TEST BANK FOR INTERNAL MEDICINE PT. 1 COMPREHENSIVE EXAM
STUDY GUIDE | VERIFIED QUESTIONS & ANSWERS WITH DETAILED
RATIONALES | HIGH-YIELD CLINICAL CASES, DIAGNOSIS &
MANAGEMENT REVIEW | LATEST INTERNAL MEDICINE PRACTICE TEST
FOR EXAM SUCCESS
A 56-YEAR-OLD MALE PRESENTS WITH CHEST PAIN THAT OCCURS WITH EXERTION AND IS
RELIEVED BY REST. THE PAIN IS DESCRIBED AS A PRESSURE-LIKE SENSATION IN THE MIDDLE OF
HIS CHEST AND LASTS FOR ABOUT 5-10 MINUTES. HIS MEDICAL HISTORY INCLUDES
HYPERTENSION AND HYPERLIPIDEMIA. WHICH OF THE FOLLOWING IS THE MOST LIKELY
DIAGNOSIS?
A. STABLE ANGINA PECTORIS
B. UNSTABLE ANGINA
C. MYOCARDIAL INFARCTION
D. AORTIC DISSECTION
CORRECT ANS>>A. STABLE ANGINA PECTORIS
STABLE ANGINA IS CHARACTERIZED BY CHEST PAIN OR DISCOMFORT THAT TYPICALLY OCCURS
WITH EXERTION OR STRESS AND IS RELIEVED BY REST OR NITROGLYCERIN. THE PAIN IS USUALLY
PREDICTABLE AND FOLLOWS A PATTERN. IN THIS CASE, THE PATIENT'S SYMPTOMS OF
EXERTIONAL CHEST PAIN RELIEVED BY REST ARE CLASSIC FOR STABLE ANGINA.
A 62-YEAR-OLD FEMALE WITH A HISTORY OF CORONARY ARTERY DISEASE PRESENTS WITH
WORSENING CHEST PAIN THAT NOW OCCURS AT REST. SHE REPORTS THAT THE PAIN HAS BEEN
INCREASING IN FREQUENCY AND DURATION OVER THE PAST FEW DAYS. HER ECG SHOWS ST-
SEGMENT DEPRESSIONS IN THE INFERIOR LEADS. WHAT IS THE MOST APPROPRIATE NEXT STEP
IN MANAGEMENT?
, A. CONTINUE WITH CURRENT OUTPATIENT MANAGEMENT
B. ADMIT TO THE HOSPITAL FOR FURTHER EVALUATION
C. PRESCRIBE A HIGHER DOSE OF SUBLINGUAL NITROGLYCERIN
D. START A LOW-DOSE ASPIRIN REGIMEN
CORRECT ANS>>B. ADMIT TO THE HOSPITAL FOR FURTHER EVALUATION
THE PATIENT'S PRESENTATION IS CONCERNING FOR UNSTABLE ANGINA, CHARACTERIZED BY
CHEST PAIN AT REST, INCREASING IN FREQUENCY, DURATION, OR SEVERITY. THIS CONDITION
REQUIRES PROMPT EVALUATION AND MANAGEMENT, INCLUDING HOSPITALIZATION FOR
MONITORING, FURTHER DIAGNOSTIC TESTING, AND TREATMENT TO PREVENT MYOCARDIAL
INFARCTION.
A 70-YEAR-OLD MAN WITH A HISTORY OF STABLE ANGINA PRESENTS TO THE CLINIC FOR A
FOLLOW-UP. HE HAS BEEN COMPLIANT WITH HIS MEDICATIONS, WHICH INCLUDE ASPIRIN,
BETA-BLOCKERS, AND STATINS. DESPITE THIS, HE REPORTS OCCASIONAL EPISODES OF CHEST
PAIN WITH MINIMAL EXERTION. WHAT IS THE BEST NEXT STEP IN HIS MANAGEMENT?
A. INCREASE THE DOSE OF HIS BETA-BLOCKER
B. REFER FOR CORONARY ANGIOGRAPHY
C. ADD A CALCIUM CHANNEL BLOCKER
D. START ON A LONG-ACTING NITRATE
CORRECT ANS>>B. REFER FOR CORONARY ANGIOGRAPHY
THE PATIENT'S STABLE ANGINA IS WORSENING DESPITE OPTIMAL MEDICAL THERAPY, WHICH
MAY INDICATE SIGNIFICANT CORONARY ARTERY DISEASE. CORONARY ANGIOGRAPHY IS
RECOMMENDED TO ASSESS THE SEVERITY OF THE DISEASE AND DETERMINE IF
REVASCULARIZATION (E.G., PERCUTANEOUS CORONARY INTERVENTION OR CORONARY ARTERY
BYPASS GRAFTING) IS NEEDED.
STUDY GUIDE | VERIFIED QUESTIONS & ANSWERS WITH DETAILED
RATIONALES | HIGH-YIELD CLINICAL CASES, DIAGNOSIS &
MANAGEMENT REVIEW | LATEST INTERNAL MEDICINE PRACTICE TEST
FOR EXAM SUCCESS
A 56-YEAR-OLD MALE PRESENTS WITH CHEST PAIN THAT OCCURS WITH EXERTION AND IS
RELIEVED BY REST. THE PAIN IS DESCRIBED AS A PRESSURE-LIKE SENSATION IN THE MIDDLE OF
HIS CHEST AND LASTS FOR ABOUT 5-10 MINUTES. HIS MEDICAL HISTORY INCLUDES
HYPERTENSION AND HYPERLIPIDEMIA. WHICH OF THE FOLLOWING IS THE MOST LIKELY
DIAGNOSIS?
A. STABLE ANGINA PECTORIS
B. UNSTABLE ANGINA
C. MYOCARDIAL INFARCTION
D. AORTIC DISSECTION
CORRECT ANS>>A. STABLE ANGINA PECTORIS
STABLE ANGINA IS CHARACTERIZED BY CHEST PAIN OR DISCOMFORT THAT TYPICALLY OCCURS
WITH EXERTION OR STRESS AND IS RELIEVED BY REST OR NITROGLYCERIN. THE PAIN IS USUALLY
PREDICTABLE AND FOLLOWS A PATTERN. IN THIS CASE, THE PATIENT'S SYMPTOMS OF
EXERTIONAL CHEST PAIN RELIEVED BY REST ARE CLASSIC FOR STABLE ANGINA.
A 62-YEAR-OLD FEMALE WITH A HISTORY OF CORONARY ARTERY DISEASE PRESENTS WITH
WORSENING CHEST PAIN THAT NOW OCCURS AT REST. SHE REPORTS THAT THE PAIN HAS BEEN
INCREASING IN FREQUENCY AND DURATION OVER THE PAST FEW DAYS. HER ECG SHOWS ST-
SEGMENT DEPRESSIONS IN THE INFERIOR LEADS. WHAT IS THE MOST APPROPRIATE NEXT STEP
IN MANAGEMENT?
, A. CONTINUE WITH CURRENT OUTPATIENT MANAGEMENT
B. ADMIT TO THE HOSPITAL FOR FURTHER EVALUATION
C. PRESCRIBE A HIGHER DOSE OF SUBLINGUAL NITROGLYCERIN
D. START A LOW-DOSE ASPIRIN REGIMEN
CORRECT ANS>>B. ADMIT TO THE HOSPITAL FOR FURTHER EVALUATION
THE PATIENT'S PRESENTATION IS CONCERNING FOR UNSTABLE ANGINA, CHARACTERIZED BY
CHEST PAIN AT REST, INCREASING IN FREQUENCY, DURATION, OR SEVERITY. THIS CONDITION
REQUIRES PROMPT EVALUATION AND MANAGEMENT, INCLUDING HOSPITALIZATION FOR
MONITORING, FURTHER DIAGNOSTIC TESTING, AND TREATMENT TO PREVENT MYOCARDIAL
INFARCTION.
A 70-YEAR-OLD MAN WITH A HISTORY OF STABLE ANGINA PRESENTS TO THE CLINIC FOR A
FOLLOW-UP. HE HAS BEEN COMPLIANT WITH HIS MEDICATIONS, WHICH INCLUDE ASPIRIN,
BETA-BLOCKERS, AND STATINS. DESPITE THIS, HE REPORTS OCCASIONAL EPISODES OF CHEST
PAIN WITH MINIMAL EXERTION. WHAT IS THE BEST NEXT STEP IN HIS MANAGEMENT?
A. INCREASE THE DOSE OF HIS BETA-BLOCKER
B. REFER FOR CORONARY ANGIOGRAPHY
C. ADD A CALCIUM CHANNEL BLOCKER
D. START ON A LONG-ACTING NITRATE
CORRECT ANS>>B. REFER FOR CORONARY ANGIOGRAPHY
THE PATIENT'S STABLE ANGINA IS WORSENING DESPITE OPTIMAL MEDICAL THERAPY, WHICH
MAY INDICATE SIGNIFICANT CORONARY ARTERY DISEASE. CORONARY ANGIOGRAPHY IS
RECOMMENDED TO ASSESS THE SEVERITY OF THE DISEASE AND DETERMINE IF
REVASCULARIZATION (E.G., PERCUTANEOUS CORONARY INTERVENTION OR CORONARY ARTERY
BYPASS GRAFTING) IS NEEDED.
