COMLEX-USA Clinical Medicine - Internal Medicine 2 — Questions and Answers
Question 1: A patient with diabetes develops painless vision loss. Fundoscopic exam shows neovascularization. The diagnosis is:
- Non-proliferative diabetic retinopathy
- Proliferative diabetic retinopathy (Correct answer)
- Central retinal artery occlusion
- Age-related macular degeneration
Correct answer: Proliferative diabetic retinopathy
Proliferative diabetic retinopathy is defined by new vessel formation (neovascularization) on the retina or disc, which can cause vitreous hemorrhage and blindness.
Question 2: The classic triad of Cushing's syndrome includes central obesity, hypertension, and:
- Hypothyroidism
- Hyperpigmentation
- Skin striae and muscle weakness (Correct answer)
- Hypocalcemia
Correct answer: Skin striae and muscle weakness
Cushing's syndrome classic features include central obesity, hypertension, purple striae, proximal muscle weakness, hirsutism, and easy bruising from excess cortisol.
Question 3: In a patient with suspected pulmonary embolism and moderate pretest probability, which is the most appropriate next diagnostic step?
- Empiric anticoagulation
- D-dimer assay
- CT pulmonary angiography (CTPA) (Correct answer)
- V/Q scan
Correct answer: CT pulmonary angiography (CTPA)
With moderate pretest probability for PE, CTPA is the preferred diagnostic test; D-dimer is used to rule out PE only with low pretest probability.
Question 4: A patient with longstanding rheumatoid arthritis develops proteinuria and renal insufficiency. Kidney biopsy shows amyloid deposits. The amyloid protein is:
- AL amyloid (immunoglobulin light chains)
- AA amyloid (serum amyloid A protein) (Correct answer)
- ATTR amyloid (transthyretin)
- Abeta amyloid
Correct answer: AA amyloid (serum amyloid A protein)
Secondary (AA) amyloidosis results from chronic inflammatory conditions like RA, depositing serum amyloid A–derived fibrils in kidneys, liver, and spleen.
Question 5: A patient with HIV and CD4 count of 50 cells/μL presents with painless, creamy white oral plaques that scrape off. The most likely diagnosis is:
- Oral hairy leukoplakia
- Oral candidiasis (thrush) (Correct answer)
- Aphthous ulcers
- Kaposi's sarcoma
Correct answer: Oral candidiasis (thrush)
Oral candidiasis (thrush) presents as removable white plaques on the buccal mucosa in immunocompromised patients; oral hairy leukoplakia cannot be scraped off.
Question 6: In a patient with acute coronary syndrome, which ECG finding indicates a complete occlusion requiring urgent reperfusion?
- ST depression in V1–V4
- New ST elevation ≥1 mm in 2 contiguous leads (STEMI) (Correct answer)
- T-wave inversions in V1–V3
- Prolonged QT interval
Correct answer: New ST elevation ≥1 mm in 2 contiguous leads (STEMI)
ST-elevation MI (STEMI) indicates complete coronary artery occlusion and requires immediate reperfusion via PCI or thrombolytics.
COMLEX-USA Clinical Medicine - Internal Medicine 2
A patient with diabetes develops painless vision loss.
Fundoscopic exam shows neovascularization.
The diagnosis is: