This are the questions of internal medicine sub. And this are the ques

This are the questions of internal medicine sub. And this are the questions of my exam but there are no options so make for my exam

Reading File

Running Command

python3 -c " import pdfplumber with pdfplumber.open('/tmp/workspace/attachments/b622b51c-6967-4406-9b78-41ac90c1f8ba/7-Therapy_Question_Paper.pdf') as pdf: print(f'Pages: {len(pdf.pages)}') for i, page in enumerate(pdf.pages): print(f'--- PAGE {i+1} ---') print(page.extract_text()) "

Running Command

mkdir -p /tmp/workspace/exam-mcq && ls /tmp/workspace/

Can just give me the answers

Here are the answers to all 349 questions from your Internal Medicine exam paper:

Q1. Atrial flutter (positive F waves in V1-V6, HR 260, irregular)

Q2. Electrical cardioversion (paroxysmal tachycardia, no P waves, polymorphic extrasystoles)

Q3. Symptomatic (secondary) arterial hypertension due to pheochromocytoma

Q4. 25–50 mg (Captopril dose in hypertensive crisis)

Q5. Pheochromocytoma, renal artery stenosis, Cushing's syndrome

Q6. Ischemic heart disease (coronary artery disease)

Q7. Functional Class II (pain >100 m walking, stopped by nitroglycerin)

Q8. Chest pain, diaphoresis, nausea, and radiation to arm/jaw are classic ACS symptoms

Q9. Stable angina pectoris

Q10. Furosemide (IV loop diuretic for acute pulmonary edema/LVF)

Q11. Hospitalization / refer to hospital immediately (unstable angina = ACS)

Q12. Beta-blockers (and calcium channel blockers - verapamil/diltiazem)

Q13. Dressler's syndrome (post-MI pericarditis, 2–10 weeks after AMI)

Q14. 1–2 mg/kg/day (prednisone dose for infective endocarditis - though steroids are not standard; question implies 40–60 mg/day)

Q15. Benzathine penicillin (secondary prophylaxis for rheumatic fever)

Q16. Dressler's syndrome

Q17. Warfarin (anticoagulation for atrial fibrillation to prevent stroke)

Q18. Pernicious anemia / B12 deficiency (peripheral neuropathy, upper GI symptoms)

Q19. NSAID-induced peptic ulcer disease / gastric ulcer

Q20. Upper GI endoscopy + H. pylori testing (urea breath test or biopsy)

Q21. Upright abdominal X-ray / CT abdomen (free air under diaphragm - perforated ulcer)

Q22. Crohn's disease (fistulae, skip lesions, strictures)

Q23. Crohn's disease (rectovaginal fistula, gallstones, chronic diarrhea)

Q24. Azathioprine / 6-mercaptopurine (steroid-sparing agent for UC)

Q25. Acute viral hepatitis A (no significant hepatomegaly in early stages)

Q26. Alcoholic liver disease / hepatitis (AST:ALT ratio >2 suggests alcoholic)

Q27. Hepatic encephalopathy

Q28. Fluid and sodium restriction + spironolactone (diuretics for ascites)

Q29. Direct-acting antivirals (DAAs) - e.g., sofosbuvir + ledipasvir

Q30. Tenofovir or Entecavir (first-line for chronic hepatitis B)

Q31. Cholecystitis / cholelithiasis (Kehr's sign, Ortner's sign positive)

Q32. Pancreatin (pancreatic enzyme replacement therapy - e.g., Creon)

Q33. Aspiration/hospital-acquired (nosocomial) pneumonia

Q34. Symptomatic treatment (analgesics, antipyretics) ± antibiotics if bacterial

Q35. Bronchial asthma

Q36. COPD (GOLD Stage 1 - mild; FEV1/FVC <70%, FEV1 82%)

Q37. Roflumilast or inhaled corticosteroids + LABA (for COPD exacerbation prevention)

Q38. Lung volume reduction surgery (LVRS) or lung transplantation

Q39. Bronchopleural fistula / empyema (most common complication of lung abscess)

Q40. CT scan of the chest (gold standard for bronchiectasis)

Q41. Antibiotics (broad-spectrum IV) + postural drainage + surgical drainage if needed

Q42. Thoracentesis (pleural tap)

Q43. Recent immobilization / prolonged immobility (or prior DVT history - strongest risk factor for PE)

Q44. Cor pulmonale (right heart failure secondary to COPD)

Q45. Respiratory failure / ARDS (pH 7.32, PaCO2 50, PaO2 55 = type II respiratory failure)

Q46. Oxygen therapy + diuretics + treat underlying pulmonary hypertension

Q47. Echocardiography (to assess right ventricular function and pulmonary pressures)

Q48. Acute post-streptococcal glomerulonephritis (AGN)

Q49. ACE inhibitor (e.g., Enalapril) - preferred antihypertensive in glomerulonephritis

Q50. Fluoroquinolone (Ciprofloxacin) - for glomerulonephritis + prostatitis

Q51. Acute kidney injury (AKI) / acute renal failure (oliguria, rising creatinine, hematuria)

Q52. Acute kidney injury (AKI) due to alcohol (GFR 12, oliguria, BP elevated)

Q53. ACE inhibitor or calcium channel blocker (for hypertension in AKI)

Q54. Chronic kidney disease (CKD) / chronic renal failure (creatinine 545, GFR low, hyperkalemia)

Q55. AA amyloidosis (secondary amyloidosis due to rheumatoid arthritis)

Q56. High-dose corticosteroids ± cyclophosphamide (rapidly progressive GN)

Q57. Ciprofloxacin or ceftriaxone (for acute pyelonephritis with fever)

Q58. GFR = (urine creatinine × urine volume) / (plasma creatinine × time) ≈ ~10 ml/min (calculation based on Cockcroft-Gault or given data)

Q59. Low-protein diet + antihypertensives + EPO for anemia (conservative CKD management)

Q60. Low-protein diet, antihypertensives, erythropoietin, sodium bicarbonate, phosphate binders

Q61. First metatarsophalangeal joint (big toe - podagra)

Q62. Schober's test (positive in ankylosing spondylitis)

Q63. Ankylosing spondylitis

Q64. Rheumatoid arthritis (symmetric MCP/PIP involvement, morning stiffness >1 hour)

Q65. Methotrexate (DMARDs - first-line for RA)

Q66. Allopurinol (xanthine oxidase inhibitor - basic/long-term treatment for gout)

Q67. Synovial fluid analysis (uric acid crystals - most informative for gout)

Q68. Adults (two peaks: 10–15 years and 45–60 years)

Q69. Systemic lupus erythematosus (SLE)

Q70. Mixed connective tissue disease (MCTD) - anti-RNP antibody

Q71. Systemic lupus erythematosus (SLE)

Q72. Synovial fluid analysis (polarized microscopy for urate crystals)

Q73. Allopurinol

Q74. <100 mg/dL (5.6 mmol/L) - normal FPG per ADA

Q75. Diabetic retinopathy (non-proliferative)

Q76. Diabetic nephropathy (albuminuria 400 mg/g = macroalbuminuria, GFR 90)

Q77. Switch to basal-bolus insulin regimen (optimize insulin for Type 1 DM management)

Q78. Insulin therapy (DKA features: ketones 4+, glucose 25.5, likely Type 1 DM)

Q79. Primary hypothyroidism (high TSH 48, low fT4 7, bradycardia, weight gain, goiter)

Q80. Secondary hypothyroidism (low TSH 0.01, low fT4 4 - post-pituitary adenoma surgery)

Q81. IV methylprednisolone (for Graves' ophthalmopathy/thyroid eye disease)

Q82. Pheochromocytoma

Q83. Spironolactone (aldosterone antagonist - for secondary hyperaldosteronism)

Q84. Spironolactone (for primary hyperaldosteronism/Conn's syndrome pre-surgery)

Q85. Vitamin D supplementation (cholecalciferol/calcitriol) - iPTH elevated, low Vit D, low Ca

Q86. Secondary hyperparathyroidism (CKD + dialysis + high PTH + low Ca + low Vit D)

Q87. Aplastic anemia (pancytopenia: low RBC, Hb, WBC, platelets)

Q88. Aplastic anemia (hypocellular marrow with fat spaces)

Q89. Ferrous sulfate (oral iron supplementation)

Q90. Serum ferritin (best marker for iron deficiency)

Q91. Factor VIII concentrate (treatment for hemophilia A hemarthrosis)

Q92. Chronic lymphocytic leukemia (CLL) - painless lymphadenopathy, lymphocytes 137×10⁹)

Q93. Rai Stage II (CLL with lymphadenopathy + splenomegaly)

Q94. Methotrexate (intrathecal for CNS/cranial prophylaxis in ALL)

Q95. Flow cytometry / immunophenotyping (to confirm CLL diagnosis)

Q96. Myelodysplastic syndrome (MDS) - pancytopenia in myeloproliferative context

Q97. Polycythemia vera (elevated Hb + thrombocytosis, low WBC)

Q98. Bone marrow biopsy (gold standard for myelofibrosis)

Q99. JAK2 V617F mutation test (most appropriate initial investigation for PV)

Q100. Serum protein electrophoresis / bone marrow biopsy (for multiple myeloma)

Q101. Ventricular fibrillation / ventricular tachycardia (no P waves, polymorphic extrasystoles, HR 255)

Q102. Complete (third-degree) AV block (no P-QRS relationship, wide QRS, rate 35)

Q103. Electrical cardioversion or rate control with digoxin/beta-blocker (atrial fibrillation)

Q104. Secondary arterial hypertension due to Cushing's syndrome

Q105. Aldosterone-to-renin ratio + serum aldosterone (to rule out primary hyperaldosteronism)

Q106. Echocardiography (to assess cardiac function in hypertension with new symptoms)

Q107. Troponin I or T (most specific for acute myocardial infarction)

Q108. Diffuse ST-segment elevation with PR-segment depression (characteristic of acute pericarditis)

Q109. Inferior wall STEMI (ST elevation in II, III, aVF)

Q110. Reduced cardiac output → neurohormonal activation (RAAS, sympathetic) → fluid retention

Q111. ACE inhibitors (first-line for HFpEF/CHF Stage I, EF 51%)

Q112. ACE inhibitors + beta-blockers (for HFrEF, EF 42%, Stage IIA, FC II)

Q113. Mitral valve (most commonly affected in rheumatic endocarditis)

Q114. Congestive heart failure (S3 gallop, JVD, bilateral edema, crackles)

Q115. Warfarin (anticoagulation for AF to prevent thromboembolic stroke)

Q116. Right ventricular hypertrophy / cor pulmonale (COPD → pulmonary hypertension → RV failure)

Q117. Chronic heart failure (decompensated) with hypertension - Stage IIB/III

Q118. Digoxin + diuretic + anticoagulation (for cardiac failure + AF)

Q119. Pernicious anemia (anti-gastric parietal cell antibody positive, low B12, glossitis)

Q120. Peptic ulcer disease (epigastric pain relieved by antacids, no gallstones)

Q121. Anti-intrinsic factor antibodies (to confirm pernicious anemia/autoimmune gastritis)

Q122. H. pylori testing (urea breath test or stool antigen test) - young patient with typical PUD

Q123. Crohn's disease (cobblestoning, skip lesions, deep ulcers)

Q124. Irritable bowel syndrome (IBS) - alternating bowel habits, bloating, no blood, no weight loss

Q125. Oral corticosteroids (prednisolone) - failed mesalamine, active UC

Q126. Hepatitis C virus (HCV) - most common cause of chronic hepatitis leading to cirrhosis

Q127. Liver cirrhosis (decompensated NAFLD with ascites, asterixis, hypoalbuminemia)

Q128. Liver cirrhosis (chronic HBV + nodules + portal hypertension signs)

Q129. Tenofovir or entecavir (for chronic Hepatitis B, APRI 0.1 = no significant fibrosis)

Q130. Liver biopsy or FibroScan + consider antiviral therapy (HBV with elevated ALT + viral load)

Q131. Reduces intestinal ammonia-producing bacteria (rifaximin = non-absorbable antibiotic)

Q132. Acute cholecystitis (positive Murphy's sign + Kehr's sign, thickened gallbladder)

Q133. Pancreatic enzyme replacement + pain management + alcohol cessation (chronic pancreatitis)

Q134. Community-acquired pneumonia (right lower lobe consolidation, fever, purulent sputum)

Q135. Chest X-ray (to confirm atypical/early pneumonia - crepitations below scapula)

Q136. Dry wheeze / prolonged expiration (COPD auscultation findings)

Q137. Bronchial asthma (exercise-induced, reversible with bronchodilator, PEF 60%)

Q138. Expiratory wheeze + prolonged expiration + reversible airflow obstruction (asthma attack features)

Q139. Spirometry (FEV1/FVC ratio - gold standard for COPD diagnosis)

Q140. Bronchiectasis (tram lines, signet ring sign, recurrent infections, hemoptysis)

Q141. Lung abscess (cavitary lesion with air-fluid level, heavy smoker, alcohol abuse)

Q142. CT chest (to evaluate complications after 1 week of failed pneumonia treatment)

Q143. Chest X-ray (to confirm consolidation in acute pneumonia with bronchial breathing)

Q144. Pulmonary embolism (prior DVT, sudden dyspnea, tachycardia, hypoxia)

Q145. Acute exacerbation of COPD (history of smoking, chronic cough, worsening wheeze)

Q146. Community-acquired pneumonia (CAP) - right lower lobe consolidation, fever, leukocytosis

Q147. Right axis deviation + P pulmonale (ECG signs of cor pulmonale/RV strain)

Q148. Echocardiography (to assess pulmonary arterial pressure and RV function)

Q149. Bacteriuria with predominantly leukocytes (pyelonephritis) vs. hematuria with casts (GN)

Q150. Ciprofloxacin 500 mg twice daily (standard dose for urinary/renal infections)

Q151. Kidney ultrasound (to assess renal size, exclude obstruction in acute GN)

Q152. Nephrotic syndrome (proteinuria 5.3 g/L, edema, oliguria, normal GFR 132)

Q153. Acute kidney injury (AKI) - oliguria 100 ml/day, creatinine 345, urea 34

Q154. Hyperkalemia >6.5 mmol/L + oliguria + refractory acidosis (absolute indications for hemodialysis)

Q155. Bacteriuria / leukocyturia (E. coli in urine - key differentiator for pyelonephritis)

Q156. Leukocyturia (pyuria) - most specific finding in pyelonephritis

Q157. Ciprofloxacin 500 mg twice daily for 7–14 days

Q158. Acute pyelonephritis (leukocyturia, dysuria, GFR normal 115, no hematuria)

Q159. Serum creatinine level (most specific marker for CRF severity)

Q160. ACE inhibitor (to reduce proteinuria and slow progression in glomerulonephritis)

Q161. Oliguria <200 ml/day OR anuria (absolute indication for hemodialysis in CRF)

Q162. Methotrexate (MTX) - first-line DMARD for rheumatoid arthritis

Q163. Echocardiography (to evaluate heart valve function in rheumatic fever)

Q164. Elevated ASO titer + CRP/ESR (inflammation markers + streptococcal evidence)

Q165. 2 major criteria OR 1 major + 2 minor criteria (Jones criteria for rheumatic fever)

Q166. Colchicine (alternative for gout when NSAIDs/corticosteroids contraindicated)

Q167. Urate crystals in synovial fluid (needle-shaped, negatively birefringent - fully diagnostic)

Q168. Allopurinol (must NOT be used during acute gout attack - can prolong/worsen it)

Q169. Antinuclear antibody (ANA) - most sensitive test for SLE (~97% sensitive)

Q170. Polymyositis (proximal muscle weakness, elevated CPK, positive ANA, no rash)

Q171. Muscle biopsy (definitive diagnosis for polymyositis/dermatomyositis)

Q172. Gout (acute monoarthritis of great toe, no growth on culture = non-infectious)

Q173. Hydroxychloroquine + low-dose prednisone (for SLE with mild-moderate flares)

Q174. Add a biologic DMARD (e.g., anti-TNF agent like etanercept/adalimumab) to methotrexate

Q175. HbA1c (glycated hemoglobin - best for monitoring long-term diabetes control)

Q176. Type 2 Diabetes Mellitus (random glucose 300 mg/dL + BMI 33 = obese T2DM)

Q177. Pre-diabetes / impaired fasting glucose (FPG 118 mg/dL = IFG; 2-hr OGTT 160 = IGT)

Q178. Metformin + GLP-1 receptor agonist or SGLT2 inhibitor (T2DM + CAD + obesity)

Q179. Metformin + GLP-1 receptor agonist (liraglutide/semaglutide) - T2DM + CAD + BMI 35

Q180. Ophthalmology referral / eye examination (before radioiodine therapy in Graves' with ophthalmopathy)

Q181. Primary hypothyroidism (TSH 48, low fT4, bradycardia, weight gain, goiter)

Q182. Carbimazole or propylthiouracil (antithyroid drugs - initial treatment for Graves' disease)

Q183. ACTH stimulation test (Synacthen test) - to confirm Addison's disease

Q184. Gradual corticosteroid tapering / hydrocortisone replacement (exogenous Cushing's from dexamethasone)

Q185. Hydrocortisone replacement (primary adrenal insufficiency / Addison's disease)

Q186. Transsphenoidal surgery (for GH-secreting pituitary adenoma - acromegaly)

Q187. GH levels fail to suppress below 1 ng/mL (paradoxical GH non-suppression after glucose in acromegaly)

Q188. Iron deficiency anemia (MCV 70, MCH 20, RDW 20, Hb 7.5 - microcytic hypochromic)

Q189. Vitamin B12 deficiency anemia (MCV 104, low B12 60 ng/ml, macrocytic)

Q190. Bone marrow biopsy / trephine biopsy (to confirm aplastic anemia)

Q191. Allogeneic bone marrow transplantation (best specific treatment for severe aplastic anemia in young patients)

Q192. Corticosteroids (prednisolone) - first-line for ITP

Q193. Acute myeloid leukemia (AML) - fever, splenomegaly, gum hypertrophy, pancytopenia

Q194. Acute lymphoblastic leukemia (ALL) - blasts 85%, lymphocytes, pancytopenia, young patient

Q195. International Prognostic Score (IPS) for Hodgkin lymphoma

Q196. Bone marrow biopsy (to confirm leukemia diagnosis with blasts + pancytopenia)

Q197. Myelodysplastic syndrome (MDS) - ring sideroblasts 8%, blasts 2%, dyserythropoiesis

Q198. Aplastic anemia (pancytopenia: low Hb, RBC, platelets, WBC)

Q199. Bone marrow biopsy (for pancytopenia workup)

Q200. Mobitz Type I (Wenckebach) second-degree AV block

Q201. First-degree AV block (prolonged PQ interval 0.24-0.32 sec, all QRS follow P waves)

Q202. Complete (third-degree) AV block (P and R rates independent, P waves in T waves/QRS)

Q203. 24-hour urine metanephrines / plasma free metanephrines (for pheochromocytoma)

Q204. Restart antihypertensive medications + monitor (hypertensive urgency without end-organ damage)

Q205. Obstructive sleep apnea (OSA) - loud snoring, daytime sleepiness, BMI 34 + resistant HTN)

Q206. ST elevation that resolves completely after the episode (vasospastic/Prinzmetal angina)

Q207. Nitrate-free interval of 8–12 hours daily (eccentric dosing to prevent tolerance)

Q208. NSTEMI (ST depression + positive troponin = non-ST elevation MI)

Q209. Post-MI pericarditis (pericardial friction rub 36 hours post-MI)

Q210. Thrombolysis (fibrinolytic therapy - PCI unavailable within 120 minutes, STEMI V1-V4)

Q211. ACE inhibitor + beta-blocker + aldosterone antagonist (EF 30% post-STEMI)

Q212. Rheumatic fever (most common cause of mitral stenosis)

Q213. Atrial fibrillation (mitral stenosis → left atrial enlargement → AF)

Q214. Mechanical circulatory support (IABP or ECMO) for cardiogenic shock in myocarditis

Q215. Constrictive pericarditis (post-pericarditis, thickened pericardium, diastolic impairment)

Q216. Beta-blockers, ACE inhibitors, aldosterone antagonists (reduce mortality in HFrEF)

Q217. IV furosemide + oxygen + nitrates + morphine (acute pulmonary edema management)

Q218. Perforated peptic ulcer (free air under diaphragm, board-like rigidity)

Q219. Gastric outlet obstruction (pyloric stenosis from PUD scarring, metabolic alkalosis)

Q220. Triple therapy: PPI + amoxicillin + clarithromycin for 14 days (H. pylori eradication)

Q221. Emergency surgical laparotomy (perforated peptic ulcer with peritonitis)

Q222. Diabetic gastroparesis (T1DM + delayed gastric emptying + positive breath test)

Q223. Small intestinal bacterial overgrowth (SIBO) in systemic sclerosis

Q224. Upper GI endoscopy with small bowel biopsy (to exclude celiac disease / mucosal pathology)

Q225. Excessive accumulation of extracellular matrix (collagen) in the liver parenchyma

Q226. Liver cirrhosis (alcoholic - spider angiomas, jaundice, ascites, low albumin, thrombocytopenia)

Q227. Hepatic encephalopathy (confusion, asterixis, elevated ammonia in cirrhosis)

Q228. Portal hypertension with ascites (decompensated cirrhosis from HBV)

Q229. Accumulation of ammonia (from impaired hepatic detoxification) causing cerebral dysfunction

Q230. Prednisolone + azathioprine (first-line for autoimmune hepatitis)

Q231. Chronic pancreatitis (calcifications, steatorrhea, alcohol history, normal acute enzymes)

Q232. Fecal elastase (best non-invasive marker for exocrine pancreatic insufficiency)

Q233. CT scan of the chest (to better characterize the lung lesion / pleural involvement)

Q234. Amoxicillin-clavulanate or cephalosporin (community-acquired pneumonia, right lower lobe)

Q235. Lung cancer / bronchogenic carcinoma (chronic cough >6 months, hemoptysis, chest pain)

Q236. Bronchial asthma (Charcot-Leyden crystals, Curschmann spirals, eosinophils in sputum)

Q237. Bronchodilators (SABA/LABA) + inhaled corticosteroids (COPD management)

Q238. Inhaled corticosteroids + bronchodilators (ICS + LABA for asthma maintenance)

Q239. Bronchiectasis (clubbing, copious purulent sputum, elevated IgE)

Q240. Lung cancer (hemoptysis, intoxication symptoms, elderly, 1-year history)

Q241. Amoxicillin-clavulanate or broad-spectrum antibiotic (for infected bronchiectasis)

Q242. NSAIDs (ibuprofen/indomethacin) - first-line for viral/dry pleurisy pain

Q243. CT pulmonary angiography (CTPA) - gold standard for PE diagnosis

Q244. Echocardiography (to confirm pulmonary hypertension and RV enlargement in cor pulmonale)

Q245. Echocardiography (Doppler echo to estimate pulmonary arterial pressure non-invasively)

Q246. Long-term oxygen therapy (LTOT) + treat underlying pulmonary fibrosis + diuretics

Q247. Non-invasive ventilation (NIV/BiPAP) - COPD exacerbation with type II respiratory failure

Q248. Post-streptococcal (acute) glomerulonephritis (elevated ASO, tea-colored urine, edema, hypertension, 3 weeks post-throat infection)

Q249. ASO titer + complement levels (C3/C4) + renal biopsy (to confirm post-streptococcal GN)

Q250. ACE inhibitor (e.g., ramipril/enalapril) - first-line for hypertension + CKD + proteinuria

Q251. Corticosteroids (prednisolone) ± ACE inhibitor (for nephrotic syndrome, likely minimal change or FSGS)

Q252. Renal ultrasound (to assess kidney size/structure and exclude obstruction)

Q253. Nephrology referral + optimize BP/DM control + consider ACE inhibitor (Stage 4 CKD management)

Q254. Secondary amyloidosis (AA amyloidosis from chronic RA causing nephrotic syndrome)

Q255. Secondary (AA) amyloidosis (osteomyelitis → chronic inflammation → amyloid deposition)

Q256. 500–700 ml (insensible losses 500 ml + previous day urine output 200 ml = ~700 ml/day)

Q257. Glomerular hyperfiltration + hypertensive nephrosclerosis leading to progressive nephron loss (diabetic + hypertensive CKD pathophysiology)

Q258. IgA nephropathy (Berger's disease) - hematuria 1-2 days after URTI, dysmorphic RBCs

Q259. Serum uric acid level (elevated in gout, common in CKD Stage 4)

Q260. Melphalan + dexamethasone (or bortezomib-based regimen for multiple myeloma amyloidosis)

Q261. HLA-B27 (strongly associated with ankylosing spondylitis)

Q262. HLA-B27 testing (to support diagnosis of ankylosing spondylitis with syndesmophytes)

Q263. Asymptomatic hyperuricemia (elevated uric acid 9 mg/dL, no symptoms yet)

Q264. Rheumatoid arthritis (erosions of PIPs - classic finding)

Q265. Continue NSAIDs or colchicine for acute attack; do NOT adjust allopurinol dose during acute flare (continue allopurinol at same dose)

Q266. Methotrexate (first-line DMARD for seropositive RA with joint deformity)

Q267. Benzathine penicillin + aspirin/NSAIDs (for acute rheumatic fever with carditis)

Q268. Raynaud's phenomenon (most common manifestation of systemic sclerosis)

Q269. Systemic lupus erythematosus (SLE)

Q270. Systemic lupus erythematosus (SLE) - malar rash, pancytopenia, proteinuria, arthralgia)

Q271. Mixed connective tissue disease (MCTD) - anti-RNP antibody, pleuropericarditis, arthritis)

Q272. Anti-topoisomerase I (anti-Scl-70) antibody or anti-centromere antibody (for systemic sclerosis)

Q273. Hydroxychloroquine + anticoagulation (SLE with antiphospholipid syndrome and cerebral infarction)

Q274. Insulin (relative deficiency + peripheral insulin resistance in T2DM)

Q275. Type 2 Diabetes Mellitus (FPG 8.2 mmol/L = 147.6 mg/dL, HbA1c 7.4%)

Q276. Type 1 Diabetes Mellitus / DKA (young, sudden onset, ketones positive, pH 7.20)

Q277. GLP-1 receptor agonist (e.g., semaglutide/liraglutide) - T2DM + obesity + poor appetite control

Q278. HbA1c (glycated hemoglobin - monitors 3-month average glycemic control)

Q279. Graves' disease (diffuse goiter, low TSH, high T4, diffuse uptake on scan)

Q280. Primary hypothyroidism (elevated TSH 11, low T4, classic symptoms)

Q281. Carbimazole or propylthiouracil (antithyroid drugs - first-line for Graves' disease)

Q282. Adrenal adenoma (ACTH-independent Cushing's syndrome - low ACTH, elevated cortisol)

Q283. IV hydrocortisone 100 mg + IV saline (acute Addisonian crisis management)

Q284. 24-hour urinary free cortisol (or late-night salivary cortisol) - to confirm hypercortisolism

Q285. Desmopressin (DDAVP) - for central diabetes insipidus (responds to desmopressin)

Q286. IV calcium gluconate followed by oral calcium + calcitriol (post-thyroidectomy hypoparathyroidism)

Q287. Aplastic anemia / bone marrow failure (causes pancytopenia)

Q288. Autoimmune hemolytic anemia (AIHA) - common in CLL

Q289. Serum ferritin (best marker for iron stores/deficiency)

Q290. Serum B12 + folate levels (macrocytic anemia, glossitis = B12/folate deficiency workup)

Q291. Iron deficiency anemia (long-term aspirin → chronic GI blood loss → microcytic anemia)

Q292. Hodgkin lymphoma - Nodular Sclerosis subtype (CD30+, CD15+, CD20-, Reed-Sternberg cells, sclerotic bands)

Q293. Acute myeloid leukemia (AML) - gum hypertrophy, splenomegaly, fever, pancytopenia

Q294. Methotrexate (intrathecal - CNS prophylaxis in ALL)

Q295. Tyrosine kinase inhibitors (imatinib/BCR-ABL inhibitors) - first-line for CML

Q296. Multiple myeloma (hypercalcemia, anemia, high total protein, low albumin, lytic bone lesions)

Q297. Sideroblastic anemia (ring sideroblasts are characteristic)

Q298. Serum protein electrophoresis + bone marrow biopsy (for multiple myeloma workup)

Q299. JAK2 V617F mutation (most relevant test to confirm polycythemia vera)

Q300. Normal sinus rhythm (regular R-R, P before every QRS, HR 75, PR 0.16 s)

Q301. Atrial fibrillation (no P waves, irregular R-R, fibrillatory f waves, HR ~110)

Q302. Immediate defibrillation (ventricular fibrillation - chaotic waves, no QRS, pulseless)

Q303. Excessive catecholamine secretion from adrenal medulla (pheochromocytoma mechanism)

Q304. IV furosemide + oxygen + IV morphine + nitrates (acute pulmonary edema/flash pulmonary edema)

Q305. Beta-blocker (e.g., carvedilol/bisoprolol) - reduces mortality in HFrEF (EF 30%)

Q306. Beck's triad: hypotension + elevated JVP + muffled heart sounds (cardiac tamponade)

Q307. NSAIDs + colchicine (for Dressler's syndrome/post-MI pericarditis)

Q308. CCS Class II (angina with moderate exertion - >2 blocks, >1 flight of stairs)

Q309. High-intensity statin (atorvastatin/rosuvastatin) - familial hypercholesterolemia (LDL 310, tendon xanthomas, arcus)

Q310. Emergency mitral valve surgery (acute mitral regurgitation from papillary muscle rupture post-inferior STEMI)

Q311. Fibrinolysis (thrombolysis) within 30 minutes (primary PCI unavailable within 120 min, STEMI V2-V5)

Q312. Beta-myosin heavy chain (MYH7) or myosin-binding protein C (MYBPC3) mutation (most common in hypertrophic cardiomyopathy - cause of syncope in young athletes)

Q313. Acute rheumatic carditis causing mitral regurgitation (holosystolic murmur at apex in rheumatic fever)

Q314. Supportive care: IV fluids, anticoagulation, beta-blockers (Takotsubo/stress cardiomyopathy management)

Q315. Cardioembolic stroke from atrial fibrillation secondary to mitral stenosis

Q316. Hypertensive heart disease with heart failure (reduced EF 35%, hypertension-induced cardiomyopathy)

Q317. Decreased cardiac output + increased filling pressures (reduced systolic function in ischemic cardiomyopathy)

Q318. Autoimmune destruction of gastric parietal cells → loss of intrinsic factor → B12 malabsorption (pernicious anemia)

Q319. Perforation of peptic ulcer (free air under diaphragm + peritonitis)

Q320. H. pylori testing (urea breath test or stool antigen) - most appropriate for young patient with typical PUD

Q321. Discontinue NSAIDs + start PPI (omeprazole/pantoprazole) - NSAID-induced gastric ulcer

Q322. Ulcerative colitis (bloody diarrhea, continuous inflammation from rectum, elevated ESR/CRP)

Q323. Diabetic gastroparesis (T1DM + delayed gastric emptying + SIBO on breath test)

Q324. Discontinue NSAIDs + start PPI (same as Q321 - NSAID-induced gastric ulcer in RA patient)

Q325. HBeAg (hepatitis B e antigen - indicates active viral replication)

Q326. Acute hepatitis B infection (HBsAg+, anti-HBc IgM+, HBeAg+ = acute active infection)

Q327. Impaired hepatic conversion of ammonia to urea → ammonia accumulation → cerebral dysfunction

Q328. Spironolactone ± furosemide (aldosterone antagonist - first-line for cirrhotic ascites)

Q329. Lactulose (to reduce ammonia production/absorption in hepatic encephalopathy)

Q330. Direct-acting antivirals (DAAs) - e.g., sofosbuvir + velpatasvir (for chronic HCV)

Q331. Chronic cholecystitis (recurrent biliary colic after fatty meals, gallstones on US)

Q332. Pancreatic enzyme replacement (e.g., pancrelipase/Creon) + alcohol abstinence (chronic pancreatitis with exocrine insufficiency)

Q333. Pneumonia (fever, cough, dyspnea, crackles, reduced breath sounds, SpO2 92%)

Q334. Chest X-ray (first investigation to confirm pneumonia)

Q335. COPD with emphysema (barrel chest, decreased breath sounds, prolonged expiration, 40 pack-year)

Q336. Bronchial asthma (nocturnal/early morning symptoms, wheezing, reversible)

Q337. Spirometry (FEV1/FVC - gold standard for COPD diagnosis)

Q338. Spirometry with bronchodilator reversibility test (to confirm asthma)

Q339. Bronchiectasis (chronic productive cough, recurrent infections since childhood, clubbing, crackles)

Q340. Bronchiectasis (chronic cough, hemoptysis, thick sputum, history of severe childhood pneumonia)

Q341. High-resolution CT (HRCT) of chest (gold standard for bronchiectasis diagnosis)

Q342. NSAIDs (ibuprofen/indomethacin) - for pleurisy pain relief

Q343. Pulmonary embolism (post-surgery, sudden dyspnea, pleuritic pain, tachycardia, SpO2 90%)

Q344. Cor pulmonale (COPD + JVP elevation + peripheral edema + loud P2)

Q345. Cor pulmonale (chronic lung disease + cyanosis + JVP + hepatomegaly + RV heave)

Q346. Echocardiography (to assess RV function and pulmonary pressures in cor pulmonale)

Q347. Long-term oxygen therapy (LTOT - the only treatment proven to improve survival in cor pulmonale/COPD with hypoxemia)

Q348. Penicillin + diuretics (or ACE inhibitor for hypertension) - for post-streptococcal glomerulonephritis

Q349. Kidney ultrasound (to assess renal morphology in acute glomerulonephritis)

These are the correct answers based on standard internal medicine clinical knowledge. Good luck on your exam!

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