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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.

Read the first 7 Medicine flashcards as text

  1. A 68-year-old man with hypertension suddenly develops left-sided weakness and facial droop. Symptoms began 2 hours ago. CT head shows no hemorrhage. NIHSS is 8. What is the most appropriate next step?

    Answer: IV tPA (alteplase) administration

    IV tPA is indicated for ischemic stroke within 4.5 hours of symptom onset in eligible patients with no contraindications, and is the most appropriate acute treatment here.

  2. A 55-year-old woman presents with symmetric small joint swelling and morning stiffness lasting >1 hour. RF is positive, anti-CCP antibodies are elevated, and X-rays show marginal erosions. Which medication is considered disease-modifying first-line therapy?

    Answer: Methotrexate

    Methotrexate is the anchor DMARD for rheumatoid arthritis, slowing joint destruction and reducing systemic inflammation.

  3. A 72-year-old nursing home resident presents with fever, productive cough, and right lower lobe consolidation on CXR. He has dysphagia. Which organism is most likely responsible?

    Answer: Aspiration of oral flora (polymicrobial)

    Aspiration pneumonia in a dysphagic nursing home patient is typically polymicrobial, involving oral anaerobes and gram-negative organisms.

  4. A 19-year-old college student presents with new-onset generalized tonic-clonic seizures. MRI brain is normal, and EEG shows generalized spike-and-wave discharges at 3 Hz. She also reports myoclonic jerks in the morning. What is the most likely diagnosis?

    Answer: Juvenile myoclonic epilepsy

    Juvenile myoclonic epilepsy classically presents in adolescents with morning myoclonic jerks, generalized tonic-clonic seizures, and 3 Hz spike-and-wave pattern on EEG.

  5. A 52-year-old obese man presents with severe pain and swelling of the right first MTP joint that started overnight. Joint aspiration reveals negatively birefringent needle-shaped crystals. Serum uric acid is 9.8 mg/dL. What is the most appropriate acute treatment?

    Answer: Colchicine or NSAIDs

    Acute gout is treated with colchicine, NSAIDs, or systemic corticosteroids; urate-lowering therapy like allopurinol is not initiated during acute attacks.

  6. A 28-year-old sexually active woman presents with dysuria and urinary frequency for 2 days. Urinalysis shows positive leukocyte esterase, nitrites, and 30 WBC/hpf. No fever or CVA tenderness. What is the most appropriate treatment?

    Answer: Nitrofurantoin for 3 days or TMP-SMX for 3 days

    Uncomplicated cystitis in a young woman is treated with a short course of nitrofurantoin or TMP-SMX; longer courses are reserved for complicated infections.

  7. A 20-year-old college student presents with severe headache, photophobia, neck stiffness, and fever. LP shows turbid CSF, WBC 1,800 with 90% neutrophils, glucose 32, protein 180. What is the most likely organism?

    Answer: Neisseria meningitidis

    Bacterial meningitis in young adults with neutrophilic pleocytosis and low CSF glucose is most commonly caused by Neisseria meningitidis.