INTERNAL MED ROSH QUESTIONS
AND EXPERT VERIFIED ANSWERS
GRADED A+
A 36-year-old diabetic health care worker is being treated for latent
tuberculosis after a positive tuberculin skin test and a negative chest
radiograph. The health care provider prescribes isoniazid daily for nine
months. Which of the following medications should be prescribed in
addition to this medication?
A) Pyrazinamide
B) Pyridoxine
C) Rifampin
D) Rifapentine
B) Pyridoxine
A 72-year-old man with a past medical history significant for
hypertension presents for a routine yearly physical exam. He has been
feeling well and has no complaints. His physical exam is benign, and a
basic metabolic panel is ordered as part of a routine series of blood tests.
The results show a calcium level that is 0.8 mg/dL above normal limits.
When compared to last year’s results, this is a new lab finding. Which of
the following studies should be ordered next to confirm the most likely
diagnosis?
A) 1,25-dihydroxyvitamin D
,B) Intact parathyroid hormone
C) Phosphate
D) Thyroid ultrasound
B) Intact parathyroid hormone
A 38-year-old woman has been diagnosed with papillary thyroid cancer.
The tumor is 2.3 cm in diameter with metastasis to regional lymph nodes
and no distant metastasis. Which of the following best describes the
stage of this cancer?
A) Stage I
B) Stage II
C) Stage III
D) Stage IV
A) Stage I
If the age is less than 45 years, then patients with any tumor size and
any node metastasis without distant metastasis are classified as stage
I
A 7-year-old boy is brought into the clinic for a cough. His mother states
that she has noticed the cough has gotten more frequent over the past
few months and is worse at night. The cough is dry. She has also noticed
occasional wheezing and coughing when he has participated in baseball
practice. He denies fever, rhinorrhea, headache, chest pain, or shortness
of breath but does state that occasionally after practicing sports, his chest
feels “tight.” Which of the following is the most appropriate diagnostic
test to order?
A) Chest radiograph
B) Complete blood count
C) IgE antibody tests
,D) Pulmonary function studies
D) Pulmonary function studies
A 73-year-old man with a 20 pack-year history of cigarette use presents
to the clinic complaining of a change in his urine color. The patient
states he has noticed his urine has a slight red tinge. He denies any
symptoms of flank pain, dysuria, malodorous urine, urethral discharge,
or urgency. His urinalysis is positive for occult blood. Which of the
following is the most likely diagnosis?
A) Benign prostatic hypertrophy
B) Bladder cancer
C) Nephrolithiasis
D) Wilms tumor
B) Bladder cancer
A 76-year-old woman with congestive heart failure presents with
palpitations and dyspnea. On exam, her pulse is irregular, with a rate of
78 beats/minute. Crackles at the lung bases are also present on lung
auscultation. Her rhythm strip is shown above. Which of the following
medications should be initiated?
A) Apixaban
B) Aspirin
C) Enalapril
D) Verapamil
A) Apixaban
The patient in the vignette above has a CHA2DS2-Vasc score of 4 and
requires anticoagulation for stroke prevention
, A 68-year-old man with sickle cell anemia has painful episodes that are
becoming more frequent. He is currently pain-free but wants to be
started on a therapy that can improve his painful crisis. Which of the
following therapies should be initiated to improve his painful episodes?
A) Bone marrow transplant
B) Gene therapy
C) Hydroxyurea
D) L-glutamine oral powder
C) Hydroxyurea
Hydroxyurea is the only pharmacologic agent that has consistently
demonstrated improvements in episodes of pain and survival rates for
patients with sickle cell anemia. It increases hemoglobin F and reduces
the production of HbS, thereby reducing the number of red cells that are
susceptible to sickling.
A 42-year-old woman presents with neck pain and tenderness,
palpitations, and anxiety. She states that the symptoms have been
present for the past two weeks. A review of systems is insignificant
except for a viral upper respiratory infection a few weeks ago that
resolved. Physical exam reveals a mildly diffusely tender, symmetrically
enlarged thyroid gland. Which of the following would be the best next
step in managing this patient’s care?
A) Begin levothyroxine
B) Order a radioiodine imaging study
C) Prescribe naproxen
D) Refer for fine-needle aspiration biopsy
C) Prescribe naproxen
AND EXPERT VERIFIED ANSWERS
GRADED A+
A 36-year-old diabetic health care worker is being treated for latent
tuberculosis after a positive tuberculin skin test and a negative chest
radiograph. The health care provider prescribes isoniazid daily for nine
months. Which of the following medications should be prescribed in
addition to this medication?
A) Pyrazinamide
B) Pyridoxine
C) Rifampin
D) Rifapentine
B) Pyridoxine
A 72-year-old man with a past medical history significant for
hypertension presents for a routine yearly physical exam. He has been
feeling well and has no complaints. His physical exam is benign, and a
basic metabolic panel is ordered as part of a routine series of blood tests.
The results show a calcium level that is 0.8 mg/dL above normal limits.
When compared to last year’s results, this is a new lab finding. Which of
the following studies should be ordered next to confirm the most likely
diagnosis?
A) 1,25-dihydroxyvitamin D
,B) Intact parathyroid hormone
C) Phosphate
D) Thyroid ultrasound
B) Intact parathyroid hormone
A 38-year-old woman has been diagnosed with papillary thyroid cancer.
The tumor is 2.3 cm in diameter with metastasis to regional lymph nodes
and no distant metastasis. Which of the following best describes the
stage of this cancer?
A) Stage I
B) Stage II
C) Stage III
D) Stage IV
A) Stage I
If the age is less than 45 years, then patients with any tumor size and
any node metastasis without distant metastasis are classified as stage
I
A 7-year-old boy is brought into the clinic for a cough. His mother states
that she has noticed the cough has gotten more frequent over the past
few months and is worse at night. The cough is dry. She has also noticed
occasional wheezing and coughing when he has participated in baseball
practice. He denies fever, rhinorrhea, headache, chest pain, or shortness
of breath but does state that occasionally after practicing sports, his chest
feels “tight.” Which of the following is the most appropriate diagnostic
test to order?
A) Chest radiograph
B) Complete blood count
C) IgE antibody tests
,D) Pulmonary function studies
D) Pulmonary function studies
A 73-year-old man with a 20 pack-year history of cigarette use presents
to the clinic complaining of a change in his urine color. The patient
states he has noticed his urine has a slight red tinge. He denies any
symptoms of flank pain, dysuria, malodorous urine, urethral discharge,
or urgency. His urinalysis is positive for occult blood. Which of the
following is the most likely diagnosis?
A) Benign prostatic hypertrophy
B) Bladder cancer
C) Nephrolithiasis
D) Wilms tumor
B) Bladder cancer
A 76-year-old woman with congestive heart failure presents with
palpitations and dyspnea. On exam, her pulse is irregular, with a rate of
78 beats/minute. Crackles at the lung bases are also present on lung
auscultation. Her rhythm strip is shown above. Which of the following
medications should be initiated?
A) Apixaban
B) Aspirin
C) Enalapril
D) Verapamil
A) Apixaban
The patient in the vignette above has a CHA2DS2-Vasc score of 4 and
requires anticoagulation for stroke prevention
, A 68-year-old man with sickle cell anemia has painful episodes that are
becoming more frequent. He is currently pain-free but wants to be
started on a therapy that can improve his painful crisis. Which of the
following therapies should be initiated to improve his painful episodes?
A) Bone marrow transplant
B) Gene therapy
C) Hydroxyurea
D) L-glutamine oral powder
C) Hydroxyurea
Hydroxyurea is the only pharmacologic agent that has consistently
demonstrated improvements in episodes of pain and survival rates for
patients with sickle cell anemia. It increases hemoglobin F and reduces
the production of HbS, thereby reducing the number of red cells that are
susceptible to sickling.
A 42-year-old woman presents with neck pain and tenderness,
palpitations, and anxiety. She states that the symptoms have been
present for the past two weeks. A review of systems is insignificant
except for a viral upper respiratory infection a few weeks ago that
resolved. Physical exam reveals a mildly diffusely tender, symmetrically
enlarged thyroid gland. Which of the following would be the best next
step in managing this patient’s care?
A) Begin levothyroxine
B) Order a radioiodine imaging study
C) Prescribe naproxen
D) Refer for fine-needle aspiration biopsy
C) Prescribe naproxen
