Medical School In-Training Exam (ITE) Clinical
Questions With Correct Answers (Verified
Answers) Plus Rationales 2026 Q&A | Instant
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1. A 65-year-old man with a history of hypertension presents with
sudden-onset right-sided weakness and aphasia for 1 hour. CT
head shows no hemorrhage. What is the most appropriate next
step?
A. Aspirin only
B. IV heparin
C. IV alteplase
D. Warfarin initiation
Answer: C. IV alteplase
Rationale: The patient presents with acute ischemic stroke within the
3–4.5 hour window and no hemorrhage on CT. IV alteplase is indicated
if there are no contraindications to thrombolysis. Anticoagulation is
not first-line in acute stroke management.
, 2. A 23-year-old woman presents with fever, flank pain, and dysuria.
Urinalysis shows WBC casts. Diagnosis?
A. Cystitis
B. Pyelonephritis
C. Glomerulonephritis
D. Interstitial cystitis
Answer: B. Pyelonephritis
Rationale: WBC casts indicate upper urinary tract infection involving
the kidney, consistent with pyelonephritis rather than lower urinary
tract infection.
3. A patient with COPD is given high-flow oxygen and becomes
drowsy. What is the mechanism?
A. Oxygen toxicity
B. Haldane effect
C. Loss of hypoxic respiratory drive
D. Carbon monoxide poisoning
Answer: C. Loss of hypoxic respiratory drive
Rationale: COPD patients may rely on hypoxia to drive respiration.
Excess oxygen can reduce ventilatory drive leading to CO2 retention
and narcosis.
, 4. A 45-year-old man has crushing chest pain radiating to the left
arm. ECG shows ST elevation in leads II, III, aVF. Which artery is
occluded?
A. LAD
B. Right coronary artery
C. Circumflex artery
D. Left main coronary artery
Answer: B. Right coronary artery
Rationale: Inferior MI (II, III, aVF) is most commonly due to RCA
occlusion.
5. A child presents with barking cough and inspiratory stridor. Best
initial treatment?
A. Antibiotics
B. Racemic epinephrine
C. High-dose steroids
D. Bronchodilators
Answer: C. High-dose steroids
Rationale: Croup is treated with corticosteroids to reduce airway
inflammation; epinephrine is used for moderate-to-severe cases.
, 6. A patient presents with jaundice, elevated AST/ALT, and positive
anti-HBc IgM. Diagnosis?
A. Hepatitis A
B. Acute hepatitis B
C. Chronic hepatitis C
D. Alcoholic hepatitis
Answer: B. Acute hepatitis B
Rationale: Anti-HBc IgM indicates acute HBV infection.
7. A 30-year-old woman has palpitations, heat intolerance, and
weight loss. TSH is low, T3/T4 elevated. Most likely diagnosis?
A. Hashimoto thyroiditis
B. Graves disease
C. Thyroid cancer
D. Subacute thyroiditis
Answer: B. Graves disease
Rationale: Hyperthyroidism with suppressed TSH and elevated thyroid
hormones is most commonly due to Graves disease.
Questions With Correct Answers (Verified
Answers) Plus Rationales 2026 Q&A | Instant
Download Pdf
1. A 65-year-old man with a history of hypertension presents with
sudden-onset right-sided weakness and aphasia for 1 hour. CT
head shows no hemorrhage. What is the most appropriate next
step?
A. Aspirin only
B. IV heparin
C. IV alteplase
D. Warfarin initiation
Answer: C. IV alteplase
Rationale: The patient presents with acute ischemic stroke within the
3–4.5 hour window and no hemorrhage on CT. IV alteplase is indicated
if there are no contraindications to thrombolysis. Anticoagulation is
not first-line in acute stroke management.
, 2. A 23-year-old woman presents with fever, flank pain, and dysuria.
Urinalysis shows WBC casts. Diagnosis?
A. Cystitis
B. Pyelonephritis
C. Glomerulonephritis
D. Interstitial cystitis
Answer: B. Pyelonephritis
Rationale: WBC casts indicate upper urinary tract infection involving
the kidney, consistent with pyelonephritis rather than lower urinary
tract infection.
3. A patient with COPD is given high-flow oxygen and becomes
drowsy. What is the mechanism?
A. Oxygen toxicity
B. Haldane effect
C. Loss of hypoxic respiratory drive
D. Carbon monoxide poisoning
Answer: C. Loss of hypoxic respiratory drive
Rationale: COPD patients may rely on hypoxia to drive respiration.
Excess oxygen can reduce ventilatory drive leading to CO2 retention
and narcosis.
, 4. A 45-year-old man has crushing chest pain radiating to the left
arm. ECG shows ST elevation in leads II, III, aVF. Which artery is
occluded?
A. LAD
B. Right coronary artery
C. Circumflex artery
D. Left main coronary artery
Answer: B. Right coronary artery
Rationale: Inferior MI (II, III, aVF) is most commonly due to RCA
occlusion.
5. A child presents with barking cough and inspiratory stridor. Best
initial treatment?
A. Antibiotics
B. Racemic epinephrine
C. High-dose steroids
D. Bronchodilators
Answer: C. High-dose steroids
Rationale: Croup is treated with corticosteroids to reduce airway
inflammation; epinephrine is used for moderate-to-severe cases.
, 6. A patient presents with jaundice, elevated AST/ALT, and positive
anti-HBc IgM. Diagnosis?
A. Hepatitis A
B. Acute hepatitis B
C. Chronic hepatitis C
D. Alcoholic hepatitis
Answer: B. Acute hepatitis B
Rationale: Anti-HBc IgM indicates acute HBV infection.
7. A 30-year-old woman has palpitations, heat intolerance, and
weight loss. TSH is low, T3/T4 elevated. Most likely diagnosis?
A. Hashimoto thyroiditis
B. Graves disease
C. Thyroid cancer
D. Subacute thyroiditis
Answer: B. Graves disease
Rationale: Hyperthyroidism with suppressed TSH and elevated thyroid
hormones is most commonly due to Graves disease.
