NCCPA Internal Medicine 2 — Questions and Answers
Question 1: A 58-year-old man with chronic kidney disease has a serum potassium of 6.2 mEq/L. Which ECG finding is most characteristic of hyperkalemia?
- Peaked T waves (Correct answer)
- Prolonged QT interval
- ST depression
- P wave inversion
Correct answer: Peaked T waves
Peaked (tall, narrow, symmetric) T waves are the earliest ECG manifestation of hyperkalemia.
Question 2: A 45-year-old woman presents with fatigue, constipation, and a serum calcium of 11.8 mg/dL. PTH is elevated. Which is the most likely diagnosis?
- Primary hyperparathyroidism (Correct answer)
- Malignancy-associated hypercalcemia
- Vitamin D toxicity
- Familial hypocalciuric hypercalcemia
Correct answer: Primary hyperparathyroidism
Elevated PTH with hypercalcemia in an asymptomatic or mildly symptomatic outpatient is classic for primary hyperparathyroidism.
Question 3: A patient with COPD exacerbation has an ABG showing pH 7.30, PaCO2 62 mmHg, HCO3 29 mEq/L. Which acid-base disorder is present?
- Acute-on-chronic respiratory acidosis (Correct answer)
- Pure acute respiratory acidosis
- Metabolic alkalosis with respiratory compensation
- Mixed metabolic and respiratory acidosis
Correct answer: Acute-on-chronic respiratory acidosis
The elevated bicarbonate indicates partial compensation, suggesting chronic retention with an acute worsening superimposed.
Question 4: A 62-year-old man with diabetes and hypertension develops proteinuria >300 mg/day and creatinine 2.1 mg/dL. Which medication class best slows progression of diabetic nephropathy?
- ACE inhibitors or ARBs (Correct answer)
- Calcium channel blockers
- Beta-blockers
- Thiazide diuretics
Correct answer: ACE inhibitors or ARBs
RAAS blockade with ACE inhibitors or ARBs reduces intraglomerular pressure and proteinuria, slowing CKD progression in diabetic nephropathy.
Question 5: Which finding best differentiates restrictive cardiomyopathy from constrictive pericarditis on echocardiography?
- Septal bounce and respiratory variation in mitral inflow (Correct answer)
- Elevated BNP levels
- Peripheral edema
- Elevated JVP
Correct answer: Septal bounce and respiratory variation in mitral inflow
Constrictive pericarditis shows a septal bounce and exaggerated respiratory variation in mitral/tricuspid inflow on echo, unlike restrictive cardiomyopathy.
Question 6: A 50-year-old woman with rheumatoid arthritis on methotrexate presents with macrocytic anemia and oral ulcers. Which supplement is indicated?
- Folic acid (Correct answer)
- Vitamin B12
- Iron
- Pyridoxine
Correct answer: Folic acid
Methotrexate inhibits dihydrofolate reductase, causing folate deficiency; folic acid supplementation prevents mucosal and hematologic toxicity.
Question 7: A 70-year-old man has a serum sodium of 122 mEq/L, urine osmolality 600 mOsm/kg, and urine sodium 45 mEq/L. He takes a thiazide diuretic. What is the most likely cause?
- Thiazide-induced hyponatremia (Correct answer)
- SIADH
- Psychogenic polydipsia
- Adrenal insufficiency
Correct answer: Thiazide-induced hyponatremia
Thiazides impair urinary dilution and can cause profound hyponatremia, especially in elderly women, mimicking SIADH biochemically.
NCCPA Internal Medicine 2
A 58-year-old man with chronic kidney disease has a serum potassium of 6.2 mEq/L.
Which ECG finding is most characteristic of hyperkalemia?