SCFHS-Style Clinical Midterm Exam
2026/2027 – Complete Exam-Style
Questions with Detailed Rationales |
100% Verified | Pass Guaranteed
1. A 72-year-old man with hypertension and type 2 diabetes
presents with acute onset of right-sided weakness and aphasia.
His last known well time was 2 hours ago. Blood pressure is
185/100 mmHg, glucose 140 mg/dL, and NIHSS score 14.
Non-contrast head CT shows no hemorrhage. What is the most
appropriate next step?
A. Administer IV alteplase (tPA) 0.9 mg/kg
B. Lower blood pressure to <140/90 mmHg immediately
C. Start oral aspirin 325 mg
D. Transfer for mechanical thrombectomy without tPA
✅ Correct Answer: A
Rationale: This patient presents with acute ischemic stroke within the 3-hour window
(last known well 2 hours ago) and no contraindications. IV alteplase is indicated if
symptom onset <4.5 hours, no hemorrhage on CT, and blood pressure can be managed
(current BP 185/100 is acceptable for tPA per AHA guidelines). Lowering BP aggressively
(B) is not recommended before tPA unless BP >185/110. Aspirin (C) is given 24 hours
after tPA or if tPA not given. Mechanical thrombectomy (D) is for large vessel occlusion
but does not replace tPA within the window.
2. A 30-year-old woman at 28 weeks gestation presents with
generalized pruritus, worse at night, without rash. Lab tests show
,elevated total bile acids (45 µmol/L) and normal liver enzymes.
What is the most appropriate management?
A. Ursodeoxycholic acid 10–15 mg/kg/day
B. Induction of labor at 32 weeks
C. Cholestyramine 4 g twice daily
D. Antihistamines (cetirizine)
✅ Correct Answer: A
Rationale: This is intrahepatic cholestasis of pregnancy (ICP). Ursodeoxycholic acid
improves pruritus and bile acid levels, and it is first-line medical therapy. Cholestyramine
(C) may help pruritus but does not reduce bile acids or fetal risks. Antihistamines (D) are
not effective for ICP pruritus. Induction at 36–37 weeks is typical; 32 weeks (B) is too
early unless severe (bile acids >100 µmol/L).
3. A 5-year-old child presents with fever (39.5°C), drooling,
stridor, and sitting upright with neck extended. What is the most
appropriate next step?
A. Direct laryngoscopy in the operating room
B. Lateral neck X-ray
C. Nebulized racemic epinephrine
D. Oral dexamethasone 0.6 mg/kg
✅ Correct Answer: A
Rationale: This presentation is classic for epiglottitis (now rare after Hib vaccine but still
possible). The patient has signs of impending airway obstruction. Direct visualization of
the epiglottis should be performed in a controlled setting (OR) by an anesthesiologist or
ENT, with immediate airway support. Lateral neck X-ray (B) delays definitive care.
Racemic epinephrine (C) and dexamethasone (D) are for croup, not epiglottitis.
,4. A 45-year-old man with alcoholic cirrhosis presents with
hematemesis and melena. His blood pressure is 85/50 mmHg,
heart rate 120 bpm. After securing two large-bore IVs and
initiating fluid resuscitation, which intervention is most urgent?
A. IV octreotide
B. IV pantoprazole
C. Emergency upper endoscopy
D. IV ceftriaxone
✅ Correct Answer: C
Rationale: This patient has suspected variceal hemorrhage with hemodynamic
instability. After resuscitation, the most urgent definitive intervention is emergency
upper endoscopy for band ligation. Octreotide (A) is a temporizing medical therapy
started concurrently, but endoscopy is the definitive treatment. Pantoprazole (B) is for
non-variceal bleeding. Ceftriaxone (D) is prophylaxis for bacterial peritonitis but does
not stop active bleeding.
5. A nurse is preparing to administer furosemide 40 mg IV push to
a patient with heart failure. Which laboratory value must be
checked before administration?
A. Serum creatinine
B. Serum potassium
C. Hemoglobin
D. Prothrombin time
✅ Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes significant potassium loss in the
urine. Hypokalemia increases the risk of cardiac arrhythmias, especially if the patient is
on digoxin. Checking potassium before each dose is a critical safety action. Creatinine
, (A) and hemoglobin (C) are important for monitoring but not an immediate safety
prerequisite. PT (D) is irrelevant.
6. A 25-year-old woman presents with palpitations, heat
intolerance, weight loss despite increased appetite, and a fine
tremor. Thyroid exam reveals a diffuse goiter. TSH is <0.01 mIU/L,
free T4 is 4.5 ng/dL. What is the best initial treatment?
A. Methimazole 10–20 mg daily
B. Propylthiouracil 100 mg three times daily
C. Radioactive iodine ablation
D. Propranolol 20 mg four times daily
✅ Correct Answer: D
Rationale: The patient has symptomatic hyperthyroidism (Graves’ disease). While
methimazole (A) is the definitive treatment, the initial priority is symptom control with a
beta-blocker (propranolol) to reduce palpitations, tremor, and anxiety. Propranolol also
inhibits peripheral conversion of T4 to T3. Methimazole will be added but takes weeks to
lower thyroid hormone levels.
7. A 68-year-old man with chronic kidney disease stage 4 (eGFR
25 mL/min) develops acute-onset shortness of breath and
hypoxia. Chest X-ray shows bilateral pulmonary edema. He is
afebrile, BP 150/90 mmHg. What is the most appropriate initial
diuretic?
A. Furosemide 40 mg IV
B. Hydrochlorothiazide 25 mg PO
C. Spironolactone 25 mg PO
D. Mannitol 100 mL IV
2026/2027 – Complete Exam-Style
Questions with Detailed Rationales |
100% Verified | Pass Guaranteed
1. A 72-year-old man with hypertension and type 2 diabetes
presents with acute onset of right-sided weakness and aphasia.
His last known well time was 2 hours ago. Blood pressure is
185/100 mmHg, glucose 140 mg/dL, and NIHSS score 14.
Non-contrast head CT shows no hemorrhage. What is the most
appropriate next step?
A. Administer IV alteplase (tPA) 0.9 mg/kg
B. Lower blood pressure to <140/90 mmHg immediately
C. Start oral aspirin 325 mg
D. Transfer for mechanical thrombectomy without tPA
✅ Correct Answer: A
Rationale: This patient presents with acute ischemic stroke within the 3-hour window
(last known well 2 hours ago) and no contraindications. IV alteplase is indicated if
symptom onset <4.5 hours, no hemorrhage on CT, and blood pressure can be managed
(current BP 185/100 is acceptable for tPA per AHA guidelines). Lowering BP aggressively
(B) is not recommended before tPA unless BP >185/110. Aspirin (C) is given 24 hours
after tPA or if tPA not given. Mechanical thrombectomy (D) is for large vessel occlusion
but does not replace tPA within the window.
2. A 30-year-old woman at 28 weeks gestation presents with
generalized pruritus, worse at night, without rash. Lab tests show
,elevated total bile acids (45 µmol/L) and normal liver enzymes.
What is the most appropriate management?
A. Ursodeoxycholic acid 10–15 mg/kg/day
B. Induction of labor at 32 weeks
C. Cholestyramine 4 g twice daily
D. Antihistamines (cetirizine)
✅ Correct Answer: A
Rationale: This is intrahepatic cholestasis of pregnancy (ICP). Ursodeoxycholic acid
improves pruritus and bile acid levels, and it is first-line medical therapy. Cholestyramine
(C) may help pruritus but does not reduce bile acids or fetal risks. Antihistamines (D) are
not effective for ICP pruritus. Induction at 36–37 weeks is typical; 32 weeks (B) is too
early unless severe (bile acids >100 µmol/L).
3. A 5-year-old child presents with fever (39.5°C), drooling,
stridor, and sitting upright with neck extended. What is the most
appropriate next step?
A. Direct laryngoscopy in the operating room
B. Lateral neck X-ray
C. Nebulized racemic epinephrine
D. Oral dexamethasone 0.6 mg/kg
✅ Correct Answer: A
Rationale: This presentation is classic for epiglottitis (now rare after Hib vaccine but still
possible). The patient has signs of impending airway obstruction. Direct visualization of
the epiglottis should be performed in a controlled setting (OR) by an anesthesiologist or
ENT, with immediate airway support. Lateral neck X-ray (B) delays definitive care.
Racemic epinephrine (C) and dexamethasone (D) are for croup, not epiglottitis.
,4. A 45-year-old man with alcoholic cirrhosis presents with
hematemesis and melena. His blood pressure is 85/50 mmHg,
heart rate 120 bpm. After securing two large-bore IVs and
initiating fluid resuscitation, which intervention is most urgent?
A. IV octreotide
B. IV pantoprazole
C. Emergency upper endoscopy
D. IV ceftriaxone
✅ Correct Answer: C
Rationale: This patient has suspected variceal hemorrhage with hemodynamic
instability. After resuscitation, the most urgent definitive intervention is emergency
upper endoscopy for band ligation. Octreotide (A) is a temporizing medical therapy
started concurrently, but endoscopy is the definitive treatment. Pantoprazole (B) is for
non-variceal bleeding. Ceftriaxone (D) is prophylaxis for bacterial peritonitis but does
not stop active bleeding.
5. A nurse is preparing to administer furosemide 40 mg IV push to
a patient with heart failure. Which laboratory value must be
checked before administration?
A. Serum creatinine
B. Serum potassium
C. Hemoglobin
D. Prothrombin time
✅ Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes significant potassium loss in the
urine. Hypokalemia increases the risk of cardiac arrhythmias, especially if the patient is
on digoxin. Checking potassium before each dose is a critical safety action. Creatinine
, (A) and hemoglobin (C) are important for monitoring but not an immediate safety
prerequisite. PT (D) is irrelevant.
6. A 25-year-old woman presents with palpitations, heat
intolerance, weight loss despite increased appetite, and a fine
tremor. Thyroid exam reveals a diffuse goiter. TSH is <0.01 mIU/L,
free T4 is 4.5 ng/dL. What is the best initial treatment?
A. Methimazole 10–20 mg daily
B. Propylthiouracil 100 mg three times daily
C. Radioactive iodine ablation
D. Propranolol 20 mg four times daily
✅ Correct Answer: D
Rationale: The patient has symptomatic hyperthyroidism (Graves’ disease). While
methimazole (A) is the definitive treatment, the initial priority is symptom control with a
beta-blocker (propranolol) to reduce palpitations, tremor, and anxiety. Propranolol also
inhibits peripheral conversion of T4 to T3. Methimazole will be added but takes weeks to
lower thyroid hormone levels.
7. A 68-year-old man with chronic kidney disease stage 4 (eGFR
25 mL/min) develops acute-onset shortness of breath and
hypoxia. Chest X-ray shows bilateral pulmonary edema. He is
afebrile, BP 150/90 mmHg. What is the most appropriate initial
diuretic?
A. Furosemide 40 mg IV
B. Hydrochlorothiazide 25 mg PO
C. Spironolactone 25 mg PO
D. Mannitol 100 mL IV
