ABIM MCQ 4

Question 1

A 68-year-old man with a history of MI presents with exertional chest pain. Nuclear stress test shows a large reversible perfusion defect in the LAD territory. EF is 45%. Coronary angiography reveals 80% stenosis of the proximal LAD. What is the preferred revascularization strategy?

Accepted Answer

Coronary artery bypass grafting (CABG)

Answer

CABG is preferred over PCI for proximal LAD disease, especially with reduced EF, due to superior long-term survival and reduced repeat revascularization rates.

Question 2

A 44-year-old woman presents with polyuria, polydipsia, and a serum sodium of 148 mEq/L. Water deprivation test fails to concentrate urine (Uosm 180 mOsm/kg). After desmopressin administration, urine osmolality rises to 680 mOsm/kg. What is the diagnosis?

Accepted Answer

Central diabetes insipidus

Answer

A robust response to desmopressin (urine Osm >50% increase) confirms central DI, where ADH is deficient but renal tubules respond normally.

Question 3

A 29-year-old man presents with fever, arthritis of the knee, and a painless penile ulcer. Urethral culture is negative for gonorrhea. He also has conjunctivitis and hyperkeratotic lesions on his palms. What is the most likely diagnosis?

Accepted Answer

Reactive arthritis (formerly Reiter's syndrome)

Answer

Reactive arthritis classically follows a GI or urogenital infection and presents with arthritis, urethritis, conjunctivitis, and skin/mucous membrane lesions (keratoderma blennorrhagicum).

Question 4

A 77-year-old woman with hypertension and atrial fibrillation is started on amiodarone for rhythm control. Six months later, she presents with dyspnea and is found to have bilateral interstitial infiltrates on CXR. PFTs show a restrictive pattern with reduced DLCO. What is the most likely cause?

Accepted Answer

Amiodarone pulmonary toxicity

Answer

Amiodarone pulmonary toxicity typically presents months to years after initiation and causes interstitial pneumonitis, manifesting as dyspnea with restrictive physiology and reduced DLCO.

Question 5

A 53-year-old man presents with confusion and asterixis. His wife notes he has been drinking heavily for 20 years. Labs reveal ammonia 142 µmol/L, total bilirubin 4.2 mg/dL, and INR 2.1. What precipitating factor should be investigated first in hepatic encephalopathy?

Accepted Answer

Gastrointestinal bleeding

Answer

GI bleeding is the most common precipitant of hepatic encephalopathy in cirrhotics, as blood in the gut is a large nitrogenous load that dramatically raises ammonia.

ABIM - American Board of Internal Medicine Practice Test

ABIM - American Board of Internal Medicine Practice Test

ABIM MCQ 4