NCCPA Internal Medicine 3 — Questions and Answers
Question 1: A 55-year-old man presents with hemoptysis, weight loss, and a cavitary lung lesion. He is an immigrant from Southeast Asia. Which organism is most likely?
- Mycobacterium tuberculosis (Correct answer)
- Staphylococcus aureus
- Aspergillus fumigatus
- Klebsiella pneumoniae
Correct answer: Mycobacterium tuberculosis
Cavitary upper-lobe infiltrate with hemoptysis and systemic symptoms in an immigrant population is classic for pulmonary tuberculosis.
Question 2: A 40-year-old woman with SLE develops pleuritis and a positive anti-dsDNA with low complement. Which complication most directly correlates with anti-dsDNA titers?
- Lupus nephritis (Correct answer)
- Libman-Sacks endocarditis
- Neuropsychiatric lupus
- Antiphospholipid syndrome
Correct answer: Lupus nephritis
Anti-dsDNA titers and low complement (C3/C4) are strongly correlated with lupus nephritis disease activity.
Question 3: A 68-year-old man with atrial fibrillation has a CHADS2-VASc score of 4. Which anticoagulation strategy is most appropriate?
- Direct oral anticoagulant (DOAC) (Correct answer)
- Aspirin alone
- No anticoagulation needed
- Heparin infusion only
Correct answer: Direct oral anticoagulant (DOAC)
A CHA2DS2-VASc score ≥2 in men warrants oral anticoagulation, with DOACs preferred over warfarin for non-valvular AF.
Question 4: A patient presents with ascending muscle weakness after a Campylobacter infection 3 weeks ago. CSF shows albuminocytologic dissociation. What is the diagnosis?
- Guillain-Barré syndrome (Correct answer)
- Myasthenia gravis
- Multiple sclerosis
- Transverse myelitis
Correct answer: Guillain-Barré syndrome
Post-infectious ascending flaccid paralysis with elevated CSF protein and normal cell count (albuminocytologic dissociation) is pathognomonic for Guillain-Barré syndrome.
Question 5: A 52-year-old woman with cirrhosis develops confusion and asterixis after starting a high-protein diet. Ammonia is elevated. What is the best initial treatment?
- Lactulose (Correct answer)
- Neomycin
- Rifaximin alone
- Protein restriction only
Correct answer: Lactulose
Lactulose acidifies the colon, trapping ammonia as ammonium and reducing its absorption, and is first-line for hepatic encephalopathy.
Question 6: A 30-year-old woman presents with episodic hypertension, headache, diaphoresis, and palpitations. Urine metanephrines are elevated. Which is the next best step?
- Adrenal CT or MRI imaging (Correct answer)
- Start alpha-blocker immediately
- 24-hour urine cortisol
- Thyroid function tests
Correct answer: Adrenal CT or MRI imaging
Once biochemical confirmation of pheochromocytoma is established, cross-sectional imaging of the adrenals is performed to localize the tumor.
Question 7: A 65-year-old man with a history of smoking presents with FEV1/FVC ratio of 0.65 and FEV1 45% predicted that does not significantly improve with bronchodilators. What is the GOLD classification?
- GOLD 3 (severe) (Correct answer)
- GOLD 1 (mild)
- GOLD 2 (moderate)
- GOLD 4 (very severe)
Correct answer: GOLD 3 (severe)
GOLD 3 is defined by post-bronchodilator FEV1 30–50% predicted with FEV1/FVC <0.70.
NCCPA Internal Medicine 3
A 55-year-old man presents with hemoptysis, weight loss, and a cavitary lung lesion.
He is an immigrant from Southeast Asia.
Which organism is most likely?