ABIM MCQ 3

Question 1

A 38-year-old woman presents with episodic hypertension, diaphoresis, and palpitations. 24-hour urine metanephrines are 4x the upper limit of normal. CT abdomen shows a 3.5 cm right adrenal mass. Before surgical resection, which medication must be initiated first?

Accepted Answer

Alpha-blocker (phenoxybenzamine)

Answer

Alpha-blockade must be established before beta-blockade in pheochromocytoma to prevent unopposed alpha-mediated hypertensive crisis from beta-blockade alone.

Question 2

A 55-year-old man with a 30 pack-year smoking history presents with a 3 cm right upper lobe lung nodule discovered on CT. PET scan shows avid FDG uptake. Mediastinal lymph nodes appear normal. What is the most appropriate next step?

Accepted Answer

CT-guided biopsy of the lung lesion

Answer

CT-guided biopsy provides tissue diagnosis before treatment planning for a suspicious solitary lung nodule in a high-risk patient, especially when mediastinal staging is needed.

Question 3

A 62-year-old woman with rheumatoid arthritis on methotrexate and a TNF inhibitor presents with two weeks of fever, night sweats, and cough. CXR shows right upper lobe infiltrate. QuantiFERON-Gold is positive. What is the most appropriate next step?

Accepted Answer

Sputum for AFB smear and culture

Answer

Active TB must be ruled out with sputum AFB smear and culture before initiating treatment, as the distinction between latent and active TB changes the regimen.

Question 4

A 48-year-old man presents with progressive fatigue and is found to have iron-deficiency anemia (Hgb 9.2 g/dL). Colonoscopy is negative. Upper endoscopy shows no lesion. Celiac serology is negative. Small bowel capsule endoscopy shows bleeding from the jejunum. What is the most likely diagnosis?

Accepted Answer

Gastrointestinal angiodysplasia

Answer

Angiodysplasia is the most common cause of small bowel bleeding in middle-aged to older adults when upper and lower endoscopy are negative.

Question 5

A 70-year-old woman presents with sudden-onset severe headache rated 10/10, described as 'the worst headache of my life.' CT head is negative. What is the next most critical diagnostic step?

Accepted Answer

Lumbar puncture for xanthochromia

Answer

A negative CT does not rule out subarachnoid hemorrhage; lumbar puncture demonstrating xanthochromia confirms the diagnosis when CT is non-diagnostic.

ABIM - American Board of Internal Medicine Practice Test

ABIM - American Board of Internal Medicine Practice Test

ABIM MCQ 3