SPEX Internal Medicine 4

Question 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?

Accepted Answer

Achalasia

Answer

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.

Question 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?

Accepted Answer

Autoimmune hepatitis

Answer

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

Question 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?

Accepted Answer

Immediate anticoagulation with heparin and urgent vascular surgery consult

Answer

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

Question 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?

Accepted Answer

Metoclopramide

Answer

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

Question 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?

Accepted Answer

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

Answer

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

SPEX Exam Practice Test

SPEX Exam Practice Test

SPEX Internal Medicine 4