NBME Medicine 2

Question 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?

Accepted Answer

Right coronary artery

Answer

Left anterior descending

Answer

Left circumflex artery

Answer

Left main coronary artery

Question 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?

Accepted Answer

Intraluminal filling defect in the pulmonary vasculature

Answer

Consolidation in the right lower lobe

Answer

Pleural effusion

Answer

Ground-glass opacities bilaterally

Question 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?

Accepted Answer

IV isotonic saline fluid resuscitation

Answer

Sodium bicarbonate IV

Answer

Insulin bolus IV

Answer

Potassium replacement only

Question 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?

Accepted Answer

Spironolactone

Answer

Digoxin

Answer

Amlodipine

Answer

Hydralazine

Question 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?

Accepted Answer

SpO2 88–92% via controlled low-flow oxygen

Answer

SpO2 >98% via non-rebreather mask

Answer

SpO2 >95% via Venturi mask at 60%

Answer

No supplemental oxygen until intubated

Question 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?

Accepted Answer

Positive anti-TPO antibodies

Answer

Elevated TSH

Answer

Low free T4

Answer

Diffuse goiter on ultrasound

Question 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?

Accepted Answer

Direct oral anticoagulant (e.g., apixaban)

Answer

Aspirin 81 mg daily

Answer

Warfarin with target INR 2–3

Answer

No anticoagulation needed