INTERNAL MEDICINE EOR TEST PAPER 2026
FULL SOLUTION GRADED A+
◉ Community Acquired Pneumonia: Most common organisms.
Answer: →S. pneumoniae--60-70%
→H. influenza
→S. aureus
→M. catarrhalis
→Atypical organisms: influenza virus, mycoplasma, chlamydia,
legionella, adenovirus, or other inidentified microorganism.
∙Outpatient treatment unless hypoxic, over 50, and with other
underlying medical problems.
◉ Pneumoccoal Vaccine:. Answer: ∙Pneumovax 23.
∙adults who are increased risk for pneumococcal disease or its
complications.
∙patients over 65. - redose q5 years
∙also use in hronic disease for anyone 2-64yo. ex. cardiac, pulm, dm,
etoh, immunocomprimised
PCV13: childhood vaccination (2mo, 4mo, 6mo, 4yr)
,◉ Aspiration Pneumonia:. Answer: ∙Bronchopulmonary infection
association with orals and gastric contents entering the lung.
∙Mostly associated with those with impaired swallowing.
∙Patient have cough and SOB.
∙Usually RML and RLL pneumonia.
∙Early prophylactic use of antibiotics is controversial because no
evidence indicates that bacterial infection plays a role in the initial
events.
∙Generally involve anaerobacteria, which normally colonize the
upper respiratory passages.
→Penicillin G and Clindamycin.
◉ Lung Cancer:. Answer: ∙Leading cause of cancer related death in
US.
∙Most common cause of cancer related deaths.
∙Symptoms: cough, DOE, hemoptysis, weight loss but may present
with other symptoms.
∙Small cell and non small cell.
∙Causes tobacco smoke, asbestos and air pollution.
◉ Most common type of lung cancer?. Answer: Adenocarcinoma
◉ Clinically aggressive lung cancer?. Answer: Small cell carcinoma
,◉ Fibromyalgia. Answer: -widespread muscular pain, fatigue,
muscle tenderness, HA, poor sleep
-Common in middle aged women
-dx: diffuse pain in 11 out of 18 trigger points for more than 3
months; bx will show "hoth-eaten" appearance
-tx: TCAs, pregabalin for pain, swimming for exercise
◉ Fibromyalgia Trigger Points. Answer: General characteristics
a. The fibromyalgia syndrome is a central pain disorder whose cause
and pathogenesis are poorly understood.
b. Fibromyalgia can occur with RA, SLE, and Sjogren's syndrome.
2. Clinical features
a. Patients have nonarticular musculoskeletal aches, pains, fatigue,
sleep disturbance, and multiple tender points on examination.
b. Anxiety, depression, headaches, irritable bowel syndrome,
dysmenorrhea, and paresthesias are associated with this condition.
◉ Gout. Answer: Uric acid deposition in soft tissue, joints, and bone.
-secondary to ingestion of purine-rich foods causing rapid change in
uric acid concentration
-some medications also cause: diuretics, acei
-MC in men esp >30yo
, ◉ Gout Clinical Manifestations. Answer: 1. acute gouty arthritis
(80% monoarthropathy) with joint erythema, swelling and stiffness.
-Podagra: 1st MTP joint MC, also knee, feet ankle are common
2. Tophi deposition*: uric acid collection in soft tissue
3. Uric acid nephrolithiasis and nephropathy
◉ Gout Dx. Answer: 1.arthrocentesis: shows negatively
birefringement needle-shaped crystals
2. Xray: "Rat-bite" "punched-out" erosions
◉ Gout Tx. Answer: Acute:
1. NSAIDS: drug of choice!!! - Indomethacin*
2. Colchicine 2nd line
Chronic:
1. Allopurinol: reduced uric acid concentration -s/e: SJS
2. Probednacid
3. febuxostat
4: Colchicine
◉ Pseudogout. Answer: Calcium Pyrophosphate deposition in joints
FULL SOLUTION GRADED A+
◉ Community Acquired Pneumonia: Most common organisms.
Answer: →S. pneumoniae--60-70%
→H. influenza
→S. aureus
→M. catarrhalis
→Atypical organisms: influenza virus, mycoplasma, chlamydia,
legionella, adenovirus, or other inidentified microorganism.
∙Outpatient treatment unless hypoxic, over 50, and with other
underlying medical problems.
◉ Pneumoccoal Vaccine:. Answer: ∙Pneumovax 23.
∙adults who are increased risk for pneumococcal disease or its
complications.
∙patients over 65. - redose q5 years
∙also use in hronic disease for anyone 2-64yo. ex. cardiac, pulm, dm,
etoh, immunocomprimised
PCV13: childhood vaccination (2mo, 4mo, 6mo, 4yr)
,◉ Aspiration Pneumonia:. Answer: ∙Bronchopulmonary infection
association with orals and gastric contents entering the lung.
∙Mostly associated with those with impaired swallowing.
∙Patient have cough and SOB.
∙Usually RML and RLL pneumonia.
∙Early prophylactic use of antibiotics is controversial because no
evidence indicates that bacterial infection plays a role in the initial
events.
∙Generally involve anaerobacteria, which normally colonize the
upper respiratory passages.
→Penicillin G and Clindamycin.
◉ Lung Cancer:. Answer: ∙Leading cause of cancer related death in
US.
∙Most common cause of cancer related deaths.
∙Symptoms: cough, DOE, hemoptysis, weight loss but may present
with other symptoms.
∙Small cell and non small cell.
∙Causes tobacco smoke, asbestos and air pollution.
◉ Most common type of lung cancer?. Answer: Adenocarcinoma
◉ Clinically aggressive lung cancer?. Answer: Small cell carcinoma
,◉ Fibromyalgia. Answer: -widespread muscular pain, fatigue,
muscle tenderness, HA, poor sleep
-Common in middle aged women
-dx: diffuse pain in 11 out of 18 trigger points for more than 3
months; bx will show "hoth-eaten" appearance
-tx: TCAs, pregabalin for pain, swimming for exercise
◉ Fibromyalgia Trigger Points. Answer: General characteristics
a. The fibromyalgia syndrome is a central pain disorder whose cause
and pathogenesis are poorly understood.
b. Fibromyalgia can occur with RA, SLE, and Sjogren's syndrome.
2. Clinical features
a. Patients have nonarticular musculoskeletal aches, pains, fatigue,
sleep disturbance, and multiple tender points on examination.
b. Anxiety, depression, headaches, irritable bowel syndrome,
dysmenorrhea, and paresthesias are associated with this condition.
◉ Gout. Answer: Uric acid deposition in soft tissue, joints, and bone.
-secondary to ingestion of purine-rich foods causing rapid change in
uric acid concentration
-some medications also cause: diuretics, acei
-MC in men esp >30yo
, ◉ Gout Clinical Manifestations. Answer: 1. acute gouty arthritis
(80% monoarthropathy) with joint erythema, swelling and stiffness.
-Podagra: 1st MTP joint MC, also knee, feet ankle are common
2. Tophi deposition*: uric acid collection in soft tissue
3. Uric acid nephrolithiasis and nephropathy
◉ Gout Dx. Answer: 1.arthrocentesis: shows negatively
birefringement needle-shaped crystals
2. Xray: "Rat-bite" "punched-out" erosions
◉ Gout Tx. Answer: Acute:
1. NSAIDS: drug of choice!!! - Indomethacin*
2. Colchicine 2nd line
Chronic:
1. Allopurinol: reduced uric acid concentration -s/e: SJS
2. Probednacid
3. febuxostat
4: Colchicine
◉ Pseudogout. Answer: Calcium Pyrophosphate deposition in joints
