New York Medical Licensing Exam
With Actual Questions & Verified
Answers,Plus Rationales/Expert
Verified For Guaranteed Pass Graded
A+/2026 /Latest Update/Instant
Download Pdf
1. A 65-year-old man with long-standing hypertension presents with
sudden right-sided weakness and slurred speech. CT head shows no
hemorrhage. The most appropriate next step within the first 4.5 hours (if
no contraindications) is:
A. Start aspirin and observe
B. Immediate intravenous alteplase (tPA) administration
C. Emergent decompressive craniectomy
D. Begin high-dose IV corticosteroids
B. Immediate intravenous alteplase (tPA) administration
Rationale: IV alteplase is indicated for ischemic stroke within 4.5 hours
in eligible patients to improve outcomes.
2. A patient with atrial fibrillation is placed on warfarin. Which lab should
be used to monitor anticoagulation and guide dosing?
A. aPTT
B. Platelet count
C. Prothrombin time / INR
D. D-dimer
C. Prothrombin time / INR
Rationale: Warfarin is monitored with PT/INR to assess the extrinsic
coagulation pathway and dosing.
,3. A 25-year-old woman presents with fever, a productive cough, and lobar
consolidation on chest x-ray. Gram stain shows gram-positive cocci in
chains. The most likely organism is:
A. Staphylococcus aureus
B. Streptococcus pneumoniae
C. Haemophilus influenzae
D. Mycoplasma pneumoniae
B. Streptococcus pneumoniae
Rationale: S. pneumoniae is the most common cause of lobar
pneumonia and appears as gram-positive diplococci/short chains.
4. A 30-year-old pregnant woman (first trimester) needs antibiotic therapy
for pyelonephritis. Which antibiotic is contraindicated in pregnancy and
should be avoided?
A. Ceftriaxone
B. Nitrofurantoin (first trimester caution)
C. Ciprofloxacin
D. Amoxicillin-clavulanate
C. Ciprofloxacin
Rationale: Fluoroquinolones (e.g., ciprofloxacin) are generally avoided
in pregnancy due to potential fetal cartilage toxicity.
5. A 55-year-old smoker has a 3-cm solitary pulmonary nodule detected on
CT. Which feature most increases the likelihood of malignancy?
A. Smooth, well-defined borders
B. Calcification in a "popcorn" pattern
C. Size >2 cm and spiculated margins
D. Stable size over 2 years
C. Size >2 cm and spiculated margins
Rationale: Larger size and spiculated/irregular margins are suspicious
for malignancy; stability over 2 years suggests benignity.
6. A newborn with suspected pyloric stenosis presents with projectile,
nonbilious vomiting. What metabolic abnormality is most likely?
A. Metabolic acidosis
B. Hypochloremic, hypokalemic metabolic alkalosis
C. Hyperchloremic metabolic acidosis
, D. Respiratory acidosis
B. Hypochloremic, hypokalemic metabolic alkalosis
Rationale: Vomiting leads to loss of gastric H+ and Cl–, causing
metabolic alkalosis with low potassium and chloride.
7. A patient with suspected myocardial infarction has chest pain for 8
hours. Which cardiac marker remains elevated longest and is therefore
useful for late detection?
A. Troponin I
B. CK-MB
C. Myoglobin
D. LDH isoenzymes
A. Troponin I
Rationale: Cardiac troponins remain elevated for up to 7–10 days after
MI and are most sensitive/specific for myocardial injury.
8. A 42-year-old woman has primary hyperaldosteronism (Conn syndrome).
Which electrolyte abnormality is typical?
A. Hyperkalemia and metabolic acidosis
B. Hypokalemia and metabolic alkalosis
C. Hyponatremia and hyperkalemia
D. Hypercalcemia and metabolic acidosis
B. Hypokalemia and metabolic alkalosis
Rationale: Excess aldosterone causes sodium retention, potassium
excretion (hypokalemia), and hydrogen loss resulting in metabolic
alkalosis.
9. A patient presents with acute pulmonary embolism and is
hemodynamically unstable. Which is the preferred immediate therapy?
A. Low-molecular-weight heparin only
B. Systemic thrombolysis (e.g., alteplase)
C. Aspirin and observation
D. Lifelong warfarin without acute therapy
B. Systemic thrombolysis (e.g., alteplase)
Rationale: Massive PE with hemodynamic instability is an indication for
systemic thrombolysis to rapidly lyse clot and restore perfusion.
, 10.Which microorganism lacks a cell wall and is not visible on Gram stain,
often causing atypical ("walking") pneumonia?
A. Chlamydia pneumoniae
B. Mycoplasma pneumoniae
C. Legionella pneumophila
D. Klebsiella pneumoniae
B. Mycoplasma pneumoniae
Rationale: Mycoplasma lacks a peptidoglycan cell wall and does not
Gram stain; it causes atypical pneumonia.
11.A 70-year-old man with benign prostatic hyperplasia complains of
urinary retention while on a new medication for hypertension. Which
class is most likely responsible (exacerbates urinary retention)?
A. ACE inhibitors
B. Beta-blockers
C. Alpha-1 blockers
D. Anticholinergic agents
D. Anticholinergic agents
Rationale: Anticholinergics reduce bladder detrusor contractility and
can precipitate urinary retention in BPH.
12.A patient with type 1 diabetes presents with confusion, Kussmaul
respirations, and fruity breath. Labs show hyperglycemia and low
bicarbonate. The immediate treatment is:
A. IV insulin and fluid resuscitation
B. Oral hypoglycemic agent
C. IV dextrose only
D. Immediate potassium supplementation without insulin
A. IV insulin and fluid resuscitation
Rationale: DKA requires IV fluids, insulin to stop ketogenesis, and
careful electrolyte management (especially potassium).
13.A 28-year-old with Hodgkin lymphoma is treated with combination
chemo including doxorubicin. Which organ toxicity is most associated
with doxorubicin?
A. Nephrotoxicity
B. Cardiotoxicity (dilated cardiomyopathy)
With Actual Questions & Verified
Answers,Plus Rationales/Expert
Verified For Guaranteed Pass Graded
A+/2026 /Latest Update/Instant
Download Pdf
1. A 65-year-old man with long-standing hypertension presents with
sudden right-sided weakness and slurred speech. CT head shows no
hemorrhage. The most appropriate next step within the first 4.5 hours (if
no contraindications) is:
A. Start aspirin and observe
B. Immediate intravenous alteplase (tPA) administration
C. Emergent decompressive craniectomy
D. Begin high-dose IV corticosteroids
B. Immediate intravenous alteplase (tPA) administration
Rationale: IV alteplase is indicated for ischemic stroke within 4.5 hours
in eligible patients to improve outcomes.
2. A patient with atrial fibrillation is placed on warfarin. Which lab should
be used to monitor anticoagulation and guide dosing?
A. aPTT
B. Platelet count
C. Prothrombin time / INR
D. D-dimer
C. Prothrombin time / INR
Rationale: Warfarin is monitored with PT/INR to assess the extrinsic
coagulation pathway and dosing.
,3. A 25-year-old woman presents with fever, a productive cough, and lobar
consolidation on chest x-ray. Gram stain shows gram-positive cocci in
chains. The most likely organism is:
A. Staphylococcus aureus
B. Streptococcus pneumoniae
C. Haemophilus influenzae
D. Mycoplasma pneumoniae
B. Streptococcus pneumoniae
Rationale: S. pneumoniae is the most common cause of lobar
pneumonia and appears as gram-positive diplococci/short chains.
4. A 30-year-old pregnant woman (first trimester) needs antibiotic therapy
for pyelonephritis. Which antibiotic is contraindicated in pregnancy and
should be avoided?
A. Ceftriaxone
B. Nitrofurantoin (first trimester caution)
C. Ciprofloxacin
D. Amoxicillin-clavulanate
C. Ciprofloxacin
Rationale: Fluoroquinolones (e.g., ciprofloxacin) are generally avoided
in pregnancy due to potential fetal cartilage toxicity.
5. A 55-year-old smoker has a 3-cm solitary pulmonary nodule detected on
CT. Which feature most increases the likelihood of malignancy?
A. Smooth, well-defined borders
B. Calcification in a "popcorn" pattern
C. Size >2 cm and spiculated margins
D. Stable size over 2 years
C. Size >2 cm and spiculated margins
Rationale: Larger size and spiculated/irregular margins are suspicious
for malignancy; stability over 2 years suggests benignity.
6. A newborn with suspected pyloric stenosis presents with projectile,
nonbilious vomiting. What metabolic abnormality is most likely?
A. Metabolic acidosis
B. Hypochloremic, hypokalemic metabolic alkalosis
C. Hyperchloremic metabolic acidosis
, D. Respiratory acidosis
B. Hypochloremic, hypokalemic metabolic alkalosis
Rationale: Vomiting leads to loss of gastric H+ and Cl–, causing
metabolic alkalosis with low potassium and chloride.
7. A patient with suspected myocardial infarction has chest pain for 8
hours. Which cardiac marker remains elevated longest and is therefore
useful for late detection?
A. Troponin I
B. CK-MB
C. Myoglobin
D. LDH isoenzymes
A. Troponin I
Rationale: Cardiac troponins remain elevated for up to 7–10 days after
MI and are most sensitive/specific for myocardial injury.
8. A 42-year-old woman has primary hyperaldosteronism (Conn syndrome).
Which electrolyte abnormality is typical?
A. Hyperkalemia and metabolic acidosis
B. Hypokalemia and metabolic alkalosis
C. Hyponatremia and hyperkalemia
D. Hypercalcemia and metabolic acidosis
B. Hypokalemia and metabolic alkalosis
Rationale: Excess aldosterone causes sodium retention, potassium
excretion (hypokalemia), and hydrogen loss resulting in metabolic
alkalosis.
9. A patient presents with acute pulmonary embolism and is
hemodynamically unstable. Which is the preferred immediate therapy?
A. Low-molecular-weight heparin only
B. Systemic thrombolysis (e.g., alteplase)
C. Aspirin and observation
D. Lifelong warfarin without acute therapy
B. Systemic thrombolysis (e.g., alteplase)
Rationale: Massive PE with hemodynamic instability is an indication for
systemic thrombolysis to rapidly lyse clot and restore perfusion.
, 10.Which microorganism lacks a cell wall and is not visible on Gram stain,
often causing atypical ("walking") pneumonia?
A. Chlamydia pneumoniae
B. Mycoplasma pneumoniae
C. Legionella pneumophila
D. Klebsiella pneumoniae
B. Mycoplasma pneumoniae
Rationale: Mycoplasma lacks a peptidoglycan cell wall and does not
Gram stain; it causes atypical pneumonia.
11.A 70-year-old man with benign prostatic hyperplasia complains of
urinary retention while on a new medication for hypertension. Which
class is most likely responsible (exacerbates urinary retention)?
A. ACE inhibitors
B. Beta-blockers
C. Alpha-1 blockers
D. Anticholinergic agents
D. Anticholinergic agents
Rationale: Anticholinergics reduce bladder detrusor contractility and
can precipitate urinary retention in BPH.
12.A patient with type 1 diabetes presents with confusion, Kussmaul
respirations, and fruity breath. Labs show hyperglycemia and low
bicarbonate. The immediate treatment is:
A. IV insulin and fluid resuscitation
B. Oral hypoglycemic agent
C. IV dextrose only
D. Immediate potassium supplementation without insulin
A. IV insulin and fluid resuscitation
Rationale: DKA requires IV fluids, insulin to stop ketogenesis, and
careful electrolyte management (especially potassium).
13.A 28-year-old with Hodgkin lymphoma is treated with combination
chemo including doxorubicin. Which organ toxicity is most associated
with doxorubicin?
A. Nephrotoxicity
B. Cardiotoxicity (dilated cardiomyopathy)
