CCSSA NBME -COMPREHENSIVE CLINICAL SCIENCE
SELF-ASSESSMENT | ALL QUESTIONS AND
ANSWERS | A+ GRADED | COMPREHENSIVE EXAM
GUIDE 2026/2027
1. A 24-year-old woman presents with fatigue, weight loss, heat intolerance, and
palpitations. Examination shows a diffusely enlarged thyroid and a fine tremor.
Laboratory studies show a suppressed TSH and elevated free T4. Which of the following is
the most likely diagnosis?
A. Hashimoto thyroiditis
B. Graves disease
C. Subacute thyroiditis
D. Toxic multinodular goiter
Rationale: Graves disease causes diffuse thyroid enlargement and hyperthyroidism due to
thyroid-stimulating immunoglobulins. The combination of suppressed TSH, elevated free T4,
heat intolerance, tremor, and palpitations is characteristic.
2. A 67-year-old man with a history of hypertension develops sudden right-sided weakness
and difficulty speaking. He was last known to be neurologically normal 90 minutes ago. CT
of the head shows no hemorrhage. Which of the following is the most appropriate next
step?
A. Administer intravenous alteplase if no contraindications are present
B. Begin aspirin and defer reperfusion therapy for 24 hours
C. Perform lumbar puncture
D. Administer intravenous heparin
Rationale: This patient has an acute ischemic stroke within the therapeutic window for
intravenous thrombolysis. After exclusion of intracranial hemorrhage and contraindications,
IV thrombolytic therapy should be considered promptly.
3. A 58-year-old man presents with crushing substernal chest pain radiating to his left arm.
ECG demonstrates ST-segment elevations in leads II, III, and aVF. Which coronary artery
is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
,Rationale: ST-segment elevation in leads II, III, and aVF indicates an inferior myocardial
infarction, which most commonly results from right coronary artery occlusion.
4. A 32-year-old woman develops fever, hypotension, diffuse abdominal pain, and altered
mental status 2 days after undergoing an abortion procedure. Blood cultures are pending.
Which initial management is most appropriate?
A. Oral doxycycline alone
B. Immediate broad-spectrum intravenous antibiotics and source control
C. Observation until cultures identify the organism
D. Corticosteroid monotherapy
Rationale: The presentation is concerning for septic shock. Treatment requires immediate
broad-spectrum IV antibiotics, aggressive hemodynamic support, and urgent identification
and control of the infectious source.
5. A 9-year-old boy presents with periorbital edema and dark urine 2 weeks after
recovering from impetigo. Urinalysis demonstrates hematuria and red blood cell casts.
Which laboratory abnormality is most likely?
A. Increased serum C3
B. Decreased serum C3
C. Increased serum calcium
D. Decreased serum sodium
Rationale: Poststreptococcal glomerulonephritis commonly causes hematuria, edema,
hypertension, and red blood cell casts with transiently decreased complement C3 levels.
6. A 45-year-old woman has recurrent episodes of severe unilateral headache associated
with nausea, photophobia, and visual aura. Which medication is most appropriate for
aborting an acute attack?
A. Sumatriptan
B. Propranolol
C. Topiramate
D. Amitriptyline
Rationale: Triptans such as sumatriptan are effective abortive therapy for moderate-to-severe
acute migraine attacks. The other agents are primarily used for migraine prevention.
,7. A 70-year-old man with chronic obstructive pulmonary disease presents with worsening
dyspnea and increased sputum purulence. Which treatment combination is most
appropriate for a moderate acute exacerbation?
A. Long-term oxygen alone
B. Inhaled bronchodilator therapy and systemic corticosteroids, with antibiotics when
indicated
C. Immediate lung transplantation
D. Anticoagulation alone
Rationale: Acute COPD exacerbations are treated with short-acting bronchodilators and
systemic corticosteroids. Antibiotics are indicated when bacterial infection is suspected,
particularly with increased sputum purulence.
8. A 21-year-old college student presents with fever, severe headache, photophobia, and
neck stiffness. Lumbar puncture shows elevated opening pressure, neutrophilic pleocytosis,
low glucose, and high protein. Which organism is most likely in an otherwise healthy
adult?
A. Cryptococcus neoformans
B. Listeria monocytogenes
C. Neisseria meningitidis
D. Cryptosporidium species
Rationale: Neisseria meningitidis is a major cause of acute bacterial meningitis in adolescents
and young adults. Typical CSF findings include neutrophils, elevated protein, decreased
glucose, and increased opening pressure.
9. A 63-year-old woman with atrial fibrillation suddenly develops abdominal pain that
appears disproportionate to physical examination findings. Serum lactate is elevated.
Which diagnosis should be suspected?
A. Acute mesenteric ischemia
B. Acute pancreatitis
C. Diverticulitis
D. Peptic ulcer disease
Rationale: Atrial fibrillation predisposes to embolic occlusion of the mesenteric arteries.
Severe abdominal pain out of proportion to examination findings is a classic warning sign of
acute mesenteric ischemia.
10. A 35-year-old man presents with polyuria, polydipsia, and weight loss. His fasting
glucose is 285 mg/dL and HbA1c is 10.2%. Which finding would most strongly support
, type 1 diabetes mellitus?
A. Central obesity
B. Low C-peptide level
C. Elevated triglycerides
D. Hypertension
Rationale: Type 1 diabetes results from autoimmune destruction of pancreatic beta cells,
causing markedly reduced endogenous insulin production and therefore low C-peptide levels.
11. A 72-year-old woman presents with new-onset headache and jaw pain while chewing.
ESR and CRP are markedly elevated. Which complication is most important to prevent?
A. Renal failure
B. Blindness
C. Pulmonary embolism
D. Peripheral neuropathy
Rationale: Giant cell arteritis can cause ischemic optic neuropathy and permanent blindness.
High-dose glucocorticoid therapy should be initiated promptly when clinical suspicion is high.
12. A 29-year-old woman has episodic wheezing, chest tightness, and cough that worsen at
night and with exercise. Pulmonary function testing demonstrates reversible airflow
obstruction. Which diagnosis is most likely?
A. Asthma
B. Pulmonary fibrosis
C. Bronchiectasis
D. Emphysema
Rationale: Asthma is characterized by variable respiratory symptoms and reversible airflow
obstruction. Symptoms often worsen at night, with exercise, or after exposure to triggers.
13. A 60-year-old man with cirrhosis presents with confusion and asterixis. Which
treatment is most appropriate for his current condition?
A. Lactulose
B. Warfarin
C. Omeprazole
D. Furosemide alone
Rationale: Hepatic encephalopathy is commonly precipitated by accumulation of ammonia
and other neurotoxins. Lactulose decreases intestinal ammonia absorption and is first-line
therapy for an acute episode.
SELF-ASSESSMENT | ALL QUESTIONS AND
ANSWERS | A+ GRADED | COMPREHENSIVE EXAM
GUIDE 2026/2027
1. A 24-year-old woman presents with fatigue, weight loss, heat intolerance, and
palpitations. Examination shows a diffusely enlarged thyroid and a fine tremor.
Laboratory studies show a suppressed TSH and elevated free T4. Which of the following is
the most likely diagnosis?
A. Hashimoto thyroiditis
B. Graves disease
C. Subacute thyroiditis
D. Toxic multinodular goiter
Rationale: Graves disease causes diffuse thyroid enlargement and hyperthyroidism due to
thyroid-stimulating immunoglobulins. The combination of suppressed TSH, elevated free T4,
heat intolerance, tremor, and palpitations is characteristic.
2. A 67-year-old man with a history of hypertension develops sudden right-sided weakness
and difficulty speaking. He was last known to be neurologically normal 90 minutes ago. CT
of the head shows no hemorrhage. Which of the following is the most appropriate next
step?
A. Administer intravenous alteplase if no contraindications are present
B. Begin aspirin and defer reperfusion therapy for 24 hours
C. Perform lumbar puncture
D. Administer intravenous heparin
Rationale: This patient has an acute ischemic stroke within the therapeutic window for
intravenous thrombolysis. After exclusion of intracranial hemorrhage and contraindications,
IV thrombolytic therapy should be considered promptly.
3. A 58-year-old man presents with crushing substernal chest pain radiating to his left arm.
ECG demonstrates ST-segment elevations in leads II, III, and aVF. Which coronary artery
is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
,Rationale: ST-segment elevation in leads II, III, and aVF indicates an inferior myocardial
infarction, which most commonly results from right coronary artery occlusion.
4. A 32-year-old woman develops fever, hypotension, diffuse abdominal pain, and altered
mental status 2 days after undergoing an abortion procedure. Blood cultures are pending.
Which initial management is most appropriate?
A. Oral doxycycline alone
B. Immediate broad-spectrum intravenous antibiotics and source control
C. Observation until cultures identify the organism
D. Corticosteroid monotherapy
Rationale: The presentation is concerning for septic shock. Treatment requires immediate
broad-spectrum IV antibiotics, aggressive hemodynamic support, and urgent identification
and control of the infectious source.
5. A 9-year-old boy presents with periorbital edema and dark urine 2 weeks after
recovering from impetigo. Urinalysis demonstrates hematuria and red blood cell casts.
Which laboratory abnormality is most likely?
A. Increased serum C3
B. Decreased serum C3
C. Increased serum calcium
D. Decreased serum sodium
Rationale: Poststreptococcal glomerulonephritis commonly causes hematuria, edema,
hypertension, and red blood cell casts with transiently decreased complement C3 levels.
6. A 45-year-old woman has recurrent episodes of severe unilateral headache associated
with nausea, photophobia, and visual aura. Which medication is most appropriate for
aborting an acute attack?
A. Sumatriptan
B. Propranolol
C. Topiramate
D. Amitriptyline
Rationale: Triptans such as sumatriptan are effective abortive therapy for moderate-to-severe
acute migraine attacks. The other agents are primarily used for migraine prevention.
,7. A 70-year-old man with chronic obstructive pulmonary disease presents with worsening
dyspnea and increased sputum purulence. Which treatment combination is most
appropriate for a moderate acute exacerbation?
A. Long-term oxygen alone
B. Inhaled bronchodilator therapy and systemic corticosteroids, with antibiotics when
indicated
C. Immediate lung transplantation
D. Anticoagulation alone
Rationale: Acute COPD exacerbations are treated with short-acting bronchodilators and
systemic corticosteroids. Antibiotics are indicated when bacterial infection is suspected,
particularly with increased sputum purulence.
8. A 21-year-old college student presents with fever, severe headache, photophobia, and
neck stiffness. Lumbar puncture shows elevated opening pressure, neutrophilic pleocytosis,
low glucose, and high protein. Which organism is most likely in an otherwise healthy
adult?
A. Cryptococcus neoformans
B. Listeria monocytogenes
C. Neisseria meningitidis
D. Cryptosporidium species
Rationale: Neisseria meningitidis is a major cause of acute bacterial meningitis in adolescents
and young adults. Typical CSF findings include neutrophils, elevated protein, decreased
glucose, and increased opening pressure.
9. A 63-year-old woman with atrial fibrillation suddenly develops abdominal pain that
appears disproportionate to physical examination findings. Serum lactate is elevated.
Which diagnosis should be suspected?
A. Acute mesenteric ischemia
B. Acute pancreatitis
C. Diverticulitis
D. Peptic ulcer disease
Rationale: Atrial fibrillation predisposes to embolic occlusion of the mesenteric arteries.
Severe abdominal pain out of proportion to examination findings is a classic warning sign of
acute mesenteric ischemia.
10. A 35-year-old man presents with polyuria, polydipsia, and weight loss. His fasting
glucose is 285 mg/dL and HbA1c is 10.2%. Which finding would most strongly support
, type 1 diabetes mellitus?
A. Central obesity
B. Low C-peptide level
C. Elevated triglycerides
D. Hypertension
Rationale: Type 1 diabetes results from autoimmune destruction of pancreatic beta cells,
causing markedly reduced endogenous insulin production and therefore low C-peptide levels.
11. A 72-year-old woman presents with new-onset headache and jaw pain while chewing.
ESR and CRP are markedly elevated. Which complication is most important to prevent?
A. Renal failure
B. Blindness
C. Pulmonary embolism
D. Peripheral neuropathy
Rationale: Giant cell arteritis can cause ischemic optic neuropathy and permanent blindness.
High-dose glucocorticoid therapy should be initiated promptly when clinical suspicion is high.
12. A 29-year-old woman has episodic wheezing, chest tightness, and cough that worsen at
night and with exercise. Pulmonary function testing demonstrates reversible airflow
obstruction. Which diagnosis is most likely?
A. Asthma
B. Pulmonary fibrosis
C. Bronchiectasis
D. Emphysema
Rationale: Asthma is characterized by variable respiratory symptoms and reversible airflow
obstruction. Symptoms often worsen at night, with exercise, or after exposure to triggers.
13. A 60-year-old man with cirrhosis presents with confusion and asterixis. Which
treatment is most appropriate for his current condition?
A. Lactulose
B. Warfarin
C. Omeprazole
D. Furosemide alone
Rationale: Hepatic encephalopathy is commonly precipitated by accumulation of ammonia
and other neurotoxins. Lactulose decreases intestinal ammonia absorption and is first-line
therapy for an acute episode.
