NCCPA Internal Medicine 3

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?

Accepted Answer

Mycobacterium tuberculosis

Answer

Staphylococcus aureus

Answer

Aspergillus fumigatus

Answer

Klebsiella pneumoniae

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?

Accepted Answer

Lupus nephritis

Answer

Libman-Sacks endocarditis

Answer

Neuropsychiatric lupus

Answer

Antiphospholipid syndrome

Question 3

A 68-year-old man with atrial fibrillation has a CHADS2-VASc score of 4. Which anticoagulation strategy is most appropriate?

Accepted Answer

Direct oral anticoagulant (DOAC)

Answer

Aspirin alone

Answer

No anticoagulation needed

Answer

Heparin infusion only

Question 4

A patient presents with ascending muscle weakness after a Campylobacter infection 3 weeks ago. CSF shows albuminocytologic dissociation. What is the diagnosis?

Accepted Answer

Guillain-Barré syndrome

Answer

Myasthenia gravis

Answer

Multiple sclerosis

Answer

Transverse myelitis

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?

Accepted Answer

Lactulose

Answer

Neomycin

Answer

Rifaximin alone

Answer

Protein restriction only

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?

Accepted Answer

Adrenal CT or MRI imaging

Answer

Start alpha-blocker immediately

Answer

24-hour urine cortisol

Answer

Thyroid function tests

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?

Accepted Answer

GOLD 3 (severe)

Answer

GOLD 1 (mild)

Answer

GOLD 2 (moderate)

Answer

GOLD 4 (very severe)