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Internal Medicine Exam Cheat Sheet 2026

The 30 highest-yield Internal Medicine Exam facts, distilled from real exam questions. Print it, save it as a PDF, or study it here β€” free, no sign-up.

200 questions
240 min time limit
70% to pass
  1. A 50-year-old woman with atrial fibrillation has a CHAβ‚‚DSβ‚‚-VASc score of 3. She has no contraindications to anticoagulation. Which therapy is most appropriate? β†’ Direct oral anticoagulant (DOAC)
  2. Von Willebrand disease most characteristically presents with which bleeding pattern? β†’ Mucocutaneous bleeding such as epistaxis and menorrhagia
  3. A 72-year-old with COPD develops CAP. Which outpatient antibiotic regimen is recommended by IDSA guidelines? β†’ Respiratory fluoroquinolone OR beta-lactam + macrolide
  4. Which scoring system is currently used to prioritize liver transplant candidates in the United States? β†’ MELD-Na score
  5. What is the most common cause of secondary hypertension in adults under 40 years of age? β†’ Renal artery stenosis due to fibromuscular dysplasia
  6. Which of the following best describes the 'washout' appearance of hepatocellular carcinoma on contrast-enhanced MRI? β†’ Arterial phase hyperenhancement followed by portal/delayed phase hypoenhancement
  7. What is the most common cause of a transudative pleural effusion in the United States? β†’ Congestive heart failure
  8. A patient with known type 1 diabetes is NPO for surgery scheduled tomorrow morning. How should insulin be managed to prevent DKA? β†’ Continue basal insulin at full dose; hold prandial insulin
  9. A patient with DKA on insulin infusion develops glucose of 180 mg/dL but still has an anion gap of 20. What is the appropriate management? β†’ Add dextrose to IV fluids and continue insulin infusion
  10. A patient with primary biliary cholangitis (PBC) is started on ursodeoxycholic acid (UDCA). Which lab trend best indicates an adequate biochemical response? β†’ Decrease in alkaline phosphatase by >40% from baseline
  11. A 62-year-old woman presents with NSTEMI. Her creatinine is 2.8 mg/dL. Which anticoagulant requires the most careful dose adjustment in this setting? β†’ Enoxaparin (LMWH)
  12. Which occupational lung disease is associated with shipbuilding and insulation work, characterized by pleural plaques and increased risk of mesothelioma? β†’ Asbestosis
  13. A patient with DKA has a serum osmolality of 340 mOsm/kg and an altered mental status. What additional diagnosis should be considered? β†’ Overlapping hyperosmolar hyperglycemic state (mixed DKA/HHS)
  14. A patient in the ICU receives tobramycin for 10 days. On day 8, creatinine begins rising. Urine shows Ξ²2-microglobulinuria. What pattern of AKI is expected? β†’ Proximal tubular necrosis with non-oliguric AKI
  15. A patient with chronic stable heart failure (EF 25%) develops a 3-second pause on Holter monitoring and near-syncope. What is the most appropriate next step? β†’ Implantable cardioverter-defibrillator (ICD) evaluation
  16. Which laboratory test provides the most accurate real-time assessment of ketone clearance in DKA? β†’ Serum beta-hydroxybutyrate level
  17. A cirrhotic patient with known varices has not bled. What is the recommended primary prophylaxis approach for large varices? β†’ Non-selective beta-blockers or endoscopic band ligation
  18. It was shown for patients with A. Rate control outperformed rhythm control. β†’ What did the AFFIRM trial show?
  19. A 55-year-old man with multiple myeloma presents with AKI, hypercalcemia, and Bence Jones proteinuria. Which mechanism directly causes AKI in this condition? β†’ Light chain cast nephropathy obstructing tubular lumens
  20. Procalcitonin (PCT) is most useful in CAP management for which purpose? β†’ Guiding antibiotic duration and de-escalation
  21. A 70-year-old man with AKI, low complement (C3, C4), RBC casts, and a history of recent streptococcal skin infection is most likely experiencing: β†’ Post-infectious (post-streptococcal) glomerulonephritis
  22. Which scoring system is preferred in the ED to determine ICU admission criteria for CAP? β†’ IDSA/ATS minor criteria
  23. A 45-year-old with CAP has Na 128, BUN 28, RR 26, BP 88/60, age <65. What is his CURB-65 score? β†’ 4
  24. Which statement about the management of community-acquired pneumonia (CAP) requiring ICU admission is correct? β†’ Beta-lactam plus macrolide or beta-lactam plus respiratory fluoroquinolone is recommended
  25. Which criterion defines 'severe CAP' requiring ICU admission per IDSA/ATS major criteria? β†’ Need for mechanical ventilation OR septic shock requiring vasopressors
  26. Which of the following is a contraindication to fibrinolytic therapy in STEMI? β†’ Ischemic stroke within the past 3 months
  27. A patient with AKI has serum potassium of 6.8 mEq/L. ECG shows peaked T waves, widened QRS, and a sine wave pattern. What is the FIRST treatment to administer? β†’ Calcium gluconate IV
  28. Which Child-Pugh score component best correlates with the severity of synthetic liver dysfunction? β†’ Prothrombin time/INR
  29. Which of the following is a characteristic feature of LΓΆfgren syndrome in the context of sarcoidosis? β†’ Bilateral hilar adenopathy, erythema nodosum, and polyarthritis
  30. Which spirometry pattern is consistent with a diagnosis of restrictive lung disease? β†’ FEV1/FVC β‰₯ 0.70 with reduced TLC
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