NBME Comprehensive Clinical Science 3

Question 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?

Accepted Answer

Administer IV alteplase (tPA)

Answer

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

Question 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?

Accepted Answer

Non-invasive positive pressure ventilation (BiPAP)

Answer

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

Question 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?

Accepted Answer

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

Answer

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.

Question 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?

Accepted Answer

IV levetiracetam or fosphenytoin

Answer

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

Question 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?

Accepted Answer

IV fluid resuscitation with crystalloid and packed RBC transfusion

Answer

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

NBME Practice Test

NBME Practice Test

NBME Comprehensive Clinical Science 3