Aquifer internal medicine case EXAM A+ GRADE ASSURED COMPLETE SOLUTIONS AND VERIFIED ANSWERS

AQUIFER CASE STUDY ms ms




Exam Solution ms




Internal Medicine Exam Cartes 2026 A+ GRADE ASSUR ms ms ms ms ms ms ms




ED COMPLETE SOLUTIONS AND VERIFIED ANSWERS (C
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181D)




QUESTION 1 ms




A 24-year-
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old woman presents with complaints of excessive thirst over the past several weeks. S
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he also notes waking up in the middle of the night to urinate. She recently underwent
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transsphenoidal resection of a pituitary adenoma. Which of the following is the most l
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ikely diagnosis? ms



A. Central diabetes insipidus
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B. Nephrogenic diabetes insipidus
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C. Primary polydipsia
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D. Type 2 diabetes mellitus
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ANSWER

A. Central diabetes insipidus Central diabetes insipidus is the most common type of diabetes insipid
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us, is associated with deficient secretion of antidiuretic hormone (ADH) by the posterior pituitary.
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QUESTION 2 ms




What is the most common presenting symptom of bladder carcinoma?
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A. Nocturia
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B. Painless hematuria
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C. Unintentional weight loss
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D. Urinary frequency
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ANSWER

B. Painless hematuria The primary modality to diagnose bladder cancer is with cystoscopy, which all
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ows for direct visualization of tissues and biopsy of any abnormalities. Smoking is the most importa
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nt risk factor of bladder cancer.
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QUESTION 3 ms

,A 25-year-
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old man presents to the clinic with fever and a sore throat. A throat swab is performe
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d and the culture comes back positive for group A streptococcus bacteria. What syste
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m of his body is at highest risk for permanent damage if proper treatment for his infe
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ction is not administered?
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A. Cardiovascular
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B. Gastrointestinal
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C. Musculoskeletal
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D. Pulmonary
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ANSWER

A. Cardiovascular Risk of rheumatic fever and pericarditis. Remember the Jones criteria for rheumati
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c fever: Major: Joints, carditis, nodes, erythema marginatum, sydenham chorea. Minor: fever, arthralgi
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a, elevated ESR, elevated CRP, and prolonged PR interval. Need 2 major, or 1 major and 2 minor, or
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3 minor
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QUESTION 4 ms




Which of the following best describes the etiology of the jaundice seen in patients wit
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h thyroid storm?
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A. Direct constricting effects of thyroid hormone on the biliary duct
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B. Hepatic tissue hypoxia due to increased peripheral consumption of oxygen
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C. Hypotension leading to decreased gut motility
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D. Impaired reabsorption of thyroid hormone in the enterohepatic circulation
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ANSWER

B. Hepatic tissue hypoxia due to increased peripheral consumption of oxygen. Signs and symptoms o
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f thyroid storm include hyperpyrexia, nausea, vomiting, diarrhea, mental status changes, jaundice, hig
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h-
output congestive heart failure, cardiac tachyarrhythmias, hypertension, and diaphoresis. PE will sho
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w goiter, lid lag, hand tremor, and warm, moist skin Labs will show low TSH and high free T4 or T
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3 Most commonly caused by an acute event Treatment is: 1) beta blocker (propranolol) 2) thionami
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de (propylthiouracil or methimazole) 3) iodine solution 4) glucocorticoids
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QUESTION 5 ms




Which of the following is associated with aortic stenosis?
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A. de Musset sign
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B. Holodiastolic decrescendo murmur
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C. Syncope
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D. Wide pulse pressure
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ANSWER

C. Syncope Patient will be older With a history of diabetes, hypertension Complaining of dyspnea, ch
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est pain, syncope PE will show crescendo-
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decrescendo systolic murmur that radiates to the carotids, paradoxically split S2, S4 gallop Most com
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, monly caused by degenerative calcification Treatment is aortic valve replacement Comments: murmu
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r decreases with Valsalva
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QUESTION 6 ms




Which of the following conditions is most commonly associated with malar or "butterf
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ly" rash? ms



A. Parvovirus B19 infection
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B. Pregnancy
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C. Rosacea
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D. Systemic lupus erythematosus
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ANSWER

D. Systemic lupus erythematosus Systemic lupus erythematosus is most commonly seen in African-
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American patients of childbearing age. Antinuclear antibodies (ANA) is the best initial screening test
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(most sensitive but not specific). The presence of either anti-double-stranded DNA (dsDNA) and anti-
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smith (anti- ms



SM) antibodies is diagnostic of SLE (very specific but not sensitive). Treatment is NSAIDs, steroids, i
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mmunosuppressants, hydroxychloroquine Drug- ms ms



induced: Hydralazine, INH, Procainamide, Phenytoin, Sulfonamides (HIPPS). False-
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positive test for syphilis ms ms ms




QUESTION 7 ms




A 44-year-old man presents for a follow-
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up visit for his known gastroesophageal reflux disease. He has been taking a histamin
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e-2-
receptor antagonist twice a day. He continues to have symptoms at least three times p
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er week. Which of the following is the next best therapy?
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A. Calcium carbonate
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B. Famotidine
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C. Omeprazole
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D. Sucralfate
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ANSWER

C. Omeprazole Proton pump inhibitors (PPIs), such as omeprazole, should be used in patients who f
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ail twice-daily histamine-2-
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receptor antagonist therapy, in patients with erosive esophagitis, or patients with severe and freque
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nt symptoms of gastroesophageal reflux disease (GERD). PPIs inhibit gastric acid secretions by irreve
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rsibly binding and inhibiting the hydrogen-
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potassium ATPase pump. They should be taken 30 minutes before the first meal of the day. Treatme
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nt is weight loss, elevation head of bed during sleep, avoidance of certain foods (caffeine, alcohol, ac
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idic foods)ms




QUESTION 8 ms