Lebanese Medical Colloquium (Colloquium Liban) Ā· Internal Medicine and Pediatrics

Adult Internal Medicine and Emergency Protocols

123 practice questions, each with the answer and an explanation.

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Random questions from this topic, one at a time. You see the answer and the explanation straight after each one.

All 123 questions

  1. A 62-year-old male with hypertension presents with 2 hours of crushing substernal chest pain. The ECG reveals 3 mm ST elevation in leads II, III, and aVF. What is the priority immediate management?
  2. A 45-year-old female presents with acute severe epigastric pain radiating to the back and vomiting. Serum lipase is 1,200 U/L (normal < 60 U/L). What is the most critical initial management step?
  3. A 28-year-old male with type 1 diabetes presents with nausea, vomiting, Kussmaul respirations, and lethargy. Blood glucose is 480 mg/dL, arterial pH is 7.18, and serum bicarbonate is 11 mEq/L. What isā€¦
  4. A 70-year-old male with long-standing severe COPD presents with increased dyspnea, purulent sputum, and drowsiness. ABG reveals pH 7.28, PaCO2 68 mmHg, and PaO2 52 mmHg on room air. What is the primarā€¦
  5. A 55-year-old female presents with fever, right upper quadrant pain, and jaundice (Charcot's triad). BP is 80/50 mmHg and she is confused (Reynolds' pentad). What is the definitive emergency interventā€¦
  6. A 35-year-old male presents with sudden-onset severe headache ('worst headache of my life'). Non-contrast head CT performed 3 hours after onset is normal. What is the mandatory next diagnostic step?
  7. A 65-year-old male with cirrhosis presents with hematemesis. Pulse is 115 bpm and BP is 90/60 mmHg. Following airway protection and packed RBC transfusion, what is the drug of choice to reduce portalā€¦
  8. A 50-year-old male presents with a painful, erythematous, hot, and swollen right knee joint. Arthrocentesis yields cloudy fluid with 75,000 WBCs/mm3. Polarized light microscopy reveals needle-shapedā€¦
  9. A 72-year-old female presents with severe generalized weakness. ECG reveals tall, peaked T waves, prolonged PR interval, and loss of P waves. Serum potassium is 7.2 mEq/L. What is the immediate firstā€¦
  10. A 30-year-old female presents with 3 months of fatigue, cold intolerance, weight gain, constipation, and dry skin. Physical examination reveals delayed deep tendon reflexes and diffuse non-tender goitā€¦
  11. A 24-year-old male presents with acute onset of severe pleuritic chest pain and dyspnea. Physical examination reveals absent breath sounds and hyperresonance on the right hemithorax, with tracheal devā€¦
  12. A 58-year-old male with persistent atrial fibrillation has a CHA2DS2-VASc score of 3. What is the guideline-directed therapy for stroke prevention?
  13. A 40-year-old female presents with fatigue, arthritis, malar rash, and proteinuria. Laboratory testing reveals positive ANA (1:640) and positive anti-double-stranded DNA (anti-dsDNA). What is the diagā€¦
  14. A 65-year-old male smoker presents with painless gross hematuria. Urinalysis confirms numerous intact RBCs without dysmorphic features or casts. What is the priority diagnostic investigation?
  15. A 22-year-old university student presents with sudden fever, severe headache, neck stiffness, and photophobia. What is the most appropriate empirical intravenous antibiotic regimen while awaiting CSFā€¦
  16. A 48-year-old male presents with persistent fever and a new regurgitant heart murmur. Blood cultures grow Streptococcus gallolyticus (formerly S. bovis). In addition to echocardiography and antibioticā€¦
  17. A 35-year-old female presents with progressive proximal muscle weakness, difficulty climbing stairs, and a heliotrope rash on the upper eyelids. Serum creatine kinase is 4,500 U/L. What is the diagnosā€¦
  18. A 52-year-old male with chronic alcoholism presents with confusion, ataxia, and horizontal nystagmus (Wernicke encephalopathy). What treatment must be administered immediately prior to any glucose infā€¦
  19. A 60-year-old male presents with sudden-onset painless jaundice and significant weight loss. Physical examination reveals a non-tender, palpable gallbladder (Courvoisier sign). What is the most likelyā€¦
  20. A 32-year-old female with Graves disease presents with severe agitation, hyperpyrexia (40.2Ā°C), tachycardia (160 bpm), and atrial fibrillation. What acute endocrine emergency is present?
  21. A 42-year-old male with chronic hepatitis B infection presents for routine surveillance. What is the recommended screening strategy for early detection of hepatocellular carcinoma (HCC)?
  22. A 68-year-old female presents with bilateral leg swelling, periorbital edema, and foamy urine. Urinalysis shows 4+ protein, and 24-hour urine collection reveals 6.8 g of protein. Serum albumin is 2.1ā€¦
  23. A 29-year-old male presents with 4 weeks of watery diarrhea, weight loss, oral aphthous ulcers, and right lower quadrant abdominal pain. Colonoscopy reveals patchy transmural inflammation and cobblestā€¦
  24. An 80-year-old male presents with resting tremor, bradykinesia, cogwheel rigidity, and postural instability. What is the pathophysiological hallmark of this disorder?
  25. A 65-year-old male with small cell lung cancer presents with confusion. Serum sodium is 118 mEq/L, serum osmolality is low (245 mOsm/kg), and urine osmolality is inappropriately high (550 mOsm/kg). Thā€¦
  26. A 45-year-old male presents with recurrent peptic ulcerations in the distal duodenum and jejunum refractory to PPI therapy. Fasting serum gastrin is 1,800 pg/mL. What diagnostic test confirms Zollingeā€¦
  27. What is the CHA2DS2-VASc score of a 72-year-old man with hypertension and diabetes with atrial fibrillation?
  28. What is the CHA2DS2-VASc score of an 80-year-old woman with heart failure with atrial fibrillation?
  29. What is the CHA2DS2-VASc score of a 60-year-old man with hypertension and a previous stroke with atrial fibrillation?
  30. What is the CHA2DS2-VASc score of a 68-year-old woman with diabetes and a previous myocardial infarction with atrial fibrillation?
  31. What is the CHA2DS2-VASc score of a healthy 45-year-old man with atrial fibrillation?
  32. What is the CHA2DS2-VASc score of a 77-year-old man with hypertension and a previous TIA with atrial fibrillation?
  33. A screening test gives TP = 90, FN = 10, TN = 80, FP = 20. What is its sensitivity?
  34. A diagnostic test gives TP = 90, FN = 10, TN = 80, FP = 20. What is the positive predictive value?
  35. A screening test gives TP = 45, FN = 5, TN = 140, FP = 10. What is its sensitivity?
  36. A diagnostic test gives TP = 45, FN = 5, TN = 140, FP = 10. What is the positive predictive value?
  37. In a trial, the event rate is 10% in the control group and 6% in the treatment group. What is the number needed to treat?
  38. In a trial, the event rate is 8% in the control group and 6% in the treatment group. What is the number needed to treat?
  39. An ECG shows an RR interval of 0.81 s and a QT interval of 360 ms. Using Bazett's formula (QTc = QT / sqrt(RR)), what is the QTc?
  40. An ECG shows an RR interval of 0.64 s and a QT interval of 352 ms. Using Bazett's formula (QTc = QT / sqrt(RR)), what is the QTc?
  41. An ECG shows an RR interval of 0.49 s and a QT interval of 308 ms. Using Bazett's formula (QTc = QT / sqrt(RR)), what is the QTc?
  42. An ECG shows an RR interval of 0.36 s and a QT interval of 264 ms. Using Bazett's formula (QTc = QT / sqrt(RR)), what is the QTc?
  43. An ECG shows an RR interval of 0.81 s and a QT interval of 405 ms. Using Bazett's formula (QTc = QT / sqrt(RR)), what is the QTc?
  44. A patient breathing room air has PaO2 80 mmHg and PaCO2 40 mmHg. Using PAO2 = 150 - PaCO2/0.8, what is the A-a gradient?
  45. A patient breathing room air has PaO2 60 mmHg and PaCO2 48 mmHg. Using PAO2 = 150 - PaCO2/0.8, what is the A-a gradient?
  46. A patient breathing room air has PaO2 90 mmHg and PaCO2 32 mmHg. Using PAO2 = 150 - PaCO2/0.8, what is the A-a gradient?
  47. A patient breathing room air has PaO2 55 mmHg and PaCO2 40 mmHg. Using PAO2 = 150 - PaCO2/0.8, what is the A-a gradient?
  48. A patient breathing room air has PaO2 70 mmHg and PaCO2 56 mmHg. Using PAO2 = 150 - PaCO2/0.8, what is the A-a gradient?
  49. An infusion of 1200 mL must run over 8 hours using a set that delivers 20 drops per mL. What is the drip rate in drops per minute?
  50. An infusion of 600 mL must run over 6 hours using a set that delivers 15 drops per mL. What is the drip rate in drops per minute?
  51. An infusion of 750 mL must run over 5 hours using a set that delivers 20 drops per mL. What is the drip rate in drops per minute?
  52. An infusion of 900 mL must run over 6 hours using a set that delivers 10 drops per mL. What is the drip rate in drops per minute?
  53. A 80 kg patient needs a dopamine infusion of 5 micrograms/kg/min. The bag contains 1,600 micrograms per mL.
  54. A 60 kg patient needs a dopamine infusion of 10 micrograms/kg/min. The bag contains 1,600 micrograms per mL.
  55. A 100 kg patient needs a dopamine infusion of 5 micrograms/kg/min. The bag contains 800 micrograms per mL.
  56. A 70 kg patient needs a dopamine infusion of 8 micrograms/kg/min. The bag contains 1,600 micrograms per mL.
  57. Serum sodium is 130 mmol/L and glucose is 350 mg/dL. Using the correction of 1.6 mmol/L of sodium for each 100 mg/dL of glucose above 100, what is the corrected sodium?
  58. Serum sodium is 124 mmol/L and glucose is 600 mg/dL. Using the correction of 1.6 mmol/L of sodium for each 100 mg/dL of glucose above 100, what is the corrected sodium?
  59. Serum sodium is 128 mmol/L and glucose is 225 mg/dL. Using the correction of 1.6 mmol/L of sodium for each 100 mg/dL of glucose above 100, what is the corrected sodium?
  60. Serum sodium is 120 mmol/L and glucose is 475 mg/dL. Using the correction of 1.6 mmol/L of sodium for each 100 mg/dL of glucose above 100, what is the corrected sodium?
  61. Haematocrit is 30% and the red cell count is 4 x 10^12/L. What is the MCV (MCV = haematocrit x 10 / RBC count)?
  62. Haematocrit is 36% and the red cell count is 4.5 x 10^12/L. What is the MCV (MCV = haematocrit x 10 / RBC count)?
  63. Haematocrit is 42% and the red cell count is 4.2 x 10^12/L. What is the MCV (MCV = haematocrit x 10 / RBC count)?
  64. Haematocrit is 24% and the red cell count is 3 x 10^12/L. What is the MCV (MCV = haematocrit x 10 / RBC count)?
  65. Haematocrit is 33% and the red cell count is 3.3 x 10^12/L. What is the MCV (MCV = haematocrit x 10 / RBC count)?
  66. Haematocrit is 27% and the red cell count is 3 x 10^12/L. What is the MCV (MCV = haematocrit x 10 / RBC count)?
  67. A patient has a heart rate of 70 beats/min and a stroke volume of 70 mL. What is the cardiac output?
  68. A patient has a heart rate of 80 beats/min and a stroke volume of 75 mL. What is the cardiac output?
  69. A patient has a heart rate of 60 beats/min and a stroke volume of 100 mL. What is the cardiac output?
  70. A patient has a heart rate of 100 beats/min and a stroke volume of 50 mL. What is the cardiac output?
  71. A patient has a heart rate of 75 beats/min and a stroke volume of 80 mL. What is the cardiac output?
  72. A man has smoked 1.5 packs per day for 20 years. How many pack-years is that?
  73. A man has smoked 0.5 packs per day for 40 years. How many pack-years is that?
  74. A man has smoked 2 packs per day for 15 years. How many pack-years is that?
  75. A man has smoked 0.75 packs per day for 40 years. How many pack-years is that?
  76. A 24-year-old woman has fatigue, petechiae and a platelet count of 12 x 10^9/L. The rest of the blood count is normal. What is the most likely diagnosis?
  77. A patient has fever, haemolytic anaemia, thrombocytopenia, renal impairment and neurological signs. What is the emergency treatment?
  78. What is the characteristic cytogenetic abnormality of chronic myeloid leukaemia?
  79. A child with sickle cell disease presents with severe bone pain and fever. Which management is essential?
  80. Which test confirms iron deficiency most reliably?
  81. Which drug is the first-line treatment of acute gout in a patient with normal renal function?
  82. Which finding in joint fluid confirms gout?
  83. A young woman has a malar rash, arthritis, proteinuria and positive anti-dsDNA antibodies. What is the diagnosis?
  84. What is the first-line disease-modifying drug for rheumatoid arthritis?
  85. Which regimen is the standard initial therapy for pulmonary tuberculosis?
  86. Which vitamin should be given with isoniazid to prevent peripheral neuropathy?
  87. Which drug is most associated with a dry cough as a side effect?
  88. A patient on lithium presents with coarse tremor, vomiting, ataxia and confusion. Which cause should be suspected?
  89. Which electrolyte abnormality commonly precipitates digoxin toxicity?
  90. Which antibiotic class carries a risk of ototoxicity and nephrotoxicity?
  91. What is the first-line treatment for Clostridioides difficile infection?
  92. Which antimalarial treatment is first line for severe falciparum malaria?
  93. What CD4 count defines AIDS in an adult with HIV infection?
  94. A patient with HIV and CD4 count of 80 develops dry cough, breathlessness and bilateral interstitial infiltrates. Which organism is likely?
  95. What is the first-line treatment for early syphilis?
  96. Which marker indicates active hepatitis B infection?
  97. Which tumour marker is raised in hepatocellular carcinoma?
  98. A patient has diarrhoea, weight loss and anaemia, and a biopsy shows villous atrophy. Which antibody is the most specific blood test?
  99. Which feature suggests Crohn disease rather than ulcerative colitis?
  100. A woman with a history of pale stools, itching and raised alkaline phosphatase has positive anti-mitochondrial antibodies. What is the diagnosis?

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