memorizing facts. Repeating NBME-style vignettes builds pattern recognition, and spacing review across weeks improves retention far more than cramming.
NBME Questions and Answers
Which medical schools use NBME exams?
Nearly all allopathic (MD) medical schools in the United States use NBME shelf exams as end-of-clerkship assessments during third and fourth year. Schools accredited by the LCME typically require NBME subject exams in core rotations including internal medicine, surgery, pediatrics, psychiatry, and obstetrics and gynecology. Some osteopathic (DO) programs also incorporate NBME exams into their clinical curriculum.
How accurate are NBME practice exams at predicting Step scores?
NBME practice exams (known as Self-Assessments) are considered the most reliable predictors of actual USMLE Step 1 and Step 2 CK performance. Most students find their real exam score falls within 10-15 points of their most recent NBME practice exam score. Taking multiple self-assessments over several weeks provides a more accurate prediction than relying on a single practice test result.
What does NBME stand for?
NBME stands for the National Board of Medical Examiners, an independent nonprofit organization founded in 1915. The NBME develops and administers standardized assessments for medical students, including USMLE Step exams and clinical subject (shelf) exams. The organization is headquartered in Philadelphia, Pennsylvania, and works alongside the Federation of State Medical Boards to oversee physician licensure testing.
How much do NBME practice exams cost?
NBME Self-Assessments are available for purchase through the NBME website. Each individual self-assessment typically costs around $60. Students often take multiple practice exams during their dedicated study period, so total costs can range from $120 to $300 or more depending on how many assessments they complete. Some medical schools provide vouchers or reimburse students for these practice tests.
When should I take NBME practice exams during my study period?
Most students take their first NBME Self-Assessment at the beginning of their dedicated study period to establish a baseline score. Additional practice exams are typically scheduled every one to two weeks throughout the study block. Taking the final NBME practice test about one week before the actual exam allows time to address weak areas without causing unnecessary anxiety from a last-minute score.
What is the scoring scale for NBME practice exams?
NBME Self-Assessments use a three-digit scoring scale that mirrors the actual USMLE scoring format. Step 1 and Step 2 CK self-assessments report scores that approximate the 1-300 scale used on the real exams. The minimum passing score for Step 1 is 196, and for Step 2 CK it is 214. NBME shelf exams for clinical clerkships use a separate scoring scale with a mean of 70 and standard deviation of 8.
Can you retake NBME practice exams?
Each NBME Self-Assessment can only be taken once per purchase. If you want to retake the same form, you would need to buy it again, though this is generally not recommended since you may remember questions from your first attempt. A better strategy is to purchase a different self-assessment form each time, as the NBME offers multiple unique forms for both Step 1 and Step 2 CK preparation.
What is the difference between NBME exams and UWorld?
NBME Self-Assessments are produced by the same organization that writes the actual USMLE, making them the closest approximation to real exam questions in style and difficulty. UWorld is a third-party question bank offering thousands of practice questions with detailed explanations designed for daily study. Most students use UWorld as their primary study tool throughout their preparation and reserve NBME practice exams as periodic benchmarks to track progress and predict their final score.
How many questions are on the NBME?
Each NBME Clinical Science Mastery Series form has 50 multiple-choice questions. (Verified Oct 19, 2026 against National Board of Medical Examiners.)
Sources & last verified
- National Board of Medical Examiners — number of questions, exam fee, validity, delivery (official source). “with 50 multiple-choice questions per form” Verified Oct 25, 2026 · source checked Oct 19, 2026.
- National Board of Medical Examiners — exam fee, validity, delivery, eligibility (official source). “Price starts at $62” Verified Oct 25, 2026 · source checked Oct 19, 2026.
How we verify: editorial & fact-checking policy. Report an error: contact us.