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Clinical Medicine Flashcards

6 cards from real USMLE practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

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  1. A 60-year-old man presents with lower back pain, hypercalcemia, anemia, and lytic bone lesions. Serum protein electrophoresis shows an M-spike. What is the diagnosis?

    Answer: Multiple myeloma

    Multiple myeloma presents with CRAB criteria: hyperCalcemia, Renal failure, Anemia, and Bone lytic lesions, with an M-protein spike on SPEP from clonal plasma cell proliferation.

  2. A patient with type 1 diabetes presents with nausea, vomiting, Kussmaul breathing, and fruity breath. ABG shows pH 7.20, glucose 450 mg/dL, and urine ketones positive. What is the treatment priority?

    Answer: IV fluid resuscitation and insulin infusion

    DKA treatment requires IV normal saline for volume resuscitation first, followed by insulin infusion (after K+ is ≥3.5 mEq/L) to suppress ketogenesis; potassium replacement is critical.

  3. A 70-year-old woman with osteoporosis has a compression fracture. DEXA scan shows T-score of -2.8. Which medication reduces fracture risk by inhibiting osteoclast function?

    Answer: Alendronate (bisphosphonate)

    Bisphosphonates like alendronate are first-line therapy for osteoporosis; they bind to hydroxyapatite and inhibit osteoclast-mediated bone resorption, reducing fracture risk by approximately 50%.

  4. A patient presents with fever, right lower quadrant pain, rebound tenderness, and elevated WBC. CT shows fat stranding around a dilated appendix. What is the diagnosis?

    Answer: Acute appendicitis

    Acute appendicitis presents with RLQ pain (McBurney point), fever, leukocytosis, and CT showing periappendiceal fat stranding with appendiceal dilation (>6mm), requiring urgent appendectomy.

  5. A 55-year-old man presents with severe epigastric pain radiating to the back, nausea, and vomiting. Serum lipase is 5x the upper limit of normal. What are the two most common causes?

    Answer: Gallstones and alcohol

    Gallstones (biliary pancreatitis) and alcohol abuse together account for approximately 80% of acute pancreatitis cases in the United States.

  6. A patient with atrial fibrillation is started on warfarin. Target INR range for non-valvular AF is:

    Answer: 2.0-3.0

    For non-valvular atrial fibrillation, the target INR is 2.0-3.0; this range balances stroke prevention with bleeding risk; mechanical heart valves require a higher INR of 2.5-3.5.