INTERNAL MEDICINE PRACTICE EXAM: 100+ HIGH-
YIELD PRACTICE QUESTIONS & VERIFIED ANSWERS
COMPREHENSIVE STUDY GUIDE (2026)
A woman presents to the clinic complaining of pedal edema. Which of the
following would be most suggestive of congestive heart failure as the likely
etiology?
A. History of bulimia nervosa
B. History of chronic renal insufficiency
C. History of diabetes mellitus
D. History of inflammatory bowel disease
- answer-C. History of diabetes mellitus
An 80-year-old woman with a 36-pack-year history of smoking tobacco
presents with a chief complaint of increasing dyspnea on exertion over the
past six months. Physical exam reveals clubbed digits and bilateral lower
lung crackles. Computed tomography shows honeycombing of the lung
parenchyma. What is the most likely diagnosis?
A. Bronchiectasis
B. Chronic obstructive pulmonary disease
C. Idiopathic pulmonary fibrosis
D. Sarcoidosis
- answer-C. Idiopathic pulmonary fibrosis
An otherwise healthy 20-year-old man suddenly collapses and dies while
playing intramural basketball. The patient's brother died two years ago
while playing soccer. Which of the following is the most likely diagnosis?
A. Dilated cardiomyopathy
B. Hypertrophic cardiomyopathy
C. Restrictive cardiomyopathy
D. Takotsubo cardiomyopathy
- answer-B. Hypertrophic
cardiomyopathy Patient will be a
young athlete
,Complaining of dyspnea on exertion (most common presenting symptom)
PE will show harsh crescendo-decrescendo systolic murmur which
increases in intensity with Valsalva maneuver and decreases with squatting
Diagnosis is made by echocardiography
Most commonly caused by an autosomal dominant genetic defect
Treatment is refraining from vigorous physical activity, beta-blockers or
calcium channel blockers
Comments: Most common cause of sudden death in young athletes
An otherwise healthy 24-year-old woman presents with a cough. The
cough is productive of white to yellow sputum and has been present for the
last three weeks. She states that it began with a fever, sinus pressure, and
fatigue, but those symptoms have since resolved. She has never had
similar symptoms in the past.
Her vital signs are all within normal limits. Lung auscultation is clear
bilaterally, although deep breaths induce coughing. What is the most likely
diagnosis?
A. Acute bronchitis
B. Asthma
C. Chronic bronchitis
D. Community-acquired pneumonia
- answer-A. Acute bronchitis
n the treatment of Alzheimer disease, which of the following pharmacologic
treatment options is found to be neuroprotective?
A. Donepezil
B. Memantine
C. Selegiline
D. Vitamin E
- answer-B. Memantine
Sildenafil is prescribed for an otherwise healthy 54-year-old man who is
diagnosed with erectile dysfunction. Which of the following is a potential
adverse effect of this medication?
A. Constipation
B. Cyanopsia
C. Prostate specific antigen elevation
,D. Urinary retention
- answer-B. Cyanopsia
Cyanopsia, or blue discoloration of vision, is a potential side effect of
sildenafil. The effect may be more likely with higher dosages of
medication and is usually temporary. Sildenafil inhibits
phosphodiesterase type five (PDE-5), thereby increasing nitric oxide
levels and cyclic guanosine monophosphate, which results in smooth
muscle relaxation.
The serum creatine kinase-MB peaks after an acute myocardial infarction in
which of the following time frames?
A. 16-24 hours
B. 48-72 hours
C. 4-6 hours
D. 8-12 hours
- answer-A. 16-24
hours Cardiac
Biomarkers
Troponin-Highest sensitivity and specificity
Time detectable from onset: 3-12 hoursPeak: 24-48
hours Return to baseline: 5-14 days
CK-MB
Time detectable from onset: 3-12
hours Peak: 24 hours
Return to baseline: 48-72 hrs
Useful for dx of reinfarction
Myoglobin-First to appear, first to peak, first to declineLacks specificity
What is the most common presenting symptom of bladder carcinoma?
A. Nocturia
B. Painless hematuria
C. Unintentional weight loss
D. Urinary frequency
- answer-B. Painless hematuria
The primary modality to diagnose bladder cancer is with cystoscopy, which
allows for direct visualization of tissues and biopsy of any abnormalities.
Smoking is the most important risk factor of bladder cancer.
, What is the treatment of choice for an otherwise healthy patient with a
confirmed diagnosis of acute idiopathic pericarditis?
A. Antiviral therapy
B. Glucocorticoids
C. NSAIDs
D. Pericardiocentesis
- answer-C.
NSAIDs
Pericarditis
Patient will be complaining of pleuritic chest pain radiating to the back that
is worse when lying back and improved when leaning forward
PE will show tachycardia and pericardial friction rub
ECG will show PR depression, PR elevation (aVR), diffuse ST-segment
elevation (concave)
A 17-year-old woman with a history of severe menorrhagia was admitted
for a blood transfusion after fainting at school. Her history is positive for
fatigue, exertional dyspnea, and increased cravings for ice over the past
several weeks. Laboratory findings show hemoglobin 6 g/dL, hematocrit
22%, mean corpuscular volume 72 fL, total serum iron 23 mcg/dL, and total
iron binding capacity 92 micromol/L. The patient was found to have
conjunctival pallor and koilonychia on physical examination. What additional
physical exam finding would you expect to find?
A. Facial plethora
B. Jaundice
C. Loss of tongue papillae
D. Petechiae
- answer-C. Loss of tongue papillae
Loss of tongue papillae or atrophic glossitis is seen in patients with iron
deficiency anemia. Iron deficiency anemia is common in women of
reproductive age and children.
YIELD PRACTICE QUESTIONS & VERIFIED ANSWERS
COMPREHENSIVE STUDY GUIDE (2026)
A woman presents to the clinic complaining of pedal edema. Which of the
following would be most suggestive of congestive heart failure as the likely
etiology?
A. History of bulimia nervosa
B. History of chronic renal insufficiency
C. History of diabetes mellitus
D. History of inflammatory bowel disease
- answer-C. History of diabetes mellitus
An 80-year-old woman with a 36-pack-year history of smoking tobacco
presents with a chief complaint of increasing dyspnea on exertion over the
past six months. Physical exam reveals clubbed digits and bilateral lower
lung crackles. Computed tomography shows honeycombing of the lung
parenchyma. What is the most likely diagnosis?
A. Bronchiectasis
B. Chronic obstructive pulmonary disease
C. Idiopathic pulmonary fibrosis
D. Sarcoidosis
- answer-C. Idiopathic pulmonary fibrosis
An otherwise healthy 20-year-old man suddenly collapses and dies while
playing intramural basketball. The patient's brother died two years ago
while playing soccer. Which of the following is the most likely diagnosis?
A. Dilated cardiomyopathy
B. Hypertrophic cardiomyopathy
C. Restrictive cardiomyopathy
D. Takotsubo cardiomyopathy
- answer-B. Hypertrophic
cardiomyopathy Patient will be a
young athlete
,Complaining of dyspnea on exertion (most common presenting symptom)
PE will show harsh crescendo-decrescendo systolic murmur which
increases in intensity with Valsalva maneuver and decreases with squatting
Diagnosis is made by echocardiography
Most commonly caused by an autosomal dominant genetic defect
Treatment is refraining from vigorous physical activity, beta-blockers or
calcium channel blockers
Comments: Most common cause of sudden death in young athletes
An otherwise healthy 24-year-old woman presents with a cough. The
cough is productive of white to yellow sputum and has been present for the
last three weeks. She states that it began with a fever, sinus pressure, and
fatigue, but those symptoms have since resolved. She has never had
similar symptoms in the past.
Her vital signs are all within normal limits. Lung auscultation is clear
bilaterally, although deep breaths induce coughing. What is the most likely
diagnosis?
A. Acute bronchitis
B. Asthma
C. Chronic bronchitis
D. Community-acquired pneumonia
- answer-A. Acute bronchitis
n the treatment of Alzheimer disease, which of the following pharmacologic
treatment options is found to be neuroprotective?
A. Donepezil
B. Memantine
C. Selegiline
D. Vitamin E
- answer-B. Memantine
Sildenafil is prescribed for an otherwise healthy 54-year-old man who is
diagnosed with erectile dysfunction. Which of the following is a potential
adverse effect of this medication?
A. Constipation
B. Cyanopsia
C. Prostate specific antigen elevation
,D. Urinary retention
- answer-B. Cyanopsia
Cyanopsia, or blue discoloration of vision, is a potential side effect of
sildenafil. The effect may be more likely with higher dosages of
medication and is usually temporary. Sildenafil inhibits
phosphodiesterase type five (PDE-5), thereby increasing nitric oxide
levels and cyclic guanosine monophosphate, which results in smooth
muscle relaxation.
The serum creatine kinase-MB peaks after an acute myocardial infarction in
which of the following time frames?
A. 16-24 hours
B. 48-72 hours
C. 4-6 hours
D. 8-12 hours
- answer-A. 16-24
hours Cardiac
Biomarkers
Troponin-Highest sensitivity and specificity
Time detectable from onset: 3-12 hoursPeak: 24-48
hours Return to baseline: 5-14 days
CK-MB
Time detectable from onset: 3-12
hours Peak: 24 hours
Return to baseline: 48-72 hrs
Useful for dx of reinfarction
Myoglobin-First to appear, first to peak, first to declineLacks specificity
What is the most common presenting symptom of bladder carcinoma?
A. Nocturia
B. Painless hematuria
C. Unintentional weight loss
D. Urinary frequency
- answer-B. Painless hematuria
The primary modality to diagnose bladder cancer is with cystoscopy, which
allows for direct visualization of tissues and biopsy of any abnormalities.
Smoking is the most important risk factor of bladder cancer.
, What is the treatment of choice for an otherwise healthy patient with a
confirmed diagnosis of acute idiopathic pericarditis?
A. Antiviral therapy
B. Glucocorticoids
C. NSAIDs
D. Pericardiocentesis
- answer-C.
NSAIDs
Pericarditis
Patient will be complaining of pleuritic chest pain radiating to the back that
is worse when lying back and improved when leaning forward
PE will show tachycardia and pericardial friction rub
ECG will show PR depression, PR elevation (aVR), diffuse ST-segment
elevation (concave)
A 17-year-old woman with a history of severe menorrhagia was admitted
for a blood transfusion after fainting at school. Her history is positive for
fatigue, exertional dyspnea, and increased cravings for ice over the past
several weeks. Laboratory findings show hemoglobin 6 g/dL, hematocrit
22%, mean corpuscular volume 72 fL, total serum iron 23 mcg/dL, and total
iron binding capacity 92 micromol/L. The patient was found to have
conjunctival pallor and koilonychia on physical examination. What additional
physical exam finding would you expect to find?
A. Facial plethora
B. Jaundice
C. Loss of tongue papillae
D. Petechiae
- answer-C. Loss of tongue papillae
Loss of tongue papillae or atrophic glossitis is seen in patients with iron
deficiency anemia. Iron deficiency anemia is common in women of
reproductive age and children.
