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General Internal Medicine Flashcards

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  1. A 55-year-old man with newly diagnosed type 2 diabetes has an A1C of 8.2%, eGFR of 55 mL/min, and established cardiovascular disease. Which medication has the greatest cardiovascular mortality benefit?

    Answer: Empagliflozin (SGLT-2 inhibitor)

    SGLT-2 inhibitors like empagliflozin have demonstrated cardiovascular mortality reduction in patients with established CVD in landmark trials (EMPA-REG).

  2. A 45-year-old woman with known HIV on antiretroviral therapy presents with confusion, fever, and neck stiffness. CD4 count is 80 cells/μL. CSF shows lymphocytic pleocytosis and positive India ink stain. The treatment of choice is:

    Answer: Liposomal amphotericin B plus flucytosine

    Cryptococcal meningitis induction therapy requires liposomal amphotericin B plus flucytosine for 2 weeks, followed by fluconazole consolidation.

  3. A 32-year-old woman with antiphospholipid syndrome (APS) and history of DVT is pregnant. How should her anticoagulation be managed during pregnancy?

    Answer: Low molecular weight heparin (LMWH) throughout pregnancy

    LMWH is the anticoagulant of choice in pregnancy as warfarin crosses the placenta and is teratogenic, particularly in the first trimester.

  4. A 65-year-old man with chronic hepatitis C cirrhosis presents with confusion, asterixis, and ammonia level of 120 μmol/L. Which treatment reduces ammonia production in the gut?

    Answer: Lactulose

    Lactulose is first-line for hepatic encephalopathy; it acidifies colonic contents, trapping ammonia as ammonium and promoting its excretion.

  5. A 58-year-old woman with rheumatoid arthritis on methotrexate and prednisone presents with fever, productive cough, and bilateral infiltrates. LDH is elevated. BAL shows Pneumocystis jirovecii. The drug of choice is:

    Answer: Trimethoprim-sulfamethoxazole (TMP-SMX)

    TMP-SMX is the treatment of choice for PCP pneumonia; adjunctive steroids are added when PaO₂ 35 mmHg.

  6. A 74-year-old man presents with fatigue and is found to have hemoglobin 9.2 g/dL, MCV 110 fL, hypersegmented neutrophils, and normal iron studies. Serum B12 is low. What is the most common cause of B12 deficiency in the elderly?

    Answer: Pernicious anemia (autoimmune gastritis)

    Pernicious anemia due to autoimmune destruction of gastric parietal cells is the most common cause of B12 deficiency in the elderly.

  7. A 50-year-old woman presents with severe epigastric pain radiating to the back, nausea, and vomiting after a fatty meal. Amylase is 1800 U/L and lipase is 4200 U/L. The most important initial treatment is:

    Answer: Aggressive IV fluid resuscitation

    Aggressive IV fluid resuscitation (250-500 mL/hr of crystalloid) is the cornerstone of acute pancreatitis management to prevent organ failure.

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