Jordanian Medical Licensing Examination (JMLE) · Clinical Medicine and General Surgery

Internal Medicine and Clinical 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 with long-standing type 2 diabetes presents for routine follow-up. Blood pressure is 148/92 mmHg, and urine albumin-to-creatinine ratio is 180 mg/g. Which antihypertensive drug clas…
  2. A 65-year-old female presents to the emergency department with acute crushing substernal chest pain radiating to her left arm. ECG demonstrates 2.5 mm ST-segment elevation in leads V1 through V4. What…
  3. A 42-year-old male presents with fatigue, cold intolerance, constipation, and a 5 kg weight gain over 3 months. Laboratory testing reveals an elevated TSH of 14.2 mIU/L (reference: 0.4-4.0) and a low…
  4. A 30-year-old female presents with acute shortness of breath and right-sided pleuritic chest pain 5 days after returning from a 12-hour international flight. She takes oral contraceptive pills. D-dime…
  5. A 72-year-old male with chronic atrial fibrillation is evaluated for stroke risk. He has a history of hypertension, type 2 diabetes, and a prior ischemic stroke 2 years ago. According to the CHA2DS2-V…
  6. A 24-year-old university student is brought to the hospital with a 1-day history of high fever, severe headache, photophobia, and neck stiffness. Physical examination reveals positive Kernig and Brudz…
  7. A 50-year-old male presents with burning epigastric pain that worsens 2 to 3 hours after meals and frequently awakens him at night. Pain is partially relieved by antacids. Endoscopy reveals a solitary…
  8. A 35-year-old female presents with palpitations, tremors, heat intolerance, and unintended weight loss. Physical examination reveals diffuse painless thyroid enlargement and mild bilateral proptosis.…
  9. A 68-year-old male with chronic obstructive pulmonary disease (COPD) presents with increased sputum purulence, increased sputum volume, and worsening dyspnea. Vital signs show SpO2 88% on room air. Wh…
  10. A 45-year-old female with systemic lupus erythematosus presents with lower extremity edema and new-onset hypertension. Urinalysis reveals 4+ protein, microscopic hematuria, and red blood cell casts. S…
  11. A 60-year-old male with a 40 pack-year smoking history presents with painless gross hematuria. Physical examination is unremarkable. Renal function tests are normal. What is the mandatory next step in…
  12. A 32-year-old male presents with recurrent episodes of bloody diarrhea, crampy lower abdominal pain, tenesmus, and weight loss. Colonoscopy reveals continuous mucosal erythema, loss of vascular patter…
  13. A 54-year-old female presents with fatigue and jaundice. Laboratory tests demonstrate unconjugated hyperbilirubinemia, elevated serum lactate dehydrogenase (LDH), undetectable haptoglobin, and a posit…
  14. A 28-year-old female presents with bilateral symmetric inflammatory polyarthritis affecting the proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints, accompanied by morning stiffness la…
  15. A 70-year-old male presents with acute right-sided hemiparesis and expressive aphasia starting 75 minutes prior to arrival. Non-contrast CT of the brain demonstrates no intracranial hemorrhage. Blood…
  16. A 62-year-old male with cirrhosis secondary to chronic hepatitis C presents with progressive abdominal distension. Paracentesis reveals clear straw-colored fluid with an albumin concentration of 0.8 g…
  17. A 22-year-old male with type 1 diabetes presents with nausea, vomiting, abdominal pain, and rapid deep breathing (Kussmaul respiration). Fingerstick glucose is 420 mg/dL. Arterial blood gas shows pH 7…
  18. A 40-year-old male presents with excruciating unilateral flank pain radiating to the groin, accompanied by microscopic hematuria. Non-contrast spiral CT of the abdomen confirms a 4 mm stone in the dis…
  19. A 73-year-old female presents with sudden onset of severe headache, scalp tenderness over the temple, jaw claudication while chewing, and transient visual blurring in her right eye. Erythrocyte sedime…
  20. A 36-year-old male with HIV infection (CD4 count 65 cells/mcL) presents with progressive exertional dyspnea, non-productive cough, and low-grade fever. Chest radiography shows bilateral diffuse inters…
  21. A 66-year-old male with chronic kidney disease (baseline eGFR 22 mL/min/1.73m2) presents with muscle weakness. ECG demonstrates tall, peaked, narrow T waves with a shortened QT interval. Serum potassi…
  22. A 29-year-old female presents with fatigue and jaundice. Physical examination reveals Kayser-Fleischer rings on slit-lamp examination. Serum ceruloplasmin is markedly decreased, and 24-hour urinary co…
  23. A 52-year-old male presents with generalized weakness, recurrent kidney stones, and bone pain. Blood tests show serum calcium 11.8 mg/dL (reference: 8.5-10.2), serum phosphate 2.1 mg/dL (reference: 2.…
  24. A 48-year-old male with alcoholic cirrhosis presents with fever, abdominal pain, and confusion. Paracentesis demonstrates cloudy ascites with an absolute neutrophil count (ANC) of 450 cells/mm3. What…
  25. A 31-year-old female presents with multiple episodes of neurological deficit separated in time and space, including left optic neuritis and right lower extremity paresthesias. Brain MRI reveals multip…
  26. A 64-year-old female with long-standing poorly controlled hypertension presents with acute dyspnea, orthopnea, and bilateral crackles up to the mid-lung fields. Echocardiography demonstrates a left ve…
  27. A patient is found to have glucose 28 mmol/L, ketones in the urine and deep rapid breathing. What is the diagnosis?
  28. A patient has a measured serum calcium of 9.2 mg/dL and an albumin of 2.1 g/dL. What is the corrected calcium?
  29. A 65-year-old woman weighing 71 kg has a serum creatinine of 0.8 mg/dL. Using the Cockcroft–Gault equation, what is the estimated creatinine clearance (mL/min), rounded to the nearest whole number?
  30. A patient has an end-diastolic volume of 180 mL and an end-systolic volume of 126 mL. What is the ejection fraction?
  31. Ascending symmetrical weakness with areflexia two weeks after a diarrhoeal illness suggests what?
  32. An ECG shows a QT interval of 352 ms and an R–R interval of 0.64 s. What is the corrected QT (Bazett's formula, QTc )?
  33. A patient has Na⁺ 144 mmol/L, glucose 180 mg/dL and urea (BUN) 42 mg/dL. What is the calculated serum osmolality (mOsm/kg)? Use .
  34. A 32-year-old woman has a blood pressure of 169/89 mmHg. What is the mean arterial pressure, to the nearest whole number?
  35. A patient has an end-diastolic volume of 160 mL and an end-systolic volume of 112 mL. What is the ejection fraction?
  36. A 70-year-old man has a blood pressure of 173/96 mmHg. What is the mean arterial pressure, to the nearest whole number?
  37. A patient shows spontaneous eye opening, confused speech and withdrawal from pain. What is the Glasgow Coma Scale score?
  38. A patient has Na⁺ 133 mmol/L, glucose 180 mg/dL and urea (BUN) 42 mg/dL. What is the calculated serum osmolality (mOsm/kg)? Use .
  39. A patient's serum values are Na⁺ 141 mmol/L, Cl⁻ 100 mmol/L and HCO₃⁻ 19 mmol/L. What is the anion gap?
  40. A patient shows eye opening to pain, confused speech and withdrawal from pain. What is the Glasgow Coma Scale score?
  41. A 65-year-old man has a blood pressure of 162/66 mmHg. What is the mean arterial pressure, to the nearest whole number?
  42. A patient has a heart rate of 80 beats/min and a stroke volume of 80 mL. What is the cardiac output?
  43. A patient with atrial fibrillation has the following: hypertension, age 75 or over, previous stroke or TIA. What is the CHA₂DS₂-VASc score? (Heart failure 1, hypertension 1, age ≥75 2, diabetes 1, str…
  44. Severe epigastric pain radiating to the back with a markedly raised serum lipase after heavy alcohol use suggests what?
  45. A patient has a measured serum calcium of 9.5 mg/dL and an albumin of 1.9 g/dL. What is the corrected calcium?
  46. An ECG shows a QT interval of 300 ms and an R–R interval of 0.36 s. What is the corrected QT (Bazett's formula, QTc )?
  47. Night sweats, weight loss and haemoptysis with an upper-lobe cavity on chest X-ray suggest which infection?
  48. A patient has an end-diastolic volume of 160 mL and an end-systolic volume of 120 mL. What is the ejection fraction?
  49. A patient has a sodium of 118 mmol/L, low serum osmolality and a urine osmolality above 100 mOsm/kg with euvolaemia. What is the diagnosis?
  50. Which anticoagulant requires monitoring with the INR?
  51. A patient's serum values are Na⁺ 141 mmol/L, Cl⁻ 103 mmol/L and HCO₃⁻ 13 mmol/L. What is the anion gap?
  52. Which bacterium is most strongly associated with duodenal ulcers?
  53. A patient has an end-diastolic volume of 140 mL and an end-systolic volume of 105 mL. What is the ejection fraction?
  54. A 43-year-old man weighing 83 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?
  55. An ECG shows a QT interval of 336 ms and an R–R interval of 0.64 s. What is the corrected QT (Bazett's formula, QTc )?
  56. A patient's serum values are Na⁺ 141 mmol/L, Cl⁻ 98 mmol/L and HCO₃⁻ 19 mmol/L. What is the anion gap?
  57. In a trial, 50% of the control group and 15% of the treated group had the event. What is the number needed to treat?
  58. In a trial, 25% of the control group and 10% of the treated group had the event. What is the number needed to treat?
  59. A patient shows eye opening to pain, no verbal response and obeys commands. What is the Glasgow Coma Scale score?
  60. A patient has a heart rate of 90 beats/min and a stroke volume of 60 mL. What is the cardiac output?
  61. A patient has a measured serum calcium of 8.7 mg/dL and an albumin of 1.8 g/dL. What is the corrected calcium?
  62. A 55-year-old man weighing 54 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?
  63. In a trial, 50% of the control group and 30% of the treated group had the event. What is the number needed to treat?
  64. A patient has Na⁺ 148 mmol/L, glucose 270 mg/dL and urea (BUN) 42 mg/dL. What is the calculated serum osmolality (mOsm/kg)? Use .
  65. A patient has a measured serum calcium of 8 mg/dL and an albumin of 2.3 g/dL. What is the corrected calcium?
  66. A patient shows eye opening to pain, no verbal response and no motor response. What is the Glasgow Coma Scale score?
  67. A patient's serum values are Na⁺ 135 mmol/L, Cl⁻ 108 mmol/L and HCO₃⁻ 16 mmol/L. What is the anion gap?
  68. A patient with atrial fibrillation has the following: congestive heart failure, female sex. What is the CHA₂DS₂-VASc score? (Heart failure 1, hypertension 1, age ≥75 2, diabetes 1, stroke/TIA 2, vascu…
  69. On a regular ECG running at 25 mm/s, the R–R interval is 5 large squares. What is the heart rate?
  70. A screening test gives true positives 90, false negatives 5, true negatives 148 and false positives 27. What is its positive predictive value?
  71. A screening test gives true positives 53, false negatives 24, true negatives 146 and false positives 40. What is its specificity?
  72. A patient has a heart rate of 80 beats/min and a stroke volume of 60 mL. What is the cardiac output?
  73. A 28-year-old man has a blood pressure of 151/54 mmHg. What is the mean arterial pressure, to the nearest whole number?
  74. A patient has Na⁺ 146 mmol/L, glucose 450 mg/dL and urea (BUN) 28 mg/dL. What is the calculated serum osmolality (mOsm/kg)? Use .
  75. A patient has a measured serum calcium of 7.3 mg/dL and an albumin of 2.1 g/dL. What is the corrected calcium?
  76. A patient has fatigue, weight gain, cold intolerance and a high TSH with a low free T4. What is the diagnosis?
  77. Bence Jones proteins in the urine, lytic bone lesions and hypercalcaemia suggest what?
  78. A 56-year-old woman weighing 89 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?
  79. A patient has an end-diastolic volume of 120 mL and an end-systolic volume of 42 mL. What is the ejection fraction?
  80. An ECG shows a QT interval of 432 ms and an R–R interval of 0.81 s. What is the corrected QT (Bazett's formula, QTc )?
  81. On a regular ECG running at 25 mm/s, the R–R interval is 4 large squares. What is the heart rate?
  82. In a trial, 50% of the control group and 10% of the treated group had the event. What is the number needed to treat?
  83. A screening test gives true positives 82, false negatives 6, true negatives 57 and false positives 57. What is its specificity?
  84. Which drug reverses opioid-induced respiratory depression?
  85. A patient with atrial fibrillation has the following: congestive heart failure, age 65 to 74. What is the CHA₂DS₂-VASc score? (Heart failure 1, hypertension 1, age ≥75 2, diabetes 1, stroke/TIA 2, vas…
  86. A patient has a measured serum calcium of 8.8 mg/dL and an albumin of 1.9 g/dL. What is the corrected calcium?

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