ITE General Internal Medicine 4

Question 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?

Accepted Answer

Empagliflozin (SGLT-2 inhibitor)

Answer

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

Question 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:

Accepted Answer

Liposomal amphotericin B plus flucytosine

Answer

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

Question 3

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

Accepted Answer

Low molecular weight heparin (LMWH) throughout pregnancy

Answer

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

Question 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?

Accepted Answer

Lactulose

Answer

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

Question 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:

Accepted Answer

Trimethoprim-sulfamethoxazole (TMP-SMX)

Answer

TMP-SMX is the treatment of choice for PCP pneumonia; adjunctive steroids are added when PaO₂ <70 mmHg or A-a gradient >35 mmHg.

ITE - Internal Medicine In-Training Exam Practice Test

ITE - Internal Medicine In-Training Exam Practice Test

ITE General Internal Medicine 4