U WORLD INTERNAL MEDICINE REAL
EXAM / ACTUAL COMAT INTERNAL
MEDICINE EXAM TEST BANK Practice
Exam 2026| Most Tested Questions
Collection & Verified Detailed Answers |
Tutor Verified Success Exam) Graded A+
1. A 68-year-old man with hypertension presents with exertional
substernal chest pressure relieved by rest. ECG is normal at rest.
What is the most likely diagnosis?
A. Unstable angina
B. Acute pericarditis
C. Stable angina
D. Aortic dissection
Answer: C. Stable angina
Exertional chest discomfort relieved by rest is classic for stable
coronary ischemia.
2. A patient develops crushing substernal chest pain with ST
elevations in leads II, III, and aVF. Which coronary artery is most
likely occluded?
A. LAD
B. Left circumflex
C. Right coronary artery
D. Left main
Answer: C. Right coronary artery
Inferior-wall myocardial infarction is most commonly caused by right
coronary artery occlusion.
,3. A 72-year-old patient has dyspnea, orthopnea, bilateral crackles,
and an S3 gallop. Which condition is most likely?
A. Right-sided heart failure
B. Left-sided systolic heart failure
C. Constrictive pericarditis
D. Pulmonary embolism
Answer: B. Left-sided systolic heart failure
Pulmonary congestion, orthopnea, and an S3 are characteristic of left
ventricular systolic dysfunction.
4. Which medication class has demonstrated mortality benefit in
patients with heart failure with reduced ejection fraction?
A. Loop diuretics alone
B. ACE inhibitors
C. Nitrates alone
D. Digoxin alone
Answer: B. ACE inhibitors
ACE inhibitors reduce mortality and hospitalization in appropriate
patients with HFrEF.
5. A patient with atrial fibrillation has a ventricular rate of 150/min
and is hypotensive with altered mental status. What is the next step?
A. Oral metoprolol
B. IV digoxin
C. Synchronized cardioversion
D. Observation
Answer: C. Synchronized cardioversion
Hemodynamic instability caused by atrial fibrillation requires
immediate synchronized cardioversion.
6. Which ECG finding is characteristic of atrial fibrillation?
A. Regular rhythm with sawtooth waves
B. Irregularly irregular rhythm without discrete P waves
,C. Wide QRS with delta waves
D. Prolonged PR interval
Answer: B. Irregularly irregular rhythm without discrete P waves
AF produces chaotic atrial activity and an irregularly irregular
ventricular response.
7. A patient has an early diastolic decrescendo murmur along the left
sternal border. Which lesion is most likely?
A. Mitral stenosis
B. Aortic stenosis
C. Aortic regurgitation
D. Mitral regurgitation
Answer: C. Aortic regurgitation
Chronic aortic regurgitation produces a high-pitched early diastolic
decrescendo murmur.
8. Which finding is most characteristic of severe aortic stenosis?
A. Bounding pulses
B. Pulsus parvus et tardus
C. Wide pulse pressure
D. Fixed split S2
Answer: B. Pulsus parvus et tardus
Severe aortic stenosis causes a delayed and diminished carotid
upstroke.
9. A patient with cardiac tamponade is most likely to have which
combination?
A. Hypertension, bradycardia, pulmonary edema
B. Hypotension, elevated JVP, muffled heart sounds
C. Fever, murmur, splinter hemorrhages
D. Wide pulse pressure and bounding pulses
Answer: B. Hypotension, elevated JVP, muffled heart sounds
This is Beck's triad, classically associated with cardiac tamponade.
, 10. What is the most common cause of infective endocarditis
involving a previously normal native valve?
A. Staphylococcus aureus
B. Candida albicans
C. Coxiella burnetii
D. Aspergillus
Answer: A. Staphylococcus aureus
S. aureus is a leading cause of acute infective endocarditis, including
infection of normal valves.
11. A patient develops fever and a new murmur after IV drug use.
Which organism is particularly associated with this presentation?
A. S. aureus
B. S. pneumoniae
C. E. coli
D. H. influenzae
Answer: A. S. aureus
Injection drug use is strongly associated with S. aureus tricuspid-valve
endocarditis.
12. Which medication is first-line for immediate relief of an acute
episode of stable angina?
A. Aspirin
B. Sublingual nitroglycerin
C. Atorvastatin
D. Metoprolol
Answer: B. Sublingual nitroglycerin
Nitroglycerin rapidly decreases myocardial oxygen demand and
relieves anginal symptoms.
13. A patient has hypotension, clear lungs, and elevated jugular
venous pressure following an inferior MI. Which complication should
be suspected?
EXAM / ACTUAL COMAT INTERNAL
MEDICINE EXAM TEST BANK Practice
Exam 2026| Most Tested Questions
Collection & Verified Detailed Answers |
Tutor Verified Success Exam) Graded A+
1. A 68-year-old man with hypertension presents with exertional
substernal chest pressure relieved by rest. ECG is normal at rest.
What is the most likely diagnosis?
A. Unstable angina
B. Acute pericarditis
C. Stable angina
D. Aortic dissection
Answer: C. Stable angina
Exertional chest discomfort relieved by rest is classic for stable
coronary ischemia.
2. A patient develops crushing substernal chest pain with ST
elevations in leads II, III, and aVF. Which coronary artery is most
likely occluded?
A. LAD
B. Left circumflex
C. Right coronary artery
D. Left main
Answer: C. Right coronary artery
Inferior-wall myocardial infarction is most commonly caused by right
coronary artery occlusion.
,3. A 72-year-old patient has dyspnea, orthopnea, bilateral crackles,
and an S3 gallop. Which condition is most likely?
A. Right-sided heart failure
B. Left-sided systolic heart failure
C. Constrictive pericarditis
D. Pulmonary embolism
Answer: B. Left-sided systolic heart failure
Pulmonary congestion, orthopnea, and an S3 are characteristic of left
ventricular systolic dysfunction.
4. Which medication class has demonstrated mortality benefit in
patients with heart failure with reduced ejection fraction?
A. Loop diuretics alone
B. ACE inhibitors
C. Nitrates alone
D. Digoxin alone
Answer: B. ACE inhibitors
ACE inhibitors reduce mortality and hospitalization in appropriate
patients with HFrEF.
5. A patient with atrial fibrillation has a ventricular rate of 150/min
and is hypotensive with altered mental status. What is the next step?
A. Oral metoprolol
B. IV digoxin
C. Synchronized cardioversion
D. Observation
Answer: C. Synchronized cardioversion
Hemodynamic instability caused by atrial fibrillation requires
immediate synchronized cardioversion.
6. Which ECG finding is characteristic of atrial fibrillation?
A. Regular rhythm with sawtooth waves
B. Irregularly irregular rhythm without discrete P waves
,C. Wide QRS with delta waves
D. Prolonged PR interval
Answer: B. Irregularly irregular rhythm without discrete P waves
AF produces chaotic atrial activity and an irregularly irregular
ventricular response.
7. A patient has an early diastolic decrescendo murmur along the left
sternal border. Which lesion is most likely?
A. Mitral stenosis
B. Aortic stenosis
C. Aortic regurgitation
D. Mitral regurgitation
Answer: C. Aortic regurgitation
Chronic aortic regurgitation produces a high-pitched early diastolic
decrescendo murmur.
8. Which finding is most characteristic of severe aortic stenosis?
A. Bounding pulses
B. Pulsus parvus et tardus
C. Wide pulse pressure
D. Fixed split S2
Answer: B. Pulsus parvus et tardus
Severe aortic stenosis causes a delayed and diminished carotid
upstroke.
9. A patient with cardiac tamponade is most likely to have which
combination?
A. Hypertension, bradycardia, pulmonary edema
B. Hypotension, elevated JVP, muffled heart sounds
C. Fever, murmur, splinter hemorrhages
D. Wide pulse pressure and bounding pulses
Answer: B. Hypotension, elevated JVP, muffled heart sounds
This is Beck's triad, classically associated with cardiac tamponade.
, 10. What is the most common cause of infective endocarditis
involving a previously normal native valve?
A. Staphylococcus aureus
B. Candida albicans
C. Coxiella burnetii
D. Aspergillus
Answer: A. Staphylococcus aureus
S. aureus is a leading cause of acute infective endocarditis, including
infection of normal valves.
11. A patient develops fever and a new murmur after IV drug use.
Which organism is particularly associated with this presentation?
A. S. aureus
B. S. pneumoniae
C. E. coli
D. H. influenzae
Answer: A. S. aureus
Injection drug use is strongly associated with S. aureus tricuspid-valve
endocarditis.
12. Which medication is first-line for immediate relief of an acute
episode of stable angina?
A. Aspirin
B. Sublingual nitroglycerin
C. Atorvastatin
D. Metoprolol
Answer: B. Sublingual nitroglycerin
Nitroglycerin rapidly decreases myocardial oxygen demand and
relieves anginal symptoms.
13. A patient has hypotension, clear lungs, and elevated jugular
venous pressure following an inferior MI. Which complication should
be suspected?
