Internal Medicine Exam Study Guide with Accurate Questions and
Answers (Verified Answers) | Latest (2026/2027) Updated Version |
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1. A 24-year-old woman presents with complaints of excessive thirst over the past
several weeks. She also notes waking up in the middle of the night to urinate. She
recently underwent transsphenoidal resection of a pituitary adenoma. Which of the
following is the most likely diagnosis?
A. Central diabetes insipidus
B. Nephrogenic diabetes insipidus
C. Primary polydipsia
D. Type 2 diabetes mellitus
Answer: A. Central diabetes insipidus
Rationale: Central diabetes insipidus is the most common type of diabetes insipidus and
is associated with deficient secretion of antidiuretic hormone (ADH) by the posterior
pituitary. This patient's recent transsphenoidal resection of a pituitary adenoma places her
at high risk for damage to the posterior pituitary, leading to decreased ADH secretion.
The classic presentation includes polydipsia and nocturia. Nephrogenic diabetes insipidus
involves renal resistance to ADH. Primary polydipsia is excessive water intake without
hormonal deficiency. Type 2 diabetes mellitus would typically present with
hyperglycemia and glycosuria.
2. What is the most common presenting symptom of bladder carcinoma?
A. Nocturia
B. Painless hematuria
C. Unintentional weight loss
D. Urinary frequency
,Answer: B. Painless hematuria
Rationale: The most common presenting symptom of bladder carcinoma is painless
hematuria. The primary modality to diagnose bladder cancer is cystoscopy, which allows
for direct visualization of tissues and biopsy of any abnormalities. Smoking is the most
important risk factor for bladder cancer.
3. A 25-year-old man presents to the clinic with fever and a sore throat. A throat
swab is performed and the culture comes back positive for group A streptococcus
bacteria. What system of his body is at highest risk for permanent damage if proper
treatment for his infection is not administered?
A. Cardiovascular
B. Gastrointestinal
C. Musculoskeletal
D. Pulmonary
Answer: A. Cardiovascular
Rationale: Group A streptococcus pharyngitis carries a risk of rheumatic fever and
pericarditis if not properly treated. Remember the Jones criteria for rheumatic fever:
Major criteria include Joints (polyarthritis), carditis, nodes (subcutaneous nodules),
erythema marginatum, and Sydenham chorea. Minor criteria include fever, arthralgia,
elevated ESR, elevated CRP, and prolonged PR interval. Diagnosis requires 2 major
criteria, or 1 major and 2 minor criteria, or 3 minor criteria.
4. A 60-year-old man with intermittent claudication returns to the clinic for
interpretation of the results of his ankle-brachial index. Which of the following
statements is most accurate?
A. A falsely high index may indicate severely hardened, non-compressible leg vessels
,B. A low ankle-brachial index indicates peripheral venous insufficiency
C. An ankle-brachial index of 1.2 indicates severe disease
D. It is the ratio of ankle to arm diastolic blood pressure
Answer: A. A falsely high index may indicate severely hardened, non-compressible
leg vessels
Rationale: The ankle-brachial index (ABI) is calculated by measuring the systolic blood
pressure in the arm and at the ankle. A ratio of ankle systolic blood pressure to brachial
systolic blood pressure under 0.90 is indicative of peripheral arterial disease. A falsely
high ABI can occur when a patient has severely hardened peripheral arteries which are
non-compressible. ABI is a ratio of systolic, not diastolic, pressures. A low ABI indicates
peripheral arterial disease, not venous insufficiency.
5. 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
Rationale: The patient is currently symptomatic with headaches and dizziness following
his third concussion. Return-to-play protocols require that athletes be asymptomatic
before resuming sports. Additionally, a history of multiple concussions increases the risk
, for future concussions and long-term complications. Chronic traumatic encephalopathy is
a neurodegenerative disease associated with repetitive head trauma, but the patient does
not currently meet criteria for this diagnosis.
6. A 64-year-old man presents to the clinic reporting a progressive tremor affecting
his hands. He states the symptom onset was approximately seven years ago. He
states his tremor is now affecting his writing but appears to improve in the evenings
after a glass of wine. He has no significant medical history. He does report that his
mother had a similar problem but never sought medical attention. On exam, he has
no tremor at rest but develops an increasing amplitude tremor in both upper
extremities when reaching for items. No bradykinesia or rigidity is present. The rest
of his examination is unremarkable. Which of the following is the most likely
diagnosis?
A. Essential tremor
B. Huntington disease
C. Parkinson disease
D. Wilson disease
Answer: A. Essential tremor
Rationale: Essential tremor is characterized by a tremor that is exacerbated by action and
improved after alcohol consumption. Diagnosis is made clinically on the basis of family
history, as an autosomal dominant transmission occurs in many cases, and clinical
presentation. Initial treatment may be episodic with primidone or propranolol; however,
long-term treatment is usually with propranolol or topiramate. Parkinson disease typically
presents with a resting tremor, bradykinesia, and rigidity. Huntington disease involves
chorea and cognitive decline. Wilson disease presents with hepatic and neurologic
symptoms in younger patients.
Answers (Verified Answers) | Latest (2026/2027) Updated Version |
100% Guaranteed Pass {JUST RELEASED}
1. A 24-year-old woman presents with complaints of excessive thirst over the past
several weeks. She also notes waking up in the middle of the night to urinate. She
recently underwent transsphenoidal resection of a pituitary adenoma. Which of the
following is the most likely diagnosis?
A. Central diabetes insipidus
B. Nephrogenic diabetes insipidus
C. Primary polydipsia
D. Type 2 diabetes mellitus
Answer: A. Central diabetes insipidus
Rationale: Central diabetes insipidus is the most common type of diabetes insipidus and
is associated with deficient secretion of antidiuretic hormone (ADH) by the posterior
pituitary. This patient's recent transsphenoidal resection of a pituitary adenoma places her
at high risk for damage to the posterior pituitary, leading to decreased ADH secretion.
The classic presentation includes polydipsia and nocturia. Nephrogenic diabetes insipidus
involves renal resistance to ADH. Primary polydipsia is excessive water intake without
hormonal deficiency. Type 2 diabetes mellitus would typically present with
hyperglycemia and glycosuria.
2. What is the most common presenting symptom of bladder carcinoma?
A. Nocturia
B. Painless hematuria
C. Unintentional weight loss
D. Urinary frequency
,Answer: B. Painless hematuria
Rationale: The most common presenting symptom of bladder carcinoma is painless
hematuria. The primary modality to diagnose bladder cancer is cystoscopy, which allows
for direct visualization of tissues and biopsy of any abnormalities. Smoking is the most
important risk factor for bladder cancer.
3. A 25-year-old man presents to the clinic with fever and a sore throat. A throat
swab is performed and the culture comes back positive for group A streptococcus
bacteria. What system of his body is at highest risk for permanent damage if proper
treatment for his infection is not administered?
A. Cardiovascular
B. Gastrointestinal
C. Musculoskeletal
D. Pulmonary
Answer: A. Cardiovascular
Rationale: Group A streptococcus pharyngitis carries a risk of rheumatic fever and
pericarditis if not properly treated. Remember the Jones criteria for rheumatic fever:
Major criteria include Joints (polyarthritis), carditis, nodes (subcutaneous nodules),
erythema marginatum, and Sydenham chorea. Minor criteria include fever, arthralgia,
elevated ESR, elevated CRP, and prolonged PR interval. Diagnosis requires 2 major
criteria, or 1 major and 2 minor criteria, or 3 minor criteria.
4. A 60-year-old man with intermittent claudication returns to the clinic for
interpretation of the results of his ankle-brachial index. Which of the following
statements is most accurate?
A. A falsely high index may indicate severely hardened, non-compressible leg vessels
,B. A low ankle-brachial index indicates peripheral venous insufficiency
C. An ankle-brachial index of 1.2 indicates severe disease
D. It is the ratio of ankle to arm diastolic blood pressure
Answer: A. A falsely high index may indicate severely hardened, non-compressible
leg vessels
Rationale: The ankle-brachial index (ABI) is calculated by measuring the systolic blood
pressure in the arm and at the ankle. A ratio of ankle systolic blood pressure to brachial
systolic blood pressure under 0.90 is indicative of peripheral arterial disease. A falsely
high ABI can occur when a patient has severely hardened peripheral arteries which are
non-compressible. ABI is a ratio of systolic, not diastolic, pressures. A low ABI indicates
peripheral arterial disease, not venous insufficiency.
5. 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
Rationale: The patient is currently symptomatic with headaches and dizziness following
his third concussion. Return-to-play protocols require that athletes be asymptomatic
before resuming sports. Additionally, a history of multiple concussions increases the risk
, for future concussions and long-term complications. Chronic traumatic encephalopathy is
a neurodegenerative disease associated with repetitive head trauma, but the patient does
not currently meet criteria for this diagnosis.
6. A 64-year-old man presents to the clinic reporting a progressive tremor affecting
his hands. He states the symptom onset was approximately seven years ago. He
states his tremor is now affecting his writing but appears to improve in the evenings
after a glass of wine. He has no significant medical history. He does report that his
mother had a similar problem but never sought medical attention. On exam, he has
no tremor at rest but develops an increasing amplitude tremor in both upper
extremities when reaching for items. No bradykinesia or rigidity is present. The rest
of his examination is unremarkable. Which of the following is the most likely
diagnosis?
A. Essential tremor
B. Huntington disease
C. Parkinson disease
D. Wilson disease
Answer: A. Essential tremor
Rationale: Essential tremor is characterized by a tremor that is exacerbated by action and
improved after alcohol consumption. Diagnosis is made clinically on the basis of family
history, as an autosomal dominant transmission occurs in many cases, and clinical
presentation. Initial treatment may be episodic with primidone or propranolol; however,
long-term treatment is usually with propranolol or topiramate. Parkinson disease typically
presents with a resting tremor, bradykinesia, and rigidity. Huntington disease involves
chorea and cognitive decline. Wilson disease presents with hepatic and neurologic
symptoms in younger patients.
