NCCPA Internal Medicine 5

Question 1

A 67-year-old man presents with hematuria and a right flank mass. CT shows a 5-cm renal mass with venous thrombus. What is the most likely diagnosis?

Accepted Answer

Renal cell carcinoma

Answer

Transitional cell carcinoma

Answer

Wilms tumor

Answer

Angiomyolipoma

Question 2

A 50-year-old man with alcohol use disorder presents with acute severe epigastric pain radiating to the back, nausea, and serum lipase 1,200 U/L. Which initial management is most appropriate?

Accepted Answer

Aggressive IV fluid resuscitation and NPO

Answer

Urgent ERCP

Answer

Broad-spectrum antibiotics

Answer

Emergency surgery

Question 3

A 38-year-old woman with fatigue, proximal muscle weakness, and a heliotrope rash is found to have elevated CK and aldolase. What is the diagnosis?

Accepted Answer

Dermatomyositis

Answer

Systemic lupus erythematosus

Answer

Polymyalgia rheumatica

Answer

Fibromyalgia

Question 4

A 70-year-old man on warfarin for atrial fibrillation presents with sudden-onset severe headache and altered consciousness. CT shows hyperdense blood in ventricles. INR is 3.8. What is the most urgent reversal agent?

Accepted Answer

4-factor prothrombin complex concentrate (PCC)

Answer

Fresh frozen plasma (FFP)

Answer

Vitamin K alone

Answer

Protamine sulfate

Question 5

A 55-year-old woman with celiac disease presents with fatigue and macrocytic anemia. She adheres to a gluten-free diet. Which deficiency is most likely contributing?

Accepted Answer

Folate deficiency

Answer

Iron deficiency

Answer

Vitamin B6 deficiency

Answer

Copper deficiency

Question 6

A 58-year-old man with stable angina on metoprolol and aspirin develops worsening symptoms despite optimal medical therapy. Stress test shows significant reversible ischemia. What is the next step?

Accepted Answer

Coronary angiography

Answer

Add a long-acting nitrate

Answer

Increase metoprolol dose

Answer

Nuclear perfusion stress test

Question 7

A 34-year-old woman with recurrent sinopulmonary infections and diarrhea is found to have undetectable serum IgA, IgG, and IgM. B cell count is very low. What is the most likely diagnosis?

Accepted Answer

X-linked agammaglobulinemia (Bruton's disease)

Answer

Common variable immunodeficiency

Answer

Selective IgA deficiency

Answer

DiGeorge syndrome