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Rosh Review Exam- Internal Medicine Questions Solved with 100% Correct Verified Answers
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Rosh Review Exam- Internal MedicineQuestions Solved with 100% Correct
Verified Answers
A 54-year-old man with a history of gastroesophageal reflux disease and hypertension presents
to the office for a new patient physical exam. He currently takes omeprazole 20 mg twice daily
and lisinopril 10 mg once daily. He has taken omeprazole for 5 years but states he has
struggled with heartburn for almost 15 years. He also reports a 20 pack-year smoking history.
His vital signs are heart rate 70 bpm, blood pressure 125/85 mm Hg, respirations 20/min,
oxygen saturation 98% on room air. His physical exam is normal, with no abdominal tenderness
to palpation. You order an upper endoscopy, which shows the findings represented in the
image above. According to the American College of Gastroenterology, what endoscopy findings
are consistent with the most likely diagnosis?
AColumnar-lined surface epithelium with goblet cells
BGastric cardiac-type epithelium
CIntestinal metaplasia at the gastroesophageal junction
DMetaplastic esophageal columnar mucosa
EStratified squamous epithelium
pneumocystis pneumonia
In patients with a history of HIV infection and a CD4 count less than 200, which of the
following opportunistic infections is trimethoprim-sulfamethoxazole (TMP-SMX) administered
for prophylaxis?
ACoccidioidomycosis
BDisseminated mycobacterium avium complex disease
,CPneumocystis pneumonia
DStreptococcus pneumoniae
evaluate iron studies
A 63-year-old man with a medical history significant for type 2 diabetes mellitus, hypertension,
and chronic kidney disease presents with fatigue and dyspnea on exertion for the past month.
A physical examination is unremarkable except for conjunctival pallor. His vital signs are within
normal limits except for a HR of 106 bpm. A fecal occult blood test is negative. Laboratory tests
are ordered and the results show a creatinine of 2.1 mg/dL, a potassium of 3.8 mmol/L, a
hemoglobin of 9.8 gm/dL, and a mean corpuscular volume of 82 fL. Which of the following is
the best next step in management of this patient’s condition?
ABegin erythropoietin therapy
BEvaluate iron stores
COrder a hemoglobin electrophoresis
DRefer for emergent dialysis
ESupplement folate and vitamin B12
altered structure of the right ventricle
Which of the following best describes cor pulmonale?
AAltered structure and function of the left ventricle
BAltered structure and function of the right ventricle
CCongenital heart disease
DRight-sided heart disease due to left-sided heart disease
reassurance
A 23-year-old man is admitted for a femur fracture. An admission ECG is shown above. What
management is indicated?
AAtropine
BBeta blocker
CReassurance
DTransvenous pacing
elevated sweat chloride
,A 16-month-old boy and his adoptive parents present to your office with a complaint of cough
and concern about the patient’s weight. The parents indicate that they don’t have much
information about the patient’s birth parents and since adopting him four months ago they
have noticed daily shortness of breath, cough and wheezing. He is also a fussy eater and is in
the second percentile of weight on the growth chart. Which lab finding is most consistent
with the diagnosis?
AElevated exhaled nitric oxide testing
BElevated sweat chloride
CElevated white blood cell count
DPositive skin allergy test
glucose-6-phosphate dehydrogenase deficiency
A 9-year-old boy presents to the emergency department with his parent, who reports the
patient has had yellowing of the skin, dark urine, and dizziness that developed quickly over
the past 24 hours. While you are obtaining the history, the parent mentions the boy recently
recovered from an upper respiratory infection but is otherwise healthy. Current vital signs are
temperature of 98.7°F, BP of 95/70 mm Hg, HR of 114 bpm, RR of 20/minute, and oxygen
saturation of 99% on room air. Physical exam shows jaundice and is otherwise unremarkable.
Laboratory studies reveal a hemoglobin of 10.2 g/dL. Bite cells and Heinz bodies are seen on
peripheral smear. Which of the following is the most likely diagnosis?
AGlucose-6-phosphate dehydrogenase deficiency
BHereditary spherocytosis
CParoxysmal nocturnal hemoglobinuria
DSickle cell disease with acute crisis
EThrombotic thrombocytopenic purpura
vancomycin and ceftriaxone
A 46-year-old woman presents to the emergency department with fever, cough, and
hemoptysis. She has a history of intravenous opioid use. Vital signs are BP 110/65 mm Hg, HR
120 beats per minute, RR 20 breaths per minute, and T 103.4°F. On auscultation of the chest,
you hear a faint systolic ejection murmur. Which of the following is the most appropriate
initial therapy?
AAmpicillin and gentamicin
BCeftriaxone
, COxacillin and rifampin
DVancomycin and ceftriaxone
< 150/90 mm Hg
According to guidelines from the Eighth Report of the Joint National Committee (JNC 8),
patients older than age 60 years with hypertension and no other medical history should
be treated to which of the following blood pressure goals?
A< 120/80 mm Hg
B< 130/85 mm Hg
C< 140/85 mm Hg
D< 150/90 mm Hg
metabolic alkalosis
A 78-year-old man undergoes laparoscopic surgery for a small bowel obstruction. Which
metabolic disturbance is he most at risk for postoperatively?
AMetabolic acidosis
BMetabolic alkalosis
CRespiratory acidosis
DRespiratory alkalosis
4 years of age
Which of the following is a risk factor for developing Kawasaki disease?
A4 years of age
BCongenital heart defect
CFemale sex
DPreceding upper respiratory tract infection
ERecent use of aspirin
acute glomerulonephritis
An 18-year-old woman presents to the ED with dark-colored urine and malaise for the past 3
days. Her vital signs are BP 155/85 mm Hg, HR 80 bpm, RR 16/min, and T 36.7°C. On exam, you
note 1+ pretibial edema. Urinalysis reveals proteinuria, hematuria, and red blood cell casts.
Which of the following is the most likely diagnosis?
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