SMLE Internal Medicine 4

Question 1

A 58-year-old patient with long-standing uncontrolled diabetes presents with decreased sensation in a glove-and-stocking distribution. Nerve conduction studies show axonal neuropathy. What type of neuropathy is this?

Accepted Answer

Distal symmetric polyneuropathy

Answer

Distal symmetric polyneuropathy is the most common form of diabetic neuropathy, presenting with sensory loss in a glove-and-stocking pattern. It is length-dependent, affecting the longest nerves first.

Question 2

A 42-year-old woman with a BMI of 38 presents with right upper quadrant pain after a fatty meal, fever, and a positive Murphy sign. What is the most appropriate initial imaging?

Accepted Answer

Abdominal ultrasound

Answer

Abdominal ultrasound is the first-line imaging for suspected acute cholecystitis. It can demonstrate gallstones, gallbladder wall thickening, pericholecystic fluid, and a sonographic Murphy sign with high sensitivity and specificity.

Question 3

Which of the following is the most common electrolyte abnormality in a patient with diabetic ketoacidosis (DKA)?

Accepted Answer

Total body potassium depletion

Answer

Despite sometimes presenting with normal or elevated serum potassium (due to transcellular shift from acidosis and insulin deficiency), patients with DKA have significant total body potassium depletion from osmotic diuresis and vomiting.

Question 4

A 25-year-old male presents with recurrent oral ulcers, genital ulcers, and anterior uveitis. What is the most likely diagnosis?

Accepted Answer

Behçet disease

Answer

Behçet disease presents with the classic triad of recurrent oral ulcers, genital ulcers, and uveitis. It is more common in countries along the ancient Silk Road, including Saudi Arabia and the Middle East.

Question 5

A patient with newly diagnosed hypertension has a potassium of 2.8 mmol/L and metabolic alkalosis. The aldosterone-to-renin ratio is elevated. What is the most likely diagnosis?

Accepted Answer

Primary hyperaldosteronism (Conn syndrome)

Answer

Primary hyperaldosteronism (Conn syndrome) presents with hypertension, hypokalaemia, metabolic alkalosis, and an elevated aldosterone-to-renin ratio. It is the most common cause of secondary hypertension due to adrenal pathology.

SMLE Practice Test

SMLE Practice Test

SMLE Internal Medicine 4