NBME Comprehensive Clinical Science 5

Question 1

A 32-year-old woman at 35 weeks gestation presents with BP 160/106 mmHg, severe frontal headache, and 3+ proteinuria. She has no prior history of hypertension. What is the definitive treatment?

Accepted Answer

Magnesium sulfate for seizure prophylaxis and proceed with delivery

Answer

IV labetalol to control BP and continue pregnancy to term

Answer

Bed rest with oral nifedipine and close monitoring

Answer

Low-dose aspirin and outpatient blood pressure monitoring

Question 2

A 3-year-old boy presents with fever (39.1°C), petechiae, neck stiffness, and irritability. He appears toxic. What is the most appropriate immediate action?

Accepted Answer

Administer IV ceftriaxone immediately, then LP when clinically safe

Answer

Lumbar puncture before any antibiotics to confirm diagnosis

Answer

CT head first to exclude increased ICP before LP

Answer

Blood cultures and close observation in the ED

Question 3

A 42-year-old woman reports 6 weeks of persistent low mood, anhedonia, hypersomnia, psychomotor slowing, and passive thoughts of death without active suicidal intent. What is the most appropriate first-line treatment?

Accepted Answer

SSRI therapy (e.g., sertraline or fluoxetine)

Answer

Referral for psychoanalytic psychotherapy only

Answer

Benzodiazepine for anxiety and sleep disturbance

Answer

Tricyclic antidepressant for hypersomnia and anhedonia

Question 4

A 28-year-old woman at 22 weeks gestation presents with right lower quadrant pain, fever, and leukocytosis. Pelvic ultrasound is non-diagnostic. What is the preferred next imaging step?

Accepted Answer

MRI abdomen without contrast

Answer

CT abdomen/pelvis with IV contrast

Answer

Immediate exploratory laparotomy without further imaging

Answer

Repeat ultrasound in 6 hours with graded compression

Question 5

A 3-day-old full-term neonate develops jaundice. Total serum bilirubin is 14.5 mg/dL. The infant is breastfeeding well, the direct Coombs test is negative, and blood type incompatibility is absent. What is the most appropriate next step?

Accepted Answer

Phototherapy

Answer

Emergent exchange transfusion

Answer

Discontinue breastfeeding and substitute formula

Answer

Observe and recheck bilirubin in 24 hours without intervention

Question 6

A 35-year-old man presents with 3 weeks of euphoria, grandiosity, decreased sleep need (2 hours/night), pressured speech, and impulsive overspending. No prior psychiatric history. What is the first-line mood-stabilizing treatment for acute mania?

Accepted Answer

Lithium carbonate

Answer

Fluoxetine to address underlying depression

Answer

Diazepam for behavioral agitation

Answer

Haloperidol monotherapy indefinitely

Question 7

A 65-year-old man on postoperative day 5 after sigmoid colectomy develops fever (38.8°C), erythema, warmth, and purulent discharge at the wound site. Which organism is the most likely causative agent?

Accepted Answer

Staphylococcus aureus

Answer

Clostridium perfringens

Answer

Pseudomonas aeruginosa

Answer

Bacteroides fragilis