ITE General Internal Medicine 2 — Questions and Answers
Question 1: A 58-year-old man with type 2 diabetes presents with a foot ulcer that probes to bone. The most appropriate next diagnostic step is:
- MRI of the foot (Correct answer)
- Plain X-ray of the foot
- Bone scan with technetium-99m
- CT scan of the foot
Correct answer: MRI of the foot
MRI is the gold standard for diagnosing osteomyelitis as it has the highest sensitivity and specificity for bone marrow involvement.
Question 2: A 45-year-old woman presents with fatigue, weight gain, cold intolerance, and constipation. TSH is 12 mIU/L and free T4 is low. Which treatment is most appropriate?
- Levothyroxine (Correct answer)
- Liothyronine
- Methimazole
- Propylthiouracil
Correct answer: Levothyroxine
Levothyroxine (synthetic T4) is the standard treatment for hypothyroidism due to its stable half-life and consistent dosing.
Question 3: A 72-year-old woman is found to have an estimated GFR of 28 mL/min/1.73m². Which medication should be dose-adjusted or avoided?
- Metformin (Correct answer)
- Amlodipine
- Atorvastatin
- Losartan
Correct answer: Metformin
Metformin is contraindicated when eGFR <30 due to risk of lactic acidosis from drug accumulation.
Question 4: A 35-year-old man presents with acute gout flare in the right first metatarsophalangeal joint. He has no renal disease or peptic ulcer disease. What is the first-line treatment?
- NSAIDs (e.g., indomethacin) (Correct answer)
- Allopurinol
- Probenecid
- Febuxostat
Correct answer: NSAIDs (e.g., indomethacin)
NSAIDs are first-line for acute gout flares in patients without contraindications, providing rapid anti-inflammatory relief.
Question 5: A patient with community-acquired pneumonia has a CURB-65 score of 3. What is the most appropriate disposition?
- Hospital admission, consider ICU (Correct answer)
- Outpatient treatment with oral antibiotics
- Emergency department observation only
- Discharge with follow-up in 24 hours
Correct answer: Hospital admission, consider ICU
A CURB-65 score of 3 indicates severe pneumonia with significant 30-day mortality risk, warranting hospital admission and possible ICU-level care.
Question 6: A 60-year-old woman with hypertension and chronic kidney disease (proteinuria 1.5 g/day) presents for medication management. The most appropriate antihypertensive is:
- ACE inhibitor (lisinopril) (Correct answer)
- Calcium channel blocker (amlodipine)
- Beta-blocker (metoprolol)
- Thiazide diuretic (hydrochlorothiazide)
Correct answer: ACE inhibitor (lisinopril)
ACE inhibitors are preferred in CKD with proteinuria because they reduce intraglomerular pressure and slow progression of kidney disease.
Question 7: A 50-year-old male smoker presents with a 30-pack-year history. Screening for lung cancer with low-dose CT is recommended for which age range and smoking history per USPSTF guidelines?
- Ages 50-80 with ≥20 pack-year history, currently smoking or quit within 15 years (Correct answer)
- Ages 40-70 with ≥10 pack-year history
- Ages 55-80 with ≥30 pack-year history, currently smoking or quit within 10 years
- Ages 45-75 with ≥25 pack-year history
Correct answer: Ages 50-80 with ≥20 pack-year history, currently smoking or quit within 15 years
The 2021 USPSTF guidelines recommend annual low-dose CT screening for adults ages 50-80 with ≥20 pack-year history who currently smoke or quit within 15 years.
ITE General Internal Medicine 2
A 58-year-old man with type 2 diabetes presents with a foot ulcer that probes to bone.
The most appropriate next diagnostic step is: