COMLEX-USA Clinical Medicine - Internal Medicine 1

Question 1

A patient with chronic kidney disease has a serum potassium of 6.8 mEq/L and peaked T waves on EKG. First-line immediate treatment is:

Accepted Answer

IV calcium gluconate

Answer

IV calcium gluconate immediately stabilizes the cardiac membrane in hyperkalemia, preventing arrhythmia, though it does not lower potassium levels.

Question 2

Which finding on pulmonary function tests is characteristic of obstructive lung disease such as COPD?

Accepted Answer

Reduced FEV1/FVC ratio (<0.70)

Answer

Obstructive disease (COPD, asthma) is defined by an FEV1/FVC ratio <0.70, reflecting air trapping and increased expiratory resistance.

Question 3

The most common cause of community-acquired pneumonia (CAP) in otherwise healthy adults is:

Accepted Answer

Streptococcus pneumoniae

Answer

Streptococcus pneumoniae remains the most common bacterial cause of CAP in adults across all age groups and severity levels.

Question 4

A patient presents with symmetric proximal muscle weakness, elevated CK, and Gottron's papules. The diagnosis is:

Accepted Answer

Dermatomyositis

Answer

Dermatomyositis presents with proximal muscle weakness, elevated CK, and pathognomonic skin findings including Gottron's papules (knuckles) and heliotrope rash.

Question 5

In the diagnosis of systemic lupus erythematosus (SLE), which antibody is most specific (though not most sensitive)?

Accepted Answer

Anti-Sm

Answer

Anti-Smith (anti-Sm) antibody is highly specific for SLE (~99% specific) though present in only ~25% of patients; ANA is most sensitive.

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COMLEX-USA Clinical Medicine - Internal Medicine 1