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Quizzes > Health & Medicine

Internal Medicine Quiz: Practice Clinical Reasoning

Quick, free clinical knowledge quiz. Instant results.

Editorial: Review CompletedCreated By: Anna LolUpdated Aug 28, 2025
Difficulty: Moderate
Questions: 20
Learning OutcomesStudy Material
Colorful paper art depicting a trivia quiz on Internal Medicine Clinical Knowledge.

This internal medicine quiz helps you practice diagnostic reasoning and treatment choices across common adult conditions, with instant results. Work through brief cases in cardiology, endocrinology, and more. For more depth, try the medicine clerkship quiz, or focus on systems with cardiology test questions and an infectious diseases quiz.

A 55-year-old man presents with sudden onset chest pain radiating to his left arm. ECG shows ST-segment elevation in leads V2 - V4. What is the most likely diagnosis?
Pericarditis
Non - ST-segment elevation myocardial infarction
Acute anterior myocardial infarction
Stable angina
ST-segment elevation localized to V2 - V4 indicates transmural infarction of the anterior wall supplied by the left anterior descending artery. This presentation is characteristic of an acute anterior myocardial infarction. Other conditions like pericarditis show diffuse ST changes, and NSTEMI does not produce ST elevations.
A 60-year-old woman presents with dyspnea on exertion, orthopnea, bilateral lung crackles, and lower extremity edema. Her BNP is elevated. What is the most likely diagnosis?
Chronic obstructive pulmonary disease exacerbation
Congestive heart failure
Pulmonary embolism
Community-acquired pneumonia
The combination of orthopnea, crackles, edema, and an elevated BNP level strongly suggests volume overload from congestive heart failure. COPD exacerbations and pneumonia usually present with wheezing or focal findings, and pulmonary embolism often presents with pleuritic pain and acute dyspnea without generalized edema.
A fasting blood glucose level is measured at 180 mg/dL on two separate occasions. Which diagnosis is most appropriate?
Reactive hypoglycemia
Diabetes mellitus
Impaired fasting glucose
Stress-induced hyperglycemia
A fasting blood glucose of 126 mg/dL or higher on two occasions meets the diagnostic criterion for diabetes mellitus. Impaired fasting glucose is defined as 100 - 125 mg/dL. Stress-induced hyperglycemia and reactive hypoglycemia do not account for persistent fasting elevations.
A 45-year-old woman presents with fatigue, weight gain, and cold intolerance. Laboratory tests show elevated TSH and low free T4. What is the most appropriate initial treatment?
Propranolol
Radioactive iodine
Levothyroxine
Methimazole
Elevated TSH with low free T4 indicates primary hypothyroidism, and levothyroxine replacement is the treatment of choice. Methimazole and radioactive iodine are used for hyperthyroidism, and propranolol is only for symptomatic control of hyperthyroid symptoms.
According to evidence-based guidelines, what is a first-line antihypertensive agent in a non - black adult without comorbidities?
Hydralazine
Thiazide diuretic
Clonidine
Beta blocker
Guidelines recommend a thiazide diuretic, ACE inhibitor, ARB, or CCB as first-line therapy in uncomplicated hypertension. Thiazide diuretics are commonly chosen for initial monotherapy. Beta blockers and clonidine are not first-line in the absence of specific indications, and hydralazine is reserved for resistant cases.
A 70-year-old man with stage 4 chronic kidney disease (eGFR 25 mL/min/1.73m2) presents with peaked T waves on ECG and a serum potassium of 6.8 mEq/L. What is the most appropriate immediate management?
IV calcium gluconate
Sodium polystyrene sulfonate
Loop diuretic
IV insulin with dextrose
IV calcium gluconate is given immediately to stabilize the cardiac membrane in life-threatening hyperkalemia with ECG changes. Insulin with dextrose, diuretics, or binders are used subsequently to lower potassium levels. Immediate membrane stabilization is the priority when peaked T waves are present.
A 50-year-old patient with community-acquired pneumonia has a CURB-65 score of 2 (age >65 or blood pressure and BUN criteria). According to guidelines, where should this patient be managed?
Outpatient doxycycline monotherapy
Home with oral macrolide therapy
Observation in the emergency department only
Hospital admission with IV antibiotics
A CURB-65 score of 2 suggests moderate severity and indicates that the patient should be hospitalized for IV antibiotic therapy. Low-risk patients (scores of 0 - 1) may be managed as outpatients, and ED observation alone is insufficient for a score of 2.
A 30-year-old type 1 diabetic presents with polyuria, polydipsia, abdominal pain, and a glucose of 450 mg/dL, pH 7.25, and bicarbonate 12 mEq/L. What is the first step in management?
Begin IV fluid resuscitation
Give sodium bicarbonate
Administer IV insulin infusion
Start IV potassium until levels normalize
Initial management of DKA is aggressive IV fluid resuscitation to restore intravascular volume and improve perfusion before or alongside insulin therapy. Insulin administration follows fluids, and potassium or bicarbonate are given based on serum levels and pH thresholds.
An ECG shows sawtooth flutter waves at a rate of 300 per minute, with a ventricular rate of 75 per minute. Which of the following is the best initial management?
Diltiazem for rate control
Digoxin loading dose
Immediate synchronized cardioversion
Amiodarone infusion
Atrial flutter with controlled ventricular response is often managed initially with AV nodal blockers such as diltiazem for rate control. Cardioversion is reserved for hemodynamic instability, and amiodarone or digoxin are less commonly first-line for rate control in stable patients.
A 65-year-old smoker with chronic cough undergoes spirometry. Post-bronchodilator FEV1/FVC ratio is 0.65. What is the most likely diagnosis?
Asthma
Chronic obstructive pulmonary disease
Normal spirometry
Restrictive lung disease
An FEV1/FVC ratio below 0.70 post-bronchodilator confirms an obstructive pattern consistent with COPD, especially in a smoker. Asthma may show reversibility, restrictive diseases yield normal or increased ratios, and normal spirometry has ratios above 0.70.
A 48-year-old woman presents with fatigue and is found to have microcytic anemia. Her ferritin is low and TIBC is elevated. What is the most likely diagnosis?
Iron deficiency anemia
Anemia of chronic disease
Sideroblastic anemia
Thalassemia trait
Low ferritin and elevated total iron-binding capacity indicate depleted iron stores, which is diagnostic of iron deficiency anemia. Anemia of chronic disease typically shows normal to high ferritin and low TIBC. Thalassemia and sideroblastic anemia have different iron studies patterns.
For the patient diagnosed with iron deficiency anemia, what is the most appropriate initial treatment?
Folic acid supplementation
Oral ferrous sulfate
Intravenous iron dextran
Vitamin B12 injections
Oral ferrous sulfate is the first-line treatment for uncomplicated iron deficiency anemia to replenish iron stores. IV iron is reserved for patients who cannot tolerate or absorb oral iron. Vitamin B12 and folic acid are used for megaloblastic anemias, not microcytic iron deficiency.
A 70-year-old patient is scheduled for hip replacement surgery. What is the recommended postoperative prophylaxis to reduce the risk of deep vein thrombosis?
No anticoagulation, mechanical only
Warfarin starting immediately post-op
Unfractionated heparin drip
Low molecular weight heparin
Low molecular weight heparin is recommended for postoperative DVT prophylaxis in orthopedic surgery due to predictable pharmacokinetics and reduced monitoring needs. Unfractionated heparin drips and warfarin are not first-line for routine prophylaxis, and mechanical methods alone are insufficient in high-risk surgeries.
A 60-year-old man with cirrhosis and tense ascites presents for management. Which regimen is most appropriate?
Acetazolamide and fluid restriction
Loop diuretic alone
Thiazide diuretic plus salt restriction
Spironolactone plus furosemide
Combined spironolactone and furosemide is the recommended diuretic regimen for ascites in cirrhosis, balancing potassium and sodium excretion. Loop diuretics alone can cause hypokalemia, and thiazides or acetazolamide are not first-line for cirrhotic ascites.
A 45-year-old woman with low pretest probability for pulmonary embolism has a negative D-dimer assay. What is the next best step?
Compression ultrasound of legs
Ventilation-perfusion scan
No further testing
CT pulmonary angiography
In a patient with low pretest probability and a negative D-dimer, no further diagnostic testing is needed as the likelihood of PE is very low. Imaging studies are reserved for patients with elevated D-dimer or higher clinical probability.
A 50-year-old man is diagnosed with acute pancreatitis. Which of the following is the most critical initial therapy?
IV broad-spectrum antibiotics
Early enteral feeding
ERCP within 24 hours
Aggressive IV crystalloid resuscitation
Early aggressive IV fluid resuscitation is the cornerstone of initial management in acute pancreatitis to maintain perfusion and prevent complications. Antibiotics are not routinely indicated unless infection is suspected, and endoscopic or feeding interventions come after stabilization.
A 35-year-old man with Wolff-Parkinson-White syndrome develops atrial fibrillation with a ventricular rate of 180. Which agent is contraindicated?
Procainamide
Ibutilide
Verapamil
Amiodarone
AV nodal blockers like verapamil are contraindicated in WPW with atrial fibrillation because they can enhance conduction down the accessory pathway and worsen ventricular rate. Procainamide is the preferred antiarrhythmic in this scenario. Amiodarone and ibutilide also pose risks but are less commonly first-line.
A 42-year-old woman has hypertension and muscle weakness. Labs show hypokalemia, metabolic alkalosis, and low plasma renin activity. Which test best confirms the suspected diagnosis?
Plasma aldosterone-to-renin ratio
24-hour catecholamine assay
Serum cortisol level
Renal artery Doppler ultrasound
A low-renin, hypokalemic hypertensive patient is suggestive of primary hyperaldosteronism. The aldosterone-to-renin ratio is the best screening test. Cortisol levels assess Cushing syndrome, Doppler ultrasound evaluates renovascular hypertension, and catecholamines assess pheochromocytoma.
In early goal-directed therapy for septic shock, which target is recommended for mean arterial pressure (MAP)?
MAP ≥65 mmHg
MAP ≥75 mmHg
MAP ≥85 mmHg
MAP ≥55 mmHg
Current guidelines recommend maintaining a MAP of at least 65 mmHg in septic shock to ensure adequate organ perfusion. Lower targets risk hypoperfusion, and higher targets have not shown clear benefit and may increase adverse effects.
A 38-year-old with pleural effusion has pleural fluid ADA activity of 65 U/L. Which diagnosis is most likely?
Heart failure - related effusion
Malignant effusion
Tuberculous pleuritis
Parapneumonic effusion
An ADA level above 40 U/L in pleural fluid strongly suggests tuberculous pleuritis due to lymphocyte activation. Malignant, parapneumonic, and transudative effusions from heart failure generally have lower ADA levels.
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Learning Outcomes

  1. Analyze complex internal medicine scenarios to make accurate diagnoses
  2. Evaluate patient presentations and lab results in common conditions
  3. Apply evidence-based guidelines to clinical decision-making
  4. Identify key pathophysiological mechanisms underlying internal disorders
  5. Demonstrate critical thinking in formulating treatment plans

Cheat Sheet

  1. VITAMINS ABCDEK Mnemonic - Turn chaotic differential lists into a well-oiled machine by covering every possible cause: Vascular, Infective, Trauma, Autoimmune, Metabolic, Idiopathic, Neoplasia, Social, Alcohol, Behavioral, Congenital, Degenerative, Endocrine, and Karyotype. This colorful acronym ensures you won't miss a sneaky etiology when you're on the diagnostic detective trail! Learn how to construct killer differentials
  2. A MUDPILE CAT for Anion Gap Acidosis - Demystify metabolic acidosis by remembering Alcohol, Methanol, Uremia, Diabetic ketoacidosis, Paraldehyde, Iron/Isoniazid, Lactic acidosis, Ethylene glycol, Carbamazepine, Aspirin, and Toluene. This playful phrase keeps you on track when acid builds up faster than your coffee buzz! Explore top internal medicine mnemonics
  3. RESTRICT for Hypervolemia Signs - Remember to Reduce IV flow, Evaluate breath sounds, use a Semi-Fowler's position, Treat with oxygen and diuretics, Reduce fluid/sodium, track I&O and weight, check Circulation and edema, and Turn frequently. With RESTRICT, you'll spot fluid overload faster than you can say "diuretic drip." NCLEX Prep: Fluid & Electrolyte Mnemonics
  4. AEIOU TIPS for Coma Causes - Quickly recall Acidosis/Alcohol, Epilepsy, Infection, Overdose, Uremia, Trauma, Insulin issues, Psychosis, and Stroke when a patient goes unconscious. This handy mnemonic is like a brainy safety net to catch every possible coma culprit! Browse essential medicine mnemonics
  5. VINDICATE for Differential Diagnosis - Cover Vascular, Infectious, Neoplastic, Degenerative, Iatrogenic, Intoxication, Congenital, Autoimmune, Traumatic, Endocrine, and Metabolic causes at a glance. Use VINDICATE to craft thorough differentials that even Sherlock Holmes would envy! Elements of a Good Differential Diagnosis
  6. HEAD HEART VESSELS for Syncope - Recall Hypoxia/Hypoglycemia, Epilepsy, Anxiety, Brain stem issues, Heart attack, Embolism, Aortic obstruction, Rhythm trouble, Tachycardia, Vasovagal, Ectopic beats, Situational triggers, Subclavian steal, ENT problems, low vascular resistance, and Sensitive carotid sinus. It's the ultimate "head-to-toe" checklist that keeps you syncope-ready! Dive into medicine mnemonics
  7. TV SPARC CUBE for Shock Signs - Spot Thirst, Vomiting, Sweating, weak Pulse, Anxious behavior, Rapid shallow Respirations, Cool skin, Cyanosis, Unconsciousness, low Blood pressure, and empty Eyes. This zippy mnemonic makes shock assessment feel like a high-speed flashcard game! Master critical care mnemonics
  8. DISK MASS for Back Pain Causes - Break down Degeneration, Infection/Injury, Spondylitis, Kidney issues, Multiple myeloma/Metastasis, Abdominal aneurysm, Skin/Strain/Scoliosis, Slipped disk/Spondylolisthesis. This compact mnemonic ensures your spine evaluations are rock-solid. Get more internal medicine mnemonics
  9. NAACP for Eosinophilia - Quickly list Neoplasm, Allergy/Asthma, Addison's, Collagen vascular disease, and Parasites when you see elevated eosinophils. This catchy phrase keeps immunology from feeling like alphabet soup! Review internal medicine essentials
  10. LMNOP for Acute LV Failure - Remember Lasix, Morphine, Nitrates, Oxygen, and Pulmonary ventilation to stabilize left ventricular collapse. With LMNOP, you'll deploy life-saving treatments before the drama turns critical! Explore life-saving mnemonics
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