NBME Comprehensive Clinical Science 3

Question 1

A 70-year-old woman with atrial fibrillation develops sudden right-sided weakness and slurred speech with symptom onset 2 hours ago.
CT head excludes hemorrhage.
What is the most appropriate next step?

Accepted Answer

Administer IV alteplase (tPA)

Answer

Start aspirin 325 mg immediately

Answer

Emergent mechanical thrombectomy

Answer

Anticoagulate with IV unfractionated heparin

Question 2

A 68-year-old man with COPD presents with worsening dyspnea and increased sputum. He uses accessory muscles. ABG shows pH 7.32, pCO2 58, pO2 55 on room air. What is the most appropriate respiratory intervention?

Accepted Answer

Non-invasive positive pressure ventilation (BiPAP)

Answer

High-flow oxygen via non-rebreather mask

Answer

Immediate intubation and mechanical ventilation

Answer

Inhaled bronchodilators alone without ventilatory support

Question 3

A 52-year-old woman presents with BP 222/134 mmHg, headache, and blurred vision. Fundoscopy shows papilledema. Creatinine rose from 0.9 to 2.3 mg/dL acutely. What is the most appropriate management?

Accepted Answer

IV labetalol targeting a 25% MAP reduction in the first hour

Answer

Oral amlodipine and discharge with urgent follow-up

Answer

IV nitroprusside to normalize BP within 1 hour

Answer

Oral hydralazine and recheck BP in 4 hours

Question 4

A 30-year-old woman with epilepsy has been seizing continuously for 35 minutes despite lorazepam 4 mg IV given twice. What is the most appropriate next intervention?

Accepted Answer

IV levetiracetam or fosphenytoin

Answer

Repeat lorazepam 4 mg IV for a third dose

Answer

Emergent EEG before further medication

Answer

Propofol infusion for refractory status epilepticus

Question 5

A 58-year-old man with chronic alcohol use vomits bright red blood. BP is 88/60 and HR is 122. Two large-bore IVs are in place. What is the single most appropriate immediate next step?

Accepted Answer

IV fluid resuscitation with crystalloid and packed RBC transfusion

Answer

Emergent upper endoscopy for diagnosis and hemostasis

Answer

Vasopressin infusion to reduce portal pressure

Answer

Emergent Sengstaken-Blakemore tube placement

Question 6

A 40-year-old woman with lupus has been on hydroxychloroquine for 5 years. Which monitoring study is most important to perform annually?

Accepted Answer

Ophthalmologic examination with visual field testing

Answer

Liver function tests

Answer

CBC to monitor for agranulocytosis

Answer

Pulmonary function tests

Question 7

A 4-year-old girl presents with dysuria, frequency, and fever of 38.8°C. Urine culture grows >100,000 CFU/mL E. coli sensitive to trimethoprim-sulfamethoxazole. Renal ultrasound is normal. What is the appropriate treatment?

Accepted Answer

Oral trimethoprim-sulfamethoxazole for 7–14 days

Answer

IV ceftriaxone and hospital admission

Answer

Nitrofurantoin for 3 days

Answer

Amoxicillin-clavulanate for 3 days