SMLE Internal Medicine 2

Question 1

A 65-year-old diabetic male presents with crushing chest pain radiating to the left arm. ECG shows ST elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?

Accepted Answer

Right coronary artery

Answer

ST elevation in leads II, III, and aVF indicates an inferior STEMI, which is most commonly caused by occlusion of the right coronary artery (RCA), which supplies the inferior wall of the heart in most patients.

Question 2

A patient with liver cirrhosis presents with confusion, asterixis, and elevated serum ammonia. What is the first-line treatment?

Accepted Answer

Lactulose

Answer

Lactulose is the first-line treatment for hepatic encephalopathy. It works by acidifying colonic contents, converting ammonia (NH3) to ammonium (NH4+) which cannot be absorbed, and promoting osmotic diarrhoea to eliminate ammonia.

Question 3

Which of the following is the most common cause of community-acquired pneumonia in Saudi Arabia?

Accepted Answer

Streptococcus pneumoniae

Answer

Streptococcus pneumoniae remains the most common cause of community-acquired pneumonia worldwide, including Saudi Arabia. Pneumococcal vaccination is part of the Saudi national immunisation programme.

Question 4

A 50-year-old male presents with epigastric pain that improves with eating. Urea breath test is positive. What is the recommended eradication regimen?

Accepted Answer

Triple therapy: PPI + amoxicillin + clarithromycin for 14 days

Answer

Standard triple therapy consisting of a PPI, amoxicillin, and clarithromycin for 14 days is the recommended first-line H. pylori eradication regimen per current guidelines endorsed by SCFHS.

Question 5

A 40-year-old female presents with weight gain, moon face, abdominal striae, and hypertension. Morning cortisol is elevated. What is the next best diagnostic step?

Accepted Answer

Low-dose dexamethasone suppression test

Answer

The low-dose dexamethasone suppression test (1 mg overnight or 2-day protocol) is used to confirm the diagnosis of Cushing syndrome before localisation studies. It determines whether cortisol production is autonomous.

SMLE Practice Test

SMLE Practice Test

SMLE Internal Medicine 2