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Medicine 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.

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  1. A 58-year-old man presents with 30 minutes of crushing substernal chest pain radiating to his left arm. ECG shows ST elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?

    Answer: Right coronary artery

    ST elevation in II, III, and aVF indicates an inferior STEMI, which is most commonly caused by right coronary artery occlusion.

  2. A 65-year-old woman with a recent 6-hour flight presents with sudden onset dyspnea and pleuritic chest pain. Her D-dimer is elevated and HR is 112 bpm. Which finding on CT pulmonary angiography would confirm the diagnosis?

    Answer: Intraluminal filling defect in the pulmonary vasculature

    CT pulmonary angiography confirms pulmonary embolism by demonstrating an intraluminal filling defect within pulmonary vessels.

  3. A 22-year-old type 1 diabetic presents with vomiting, abdominal pain, and fruity breath. ABG shows pH 7.22, HCO3 10 mEq/L, glucose 480 mg/dL. What is the priority initial treatment?

    Answer: IV isotonic saline fluid resuscitation

    Fluid resuscitation with IV isotonic saline is the first priority in DKA to correct volume depletion before initiating insulin.

  4. A 70-year-old man with systolic heart failure (EF 30%) presents with worsening dyspnea and bilateral leg edema. His current medications include lisinopril and carvedilol. Which additional drug has been shown to reduce mortality in this patient?

    Answer: Spironolactone

    Spironolactone (an aldosterone antagonist) reduces mortality in patients with reduced EF heart failure when added to ACE inhibitor and beta-blocker therapy.

  5. A 67-year-old smoker with known COPD presents with worsened dyspnea and increased yellow sputum production. ABG shows pH 7.32, PaCO2 58, PaO2 54. What is the most appropriate initial oxygen target?

    Answer: SpO2 88–92% via controlled low-flow oxygen

    COPD patients with hypercapnia should receive controlled low-flow oxygen targeting SpO2 88–92% to avoid suppressing the hypoxic respiratory drive.

  6. A 45-year-old woman reports fatigue, cold intolerance, constipation, and weight gain over 6 months. TSH is 18 mIU/L and free T4 is low. Which finding would most specifically indicate an autoimmune cause?

    Answer: Positive anti-TPO antibodies

    Positive anti-thyroid peroxidase (anti-TPO) antibodies are the hallmark of Hashimoto thyroiditis, the most common autoimmune cause of hypothyroidism.

  7. A 72-year-old man with hypertension presents with palpitations. ECG shows irregularly irregular rhythm with absent P waves. He has no prior anticoagulation history. CHA2DS2-VASc score is 3. What is the most appropriate management for stroke prevention?

    Answer: Direct oral anticoagulant (e.g., apixaban)

    A CHA2DS2-VASc score ≥2 in men with atrial fibrillation warrants anticoagulation; DOACs are preferred over warfarin for non-valvular AF due to better efficacy and safety profile.