Rosh Internal Medicine Practice Exam

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• In COPD patient with persistent symptoms on albuterol, which addition is most appropriate for group B?
• In polyarteritis nodosa, which organ system is typically spared from involvement?
• A patient with chronic venous insufficiency is treated with a procedure. What is the most effective intervention?
• For dental procedures in patients with prosthetic heart valves, prophylaxis guidelines recommend:
• In suspected temporal arteritis with headaches and jaw claudication, what is the first priority in management?
• Which electrolyte disturbance predisposes to digitalis toxicity?
• In empiric meningitis therapy, when should ampicillin be added?
• Which set of factors constitutes the Virchow triad for venous thrombosis?
• A 23-year-old woman four days after ACL repair presents with unilateral leg swelling and warmth. What is the initial diagnostic study of choice for the suspected deep vein thrombosis?
• Which of the following is NOT typically included in long-term pharmacologic therapy for unstable angina?
• For noninfectious fever and weight loss with elevated ESR, which is a recommended short-term alternative to NSAIDs?
• A 72-year-old patient with syncope is diagnosed with sick sinus syndrome. What is the definitive clinical intervention?
• Which patient is at risk for having an atypical presentation of an acute myocardial infarction?
• In severe hypokalemia (K 2.2 mEq/L) with U waves on ECG, what is the first step in management?
• If IV access is not available in status epilepticus, which benzodiazepine can be used as an alternative?
• Hospital-acquired pneumonia is defined as pneumonia that occurs at least how many hours after hospital admission?
• A 24-year-old woman with postprandial abdominal pain characteristic of biliary colic undergoes imaging. What is the best initial diagnostic study?
• In intravenous drug users, which organism most commonly causes acute bacterial endocarditis?
• What renal biopsy finding is most closely associated with rapidly progressive glomerulonephritis?
• Hypernatremia in an elderly patient with low water intake is best treated by:
• A 35-year-old man with retrosternal burning after meals; lifestyle modification recommended for GERD?
• Which physical finding is commonly associated with hypothyroidism and may be observed as periorbital edema?
• According to guidelines, antibiotic prophylaxis for dental procedures is recommended for which patients?
• Macrocytic anemia with hypersegmented neutrophils and macro-ovalocytes is classic for pernicious anemia. Which smeal feature is most consistent with this diagnosis?
• In a patient with stage 4 chronic kidney disease, which dietary modification is most appropriate?
• In chronic venous insufficiency with edema and stasis dermatitis, what is the initial recommended intervention?
• What is another name for a prolactinoma?
• Polymyositis is classically associated with which autoantibody?
• In Addison disease, what menstrual irregularity can occur?
• What is the name of the contagious, nonsexually transmitted disease seen in tropical regions caused by Treponema pallidum subspecies pertenue that is characterized by granulomatous lesions?
• What is the best initial management step for a patient with suspected ACS who is already on dual antiplatelet therapy and develops active bleeding?
• Empiric therapy for community-acquired pneumonia in a previously healthy adult with no comorbidities is:
• What is the first-line disease-modifying therapy for rheumatoid arthritis?
• In shock with poor perfusion, what is the initial fluid resuscitation volume?
• In diabetic kidney disease, which biomarker helps assess early risk of progression?
• G6PD deficiency commonly shows which smear findings?
• A patient with fever, dysuria, and CVA tenderness. Urinalysis shows pyuria and nitrites positive. Most likely diagnosis?
• In a patient with suspected endocarditis, which organism is most common for culture-negative endocarditis?
• ST-elevation in leads II, III, and aVF indicates occlusion of which coronary artery?
• A patient presents with a deep tear at the posterior aspect of the anal canal causing severe pain with defecation and bright red blood; which is the most likely diagnosis?
• In this patient with Cushing disease due to a pituitary adenoma, what is the best initial surgical intervention?
• Right axis deviation on ECG is defined as QRS axis greater than what angle?
• In suspected heparin-induced thrombocytopenia, what is the initial management step?
• Which of the following patients meets the diagnostic criteria for diabetes mellitus according to the American Diabetes Association?
• A 32-year-old with exertional dyspnea has a crescendo-decrescendo systolic murmur that increases with Valsalva; what is the most likely diagnosis?
• Which imaging modality is second-line but excellent for identifying stones in the biliary tract in suspected choledocholithiasis?
• Which finding is most characteristic of nephrotic syndrome?
• A patient from the Mississippi River valley with cough, unilateral pulmonary infiltrate, mediastinal lymphadenopathy, and a normal ACE level most likely has which infection?
• What is the best test to confirm suspected multiple sclerosis?
• What is the mechanism of action of apixaban?
• Systemic lupus erythematosus commonly presents with a triad of symptoms including joint pain, fever, and what skin finding?
• Which of the following is considered first-line therapy for COPD exacerbation?
• Which class of biologic medications should be avoided in patients with multiple sclerosis?
• The presence of an opening snap on auscultation is most characteristic of which condition?
• Which medication can be used for latent tuberculosis infection treatment?
• In a patient with cirrhosis and hyperventilation, which acid-base disorder is most likely?
• During an acute gout flare, which intervention is best avoided?
• Which group should be screened for hepatocellular carcinoma?
• First-line therapy for COPD exacerbation includes:
• Rocky Mountain spotted fever exam finding in early RMSF?
• Winter's formula for expected PaCO2 in a metabolic acidosis with bicarbonate 12 mEq/L is approximately:
• In suspected acute diverticulitis with LLQ pain and mass, which imaging test has the highest sensitivity and specificity for confirming the diagnosis?
• In a patient with chronic hypernatremia, what complication must be considered when initiating rapid volume repletion and sodium reduction?
• Which physical examination finding is a sensitive indicator of acute pericarditis, though not always present?
• In type 2 diabetes management, which agent is preferred for patients with established cardiovascular disease to reduce major adverse events?
• A patient with widespread pain, fatigue, sleep disturbance; which physical finding is most likely?
• In status epilepticus, which benzodiazepine is first-line when IV access is available?
• Which of the following is used for Guillain-Barré syndrome treatment options?
• In cirrhosis with ascites and pleural effusion due to hepatic disease, what is the appropriate initial management?
• In a patient with suspected Prinzmetal (variant) angina and normal coronary arteries, which medication is inappropriate to use?
• Empiric treatment for suspected bacterial meningitis in adults (non-immunocompromised) includes:
• In a patient with pulmonary hypertension, which physical exam finding is most characteristic?
• What club-deformity is classically associated with rheumatoid arthritis on examination?
• What tidal volume is recommended to minimize ventilator-induced lung injury in adults on mechanical ventilation?
• Acute kidney injury in a patient with severe dehydration is most likely due to which type of azotemia?
• Why is doxycycline typically contraindicated in children?
• A 55-year-old woman exhibits marked behavioral change over the past year, including impulsivity, loss of social tact, and oral exploration of objects. On examination, memory is relatively preserved and MMSE is normal. Which diagnosis is most likely?
• For a patient with hospital-acquired pneumonia requiring ventilatory support, which empiric regimen is appropriate?
• A 35-year-old woman with systemic lupus erythematosus presents with lupus nephritis. Which medication is indicated for treatment of this complication?
• A typical first-line therapy for CAP due to Streptococcus pneumoniae is amoxicillin. Which option correctly reflects this choice?
• Which antiarrhythmic drug classes are preferred for medical prophylaxis of reentrant tachycardia in Wolff-Parkinson-White syndrome?
• Which vaccine is recommended annually for adults with chronic diseases to reduce influenza risk?
• In heart failure with reduced ejection fraction, which therapy adds mortality benefit when used with ACE inhibitors or ARBs and beta-blockers?
• Salmonella carrier state is eradicated with which surgical procedure?
• Which description best characterizes right bundle branch block on an ECG?
• In polymyalgia rheumatica, what is the first-line treatment to initiate?
• In pseudogout, which joint is most commonly affected?
• Which two structures compress the left renal vein in nutcracker syndrome?
• A 40-year-old with proximal muscle weakness and anti-Jo-1 antibodies; most likely diagnosis?
• Following head trauma, which exam finding most likely indicates early uncal herniation?
• What low-molecular-weight protein is a cysteine protease inhibitor that can be used as a serum biomarker for detecting acute kidney injury?
• Which condition affecting pregnant women may predispose to Mallory-Weiss tears?
• In polyarteritis nodosa, which description of the skin rash is most characteristic?
• In an uncomplicated parapneumonic effusion following bacterial pneumonia, which management is indicated after starting antibiotics?
• Which finding most supports prerenal azotemia due to dehydration?
• A patient with chronic diarrhea develops a hyperchloremic, non-anion gap metabolic acidosis. What is the most likely mechanism?
• In a 23-year-old with new-onset type 1 diabetes and severe dehydration with potassium 3.1 mEq/L, after initial fluids what is the next step in management?
• Which finding would be sufficient to make an initial diagnosis of acute rheumatic fever in a patient with recent streptococcal infection?
• In a 53-year-old with knee OA and hand OA features with Heberden and Bouchard nodes, what is the most likely diagnosis?
• Which type of IV fluid is used for the initial 20 mL/kg bolus in shock?
• What daily protein excretion level defines nephrotic-range proteinuria?
• Which initial anticoagulant is appropriate for a new deep vein thrombosis with bridging to long-term therapy?
• Which urine finding is typical in nephrotic syndrome?
• A 45-year-old man with recent close contact and tuberculosis exposure has a tuberculin skin test. Which induration measurement is the minimum induration for a positive test in this patient?
• If corrected calcium is normal, what is the recommended management?
• Hyponatremia with euvolemia and low uric acid often suggests which condition?
• A 38-year-old woman with papillary thyroid cancer 2.3 cm with regional lymph node metastasis but no distant metastasis is staged as which stage?
• Which finding would support a diagnosis of metabolic syndrome in this patient?
• A 10-year-old with mild persistent asthma should be treated with which regimen?
• In sepsis, what is emphasized within the first hour of recognition?
• What do STOPP/START criteria address in elderly patients?
• In severe hyperkalemia with refractory arrhythmias, which intervention provides rapid potassium reduction?
• In noninfectious causes of fever and weight loss with elevated ESR, which gout-like medication should be used with caution due to cardiovascular risk?
• Polypharmacy is most common in which population, and which tool helps manage it?
• Fitz-Hugh-Curtis syndrome is best described as which of the following?
• In latent TB treatment with isoniazid, which supplement should be given?
• What is the Levine sign?
• In the management of diabetic ketoacidosis, which electrolyte requires careful monitoring due to risk of shift during insulin therapy?
• What is the most appropriate first-line treatment for essential tremor?
• A 46-year-old man from New Mexico with a renal transplant presents with cough and fever. For suspected coccidioidomycosis, which treatment is recommended for an immunocompromised patient?
• After stabilizing the myocardium with IV calcium in hyperkalemia, which therapy lowers serum potassium rapidly?
• A patient with a deep vein thrombosis should be started on which initial anticoagulant?
• Which physical examination finding is most consistent with hypothyroidism in a patient with elevated TSH and low free T4?
• Which statement best describes the cause of G6PD deficiency-related hemolysis?
• Which physical exam finding is most commonly associated with systolic heart failure with reduced ejection fraction?
• In a patient with rheumatoid arthritis who requires intubation, which diagnostic study is most important to assess prior to anesthesia?
• Which of the following is the most appropriate next step in management for an adolescent with isolated mitral valve prolapse and no mitral regurgitation on echocardiography?
• Which antibody is most likely positive in autoimmune hypothyroidism?
• For type 2 diabetes with established cardiovascular disease, which therapeutic class reduces major adverse cardiovascular events?
• A patient presents with peaked T waves on ECG and a potassium of 7.0 mEq/L. What is the immediate treatment?
• Which features are used to characterize pulmonary nodules on CT imaging?
• A diastolic murmur best heard when the patient leans forward is most consistent with which condition?
• The causative agent of chickenpox and shingles is which virus?
• The most common cause of community-acquired pneumonia in adults is which organism, and what is a typical first-line therapy?
• Which statement best describes the Frank-Starling mechanism?
• What is the most appropriate antianginal therapy for a patient with stable angina and significant COPD where beta-blockers are contraindicated?
• A 64-year-old man with pneumonia has hyponatremia on laboratory testing. Which finding most supports Legionella as the causative pathogen?
• A 62-year-old man with fatigable weakness and ptosis with positive acetylcholine receptor antibodies and a thymoma on CT most likely has which diagnosis?
• In adults with suspected meningitis before neuroimaging, empiric regimen is:
• CT findings of bronchial dilation and a history of chronic productive cough in a young adult most strongly suggest which diagnosis?
• In suspected giant cell arteritis, what is the best initial management to prevent vision loss?
• The first-line antihypertensive medication to slow progression of diabetic nephropathy is:
• Which preventive screening is recommended for a patient newly diagnosed with HIV?
• For complicated parapneumonic effusions, which adjunct therapy has been shown to improve clinical outcomes?
• Which medication classes, in addition to antidepressants, may contribute to erectile dysfunction?
• In suspected polyarteritis nodosa, which infection should be screened for?
• Purple urine bag syndrome is most commonly associated with which condition?
• In sepsis, a lactate level ≥ 2 mmol/L indicates what?
• A patient has low total calcium but normal albumin. How do you interpret the calcium level?
• For a patient with a 9 mm pulmonary nodule and a smoking history, what is the best management?
• What is the time window for administering IV tPA in acute ischemic stroke?
• In SIADH, which laboratory finding is typically observed?
• In acute angle-closure glaucoma, which topical medication is most appropriate after systemic therapy?
• In ARDS, which ventilator strategy improves mortality?
• For suspected dilated cardiomyopathy, what is the preferred initial diagnostic imaging modality to assess cardiac structure and function?
• Which neurological finding is commonly seen in vitamin B12 deficiency causing pernicious anemia?
• In a hemodynamically stable patient with acute chest pain and an uncertain diagnosis, what is the most appropriate initial evaluation?
• In a patient with a history of IV drug use and suspected infectious endocarditis presenting with fever and Janeway lesions, which finding is most likely to confirm the diagnosis?
• Which food should be avoided on warfarin therapy because it is high in vitamin K?
• A 68-year-old man with substernal chest tightness on exertion that lasts about five minutes and is relieved by rest. Resting ECG and labs are normal. What is the most likely next step in diagnostic evaluation?
• A 52-year-old man with acute toe pain, swollen red MTP joint, fever; WBC elevated; uric acid 5.9; which is the most likely diagnosis?
• In suspected acute pulmonary embolism, which diagnostic test is most appropriate to confirm the diagnosis?
• In intravenous drug user with fever and Osler nodes, which diagnostic test would confirm suspected endocarditis?
• A pregnant patient with influenza should be treated with which antiviral agent?
• Which vitamin deficiency commonly presents with neuropathy and anemia and is treated with supplementation?
• In a patient with a history of intravenous drug use presenting with signs of chronic liver disease, which virus is most commonly associated with chronic infection and progression to cirrhosis?
• Rapid correction of hypernatremia can lead to which complication?
• What is a primary indication for coronary artery bypass grafting in patients with coronary artery disease?
• Which feature is most indicative of unstable angina?
• Which organism is the most common cause of atypical pneumonia presenting with a low-grade fever and diffuse bilateral infiltrates in young adults?
• Which symptom commonly accompanies pancreatitis?
• What type of crystals are found in joints affected by gout?
• Which CSF profile confirms bacterial meningitis in an infant?
• Which statement about non-selective beta-blockers in cirrhosis is true?
• Which of the following best describes the best initial management of delirium in elderly patients?
• Which therapy has the strongest evidence for reducing mortality in heart failure with reduced ejection fraction?
• Which characteristic most strongly indicates Dressler syndrome rather than an acute myocardial infarction?
• What is the most likely diagnosis for a patient with unilateral, severe, burning pain in a limb lasting months after a fracture, with allodynia and changes in color?
• A 7-year-old boy presents with a nocturnal cough and exercise-induced wheeze. Which diagnostic test best confirms asthma?
• In secondary syphilis, which physical examination finding is most consistent with the diagnosis?
• What are the four types of cerebral aneurysms?
• A patient with transient ischemic attack; best next step in management is to
• In suspected subarachnoid hemorrhage with a normal noncontrast CT scan, which diagnostic study is indicated next?
• A 32-year-old woman with flank pain, hematuria, and palpable kidneys has a family history suggestive of autosomal dominant polycystic kidney disease. What diagnostic study is indicated at this time?
• In a patient started on metformin for type 2 diabetes, what is the most common side effect?
• Carvallo sign refers to which auscultatory finding?
• According to Light's criteria, which finding indicates an exudative pleural effusion?
• In an HIV-infected patient with CD4 count 110 cells/microL and a sulfa allergy, which antimicrobial should be used prophylactically for Pneumocystis jirovecii pneumonia?
• A 65-year-old man with chest pain and rising troponin but no ST elevations on ECG most likely has which diagnosis?
• A 55-year-old man with depression, anxiety, BPH, and angina on multiple medications reports erectile dysfunction. Which medication is the most likely contributor to his ED?
• In constrictive pericarditis, which physical examination finding is most characteristic?
• A 44-year-old woman with symmetric bilateral hilar adenopathy most likely has which exam finding?
• Which dysrhythmia is consistent with slowed conduction through the right ventricle, often presenting with a wide QRS complex and an rsR' pattern in V1?
• A 28-year-old woman presents with palpitations, high fever, agitation, tremor, and atrial fibrillation; what is the most likely diagnosis?
• Barrett esophagus is best described as ...
• In idiopathic pulmonary fibrosis, which physical examination finding is commonly expected?
• Pulmonary function testing in restrictive lung disease typically shows which combination?
• In polyarteritis nodosa, which organ is classically spared from involvement?
• What is the recommended treatment of pelvic inflammatory disease in a nonpregnant patient?
• Abrupt, severe tearing chest pain with blood pressure discrepancy between arms; most likely diagnosis?
• Which papillary thyroid cancer variants are associated with a poorer prognosis?
• Placement of a pacemaker lead most commonly contributes to which valvular lesion?
• Which statement best describes the relationship between magnesium and potassium repletion?
• What is midodrine and how is it used in cirrhosis-induced hyponatremia?
• What is the most common cause of acute liver failure in the United States?
• In sepsis, if elevated lactate persists after initial resuscitation, what is the recommended action?
• A patient with microcytic anemia and heavy menses. Most likely diagnosis?
• In nephrotic syndrome, which laboratory finding is typically decreased?
• Neisseria gonorrhoeae is best described as which morphology?
• Guillain-Barré syndrome treatment options include which of the following?
• In suspected bacterial meningitis, which imaging or test should be obtained before lumbar puncture if signs of increased intracranial pressure are present?
• In ARDS, the recommended tidal volume is approximately:
• HIV patient with CD4 <200 needs prophylaxis against Pneumocystis jirovecii pneumonia. Which agent is recommended?
• Which of the following is the most appropriate guidance for return-to-play after concussion?
• A young man of East Asian descent presents with sudden gross hematuria 1-2 days after a viral URI with normal complement; most likely diagnosis?
• Elevated CK-MB after myocardial injury typically returns to baseline within which time frame?
• In a patient with ST-segment elevation myocardial infarction, what is the preferred reperfusion method when available?
• In the treatment of uncomplicated Neisseria gonorrhoeae infection in nonpregnant patients, which regimen is recommended to cover Chlamydia coinfection?
• A routine check reveals a mild, new elevation in calcium in an older patient; which test should be ordered next to evaluate suspected primary hyperparathyroidism?
• Empiric treatment for suspected acute bacterial meningitis in adults?
• In HIT management, which of the following is a non-heparin anticoagulant commonly used?
• In multiple myeloma, which urine finding is classically present?
• Which antibody is a diagnostic marker for polymyositis?
• What is the primary treatment modality for papillary thyroid cancer?
• In a hemodynamically stable patient with suspected pulmonary embolism and low pretest probability, first-step test?
• Which radiographic finding is most characteristic of osteoarthritis?
• Which pathologic fracture is most commonly associated with multiple myeloma?
• In STEMI, what is the preferred reperfusion strategy if PCI can be performed within 90 minutes?
• What is the primary diagnostic test for acute pancreatitis?
• Which ECG finding is most indicative of acute pericarditis in the early phase?
• In patients with cirrhosis and portal hypertension, which medication reduces portal pressure and helps prevent variceal bleeding?
• What is the correct formula for calculating the anion gap?
• A patient with severe hypercalcemia symptoms and dehydration. Immediate management includes:
• Hydroxychloroquine is a cornerstone therapy for which autoimmune disease?
• Heart failure with a pleural effusion is typically associated with which type of effusion?
• Acute bronchitis is typically treated with which management approach?
• Which statement about delirium management is true?
• Which genetic marker has been linked to reactive arthritis?
• In hypertensive emergency with acute target organ damage, which IV antihypertensive is preferred for rapid blood pressure reduction?
• In outpatient management of diverticulitis, which antibiotic regimen is preferred?
• In a patient with chronic kidney disease presenting with severe hyperkalemia, after initial fluid resuscitation what is the most important next step?
• In essential tremor, how does alcohol affect the tremor?
• In sepsis, within the first hour of recognition, which is emphasized?
• Malnutrition in hospitalized patients is commonly assessed with which index?
• In multiple myeloma, the CRAB criteria include which combination of features?
• Delirium in the elderly is associated with increased mortality. Which of the following statements best reflects this relationship?
• In a 23-year-old woman with polyuria and polydipsia, glucose 520 mg/dL, positive ketones, and anion-gap metabolic acidosis, what is the most appropriate initial management step in the ED?
• Which medication is most appropriate for prophylaxis of cluster headaches?
• Polymyositis with Anti-Jo-1 antibodies is commonly associated with which extra-muscular manifestation?
• Which exercise protocol is the most commonly used in exercise ECG testing?
• Which large-vessel vasculitis presents with temporal artery inflammation, jaw claudication, and amaurosis fugax?
• A 57-year-old man presents with fatigue, a smooth tongue, cheilosis, and stocking-glove neuropathy. CBC shows macrocytic anemia with hypersegmented neutrophils; serum homocysteine and methylmalonic acid are elevated. What is the most likely diagnosis?
• A patient with atrial fibrillation and rapid ventricular response but no structural heart disease. Which agent is commonly used for rate control?