Clinical Medicine - Internal Medicine Flashcards

A patient with diabetes develops painless vision loss. Fundoscopic exam shows neovascularization. The diagnosis is:

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.

The classic triad of Cushing's syndrome includes central obesity, hypertension, and:

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.

In a patient with suspected pulmonary embolism and moderate pretest probability, which is the most appropriate next diagnostic step?

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.

A patient with longstanding rheumatoid arthritis develops proteinuria and renal insufficiency. Kidney biopsy shows amyloid deposits. The amyloid protein is:

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.

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:

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.

In a patient with acute coronary syndrome, which ECG finding indicates a complete occlusion requiring urgent reperfusion?

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.