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Internal Medicine Flashcards

7 cards from real SPEX practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

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  1. A 60-year-old man presents with progressive dysphagia, weight loss, and a barium swallow showing a 'bird's beak' appearance of the distal esophagus. What is the most likely diagnosis?

    Answer: Achalasia

    Achalasia presents with dysphagia to solids and liquids, regurgitation, and the classic 'bird's beak' tapering on barium swallow due to failure of LES relaxation.

  2. A 35-year-old woman presents with fatigue, arthralgias, and jaundice. Labs show AST 480 U/L, ALT 520 U/L, ANA 1:640, and anti-smooth muscle antibody positive. What is the most likely diagnosis?

    Answer: Autoimmune hepatitis

    Autoimmune hepatitis is characterized by elevated transaminases, positive ANA and anti-smooth muscle antibodies, and responds to immunosuppressive therapy.

  3. A 78-year-old man with atrial fibrillation presents with an acute, painful, pulseless lower extremity. Doppler shows absent signals below the popliteal artery. What is the MOST appropriate next step?

    Answer: Immediate anticoagulation with heparin and urgent vascular surgery consult

    Acute limb ischemia requires emergent anticoagulation to prevent clot propagation and urgent surgical or endovascular revascularization within hours to save the limb.

  4. A patient with long-standing type 1 diabetes develops orthostatic hypotension, early satiety, nausea, and vomiting. A gastric emptying study shows delayed gastric emptying. What is the first-line pharmacological treatment?

    Answer: Metoclopramide

    Metoclopramide is the only FDA-approved medication for diabetic gastroparesis, acting as a dopamine antagonist and prokinetic agent.

  5. A 52-year-old woman with no prior cardiac history is found to have a troponin I of 2.8 ng/mL, new ST depressions in leads V4–V6, and chest pain at rest. What is the most appropriate management?

    Answer: Admit, anticoagulate, and perform early invasive strategy (coronary angiography within 24–72 h)

    Non-ST elevation MI (NSTEMI) with elevated troponin and ischemic ECG changes warrants hospital admission, anticoagulation, and early invasive angiography per guidelines.

  6. A 44-year-old man presents with severe acute pancreatitis. On day 3, his Ranson's criteria score is 5. Which complication should be most anticipated in the next 48 hours?

    Answer: Respiratory failure from ARDS or pleural effusion

    Severe pancreatitis (Ranson's ≥3) carries high risk of systemic complications including ARDS, respiratory failure, pleural effusions, and multi-organ dysfunction.

  7. A 68-year-old woman with newly diagnosed multiple myeloma has serum calcium of 12.8 mg/dL, creatinine 2.0 mg/dL, hemoglobin 8.2 g/dL, and lytic bone lesions. Which of the following is the best initial treatment for her hypercalcemia?

    Answer: IV normal saline hydration plus zoledronic acid

    IV hydration is the first step in managing hypercalcemia; bisphosphonates (zoledronic acid) are added for malignancy-related hypercalcemia and also protect bone.