ITE General Internal Medicine 3

Question 1

A 68-year-old man with atrial fibrillation and a CHA₂DS₂-VASc score of 4 is started on anticoagulation. Which anticoagulant requires routine INR monitoring?

Accepted Answer

Warfarin

Answer

Warfarin requires routine INR monitoring (target 2-3) due to its narrow therapeutic index and variable metabolism.

Question 2

A 55-year-old woman presents with sudden onset severe headache described as 'the worst headache of my life.' CT head is negative. What is the next best step?

Accepted Answer

Lumbar puncture

Answer

Lumbar puncture is required after a negative CT to detect xanthochromia, which indicates subarachnoid hemorrhage not visible on CT.

Question 3

A 40-year-old woman with SLE develops worsening hypertension and proteinuria of 3.5 g/day. Serum creatinine rises from 0.9 to 1.8 mg/dL over 3 months. The next best step is:

Accepted Answer

Kidney biopsy

Answer

Kidney biopsy is needed to classify lupus nephritis histologically, which guides immunosuppressive therapy selection.

Question 4

A 62-year-old man presents with episodic headaches, palpitations, and diaphoresis. Blood pressure is 185/110 mmHg during an episode. 24-hour urine metanephrines are elevated. What is the most appropriate initial treatment before surgery?

Accepted Answer

Alpha-blocker (phenoxybenzamine) followed by beta-blocker

Answer

Alpha-blockade must be established before beta-blockade in pheochromocytoma to prevent paradoxical hypertension from unopposed alpha stimulation.

Question 5

A 48-year-old woman presents with progressive proximal muscle weakness and difficulty rising from a chair. CK is 3500 U/L. ANA is positive. What is the most likely diagnosis?

Accepted Answer

Polymyositis

Answer

Polymyositis presents with symmetric proximal muscle weakness, elevated CK, and positive ANA; EMG and muscle biopsy confirm the diagnosis.

ITE - Internal Medicine In-Training Exam Practice Test

ITE - Internal Medicine In-Training Exam Practice Test

ITE General Internal Medicine 3