NBME Comprehensive Clinical Science 2

Question 1

A 65-year-old man with crushing chest pain and ST elevation in leads II, III, and aVF arrives at a PCI-capable hospital. BP 110/70, HR 95. What is the most appropriate next step?

Accepted Answer

Perform emergency primary PCI

Answer

Administer IV thrombolytics

Answer

Start IV heparin and admit to CCU

Answer

Obtain serial troponins and echocardiogram

Question 2

A 50-year-old woman 3 days post-total hip replacement develops acute dyspnea, pleuritic chest pain, and tachycardia (HR 118). SpO2 is 90% on room air. BP is 105/70. What is the most likely diagnosis?

Accepted Answer

Pulmonary embolism

Answer

Hospital-acquired pneumonia

Answer

Acute NSTEMI

Answer

Spontaneous pneumothorax

Question 3

A 72-year-old diabetic man presents with altered mental status and fruity breath. ABG shows pH 7.18, pCO2 22, HCO3 8 mEq/L. Blood glucose is 520 mg/dL with urine ketones. What is the first priority in management?

Accepted Answer

IV normal saline fluid resuscitation

Answer

IV insulin infusion at 0.1 units/kg/hr

Answer

Sodium bicarbonate infusion

Answer

Potassium supplementation

Question 4

A 55-year-old woman with sepsis develops oozing from IV sites, petechiae, platelets 38,000/μL, prolonged PT and PTT, low fibrinogen, and schistocytes on peripheral smear. What is the most likely diagnosis?

Accepted Answer

Disseminated intravascular coagulation

Answer

Immune thrombocytopenic purpura

Answer

Heparin-induced thrombocytopenia

Answer

Thrombotic thrombocytopenic purpura

Question 5

A 60-year-old man develops sudden severe 'thunderclap' headache described as the worst of his life, followed by neck stiffness and photophobia. CT head is normal. What is the most appropriate next step?

Accepted Answer

Lumbar puncture

Answer

MRI brain with gadolinium

Answer

Empiric antibiotics for bacterial meningitis

Answer

Cerebral angiography

Question 6

A 25-year-old woman with 6 weeks of amenorrhea presents with right lower quadrant pain and a positive urine pregnancy test. Pelvic ultrasound shows no intrauterine pregnancy and a 2.5 cm right adnexal mass. What is the diagnosis?

Accepted Answer

Ectopic pregnancy

Answer

Ruptured ovarian cyst

Answer

Acute appendicitis

Answer

Ovarian torsion

Question 7

A 48-year-old man with alcoholic cirrhosis develops fever, abdominal pain, and worsening encephalopathy. Paracentesis reveals a PMN count of 380 cells/mm³. What is the most appropriate treatment?

Accepted Answer

IV cefotaxime

Answer

Emergent surgical drainage of peritoneal cavity

Answer

IV ampicillin-sulbactam

Answer

Oral ciprofloxacin and outpatient follow-up