Internal Medicine ALL question and verified
answers latest update 2026|pass assured
|grade A+
A 55-year-old man presents to a primary care provider for concerns about erectile dysfunction.
He reports that he has had difficulty maintaining an erection for several months. He is currently
on medication for depression, anxiety, benign prostatic hyperplasia, and angina. Which of the
following medications is the most likely cause of his erectile dysfunction?
Options: Duloxetine, Nitroglycerin, Prazosin, Selegiline
Duloxetine.
Antidepressant medications such as selective serotonin reuptake inhibitors (e.g., fluoxetine,
paroxetine, sertraline), serotonin and norepinephrine reuptake inhibitors (e.g., duloxetine,
venlafaxine), tricyclics (e.g., amitriptyline, nortriptyline), and older monoamine oxidase
inhibitors (e.g., isocarboxazid, phenelzine) have the potential to cause erectile dysfunction.
Other classes of medications that may cause erectile dysfunction include diuretics, certain beta-
blockers, and opioids.
A 23-year-old woman presents to the emergency department four days after surgical repair of
her anterior cruciate ligament. She has no significant past medical history, and her only
medication is a combined oral contraceptive pill. She reports increased pain and swelling in her
left leg. On exam, her left calf is erythematous, and its circumference is 4 cm greater than her
right calf. What is the initial diagnostic study of choice for the suspected condition?
Computed tomography angiography
,Plain radiography
Venous duplex ultrasound
Ventilation-perfusion scan
Venous duplex ultrasound
This patient presents with a deep vein thrombosis (DVT). A deep vein thrombosis results when a
clot forms in large veins, most commonly the legs. Virchow triad describes the three biggest risk
factors for a DVT: venous stasis, endothelial damage, and hypercoagulability. Other risk factors
include increased age, malignancy, pregnancy, oral contraceptives, and stroke. Patients will
present with complaints of unilateral extremity swelling and tenderness, and physical exam will
reveal swelling, tenderness, warmth, and erythema.
A 64-year-old man is diagnosed with pneumonia and admitted into the hospital. Which of the
following findings supports Legionella as the pathogen causing pneumonia?
Hypoglycemia
Hyponatremia
Infiltrate in the upper lobes
Pleuritic chest pain
Hyponatremia.
There are no findings on history, exam, or radiographic imaging that are specific enough to
distinguish Legionella pneumonia from other causes of pneumonia. However, gastrointestinal
symptoms, such as nausea, vomiting, and diarrhea, are more common in Legionella pneumonia.
In patients who have laboratory testing obtained, hyponatremia supports the diagnosis of
Legionella pneumonia.
,A 46-year-old man from New Mexico with a past medical history of a renal transplant presents
to the emergency department with one week of cough and fever. Vital signs are T 100.6°F, HR
108 bpm, BP 116/76 mm Hg, RR 20.min, and oxygen saturation 97% on room air. Chest X-ray
shows an upper lobe infiltrate with hilar adenopathy. A fungal pathogen is suspected. Which of
the following is the recommended treatment?
Amphotericin B
Ceftriaxone and azithromycin
Fluconazole
Supportive care
Fluconazole
Coccidioidomycosis is a fungal infection that most commonly manifests clinically with
pulmonary disease. It is endemic in the southwestern part of the United States, including
Arizona, New Mexico, central and southern California, and western Texas. The treatment of
coccidioidomycosis varies based on the immune status of the patient and the severity of illness.
Healthy patients with mild to moderate illness do not require antifungal treatment. Healthy and
nonpregnant patients with severe illness (severe dyspnea or hypoxia on room air) are treated
with fluconazole or itraconazole. Amphotericin B should be used in patients with respiratory
compromise requiring mechanical ventilation. Immunocompromised patients should be treated
with fluconazole or itraconazole regardless of disease severity. Patients with coccidioidomycosis
should be monitored following treatment for the resolution or return of symptoms. Sequelae
may include prolonged fatigue or the development of pulmonary nodules.
A 53-year-old man presents for a routine complete physical. Screening blood work is completed
that demonstrates a fasting blood glucose of 189 mg/dL and hemoglobin A1C of 7.8%. The
patient is prescribed metformin. Which of the following is the most common side effect of this
medication?
, Diarrhea
Hypoglycemia
Lactic acidosis
Vitamin B12 deficiency
Diarrhea
The adverse effects that are associated with metformin include gastrointestinal upset, including
diarrhea, nausea, a metallic taste in the mouth, and anorexia. These are the most common side
effects associated with this medication, and patients should be aware of these before beginning
this drug. These side effects are often transient in nature and can be controlled by reducing the
dosage of the medication or discontinuing the drug if the side effects are intolerable.
Hypoglycemia (B) is not a side effect of metformin, which makes it a more desirable choice than
other antidiabetic medications. Hypoglycemia is more common with insulin and sulfonylurea
medications. Lactic acidosis (C) is a serious but uncommon adverse event that can occur while
taking metformin. This drug should not be administered to those at risk of developing lactic
acidosis, including those with impaired kidney or liver function, a history of alcohol abuse, or a
past history of lactic acidosis with metformin use. Vitamin B12 deficiency (D) can occur while
taking metformin, however, this side effect is less common and is typically not severe enough to
cause a megaloblastic anemia.
A 65-year-old man with a history of hyperlipidemia who is a current everyday smoker presents
to the emergency department with chest pain that started two hours ago. The pain began when
he was shoveling snow. Physical exam is unremarkable. His initial ECG is shown above. His initial
troponin level is 0.5 ng/mL, and his serum troponin two hours later is 1.2 ng/mL. Which of the
following is the most likely diagnosis?
ANon-ST elevation myocardial infarction
BPrinzmetal angina
CST elevation myocardial infarction
answers latest update 2026|pass assured
|grade A+
A 55-year-old man presents to a primary care provider for concerns about erectile dysfunction.
He reports that he has had difficulty maintaining an erection for several months. He is currently
on medication for depression, anxiety, benign prostatic hyperplasia, and angina. Which of the
following medications is the most likely cause of his erectile dysfunction?
Options: Duloxetine, Nitroglycerin, Prazosin, Selegiline
Duloxetine.
Antidepressant medications such as selective serotonin reuptake inhibitors (e.g., fluoxetine,
paroxetine, sertraline), serotonin and norepinephrine reuptake inhibitors (e.g., duloxetine,
venlafaxine), tricyclics (e.g., amitriptyline, nortriptyline), and older monoamine oxidase
inhibitors (e.g., isocarboxazid, phenelzine) have the potential to cause erectile dysfunction.
Other classes of medications that may cause erectile dysfunction include diuretics, certain beta-
blockers, and opioids.
A 23-year-old woman presents to the emergency department four days after surgical repair of
her anterior cruciate ligament. She has no significant past medical history, and her only
medication is a combined oral contraceptive pill. She reports increased pain and swelling in her
left leg. On exam, her left calf is erythematous, and its circumference is 4 cm greater than her
right calf. What is the initial diagnostic study of choice for the suspected condition?
Computed tomography angiography
,Plain radiography
Venous duplex ultrasound
Ventilation-perfusion scan
Venous duplex ultrasound
This patient presents with a deep vein thrombosis (DVT). A deep vein thrombosis results when a
clot forms in large veins, most commonly the legs. Virchow triad describes the three biggest risk
factors for a DVT: venous stasis, endothelial damage, and hypercoagulability. Other risk factors
include increased age, malignancy, pregnancy, oral contraceptives, and stroke. Patients will
present with complaints of unilateral extremity swelling and tenderness, and physical exam will
reveal swelling, tenderness, warmth, and erythema.
A 64-year-old man is diagnosed with pneumonia and admitted into the hospital. Which of the
following findings supports Legionella as the pathogen causing pneumonia?
Hypoglycemia
Hyponatremia
Infiltrate in the upper lobes
Pleuritic chest pain
Hyponatremia.
There are no findings on history, exam, or radiographic imaging that are specific enough to
distinguish Legionella pneumonia from other causes of pneumonia. However, gastrointestinal
symptoms, such as nausea, vomiting, and diarrhea, are more common in Legionella pneumonia.
In patients who have laboratory testing obtained, hyponatremia supports the diagnosis of
Legionella pneumonia.
,A 46-year-old man from New Mexico with a past medical history of a renal transplant presents
to the emergency department with one week of cough and fever. Vital signs are T 100.6°F, HR
108 bpm, BP 116/76 mm Hg, RR 20.min, and oxygen saturation 97% on room air. Chest X-ray
shows an upper lobe infiltrate with hilar adenopathy. A fungal pathogen is suspected. Which of
the following is the recommended treatment?
Amphotericin B
Ceftriaxone and azithromycin
Fluconazole
Supportive care
Fluconazole
Coccidioidomycosis is a fungal infection that most commonly manifests clinically with
pulmonary disease. It is endemic in the southwestern part of the United States, including
Arizona, New Mexico, central and southern California, and western Texas. The treatment of
coccidioidomycosis varies based on the immune status of the patient and the severity of illness.
Healthy patients with mild to moderate illness do not require antifungal treatment. Healthy and
nonpregnant patients with severe illness (severe dyspnea or hypoxia on room air) are treated
with fluconazole or itraconazole. Amphotericin B should be used in patients with respiratory
compromise requiring mechanical ventilation. Immunocompromised patients should be treated
with fluconazole or itraconazole regardless of disease severity. Patients with coccidioidomycosis
should be monitored following treatment for the resolution or return of symptoms. Sequelae
may include prolonged fatigue or the development of pulmonary nodules.
A 53-year-old man presents for a routine complete physical. Screening blood work is completed
that demonstrates a fasting blood glucose of 189 mg/dL and hemoglobin A1C of 7.8%. The
patient is prescribed metformin. Which of the following is the most common side effect of this
medication?
, Diarrhea
Hypoglycemia
Lactic acidosis
Vitamin B12 deficiency
Diarrhea
The adverse effects that are associated with metformin include gastrointestinal upset, including
diarrhea, nausea, a metallic taste in the mouth, and anorexia. These are the most common side
effects associated with this medication, and patients should be aware of these before beginning
this drug. These side effects are often transient in nature and can be controlled by reducing the
dosage of the medication or discontinuing the drug if the side effects are intolerable.
Hypoglycemia (B) is not a side effect of metformin, which makes it a more desirable choice than
other antidiabetic medications. Hypoglycemia is more common with insulin and sulfonylurea
medications. Lactic acidosis (C) is a serious but uncommon adverse event that can occur while
taking metformin. This drug should not be administered to those at risk of developing lactic
acidosis, including those with impaired kidney or liver function, a history of alcohol abuse, or a
past history of lactic acidosis with metformin use. Vitamin B12 deficiency (D) can occur while
taking metformin, however, this side effect is less common and is typically not severe enough to
cause a megaloblastic anemia.
A 65-year-old man with a history of hyperlipidemia who is a current everyday smoker presents
to the emergency department with chest pain that started two hours ago. The pain began when
he was shoveling snow. Physical exam is unremarkable. His initial ECG is shown above. His initial
troponin level is 0.5 ng/mL, and his serum troponin two hours later is 1.2 ng/mL. Which of the
following is the most likely diagnosis?
ANon-ST elevation myocardial infarction
BPrinzmetal angina
CST elevation myocardial infarction
