Internal Medicine Flashcards

A 45-year-old patient presents with progressive exertional dyspnoea, bilateral basal crackles, and an S3 gallop. Echocardiogram shows an ejection fraction of 30%. What is the initial pharmacological management?

Answer: ACE inhibitor and beta-blocker

For heart failure with reduced ejection fraction (HFrEF), first-line pharmacological therapy includes ACE inhibitors (or ARBs) and beta-blockers, which reduce mortality. These should be initiated together with diuretics for symptom relief.

A 22-year-old Saudi male with sickle cell disease presents with severe bilateral hip pain. MRI shows bilateral avascular necrosis of the femoral heads. What is the underlying pathophysiology?

Answer: Vaso-occlusion leading to bone infarction

Sickle cell disease causes vaso-occlusion by sickled red blood cells that obstruct small vessels, leading to ischaemia and infarction of bone tissue. Avascular necrosis of the femoral head is a common complication in Saudi patients with SCD.

A patient with type 1 diabetes on insulin develops postprandial hyperglycaemia and fasting hypoglycaemia. The insulin regimen uses NPH and regular insulin. What adjustment is most appropriate?

Answer: Switch to basal-bolus regimen with long-acting and rapid-acting analogues

Switching to a basal-bolus regimen using long-acting insulin (glargine/detemir) and rapid-acting analogues (lispro/aspart) provides more physiological insulin coverage, reducing fasting hypoglycaemia and improving postprandial control.

Which of the following is the recommended screening test for colorectal cancer in an average-risk 50-year-old Saudi patient?

Answer: Colonoscopy

Colonoscopy is the gold standard screening test for colorectal cancer, recommended starting at age 50 in average-risk individuals per Saudi Cancer Society and SCFHS guidelines. It allows both detection and removal of precancerous polyps.

A 38-year-old man presents with severe headache, visual field defect, and a pituitary mass on MRI. Prolactin level is 250 ng/mL. What is the first-line treatment?

Answer: Cabergoline

Dopamine agonists (cabergoline is preferred over bromocriptine) are first-line treatment for prolactinomas regardless of size. Cabergoline effectively reduces prolactin levels and tumour size in most patients.

A 60-year-old patient with chronic atrial fibrillation and a CHA2DS2-VASc score of 4 is not on anticoagulation. What is the most appropriate anticoagulant?

Answer: Direct oral anticoagulant (e.g., rivaroxaban)

Direct oral anticoagulants (DOACs) such as rivaroxaban, apixaban, or dabigatran are now preferred over warfarin for stroke prevention in non-valvular atrial fibrillation due to their predictable pharmacokinetics and lower intracranial bleeding risk.