Egyptian Medical Licensing Examination (EMLE) · Clinical Medicine and Surgery

Internal Medicine and Therapeutics

86 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 86 questions

  1. A 58-year-old male presents with acute central chest pressure radiating to the left arm. ECG demonstrates ST-segment elevation of 2.5 mm in leads II, III, and aVF. Which coronary artery is most likely

  2. A 64-year-old female with chronic heart failure has persistent dyspnea and bilateral ankle edema despite enalapril and furosemide. Echocardiogram reveals an LVEF of 32%. Which drug has proven mortalit

  3. A 28-year-old female presents with heat intolerance, weight loss, fine hand tremor, and diffuse painless goiter. Laboratory tests show TSH < 0.01 mIU/L and elevated free T4. Which laboratory finding c

  4. A 45-year-old male with chronic hepatitis C cirrhosis presents with fever, generalized abdominal pain, and worsening ascites. Paracentesis yields cloudy fluid with an absolute neutrophil count of 340

  5. A 32-year-old male with type 1 diabetes presents to the emergency department with vomiting, abdominal pain, and Kussmaul respirations. Blood glucose is 480 mg/dL, arterial pH is 7.18, and serum bicarb

  6. A 68-year-old male smoker presents with progressive exertional dyspnea and chronic morning productive cough. Spirometry demonstrates a post-bronchodilator FEV1/FVC ratio of 0.58 and FEV1 of 62% predic

  7. A 72-year-old female presents with acute right-sided hemiparesis and aphasia starting 90 minutes ago. Non-contrast brain CT excludes intracranial hemorrhage. Blood pressure is 165/95 mmHg, and blood g

  8. A 42-year-old male presents with epigastric burning pain that improves with meals but awakens him at 2 AM. Endoscopy reveals a 1.2 cm duodenal ulcer, and a rapid urease test is positive. Which regimen

  9. A 50-year-old male with longstanding untreated hypertension presents for routine review. Serum creatinine is 2.4 mg/dL (baseline 1.0 mg/dL a year ago) and spot urine albumin-to-creatinine ratio is 340

  10. A 35-year-old female presents with bilateral symmetric polyarthritis involving the proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints, with morning stiffness lasting 90 minutes. Which

  11. A 24-year-old medical student sustains a needle-stick injury from an HBsAg-positive patient. The student received 3 hepatitis B vaccine doses 5 years ago, and current anti-HBs titer is 180 mIU/mL. Wha

  12. A 60-year-old male with chronic alcoholism presents with confusion, ataxia, and horizontal nystagmus. What is the immediate treatment required to prevent irreversible neurological damage?
  13. A 70-year-old male presents with progressive fatigue. Complete blood count shows Hb 8.2 g/dL, MCV 112 fL, platelets 110,000/uL, and WBC 3,800/uL. Peripheral blood smear shows hypersegmented neutrophil

  14. A 52-year-old male presents with acute severe pain, swelling, and erythema of the right first metatarsophalangeal joint. Arthrocentesis demonstrates needle-shaped, negatively birefringent crystals und

  15. A 30-year-old female presents with recurrent episodes of palpitations, episodic headaches, and diaphoresis. Her blood pressure is 195/110 mmHg. Which screening diagnostic test is most sensitive for th

  16. A 65-year-old male with community-acquired pneumonia has a respiratory rate of 32/min, blood pressure 85/55 mmHg, confusion, and blood urea nitrogen of 28 mg/dL. What is his CURB-65 score and recommen

  17. Which antiretroviral drug class includes dolutegravir and bictegravir, forming the core of modern first-line HIV treatment regimens?
  18. A 45-year-old female presents with jaundice, pruritus, fatigue, and elevated alkaline phosphatase. Serum antimitochondrial antibodies (AMA) are positive at high titer. Liver biopsy shows granulomatous

  19. A 60-year-old male with acute renal failure following iodinated contrast CT has peaked T-waves and widened QRS complexes on ECG. Serum potassium is 7.2 mEq/L. What is the immediate first drug to admin

  20. Which pathogen is the most common cause of community-acquired bacterial meningitis in immunocompetent adults?
  21. A 25-year-old male presents with recurrent episodes of hemoptysis and hematuria. Renal biopsy shows linear deposition of IgG along the glomerular basement membrane on immunofluorescence. What is the d

  22. A 74-year-old male with persistent atrial fibrillation has a CHA2DS2-VASc score of 4. Which anticoagulant therapy is recommended for long-term stroke prevention in the absence of mechanical prosthetic

  23. Which physical examination finding is most characteristic of severe aortic stenosis?
  24. A 38-year-old male presents with progressive fatigue, hyperpigmentation of palmar creases and buccal mucosa, orthostatic hypotension, and hyponatremia with hyperkalemia. What is the diagnosis?
  25. A 29-year-old female presents with painful oral ulcers, genital aphthae, and recurrent anterior uveitis. What is the most likely systemic vasculitis?
  26. What is the target therapeutic International Normalized Ratio (INR) for a patient receiving warfarin for a mechanical bileaflet aortic valve prosthesis without other thromboembolic risk factors?
  27. A 58-year-old male presents with sudden-onset crushing chest pain radiating to the left arm. ECG shows 3 mm ST elevation in leads II, III, and aVF with reciprocal depression in I and aVL. What is the

  28. A 24-year-old female with type 1 diabetes presents comatose with deep, rapid respirations. Blood glucose is , arterial pH , bicarbonate , and serum potassium

  29. A 65-year-old male presents with sudden right-sided hemiplegia and expressive aphasia starting 90 minutes ago. Non-contrast head CT shows no hemorrhage. Blood pressure is . What is

  30. A 70-year-old male with septic shock remains hypotensive (MAP ) despite crystalloid fluid resuscitation. What is the first-line vasopressor of choice?
  31. A 45-year-old female presents with sudden severe epigastric pain radiating to the back. Serum lipase is (normal ). What is the most common underlying etiology requiring abdomin

  32. A patient has Naâș 141 mmol/L, glucose 180 mg/dL and urea (BUN) 14 mg/dL. What is the calculated serum osmolality (mOsm/kg)? Use .
  33. A patient's serum values are Naâș 132 mmol/L, Cl⁻ 99 mmol/L and HCO₃⁻ 14 mmol/L. What is the anion gap?
  34. An ECG shows a QT interval of 252 ms and an R–R interval of 0.36 s. What is the corrected QT (Bazett's formula, QTc )?
  35. On a regular ECG running at 25 mm/s, the R–R interval is 6 large squares. What is the heart rate?
  36. A patient has a measured serum calcium of 6.9 mg/dL and an albumin of 2.8 g/dL. What is the corrected calcium?
  37. A patient has Naâș 148 mmol/L, glucose 90 mg/dL and urea (BUN) 56 mg/dL. What is the calculated serum osmolality (mOsm/kg)? Use .
  38. An ECG shows a QT interval of 400 ms and an R–R interval of 0.64 s. What is the corrected QT (Bazett's formula, QTc )?
  39. A patient has a measured serum calcium of 7.2 mg/dL and an albumin of 1.8 g/dL. What is the corrected calcium?
  40. A patient has Naâș 128 mmol/L, glucose 180 mg/dL and urea (BUN) 14 mg/dL. What is the calculated serum osmolality (mOsm/kg)? Use .
  41. A young woman has a malar rash, arthralgia and anti-dsDNA antibodies. What is the diagnosis?
  42. A patient has a heart rate of 60 beats/min and a stroke volume of 70 mL. What is the cardiac output?
  43. A patient has an end-diastolic volume of 120 mL and an end-systolic volume of 90 mL. What is the ejection fraction?
  44. On a regular ECG running at 25 mm/s, the R–R interval is 10 large squares. What is the heart rate?
  45. A patient has a heart rate of 70 beats/min and a stroke volume of 60 mL. What is the cardiac output?
  46. A 41-year-old man weighing 87 kg has a serum creatinine of 2 mg/dL. Using the Cockcroft–Gault equation, what is the estimated creatinine clearance (mL/min), rounded to the nearest whole number?
  47. A patient has a heart rate of 60 beats/min and a stroke volume of 80 mL. What is the cardiac output?
  48. On a regular ECG running at 25 mm/s, the R–R interval is 2 large squares. What is the heart rate?
  49. A patient's serum values are Naâș 139 mmol/L, Cl⁻ 107 mmol/L and HCO₃⁻ 19 mmol/L. What is the anion gap?
  50. A 32-year-old woman has a blood pressure of 111/70 mmHg. What is the mean arterial pressure, to the nearest whole number?
  51. Ptosis and double vision that worsen by evening in a young woman, with antibodies to acetylcholine receptors, suggest what?
  52. A patient with atrial fibrillation has the following: age 65 to 74, diabetes mellitus, female sex. What is the CHA₂DS₂-VASc score? (Heart failure 1, hypertension 1, age ≄75 2, diabetes 1, stroke/TIA 2

  53. A patient has a measured serum calcium of 6.7 mg/dL and an albumin of 2.9 g/dL. What is the corrected calcium?
  54. A screening test gives true positives 78, false negatives 12, true negatives 172 and false positives 45. What is its sensitivity?
  55. In a trial, 40% of the control group and 5% of the treated group had the event. What is the number needed to treat?
  56. A patient's serum values are Naâș 141 mmol/L, Cl⁻ 107 mmol/L and HCO₃⁻ 19 mmol/L. What is the anion gap?
  57. On a regular ECG running at 25 mm/s, the R–R interval is 3 large squares. What is the heart rate?
  58. A patient has an end-diastolic volume of 180 mL and an end-systolic volume of 63 mL. What is the ejection fraction?
  59. A screening test gives true positives 74, false negatives 14, true negatives 95 and false positives 25. What is its sensitivity?
  60. A patient has a heart rate of 60 beats/min and a stroke volume of 60 mL. What is the cardiac output?
  61. A patient shows eye opening to voice, no verbal response and obeys commands. What is the Glasgow Coma Scale score?
  62. A 54-year-old woman has a blood pressure of 112/62 mmHg. What is the mean arterial pressure, to the nearest whole number?
  63. A COPD patient is most likely to benefit in terms of survival from which intervention?
  64. A patient shows no eye opening, orientated speech and extension to pain. What is the Glasgow Coma Scale score?
  65. Continuous inflammation starting in the rectum and limited to the mucosa is typical of which condition?
  66. A screening test gives true positives 48, false negatives 30, true negatives 80 and false positives 37. What is its specificity?
  67. A 58-year-old woman weighing 79 kg has a serum creatinine of 1 mg/dL. Using the Cockcroft–Gault equation, what is the estimated creatinine clearance (mL/min), rounded to the nearest whole number?
  68. A screening test gives true positives 55, false negatives 33, true negatives 52 and false positives 27. What is its sensitivity?
  69. A 28-year-old man has a blood pressure of 174/74 mmHg. What is the mean arterial pressure, to the nearest whole number?
  70. A 46-year-old man weighing 84 kg has a serum creatinine of 1.2 mg/dL. Using the Cockcroft–Gault equation, what is the estimated creatinine clearance (mL/min), rounded to the nearest whole number?
  71. A 60-year-old woman has a blood pressure of 94/68 mmHg. What is the mean arterial pressure, to the nearest whole number?
  72. In a trial, 50% of the control group and 5% of the treated group had the event. What is the number needed to treat?
  73. A patient has an end-diastolic volume of 160 mL and an end-systolic volume of 56 mL. What is the ejection fraction?
  74. A patient's serum values are Naâș 130 mmol/L, Cl⁻ 100 mmol/L and HCO₃⁻ 10 mmol/L. What is the anion gap?
  75. A patient shows spontaneous eye opening, no verbal response and abnormal flexion to pain. What is the Glasgow Coma Scale score?
  76. In a trial, 20% of the control group and 5% of the treated group had the event. What is the number needed to treat?
  77. A patient with atrial fibrillation has the following: female sex, congestive heart failure, age 75 or over, peripheral vascular disease. What is the CHA₂DS₂-VASc score? (Heart failure 1, hypertension

  78. A 49-year-old woman weighing 90 kg has a serum creatinine of 2 mg/dL. Using the Cockcroft–Gault equation, what is the estimated creatinine clearance (mL/min), rounded to the nearest whole number?
  79. A patient has an end-diastolic volume of 150 mL and an end-systolic volume of 105 mL. What is the ejection fraction?
  80. A patient with atrial fibrillation has the following: female sex, age 75 or over. What is the CHA₂DS₂-VASc score? (Heart failure 1, hypertension 1, age ≄75 2, diabetes 1, stroke/TIA 2, vascular diseas

  81. In a trial, 40% of the control group and 25% of the treated group had the event. What is the number needed to treat?
  82. A patient with atrial fibrillation has the following: age 65 to 74, peripheral vascular disease, female sex, diabetes mellitus. What is the CHA₂DS₂-VASc score? (Heart failure 1, hypertension 1, age ≄7

  83. A patient has a measured serum calcium of 8.2 mg/dL and an albumin of 2 g/dL. What is the corrected calcium?
  84. An ECG shows a QT interval of 288 ms and an R–R interval of 0.36 s. What is the corrected QT (Bazett's formula, QTc )?
  85. An ECG shows a QT interval of 304 ms and an R–R interval of 0.64 s. What is the corrected QT (Bazett's formula, QTc )?
  86. A patient has Naâș 139 mmol/L, glucose 90 mg/dL and urea (BUN) 42 mg/dL. What is the calculated serum osmolality (mOsm/kg)? Use .

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