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Comprehensive Clinical Science Flashcards

7 cards from real NBME practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

Read the first 7 Comprehensive Clinical Science flashcards as text

  1. A 70-year-old woman with atrial fibrillation develops sudden right-sided weakness and slurred speech with symptom onset 2 hours ago. CT head excludes hemorrhage. What is the most appropriate next step?

    Answer: Administer IV alteplase (tPA)

    IV tPA is indicated for ischemic stroke within 4.5 hours of symptom onset when intracranial hemorrhage has been excluded by CT.

  2. A 68-year-old man with COPD presents with worsening dyspnea and increased sputum. He uses accessory muscles. ABG shows pH 7.32, pCO2 58, pO2 55 on room air. What is the most appropriate respiratory intervention?

    Answer: Non-invasive positive pressure ventilation (BiPAP)

    BiPAP is first-line ventilatory support for acute COPD exacerbation with hypercapnic respiratory failure, reducing intubation rates and mortality.

  3. A 52-year-old woman presents with BP 222/134 mmHg, headache, and blurred vision. Fundoscopy shows papilledema. Creatinine rose from 0.9 to 2.3 mg/dL acutely. What is the most appropriate management?

    Answer: IV labetalol targeting a 25% MAP reduction in the first hour

    Hypertensive emergency with end-organ damage requires IV antihypertensives to reduce MAP by 10–25% in the first hour—not to normotension, to avoid ischemia.

  4. A 30-year-old woman with epilepsy has been seizing continuously for 35 minutes despite lorazepam 4 mg IV given twice. What is the most appropriate next intervention?

    Answer: IV levetiracetam or fosphenytoin

    Benzodiazepine-refractory status epilepticus requires second-line agents such as IV levetiracetam, fosphenytoin, or valproate.

  5. A 58-year-old man with chronic alcohol use vomits bright red blood. BP is 88/60 and HR is 122. Two large-bore IVs are in place. What is the single most appropriate immediate next step?

    Answer: IV fluid resuscitation with crystalloid and packed RBC transfusion

    Hemodynamic resuscitation with IV fluids and blood transfusion must precede endoscopy in a hemodynamically unstable patient with active GI hemorrhage.

  6. A 40-year-old woman with lupus has been on hydroxychloroquine for 5 years. Which monitoring study is most important to perform annually?

    Answer: Ophthalmologic examination with visual field testing

    Hydroxychloroquine can cause irreversible retinal toxicity that is dose- and duration-dependent, requiring annual ophthalmologic screening after 5 years.

  7. A 4-year-old girl presents with dysuria, frequency, and fever of 38.8°C. Urine culture grows >100,000 CFU/mL E. coli sensitive to trimethoprim-sulfamethoxazole. Renal ultrasound is normal. What is the appropriate treatment?

    Answer: Oral trimethoprim-sulfamethoxazole for 7–14 days

    Febrile UTI in a young child suggests upper urinary tract involvement; 7–14 days of oral antibiotics with appropriate sensitivity covers this adequately.