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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 72-year-old man with heart failure on digoxin presents with nausea, yellow-green visual halos, and bradycardia. ECG shows second-degree heart block. Serum digoxin level is 3.4 ng/mL. What is the most appropriate intervention?

    Answer: Digoxin-specific antibody fragments (Digibind)

    Life-threatening digoxin toxicity with dysrhythmia is treated with digoxin-specific Fab fragments (Digibind), which rapidly bind and neutralize the drug.

  2. A 58-year-old woman with type 2 diabetes and CKD stage 4 (eGFR 22 mL/min/1.73m²) has an HbA1c of 8.4%. Which medication is contraindicated?

    Answer: Metformin

    Metformin is contraindicated at eGFR <30 mL/min/1.73m² due to risk of lactic acidosis from impaired renal clearance.

  3. A 65-year-old man with post-MI systolic heart failure (EF 32%) is started on carvedilol. He develops mild peripheral edema managed with increased furosemide. What is the appropriate action regarding carvedilol?

    Answer: Continue carvedilol and optimize diuresis

    Beta-blockers reduce mortality in systolic heart failure; mild fluid retention should be managed with diuretic adjustment rather than beta-blocker discontinuation.

  4. A 48-year-old woman with rheumatoid arthritis on prednisone 10 mg/day for 2 years has a DEXA T-score of −2.7 at the lumbar spine and no prior fractures. What is the most appropriate treatment?

    Answer: Alendronate plus calcium and vitamin D

    Glucocorticoid-induced osteoporosis with T-score below −2.5 warrants bisphosphonate therapy plus calcium and vitamin D.

  5. A 35-year-old man is found unresponsive. RR is 5 breaths/min, pupils are pinpoint bilaterally, and he is cyanotic. Bystanders report he uses opioids. What is the immediate treatment?

    Answer: IV naloxone 0.4–2 mg

    The opioid toxidrome (miosis, respiratory depression, unconsciousness) requires immediate IV naloxone, a competitive opioid receptor antagonist.

  6. A 62-year-old man with CKD (eGFR 35) and HFrEF (EF 28%) on lisinopril develops serum potassium of 5.8 mEq/L after spironolactone is added. What is the most appropriate action?

    Answer: Discontinue spironolactone due to hyperkalemia

    Potassium >5.5 mEq/L in a patient on ACE inhibitor plus aldosterone antagonist requires discontinuation of spironolactone to prevent life-threatening arrhythmias.

  7. A 52-year-old asymptomatic woman has incidental serum calcium of 11.9 mg/dL on routine labs. PTH is 98 pg/mL (elevated). 24-hour urine calcium is elevated. What is the most common underlying cause?

    Answer: Primary hyperparathyroidism

    Primary hyperparathyroidism is the most common cause of hypercalcemia in outpatients, with characteristically elevated PTH and elevated serum calcium.