NBME Comprehensive Clinical Science 2

Question 1

A 65-year-old man with crushing chest pain and ST elevation in leads II, III, and aVF arrives at a PCI-capable hospital. BP 110/70, HR 95. What is the most appropriate next step?

Accepted Answer

Perform emergency primary PCI

Answer

Primary PCI is the preferred reperfusion strategy for inferior STEMI when available within 90 minutes of first medical contact.

Question 2

A 50-year-old woman 3 days post-total hip replacement develops acute dyspnea, pleuritic chest pain, and tachycardia (HR 118). SpO2 is 90% on room air. BP is 105/70. What is the most likely diagnosis?

Accepted Answer

Pulmonary embolism

Answer

Pulmonary embolism classically presents with acute dyspnea, pleuritic chest pain, and hypoxia following prolonged immobilization or orthopedic surgery.

Question 3

A 72-year-old diabetic man presents with altered mental status and fruity breath. ABG shows pH 7.18, pCO2 22, HCO3 8 mEq/L. Blood glucose is 520 mg/dL with urine ketones. What is the first priority in management?

Accepted Answer

IV normal saline fluid resuscitation

Answer

Aggressive IV fluid resuscitation with normal saline corrects dehydration and must precede insulin administration in DKA.

Question 4

A 55-year-old woman with sepsis develops oozing from IV sites, petechiae, platelets 38,000/μL, prolonged PT and PTT, low fibrinogen, and schistocytes on peripheral smear. What is the most likely diagnosis?

Accepted Answer

Disseminated intravascular coagulation

Answer

DIC in sepsis presents with consumption of clotting factors and platelets causing simultaneous bleeding and thrombosis, with low fibrinogen distinguishing it from TTP.

Question 5

A 60-year-old man develops sudden severe 'thunderclap' headache described as the worst of his life, followed by neck stiffness and photophobia. CT head is normal. What is the most appropriate next step?

Accepted Answer

Lumbar puncture

Answer

A normal CT in a patient with thunderclap headache requires lumbar puncture to detect xanthochromia or RBCs, confirming subarachnoid hemorrhage.

NBME Practice Test

NBME Practice Test

NBME Comprehensive Clinical Science 2