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INTERNAL MEDICINE PAEA QUESTIONS WITH COMPLETE SOLUTIONS
RATED A+ | 2024
“diagnose AAA: - CORRECT ANSWER US"
"what size AAA do you treat with surgery - CORRECT ANSWER > 5 cm or growing >0.5 cm/year"
"what is the neurotransmitter decreased in parkinsons - CORRECT ANSWER dopamine"
"pt with bony enlargements at DIP joints what is the diagnosis? - CORRECT ANSWER OA"
"(+) befiringement - CORRECT ANSWER pseudogout"
"pt has a swollen tender joint what is the best test to get to a diagnosis - CORRECT ANSWER
arthrocentesis"
"treatment of copd - CORRECT ANSWER ipatropium"
"severe constant midepigastric or LUQ pain radiating to the back nausea vomitting grey turner sign and
cullen sign what is the diagnosis - CORRECT ANSWER pancreatitis"
"best test to diagnose barrets esophagus - CORRECT ANSWER EGD"
"hematemesis following a bout of retching - CORRECT ANSWER mallory weiss tear"
"ruq pain fever tachy muphys sign - CORRECT ANSWER cholecystitis"
"dry eyes and mouth what is the diagnosis - CORRECT ANSWER sjorgens"
"what disease will give you hypokalemia - CORRECT ANSWER adrenal adenoma"
"which lung cancer has the poorest prognosis - CORRECT ANSWER small cell"
"what nutrients is lacking if you remove the ileum - CORRECT ANSWER b12"
"how do you treat legionella - CORRECT ANSWER macrolide"
"very thin male who smokes and has lung disease what type of COPD? - CORRECT ANSWER
emphysema"
"you have increased tactile fremitus with which lung pathology - CORRECT ANSWER pneumonia"
"most sensitive test for RA - CORRECT ANSWER sensitive - RF
Specific - anti-ccp"
"diagnositic test for ulcerative colitis - CORRECT ANSWER sigmoidoscopy"
"treatment of esophagitis - CORRECT ANSWER protonix"
"pt with weight loss and low hematocrit anoscopy reveals internal hemorrhoid what is the next best
step - CORRECT ANSWER colonacopy -cancer causing constipaiton- rectal cancer"
"linear muscosal ulcerations - CORRECT ANSWER chrons skip lessons"
s
"treatment of lupus - CORRECT ANSWER hydroxychloroquine for skin lesions only, put on NSAID or
APAP for muscle and joint pain, add steroid if rf.x, MTX if nasals and steroids are not enough..and cyclopophosphamide for kidney involvement"
"what would you see in gouty arthritis - CORRECT ANSWER don't know the options or answer"
"what do you see on X-ray on emphysema - CORRECT ANSWER hyperinflation"
"best medication for insomnia for elderly - CORRECT ANSWER options: barbituates, benzos, ??????"
"alcoholic with red sputum pna - CORRECT ANSWER klebsiella"
"management of carpal tunnel - CORRECT ANSWER wrist splint"
"left sided heart failure blood backs up to the ____ - CORRECT ANSWER lungs, will see orthopnea,
PND, dyspnea on exertion, s2 gallop, crackles"
"what blood test will be elevated in CHF - CORRECT ANSWER BNP"
"MCC Right heart failure - CORRECT ANSWER left heart failure"
"McC Left heart failure - CORRECT ANSWER CAD, hypertension, valvular disease endocarditis"
"class I: - CORRECT ANSWER no limitation"
"class II CHF
: - CORRECT ANSWER slight limitations with exertion"
"class III: - CORRECT ANSWER marked limitation with exertion"
"troponin is elevated within ____ hours but remains for - days - CORRECT ANSWER 3, 7-10 so this
means you cant use it if suspecting a reinfarct bc it will still be high"
"when a pt with suspected MI(STEMI & NSTEMI) comes to the ED we begin: - CORRECT ANSWER
Morphine Oxygen Nitrates ASA BB"
"what are the five P's of occlusive arterial artherosclerosis - CORRECT ANSWER 1. pain (b/c no blood
flow)
- pulselessness
- Poikilothermic (cold)
- Paresthesias (b/c vascular compromise)
- pale"
"how do you diagnose occlusive arterial artherosclerosis - CORRECT ANSWER arteriogram"
"pt presents with pleuritic chest pain on inspiration relieved with leaning forward.
- what will you expect to hear on auscultation of this patient?
- what will you see on EKG
3. how do you treat - CORRECT ANSWER 1. pericardial friction rub
- global ST elevations and PR segment depressions*
- NSAIDs..colchine for recurrent"
"in peripheral artery disease what color changes will you see in the legs? - CORRECT ANSWER pale
bluish arterial- pale, bluesh, shiny, loss of hair, bad nails" "what EKG is consistent with bradycardia then tachycardia then bradycardia? what is the definitive
treatment? - CORRECT ANSWER sick sinus syndrome
PACEMAKER"
"holosystolic blowing medium-pitched murmur left sternal border 5th ICS, what sign is associated with
it? - CORRECT ANSWER TR
Carvallos sign - increased by inspiration"
"post MI, coming in with symptoms of cardiac tamponade. On EKY there are ST elevation in v2-v4. -
CORRECT ANSWER ventricular aneurism,coronary angiography, treat with surgery"
"accessory pathway that allows the electrical signal to travel from sinus node to ventricle bypassing the
A-V node. what will you see on EKG? how do you treat?? - CORRECT ANSWER WPW
delta wave (slurring upstroke of QRS) tx:stable: procainamide, amiodarone unstable: synchronized cardioversion" "chronic episodic predicatable pain syndrome due to temporary myocardial ischemia, resolves with
rest of medication. what is it and how do you treat? - CORRECT ANSWER stable angina treat CHRONIC
with BB..in acute attack give NTG" "new onset of angina pain, angina pain that changes, pain at rest. what is it, what must you work them
up for? - CORRECT ANSWER unstable angina must be worked up for MI, treat as MI - MONAb"
"due to coronary vasospasm, not linked to exertion, distinguished from unstable by chronic intermittent
nature, pain usually occurs at a specific hour in the early morning, what is it how do you treat? -
CORRECT ANSWER prinzmetals angina (variant) - treat with CCB and nitrates"
"pt presents with sudden searing chest pain with radiation to the back, abdomen.
- what will you expect on PE?
- what will you expect on CXR?
3. what do you want to do for this patient? - CORRECT ANSWER 1. pulse discrepencies in the
extremities(left verse right arm)
- widened mediastinum on CXR
- start am IV BB and get STAT CTA"
"anterior MI: what leads and what vessel - CORRECT ANSWER V1-V4 Left Anterior Descending (LAD)"
"Inferior MI: what leads and what vessel - CORRECT ANSWER II, III, aVF Right Coronary Artery (RCA)
DONT GIVE NITRATE"
"Lateral MI: what leads and what vessel - CORRECT ANSWER I, aVL, V5, V6 Left Circumflex Artery
(LCA)"
"Posterior MI: what leads and what vessel - CORRECT ANSWER V1, V2: RCA or LCX"
"DKA is due to severely depressed ______ levels.
- which DM is most affected?
- what is patient going to be complaining of?
- how do you diagnose (ABG findings and labs)
4. how do you treat - CORRECT ANSWER insulin
1. DM 1
- polyuria, polydipsia, abdominal pain N/V, kussmaul breathing, acetone fruity breath(breathing out ketones), lethargic
- ABG: anion gap metabolic acidosis, hyperglycemia, hyperketonuria(peeing out ketones), high potassium
4. what is the treatment for all DI - CORRECT ANSWER vasopressin
- autoimmunity against hypothalmic arginine vasopressin secreting cells
- damage to the hypothalmus (tumor, trauma, accidental, surgical)
- defect in the kidney tubules that interferes with water reabsorption
- Nephro- low salt and protein plus hctz Central - desmopressin/ddavp"
"diabetic medication that decreased the absorption of carbohydrates from the intestine - CORRECT
ANSWER alpha glucosidase inhibitor -**ACARBOSE (PRECOSE)****"
"DM is confirmed with a fasting serum glucose > ______ - CORRECT ANSWER 126"
"MCC of renal failure - CORRECT ANSWER diabetic nephropathy"
"how do you diagnose diabetic nephropathy? how do you treat? - CORRECT ANSWER microalbumin to
creatinine ratios and serum creatinine tx: ACE or ARB progresses from microalbuminuria -> macroalbuminuria -> nephrotic syndrome"
"diagnostic criteria for metabolic syndrome - CORRECT ANSWER BP > 130/
FBS > 100
HDL low Triglycerides > 150 Abdominal obesity" "SIADH:
- what labs will you see on presentation?
2. how do you treat - CORRECT ANSWER 1. increased ADH, hyponatremia, low serum osmolality, high
urinary sodium, confusion, muscle cramps, seizure, coma
- fluid restriction: correct hyponatremia safely at rate that does not cause neurologic problems" "pt presents with painless swelling in thyroid. On PE thyroid is palpable and firm. what is the diagnosis?
which type can cause flushing and diarrhea as the initial feature - CORRECT ANSWER thyroid cancer
medullary carcinoma" "38 year old female on labetalol presents with poorly controlled HTN, frequent headaches, and palpitations and she's sweating
- what is the diagnosis?
- what is the triad?
3. how do you diagnose - CORRECT ANSWER 1. pheochromocytoma
- headache, palpitations, diaphoreiss
- elevated 24 hour urine catecholamines and metanephrines"
"what are the F's associated with cholecystitis - CORRECT ANSWER fat forty female fertile fibrosis
familial"
"how do you diagnose cholecystiits - CORRECT ANSWER Us"
"how to diagnose UC - CORRECT ANSWER signmoidoscopy"
"what will you see on PE of antiphospholipid syndrome - CORRECT ANSWER livedo reticularis"
"treatment of autoimmune hemolytic anemia
--> pt will go in cold weather and have acrocynaosis. - CORRECT ANSWER corticosteroids"
"treatment of ITP (bleeding gums and purpura) - CORRECT ANSWER steroids"
"what will you see on PE of VWd - CORRECT ANSWER mucosal bleeding"
"HIV patient with perivascular hemorrhage and exudates on fundoscopy - CORRECT ANSWER cmv
retinitis" "28 year old can't grab his coffee but it goes away with alcohol grandpa has same thing what does he
have - CORRECT ANSWER benign essentail tremor"
"Conns is ________ Na and __________ K
what is it associated with? - CORRECT ANSWER increased Na decreased K
associated with secondary hypertension one answer is primary adrenal tumor"
"Addisons is _______ Na and _______ K and _________cortisol - CORRECT ANSWER decreased NA
increased K decreased cortisol"
"pt presents with increased pigmentation, salt crazing electrolyte imbalances what is the diagnosis -
CORRECT ANSWER addisons"
"pt had their pituitary gland removed for acromegaly and is presenting with a low TSH and low t3 what
do you want to give them - CORRECT ANSWER levothyroxine"
"a guy from ukraine was evacuated from his house after the chernobyl accident what type of cancer is
he susceptible to? - CORRECT ANSWER thyroid cancer(papillary)"
"a woman presented with a lump on her neck there was a non tender there mass palpated what is the
diagnosis - CORRECT ANSWER thyroid cancer"
"48 year old woman with no omg no sxs no new medical condition comes to her PCP with a BP of
180/122 what is her diagnosis - CORRECT ANSWER hypertensive urgency"
"what is becks triad what does it diagnose - CORRECT ANSWER JVD hypotension muddled heart
sounds diagnoses cardiac tamponade"
"a smoker with perfectly described PE what do you do to prevent this from happening again - CORRECT
ANSWER quit smoking"
"decreased distal pulses compared to upper extremities what is the diagnoiss - CORRECT ANSWER
COA"
"pulses uneven between the upper extremities - CORRECT ANSWER aortic dissection"
"aurrer rods is associated with what cancer - CORRECT ANSWER AML"
"young man with a supraclavicular lump what cancer - CORRECT ANSWER this is the virchows node he
has gastric cancer"
"systolic murmur at Right sternal border radiating to carotids - CORRECT ANSWER AS"
"what is the greatest RF for AAA - CORRECT ANSWER smoking"
"what is the mechanism behind CHF - CORRECT ANSWER increase in pulmonary vascular congestion"
"woman with jaw pain that gets worse with exertion what drugs should be added to her current meds -
CORRECT ANSWER beta blocker this is CHRONIC stable angina"
"a man with HIV has vision problem and some eye findings on exam what is the diagnosis - CORRECT
ANSWER CMV retinitis"
"woman with bleeding gums for two days and some petechiae on her shins how do you treat -
CORRECT ANSWER steroids - this is ITP"
"what echo findings are associated with hypertrophic cardiomyopathy - CORRECT ANSWER septal
hypertrophy and LVH"
"guy with cough x 3 years gets worse in winter coughs up a lot of sputum - CORRECT ANSWER chronic
bronchitis"
"what is the only thing that improves COPD - CORRECT ANSWER home o2"
"african american lady with bilateral hillier lymphadenopathy - CORRECT ANSWER sarcoidosis"
"man with cough and chest pain, sounds like they might be describing GERD normal heart and lung
exam, normal upper endoscopy what do you do next - CORRECT ANSWER pH monitoring"
"antibiotic treatment for shigella - CORRECT ANSWER fluoroquinolone (floxacins)
supposedly answer isn't bacterium on this test: )"
"alcoholic man vomits vomits vomits than tears on endoscopy what is the diagnoiss - CORRECT
ANSWER mallory weiss"
"acute hep B IGM Hbsag total anti hbc
anti hbs - CORRECT ANSWER acute hep B
IGM +
Hbsag + total anti hbc + anti hbs -" "chronic hep B IGM Hbsag total anti hbc
anti hbs - CORRECT ANSWER IGM +
Hbsag + total anti hbc _ anti hbs -"
"what are the markers on celiac biopsy of small bowel - CORRECT ANSWER iga endomysial antibody
and IGA tissue translutaminase tTG"
"treatment of BPH - CORRECT ANSWER flomax tamulosin"
"nephrotic syndrome will have what in the urine - CORRECT ANSWER protein > 3.5"
"mechnism for hyperparathyroidism with renal failure - CORRECT ANSWER kidneys don't convert
vitamin d to active form, so calcium can't be absorbed, so increase in PTH"
"what other symptom is seen with pyelonephritis other than fever and CVA tenderness/flank pain? -
CORRECT ANSWER Nausea
other options: night sweats, anorexia, nausea is right answer"
"pt has history of a DVT and miscarriage what does she have - CORRECT ANSWER antiphosphilipid
syndrome"
"how do you screen for diabetic nephropathy - CORRECT ANSWER micralbuminuria"
"pt with growing hands nose ears - CORRECT ANSWER acromegaly"
"HIV pt with pneumonia - which type - CORRECT ANSWER PCP"
"pt has penile discharge with flagellated protozoa what do you treat him with - CORRECT ANSWER
man got trich - gotta give him metronidazole 2 gm"
"pt with abdominal obesity low hdl high triglycerides glucose 115 what is the diagnosis - CORRECT
ANSWER metabolic syndrome"
"pt with fruity odor whats the treatment - CORRECT ANSWER regular insulin is the answer..but fluids
first" "pt with low back pain radiating to buttock mri shows spinal stenosis(pain relieved with forward flexion)
whats the initial treatment? - CORRECT ANSWER steroid injection"
"pericardial knock on PE - CORRECT ANSWER constrictive pericarditis"
"pt with an ejection fraction of 25 what is the treatment - CORRECT ANSWER AICD"
"what is chronic long term treatment of a pt with life threatening arrythmias - CORRECT ANSWER ICD"
"pt in a treadmill for stress test collapses and has no pulse. keg shows no discernible p or qrs waves an
an irregular waveform pattern what do you do first - CORRECT ANSWER defib"
"pt with DM has 2 bp readings greater than 140/90 best reatmewnt for this patient - CORRECT
ANSWER ace"
"yound adult with no pmh has htn and low potassium what is the most likely cause of his hypertension -
CORRECT ANSWER primary aldosteronism"
"pain out of proportion to abdominal PE - CORRECT ANSWER mesenteric ischemia-- triade- POP, afib,
recently on digitalis"
"pericardal knock - CORRECT ANSWER constrictive pericarditis-> this is a loud s3"
"how do you diagnose constrictive pericarditis - CORRECT ANSWER echo shows pericardial thickening
and normal left ventricular function"
"what murmur "widened pulse pressure" - CORRECT ANSWER AR
-> this is when systolic pulse- diastolic pulse is >40"
"how do you diagnose COA - CORRECT ANSWER echo/doppler"
"right sided heart failure blood backs up to the _______ - CORRECT ANSWER periphery, will see JVD,
hepatosplenomegaly, peripheral edema, ascities,"
"pt with stable angina what is first line treatment - CORRECT ANSWER bb"
"pt has brown ulcer above medial malleolus what type of ulcer - CORRECT ANSWER venous
insufficiency"
"pt with metastatic colon cancer is being cared for at home by his son what do you recommend -
CORRECT ANSWER hospice care"
"MCC endocarditis in IVDA - CORRECT ANSWER s aureus"
"what test is diagnostic of pericarditis - CORRECT ANSWER pr depressions and st elevations on ekg"
"what is a case of transudative pleural effusion - CORRECT ANSWER CHF"
"person with irregularly irreular rhythm what do you want to give them before you cardiovert them -
CORRECT ANSWER LMWH, unfractionated heparin, warfarin
she put warfarin idk"
"pt had an MI what medications do they have to be discharged on - CORRECT ANSWER BASH
bb ace statin heparin (bridged to coumadin)" "person was away in a foreign country and had chest pain 7 days ago but had no access to ekg or labs he
has a nstemi what would be positive? - CORRECT ANSWER troponin"
"3 questions on post thyroidectomy all patients had symptoms of hypocalcemia due to hypoparathyroidism one pt had chovsteks sign one pt had trousseous one question asked what was the
cause? hypocalcemia - CORRECT ANSWER chovsteks- cheek
trousseou - bp cuff" "pt with 2 pack a day smoking history for 20 years has hoarseness dysphagia what is the most likely
diagnosis? - CORRECT ANSWER bronchial tumor
"MCC of pancreatic cancer in the US - CORRECT ANSWER smoking"
"treatment of acute glaucoma - CORRECT ANSWER acetazolamide"
"know pericarditis has a pericardial friction rub - CORRECT ANSWER we know this by nwo"
"how to differentiate status epileptics from tonic clonic - CORRECT ANSWER status does not have a
post ictal or lucid interval"
"lung cancer patient has a nodule on cxr with bilateral hillier andenopathy what do they have? -
CORRECT ANSWER sarcoidosis"
"what condition arises from increased pressure in the pulmonary arteries - CORRECT ANSWER
pulmonary hypertension aka cor pulmonale"
"pt presents with aMS and flapping of hands LFTS increased what do they have and how do you treat -
CORRECT ANSWER hepatic encephalopathy tx with lactulose"
"CVA tenderness and wbc casts in ua - CORRECT ANSWER pyelonephritis"
"tx fibromyalgia - CORRECT ANSWER amitriptyline"
"philadelphia chromosome what cancer - CORRECT ANSWER CML
matt rides a camel to philadelphia tx imatinib"
"pt has stiffness then convulsion what do they have - CORRECT ANSWER tonic clonic seizure"
"pt had sphenoidal surgery and now complaining she's fat and has coarse hair how do you want to treat
her - CORRECT ANSWER levothyroxine"
"keg finding of hyperkalemia - CORRECT ANSWER peak t"
"treatment of influenza B - CORRECT ANSWER oseltamavir (tamiflu)"
"treatment of gonnorhea - CORRECT ANSWER 1gm ceftriaxone im"
"what are the b symptoms ass with non hodgkins - CORRECT ANSWER weight loss and night sweats"
"LLQ pain and fever diagnosis - CORRECT ANSWER diverticulitis"
"increased iron in blood what is the diagnosis and how do you treat - CORRECT ANSWER
hemochromatosis treat with phlebotomy"
"write out hep B antigens and antibodies - CORRECT ANSWER -"
"someone presents with low blood pressure distant heart sounds and jvd what do they have -
CORRECT ANSWER cardiac tamponade"
"a person with gout eats too much ______ _____ - CORRECT ANSWER red meats"
"positive murphy sign indicates - CORRECT ANSWER cholecystitis"
"a person with pyelonephritis will have cva tenderness wbc and what other symptom? - CORRECT
ANSWER the answer is nausea"
"tear at the lower end of the gastroesophageal junction - CORRECT ANSWER mallory weiss tear"
"pain in joints that worsens in the morning also involves MCP joints - CORRECT ANSWER RA"
"reactive arthritis is most likely precipitated by what - CORRECT ANSWER dysenteric infection"
"how do you treat polyarteritis nordosa - CORRECT ANSWER prednisone"
"what medication will help with cognitive loss in alzheimers - CORRECT ANSWER donepezil aka
aricept"
"aurer rods - CORRECT ANSWER AML"
"picture of someone with anemia MCV < 60 and asks what test you also want to look at - CORRECT
ANSWER ferritin"
"Pt with no p waves or qrs waves and irregular rhythm what is it what do you want to do - CORRECT
ANSWER vfib defib"
"76 year old with htn and fib what do you want to do - CORRECT ANSWER warfarin 2 points on
chadsvasc have to AC her"
"lesion in lymes - CORRECT ANSWER erythema migrans"
"what is the recommended course of anticoagulation for a dVT - CORRECT ANSWER 3 months"
"person with whooping cough should have gotten what vaccine - CORRECT ANSWER dTAP"
"LVH what do you hear on PE - CORRECT ANSWER s4"
"little girl with erythematous papules - CORRECT ANSWER variella"
"1+ edema, fat smoker what kind of COPD - CORRECT ANSWER chronic bronchitis"
"treatment of nausea for pt going thru chemo - CORRECT ANSWER zofran"
"pt has cold skin capillary refill is 4 seconds what do you want to do - CORRECT ANSWER fluid
resusitation"
"drug that improves remodeling of the heart after MI - CORRECT ANSWER ACE ??? or BB?"
"what is outside of the joint manifestations of RA - CORRECT ANSWER vasculitis"
"boy with wPW what is treatment for long term benefit - CORRECT ANSWER radioablation"
"what is a symptom of von willebrand - CORRECT ANSWER bleeding gums"
"pt has target cells what is the test to diagnose this disease - CORRECT ANSWER hgb electrophoresis
to dx sickle cell"
"pt with leukemia, elevated wbcs what is the PE finding - CORRECT ANSWER splenomegaly"
"shoulder and neck pain in the morning - CORRECT ANSWER polymyalgia rheuymatica"
"what do you want to measure in zollinger ellison syndrome - CORRECT ANSWER gastrin levels"
"what do you give for a htn crisis - CORRECT ANSWER IV labetalol"
"how do you diagnose pericardial effusion - CORRECT ANSWER echo?? person said keg"
"masked facies - name the disease - CORRECT ANSWER parkinsons"
"pneumonia with diarrhea - CORRECT ANSWER legionella"
"what do you have to check when you prescribe depakore - CORRECT ANSWER lfts"
"symptom of antiphospholipid syndrome - CORRECT ANSWER livedo reticularis"
"what antibiotic is contraindicated in g6pd - CORRECT ANSWER sulfas, bactrim"
"what type of hypertension medication helps decrease macroalbuminuria in DM pt - CORRECT
ANSWER ACE"
"in coma arms and legs held straight out toes pointed downward what is this called - CORRECT
ANSWER decerabrate"
"scleroderma is associated with what pulm finding - CORRECT ANSWER pulmonary fibrosis
everything just hard"
"ELISSA FB - CORRECT ANSWER "
"classic presentation of asbestosis - CORRECT ANSWER pleural plaques"
"side effect of inflizimad - CORRECT ANSWER thrombocytopenia"
"side effect of salmeterol - CORRECT ANSWER thrush"
"anti hypertensive most likely to cause Erectile Dysfunction - CORRECT ANSWER BB"
"what secretes pepsinogen - CORRECT ANSWER chief cells"
"what is contraindicated in acute glaucoma - CORRECT ANSWER atropine"
"paraspinal pain, on NSAIDs what do you do next - CORRECT ANSWER continue normal activities"
"what test tells us the concentration of urine - CORRECT ANSWER Specific Gravity"
"where is lung adenocarcinoma found - CORRECT ANSWER peripherally"
"Rheumtic fever F presentaiton - pt has nodules what is the causative afent - CORRECT ANSWER
GABHS-which is strep pyo"
"what is a noninfectious cause of fever - CORRECT ANSWER PE"
"PE of CML - CORRECT ANSWER splenomegaly"
"old man with 78% lymphocytes in blood - CORRECT ANSWER CLL"
