Aquifer internal medicine case EXAM A+ GRADE ASSURED COMPLETE SOLUTIONS AND VERIFIED ANSWERS

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Internal Medicine Exam Cartes 2026 A+ GRADE ASSURE vc vc vc vc vc vc vc




D COMPLETE SOLUTIONS AND VERIFIED ANSWERS (C79
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51)




QUESTION 1 vc




A 24-year-
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old woman presents with complaints of excessive thirst over the past several weeks. She
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also notes waking up in the middle of the night to urinate. She recently underwent trans
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sphenoidal resection of a pituitary adenoma. Which of the following is the most likely di
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agnosis?
A. Central diabetes insipidus
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B. Nephrogenic diabetes insipidus
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C. Primary polydipsia
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D. Type 2 diabetes mellitus
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ANSWER

A. Central diabetes insipidus Central diabetes insipidus is the most common type of diabetes insipidus, i
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s associated with deficient secretion of antidiuretic hormone (ADH) by the posterior pituitary.
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QUESTION 2 vc




What is the most common presenting symptom of bladder carcinoma?
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A. Nocturia
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B. Painless hematuria
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C. Unintentional weight loss
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D. Urinary frequency
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ANSWER

B. Painless hematuria The primary modality to diagnose bladder cancer is with cystoscopy, which allow
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s for direct visualization of tissues and biopsy of any abnormalities. Smoking is the most important risk
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factor of bladder cancer. vc vc vc




QUESTION 3 vc

,A 25-year-
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old man presents to the clinic with fever and a sore throat. A throat swab is performed a
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nd the culture comes back positive for group A streptococcus bacteria. What system of hi
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s body is at highest risk for permanent damage if proper treatment for his infection is no
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t administered?
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A. Cardiovascular
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B. Gastrointestinal
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C. Musculoskeletal
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D. Pulmonary
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ANSWER

A. Cardiovascular Risk of rheumatic fever and pericarditis. Remember the Jones criteria for rheumatic fe
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ver: Major: Joints, carditis, nodes, erythema marginatum, sydenham chorea. Minor: fever, arthralgia, elev
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ated ESR, elevated CRP, and prolonged PR interval. Need 2 major, or 1 major and 2 minor, or 3 minor
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QUESTION 4 vc




Which of the following best describes the etiology of the jaundice seen in patients with t
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hyroid storm? vc



A. Direct constricting effects of thyroid hormone on the biliary duct
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B. Hepatic tissue hypoxia due to increased peripheral consumption of oxygen
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C. Hypotension leading to decreased gut motility
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D. Impaired reabsorption of thyroid hormone in the enterohepatic circulation
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ANSWER

B. Hepatic tissue hypoxia due to increased peripheral consumption of oxygen. Signs and symptoms of th
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yroid storm include hyperpyrexia, nausea, vomiting, diarrhea, mental status changes, jaundice, high-
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output congestive heart failure, cardiac tachyarrhythmias, hypertension, and diaphoresis. PE will show g
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oiter, lid lag, hand tremor, and warm, moist skin Labs will show low TSH and high free T4 or T3 Most c
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ommonly caused by an acute event Treatment is: 1) beta blocker (propranolol) 2) thionamide (propylth
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iouracil or methimazole) 3) iodine solution 4) glucocorticoids
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QUESTION 5 vc




Which of the following is associated with aortic stenosis?
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A. de Musset sign
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B. Holodiastolic decrescendo murmur
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C. Syncope
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D. Wide pulse pressure
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ANSWER

C. Syncope Patient will be older With a history of diabetes, hypertension Complaining of dyspnea, chest
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pain, syncope PE will show crescendo-
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decrescendo systolic murmur that radiates to the carotids, paradoxically split S2, S4 gallop Most commo
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nly caused by degenerative calcification Treatment is aortic valve replacement Comments: murmur decr
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eases with Valsalva vc vc

, QUESTION 6 vc




Which of the following conditions is most commonly associated with malar or "butterfly"
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rash?
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A. Parvovirus B19 infection
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B. Pregnancy
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C. Rosaceavc



D. Systemic lupus erythematosus
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ANSWER

D. Systemic lupus erythematosus Systemic lupus erythematosus is most commonly seen in African-
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American patients of childbearing age. Antinuclear antibodies (ANA) is the best initial screening test (m
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ost sensitive but not specific). The presence of either anti-double-stranded DNA (dsDNA) and anti-
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smith (anti- vc



SM) antibodies is diagnostic of SLE (very specific but not sensitive). Treatment is NSAIDs, steroids, imm
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unosuppressants, hydroxychloroquine Drug- vc vc



induced: Hydralazine, INH, Procainamide, Phenytoin, Sulfonamides (HIPPS). False-
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positive test for syphilis vc vc vc




QUESTION 7 vc




A 44-year-old man presents for a follow-
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up visit for his known gastroesophageal reflux disease. He has been taking a histamine-
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2-
receptor antagonist twice a day. He continues to have symptoms at least three times per
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week. Which of the following is the next best therapy?
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A. Calcium carbonate
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B. Famotidine
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C. Omeprazole
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D. Sucralfate vc




ANSWER

C. Omeprazole Proton pump inhibitors (PPIs), such as omeprazole, should be used in patients who fail t
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wice-daily histamine-2- vc



receptor antagonist therapy, in patients with erosive esophagitis, or patients with severe and frequent s
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ymptoms of gastroesophageal reflux disease (GERD). PPIs inhibit gastric acid secretions by irreversibly
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binding and inhibiting the hydrogen- vc vc vc vc



potassium ATPase pump. They should be taken 30 minutes before the first meal of the day. Treatment i
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s weight loss, elevation head of bed during sleep, avoidance of certain foods (caffeine, alcohol, acidic foo
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ds)



QUESTION 8 vc




Which of the following laboratory values is most likely to be elevated in a patient with h
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ypertonic hyponatremia? vc