A healthy 82-year-old man feels lightheaded for a few seconds when he stands up quickly from a chair. Which normal change of aging helps explain this?MedlinePlus Medical Encyclopedia, "Aging changes in the heart and blood vessels", Summary. Outline: NBME Medicine Subject Exam content outline, General Principles, Including Normal Age-Related Findings and Care of the Well Patient.
Immune system 2
A 38-year-old man with AIDS has had a mild dry cough, a fever and shortness of breath on exertion that built up over 3 weeks. Pneumocystis jirovecii pneumonia is diagnosed and his oxygen level is low. What is often prescribed along with the anti-infection medicine?MedlinePlus Medical Encyclopedia, "Pneumocystis jirovecii pneumonia", Causes; Symptoms; Treatment; Prevention. Outline: NBME Medicine Subject Exam content outline, Immune System.
A 61-year-old man who has taken hydralazine for 2 years has joint pain and a fever. Drug-induced lupus is diagnosed. What usually happens after the medicine is stopped?MedlinePlus Medical Encyclopedia, "Drug-induced lupus erythematosus", Causes; Symptoms; Treatment; Outlook (Prognosis). Outline: NBME Medicine Subject Exam content outline, Immune System.
Show all 48 questions (45 more)
Blood and lymphoreticular system 4
A 52-year-old man has fatigue, joint pain, bronze-colored skin and new diabetes. His ferritin level and transferrin saturation are high. What is the best method of removing the excess iron?MedlinePlus Medical Encyclopedia, "Hemochromatosis", Symptoms; Exams and Tests; Treatment; Possible Complications. Outline: NBME Medicine Subject Exam content outline, Blood & Lymphoreticular System.
A 61-year-old man has headaches, a red face, itching after a warm bath and a full feeling in the left upper abdomen. His red blood cell count is high. A genetic test for which variant supports polycythemia vera?MedlinePlus Medical Encyclopedia, "Polycythemia vera", Causes; Symptoms; Exams and Tests. Outline: NBME Medicine Subject Exam content outline, Blood & Lymphoreticular System.
A 67-year-old woman has fatigue, a swollen red tongue and numbness and tingling in her hands and feet. Her vitamin B12 level is low, and antibodies against intrinsic factor are found. Why must treatment start early?MedlinePlus Medical Encyclopedia, "Pernicious anemia", Symptoms; Exams and Tests; Outlook (Prognosis). Outline: NBME Medicine Subject Exam content outline, Blood & Lymphoreticular System.
A 70-year-old man has back pain, anemia and a high blood calcium level. Serum protein electrophoresis is abnormal, and multiple myeloma is suspected. Which test is performed next?MedlinePlus Medical Encyclopedia, "Multiple myeloma", Symptoms; Exams and Tests; Possible Complications. Outline: NBME Medicine Subject Exam content outline, Blood & Lymphoreticular System.
Behavioral health 2
A 49-year-old man who drinks heavily every day is admitted with pneumonia. His last drink was this morning. When do alcohol withdrawal symptoms tend to peak?MedlinePlus Medical Encyclopedia, "Alcohol withdrawal", Symptoms; Treatment. Outline: NBME Medicine Subject Exam content outline, Behavioral Health.
An 84-year-old woman admitted with a urinary infection becomes suddenly confused on her second night, drifting between lethargy and agitation. A sleeping pill was started in the hospital. Besides treating the infection, what may improve her mental function?MedlinePlus Medical Encyclopedia, "Delirium", Symptoms; Treatment. Outline: NBME Medicine Subject Exam content outline, Behavioral Health.
Nervous system and special senses 2
A 44-year-old man with AIDS has had a headache, fever and confusion that came on over 2 weeks. His spinal fluid is positive for cryptococcal antigen. What is the most common treatment?MedlinePlus Medical Encyclopedia, "Meningitis - cryptococcal", Symptoms; Exams and Tests; Treatment. Outline: NBME Medicine Subject Exam content outline, Nervous System & Special Senses.
A 60-year-old woman has numbness, tingling and burning pain that began in her toes and now affects both feet. What is the most common cause of this type of nerve problem?MedlinePlus Medical Encyclopedia, "Peripheral neuropathy", Causes; Symptoms. Outline: NBME Medicine Subject Exam content outline, Nervous System & Special Senses.
Skin 1
A 29-year-old woman has a fever and tender, hot, red lumps about an inch across on the front of both shins. Which infection is most commonly associated with this disorder?MedlinePlus Medical Encyclopedia, "Erythema nodosum", Causes; Symptoms; Exams and Tests. Outline: NBME Medicine Subject Exam content outline, Skin & Subcutaneous Tissue.
Musculoskeletal system 2
A 26-year-old man has had low back pain and stiffness for a year. It is worse at night and in the morning and gets better with exercise. Which blood test detects the gene linked to this disease?MedlinePlus Medical Encyclopedia, "Ankylosing spondylitis", Causes; Symptoms; Exams and Tests. Outline: NBME Medicine Subject Exam content outline, Musculoskeletal System.
A 76-year-old woman has a suddenly swollen, painful knee. The joint fluid holds crystals that are not uric acid, and an x-ray shows calcium deposits in the joint. What is the likely diagnosis?MedlinePlus Medical Encyclopedia, "Calcium pyrophosphate arthritis", Summary; Causes; Symptoms; Exams and Tests. Outline: NBME Medicine Subject Exam content outline, Musculoskeletal System.
Cardiovascular system 7
A 19-year-old basketball player collapses in practice and is revived. His father died suddenly at 35, and echocardiography shows a very thick heart muscle. Which treatment recognizes a life-threatening heart rhythm and sends an electrical pulse to stop it?MedlinePlus Medical Encyclopedia, "Hypertrophic cardiomyopathy", Causes; Symptoms; Treatment; Outlook (Prognosis). Outline: NBME Medicine Subject Exam content outline, Cardiovascular System.
A 34-year-old man who injects drugs has had fever, chills and night sweats for 2 weeks. He has a new heart murmur and small areas of bleeding under his nails. Blood cultures grow bacteria. How long is antibiotic therapy most often needed?MedlinePlus Medical Encyclopedia, "Endocarditis", Causes; Symptoms; Exams and Tests; Treatment. Outline: NBME Medicine Subject Exam content outline, Cardiovascular System.
A 46-year-old woman has shortness of breath with activity and a first episode of atrial fibrillation. A rumbling murmur is heard during the resting phase of the heartbeat, and mitral stenosis is found. Which earlier illness is the most frequent cause in adults?MedlinePlus Medical Encyclopedia, "Mitral stenosis", Causes; Symptoms; Exams and Tests. Outline: NBME Medicine Subject Exam content outline, Cardiovascular System.
A 68-year-old man with known angina has chest tightness that now comes on at rest and does not go away with his usual medicine. Unstable angina is diagnosed. Which medicines are given as soon as possible to lower the chance of a heart attack?MedlinePlus Medical Encyclopedia, "Unstable angina", Symptoms; Treatment. Outline: NBME Medicine Subject Exam content outline, Cardiovascular System.
A 71-year-old woman with heart failure weighs herself at home each morning. Over a few days she gains weight and her legs swell. What can this be a sign of?MedlinePlus Medical Encyclopedia, "Heart failure", Symptoms; Exams and Tests; Treatment. Outline: NBME Medicine Subject Exam content outline, Cardiovascular System.
A 74-year-old woman has a racing, uneven pulse of 150 beats a minute, and her ECG shows atrial fibrillation. Her blood pressure is falling. Which treatment may be used to return the heart to a normal rhythm right away?MedlinePlus Medical Encyclopedia, "Atrial fibrillation and atrial flutter", Exams and Tests; Treatment. Outline: NBME Medicine Subject Exam content outline, Cardiovascular System.
A 78-year-old man has chest tightness and fainting with activity. An echocardiogram shows that his aortic valve does not open fully. What mainly causes this valve problem in older people?MedlinePlus Medical Encyclopedia, "Aortic stenosis", Causes; Symptoms. Outline: NBME Medicine Subject Exam content outline, Cardiovascular System.
Respiratory system 4
A 34-year-old woman has a dry cough, shortness of breath and fatigue. A chest x-ray shows enlarged lymph nodes, and sarcoidosis is suspected. What is often needed to diagnose it?MedlinePlus Medical Encyclopedia, "Sarcoidosis", Symptoms; Exams and Tests. Outline: NBME Medicine Subject Exam content outline, Respiratory System.
A 66-year-old man with heart failure has a large pleural effusion on the right. It causes chest pressure, shortness of breath and a low oxygen level. Which procedure removes the fluid so the lung can expand?MedlinePlus Medical Encyclopedia, "Pleural effusion", Treatment. Outline: NBME Medicine Subject Exam content outline, Respiratory System.
A 70-year-old man who lives at home has a fever, shaking chills, a cough with green mucus and new confusion. Crackles are heard over the right lung. Which test will his provider likely order to look for pneumonia?MedlinePlus Medical Encyclopedia, "Community-acquired pneumonia in adults", Causes; Symptoms; Exams and Tests. Outline: NBME Medicine Subject Exam content outline, Respiratory System.
Two days after admission for septic shock, a 58-year-old woman has severe shortness of breath and crackles in both lungs, and ARDS is diagnosed. What is used to deliver high doses of oxygen and positive pressure to her damaged lungs?MedlinePlus Medical Encyclopedia, "Acute respiratory distress syndrome", Causes; Exams and Tests; Treatment. Outline: NBME Medicine Subject Exam content outline, Respiratory System.
Gastrointestinal system 4
A 52-year-old woman who does not drink alcohol has severe upper abdominal pain that spreads to her back and is worse when she lies flat. Her serum lipase level is high. What is the most common cause of acute pancreatitis?MedlinePlus Medical Encyclopedia, "Acute pancreatitis", Causes; Symptoms; Exams and Tests. Outline: NBME Medicine Subject Exam content outline, Gastrointestinal System.
A 55-year-old man with cirrhosis vomits blood, and endoscopy shows bleeding esophageal varices. What is the most common endoscopic treatment?MedlinePlus Medical Encyclopedia, "Bleeding esophageal varices", Causes; Treatment. Outline: NBME Medicine Subject Exam content outline, Gastrointestinal System.
A 67-year-old woman with cirrhosis and ascites has a fever, abdominal pain and tenderness. A sample of the peritoneal fluid is tested. Which result is diagnostic for spontaneous bacterial peritonitis?MedlinePlus Medical Encyclopedia, "Peritonitis - spontaneous bacterial", Causes; Symptoms; Exams and Tests; Treatment. Outline: NBME Medicine Subject Exam content outline, Gastrointestinal System.
A 72-year-old woman finishing a course of clindamycin has watery diarrhea 8 times a day, cramps and a fever, and her stool is positive for C difficile toxin. She is treated with vancomycin and asks whether the infection can come back. What is the answer?MedlinePlus Medical Encyclopedia, "Pseudomembranous colitis", Causes; Symptoms; Exams and Tests; Treatment; Outlook (Prognosis). Outline: NBME Medicine Subject Exam content outline, Gastrointestinal System.
Renal and urinary system 4
A 38-year-old man has high blood pressure and enlarged kidneys, and his father had kidney failure. An ultrasound shows many cysts in both kidneys. He now has headaches. For which associated condition should he be tested?MedlinePlus Medical Encyclopedia, "Polycystic kidney disease", Causes; Exams and Tests. Outline: NBME Medicine Subject Exam content outline, Renal & Urinary System.
A 50-year-old man has swollen ankles and foamy urine. Tests show protein in the urine, a low blood albumin level and high cholesterol. What is the most common cause of this syndrome in adults?MedlinePlus Medical Encyclopedia, "Nephrotic syndrome", Causes; Symptoms; Exams and Tests. Outline: NBME Medicine Subject Exam content outline, Renal & Urinary System.
After hours of very low blood pressure from septic shock, a 69-year-old man makes little urine and his creatinine climbs. Acute tubular necrosis is diagnosed. What is true of this condition in most people?MedlinePlus Medical Encyclopedia, "Acute tubular necrosis", Causes; Symptoms; Treatment; Outlook (Prognosis). Outline: NBME Medicine Subject Exam content outline, Renal & Urinary System.
Days after starting a penicillin antibiotic, a 59-year-old woman has a fever, a rash, blood in the urine and a rising creatinine. Acute interstitial nephritis is suspected. What may quickly relieve the condition?MedlinePlus Medical Encyclopedia, "Interstitial nephritis", Causes; Symptoms; Treatment. Outline: NBME Medicine Subject Exam content outline, Renal & Urinary System.
Female reproductive system and breast 1
A 52-year-old woman with diabetes has vaginal itching and a thick, white discharge a week after a course of antibiotics for a sinus infection. How do antibiotics lead to a vaginal yeast infection?MedlinePlus Medical Encyclopedia, "Vaginal yeast infection", Causes; Symptoms; Treatment. Outline: NBME Medicine Subject Exam content outline, Female Reproductive System & Breast.
Male reproductive system 1
A 48-year-old man has a fever, chills, burning with urination and an ache between the genitals and anus. Acute bacterial prostatitis is suspected. Why should the digital rectal exam be done very gently?MedlinePlus Medical Encyclopedia, "Prostatitis - bacterial", Symptoms; Exams and Tests; Treatment. Outline: NBME Medicine Subject Exam content outline, Male Reproductive System.
Endocrine system 4
A 29-year-old woman has weight loss despite a large appetite, heat intolerance, a rapid heartbeat, bulging eyes and a goiter. Graves disease is diagnosed. Which medicine may treat her rapid heart rate, sweating and anxiety until the thyroid is controlled?MedlinePlus Medical Encyclopedia, "Graves disease", Symptoms; Exams and Tests; Treatment. Outline: NBME Medicine Subject Exam content outline, Endocrine System.
A 36-year-old woman has had months of extreme fatigue, darkening of the skin and dizziness when standing up. Her sodium level is low and her potassium level is high. Which test may be ordered to check her adrenal glands?MedlinePlus Medical Encyclopedia, "Addison disease", Symptoms; Exams and Tests. Outline: NBME Medicine Subject Exam content outline, Endocrine System.
A 55-year-old woman has taken prednisone every day for 3 years for arthritis. She has a round, red, full face and weight gain on the trunk with thin arms and legs. If the prednisone can be stopped, how is that done?MedlinePlus Medical Encyclopedia, "Cushing syndrome", Causes; Symptoms; Treatment. Outline: NBME Medicine Subject Exam content outline, Endocrine System.
A 68-year-old man with small cell lung cancer has SIADH, with a low blood sodium level and very concentrated urine. He now has severe symptoms, which is a medical emergency. How is this usually treated in the hospital?MedlinePlus Medical Encyclopedia, "Syndrome of inappropriate antidiuretic hormone secretion", Causes; Symptoms; Treatment. Outline: NBME Medicine Subject Exam content outline, Endocrine System.
Multisystem disorders 7
A 26-year-old woman has pain and swelling in the joints of her fingers and wrists, a butterfly rash on her face and chest pain when she takes a deep breath. Which blood test is positive in nearly all people with this disease?MedlinePlus Medical Encyclopedia, "Systemic lupus erythematosus", Causes; Symptoms; Exams and Tests. Outline: NBME Medicine Subject Exam content outline, Multisystem Processes & Disorders.
A 34-year-old woman has had severe diarrhea for 4 days, and a blood gas shows metabolic acidosis. Which type is caused by the loss of too much sodium bicarbonate from the body?MedlinePlus Medical Encyclopedia, "Metabolic acidosis", Causes. Outline: NBME Medicine Subject Exam content outline, Multisystem Processes & Disorders.
A 44-year-old woman's fingers turn white and blue in the cold. The skin of her fingers and face is tight and thick, and she has heartburn and difficulty swallowing. What is the likely diagnosis?MedlinePlus Medical Encyclopedia, "Scleroderma", Symptoms; Exams and Tests. Outline: NBME Medicine Subject Exam content outline, Multisystem Processes & Disorders.
A 48-year-old man has frequent sinus infections and nosebleeds, a cough with bloody sputum, and blood and protein in his urine. Granulomatosis with polyangiitis is suspected. Which blood test is often positive?MedlinePlus Medical Encyclopedia, "Granulomatosis with polyangiitis", Causes; Symptoms; Exams and Tests. Outline: NBME Medicine Subject Exam content outline, Multisystem Processes & Disorders.
A 66-year-old woman with breast cancer has nausea, constipation and confusion. Her blood calcium level is very high, and she is admitted to the hospital. What is the most important therapy?MedlinePlus Medical Encyclopedia, "Hypercalcemia", Causes; Symptoms; Treatment. Outline: NBME Medicine Subject Exam content outline, Multisystem Processes & Disorders.
A 72-year-old woman who takes a water pill for swollen legs has muscle weakness and palpitations, and her blood potassium level is low. She still needs a diuretic. What may her provider do?MedlinePlus Medical Encyclopedia, "Low blood potassium", Causes; Symptoms; Treatment. Outline: NBME Medicine Subject Exam content outline, Multisystem Processes & Disorders.
Five days after a tick bite on a camping trip, a 30-year-old man has a fever, headache and muscle pain. A rash of small spots began on his wrists and ankles and is spreading. Which antibiotic is used?MedlinePlus Medical Encyclopedia, "Rocky Mountain spotted fever", Symptoms; Treatment. Outline: NBME Medicine Subject Exam content outline, Multisystem Processes & Disorders.
Biostatistics and epidemiology 1
In one year a hospital admits 200 patients with a certain infection, and 30 of them die of it. What is the case-fatality rate?CDC, Principles of Epidemiology in Public Health Practice, 3rd edition (archived), Lesson 3, Section 3: Mortality Frequency Measures. Outline: NBME Medicine Subject Exam content outline, Biostatistics, Epidemiology/Population Health, & Interpretation of the Medical Lit..
Social sciences 1
A 79-year-old man with advanced dementia cannot make decisions about his care, and his daughter is his surrogate. His wishes about a feeding tube were written in an advance directive. By the AMA Code of Medical Ethics, which standard should guide her decision?AMA Code of Medical Ethics, Opinion 2.1.2, Decisions for Adult Patients Who Lack Capacity. Outline: NBME Medicine Subject Exam content outline, Social Sciences, Including Medical Ethics and Jurisprudence.
How this list was compiled: Our own questions, written to the content outline of the Medicine Subject Exam that NBME publishes (https://www.nbme.org/institutions/assess-learn/subject-exams/clinical-science/medicine/, read 2026-10-15). Its seventeen systems and their ranges: General Principles 1-5%, Immune System 1-5%, Blood & Lymphoreticular System 5-10%, Behavioral Health 1-5%, Nervous System & Special Senses 1-5%, Skin & Subcutaneous Tissue 1-5%, Musculoskeletal System 1-5%, Cardiovascular System 10-15%, Respiratory System 5-10%, Gastrointestinal System 5-10%, Renal & Urinary System 5-10%, Female Reproductive System & Breast 1-5%, Male Reproductive System 1-5%, Endocrine System 5-10%, Multisystem Processes & Disorders 10-15%, Biostatistics, Epidemiology/Population Health & Interpretation of the Medical Literature 1-5%, Social Sciences 1-5%. The bank holds 1, 2, 4, 2, 2, 1, 2, 7, 4, 4, 4, 1, 1, 4, 7, 1 and 1 questions in that order, 48 in all. Every clinical fact was read on 2026-10-15 in the MedlinePlus Medical Encyclopedia (National Library of Medicine) article the question names; the statistics question rests on the CDC course Principles of Epidemiology in Public Health Practice and the ethics question on the AMA Code of Medical Ethics. Licence: Questions, choices and explanations are original work of this site.
How it works
This free NBME internal medicine practice test has 48 short cases of our own for the Medicine Subject Exam, the shelf that ends the medicine clerkship. It is unofficial: the National Board of Medical Examiners (NBME) is not affiliated with this site.
Read the full guide
What the internal medicine shelf covers
NBME's Medicine Subject Exam content outline, read October 15, 2026, lists 17 systems. The 48 cases keep its shares: seven each on the heart and vessels and on multisystem disorders, four each on blood, lungs, digestion, kidneys and hormones, one or two on each of the rest.
How the cases are built
Every patient is an adult, as the outline requires, and each case ends in one question: the diagnosis, the next test, the treatment or the mechanism. Each answer names the article and section it was read in, from MedlinePlus in all but two.
Timed practice
The real exam allows a minute and a half an item. The timed round keeps that pace: 40 cases in 60 minutes.
Numbers that decide answers: over 250 neutrophils per cubic millimeter of ascitic fluid means spontaneous bacterial peritonitis; endocarditis takes 4 to 6 weeks of antibiotics.
Questions and answers
How many questions are on the NBME internal medicine shelf exam?
NBME's Subject Examination Timing Chart (July 2021) gives the Medicine exam 110 items and 2 hours 45 minutes. A tutorial before a web exam adds 15 minutes.
Are these real NBME internal medicine shelf questions?
No. All 48 cases were written for this page from the public content outline and public health pages. NBME's sample items and self-assessments were not opened, and no question bank or review book was used or reworded.
What is high yield for the internal medicine shelf?
By NBME's outline, the cardiovascular system and multisystem disorders carry 10 to 15% of items each. Blood, respiratory, gastrointestinal, renal and endocrine carry 5 to 10% each, and the other ten systems 1 to 5% each.
Is the internal medicine shelf a USMLE exam?
No. It is an NBME Subject Exam, the Medicine exam, which schools often use as the final assessment of a clerkship. NBME's exam named Internal Medicine is a different one: an Advanced Clinical exam of 100 items, typically for fourth-year students.
Does NBME have its own medicine shelf practice exam?
Yes, for a fee. NBME's Clinical Science Mastery Series has Medicine forms at $21 each, with 50 multiple-choice questions a form, by its site on October 15, 2026. This page is free and is not one of them.