NMLE Integrated case studies
NMLE Integrated · Put your knowledge to work in context.
The NMLE Integrated (National Medical Licensing Examination, Integrated) is a multiple-choice licensing examination for doctors. It tests whether a candidate can apply basic science and clinical knowledge to realistic patient scenarios across the full breadth of medical practice rather than within a single specialty. The NMLE Integrated case studies are 5 cases and about 4,215 words.
1Confusion, Seizure, and a Sodium of 110 after Starting a Thiazide
A 67-year-old woman with hypertension is brought to the emergency department after her daughter found her confused and vomiting. Hydrochlorothiazide 25 mg daily was started three weeks ago; she takes no other medication and denies alcohol use.
848 words, about 4 min2Closed-Loop Small Bowel Obstruction on Apixaban with a Rising Lactate
A 64-year-old man with atrial fibrillation on apixaban 5 mg twice daily and two previous abdominal operations (sigmoid colectomy for diverticulitis four years ago, open cholecystectomy) presents with 36 hours of crampy abdominal pain, bilious vomiting, distension, and no flatus or stool. He is alert and oriented and gives his own consent.
821 words, about 4 min3Severe Preeclampsia with HELLP Features at 30 Weeks: Timing, Steroids and Mode of Delivery
A 29-year-old woman, gravida 2 para 1, at 30 weeks and 2 days of gestation, presents with a two-day history of frontal headache and new flashing lights. Blood pressure is 162/108 mmHg on two readings 15 minutes apart.
804 words, about 4 min4A 23-Day-Old with Fever and a Bloody Lumbar Puncture
A 23-day-old boy, born at 36 weeks by vaginal delivery with a birth weight of 2.4 kg, is brought to the emergency department with 12 hours of poor feeding and one episode of nonbilious emesis. Rectal temperature is 38.4 °C.
870 words, about 4 min5Hollow-Bore Needlestick when the Source Patient Refuses Testing
A 26-year-old registered nurse sustains a needlestick while placing an intravenous line in an agitated patient in the emergency department. The device is a hollow-bore needle that had just been used to draw blood; it penetrates the pad of her left index finger deeply, and the needle is visibly blood-filled.
872 words, about 4 min