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100+ Free Medicine Shelf Practice Questions
NBME Clinical Science Subject Exam: Medicine practice questions are available now; exam metadata is being verified.
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A 63-year-old man with pneumonia has temperature 39.2 C, heart rate 124/min, blood pressure 78/44 mm Hg, lactate 5.1 mmol/L, and altered mental status. What is the best immediate management?
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2026 Statistics
Key Facts: Medicine Shelf Exam
110
Official Items
NBME Subject Examination Timing Chart
2 hr 45 min
Official Exam Time
NBME Subject Examination Timing Chart
45%-50%
Diagnosis Task Weight
NBME Medicine Content Outline
25%-30%
Management Task Weight
NBME Medicine Content Outline
35%-40%
Ambulatory Site of Care
NBME Medicine Content Outline
40%-45%
Inpatient Site of Care
NBME Medicine Content Outline
100
Practice Questions Here
Open Exam Prep
For the Medicine shelf, prioritize common inpatient and ambulatory internal medicine decisions: ACS and heart failure, COPD and pneumonia, GI bleeding and cirrhosis, AKI and electrolytes, diabetes and thyroid emergencies, sepsis and HIV/TB, anemia and thrombosis, rheumatologic emergencies, stroke, cancer screening, and patient safety.
Sample Medicine Shelf Practice Questions
Try these sample questions to test your Medicine Shelf exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.
1A 59-year-old man has 50 minutes of crushing substernal chest pressure, diaphoresis, and nausea. ECG shows 3-mm ST-segment elevation in leads II, III, and aVF. He is at a hospital with an available catheterization laboratory. What is the next best step?
A.Immediate coronary angiography with primary percutaneous coronary intervention
B.Begin an exercise treadmill stress test
C.Administer fibrinolytic therapy and observe for 24 hours
D.Schedule outpatient cardiology follow-up
Explanation: This patient has an acute inferior STEMI. At a PCI-capable hospital, immediate primary PCI is preferred because rapid mechanical reperfusion improves survival and limits infarct size.
2A 67-year-old woman has chest pressure at rest, dynamic ST depressions, and an elevated troponin. Blood pressure is stable. Which medication should be started unless contraindicated while arranging inpatient risk stratification?
A.Aspirin plus anticoagulation with unfractionated heparin or enoxaparin
B.Alteplase infusion
C.High-dose oral prednisone
D.Oral amoxicillin-clavulanate
Explanation: NSTEMI is managed with antiplatelet therapy, anticoagulation, anti-ischemic therapy, statin therapy, and risk-based invasive evaluation. Aspirin and therapeutic anticoagulation reduce thrombus propagation.
3A 61-year-old man has exertional chest pressure that resolves with rest. ECG at rest is normal, and troponin is negative. He can exercise and has an intermediate pretest probability of coronary disease. What is the most appropriate diagnostic test?
A.Exercise ECG stress testing
B.Immediate fibrinolytic therapy
C.Coronary angiography without noninvasive testing
D.D-dimer assay
Explanation: Stable exertional angina in an interpretable ECG patient who can exercise is commonly evaluated first with exercise treadmill testing. It provides diagnostic and prognostic information.
4A 72-year-old man with ischemic cardiomyopathy has orthopnea, crackles, jugular venous distention, and leg edema. Oxygen saturation is 88% on room air. Chest x-ray shows pulmonary edema. What is the best initial treatment?
A.Intravenous furosemide with supplemental oxygen
B.Large-volume normal saline bolus
C.Immediate oral metoprolol uptitration
D.Oral hydrochlorothiazide alone
Explanation: Acute decompensated heart failure with pulmonary edema is treated with oxygen if hypoxemic and IV loop diuretics to reduce congestion. Noninvasive ventilation and vasodilators may be added depending on severity and blood pressure.
5A 58-year-old woman with prior anterior myocardial infarction has an ejection fraction of 30% and mild exertional dyspnea. She is euvolemic and has normal potassium and renal function. Which regimen most directly improves survival?
A.Sacubitril-valsartan, evidence-based beta-blocker, mineralocorticoid receptor antagonist, and SGLT2 inhibitor
B.Digoxin, furosemide, diltiazem, and aspirin
C.Hydrochlorothiazide, verapamil, nitrates, and amiodarone
D.Loop diuretic alone titrated to symptom relief
Explanation: Chronic HFrEF mortality benefit comes from guideline-directed therapy with an ARNI or ACE inhibitor/ARB, evidence-based beta-blocker, mineralocorticoid receptor antagonist, and SGLT2 inhibitor when tolerated.
6A 34-year-old man has sudden palpitations. ECG shows an irregular wide-complex tachycardia with beat-to-beat variation and very rapid ventricular rates. He has a history of Wolff-Parkinson-White pattern. Blood pressure is 118/74 mm Hg. What is the best treatment?
A.Intravenous procainamide
B.Intravenous diltiazem
C.Intravenous adenosine
D.Intravenous digoxin
Explanation: Atrial fibrillation with preexcitation through an accessory pathway can degenerate into ventricular fibrillation. In a stable patient, procainamide is appropriate; unstable patients need synchronized cardioversion.
7A 76-year-old woman with an inferior myocardial infarction becomes lightheaded. Heart rate is 38/min, blood pressure is 82/50 mm Hg, and ECG shows sinus bradycardia. What is the next best step?
A.Intravenous atropine
B.Oral amlodipine
C.Observation only
D.Intravenous esmolol
Explanation: Symptomatic bradycardia with hypotension should be treated immediately with atropine while preparing for transcutaneous pacing if ineffective. Inferior MI can trigger vagally mediated bradycardia.
8A 23-year-old man has sharp pleuritic chest pain that improves when he leans forward. ECG shows diffuse ST-segment elevation and PR-segment depression. Troponin is normal. What is the most appropriate treatment?
A.Ibuprofen plus colchicine
B.Emergent coronary stenting
C.Intravenous heparin infusion
D.High-dose furosemide
Explanation: Acute pericarditis causes pleuritic positional pain with diffuse ST elevation and PR depression. NSAIDs plus colchicine reduce symptoms and recurrence risk when there is no contraindication.
9A 49-year-old woman with metastatic breast cancer has dyspnea, hypotension, jugular venous distention, muffled heart sounds, and pulsus paradoxus. Bedside ultrasound shows a large pericardial effusion with right atrial collapse. What is the next best step?
A.Urgent pericardiocentesis
B.Oral ibuprofen and discharge
C.Intravenous beta-blocker
D.Outpatient echocardiogram in 1 week
Explanation: Cardiac tamponade is obstructive shock from elevated pericardial pressure. Hypotension, JVD, muffled heart sounds, pulsus paradoxus, and chamber collapse require urgent pericardial drainage.
10A 64-year-old man has blood pressure 224/128 mm Hg, confusion, papilledema, and a creatinine of 2.1 mg/dL from a baseline of 0.9 mg/dL. What is the most appropriate initial management?
A.Intravenous nicardipine with controlled blood pressure reduction
B.Immediate sublingual nifedipine to normalize blood pressure
C.Discharge with oral lisinopril
D.No therapy until repeat office readings are obtained
Explanation: Hypertensive emergency is severe hypertension with acute target-organ damage. It requires ICU-level monitoring and IV titratable antihypertensives, lowering mean arterial pressure by about 20%-25% in the first hour.
About the Medicine Shelf Practice Questions
Verified exam format metadata for NBME Clinical Science Subject Exam: Medicine is pending. The practice questions above remain available while official exam length, timing, passing score, fee, and administrator details are reviewed.