SMLE Internal Medicine

Question 1

A 55-year-old male presents with polyuria, polydipsia, and a fasting blood glucose of 9.5 mmol/L on two occasions. What is the most appropriate initial management?

Accepted Answer

Lifestyle modification and metformin

Answer

According to SCFHS guidelines aligned with international standards, first-line management of newly diagnosed type 2 diabetes includes lifestyle modifications combined with metformin, which improves insulin sensitivity and has cardiovascular benefits.

Question 2

A 60-year-old patient with a history of atrial fibrillation presents with sudden onset right-sided weakness and aphasia. CT brain shows no haemorrhage. What is the most appropriate immediate intervention?

Accepted Answer

IV alteplase within the thrombolytic window

Answer

In acute ischaemic stroke presenting within the thrombolytic window (4.5 hours) with no contraindications and no haemorrhage on CT, IV alteplase is the standard of care for reperfusion therapy.

Question 3

Which autoantibody is most specific for systemic lupus erythematosus (SLE)?

Accepted Answer

Anti-double-stranded DNA (anti-dsDNA)

Answer

While ANA is highly sensitive for SLE, anti-dsDNA antibodies are highly specific and correlate with disease activity, particularly lupus nephritis.

Question 4

A 45-year-old woman presents with progressive dyspnoea and a butterfly-shaped infiltrate on chest X-ray. She has a history of mitral stenosis. What is the most likely cause of the radiographic finding?

Accepted Answer

Pulmonary oedema

Answer

A butterfly or bat-wing pattern on chest X-ray is classic for pulmonary oedema. In a patient with mitral stenosis, elevated left atrial pressure leads to pulmonary venous congestion and transudative pulmonary oedema.

Question 5

A patient with chronic kidney disease stage 4 has a serum potassium of 6.2 mmol/L and peaked T waves on ECG. What is the most urgent first step?

Accepted Answer

IV calcium gluconate

Answer

IV calcium gluconate is the most urgent intervention as it stabilises the cardiac membrane and protects against arrhythmias. It does not lower potassium but buys time for definitive treatment.

SMLE Practice Test

SMLE Practice Test

SMLE Internal Medicine