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

ST elevation in II, III, and aVF indicates an inferior STEMI, which is most commonly caused by right coronary artery occlusion.

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

CT pulmonary angiography confirms pulmonary embolism by demonstrating an intraluminal filling defect within pulmonary vessels.

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

Fluid resuscitation with IV isotonic saline is the first priority in DKA to correct volume depletion before initiating insulin.

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

Spironolactone (an aldosterone antagonist) reduces mortality in patients with reduced EF heart failure when added to ACE inhibitor and beta-blocker therapy.

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

COPD patients with hypercapnia should receive controlled low-flow oxygen targeting SpO2 88–92% to avoid suppressing the hypoxic respiratory drive.

NBME Practice Test

NBME Practice Test

NBME Medicine 2