Stanford University INDE 201 Practice of Medicine I
– Stanford Medical School Study Guide, Original
Practice Questions & Answers, INDE 201 Exam
Preparation, Comprehensive Practice of Medicine
Review, Medical Interviewing, Physical
Examination, Clinical Reasoning, Patient
Communication, Information Literacy, Nutrition,
Clinical Epidemiology, Biostatistics, Evidence-Based
Medicine, Psychiatry, Biomedical Ethics, Health
Policy, Population Health & Simulated Clinical
Encounters
Question 1: A 72-year-old male with a history of hypertension and type 2
diabetes presents with a 3-day history of progressive, painless jaundice. He
reports dark urine and clay-colored stools. He has lost 10 pounds
unintentionally over the last two months. On examination, his abdomen is soft
and non-tender, but a palpable, non-tender gallbladder is noted. Which of the
following is the most likely diagnosis?
A. Acute cholecystitis
B. Choledocholithiasis
C. Pancreatic adenocarcinoma
D. Primary biliary cholangitis
CORRECT ANSWER: C. Pancreatic adenocarcinoma
Rationale: The classic presentation of painless jaundice with a palpable, non-tender
gallbladder (Courvoisier's sign) in an elderly patient with weight loss is highly suspicious
for a malignant obstruction of the common bile duct, most commonly due to pancreatic
adenocarcinoma. Choledocholithiasis typically presents with painful jaundice, and acute
cholecystitis presents with right upper quadrant pain and fever.
Question 2: A 45-year-old woman presents with fatigue, joint pain, and a facial
rash that spares the nasolabial folds. Laboratory findings reveal pancytopenia,
positive antinuclear antibodies (ANA), and anti-dsDNA antibodies. Which of
the following is the most specific renal finding associated with her underlying
condition?
A. Focal segmental glomerulosclerosis
B. Membranous nephropathy
C. Diffuse proliferative glomerulonephritis
D. Minimal change disease
CORRECT ANSWER: C. Diffuse proliferative glomerulonephritis
,Rationale: The patient's presentation is classic for Systemic Lupus Erythematosus (SLE).
Diffuse proliferative glomerulonephritis (Class IV) is the most common and severe form
of lupus nephritis, characterized by immune complex deposition and a "wire-loop"
appearance on histology. It is a major predictor of poor renal prognosis.
Question 3: A 68-year-old male with a 40-pack-year smoking history presents
with a chronic cough and hemoptysis. A chest CT reveals a 3-cm mass in the
right upper lobe. A biopsy of the mass shows small, oval cells with scant
cytoplasm and dense neurosecretory granules. Which of the following
paraneoplastic syndromes is most commonly associated with this malignancy?
A. Hypercalcemia
B. Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
C. Hypertrophic osteoarthropathy
D. Acanthosis nigricans
CORRECT ANSWER: B. Syndrome of Inappropriate Antidiuretic Hormone
(SIADH)
Rationale: The pathology describes small cell lung cancer (SCLC). SCLC is highly
associated with paraneoplastic syndromes, most notably SIADH (due to ectopic ADH
production) and Lambert-Eaton myasthenic syndrome. Hypercalcemia is more common
with squamous cell lung cancer.
Question 4: A 55-year-old man with a history of alcohol use disorder presents
with confusion, ataxia, and bilateral ophthalmoplegia. Which of the following
is the most likely underlying deficiency?
A. Vitamin B12
B. Thiamine (Vitamin B1)
C. Niacin (Vitamin B3)
D. Vitamin C
CORRECT ANSWER: B. Thiamine (Vitamin B1)
Rationale: The classic triad of confusion, ataxia, and ophthalmoplegia defines
Wernicke's encephalopathy, which is caused by a deficiency of thiamine (Vitamin B1),
commonly seen in patients with alcohol use disorder or malnutrition.
Question 5: A 62-year-old woman with a history of rheumatoid arthritis is
prescribed a new medication. She develops a non-productive cough and
progressive dyspnea. High-resolution CT shows bilateral ground-glass
opacities. Which of the following medications is the most likely cause of this
pulmonary toxicity?
,A. Methotrexate
B. Hydroxychloroquine
C. Sulfasalazine
D. Prednisone
CORRECT ANSWER: A. Methotrexate
Rationale: Methotrexate is a disease-modifying antirheumatic drug (DMARD)
commonly used for rheumatoid arthritis. A well-known adverse effect is methotrexate-
induced pneumonitis, which can present with subacute dyspnea, cough, and bilateral
interstitial infiltrates or ground-glass opacities on imaging.
Question 6: A 34-year-old female presents with palpitations, heat intolerance,
and weight loss. She is found to have a diffusely enlarged, non-tender thyroid
gland. Laboratory studies show a low TSH and elevated free T4. A radioactive
iodine uptake (RAIU) scan shows increased uptake. Which of the following is
the most likely underlying etiology?
A. Grave's disease
B. Toxic multinodular goiter
C. Subacute thyroiditis
D. Pituitary adenoma
CORRECT ANSWER: A. Grave's disease
Rationale: This is a classic presentation of hyperthyroidism. A diffuse, non-tender goiter
with increased RAIU is characteristic of Graves' disease, an autoimmune disorder
caused by thyroid-stimulating immunoglobulins. Subacute thyroiditis would present with
a painful goiter and decreased RAIU.
Question 7: A 25-year-old male is brought to the emergency department after a
motor vehicle accident. He has a suspected pelvic fracture. Which of the
following findings would indicate a retroperitoneal hemorrhage as a
complication of this fracture?
A. Hematuria
B. Cullen's sign
C. Grey Turner's sign
D. Rebound tenderness in the right lower quadrant
CORRECT ANSWER: C. Grey Turner's sign
Rationale: Grey Turner's sign refers to ecchymosis (bruising) in the flank region, which
is a sign of retroperitoneal hemorrhage. Pelvic fractures can cause significant
retroperitoneal bleeding. Cullen's sign is periumbilical ecchymosis.
, Question 8: A 60-year-old male presents with dysphagia to both solids and
liquids. He also reports regurgitation of undigested food. Barium swallow
shows a "bird's beak" sign. Which of the following is the primary defect in this
condition?
A. Failure of the lower esophageal sphincter to relax
B. Absence of myenteric (Auerbach's) plexus in the distal esophagus
C. Fibrous stricture formation
D. Hypertrophy of the upper esophageal sphincter
CORRECT ANSWER: B. Absence of myenteric (Auerbach's) plexus in the distal
esophagus
Rationale: This is a classic presentation of achalasia. The primary defect is the
degeneration of ganglion cells in the myenteric plexus of the distal esophagus, leading to
a failure of the lower esophageal sphincter (LES) to relax, resulting in the characteristic
"bird's beak" sign on barium swallow.
Question 9: A 48-year-old woman presents with progressive proximal muscle
weakness. She reports difficulty rising from a chair and combing her hair.
Examination reveals a heliotrope rash on her eyelids and Gottron's papules on
her knuckles. Which of the following serum laboratory findings is most specific
for this condition?
A. Anti-Jo-1 antibodies
B. Anti-Scl-70 antibodies
C. Anti-CCP antibodies
D. Anti-centromere antibodies
CORRECT ANSWER: A. Anti-Jo-1 antibodies
Rationale: The clinical presentation of proximal muscle weakness with pathognomonic
skin findings (heliotrope rash and Gottron's papules) is diagnostic of dermatomyositis.
Anti-Jo-1 antibodies are highly specific for dermatomyositis and polymyositis and are
associated with antisynthetase syndrome.
Question 10: A 72-year-old male with a history of benign prostatic hyperplasia
(BPH) is evaluated for a 2-year history of progressive memory loss and urinary
incontinence. He also develops a wide-based, shuffling gait. Which of the
following is the most likely diagnosis?
A. Alzheimer's disease
B. Normal pressure hydrocephalus (NPH)
C. Parkinson's disease
D. Multi-infarct dementia
– Stanford Medical School Study Guide, Original
Practice Questions & Answers, INDE 201 Exam
Preparation, Comprehensive Practice of Medicine
Review, Medical Interviewing, Physical
Examination, Clinical Reasoning, Patient
Communication, Information Literacy, Nutrition,
Clinical Epidemiology, Biostatistics, Evidence-Based
Medicine, Psychiatry, Biomedical Ethics, Health
Policy, Population Health & Simulated Clinical
Encounters
Question 1: A 72-year-old male with a history of hypertension and type 2
diabetes presents with a 3-day history of progressive, painless jaundice. He
reports dark urine and clay-colored stools. He has lost 10 pounds
unintentionally over the last two months. On examination, his abdomen is soft
and non-tender, but a palpable, non-tender gallbladder is noted. Which of the
following is the most likely diagnosis?
A. Acute cholecystitis
B. Choledocholithiasis
C. Pancreatic adenocarcinoma
D. Primary biliary cholangitis
CORRECT ANSWER: C. Pancreatic adenocarcinoma
Rationale: The classic presentation of painless jaundice with a palpable, non-tender
gallbladder (Courvoisier's sign) in an elderly patient with weight loss is highly suspicious
for a malignant obstruction of the common bile duct, most commonly due to pancreatic
adenocarcinoma. Choledocholithiasis typically presents with painful jaundice, and acute
cholecystitis presents with right upper quadrant pain and fever.
Question 2: A 45-year-old woman presents with fatigue, joint pain, and a facial
rash that spares the nasolabial folds. Laboratory findings reveal pancytopenia,
positive antinuclear antibodies (ANA), and anti-dsDNA antibodies. Which of
the following is the most specific renal finding associated with her underlying
condition?
A. Focal segmental glomerulosclerosis
B. Membranous nephropathy
C. Diffuse proliferative glomerulonephritis
D. Minimal change disease
CORRECT ANSWER: C. Diffuse proliferative glomerulonephritis
,Rationale: The patient's presentation is classic for Systemic Lupus Erythematosus (SLE).
Diffuse proliferative glomerulonephritis (Class IV) is the most common and severe form
of lupus nephritis, characterized by immune complex deposition and a "wire-loop"
appearance on histology. It is a major predictor of poor renal prognosis.
Question 3: A 68-year-old male with a 40-pack-year smoking history presents
with a chronic cough and hemoptysis. A chest CT reveals a 3-cm mass in the
right upper lobe. A biopsy of the mass shows small, oval cells with scant
cytoplasm and dense neurosecretory granules. Which of the following
paraneoplastic syndromes is most commonly associated with this malignancy?
A. Hypercalcemia
B. Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
C. Hypertrophic osteoarthropathy
D. Acanthosis nigricans
CORRECT ANSWER: B. Syndrome of Inappropriate Antidiuretic Hormone
(SIADH)
Rationale: The pathology describes small cell lung cancer (SCLC). SCLC is highly
associated with paraneoplastic syndromes, most notably SIADH (due to ectopic ADH
production) and Lambert-Eaton myasthenic syndrome. Hypercalcemia is more common
with squamous cell lung cancer.
Question 4: A 55-year-old man with a history of alcohol use disorder presents
with confusion, ataxia, and bilateral ophthalmoplegia. Which of the following
is the most likely underlying deficiency?
A. Vitamin B12
B. Thiamine (Vitamin B1)
C. Niacin (Vitamin B3)
D. Vitamin C
CORRECT ANSWER: B. Thiamine (Vitamin B1)
Rationale: The classic triad of confusion, ataxia, and ophthalmoplegia defines
Wernicke's encephalopathy, which is caused by a deficiency of thiamine (Vitamin B1),
commonly seen in patients with alcohol use disorder or malnutrition.
Question 5: A 62-year-old woman with a history of rheumatoid arthritis is
prescribed a new medication. She develops a non-productive cough and
progressive dyspnea. High-resolution CT shows bilateral ground-glass
opacities. Which of the following medications is the most likely cause of this
pulmonary toxicity?
,A. Methotrexate
B. Hydroxychloroquine
C. Sulfasalazine
D. Prednisone
CORRECT ANSWER: A. Methotrexate
Rationale: Methotrexate is a disease-modifying antirheumatic drug (DMARD)
commonly used for rheumatoid arthritis. A well-known adverse effect is methotrexate-
induced pneumonitis, which can present with subacute dyspnea, cough, and bilateral
interstitial infiltrates or ground-glass opacities on imaging.
Question 6: A 34-year-old female presents with palpitations, heat intolerance,
and weight loss. She is found to have a diffusely enlarged, non-tender thyroid
gland. Laboratory studies show a low TSH and elevated free T4. A radioactive
iodine uptake (RAIU) scan shows increased uptake. Which of the following is
the most likely underlying etiology?
A. Grave's disease
B. Toxic multinodular goiter
C. Subacute thyroiditis
D. Pituitary adenoma
CORRECT ANSWER: A. Grave's disease
Rationale: This is a classic presentation of hyperthyroidism. A diffuse, non-tender goiter
with increased RAIU is characteristic of Graves' disease, an autoimmune disorder
caused by thyroid-stimulating immunoglobulins. Subacute thyroiditis would present with
a painful goiter and decreased RAIU.
Question 7: A 25-year-old male is brought to the emergency department after a
motor vehicle accident. He has a suspected pelvic fracture. Which of the
following findings would indicate a retroperitoneal hemorrhage as a
complication of this fracture?
A. Hematuria
B. Cullen's sign
C. Grey Turner's sign
D. Rebound tenderness in the right lower quadrant
CORRECT ANSWER: C. Grey Turner's sign
Rationale: Grey Turner's sign refers to ecchymosis (bruising) in the flank region, which
is a sign of retroperitoneal hemorrhage. Pelvic fractures can cause significant
retroperitoneal bleeding. Cullen's sign is periumbilical ecchymosis.
, Question 8: A 60-year-old male presents with dysphagia to both solids and
liquids. He also reports regurgitation of undigested food. Barium swallow
shows a "bird's beak" sign. Which of the following is the primary defect in this
condition?
A. Failure of the lower esophageal sphincter to relax
B. Absence of myenteric (Auerbach's) plexus in the distal esophagus
C. Fibrous stricture formation
D. Hypertrophy of the upper esophageal sphincter
CORRECT ANSWER: B. Absence of myenteric (Auerbach's) plexus in the distal
esophagus
Rationale: This is a classic presentation of achalasia. The primary defect is the
degeneration of ganglion cells in the myenteric plexus of the distal esophagus, leading to
a failure of the lower esophageal sphincter (LES) to relax, resulting in the characteristic
"bird's beak" sign on barium swallow.
Question 9: A 48-year-old woman presents with progressive proximal muscle
weakness. She reports difficulty rising from a chair and combing her hair.
Examination reveals a heliotrope rash on her eyelids and Gottron's papules on
her knuckles. Which of the following serum laboratory findings is most specific
for this condition?
A. Anti-Jo-1 antibodies
B. Anti-Scl-70 antibodies
C. Anti-CCP antibodies
D. Anti-centromere antibodies
CORRECT ANSWER: A. Anti-Jo-1 antibodies
Rationale: The clinical presentation of proximal muscle weakness with pathognomonic
skin findings (heliotrope rash and Gottron's papules) is diagnostic of dermatomyositis.
Anti-Jo-1 antibodies are highly specific for dermatomyositis and polymyositis and are
associated with antisynthetase syndrome.
Question 10: A 72-year-old male with a history of benign prostatic hyperplasia
(BPH) is evaluated for a 2-year history of progressive memory loss and urinary
incontinence. He also develops a wide-based, shuffling gait. Which of the
following is the most likely diagnosis?
A. Alzheimer's disease
B. Normal pressure hydrocephalus (NPH)
C. Parkinson's disease
D. Multi-infarct dementia
