Internal Medicine Flashcards

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?

Answer: Lifestyle modification and metformin

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.

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?

Answer: IV alteplase within the thrombolytic window

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.

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

Answer: Anti-double-stranded DNA (anti-dsDNA)

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

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?

Answer: Pulmonary oedema

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.

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?

Answer: IV calcium gluconate

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.

A 30-year-old male from Riyadh presents with fever, dry cough, and bilateral ground-glass opacities. He works at a camel farm. What is the most likely causative organism?

Answer: Middle East Respiratory Syndrome Coronavirus (MERS-CoV)

MERS-CoV is endemic in Saudi Arabia with dromedary camels serving as the primary zoonotic reservoir. Camel farm workers are at high risk. The presentation with fever, cough, and bilateral ground-glass opacities is characteristic.