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Test Your Skills with Internal Medicine MCQ Quiz

Sharpen Diagnostic Skills with Internal Medicine MCQs

Difficulty: Moderate
Questions: 20
Learning OutcomesStudy Material
Colorful paper art depicting elements related to Internal Medicine MCQ Quiz

Are you ready for rigorous clinical exams? This practice internal medicine quiz features 15 MCQs covering core topics like cardiology and pulmonology. Explore related challenges such as the Internal Medicine Clinical Knowledge Quiz or refine your skills with the Respiratory Medicine Knowledge Quiz for a deeper dive. All quizzes are fully editable - personalise questions in our editor to suit your learning goals. Browse more quizzes and continue sharpening your clinical expertise today.

Which mechanism explains the blood pressure - lowering effect of ACE inhibitors?
Inhibition of renin release
Decreased conversion of angiotensin I to angiotensin II
Increased bradykinin breakdown
Blockade of aldosterone receptors
ACE inhibitors block the conversion of angiotensin I to angiotensin II, reducing vasoconstriction and aldosterone-mediated volume expansion. This mechanism directly lowers systemic vascular resistance and blood pressure.
Which laboratory marker is most specific for myocardial injury?
Aspartate aminotransferase (AST)
Lactate dehydrogenase (LDH)
Troponin I
Creatine kinase-MB (CK-MB)
Cardiac troponins, especially troponin I, are highly specific to myocardial tissue and remain elevated longer than other enzymes. This makes troponin I the most specific marker for myocardial injury.
According to current guidelines, what is the first-line pharmacotherapy for newly diagnosed type 2 diabetes mellitus?
Glyburide
Metformin
Acarbose
Insulin
Metformin is recommended as first-line therapy in type 2 diabetes due to its efficacy, safety, and favorable effects on weight and cardiovascular outcomes. It also improves insulin sensitivity with a low risk of hypoglycemia.
In anemia of chronic disease, what is the primary mechanism leading to decreased serum iron?
Increased hepcidin production leading to iron sequestration
Increased ferritin degradation
Reduced myelopoiesis
Decreased erythropoietin production
Chronic inflammatory states increase hepcidin synthesis, which traps iron in macrophages and decreases intestinal iron absorption. This sequestration lowers serum iron despite adequate total body iron stores.
Which antibiotic is considered first-line therapy for methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection?
Cefazolin
Piperacillin - tazobactam
Vancomycin
Clindamycin
Vancomycin is the standard initial treatment for MRSA bacteremia because of its activity against gram-positive organisms resistant to beta-lactams. Alternatives are used only when resistance or toxicity is an issue.
A 65-year-old man presents with chest pain. ECG shows ST-elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
Left anterior descending artery
Right coronary artery
Left circumflex artery
Posterior descending artery
ST-elevations in leads II, III, and aVF indicate an inferior myocardial infarction, most commonly resulting from occlusion of the right coronary artery. This artery supplies the inferior wall of the left ventricle.
In diabetic ketoacidosis (DKA), the anion gap metabolic acidosis primarily results from:
Increased acetyl-CoA utilization in the Krebs cycle
Increased gluconeogenesis due to high insulin levels
Decreased lipolysis
Increased fatty acid oxidation to ketone bodies due to insulin deficiency
Insulin deficiency in DKA leads to unopposed lipolysis and fatty acid oxidation, producing high levels of ketone bodies and causing an anion gap metabolic acidosis. Gluconeogenesis and acetyl-CoA use do not drive this acidosis.
A patient with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) develops hyponatremia. What is the primary pathophysiological mechanism?
Excess natriuretic peptide
Decreased ADH inactivation
Increased aldosterone secretion
Excess ADH causes free water retention
SIADH is characterized by inappropriately high ADH levels, causing renal water reabsorption and dilutional hyponatremia. Aldosterone and natriuretic peptides play no primary role in this scenario.
According to the New York Heart Association (NYHA) classification, which describes Class III heart failure?
Symptoms at rest
Marked limitation of activity; comfortable at rest and symptomatic with less than ordinary activity
Slight limitation of physical activity
No limitation of physical activity
NYHA Class III is defined by marked limitation of physical activity: patients are comfortable at rest but experience symptoms with activities less than ordinary. Class IV describes symptoms at rest.
What is the preferred initial anticoagulation therapy for a pregnant woman diagnosed with acute deep vein thrombosis (DVT)?
Low-molecular-weight heparin
Direct oral anticoagulant
Warfarin
Unfractionated heparin
Low-molecular-weight heparin is the preferred anticoagulant in pregnancy due to its safety profile, predictable dosing, and minimal placental transfer. Warfarin and DOACs are contraindicated due to teratogenicity.
Which beta-blocker has been shown to reduce mortality in patients with heart failure with reduced ejection fraction (HFrEF)?
Carvedilol
Metoprolol tartrate
Propranolol
Atenolol
Carvedilol, along with metoprolol succinate and bisoprolol, has been shown in randomized trials to reduce mortality in HFrEF. Atenolol and propranolol lack specific evidence in this population.
In hepatic encephalopathy, accumulation of which toxin is primarily responsible for neuropsychiatric manifestations?
Ammonia
Bilirubin
Lactate
Urea
Ammonia crosses the blood-brain barrier and is neurotoxic, leading to the cognitive disturbances seen in hepatic encephalopathy. Urea and bilirubin do not directly cause these neuropsychiatric changes.
Interpret the following arterial blood gas: pH 7.25, pCO2 50 mmHg, HCO3 - 24 mmol/L. What is the primary acid - base disturbance?
Metabolic alkalosis
Respiratory acidosis
Metabolic acidosis
Respiratory alkalosis
The low pH and elevated pCO2 indicate a primary respiratory acidosis. The bicarbonate is normal, showing inadequate renal compensation. A metabolic disorder would present with a primary change in bicarbonate.
A polymorphism in which enzyme most significantly affects warfarin metabolism and dosing?
CYP3A4
CYP2C9
CYP2D6
CYP1A2
CYP2C9 is the primary hepatic enzyme metabolizing the more potent S-enantiomer of warfarin. Genetic variants in CYP2C9 significantly alter drug clearance and dosing requirements.
According to community-acquired pneumonia guidelines, which initial empirical regimen is appropriate for an ICU-admitted patient?
Macrolide monotherapy
Beta-lactam plus macrolide
Beta-lactam plus aminoglycoside
Respiratory fluoroquinolone monotherapy
Guidelines recommend a beta-lactam combined with a macrolide for severe CAP requiring ICU admission to cover typical and atypical pathogens. Monotherapy or aminoglycoside regimens lack adequate atypical coverage.
A patient with HFrEF remains symptomatic on optimal ACE inhibitor and beta-blocker therapy. Which agent should be added next to reduce mortality?
Digoxin
Spironolactone
Hydralazine
Hydralazine - isosorbide dinitrate
Mineralocorticoid receptor antagonists like spironolactone are recommended as the next step in HFrEF for further mortality reduction after ACE inhibitors and beta-blockers. Hydralazine - nitrates and digoxin have different indications.
In septic shock unresponsive to adequate fluid resuscitation, which vasopressor is recommended as first-line therapy?
Phenylephrine
Norepinephrine
Epinephrine
Dopamine
Current surviving sepsis guidelines recommend norepinephrine as the first-line vasopressor in septic shock after fluid resuscitation. It has a strong alpha-adrenergic effect with fewer arrhythmias than alternatives.
Which of the following is not part of the recommended initial management of acute variceal hemorrhage?
Initiate nonselective beta-blockers immediately prior to bleeding control
Endoscopic variceal ligation
Antibiotic prophylaxis
Octreotide infusion
Nonselective beta-blockers are used for secondary prophylaxis to prevent rebleeding but are not started acutely before hemostasis. Octreotide, antibiotics, and urgent endoscopic ligation are initial management steps.
A polymorphism in VKORC1 primarily affects the pharmacodynamics of which drug?
Warfarin
Heparin
Atorvastatin
Clopidogrel
VKORC1 encodes the target enzyme of warfarin. Polymorphisms in VKORC1 alter sensitivity to warfarin, affecting required dosing and bleeding risk. Other drugs are not influenced by VKORC1 variants.
SGLT2 inhibitors reduce heart failure hospitalizations primarily through which mechanism?
Inhibition of renin release
Causing systemic vasoconstriction
Increased glycosuria and osmotic diuresis reducing preload
Direct beta-adrenergic blockade
SGLT2 inhibitors promote glycosuria, leading to osmotic diuresis and natriuresis, which reduce intravascular volume and preload. This mechanism contributes to lower rates of heart failure hospitalization.
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Learning Outcomes

  1. Analyse pathophysiological processes in clinical scenarios
  2. Identify critical diagnostic clues in patient presentations
  3. Evaluate appropriate treatment strategies for internal disorders
  4. Apply evidence-based guidelines to clinical case problems
  5. Demonstrate mastery of pharmacological intervention principles

Cheat Sheet

  1. Centor Criteria for Strep Throat - Think of Centor as your strep-detecting sidekick! By checking for fever, absence of cough, tender anterior cervical lymph nodes, and tonsillar exudates, you can quickly gauge the odds of streptococcal pharyngitis and decide if you need a rapid strep test or throat culture. Learn more on Knowmedge
  2. Biostatistics Basics: SPin and SNout - Imagine sensitivity and specificity as your diagnostic superheroes: "SNout" (high Sensitivity rules OUT disease when negative) and "SPin" (high Specificity rules IN disease when positive). These simple mnemonics will save you time and mental energy when interpreting lab tests in the clinic. Dive deeper on Knowmedge
  3. Smoking Cessation Strategies - Quitting smoking feels tough, but varenicline can boost your success by about 3.5 times compared to placebo. Just remember to screen for suicidal ideation and cardiovascular risk before prescribing. Get tips on Knowmedge
  4. Chronic Bronchitis Pathophysiology - Picture a patient hacking away for at least three months over two consecutive years - classic chronic bronchitis. Exclude other lung diseases, and you'll understand why mucus hypersecretion and airway inflammation steal the show. Review on Brainscape
  5. Primary Aldosteronism (Conn Syndrome) - Spot resistant hypertension with unexplained hypokalemia, and think Conn syndrome. An aldosterone-to-renin ratio over 30 is your green light for further workup. Explore details on BasicMedicalKey
  6. Addison's Disease Clinical Clues - Hyperpigmentation in creases and friction zones, hyponatremia, and hyperkalemia are the hallmarks of adrenal insufficiency. These unique skin changes make Addison's a memorable diagnosis on exam day. Read more on BasicMedicalKey
  7. Cardiovascular Focus for Exams - With heart disease dominating internal medicine boards, you can't afford to skip murmurs, jugular venous pressure, or management algorithms. Master physical exam pearls and treatment pathways to ace those questions. Check out BoardVitals advice
  8. Maximizing Question Banks - Active learning through question banks solidifies concepts and highlights weak spots faster than passive reading. Consistency and review are your secret weapons for long-term retention. Study tips on NEJM Knowledge+
  9. MCQ Mastery Techniques - Tackle multiple-choice questions by practicing time management, understanding common distractors, and dissecting question stems. Familiarity with exam format transforms anxiety into confidence on test day. Learn strategies on FACMedicine forum
  10. Staying Current with Guidelines - Medicine evolves rapidly, so carve out time each week to skim reputable sources for updates on treatment protocols. Being up-to-date gives you an edge both in practice and on exams. Keep learning on NEJM Knowledge+
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