1

HIGH-YIELD NBME
PICTURES
By ROCKS2018

NBME PICTURES ROCKS 1

2

NBME PICTURES ROCKS 2

3

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 3

4

NBME 1

Toxoplasma gondii

ring enhancinglesions

AIDS
TMPSMX

nasal maxillary

Cleft lip and palate

(Multifactorial inheritance)

NBME PICTURES ROCKS 4

5

hyphae
hyphaebuds pseudo

Candida (Vignette mentions

vaginal discharge)

whitethick

Esophageal varices

portal MN

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 5

6

Infantile hemangioma

growsthenregresses

sun
roughskin
Actinic keratosis. Prevent by
sunscreen

progressto SCC

ohr 17
Neurofibromatosis (NF-1)

Cateaulaitspots
fibromas
neuro

NBME PICTURES ROCKS 6

7

Angiofibroma. Case of
Tuberous Sclerosis

TS angiokbromas

ashleafspots

Gap Junction

connectionbetweencells

Aplastic Anemia

fat in BM
pancytopenia

NBME PICTURES ROCKS 7

8

NBME 2

asbestosbodies

Asbestosis

bronchogenic carcinoma
mesothelioma

Pulmonary infarct

hemorrhagicintact

dualbloodsupply

NBME PICTURES ROCKS 8

9

HPV 6 t Il
HPV Wart (Thickened stratum
corneum and epidermis and
vacuolated squamous cells)

koilocytes

CMV

outseye

Renal Infarct

paleinfant

NBME PICTURES ROCKS 9

10

Dementia -> Alzheimer’s dz

ABamyloidplaques
Tautangles

Turner's
Horseshoe kidney. Associated
with NORMAL renal function
(Asymptomatic)

IMA

PSGN

hyperuldar

kid t nephritic
weeks afterstrepinfection

NBME PICTURES ROCKS 10

11

Opening into parotid

duct gland

Pneumocystis Jirovecii

pneumonia

discshaped
silverstain
HIV

NBME PICTURES ROCKS 11

12

NBME 3

Q was testing pernicious

segmented anemia
Hyper
neutrophils autoimmune
attacks parietalcells
needed to
IF ty IF toB12
absorb B12
interminal p.yacrocyticanemia
ileum

Infectious mononucleosis

Tos EBV
Atypical
teenager
withsorethroat
T cells splenomegaly avoid
sports for 3 Y weeks

EBV infects B cells

T cellsreact

NBME PICTURES ROCKS 12

13

Nerve injured in X ->

Dorsiflexion of the foot
impaired

deep peroneal nerve

Girl with chronic renal

insufficiency -> what is
the cause of that
insufficiency from the
picture ->
Vesicoureteral reflux.
(Tbh I hate this pic !!!)

kid t recurrentVMs
or chronic renalissues
4 hydronephrosis
REFLUX

Psoriasis = hyperplasia
of epidermis

silverscaly
plaques on
extensors
psoriasis
NBME PICTURES ROCKS 13
14

Enterobius Vermicularis
pinworm. This is from
cellophane tape test from
perirectal region. You
treat by mebendazole

Enterobius
child y itchybum
tape testto look at
eggs

plugs
mucus
Cystic fibrosis ->> bronchiectasis

diluted
airspaces

Cryptococcus neoformans

AIDS pt meningitis

IndiaInkstain
thickcapsule

NBME PICTURES ROCKS 14

15

infarction
lacunar pm1HINin
Pt
blood
Lenticulostriate artery
basal
hemorrhage ganglia

Medial meniscus

athlete to kneeinjury

NBME PICTURES ROCKS 15

16

Multiple Myeloma

Calcium 9
Renal 9 Bun or
Anemia toHb Hit
B one pain

Neisseria gonorrhoeae

muwpurulent vaginal
discharge

gramstain to

NBME PICTURES ROCKS 16

17

3rd degree AV
Block

equalspacingbetween
ps
equalspacingbetween
QRS's

Intraluminal mass in
transverse colon -> most
likely adenocarcinoma.
Vignette helps, because it
can also look like adenoma

elder t rectalbleeding

NBME PICTURES ROCKS 17

18

NBME 4

dusen dry ARMD

f Macular degeneration

straightlinesappearwavy
centralvision affected

Trichophyton rubrum ->>

tinea pedis ->> treat by
miconazole

itchingbetweentoes

NBME PICTURES ROCKS 18

19

Solid cystic mass in right

kidney ->> RCC

eldermale
smokerwith
bloodinwine
flankpain

owl O
eye
inclusions
CMV
owl'seye

NBME PICTURES ROCKS 19

20

Disease that will

affect the primary
function of this tissue
in the pic ->> lobar
pneumonia

feverinfiltratein lungs

Renal insufficiency
and this structure on
urinalysis ->> PSGN

weeksafter
sorethroat
bloodinwine

NBME PICTURES ROCKS 20

21

of
buildup to
fluiddue
obstitio
Right ureteral obstruction

dilatedcollectingsystem

lesion
multiple
Bloodborne metastasis
to liver

Africanchild yjaw
Burkitt’s Lymphoma
mass

c myo

NBME PICTURES ROCKS 21

22

Subdural Hematoma

elderwithmultiplefalls
or shakenbabysyndrome
crescent moonshape
1
veins
rupture of bridging

Staghorn calculus

proteus
bigstone
recurrentintern
ppH

NBME PICTURES ROCKS 22

23

thymus

Thymus in 3-yr-old. Can

be seen in Wilms tumor

thymoma myasthenia
gravis

NBME PICTURES ROCKS 23

24

NBME 5

t bonepain
fever
Osteomyelitis in right
thumb (arrow) -> Affect
Flexor Pollicis Longus
tendon

healthy staphaureus
sicklecell Salmonella

Axillaryinjury

Axillary nerve injured in this picture

NBME PICTURES ROCKS 24

25

Pinealoma

pinealglandtumor
andsyndrome
pain ward
can'tlookup

Kaposi Sanoma
HIVptwith
HHV-8 in HIV (lesion purpleSki
biopsy from forehead lesions
lesion)

caseating
hike
non
granulomas
W skin
Cutaneous Sarcoidosis changes
manifestation. Vignette
gives you hilar
lymphadenopathy

NBME PICTURES ROCKS 25

26

caseating
TD
sarcoid
non caseating
Granulomatous
inflammation

communication
betweencells
Gap junctions

Lab that will show

earliest response
after treatment
for this ->
reticulocyte count

NBME PICTURES ROCKS 26

27

The legendary photo

of Coxsackie virus
infection (HFMD).

Ihandfootmouth
disease

Pottery Syndrome

Crohn’s dz

cobblestoningcreepingtot

skiplesions
sidepaininabdomen

NBME PICTURES ROCKS 27

28

Atrial flutter

Sawtooth
pattern

that
G 0 rodcauses
Pseudomonas aeruginosa
bronchiatas
(Culture at autopsy of this
bronchiectasis) incr
dilated bronchioles
in CF pt

toblood
Pulmonary infarct

wedgeshape lesion

NBME PICTURES ROCKS 28

29

Emphysema

obstructive
1mgdz
FEU c so1
NC

Monochorionic
monoamniotic

conjoinedtwins

NBME PICTURES ROCKS 29

30

NBME 6

Mass resected from

head of pancreas ->>
the patient has
gastrinoma

multipleulcers

And here is the

legendary NBME
picture, which everyone
loves

Ureteral obstruction
(autopsy of 69-yr-old)

Obstruction dilates

collectingsystem

Nodular glomerulosclerosis
(Diabetic)

Diabetes
O Kimmelskitwilson
nodules
pink circles in
glomeruli

NBME PICTURES ROCKS 30

31

From esophagus ->>

adenocarcinoma

GERD BE can

Crohn’s dz

skiplesions
creeping fat
terminalileum
affected

Caused by
systemic HTN

thickventriclewalls

NBME PICTURES ROCKS 31

32

Coagulative necrosis

deadtissue

ringshapedin
Malaria

RBCs

Problem with collagen

synthesis (man with
bleeding gums, loose
teeth, bruises on legs).
Vit C deficiency

scurvy

NBME PICTURES ROCKS 32

33

Invasion of submucosa
and muscular layer by
malignant neoplasm in
colon

elder rectalbleedin
irondef anemia

interval lens
lucid
shape middle
meningeal
Epidural hematoma.
This pic sucks, but artery
vignette helps rupture

NBME PICTURES ROCKS 33

34

vines skincolor
pox cental
4 umbilication
Molluscum Bodies

p up
Papilledema

g
Radial nerve at greatest risk
of injury here

Median

NBME PICTURES ROCKS 34

35

NBME 7

Primordial germ cell

migration defect. This is the
legendary pic of
sacrococcygeal teratoma

coccygealteratoma
Sacro

nonenvelopedSSDNA
virus
Parvovirus B19. This is from
BM smear.

red cheeks
aplasticcrisis
to RDCprecursors
hydropstotalis

NBME PICTURES ROCKS 35

36

Left Pneumothorax

lungcollapse

Neonatal respiratory
distress syndrome

prematurebaby
hyalinemembranes
forrn

nephrotic T proteinuria
Membranous nephropathy
(Spike and dome)

NBME PICTURES ROCKS 36

37

Ossification of MCL

pox
Molluscum Contagiosum

This mass will be

causing hearing loss.

Schwannoma
vestibular
neuroma

NBME PICTURES ROCKS 37

38

Patient at risk of
P
choriocarcinoma. hCG
Complete Hydatidiform
mole

Snowstormappearance
on 45
no fetalparts seen
TT hCG

Acute Pyelonephritis

fever flankpain
WA tenderness
dysuriafrequency

NBME PICTURES ROCKS 38

39

Strep Pneumonia

Gt dipplococci

Diabetic Glomerulosclerosis

pinknodules

NBME PICTURES ROCKS 39

40

NBME 11

Urothelial cancer

painlessbloodyurine

Oral Thrush -> Candida

whiteplaques
that scrapeoff

T bilirubin inbrain
Kernicterus from
unconjugated
hyperbilirubinemia

NBME PICTURES ROCKS 40

41

painful bloodon
toiletpaper
External
Hemorrhoids.
Vignette tells
patient feels pain

CaliArizona
Coccidioides immitis

Subdural hematoma

crescentshape
veins
bridging

NBME PICTURES ROCKS 41

42

shrunken nodular
liver
Liver cirrhosis
fibrosissders

bulkeye rash
Lyme disease and
leptospirosis
(Spirochete infections)

Spleen is damaged from

gun shot

spleeninjury

NBME PICTURES ROCKS 42

43

Which valve is
replaced here ->
Tricuspid

Chancre -> Syphilis

Defect in fibrillar
collagen synthesis

NBME PICTURES ROCKS 43

44

NBME 12

Neisseria Meningitidis/gonorrhea

Uterine Leiomyoma

NBME PICTURES ROCKS 44

45

Malrotation

Iaddbands

from PCT

RCC hematuria
flankpain
smoker

Cutaneous larva migrans

-> Ancylostoma sp,
Necator americanus
(hookworms)

barefoothookworm
anemia
fatigue

NBME PICTURES ROCKS 45

46

Cryptococcus
AIDS
capsule

SLE
malarfdiscoidrash
joints

NBME PICTURES ROCKS 46

47

Lesion in vocal
cords ->
Squamous cell
carcinoma

keratinpearls

Chronic Graft rejection

fibrosis thickening

Perforated viscus -> causing

pneumoperitoneum

NBME PICTURES ROCKS 47

48

1-week history of fever -

> So you guys already
know -> Kawasaki
disease or
mucocutaneous lymph
node syndrome

Kawasaki
conjunctivitis
strawberry
tongue
fever

Chest tube inserted

through serratus
anterior

C5 Cb A
wingedscapula

NBME PICTURES ROCKS 48

49

NBME 13

Scleroderma/CREST

Calcinosis don'tgive
phenylphreni
Raynaud
Csophdysmolility
Silendactyly
Telangiectasia

pulmHTN
derelops

Vascular malformation
(AVMs)

Tangleof BV

Malformation of
paramesonephric ducts -
> Unicornuate uterus

I side

NBME PICTURES ROCKS 49

50

Listeria
G t rod
pregnancy

Listeria. Vignette about

pregnant woman

Multiple myeloma

plasma cells protein

para

backpain
Pig
hypercalcemia
renal
anemia

NBME PICTURES ROCKS 50

51

Subarachnoid hemorrhage

SAH
berryaneurysm

Paraganglioma -> In
bifurcation of carotid
arteries

sideofneck
bit ofcarotidarteries

DYL200
Pneumocystis Jirovecii

silverstain

NBME PICTURES ROCKS 51

52

Dermatitis Herpetiformis

IgA attipsofpapilla
celiacdisease

Sickle cell dz
0 sicklecells

Vasoocclusive hydroxinea
THbf

NBME PICTURES ROCKS 52

53

NBME 15

Contact Dermatitis

type N
Tolls

Multiple myeloma

Rouleau formation
x

NBME PICTURES ROCKS 53

54

Enzymaticfat necrosis

Action of pancreatic
enzymes on adipose
tissue

Ectopic pregnancy

adnexal mass
embryo
9hCG

NBME PICTURES ROCKS 54

55

The legendary external

hemorrhoid picture (with
thrombosis)

itchy but t blood

external
veins

Same exact picture as in

NBME 3, but different
vignette. Now this is
hydronephrosis. Can’t
they even afford to have
better pictures !!!

Hydronephrosis

NBME PICTURES ROCKS 55

56

NBME 16

portalHTN
liver
Schistosoma mansoni

eosinophils
IgE

haematobium
urinary

Candida (budding)

buds

NBME PICTURES ROCKS 56

57

Peutz-Jeghers Syndrome

polyps t hamarlomas

Kline
letter
XXY
testicularatrophy

Klinefelter’s
syndrome (testicular
atrophy) -> you can’t
visualize any
spermatogonia

Cryptococcus

thickcapsule

NBME PICTURES ROCKS 57

58

NBME 17

Epidural Hematoma

middlemeningealartery
trauma
lensshape

These ferruginous bodies react

with alveolar macrophages

bronchogenic asbestos
mesothelioma

Congenital diaphragmatic
hernia = incomplete formation
of pleuroperitoneal
membrane

diaphragmatic
hernia
plainperitoneal

NBME PICTURES ROCKS 58

59

Actinic Keratosis

A solarelastosis
roughskin

Here comes the legendary

picture again !!! But what
leveler could it be this time
around??
obstruction
Congenital Ureteral
atrophy obstruction. Phew !! Not
that different from the last
one (NBME 4)

HSV-2

recurrent
latent dynein
retrograde
tobrain

NBME PICTURES ROCKS 59

60

Inferior alveolar
nerve. Look at that
fracture !!!

Myxoma in left
atrium, NOT
MITRAL VALVE !!!

LA cardiacmyxoma

Strangulation

twisting
valuedus

NBME PICTURES ROCKS 60

61

NBME 18

neutrophils
gout
shelling red

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

Amyloid pink

NBME PICTURES ROCKS 61

62

Barefoot hookworm
irondefanemia
Ancylostoma/Necator.
Vignette helps by saying
patient is barefoot.
Expect to see microcytic
anemia

Kaposi Sarcoma

HAV 8 t AIDS

Parkinson’s Dz

substantia
nigra
to dopamine
restingtremor cogwheel
rigidity
NBME PICTURES ROCKS 62
63

You get Axillary

nerve damage

humerus neck
axillary
lateralsensation
abduction

Osler-Weber-
Rendu Syndrome

AVmalformation
nosebleeds

NBME PICTURES ROCKS 63

64

NBME 19

Granuloma
multinucleated
epithelioidmy
IFNV
TH l

Legendary H. pylori Peptic

ulcer disease

H pylori
ulcers
peptic
cancer
gastric

NBME PICTURES ROCKS 64

65

Herpes

multinucleated

tophi
Gout

Familial Adenomatous
Polyposis

LOTSof polyps
APE
NBME PICTURES ROCKS 65
66

Cholesterol Emboli

clefts

Osteogenesis Imperfecta

Those eyes sure look blue !!!

Problem with scar formation, NOT

GRANULATION TISSUE
DEPOSITION (REMEMBER IT’S A
COLLAGE 1 PROBLEM)

01 type1collagen
fractures
bluesclera
scarformation

NBME PICTURES ROCKS 66

67

NBME 20

Mass of meningeal
origin

Meningioma

Tumor in Rectus
Femoris muscle

NBME PICTURES ROCKS 67

68

AGAIN ????

Ok what is it now??

Ok I guess now it is
urothelial cancer. Thank
you, biopsy, I love you
so much.

urothelial cancer

Schistosoma mansoni

portalATN

NBME PICTURES ROCKS 68

69

Infantile hemangioma

strawberryhemangioma

thenregress
grow

NBME PICTURES ROCKS 69

70

NBME 21

Chondrosarcoma

chondrocytes

cartilage

Diverticulitis

LLQpain elders
Vasarecta

NBME PICTURES ROCKS 70

71

Centralsmokers
Squamous cell carcinoma of
the lung

4 Lait

Giardia Lamblia

pearshape
stool
fatty
hikers campers

metronidazole

NBME PICTURES ROCKS 71

72

PCOS

hirsutismirregularperiods

Actinic Keratosis

rough
su risk

Trichotillomania

pullinghairout
ditt lengths

NBME PICTURES ROCKS 72

73

NBME 22

Avascular Necrosis

medialcircumflexartery

trisomy
13Patan

Cleft lip/palate -> Failure of fusion

of maxillary and medial nasal
prominences

NBME PICTURES ROCKS 73

74

ADPKD

palpablekidneys
hematuria

SAH

insidetelescoping

f
Jejunal intussusception

NBME PICTURES ROCKS 74

75

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

Tenri
colon
mega
esophagus
mega
Dilated lol

Pott’s fracture, from

forced eversion

NBME PICTURES ROCKS 75

76

Scabies

itchy

NBME PICTURES ROCKS 76

77

NBME 23

Bed bugs serve

as carriers of
MRSA. WOW !!!

Metastasis to the liver

Multiple lesions

NBME PICTURES ROCKS 77

78

Staghorn calculi

Proteus

TpH
uneaseto

Renal angiogram showing

fibromuscular dysplasia

youngfemale

Capillary Hemangioma

dilatedBV

NBME PICTURES ROCKS 78

79

Painless transilluminating
mass -> Ganglion cyst ->
resolves on its own

Entrapment of inferior
rectus muscle

interiororbit
intrectus

rings in RBC
Malaria
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 79

80

Dylan
The cystic structure
is a yolk sac

P1AP
Seminoma is the most
common testicular tumor. It's
a germ cell tumor. Commonly
see "fried egg cells".

NBME PICTURES ROCKS 80

81

NBME 24

Monosodium urate
crystals

MSU
needleshaped
0birefringence

VEGF
Granulation tissue

healing

NBME PICTURES ROCKS 81

82

Niacin deficiency

3D's
dermatitis diarrhea dementia

Aphthous ulcers

stress
IBD

NBME PICTURES ROCKS 82

83

Abdominal Aortic
Aneurysm (Crescent
sign)

AAA smokers male AS

Cryptococcus

thickcapsule
indiaink muciCarmine

NBME PICTURES ROCKS 83

84

tunnel
carpet
Lunate
dislocation

Strongyloides infection

larvae

NBME PICTURES ROCKS 84