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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 58-year-old man with type 2 diabetes presents with a serum creatinine of 2.4 mg/dL and a urine albumin-to-creatinine ratio of 450 mg/g. Which medication class is MOST important to initiate to slow progression of his diabetic kidney disease?

    Answer: SGLT2 inhibitor

    SGLT2 inhibitors (e.g., dapagliflozin, empagliflozin) have demonstrated significant nephroprotective effects in diabetic kidney disease, reducing progression to ESRD.

  2. A 45-year-old woman presents with fatigue, cold intolerance, and constipation. Labs show TSH 28 mIU/L and free T4 0.4 ng/dL. What is the most appropriate initial treatment?

    Answer: Levothyroxine 25–50 mcg daily

    Primary hypothyroidism is treated with levothyroxine; low doses are used initially, especially in the elderly or those with cardiac disease.

  3. A 70-year-old man develops sudden-onset severe headache, neck stiffness, and photophobia. CT head is negative. What is the next best step?

    Answer: Perform lumbar puncture immediately

    A negative CT followed by lumbar puncture is required to rule out subarachnoid hemorrhage and meningitis when clinical suspicion is high.

  4. Which finding is MOST specific for systemic lupus erythematosus (SLE)?

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

    Anti-dsDNA antibodies are highly specific for SLE and correlate with disease activity, particularly nephritis.

  5. A patient with COPD has an FEV1/FVC ratio of 0.58 and FEV1 of 42% predicted. Which GOLD stage does this represent?

    Answer: GOLD 3 (Severe)

    GOLD Stage 3 (Severe) is defined by FEV1 30–49% predicted with obstructive pattern (FEV1/FVC <0.70).

  6. A 62-year-old woman with a history of osteoporosis is started on alendronate. She returns 1 month later with severe retrosternal chest pain worse with swallowing. What is the most likely complication?

    Answer: Esophageal erosions or ulceration

    Bisphosphonates like alendronate can cause esophageal ulceration; patients must remain upright for 30 minutes after taking the medication.

  7. A 55-year-old man with hypertension and gout presents with a serum uric acid of 9.8 mg/dL and his third gout flare this year. Which antihypertensive agent would be MOST beneficial to add given his history?

    Answer: Losartan

    Losartan (an ARB) has uricosuric properties that lower serum uric acid, making it a preferred antihypertensive in patients with gout.