INTERNAL MEDICINE
PRACTICE EXAM
QUESTIONS WITH
VERIFIED ANSWERS
, INTERNAL MEDICINE PRACTICE EXAM QUESTIONS WITH
VERIFIED ANSWERS
A 17-year-old woman with a history of severe menorrhagia was admitted for a blood transfusion
after fainting at school. Her history is positive for fatigue, exertional dyspnea, and increased
cravings for ice over the past several weeks. Laboratory findings show hemoglobin 6 g/dL,
hematocrit 22%, mean corpuscular volume 72 fL, total serum iron 23 mcg/dL, and total iron
binding capacity 92 micromol/L. The patient was found to have conjunctival pallor and
koilonychia on physical examination. What additional physical exam finding would you expect to
find?
A. Facial plethora
B. Jaundice
C. Loss of tongue papillae
D. Petechiae - - Answer --C. Loss of tongue papillae
Loss of tongue papillae or atrophic glossitis is seen in patients with iron deficiency anemia. Iron
deficiency anemia is common in women of reproductive age and children.
A 20-year-old woman with a history of cystic fibrosis presents for evaluation of a two year
history of multiple episodes of what she describes as "bronchitis". She complains of chronic
cough productive of foul-smelling sputum. Auscultation reveals crackles at the lung bases.
Chest X-ray is notable for airway dilatation and thickening. Which of the following is the most
likely diagnosis?
A. Asthma
B. Bronchiectasis
C. Chronic bronchitis
D. Emphysema - - Answer --B. Bronchiectasis
A 21-year-old man presents with a complaint of a painless "lump" near his anus. He reports
occasional blood on the toilet paper when he wipes after straining to have a bowel movement.
He also complains of intermittent peri-anal itching. On inspection, you note a pink, circular lesion
visualized on the anus that is not pedunculated. It is firm and non-tender. What is the most likely
diagnosis?
A. Anal abscess
B. Anal skin tag
C. External hemorrhoid
D. Internal hemorrhoid - - Answer --C. External hemorrhoid
Hemorrhoids
Patient will be complaining of pain and itching in the anal region
PE will show:
Internal - proximal to the dentate line
External - distal to the dentate line
Treatment is lifestyle modifications, sitz baths, analgesic creams, or surgical excision
A 21-year-old woman presents to the clinic with several large, anterior and posterior cervical
lymph nodes. She complains of weight loss and night sweats for the past four months. Which of
the following is the most effective next step in the diagnosis of Hodgkin lymphoma?
A. CT scan of neck, chest and abdomen
,B. Fluorescence immunophenotyping
C. Lymph node excisional biopsy
D. Lymph node fine needle aspiration - - Answer --C. Lymph node excisional biopsy
Hodgkin Lymphoma
Patient will be complaining of lymphadenopathy (often cervical and painless), pruritus, fever,
night sweats, unintentional weight loss, and frequent infections
Diagnosis is made by lymph node biopsy showing Reed-Sternberg cells
A 22-year-old man presents to the office for his one week follow up after his third concussion in
four years. The patient plays rugby on his college intramural team. His most recent concussion
was complicated by a period of loss of consciousness at the time of injury. He admits to having
headaches and intermittent dizziness for the past couple of days. His headache appears to be
tension-type in nature. He is eager to return to rugby and is requesting clearance to play. Which
of the following is the most appropriate education to give your patient?
A. Can return as headaches after a concussion are expected
B. Can return as subsequent concussions increase resilience to future ones
C. Cannot return as patient is currently symptomatic
D. Cannot return as patient meets criteria for chronic traumatic encephalopathy - - Answer --C.
Cannot return as patient is currently symptomatic
A 23-year-old African American woman, with no risk factors for heart disease, presents to the
clinic with complaints of sternal chest pain, fatigue, nonproductive cough, and shortness of
breath. Vitals and physical exam are normal. Chest X-ray reveals bilateral hilar adenopathy and
diffuse reticular opacities. Which of the following is most likely to confirm the diagnosis?
A. Endobronchial lung biopsy
B. Positron emission tomography scan
C. Pulmonary function tests
D. Surgical biopsy of mediastinum and lung - - Answer --A. Endobronchial lung biopsy
A 23-year-old man presents for evaluation of a painless right-sided scrotal mass that he noted
for the first time while showering one week ago. On physical examination, the mass is located
on the anterior surface of the testicle. It is soft on palpation and transilluminates. Which of the
following is the most likely diagnosis?
A. Hydrocele
B. Spermatocele
C. Testicular cancer
D. Varicocele - - Answer --A. Hydrocele
A 23-year-old man presents to the emergency department after being stabbed in the flank
during a bar fight. He received 2 liters of normal saline by EMS. On arrival, his vital signs are T
37.2°C, HR 130, BP 75/50, RR 30. He appears anxious and diaphoretic. On examination, he
has a stab wound to the right flank, abdominal distention, no sensation below the level of T10,
weakness of bilateral lower extremities, poor peripheral pulses and cool extremities. Which of
the following is the most likely cause of this patient's hemodynamic instability?
A. Hypovolemic shock
B. Neurogenic shock
C. Obstructive shock
, D. Spinal shock - - Answer --A. Hypovolemic shock
A 23-year-old woman, with no risk factors for heart disease, presents to the clinic with
complaints of sternal chest pain, fatigue, and shortness of breath. She was recently diagnosed
with sarcoidosis. In your review of systems check, other than pulmonary, what area do you want
to focus on the most?
A. Gastrointestinal
B. Musculoskeletal
C. Renal
D. Skin - - Answer --D. Skin
Skin and lymph nodes are the two most commonly affected areas, after the lungs, by
sarcoidosis. History and physical exam should include a thorough review of skin changes.
Sarcoidosis is an inflammatory condition characterized by the presence of noncaseating
granulomas in organs and tissues, such as the lungs, skin, lymph nodes, eyes, kidneys, joints,
and various others.
Lupus pernio (chronic, violaceous, raised plaques and nodules commonly found on the cheeks,
nose, and around the eyes) is pathognomonic for sarcoidosis and is the most specific physical
exam finding in this disease
A 24-year-old man presents to the emergency department with fever and chills, right upper
quadrant pain, and jaundice. Abdominal ultrasound shows dilation of the common bile duct.
What is the most likely diagnosis?
A. Acute cholangitis
B. Acute cholecystitis
C. Acute hepatitis
D. Cholelithiasis - - Answer --A. Acute cholangitis
Patient will be complaining of right upper quadrant pain, jaundice, fever (Charcot triad)
Diagnosis is made by RUQ ultrasound, CT scan, or ERCP (gold standard)
Most commonly caused by choledocholithiasis leading to bacterial infection, E. coli
Treatment is antibiotics, definitive treatment is ERCP with antibiotics typically an adjunct
Comments: Charcot triad + hypotension and AMS = Reynolds pentad, acute obstruction
A 24-year-old woman is admitted to the intensive care unit after developing thyroid storm status
post appendectomy and is being treated with propylthiouracil. What is the mechanism of action
of this drug?
A. Decreases adrenergic tone
B. Decreases vasomotor instability
C. Inhibits conversion of thyroxine to triiodothyronine
D. Inhibits release of thyroid hormone - - Answer --C. Inhibits conversion of thyroxine to
triiodothyronine
A 24-year-old woman presents to the clinic with sudden onset of fever, chills, dry cough,
malaise, substernal soreness, coryza, nasal congestion, and myalgias. Her symptoms came on
suddenly yesterday while she was at work. Her husband was recently sick with similar
symptoms. Physical exam reveals a temperature of 38.6°C, pharyngeal injection, conjunctival
injection, and facial flushing. A chest X-ray is obtained and is negative for any acute
cardiopulmonary process. What is the most likely diagnosis?
PRACTICE EXAM
QUESTIONS WITH
VERIFIED ANSWERS
, INTERNAL MEDICINE PRACTICE EXAM QUESTIONS WITH
VERIFIED ANSWERS
A 17-year-old woman with a history of severe menorrhagia was admitted for a blood transfusion
after fainting at school. Her history is positive for fatigue, exertional dyspnea, and increased
cravings for ice over the past several weeks. Laboratory findings show hemoglobin 6 g/dL,
hematocrit 22%, mean corpuscular volume 72 fL, total serum iron 23 mcg/dL, and total iron
binding capacity 92 micromol/L. The patient was found to have conjunctival pallor and
koilonychia on physical examination. What additional physical exam finding would you expect to
find?
A. Facial plethora
B. Jaundice
C. Loss of tongue papillae
D. Petechiae - - Answer --C. Loss of tongue papillae
Loss of tongue papillae or atrophic glossitis is seen in patients with iron deficiency anemia. Iron
deficiency anemia is common in women of reproductive age and children.
A 20-year-old woman with a history of cystic fibrosis presents for evaluation of a two year
history of multiple episodes of what she describes as "bronchitis". She complains of chronic
cough productive of foul-smelling sputum. Auscultation reveals crackles at the lung bases.
Chest X-ray is notable for airway dilatation and thickening. Which of the following is the most
likely diagnosis?
A. Asthma
B. Bronchiectasis
C. Chronic bronchitis
D. Emphysema - - Answer --B. Bronchiectasis
A 21-year-old man presents with a complaint of a painless "lump" near his anus. He reports
occasional blood on the toilet paper when he wipes after straining to have a bowel movement.
He also complains of intermittent peri-anal itching. On inspection, you note a pink, circular lesion
visualized on the anus that is not pedunculated. It is firm and non-tender. What is the most likely
diagnosis?
A. Anal abscess
B. Anal skin tag
C. External hemorrhoid
D. Internal hemorrhoid - - Answer --C. External hemorrhoid
Hemorrhoids
Patient will be complaining of pain and itching in the anal region
PE will show:
Internal - proximal to the dentate line
External - distal to the dentate line
Treatment is lifestyle modifications, sitz baths, analgesic creams, or surgical excision
A 21-year-old woman presents to the clinic with several large, anterior and posterior cervical
lymph nodes. She complains of weight loss and night sweats for the past four months. Which of
the following is the most effective next step in the diagnosis of Hodgkin lymphoma?
A. CT scan of neck, chest and abdomen
,B. Fluorescence immunophenotyping
C. Lymph node excisional biopsy
D. Lymph node fine needle aspiration - - Answer --C. Lymph node excisional biopsy
Hodgkin Lymphoma
Patient will be complaining of lymphadenopathy (often cervical and painless), pruritus, fever,
night sweats, unintentional weight loss, and frequent infections
Diagnosis is made by lymph node biopsy showing Reed-Sternberg cells
A 22-year-old man presents to the office for his one week follow up after his third concussion in
four years. The patient plays rugby on his college intramural team. His most recent concussion
was complicated by a period of loss of consciousness at the time of injury. He admits to having
headaches and intermittent dizziness for the past couple of days. His headache appears to be
tension-type in nature. He is eager to return to rugby and is requesting clearance to play. Which
of the following is the most appropriate education to give your patient?
A. Can return as headaches after a concussion are expected
B. Can return as subsequent concussions increase resilience to future ones
C. Cannot return as patient is currently symptomatic
D. Cannot return as patient meets criteria for chronic traumatic encephalopathy - - Answer --C.
Cannot return as patient is currently symptomatic
A 23-year-old African American woman, with no risk factors for heart disease, presents to the
clinic with complaints of sternal chest pain, fatigue, nonproductive cough, and shortness of
breath. Vitals and physical exam are normal. Chest X-ray reveals bilateral hilar adenopathy and
diffuse reticular opacities. Which of the following is most likely to confirm the diagnosis?
A. Endobronchial lung biopsy
B. Positron emission tomography scan
C. Pulmonary function tests
D. Surgical biopsy of mediastinum and lung - - Answer --A. Endobronchial lung biopsy
A 23-year-old man presents for evaluation of a painless right-sided scrotal mass that he noted
for the first time while showering one week ago. On physical examination, the mass is located
on the anterior surface of the testicle. It is soft on palpation and transilluminates. Which of the
following is the most likely diagnosis?
A. Hydrocele
B. Spermatocele
C. Testicular cancer
D. Varicocele - - Answer --A. Hydrocele
A 23-year-old man presents to the emergency department after being stabbed in the flank
during a bar fight. He received 2 liters of normal saline by EMS. On arrival, his vital signs are T
37.2°C, HR 130, BP 75/50, RR 30. He appears anxious and diaphoretic. On examination, he
has a stab wound to the right flank, abdominal distention, no sensation below the level of T10,
weakness of bilateral lower extremities, poor peripheral pulses and cool extremities. Which of
the following is the most likely cause of this patient's hemodynamic instability?
A. Hypovolemic shock
B. Neurogenic shock
C. Obstructive shock
, D. Spinal shock - - Answer --A. Hypovolemic shock
A 23-year-old woman, with no risk factors for heart disease, presents to the clinic with
complaints of sternal chest pain, fatigue, and shortness of breath. She was recently diagnosed
with sarcoidosis. In your review of systems check, other than pulmonary, what area do you want
to focus on the most?
A. Gastrointestinal
B. Musculoskeletal
C. Renal
D. Skin - - Answer --D. Skin
Skin and lymph nodes are the two most commonly affected areas, after the lungs, by
sarcoidosis. History and physical exam should include a thorough review of skin changes.
Sarcoidosis is an inflammatory condition characterized by the presence of noncaseating
granulomas in organs and tissues, such as the lungs, skin, lymph nodes, eyes, kidneys, joints,
and various others.
Lupus pernio (chronic, violaceous, raised plaques and nodules commonly found on the cheeks,
nose, and around the eyes) is pathognomonic for sarcoidosis and is the most specific physical
exam finding in this disease
A 24-year-old man presents to the emergency department with fever and chills, right upper
quadrant pain, and jaundice. Abdominal ultrasound shows dilation of the common bile duct.
What is the most likely diagnosis?
A. Acute cholangitis
B. Acute cholecystitis
C. Acute hepatitis
D. Cholelithiasis - - Answer --A. Acute cholangitis
Patient will be complaining of right upper quadrant pain, jaundice, fever (Charcot triad)
Diagnosis is made by RUQ ultrasound, CT scan, or ERCP (gold standard)
Most commonly caused by choledocholithiasis leading to bacterial infection, E. coli
Treatment is antibiotics, definitive treatment is ERCP with antibiotics typically an adjunct
Comments: Charcot triad + hypotension and AMS = Reynolds pentad, acute obstruction
A 24-year-old woman is admitted to the intensive care unit after developing thyroid storm status
post appendectomy and is being treated with propylthiouracil. What is the mechanism of action
of this drug?
A. Decreases adrenergic tone
B. Decreases vasomotor instability
C. Inhibits conversion of thyroxine to triiodothyronine
D. Inhibits release of thyroid hormone - - Answer --C. Inhibits conversion of thyroxine to
triiodothyronine
A 24-year-old woman presents to the clinic with sudden onset of fever, chills, dry cough,
malaise, substernal soreness, coryza, nasal congestion, and myalgias. Her symptoms came on
suddenly yesterday while she was at work. Her husband was recently sick with similar
symptoms. Physical exam reveals a temperature of 38.6°C, pharyngeal injection, conjunctival
injection, and facial flushing. A chest X-ray is obtained and is negative for any acute
cardiopulmonary process. What is the most likely diagnosis?
