MD Internal Medicine 2

Question 1

A 58-year-old man with type 2 diabetes presents with a serum creatinine of 2.4 mg/dL and a urine albumin-to-creatinine ratio of 350 mg/g. Which medication class provides the most renoprotective benefit in this setting?

Accepted Answer

SGLT2 inhibitors

Answer

SGLT2 inhibitors (e.g., dapagliflozin, empagliflozin) have demonstrated significant renoprotective effects in diabetic kidney disease, reducing progression of CKD and cardiovascular events.

Question 2

A 45-year-old woman presents with episodic flushing, diarrhea, and wheezing. Urine 5-HIAA levels are markedly elevated. What is the most likely diagnosis?

Accepted Answer

Carcinoid syndrome

Answer

Carcinoid syndrome results from serotonin-secreting neuroendocrine tumors, causing flushing, diarrhea, and wheezing; elevated urinary 5-HIAA confirms serotonin overproduction.

Question 3

A patient with rheumatoid arthritis on methotrexate develops macrocytic anemia and oral ulcers. What is the most appropriate intervention?

Accepted Answer

Add folic acid supplementation

Answer

Methotrexate acts as a folate antagonist; folic acid supplementation reduces mucosal and hematologic side effects without significantly diminishing the drug's anti-inflammatory efficacy.

Question 4

A 72-year-old woman is found to have a serum calcium of 11.8 mg/dL. Intact PTH is 95 pg/mL (normal 15–65). She is asymptomatic. What is the most likely diagnosis?

Accepted Answer

Primary hyperparathyroidism

Answer

Elevated PTH in the setting of hypercalcemia is diagnostic of primary hyperparathyroidism, most commonly caused by a solitary parathyroid adenoma.

Question 5

Which finding on spirometry is most consistent with obstructive lung disease?

Accepted Answer

FEV1/FVC < 0.70 with normal or increased TLC

Answer

Obstructive physiology is defined by a reduced FEV1/FVC ratio (<0.70 post-bronchodilator); air trapping leads to normal or elevated TLC.

MD - Doctor of Medicine Practice Test

MD - Doctor of Medicine Practice Test

MD Internal Medicine 2