MD Internal Medicine 3

Question 1

A 50-year-old man with alcoholic liver disease presents with confusion and asterixis. Labs show elevated ammonia. Which dietary modification is most appropriate?

Accepted Answer

Moderate protein intake with preference for branched-chain amino acids

Answer

Hepatic encephalopathy patients should receive adequate protein (preferably plant-based or branched-chain amino acids) rather than protein restriction, which worsens sarcopenia and outcomes.

Question 2

A 40-year-old woman presents with fatigue, arthralgia, and a butterfly-shaped facial rash. ANA is positive at 1:320 with anti-dsDNA antibodies detected. Which of the following best monitors disease activity?

Accepted Answer

Anti-dsDNA antibody titers and complement levels

Answer

Anti-dsDNA titers correlate with SLE disease activity, particularly lupus nephritis, and falling complement levels (C3, C4) reflect active immune complex deposition.

Question 3

A patient presents with severe hyponatremia (Na 118 mEq/L) and is asymptomatic. Urine osmolality is 600 mOsm/kg and urine Na is 55 mEq/L. Serum osmolality is low. What is the most likely cause?

Accepted Answer

SIADH

Answer

SIADH presents with euvolemic hyponatremia, inappropriately concentrated urine (>100 mOsm/kg), and high urine sodium (>40 mEq/L), reflecting inappropriate ADH secretion.

Question 4

A 60-year-old man with CKD stage 3 is found to have hyperkalemia (K 6.2 mEq/L) on routine labs. He is on lisinopril and spironolactone. ECG shows peaked T-waves. What is the first step in management?

Accepted Answer

Give IV calcium gluconate

Answer

IV calcium gluconate is given first to stabilize the cardiac membrane and prevent arrhythmias when ECG changes are present; it does not lower potassium but protects the heart.

Question 5

A 35-year-old woman with no prior cardiac history develops palpitations, diaphoresis, and hypertension to 210/120 mmHg lasting 20 minutes. 24-hour urine metanephrines are markedly elevated. What is the treatment of choice?

Accepted Answer

Alpha-blocker followed by beta-blocker, then surgical resection

Answer

Pheochromocytoma requires alpha-blockade (phenoxybenzamine) before beta-blockade to prevent unopposed alpha-mediated hypertensive crisis, followed by surgical resection.

MD - Doctor of Medicine Practice Test

MD - Doctor of Medicine Practice Test

MD Internal Medicine 3