I n t e r n a L medicine questions Bank

Ph : 7 , protein : trace elements , Cl 75 meq / L , glucose : negative , K : 74 meq/L , Na : 55 meq /L
The clinical findings are most consistent with :
A .) Hypokalemic periodic paralysis B ) Villous adenoma
C ) Primary aldosteronism D ) Bartter s syndrome xxx E ) Surreptitious vomiting

2. 
   ) A 20 year old primigravida in her 32 nd week of gestation is admitted to the hospital because of epigastric pain , nausea & vomiting . physical exam shows Blood pressure 150/105 mm Hg , puffiness of the eyes , + 1 peripheral edema , segmental arteriolar narrowing but no hemorrhages or exudates of the fundus , cardiovascular exam is normal Labs :
   

Hct :40 % ,WBC 7000 / µL , platelets 70 , 000 /µL , BUN 15 mg/dl , Uric acid 8.3 mg/dl
, Cr 1.7 mg/dl , Bilirubin 2.7 mg/dl , ALT 500 U/L , lactate dehydrogenase 500, Haptoglobin 14 mg / dl , Urine analysis + 2 protein , no RBC .
Peripheral smear shows schistocytes & helmet cells , retic 5 % , fibrin split products 20 mg/dl ( normal < 10 ) .
What is the most likely diagnosis ?
A ) Thrombotic thrombocytopenic purpura
B ) Malignant hypertension C ) Acute glomerulonephritis D ) Acute pancreatitis
E ) Fulminant Preeclampsia ( HELLP)

3. 
   ) During a routine physical examination for obtaining health care insurance , a 31 year old woman is found t have asymptomatic hematuria with 25-30 RBC/HPF in her urine
   

. Her serum Cr level is 0.9 mg/dl , and her BUN is 12 mg/dl . On questioning , the patient said that she had a sore hroat within the past month . Physical Exam is unremarkable & shows no evidence of hypertension or edema . Dipstick analysis shows only trace proteinuria .
The patient returns for follow up evaluation 2 weeks later , the microscopic hematuria has resolved .
What is the most appropriate next step you would take to arrive at a diagnosis ?
A ) Order complement , ANA, and ANCA tests B ) Order a urine test for cytology
C ) Order measurement of Serum IgA level D ) Repeat urine analysis xxx
E ) Order an intravenous pyelogram

4. 
   ) A 67 year old man with a 4 year history of NIDDM is admitted to the hospital with DVT in his calf . He is placed at bed rest & given a diet for diabetic patients & started on heparin therapy . He is treated with his chronic antihypertensive regimen of Captopril , 25 mg, twice daily