Internal Medicine Flashcards

A 62-year-old male with liver cirrhosis presents with massive haematemesis. Vitals show tachycardia and hypotension. What is the most likely source of bleeding?

Answer: Oesophageal varices

In a patient with liver cirrhosis, massive upper GI bleeding is most commonly from oesophageal varices due to portal hypertension. Variceal bleeding is life-threatening and requires urgent resuscitation and endoscopic intervention.

A 48-year-old woman presents with joint pain, skin tightening of the fingers, Raynaud phenomenon, and dysphagia. Anti-centromere antibodies are positive. What is the most likely diagnosis?

Answer: Limited cutaneous systemic sclerosis (CREST syndrome)

Limited cutaneous systemic sclerosis (formerly CREST syndrome) is characterised by Calcinosis, Raynaud phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia. Anti-centromere antibodies are highly specific for this condition.

A diabetic patient is found unconscious with profuse sweating, tremor, and a blood glucose of 2.1 mmol/L. What is the immediate treatment?

Answer: IV dextrose 50% bolus

In an unconscious patient with severe hypoglycaemia, IV dextrose (50% or 10% depending on access) is the treatment of choice as oral glucose cannot be safely administered. IM glucagon is an alternative if IV access is unavailable.

A 30-year-old male presents with colicky loin-to-groin pain and haematuria. Non-contrast CT shows a 4 mm stone in the distal ureter. What is the initial management?

Answer: Conservative management with analgesia and hydration

Ureteric stones less than 5 mm have a high spontaneous passage rate (>90%). Initial management includes adequate analgesia (NSAIDs first-line), hydration, and medical expulsive therapy with an alpha-blocker such as tamsulosin.

What is the most common cause of iron deficiency anaemia in a premenopausal woman?

Answer: Menorrhagia

Menorrhagia (heavy menstrual bleeding) is the most common cause of iron deficiency anaemia in premenopausal women. A thorough menstrual history should be obtained before pursuing GI investigations.

A 55-year-old smoker presents with weight loss, haemoptysis, and a hilar mass on chest X-ray. Serum calcium is elevated. Which lung cancer type is most likely?

Answer: Squamous cell carcinoma

Squamous cell carcinoma of the lung is strongly associated with smoking, central/hilar location, and hypercalcaemia due to PTHrP (parathyroid hormone-related peptide) secretion, a paraneoplastic syndrome.