ENAM Practice (Peru National Medical Examination) · Internal Medicine

More internal medicine

17 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 17 questions

  1. A 55-year-old man has crushing chest pain and the ECG shows ST depression with elevated troponin. What is the diagnosis?
  2. A 45-year-old woman has palpitations, an ECG with a regular narrow complex tachycardia at 180 per minute and a stable blood pressure. What is the first manoeuvre?
  3. A 60-year-old man is breathless and has a raised JVP, basal crackles and an S3. What is the first-line drug for rapid symptom relief?
  4. A 25-year-old woman has dyspnoea, pleuritic pain and a unilateral swollen calf after a long flight. Which finding on arterial blood gas is typical?
  5. A 70-year-old man has long-standing cough, sputum and an FEV1 of 40% predicted. Which intervention reduces mortality in COPD with respiratory failure?
  6. A 35-year-old woman has fatigue and weight loss, with night sweats and mediastinal lymphadenopathy. Biopsy shows Reed-Sternberg cells. What is the diagnosis?
  7. A 5-year-old has easy bruising, pallor and bone pain, with a white cell count of 80,000 per microlitre and blasts on the film. What is the most likely diagnosis?
  8. A 45-year-old man has an acute hot swollen knee and fever. What is the first investigation?
  9. A 50-year-old man has a long history of reflux and now has dysphagia. Biopsy shows intestinal metaplasia. What is the diagnosis?
  10. A 28-year-old woman has chronic watery diarrhoea, weight loss and positive anti-tissue transglutaminase antibodies. What dietary advice is correct?
  11. A 40-year-old woman has pruritus, raised alkaline phosphatase and positive antimitochondrial antibodies. What is the diagnosis?
  12. A 30-year-old man has a positive HBsAg, positive anti-HBc IgM and raised ALT. What is the diagnosis?
  13. A 60-year-old woman has a fracture after minimal trauma and a T-score of -3.0 on densitometry. What is the diagnosis?
  14. A 35-year-old woman has hypercalcaemia, raised PTH and a history of kidney stones. What is the most likely cause?
  15. A 50-year-old woman has a moon face, abdominal striae, hypertension and a raised 24-hour urinary free cortisol. What is the next step to find the cause?
  16. A 24-year-old woman has a heart rate of 130 per minute, tremor and a suppressed TSH. What is the symptomatic treatment?
  17. A 65-year-old man has a tremor at rest, bradykinesia and rigidity. What is the first-line treatment in an older patient?

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