SMLE (Saudi Medical Licensing Exam) Ā· Internal Medicine

Cardiovascular, Respiratory, Endocrine, Nephrology and Infectious Diseases

34 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 34 questions

  1. A 58-year-old male presents to the emergency department with severe substernal chest pressure radiating to his left jaw for 90 minutes. ECG demonstrates 3-mm ST-segment elevation in leads II, III, andā€¦
  2. A 64-year-old female with a history of long-standing hypertension presents with dyspnea on minimal exertion and bilateral ankle edema. Echocardiography reveals a left ventricular ejection fraction ofā€¦
  3. A 45-year-old female presents with fatigue, cold intolerance, weight gain, and constipation. Physical examination reveals delayed relaxation of deep tendon reflexes and non-pitting periorbital edema.ā€¦
  4. A 32-year-old male with type 1 diabetes presents to the emergency department with nausea, vomiting, diffuse abdominal pain, and deep, rapid respirations (Kussmaul breathing). Point-of-care capillary gā€¦
  5. A 68-year-old male smoker presents with a 2-month history of productive morning cough and worsening exertional dyspnea. Spirometry reveals a post-bronchodilator FEV1/FVC ratio of 0.58 and an FEV1 of 6ā€¦
  6. A 52-year-old male with chronic hepatitis B cirrhosis presents with increasing abdominal distension and fever. Paracentesis is performed, and ascitic fluid analysis reveals an absolute neutrophil counā€¦
  7. A 40-year-old male presents with sudden onset of severe excruciating pain and erythema in his right first metatarsophalangeal joint (podagra). Arthrocentesis yields synovial fluid demonstrating needleā€¦
  8. A 35-year-old female presents with persistent daytime fatigue, muscle weakness, and weight loss. On examination, she exhibits diffuse hyperpigmentation of palmar creases and buccal mucosa. Blood pressā€¦
  9. A 62-year-old male with a history of hypertension and diabetes is admitted with acute ischemic stroke. Non-contrast head CT rules out intracranial hemorrhage. Symptom onset was verified as exactly 2 hā€¦
  10. A 24-year-old male university student is brought to the emergency department with high fever, severe headache, photophobia, and neck stiffness. Lumbar puncture reveals opening pressure of 260 mm H2Oā€¦
  11. A 72-year-old male with chronic kidney disease (baseline creatinine 1.8 mg/dL) develops sudden hyperkalemia with a serum potassium of 7.2 mmol/L. ECG shows tall peaked T waves, widening of the QRS comā€¦
  12. A 30-year-old female presents with persistent bloody diarrhea (6-8 bowel movements daily), lower abdominal cramping, and tenesmus for 6 weeks. Colonoscopy demonstrates continuous, diffuse, superficialā€¦
  13. A 60-year-old female presents with a 3-week history of severe unilateral temporal headache, jaw claudication while chewing, and low-grade fever. Erythrocyte sedimentation rate (ESR) is markedly elevatā€¦
  14. A 48-year-old female presents with progressive fatigue, jaundice, and pruritus. Laboratory investigation reveals total bilirubin 3.8 mg/dL, alkaline phosphatase 540 IU/L (elevated), and AST/ALT only mā€¦
  15. A 55-year-old male with a history of deep vein thrombosis is receiving unfractionated heparin. On day 6 of therapy, his platelet count drops precipitously from 260,000/mm^3 to 85,000/mm^3 (a > 50% droā€¦
  16. A 28-year-old female presents with malar facial erythema, photosensitivity, symmetric polyarthritis of the hands, and pleuritic chest pain. Laboratory evaluation reveals antinuclear antibodies (ANA) pā€¦
  17. A 65-year-old male with chronic kidney disease presents with severe normocytic, normochromic anemia (hemoglobin 7.8 g/dL). Ferritin is 280 ng/mL and transferrin saturation is 28% (iron stores replete)ā€¦
  18. A 34-year-old male presents with acute fever, chills, and productive cough with rust-colored sputum. Chest radiograph confirms dense lobar consolidation in the right middle lobe. What is the most commā€¦
  19. A 50-year-old male is evaluated for resistant hypertension. Serum electrolytes demonstrate persistent hypokalemia (potassium 2.9 mmol/L) despite normal renal function. Plasma aldosterone concentrationā€¦
  20. A 63-year-old female presents with sudden onset of palpitations, lightheadedness, and shortness of breath. ECG reveals an irregularly irregular rhythm with narrow QRS complexes and absence of discerniā€¦
  21. A 22-year-old male presents with acute right knee swelling, warmth, and intense pain. Arthrocentesis reveals cloudy synovial fluid with 85,000 WBCs/mm^3 (95% neutrophils). Gram stain reveals intracellā€¦
  22. A 70-year-old male with chronic lymphocytic leukemia (CLL) is admitted with febrile neutropenia (absolute neutrophil count 350 cells/mm^3 and temperature 38.6Ā°C). Which empirical monotherapy antibiotiā€¦
  23. A 42-year-old female presents with recurrent episodes of intense vertigo lasting 2 to 4 hours, accompanied by fluctuating low-frequency sensorineural hearing loss, roaring tinnitus, and a sensation ofā€¦
  24. A 54-year-old male with long-standing alcohol use disorder is brought to the hospital confused and ataxia. Physical examination demonstrates bilateral horizontal nystagmus, ophthalmoplegia, and profouā€¦
  25. A 60-year-old female presents with progressive fatigue and exertional dyspnea. Peripheral blood smear reveals macro-ovalocytes and hypersegmented neutrophils (neutrophils with 6 or more nuclear lobes)ā€¦
  26. A 38-year-old female presents with episodic throbbing headache, palpitations, and profuse diaphoresis. Blood pressure is 210/115 mmHg. 24-hour urinary fractionated metanephrines are elevated four-foldā€¦
  27. A 67-year-old male with chronic smoking history presents with painless gross hematuria and weight loss. What is the most definitive diagnostic investigation to evaluate for bladder carcinoma?
  28. A 29-year-old male with known HIV infection (CD4 count 65 cells/mm^3) presents with subacute fever, dry non-productive cough, and exertional hypoxia. Chest radiography demonstrates diffuse bilateral iā€¦
  29. A 64-year-old man with chronic kidney disease taking an ACE inhibitor and spironolactone has potassium 7.2 mmol/L. The ECG shows peaked T waves and a widened QRS complex. Which sequence of treatment iā€¦
  30. A 70-year-old woman presents 2 hours after onset of right-sided weakness and aphasia. CT shows no haemorrhage. Her blood pressure is 195/110 mmHg and she has no contraindication otherwise. What shouldā€¦
  31. A 52-year-old man with leg swelling and pleuritic chest pain is haemodynamically stable. CT pulmonary angiography shows bilateral pulmonary emboli with right ventricular dilatation, and troponin is elā€¦
  32. A 45-year-old woman with small cell lung cancer has a generalised seizure. Serum sodium is 108 mmol/L, serum osmolality is low, urine sodium is high and she is euvolaemic. What is the best immediate tā€¦
  33. A 62-year-old man with type 2 diabetes, HbA1c 8.4 percent, heart failure with reduced ejection fraction and an eGFR of 45 mL/min/1.73 m2 is on metformin. Which add-on agent is most appropriate?
  34. A 63-year-old man has fever, neck stiffness and confusion. A CT of the head is normal and lumbar puncture shows turbid cerebrospinal fluid with neutrophils and low glucose. What empirical regimen is mā€¦

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