SMLE Internal Medicine 3

Question 1

A 70-year-old male with COPD presents with acute dyspnoea, right-sided pleuritic chest pain, and tachycardia. D-dimer is elevated. What is the next step?

Accepted Answer

CT pulmonary angiography

Answer

With high clinical suspicion for pulmonary embolism (acute dyspnoea, pleuritic pain, tachycardia) and elevated D-dimer, CT pulmonary angiography (CTPA) is the gold standard imaging to confirm or exclude PE.

Question 2

What is the target HbA1c recommended by Saudi Diabetes Clinical Practice Guidelines for most adult patients with type 2 diabetes?

Accepted Answer

Less than 7%

Answer

The Saudi Diabetes Clinical Practice Guidelines, aligned with SCFHS standards, recommend an HbA1c target of less than 7% for most non-pregnant adults with type 2 diabetes to reduce microvascular complications.

Question 3

A 35-year-old woman presents with palpitations, weight loss, heat intolerance, and diffuse goitre with a bruit. TSH is suppressed and free T4 is elevated. What is the most likely diagnosis?

Accepted Answer

Graves disease

Answer

Graves disease is the most common cause of hyperthyroidism in young adults, characterised by diffuse goitre with bruit (due to increased vascularity), suppressed TSH, and elevated free T4. It is caused by TSH receptor-stimulating antibodies.

Question 4

A 28-year-old man presents with haemoptysis, haematuria, and bilateral pulmonary infiltrates. Anti-GBM antibodies are positive. What is the diagnosis?

Accepted Answer

Goodpasture syndrome

Answer

Goodpasture syndrome (anti-GBM disease) presents with the classic triad of haemoptysis, glomerulonephritis (haematuria), and positive anti-glomerular basement membrane antibodies, affecting both lungs and kidneys.

Question 5

A patient receiving blood transfusion develops fever, rigors, and flank pain 30 minutes into the transfusion. What is the most critical immediate action?

Accepted Answer

Stop the transfusion immediately

Answer

Fever, rigors, and flank pain during transfusion suggest an acute haemolytic transfusion reaction (ABO incompatibility). The transfusion must be stopped immediately to prevent further haemolysis, DIC, and renal failure.

SMLE Practice Test

SMLE Practice Test

SMLE Internal Medicine 3