Practice Test GeeksSPEX Exam Practice Test
← All SPEX Flashcard Decks

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.

Read the first 7 Internal Medicine flashcards as text

  1. A 48-year-old woman presents with episodic hypertension, headache, palpitations, and diaphoresis. Plasma metanephrines are markedly elevated. What is the definitive treatment?

    Answer: Surgical resection of the tumor after alpha-blockade

    Pheochromocytoma requires alpha-blockade (e.g., phenoxybenzamine) for 1–2 weeks before surgical resection to prevent hypertensive crisis intraoperatively.

  2. A 30-year-old man with HIV (CD4 count 80 cells/µL) presents with a ring-enhancing brain lesion on MRI and positive Toxoplasma IgG serology. What is the most appropriate initial management?

    Answer: Empiric pyrimethamine + sulfadiazine + leucovorin

    In HIV patients with CD4 <100 and positive Toxoplasma serology, empiric anti-toxoplasma therapy is initiated; response within 2 weeks confirms the diagnosis.

  3. A 72-year-old man with heart failure (EF 30%) is started on carvedilol. Which mechanism best explains the benefit of beta-blockers in heart failure with reduced ejection fraction?

    Answer: Reversal of maladaptive cardiac remodeling by blocking sympathetic activation

    Chronic sympathetic activation in HFrEF causes maladaptive remodeling; beta-blockers reverse this by reducing heart rate and myocardial oxygen demand.

  4. A 40-year-old woman presents with amenorrhea, galactorrhea, and visual field defects. MRI shows a 1.8 cm sellar mass. What is the first-line treatment?

    Answer: Bromocriptine or cabergoline (dopamine agonist)

    Macroprolactinomas are first-line treated with dopamine agonists (cabergoline preferred), which shrink the tumor and normalize prolactin levels.

  5. A patient with chronic liver disease develops worsening confusion, asterixis, and elevated ammonia despite lactulose therapy. Which additional intervention is most evidence-based for reducing hepatic encephalopathy recurrence?

    Answer: Rifaximin 550 mg twice daily

    Rifaximin, a minimally absorbed antibiotic, reduces intestinal ammonia-producing bacteria and is proven to prevent recurrence of hepatic encephalopathy.

  6. A 65-year-old woman with rheumatoid arthritis on methotrexate 15 mg/week presents with macrocytic anemia, oral ulcers, and elevated LFTs. What is the most appropriate intervention?

    Answer: Add folic acid 1 mg daily

    Folic acid supplementation (1 mg/day) reduces methotrexate toxicity including mucositis, hepatotoxicity, and cytopenias without diminishing its anti-inflammatory efficacy.

  7. A 55-year-old man with a long smoking history presents with hyponatremia (Na 122 mEq/L), concentrated urine, and a pulmonary mass on chest X-ray. What is the underlying mechanism of his hyponatremia?

    Answer: Syndrome of inappropriate ADH secretion (SIADH)

    Small cell lung carcinoma is the most common malignancy associated with SIADH, which causes euvolemic hyponatremia with concentrated urine.