SPEX Internal Medicine 5

Question 1

A 50-year-old man presents with hemoptysis, hematuria, and bilateral pulmonary infiltrates. Serum creatinine is 3.2 mg/dL and ANCA testing is strongly positive for anti-PR3 (c-ANCA). What is the most likely diagnosis?

Accepted Answer

Granulomatosis with polyangiitis (Wegener's)

Answer

Granulomatosis with polyangiitis classically presents with upper and lower respiratory tract involvement plus renal disease, with c-ANCA/anti-PR3 positivity.

Question 2

A 38-year-old woman presents with episodic flushing, watery diarrhea, and wheezing. Urine 5-HIAA is markedly elevated. CT scan reveals a hepatic mass. What is the underlying diagnosis?

Accepted Answer

Carcinoid tumor with carcinoid syndrome

Answer

Carcinoid syndrome (flushing, diarrhea, wheezing) occurs when carcinoid tumors metastasize to the liver, allowing serotonin to bypass hepatic metabolism; elevated urinary 5-HIAA confirms it.

Question 3

A 66-year-old man with a 40-pack-year smoking history develops progressive weakness of the proximal limbs and thighs, with strength improving after repeated muscle testing. EMG shows facilitation. Chest imaging reveals a hilar mass. What is the most likely diagnosis?

Accepted Answer

Lambert-Eaton myasthenic syndrome (LEMS)

Answer

Lambert-Eaton syndrome is a paraneoplastic disorder associated with small cell lung cancer; unlike MG, strength improves with repeated activity due to facilitated calcium channel opening.

Question 4

A 28-year-old woman at 32 weeks gestation develops blood pressure of 158/104 mmHg, proteinuria 3+, and thrombocytopenia (platelets 85,000). LFTs are elevated. What is the appropriate diagnosis and management?

Accepted Answer

HELLP syndrome — delivery is definitive treatment regardless of gestational age

Answer

HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) is a severe complication requiring prompt delivery as definitive treatment, regardless of gestational age.

Question 5

A 60-year-old man with alcoholic cirrhosis develops fever, abdominal pain, and confusion. Paracentesis shows PMN count of 350 cells/µL in ascitic fluid. What is the treatment of choice?

Accepted Answer

IV cefotaxime plus IV albumin infusion

Answer

Spontaneous bacterial peritonitis (SBP) is treated with IV third-generation cephalosporin (cefotaxime); IV albumin reduces risk of renal failure and improves survival.

SPEX Exam Practice Test

SPEX Exam Practice Test

SPEX Internal Medicine 5