ENAM Practice (Peru National Medical Examination) · Internal Medicine

Internal Medicine

41 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 41 questions

  1. A 58-year-old man has crushing chest pain for 40 minutes. The ECG shows ST elevation in leads II, III and aVF. Which artery is most likely occluded?
  2. Which drug is the usual first-line oral agent for a newly diagnosed adult with type 2 diabetes and normal kidney function?
  3. A man with diabetic ketoacidosis has glucose 28 mmol/L, pH 7.1 and serum potassium 3.0 mmol/L before any treatment. What should be done first?
  4. HbA1c reflects the average blood glucose over roughly which period?
  5. A 62-year-old man has fatigue, microcytic anaemia and a low ferritin. He has no bleeding symptoms. What is the most appropriate next step?
  6. A man with heart failure has a serum potassium of 6.4 mmol/L and the ECG shows peaked T waves and a widened QRS. What is the first treatment?
  7. A 72-year-old woman with hypertension and type 2 diabetes has atrial fibrillation. What is her CHA2DS2-VASc score?
  8. A patient has sudden dyspnoea and pleuritic chest pain after a long flight and a high pre-test probability of pulmonary embolism. What is the best test?
  9. What oxygen saturation target is recommended for a patient with an exacerbation of COPD at risk of hypercapnic respiratory failure?
  10. Which treatment combination is standard for an acute severe asthma attack in the emergency department?
  11. A 70-year-old man is confused, has a respiratory rate of 32 per minute, blood pressure 120/80 and a normal urea. He has pneumonia. What is his CURB-65 score?
  12. Which drugs make up the standard intensive-phase treatment of drug-susceptible pulmonary tuberculosis?
  13. Which finding defines nephrotic syndrome in an adult?
  14. A man with vomiting and diarrhoea has acute kidney injury. Which urine finding supports a pre-renal cause?
  15. A patient with a lung tumour has a serum sodium of 124 mmol/L, a low serum osmolality, a high urine osmolality and no oedema. What is the first-line management?
  16. A patient with cirrhosis and ascites has fever and abdominal tenderness. Which test confirms spontaneous bacterial peritonitis?
  17. A patient has HBsAg negative, anti-HBs positive and anti-HBc negative. What does this pattern show?
  18. A young woman has weight loss, tremor, a diffuse goitre and exophthalmos. Which antibody is responsible?
  19. How is replacement therapy with levothyroxine monitored in primary hypothyroidism?
  20. A man has hypotension, hyponatraemia, hyperkalaemia and skin pigmentation. Which test confirms the likely diagnosis?
  21. A man has macrocytic anaemia, loss of vibration sense and a sore tongue. Which antibody supports pernicious anaemia?
  22. A woman has MCV 62 fL, red cell count 6.1 million per microlitre and a normal ferritin. What is the Mentzer index and the most likely diagnosis?
  23. Which finding signals the transition to the critical phase of dengue and should prompt close monitoring?
  24. Which test is used to diagnose malaria in a febrile traveller returning from the Amazon?
  25. Which class of antihypertensive drug is contraindicated in pregnancy?
  26. Which adverse effect most typically limits statin therapy?
  27. Which drug class improves survival in heart failure with reduced ejection fraction?
  28. Which murmur is typical of severe aortic stenosis?
  29. An intravenous drug user has fever and a tricuspid valve vegetation. Which organism is most likely?
  30. Which two of the following criteria are needed, with a third, to diagnose acute pancreatitis?
  31. A man presents with melaena and a blood pressure of 85/50 mmHg. What is the first priority?
  32. Which drug is the usual first-line disease-modifying agent in rheumatoid arthritis?
  33. Which crystals are seen in the joint fluid of acute gout?
  34. A patient presents two hours after the onset of right-sided weakness and aphasia. What is the first investigation?
  35. Which cerebrospinal fluid pattern is typical of bacterial meningitis?
  36. Blood results: sodium 140, chloride 100 and bicarbonate 10 mmol/L. What is the anion gap and what does it mean?
  37. A patient has calcium 1.9 mmol/L and albumin 25 g/L. Using a correction of 0.02 mmol/L for each g/L of albumin below 40, what is the corrected calcium?
  38. Bartonella bacilliformis causes a biphasic illness in the Andean valleys of Peru. Which vector transmits it?
  39. A patient with acute kidney injury has creatinine 6 mg/dL, K 6.8 mmol/L with ECG changes and pulmonary oedema unresponsive to diuretics. What is the definitive treatment?
  40. A woman with diabetic ketoacidosis has glucose 26 mmol/L, pH 7.05 and serum potassium 5.8 mmol/L on admission. What is the correct approach to potassium?
  41. A man with inferior ST elevation has a blood pressure of 80/50 mmHg, a raised jugular venous pressure and clear lungs. What is the best initial management?

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