SPEX Internal Medicine 3

Question 1

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

Accepted Answer

Surgical resection of the tumor after alpha-blockade

Answer

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

Question 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?

Accepted Answer

Empiric pyrimethamine + sulfadiazine + leucovorin

Answer

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

Question 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?

Accepted Answer

Reversal of maladaptive cardiac remodeling by blocking sympathetic activation

Answer

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

Question 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?

Accepted Answer

Bromocriptine or cabergoline (dopamine agonist)

Answer

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

Question 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?

Accepted Answer

Rifaximin 550 mg twice daily

Answer

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

SPEX Exam Practice Test

SPEX Exam Practice Test

SPEX Internal Medicine 3