U WORLD INTERNAL MEDICINE REAL 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
Lab Findings a/w Primary Adrenal Insufficiency
• Hyponatremia
• Hyperkalemia
• Eosinophilia
• Low morning cortisol
• High ACTH
What is the impact of intensive blood glucose control with insulin in
patients with diabetes mellitus?
• Decreased risk of microvascular complications (e.g. retinopathy,
nephropathy)
• Uncertain/no effect on macrovascular complications (e.g. stroke, MI)
and mortality
• Very strict glycemic control (e.g. A1c <6.5%) is a/w increased risk of
hypoglycemia and increased cardiovascular mortality
- Therefore, recommended target hemoglobin for most non-elderly
patients is 7.0%
,Arterial vs. Venous Insufficiency
• Arterial: intermittent claudication, dermal atrophy, absent distal pulses
• Venous: scaling, weeping, superficial erosions, pitting edema, itchy,
achy pain
- Acute = erythema, warmth
- Chronic = red/brown discoloration (deposition of hemosiderin),
woody induration, fibrosis
• Multifocal lesions with brownish hue
• Dilated blood vessels
• Patients with DM
• What is this concerning for?
Necrobiosis Lipoidica Diabeticorum
• Sudden-onset odynophagia and retrosternal pain
• Sometimes difficulty swallowing
• Endoscopy: discrete ulcers with normal-appearing surround mucosa
• What is this concerning for?
Medication-Induced Esophagitis
Metabolic Alkalosis Differential Diagnosis
• Low urine chloride (<20 mEq/L): saline responsive
- Vomiting/nasogastric aspiration
- Diuretic overuse
• High urine chloride (>20 mEq/L): saline unresponsive
- Hypovolemic = Bartter and Gitelman syndromes
- Hypervolemic = excess mineralcorticoid activity (primary
hyperaldosteronism, cushing dx, ectopic ACTH production)
,Acute Liver Failure Manifestations and Next Steps
• Severe acute liver injury without underlying liver disease with:
- Elevated aminotransferases (often >1K U/L)
- Hepatic encephalopathy
- Synthetic liver dysfunction (prolonged PT with INR >1.5)
• Worsening ALF = manifested by rising serum bilirubin and PT, cerebral
edema
• Next Step: liver transplant (in patients with grade III or IV hepatic
encephalopathy, PT > 100s, serum creatinine >3.4)
Pancreatic/GI Neuroendocrine Tumors
• Gastrinoma: recurrent peptic ulcers
• Insulinoma: hypoglycemia
• VIPoma: secretory diarrhea, hypokalemia, hypochlorhydria
• Glucagonoma: weight loss, necrolytic migratory erythema,
hyperglycemia
Pulmonary Function Testing Results
• Obstructive Disease: low FEV1/FVC ratio (decreased FEV1), increased
TLC (hyperinflation, airway obstruction during exhalation)
- Normal/increased DLCO = asthma
- Decreased DLCO = COPD
• Restrictive Disease: normal or high FEV1/FVC ratio (normal/reduced
FVC, normal/reduced FEV1), reduced TLC
- Normal DLCO = chest wall weakness (i.e. obesity hypoventilation sx)
- Decreased DLCO = ILD, granulomatous dx
, • Mediastinal fullness and scattered reticular opacities in upper lobe
• Hypercalcemia
• What is this concerning for?
• Pulmonary Function Testing Results?
Sarcoidosis
• Pulmonary Function Testing Results: restrictive pattern (normal or
high FEV1/FVC ratio)
- Normal or high FEV1/FVC ratio (normal/reduced FVC,
normal/reduced FEV1)
- Reduced TLC
• Heart palpitations, dyspnea
• 3/6 systolic murmur that decreases in intensity with maneuvers that
increase ventricular blood volume (e.g. squatting)
• What is this concerning for?
• Pathogenesis?
Hypertrophic Cardiomyopathy (HCM) - most common inherited
myopathy (autosomal dominant mutation in myocardial contractile
proteins of cardiac sarcomere - cardiac myosin-binding protein C and
cardiac beta-myosin heavy chain)
• Involves enlargement of interventricular septum which can cause
dynamic LVOT obstruction leading to exertional sx (dyspnea, angina,
syncope)
• Agitation, restlessness
• Hyperglycemia
• Weight gain
• Hypertension
• What is this concerning for?
Cushing syndrome (hypercortisolism)
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
Lab Findings a/w Primary Adrenal Insufficiency
• Hyponatremia
• Hyperkalemia
• Eosinophilia
• Low morning cortisol
• High ACTH
What is the impact of intensive blood glucose control with insulin in
patients with diabetes mellitus?
• Decreased risk of microvascular complications (e.g. retinopathy,
nephropathy)
• Uncertain/no effect on macrovascular complications (e.g. stroke, MI)
and mortality
• Very strict glycemic control (e.g. A1c <6.5%) is a/w increased risk of
hypoglycemia and increased cardiovascular mortality
- Therefore, recommended target hemoglobin for most non-elderly
patients is 7.0%
,Arterial vs. Venous Insufficiency
• Arterial: intermittent claudication, dermal atrophy, absent distal pulses
• Venous: scaling, weeping, superficial erosions, pitting edema, itchy,
achy pain
- Acute = erythema, warmth
- Chronic = red/brown discoloration (deposition of hemosiderin),
woody induration, fibrosis
• Multifocal lesions with brownish hue
• Dilated blood vessels
• Patients with DM
• What is this concerning for?
Necrobiosis Lipoidica Diabeticorum
• Sudden-onset odynophagia and retrosternal pain
• Sometimes difficulty swallowing
• Endoscopy: discrete ulcers with normal-appearing surround mucosa
• What is this concerning for?
Medication-Induced Esophagitis
Metabolic Alkalosis Differential Diagnosis
• Low urine chloride (<20 mEq/L): saline responsive
- Vomiting/nasogastric aspiration
- Diuretic overuse
• High urine chloride (>20 mEq/L): saline unresponsive
- Hypovolemic = Bartter and Gitelman syndromes
- Hypervolemic = excess mineralcorticoid activity (primary
hyperaldosteronism, cushing dx, ectopic ACTH production)
,Acute Liver Failure Manifestations and Next Steps
• Severe acute liver injury without underlying liver disease with:
- Elevated aminotransferases (often >1K U/L)
- Hepatic encephalopathy
- Synthetic liver dysfunction (prolonged PT with INR >1.5)
• Worsening ALF = manifested by rising serum bilirubin and PT, cerebral
edema
• Next Step: liver transplant (in patients with grade III or IV hepatic
encephalopathy, PT > 100s, serum creatinine >3.4)
Pancreatic/GI Neuroendocrine Tumors
• Gastrinoma: recurrent peptic ulcers
• Insulinoma: hypoglycemia
• VIPoma: secretory diarrhea, hypokalemia, hypochlorhydria
• Glucagonoma: weight loss, necrolytic migratory erythema,
hyperglycemia
Pulmonary Function Testing Results
• Obstructive Disease: low FEV1/FVC ratio (decreased FEV1), increased
TLC (hyperinflation, airway obstruction during exhalation)
- Normal/increased DLCO = asthma
- Decreased DLCO = COPD
• Restrictive Disease: normal or high FEV1/FVC ratio (normal/reduced
FVC, normal/reduced FEV1), reduced TLC
- Normal DLCO = chest wall weakness (i.e. obesity hypoventilation sx)
- Decreased DLCO = ILD, granulomatous dx
, • Mediastinal fullness and scattered reticular opacities in upper lobe
• Hypercalcemia
• What is this concerning for?
• Pulmonary Function Testing Results?
Sarcoidosis
• Pulmonary Function Testing Results: restrictive pattern (normal or
high FEV1/FVC ratio)
- Normal or high FEV1/FVC ratio (normal/reduced FVC,
normal/reduced FEV1)
- Reduced TLC
• Heart palpitations, dyspnea
• 3/6 systolic murmur that decreases in intensity with maneuvers that
increase ventricular blood volume (e.g. squatting)
• What is this concerning for?
• Pathogenesis?
Hypertrophic Cardiomyopathy (HCM) - most common inherited
myopathy (autosomal dominant mutation in myocardial contractile
proteins of cardiac sarcomere - cardiac myosin-binding protein C and
cardiac beta-myosin heavy chain)
• Involves enlargement of interventricular septum which can cause
dynamic LVOT obstruction leading to exertional sx (dyspnea, angina,
syncope)
• Agitation, restlessness
• Hyperglycemia
• Weight gain
• Hypertension
• What is this concerning for?
Cushing syndrome (hypercortisolism)
