Internal Medicine Practice Exam
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: A. Central diabetes insipidus
Central diabetes insipidus is the most common type of diabetes insipidus, is associated
with deficient secretion of antidiuretic hormone (ADH) by the posterior pituitary.
2. What is the most common presenting symptom of bladder carcinoma?
A. Nocturia
B. Painless hematuria
C. Unintentional weight loss
D. Urinary frequency: B. Painless hematuria
The primary modality to diagnose bladder cancer is with cystoscopy, which allows for
direct visualization of tissues and biopsy of any abnormalities.
Smoking is the most important risk factor of 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
, Internal Medicine Practice Exam
D. Pulmonary: A. Cardiovascular
Risk of rheumatic fever and pericarditis.
Remember the Jones criteria for rheumatic fever:
Major: Joints, carditis, nodes, erythema marginatum, sydenham chorea.
Minor: fever, arthralgia, elevated ESR, elevated CRP, and prolonged PR interval.
Need 2 major, or 1 major and 2 minor, or 3 minor
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: A. A falsely high index may indicate
severely hardened, non-compressible leg vessels.
The ankle-brachial index 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 ankle-
brachial index can occur when a patient has severely hardened peripheral arteries which
are non-compressible.
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?
, Internal Medicine Practice Exam
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 encephalopa-thy: C.
Cannot return as patient is currently symptomatic
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: A. Essential tremor
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
Complaining of hand tremor that is exacerbated by action and improved after alcohol
consumption
7. Which of the following best describes the etiology of the jaundice seen in patients with
thyroid storm?
A. Direct constricting effects of thyroid hormone on the biliary duct
, Internal Medicine Practice Exam
B. Hepatic tissue hypoxia due to increased peripheral consumption of oxygen
C. Hypotension leading to decreased gut motility
D. Impaired reabsorption of thyroid hormone in the enterohepatic circulation-
: B. Hepatic tissue hypoxia due to increased peripheral consumption of oxygen.
Signs and symptoms of thyroid storm include hyperpyrexia, nausea, vomiting,
diarrhea, mental status changes, jaundice, high-output congestive heart failure,
cardiac tachyarrhythmias, hypertension, and diaphoresis. PE will show goiter, lid lag,
hand tremor, and warm, moist skin
Labs will show low TSH and high free
T4 or T3 Most commonly caused by an
acute event
Treatment is: 1) beta blocker (propranolol) 2) thionamide (propylthiouracil or
methimazole) 3) iodine solution 4) glucocorticoids
8. Which of the following is associated with aortic stenosis?
A. de Musset sign
B. Holodiastolic decrescendo murmur
C. Syncope
D. Wide pulse pressure: C. Syncope
Patient will be older
With a history of diabetes, hypertension
Complaining of dyspnea, chest pain, syncope
PE will show crescendo-decrescendo systolic murmur that radiates to the carotids,
paradoxically split S2, S4 gallop Most commonly caused by degenerative calcification
Treatment is aortic valve replacement
Comments: murmur decreases with Valsalva
9. A 32-year-old woman with Marfan syndrome is brought to the emergency department
by her husband after she experienced a syncopal episode. She complains of acute onset of
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: A. Central diabetes insipidus
Central diabetes insipidus is the most common type of diabetes insipidus, is associated
with deficient secretion of antidiuretic hormone (ADH) by the posterior pituitary.
2. What is the most common presenting symptom of bladder carcinoma?
A. Nocturia
B. Painless hematuria
C. Unintentional weight loss
D. Urinary frequency: B. Painless hematuria
The primary modality to diagnose bladder cancer is with cystoscopy, which allows for
direct visualization of tissues and biopsy of any abnormalities.
Smoking is the most important risk factor of 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
, Internal Medicine Practice Exam
D. Pulmonary: A. Cardiovascular
Risk of rheumatic fever and pericarditis.
Remember the Jones criteria for rheumatic fever:
Major: Joints, carditis, nodes, erythema marginatum, sydenham chorea.
Minor: fever, arthralgia, elevated ESR, elevated CRP, and prolonged PR interval.
Need 2 major, or 1 major and 2 minor, or 3 minor
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: A. A falsely high index may indicate
severely hardened, non-compressible leg vessels.
The ankle-brachial index 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 ankle-
brachial index can occur when a patient has severely hardened peripheral arteries which
are non-compressible.
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?
, Internal Medicine Practice Exam
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 encephalopa-thy: C.
Cannot return as patient is currently symptomatic
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: A. Essential tremor
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
Complaining of hand tremor that is exacerbated by action and improved after alcohol
consumption
7. Which of the following best describes the etiology of the jaundice seen in patients with
thyroid storm?
A. Direct constricting effects of thyroid hormone on the biliary duct
, Internal Medicine Practice Exam
B. Hepatic tissue hypoxia due to increased peripheral consumption of oxygen
C. Hypotension leading to decreased gut motility
D. Impaired reabsorption of thyroid hormone in the enterohepatic circulation-
: B. Hepatic tissue hypoxia due to increased peripheral consumption of oxygen.
Signs and symptoms of thyroid storm include hyperpyrexia, nausea, vomiting,
diarrhea, mental status changes, jaundice, high-output congestive heart failure,
cardiac tachyarrhythmias, hypertension, and diaphoresis. PE will show goiter, lid lag,
hand tremor, and warm, moist skin
Labs will show low TSH and high free
T4 or T3 Most commonly caused by an
acute event
Treatment is: 1) beta blocker (propranolol) 2) thionamide (propylthiouracil or
methimazole) 3) iodine solution 4) glucocorticoids
8. Which of the following is associated with aortic stenosis?
A. de Musset sign
B. Holodiastolic decrescendo murmur
C. Syncope
D. Wide pulse pressure: C. Syncope
Patient will be older
With a history of diabetes, hypertension
Complaining of dyspnea, chest pain, syncope
PE will show crescendo-decrescendo systolic murmur that radiates to the carotids,
paradoxically split S2, S4 gallop Most commonly caused by degenerative calcification
Treatment is aortic valve replacement
Comments: murmur decreases with Valsalva
9. A 32-year-old woman with Marfan syndrome is brought to the emergency department
by her husband after she experienced a syncopal episode. She complains of acute onset of
