ITE General Internal Medicine 2

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:

Accepted Answer

MRI of the foot

Answer

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?

Accepted Answer

Levothyroxine

Answer

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?

Accepted Answer

Metformin

Answer

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?

Accepted Answer

NSAIDs (e.g., indomethacin)

Answer

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?

Accepted Answer

Hospital admission, consider ICU

Answer

A CURB-65 score of 3 indicates severe pneumonia with significant 30-day mortality risk, warranting hospital admission and possible ICU-level care.

ITE - Internal Medicine In-Training Exam Practice Test

ITE - Internal Medicine In-Training Exam Practice Test

ITE General Internal Medicine 2