This is Part 1 of the Internal Medicine
Fundamentals 22nd Edition Comprehensive
Test Bank by Harrison, Fauci, Kasper,
Hauser, Longo, Jameson, & Loscalzo.
TABLE OF CONTENTS — PART 1
Chapter 1: Cardiology — Questions 1–20
Chapter 2: Pulmonology — Questions 21–40
Chapter 3: Gastroenterology — Questions 41–60
Chapter 4: Nephrology — Questions 61–80
Chapter 5: Endocrinology — Questions 81–100
Chapter 1: Cardiology — Questions 1–20
Q1. A 65-year-old man presents with crushing substernal chest pain radiating to the left arm. ECG
shows ST-segment elevation in leads V1 through V4. Which coronary artery is most likely occluded?
A. Right coronary artery
B. Left circumflex artery
C. Left anterior descending artery
D. Left main coronary artery
Correct Answer: C
Rationale: ST-segment elevation in leads V1 through V4 indicates an anterior wall myocardial
infarction, which is most commonly caused by occlusion of the left anterior descending artery.
Option A is incorrect because right coronary artery occlusion typically produces inferior wall changes
in leads II, III, and aVF. Option B is wrong because left circumflex occlusion affects the lateral wall
with changes in leads I, aVL, V5, and V6. Option D is incorrect because left main occlusion produces
widespread changes and is often fatal. Recognizing the coronary territory associated with each ECG
lead is essential for identifying the culprit vessel and guiding emergent reperfusion therapy.
Q2. A 72-year-old woman with hypertension and diabetes presents with acute decompensated heart
failure, bilateral crackles, and an S3 gallop. Which medication improves survival in heart failure with
reduced ejection fraction?
,A. Furosemide
B. Spironolactone
C. Metoprolol
D. Lisinopril
Correct Answer: D
Rationale: Lisinopril is an ACE inhibitor that improves survival in heart failure with reduced
ejection fraction by reducing afterload, decreasing aldosterone secretion, and preventing adverse
cardiac remodeling. Option A is incorrect because furosemide provides symptomatic relief from
congestion but does not improve mortality. Option B is wrong because spironolactone also improves
survival but is typically added after ACE inhibitors and beta-blockers are established. Option C is
incorrect because metoprolol also improves survival but is not the first agent initiated in most
protocols. Guideline-directed medical therapy combining these agents is essential for optimal
outcomes.
Q3. A 58-year-old man presents with palpitations and a heart rate of 150 beats per minute. ECG
shows a narrow-complex tachycardia with no visible P waves, and he is hemodynamically stable.
Which is the most appropriate initial intervention?
A. Adenosine administration
B. Synchronized cardioversion
C. Vagal maneuvers
D. Amiodarone infusion
Correct Answer: C
Rationale: Vagal maneuvers are the first-line intervention for stable narrow-complex
tachycardia such as paroxysmal supraventricular tachycardia because they increase vagal tone and
can terminate the arrhythmia. Option A is incorrect because adenosine is used when vagal
maneuvers fail and is not the initial step. Option B is wrong because synchronized cardioversion is
reserved for hemodynamically unstable patients. Option D is incorrect because amiodarone is used
for ventricular arrhythmias or refractory cases. Following the stepwise approach to tachycardia
management ensures patient safety and avoids unnecessary interventions.
Q4. A 45-year-old woman presents with weight loss, heat intolerance, and palpitations. TSH is low
and free T4 is high. Which treatment is definitive for Graves disease?
A. Methimazole
B. Levothyroxine
C. Propranolol
D. Radioactive iodine
,Correct Answer: D
Rationale: Radioactive iodine is a definitive treatment for Graves disease because it ablates
thyroid tissue and reduces hormone production permanently. Option A is incorrect because
methimazole is an antithyroid drug used for acute management but is not definitive and requires
long-term monitoring. Option B is wrong because levothyroxine treats hypothyroidism and would
worsen hyperthyroidism. Option C is incorrect because propranolol controls symptoms such as
palpitations and tremor but does not treat the underlying disease. Understanding the difference
between symptomatic and definitive therapy is essential in endocrinology.
Q5. A 68-year-old man with atrial fibrillation presents with sudden onset of right-sided weakness and
aphasia. CT head is negative for hemorrhage, and he presents within 2 hours of symptom onset.
Which medication should be administered?
A. Aspirin
B. Heparin
C. Alteplase
D. Clopidogrel
Correct Answer: C
Rationale: Alteplase is a tissue plasminogen activator indicated for acute ischemic stroke
within 3 to 4.5 hours of symptom onset after hemorrhage has been excluded by CT. Option A is
incorrect because aspirin is typically given after 24 hours or if thrombolysis is contraindicated. Option
B is wrong because heparin is not routinely used in acute ischemic stroke and may increase bleeding
risk. Option D is incorrect because clopidogrel is used for secondary prevention rather than acute
therapy. Timely thrombolysis can significantly reduce disability and improve functional outcomes.
Q6. A 55-year-old man presents with exertional chest pain that resolves with rest. He has diabetes
and a history of smoking. Which diagnostic test is most appropriate for initial evaluation?
A. Exercise stress test
B. Coronary angiography
C. Echocardiography
D. Cardiac MRI
Correct Answer: A
Rationale: Exercise stress test is the initial diagnostic test for stable angina in patients who can
exercise because it evaluates for inducible ischemia and provides prognostic information. Option B is
incorrect because coronary angiography is invasive and reserved for high-risk patients or those with
positive stress tests. Option C is wrong because echocardiography assesses structure and function
but does not evaluate for ischemia. Option D is incorrect because cardiac MRI is not first-line for
, stable angina. Appropriate use of non-invasive testing guides further management and avoids
unnecessary invasive procedures.
Q7. A 70-year-old woman presents with syncope and a heart rate of 35 beats per minute. ECG shows
complete heart block. Which intervention is most appropriate?
A. Atropine
B. Dopamine
C. Isoproterenol
D. Transcutaneous pacing
Correct Answer: D
Rationale: Transcutaneous pacing is the immediate intervention for symptomatic complete
heart block because it provides temporary electrical support until a permanent pacemaker can be
placed. Option A is incorrect because atropine may not be effective in complete heart block due to
the lack of conduction through the AV node. Option B is wrong because dopamine is a temporizing
measure but pacing is more definitive. Option C is incorrect because isoproterenol is rarely used and
may worsen ischemia. Recognizing indications for emergent pacing is essential in emergency
medicine.
Q8. A 62-year-old man with hypertension presents with a blood pressure of 190/110 mmHg and a
headache but no signs of end-organ damage. Which oral medication is appropriate for asymptomatic
severe hypertension?
A. Labetalol
B. Nitroprusside
C. Hydralazine
D. Metoprolol
Correct Answer: D
Rationale: Metoprolol is an oral beta-blocker that can be used for asymptomatic severe
hypertension to gradually lower blood pressure without causing rapid hemodynamic changes. Option
A is incorrect because labetalol is also appropriate but D is the answer. Option B is wrong because
nitroprusside is intravenous and reserved for hypertensive emergencies with end-organ damage.
Option C is incorrect because hydralazine is often used intravenously and can cause reflex
tachycardia. The distinction between hypertensive urgency and emergency is critical for safe
management.
Q9. A 48-year-old woman presents with dyspnea on exertion and leg swelling. Echocardiogram
shows an ejection fraction of 30 percent. Which medication should be initiated to reduce mortality?
Fundamentals 22nd Edition Comprehensive
Test Bank by Harrison, Fauci, Kasper,
Hauser, Longo, Jameson, & Loscalzo.
TABLE OF CONTENTS — PART 1
Chapter 1: Cardiology — Questions 1–20
Chapter 2: Pulmonology — Questions 21–40
Chapter 3: Gastroenterology — Questions 41–60
Chapter 4: Nephrology — Questions 61–80
Chapter 5: Endocrinology — Questions 81–100
Chapter 1: Cardiology — Questions 1–20
Q1. A 65-year-old man presents with crushing substernal chest pain radiating to the left arm. ECG
shows ST-segment elevation in leads V1 through V4. Which coronary artery is most likely occluded?
A. Right coronary artery
B. Left circumflex artery
C. Left anterior descending artery
D. Left main coronary artery
Correct Answer: C
Rationale: ST-segment elevation in leads V1 through V4 indicates an anterior wall myocardial
infarction, which is most commonly caused by occlusion of the left anterior descending artery.
Option A is incorrect because right coronary artery occlusion typically produces inferior wall changes
in leads II, III, and aVF. Option B is wrong because left circumflex occlusion affects the lateral wall
with changes in leads I, aVL, V5, and V6. Option D is incorrect because left main occlusion produces
widespread changes and is often fatal. Recognizing the coronary territory associated with each ECG
lead is essential for identifying the culprit vessel and guiding emergent reperfusion therapy.
Q2. A 72-year-old woman with hypertension and diabetes presents with acute decompensated heart
failure, bilateral crackles, and an S3 gallop. Which medication improves survival in heart failure with
reduced ejection fraction?
,A. Furosemide
B. Spironolactone
C. Metoprolol
D. Lisinopril
Correct Answer: D
Rationale: Lisinopril is an ACE inhibitor that improves survival in heart failure with reduced
ejection fraction by reducing afterload, decreasing aldosterone secretion, and preventing adverse
cardiac remodeling. Option A is incorrect because furosemide provides symptomatic relief from
congestion but does not improve mortality. Option B is wrong because spironolactone also improves
survival but is typically added after ACE inhibitors and beta-blockers are established. Option C is
incorrect because metoprolol also improves survival but is not the first agent initiated in most
protocols. Guideline-directed medical therapy combining these agents is essential for optimal
outcomes.
Q3. A 58-year-old man presents with palpitations and a heart rate of 150 beats per minute. ECG
shows a narrow-complex tachycardia with no visible P waves, and he is hemodynamically stable.
Which is the most appropriate initial intervention?
A. Adenosine administration
B. Synchronized cardioversion
C. Vagal maneuvers
D. Amiodarone infusion
Correct Answer: C
Rationale: Vagal maneuvers are the first-line intervention for stable narrow-complex
tachycardia such as paroxysmal supraventricular tachycardia because they increase vagal tone and
can terminate the arrhythmia. Option A is incorrect because adenosine is used when vagal
maneuvers fail and is not the initial step. Option B is wrong because synchronized cardioversion is
reserved for hemodynamically unstable patients. Option D is incorrect because amiodarone is used
for ventricular arrhythmias or refractory cases. Following the stepwise approach to tachycardia
management ensures patient safety and avoids unnecessary interventions.
Q4. A 45-year-old woman presents with weight loss, heat intolerance, and palpitations. TSH is low
and free T4 is high. Which treatment is definitive for Graves disease?
A. Methimazole
B. Levothyroxine
C. Propranolol
D. Radioactive iodine
,Correct Answer: D
Rationale: Radioactive iodine is a definitive treatment for Graves disease because it ablates
thyroid tissue and reduces hormone production permanently. Option A is incorrect because
methimazole is an antithyroid drug used for acute management but is not definitive and requires
long-term monitoring. Option B is wrong because levothyroxine treats hypothyroidism and would
worsen hyperthyroidism. Option C is incorrect because propranolol controls symptoms such as
palpitations and tremor but does not treat the underlying disease. Understanding the difference
between symptomatic and definitive therapy is essential in endocrinology.
Q5. A 68-year-old man with atrial fibrillation presents with sudden onset of right-sided weakness and
aphasia. CT head is negative for hemorrhage, and he presents within 2 hours of symptom onset.
Which medication should be administered?
A. Aspirin
B. Heparin
C. Alteplase
D. Clopidogrel
Correct Answer: C
Rationale: Alteplase is a tissue plasminogen activator indicated for acute ischemic stroke
within 3 to 4.5 hours of symptom onset after hemorrhage has been excluded by CT. Option A is
incorrect because aspirin is typically given after 24 hours or if thrombolysis is contraindicated. Option
B is wrong because heparin is not routinely used in acute ischemic stroke and may increase bleeding
risk. Option D is incorrect because clopidogrel is used for secondary prevention rather than acute
therapy. Timely thrombolysis can significantly reduce disability and improve functional outcomes.
Q6. A 55-year-old man presents with exertional chest pain that resolves with rest. He has diabetes
and a history of smoking. Which diagnostic test is most appropriate for initial evaluation?
A. Exercise stress test
B. Coronary angiography
C. Echocardiography
D. Cardiac MRI
Correct Answer: A
Rationale: Exercise stress test is the initial diagnostic test for stable angina in patients who can
exercise because it evaluates for inducible ischemia and provides prognostic information. Option B is
incorrect because coronary angiography is invasive and reserved for high-risk patients or those with
positive stress tests. Option C is wrong because echocardiography assesses structure and function
but does not evaluate for ischemia. Option D is incorrect because cardiac MRI is not first-line for
, stable angina. Appropriate use of non-invasive testing guides further management and avoids
unnecessary invasive procedures.
Q7. A 70-year-old woman presents with syncope and a heart rate of 35 beats per minute. ECG shows
complete heart block. Which intervention is most appropriate?
A. Atropine
B. Dopamine
C. Isoproterenol
D. Transcutaneous pacing
Correct Answer: D
Rationale: Transcutaneous pacing is the immediate intervention for symptomatic complete
heart block because it provides temporary electrical support until a permanent pacemaker can be
placed. Option A is incorrect because atropine may not be effective in complete heart block due to
the lack of conduction through the AV node. Option B is wrong because dopamine is a temporizing
measure but pacing is more definitive. Option C is incorrect because isoproterenol is rarely used and
may worsen ischemia. Recognizing indications for emergent pacing is essential in emergency
medicine.
Q8. A 62-year-old man with hypertension presents with a blood pressure of 190/110 mmHg and a
headache but no signs of end-organ damage. Which oral medication is appropriate for asymptomatic
severe hypertension?
A. Labetalol
B. Nitroprusside
C. Hydralazine
D. Metoprolol
Correct Answer: D
Rationale: Metoprolol is an oral beta-blocker that can be used for asymptomatic severe
hypertension to gradually lower blood pressure without causing rapid hemodynamic changes. Option
A is incorrect because labetalol is also appropriate but D is the answer. Option B is wrong because
nitroprusside is intravenous and reserved for hypertensive emergencies with end-organ damage.
Option C is incorrect because hydralazine is often used intravenously and can cause reflex
tachycardia. The distinction between hypertensive urgency and emergency is critical for safe
management.
Q9. A 48-year-old woman presents with dyspnea on exertion and leg swelling. Echocardiogram
shows an ejection fraction of 30 percent. Which medication should be initiated to reduce mortality?
