INTERNAL MEDICINE COMAT EXAM / ACTUAL COMAT INTERNAL
MEDICINE EXAM TEST BANK EXAM PRACTICE QUESTIONS AND
STUDY GUIDE EXAM COMPLETE EXAM WITH REAL QUESTIONS
AND CORRECT VERIFIED ANSWERS WITH DETAILED RATIONALES
(RELIABLE ANSWERS) CURRENT UPDATED VERSION 2026-2027
A 44-year-old man presents for a follow-up visit for his known
gastroesophageal reflux disease. He has been taking a histamine-2-
receptor antagonist twice a day. He continues to have symptoms at
least three times per week. Which of the following is the next best
therapy?
A. Calcium carbonate
B. Famotidine
C. Omeprazole
D. Sucralfate
C. Omeprazole
Proton pump inhibitors (PPIs), such as omeprazole, should be used in
patients who fail twice-daily histamine-2-receptor antagonist therapy, in
patients with erosive esophagitis, or patients with severe and frequent
symptoms of gastroesophageal reflux disease (GERD). PPIs inhibit
gastric acid secretions by irreversibly binding and inhibiting the
hydrogen-potassium ATPase pump. They should be taken 30 minutes
before the first meal of the day.
Treatment is weight loss, elevation head of bed during sleep, avoidance
of certain foods (caffeine, alcohol, acidic foods)
,A 59-year-old woman presents to the clinic reporting numbness in her
hands and around her mouth, as well as muscle cramps, fatigue, and
intermittent hoarseness. Her medical history includes hypertension,
hyperlipidemia, diabetes, and a thyroid malignancy which was recently
treated by surgical excision. On physical examination, she is noted to
have an ataxic gait, hyperresponsive deep tendon reflexes, and
appears to be anxious. Additionally, carpal spasms are noted when her
blood pressure is taken. Her vital signs are within normal limits for her
age. Results of a complete blood count and complete metabolic
profile are notable for a low total calcium. Which of the following is the
most likely diagnosis?
A. Hyperparathyroidism
B. Hypoparathyroidism
C. Hypophosphatemia
D. Hypothyroidism
B. Hypoparathyroidism
Two classic exam findings are Chvostek sign, facial twitching caused by
tapping around the facial nerve, and Trousseau sign, which is carpal
spasming induced with obliteration of the brachial artery.
Patient with a history of recent thyroid surgery
Complaining of extremity and perioral paresthesias, tetany, and
lethargy
Labs will show low PTH, low calcium, high phosphorus
,A 46-year-old man presents with a painful, red first toe on his right
foot. His symptoms came on suddenly one day ago. He states that even
light touch is almost unbearable. He denies this ever happening in the
past. His vital signs are within normal limits. Erythrocyte sedimentation
rate and white blood cell count are normal. Synovial fluid analysis
reveals negatively birefringent intra- and extracellular crystals. Which
of the following is the most likely diagnosis?
A. Gout
B. Pseudogout
C. Rheumatoid arthritis
D. Septic arthritis
A. Gout
Patient will be a middle-aged man
Complaining of acute onset of pain in the first MTP (Podagra)
Labs will show needle-shaped crystal with negative birefringence
Most commonly caused by uric acid crystals
Treatment is: Acute: NSAIDs, steroids, colchicine Chronic: allopurinol or
colchicine
Comments: Can be triggered by loop and thiazide diuretics
, Which of the following laboratory values is most likely to be elevated in
a patient with hypertonic hyponatremia?
A. Serum glucose
B. Serum potassium
C. Serum sodium
D. Serum triglycerides
A. Serum glucose
In hyponatremia concurrent with hyperglycemia, a corrected serum
sodium should be estimated by remembering that the serum sodium
concentration decreases by about 2 mEq/L with every 100 mg/dL
increase in glucose concentration. To avoid osmotic demyelination
syndrome, hyponatremia of any cause should never be corrected by
more than 8 mEq/L in a 24 hour period.
MEDICINE EXAM TEST BANK EXAM PRACTICE QUESTIONS AND
STUDY GUIDE EXAM COMPLETE EXAM WITH REAL QUESTIONS
AND CORRECT VERIFIED ANSWERS WITH DETAILED RATIONALES
(RELIABLE ANSWERS) CURRENT UPDATED VERSION 2026-2027
A 44-year-old man presents for a follow-up visit for his known
gastroesophageal reflux disease. He has been taking a histamine-2-
receptor antagonist twice a day. He continues to have symptoms at
least three times per week. Which of the following is the next best
therapy?
A. Calcium carbonate
B. Famotidine
C. Omeprazole
D. Sucralfate
C. Omeprazole
Proton pump inhibitors (PPIs), such as omeprazole, should be used in
patients who fail twice-daily histamine-2-receptor antagonist therapy, in
patients with erosive esophagitis, or patients with severe and frequent
symptoms of gastroesophageal reflux disease (GERD). PPIs inhibit
gastric acid secretions by irreversibly binding and inhibiting the
hydrogen-potassium ATPase pump. They should be taken 30 minutes
before the first meal of the day.
Treatment is weight loss, elevation head of bed during sleep, avoidance
of certain foods (caffeine, alcohol, acidic foods)
,A 59-year-old woman presents to the clinic reporting numbness in her
hands and around her mouth, as well as muscle cramps, fatigue, and
intermittent hoarseness. Her medical history includes hypertension,
hyperlipidemia, diabetes, and a thyroid malignancy which was recently
treated by surgical excision. On physical examination, she is noted to
have an ataxic gait, hyperresponsive deep tendon reflexes, and
appears to be anxious. Additionally, carpal spasms are noted when her
blood pressure is taken. Her vital signs are within normal limits for her
age. Results of a complete blood count and complete metabolic
profile are notable for a low total calcium. Which of the following is the
most likely diagnosis?
A. Hyperparathyroidism
B. Hypoparathyroidism
C. Hypophosphatemia
D. Hypothyroidism
B. Hypoparathyroidism
Two classic exam findings are Chvostek sign, facial twitching caused by
tapping around the facial nerve, and Trousseau sign, which is carpal
spasming induced with obliteration of the brachial artery.
Patient with a history of recent thyroid surgery
Complaining of extremity and perioral paresthesias, tetany, and
lethargy
Labs will show low PTH, low calcium, high phosphorus
,A 46-year-old man presents with a painful, red first toe on his right
foot. His symptoms came on suddenly one day ago. He states that even
light touch is almost unbearable. He denies this ever happening in the
past. His vital signs are within normal limits. Erythrocyte sedimentation
rate and white blood cell count are normal. Synovial fluid analysis
reveals negatively birefringent intra- and extracellular crystals. Which
of the following is the most likely diagnosis?
A. Gout
B. Pseudogout
C. Rheumatoid arthritis
D. Septic arthritis
A. Gout
Patient will be a middle-aged man
Complaining of acute onset of pain in the first MTP (Podagra)
Labs will show needle-shaped crystal with negative birefringence
Most commonly caused by uric acid crystals
Treatment is: Acute: NSAIDs, steroids, colchicine Chronic: allopurinol or
colchicine
Comments: Can be triggered by loop and thiazide diuretics
, Which of the following laboratory values is most likely to be elevated in
a patient with hypertonic hyponatremia?
A. Serum glucose
B. Serum potassium
C. Serum sodium
D. Serum triglycerides
A. Serum glucose
In hyponatremia concurrent with hyperglycemia, a corrected serum
sodium should be estimated by remembering that the serum sodium
concentration decreases by about 2 mEq/L with every 100 mg/dL
increase in glucose concentration. To avoid osmotic demyelination
syndrome, hyponatremia of any cause should never be corrected by
more than 8 mEq/L in a 24 hour period.
