SPEX Internal Medicine 2

Question 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?

Accepted Answer

SGLT2 inhibitor

Answer

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

Question 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?

Accepted Answer

Levothyroxine 25–50 mcg daily

Answer

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

Question 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?

Accepted Answer

Perform lumbar puncture immediately

Answer

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

Question 4

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

Accepted Answer

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

Answer

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

Question 5

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

Accepted Answer

GOLD 3 (Severe)

Answer

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

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SPEX Exam Practice Test

SPEX Internal Medicine 2