1
GENERAL INTERNAL MEDICINE ONE MCQS
SPECIFIC TO ACTUAL EXAM SAT ON 2025
1. You are seeing a 60 year old man with erectile dysfunction. He had myocardial infarction six
months ago. He is a type II diabetic, well-controlled on glimepride. HbA1c is 6.8%. He is also on
bisoprolol, ACE inhibitors, statin, and aspirin. On stress test there is evidence of mild ischemia on
maximal exertion. His testosterone and prolactin levels are normal. What is the best therapy for
his erectile dysfunction?
A) Stop the statin
B) Stop the beta-blocker
C) Give testosterone injections
D) Give tadalafil
E) Change glimepride to metformin
2. Which of the following conditions is likely to precipitate symptomatic heart failure in patient
with previously compensated left ventricular dysfunction?
A) Atrial fibrillation
B) Marked sinus bradycardia
C) A-V dissociation
D) Right ventricular apical pacing
E) All of the above
3. All the following conditions are associated with high output heart failure EXCEPT
A) Iron overload
B) Hyperthyroidism
C) Systemic arteriovenous fistula
D) Thiamine deficiency
MBChB KIU-WC 2024 1
,2
E) Paget disease
4. A 42-year-old man was hospitalized for thrombotic thrombocytopenic purpura for which he
underwent therapeutic plasmapherisis. After 5 days of treatment, he developed fever and cough
with progression of respiratory symptoms to severe dyspnea, with some wheezing. On
examination, he is dyspneic and cyanotic; his blood pressure is 120/80 mm Hg, pulse 110
beat/minute and temperature 38.5 °C. There is no rash or hives. Chest is full of rhonchi
bilaterally. Oxygen saturation is 84% on room air, and a blood gas study shows an arterial PO2of
58 mm Hg. A chest radiograph reveals diffuse opacifications of both lungs and a normal-sized
heart and no pleural effusion. Which of the following is the most likely cause for this patient's
reaction?
A) Pulmonary embolism
B) Antileukocyte antibodies
C) Allergy to donor plasma proteins
D) Circulatory overload
E) All of the above
5. A 55-year-old man presents to the emergency department with severe headache that began
10 hours ago. His medical history is remarkable for poorly controlled hypertension treated with
indepamide and atenolol. On physical examination, his pulse rate is 85/min, respiration rate is
14/min, and blood pressure is 210/150 mm Hg. Optic disc examination shows papilloedema and
hemorrhagic exudates. Serum creatinine concentration is 2.8 mg/dL (247.5 µmol/L), and serum
electrolytes are normal. An intravenous line is inserted to initiate therapy with nitroprusside, and
an arterial line is inserted to monitor blood pressure. Which of the following parameters is used
to determine whether a loading dose of nitroprusside is required in this patient?
A) Half-life
B) Bioavailability
C) Clearance
D) Volume of distribution
E) All of the above
MBChB KIU-WC 2024 2
,3
6. A 55-year-old man is scheduled for abdomen CT with contrast. He has type 2 diabetes; well
controlled with pioglitazone, metformin, and glimepride. On the day of the procedure he is to
receive nothing by mouth all morning except for medications until after the procedure. Which of
the following would be the most appropriate oral regimen on the day of the procedure?
A) Continue all medications
B) Hold metformin, and continue glimepride and pioglitazone
C) Hold glimepride and metformin, and continue pioglitazone
D) Hold glimepride and pioglitazone and decrease metformin dose by half
E) Hold metformin and pioglitazone, and continue glimepride
7. A 68-year-old man presents with chills and right upper quadrant abdominal pain. On
examination the patient is icteric. His transaminase levels are mildly elevated, the direct bilirubin
level is 6 mg/dl (102.6 µmol/l), and the leucocyte count is 18.0 X 109/l. Which of the following is
the most appropriate therapeutic approach?
A) Perform an ERCP.
B) Obtain CT scan of the liver.
C) Order viral hepatitis serology
D) Start broad spectrum IV antibiotics
E) Obtain a magnetic resonance imaging (MRI) study of the liver
8. Concerning pseudomyxoma peritonei: All are true EXCEPT
A) Begins with a mucinous cystadenocarcinoma, most commonly involving either the ovary or
appendix.
B) Rupture of the lesion results in diffuse metastatic spread with implantation of the mucin
secreting lesions on the omentum as well as the peritoneum.
C) Average age of presentation of this disease process is 45-55, with men making up 80% of
cases.
D) Presenting symptoms are non-specific, generally including pain, but also usually with a
palpable mass.
MBChB KIU-WC 2024 3
, 4
E) A 5-year survival of these patients is only approximately 50%.
9. A 42-year-old wig manufacturer returned 5 days ago from Iran where he was inspecting herds
for raw material. He had initially experienced only mild upper respiratory tract symptoms, but 2
days later was brought to the emergency room with fever, severe dyspnea, cyanosis, and
tachycardia. Blood cultures were drawn and after 16 hours of incubation, the smears revealed
large, gram-positive rods with subterminal spores. The organism was non-hemolytic on blood
agar and non-motile. What is the most probable identity of this organism?
A) Clostridium tertium
B) Bacillus anthracis
C) Clostridium perfringens
D) Bacillus subtilis
E) None of the above
10. In chronic lymphocytic leukemia (CLL), patient are prone to develop all the following EXCEPT
A) Hypogammaglobulinemia
B) Autoimmune hemolytic anemia
C) Opportunistic infections
D) high-grade lymphoid neoplasm
E) Conversion to a myeloid blast crisis
11. A 28-year-old man presents to the clinic asking for a treatment plan for his recently
diagnosed multiple sclerosis. Three years ago, he had an episode of diplopia that resolved
entirely after 2 months. One month ago, he had mild weakness and numbness of the right leg.
MRI of the brain at that time showed multiple cerebral white-matter lesions in a periventricular
distribution classic for multiple sclerosis. His leg weakness resolved without treatment. He is now
asymptomatic and has a normal neurologic examination. Which of the following is the most
appropriate treatment recommendation at this time?
A) High-dose intravenous methylprednisolone
B) Chronic oral prednisone
C) Observation
MBChB KIU-WC 2024 4
GENERAL INTERNAL MEDICINE ONE MCQS
SPECIFIC TO ACTUAL EXAM SAT ON 2025
1. You are seeing a 60 year old man with erectile dysfunction. He had myocardial infarction six
months ago. He is a type II diabetic, well-controlled on glimepride. HbA1c is 6.8%. He is also on
bisoprolol, ACE inhibitors, statin, and aspirin. On stress test there is evidence of mild ischemia on
maximal exertion. His testosterone and prolactin levels are normal. What is the best therapy for
his erectile dysfunction?
A) Stop the statin
B) Stop the beta-blocker
C) Give testosterone injections
D) Give tadalafil
E) Change glimepride to metformin
2. Which of the following conditions is likely to precipitate symptomatic heart failure in patient
with previously compensated left ventricular dysfunction?
A) Atrial fibrillation
B) Marked sinus bradycardia
C) A-V dissociation
D) Right ventricular apical pacing
E) All of the above
3. All the following conditions are associated with high output heart failure EXCEPT
A) Iron overload
B) Hyperthyroidism
C) Systemic arteriovenous fistula
D) Thiamine deficiency
MBChB KIU-WC 2024 1
,2
E) Paget disease
4. A 42-year-old man was hospitalized for thrombotic thrombocytopenic purpura for which he
underwent therapeutic plasmapherisis. After 5 days of treatment, he developed fever and cough
with progression of respiratory symptoms to severe dyspnea, with some wheezing. On
examination, he is dyspneic and cyanotic; his blood pressure is 120/80 mm Hg, pulse 110
beat/minute and temperature 38.5 °C. There is no rash or hives. Chest is full of rhonchi
bilaterally. Oxygen saturation is 84% on room air, and a blood gas study shows an arterial PO2of
58 mm Hg. A chest radiograph reveals diffuse opacifications of both lungs and a normal-sized
heart and no pleural effusion. Which of the following is the most likely cause for this patient's
reaction?
A) Pulmonary embolism
B) Antileukocyte antibodies
C) Allergy to donor plasma proteins
D) Circulatory overload
E) All of the above
5. A 55-year-old man presents to the emergency department with severe headache that began
10 hours ago. His medical history is remarkable for poorly controlled hypertension treated with
indepamide and atenolol. On physical examination, his pulse rate is 85/min, respiration rate is
14/min, and blood pressure is 210/150 mm Hg. Optic disc examination shows papilloedema and
hemorrhagic exudates. Serum creatinine concentration is 2.8 mg/dL (247.5 µmol/L), and serum
electrolytes are normal. An intravenous line is inserted to initiate therapy with nitroprusside, and
an arterial line is inserted to monitor blood pressure. Which of the following parameters is used
to determine whether a loading dose of nitroprusside is required in this patient?
A) Half-life
B) Bioavailability
C) Clearance
D) Volume of distribution
E) All of the above
MBChB KIU-WC 2024 2
,3
6. A 55-year-old man is scheduled for abdomen CT with contrast. He has type 2 diabetes; well
controlled with pioglitazone, metformin, and glimepride. On the day of the procedure he is to
receive nothing by mouth all morning except for medications until after the procedure. Which of
the following would be the most appropriate oral regimen on the day of the procedure?
A) Continue all medications
B) Hold metformin, and continue glimepride and pioglitazone
C) Hold glimepride and metformin, and continue pioglitazone
D) Hold glimepride and pioglitazone and decrease metformin dose by half
E) Hold metformin and pioglitazone, and continue glimepride
7. A 68-year-old man presents with chills and right upper quadrant abdominal pain. On
examination the patient is icteric. His transaminase levels are mildly elevated, the direct bilirubin
level is 6 mg/dl (102.6 µmol/l), and the leucocyte count is 18.0 X 109/l. Which of the following is
the most appropriate therapeutic approach?
A) Perform an ERCP.
B) Obtain CT scan of the liver.
C) Order viral hepatitis serology
D) Start broad spectrum IV antibiotics
E) Obtain a magnetic resonance imaging (MRI) study of the liver
8. Concerning pseudomyxoma peritonei: All are true EXCEPT
A) Begins with a mucinous cystadenocarcinoma, most commonly involving either the ovary or
appendix.
B) Rupture of the lesion results in diffuse metastatic spread with implantation of the mucin
secreting lesions on the omentum as well as the peritoneum.
C) Average age of presentation of this disease process is 45-55, with men making up 80% of
cases.
D) Presenting symptoms are non-specific, generally including pain, but also usually with a
palpable mass.
MBChB KIU-WC 2024 3
, 4
E) A 5-year survival of these patients is only approximately 50%.
9. A 42-year-old wig manufacturer returned 5 days ago from Iran where he was inspecting herds
for raw material. He had initially experienced only mild upper respiratory tract symptoms, but 2
days later was brought to the emergency room with fever, severe dyspnea, cyanosis, and
tachycardia. Blood cultures were drawn and after 16 hours of incubation, the smears revealed
large, gram-positive rods with subterminal spores. The organism was non-hemolytic on blood
agar and non-motile. What is the most probable identity of this organism?
A) Clostridium tertium
B) Bacillus anthracis
C) Clostridium perfringens
D) Bacillus subtilis
E) None of the above
10. In chronic lymphocytic leukemia (CLL), patient are prone to develop all the following EXCEPT
A) Hypogammaglobulinemia
B) Autoimmune hemolytic anemia
C) Opportunistic infections
D) high-grade lymphoid neoplasm
E) Conversion to a myeloid blast crisis
11. A 28-year-old man presents to the clinic asking for a treatment plan for his recently
diagnosed multiple sclerosis. Three years ago, he had an episode of diplopia that resolved
entirely after 2 months. One month ago, he had mild weakness and numbness of the right leg.
MRI of the brain at that time showed multiple cerebral white-matter lesions in a periventricular
distribution classic for multiple sclerosis. His leg weakness resolved without treatment. He is now
asymptomatic and has a normal neurologic examination. Which of the following is the most
appropriate treatment recommendation at this time?
A) High-dose intravenous methylprednisolone
B) Chronic oral prednisone
C) Observation
MBChB KIU-WC 2024 4
