Kuwait Medical Licensing Examination (KMLE / KIMS) · Clinical Medicine And Surgery

Internal Medicine and Emergency Therapeutics

31 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 31 questions

  1. A 65-year-old male with type 2 diabetes presents with acute retrosternal chest pain radiating to his left shoulder for 45 minutes. ECG shows 3 mm ST-segment elevation in leads II, III, and aVF with re…
  2. A 58-year-old female presents to the emergency department with fever (39.1°C), altered mental status, and severe dysuria. Blood pressure is 78/48 mmHg, heart rate is 126 bpm, and serum lactate is 4.2…
  3. A 72-year-old male with chronic heart failure (ejection fraction 28%) presents with progressive orthopnea, bilateral lower extremity pitting edema, and elevated jugular venous pressure. Which drug cla…
  4. A 66-year-old female presents with palpitations and lightheadedness. ECG confirms rapid Atrial Fibrillation with a ventricular response rate of 145 bpm. Blood pressure is 125/82 mmHg. She has a histor…
  5. A 54-year-old male presents with sudden pleuritic right-sided chest pain, acute dyspnea, and hemoptysis. Heart rate is 118 bpm, respiratory rate is 26/min, and oxygen saturation is 91% on room air. We…
  6. A 62-year-old male with severe chronic obstructive pulmonary disease (COPD) presents with worsening dyspnea, wheezing, and purulent sputum production. Arterial blood gas shows pH 7.30, PaCO2 60 mmHg…
  7. A 45-year-old male with decompensated alcoholic cirrhosis presents with diffuse abdominal pain, fever (38.5°C), and increasing ascites. Diagnostic paracentesis yields cloudy fluid with an absolute neu…
  8. A 24-year-old female presents with severe agitation, profuse sweating, palpitations, and fever (39.5°C). Examination reveals a diffuse goiter with a bruit, exophthalmos, atrial fibrillation with ventr…
  9. A 68-year-old male with end-stage renal disease misses two consecutive hemodialysis sessions. He presents with severe generalized muscle weakness. ECG demonstrates tall peaked T-waves, PR interval pro…
  10. A 70-year-old female presents with severe pain and throbbing in her right temple, scalp tenderness when brushing her hair, jaw claudication while chewing, and transient blurring of vision in her right…
  11. A 30-year-old female presents with petechial rash, fever, profound fatigue, and fluctuating confusion. Laboratory workup reveals: Hb 7.2 g/dL, Platelets 14,000/uL, serum LDH 1850 U/L, total bilirubin…
  12. A 50-year-old male with a history of alcohol use presents with sudden hematemesis and melena. Vital signs: BP 85/50 mmHg, HR 122 bpm. Physical examination reveals spider angiomas, palmar erythema, and…
  13. A 28-year-old male is brought to the emergency department in continuous generalized tonic-clonic convulsions lasting 25 minutes without regaining consciousness. IV access has been established. What is…
  14. A 35-year-old male presents with severe headache, photophobia, fever (39.2°C), and neck stiffness. Kernig's and Brudzinski's signs are positive. Suspecting acute bacterial meningitis, which adjuvant m…
  15. A 60-year-old female presents with acute left-sided hemiparesis and facial droop that started 90 minutes ago. Non-contrast head CT rules out intracranial hemorrhage and large hypodense infarction. Blo…
  16. A 68-year-old male with chronic cough presents with fever, right lower lobe consolidation, confusion, blood urea nitrogen (BUN) 28 mg/dL, respiratory rate 32/min, and blood pressure 88/56 mmHg. His CU…
  17. A 22-year-old female presents with acute severe asthma exacerbation. She speaks in single words, respiratory rate is 36/min, heart rate is 130 bpm, and oxygen saturation is 88% on room air. Auscultati…
  18. A 21-year-old male with Type 1 Diabetes presents with nausea, vomiting, abdominal pain, and Kussmaul respirations. Blood glucose is 420 mg/dL, arterial pH is 7.18, serum bicarbonate is 11 mEq/L, and s…
  19. A 74-year-old male with type 2 diabetes presents with progressive lethargy, extreme thirst, and dry mucous membranes. Blood glucose is 980 mg/dL, serum sodium is 148 mEq/L, serum osmolality is 360 mOs…
  20. A 64-year-old female presents with confusion, generalized seizures, and severe hyponatremia (serum sodium 108 mEq/L). What is the immediate treatment to stop neurological symptoms, and what is the max…
  21. An 80-year-old male with acute-on-chronic kidney disease presents with severe oliguria, asterixis, pericardial friction rub, blood urea nitrogen (BUN) 140 mg/dL, serum creatinine 9.2 mg/dL, and serum…
  22. A 38-year-old female with known Addison's disease on maintenance hydrocortisone presents with severe gastroenteritis, persistent vomiting, hypotension (BP 72/44 mmHg), abdominal pain, and hypoglycemia…
  23. A 48-year-old male with a prosthetic aortic valve presents with fever (38.8°C), new systolic heart murmur, splinter hemorrhages beneath his nails, and painless erythematous macules on his palms (Janew…
  24. A 65-year-old hospitalized patient develops profuse watery diarrhea (8 unformed stools per day), crampy abdominal pain, and leukocytosis (WBC 16,000/uL) five days after completing a course of clindamy…
  25. A 55-year-old male with prior myocardial infarction presents with sudden palpitations. ECG confirms monomorphic Ventricular Tachycardia (VT) with a rate of 170 bpm. Blood pressure is 122/80 mmHg, he i…
  26. A 23-year-old male is stung by a bee and within minutes develops generalized urticaria, facial and laryngeal edema, severe stridor, and dizziness. Blood pressure is 74/40 mmHg and heart rate is 135 bp…
  27. A 58-year-old male with type 2 diabetes and hypertension is brought to emergency with acute crushing retrosternal pain radiating to the jaw. ECG shows 3 mm ST elevation in V1-V4. Heart rate is 52 bpm…
  28. A 46-year-old woman presents with persistent abdominal pain, watery diarrhea, and flushing. CT reveals a 4 cm pancreatic tail mass with multiple liver metastases. Serum fasting gastrin is normal, but…
  29. A 32-year-old male with ulcerative colitis on azathioprine presents with acute high fever, severe right upper quadrant abdominal pain, and deep jaundice (Charcot triad). Lab results show total bilirub…
  30. A 23-year-old previously healthy female develops sudden high fever, headache, photophobia, and petechial purpura on the trunk. Lumbar puncture demonstrates cloudy CSF with opening pressure 280 mm H2O…
  31. A 64-year-old male presents with persistent epigastric gnawing pain that wakes him at night, accompanied by black tarry stools. Endoscopy reveals a 2.5 cm solitary cratered gastric ulcer with an activ…

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