Final Exam: Internal Medicine 101

A 65-year-old male presents to the emergency department with a 5-day history of productive cough, fever, and shortness of breath. On examination, he has a temperature of 38.5°C, respiratory rate of 28 breaths/min, heart rate of 110 beats/min, and oxygen saturation of 90% on room air. Chest x-ray shows multilobar infiltrates. He has a history of COPD and was recently treated with antibiotics for a urinary tract infection. Which of the following is the most appropriate empiric antibiotic regimen for this patient?

A 22-year-old female college student presents with productive cough, pleuritic chest pain, and fever for 2 days. She has no significant past medical history. Chest x-ray shows right lower lobe pneumonia. Which of the following is the most appropriate antibiotic for outpatient treatment?

A 72-year-old female is admitted to the ICU with sepsis secondary to multilobar CAP. She is requiring 4L of oxygen via nasal cannula to keep her oxygen saturation above 90%. She has a history of bronchiectasis and frequent COPD exacerbations treated with antibiotics. Which of the following empiric antibiotic regimens is most appropriate?

A 67-year-old male is started on empiric therapy with ceftriaxone and azithromycin for CAP. Sputum cultures grow pan-sensitive S. pneumoniae. What would be the best next step in management?

A 55-year-old female presents with a productive cough, dyspnea, and fevers. Chest CT shows a cavitary lesion concerning for necrosis. She injects heroin daily. Which of the following empiric antibiotic regimens is recommended?

A 40-year-old male presents with 5 days of productive cough, fevers, and dyspnea. He has no significant medical history. Chest x-ray confirms CAP. He is admitted to the hospital for oxygen supplementation. The CURB-65 severity score is 2. What is the appropriate site of care?

A 28-year-old female presents with 2 days of productive cough, fevers, and pleuritic chest pain. She has no significant medical history and confirms she has not used any antibiotics in the past 3 months. A chest x-ray confirms uncomplicated CAP. What is the recommended duration of antibiotic therapy?

A 75-year-old male was admitted 3 days ago for CAP. He was initially hypoxic but currently saturating 95% on room air. He has been afebrile for 36 hours and his productive cough is resolving. What would be the best next step?

A 66-year-old female was discharged home on azithromycin and amoxicillin-clavulanate after a 3-day hospitalization for CAP. She calls on day 6 due to diarrhea. What would be the best management?

A 22-year-old male with a penicillin allergy presents with CAP. Which of the following antibiotics would be appropriate for outpatient treatment?

A 45-year-old female with leg pain and swelling presents to the emergency department. Her Wells score is calculated as 3, categorizing her as having a moderate probability of deep vein thrombosis (DVT).

What does the Wells score of 3 indicate in this patient with suspected DVT?

A 60-year-old male with leg pain undergoes a D-dimer test as part of his diagnostic workup for suspected DVT.

How should a negative D-dimer result be interpreted in this patient with suspected DVT?

A 50-year-old male presents with sudden-onset leg pain, swelling, and warmth. Doppler ultrasound reveals non-compressible veins with lack of flow augmentation in the affected limb.

What do the Doppler ultrasound findings suggest in this patient with suspected DVT?

A 55-year-old female with DVT is being initiated on warfarin therapy.

What is the target international normalized ratio (INR) range when initiating warfarin for DVT treatment?

A patient with DVT is receiving concurrent treatment with low molecular weight heparin (LMWH) while transitioning to warfarin.

How long should concurrent heparin or LMWH therapy be continued with warfarin treatment for DVT?

A patient with DVT is being considered for anticoagulant therapy with direct oral anticoagulants (DOACs).

Which of the following is a contraindication for the use of DOACs in DVT treatment?

A patient with extensive DVT and high bleeding risk is being evaluated for an inferior vena cava (IVC) filter.

In what situation is the placement of an IVC filter indicated in DVT management?

A patient with DVT is being treated with low molecular weight heparin (LMWH).

What is the target peak anti-Xa level when using therapeutic dose LMWH for DVT treatment?

A patient with DVT experiences sudden worsening leg pain, shortness of breath, and chest pain.

What warning signs and symptoms suggest DVT progression or embolization in this patient?

A patient with DVT has been initiated on warfarin therapy.

What is the recommended duration of anticoagulation therapy for a first episode of unprovoked DVT?

A 55-year-old male with a history of smoking and recent long-haul air travel presents with acute dyspnea and pleuritic chest pain. His vital signs are stable.

Which clinical prediction rule can assist in risk stratifying this patient suspected of having a pulmonary embolism (PE)?

A 40-year-old female presents with sudden-onset dyspnea and pleuritic chest pain. She has no significant medical history. On examination, she appears anxious, and her oxygen saturation is 96% on room air.

In this patient with suspected pulmonary embolism (PE), when is D-dimer testing most appropriate?

A 50-year-old female presents with acute dyspnea and chest pain. CT angiography reveals a filling defect within a segmental pulmonary artery.

What key finding on CT angiography is characteristic of pulmonary embolism (PE)?

A 62-year-old male presents with sudden-onset dyspnea, chest pain, and tachycardia. ECG shows T wave inversions in leads V1-V3.

What ECG finding is suggestive of right heart strain in the context of pulmonary embolism (PE)?

A 68-year-old male with a history of hypertension and recent surgery presents with acute dyspnea and chest pain. His blood pressure is 140/90 mmHg, heart rate is 110 bpm, and oxygen saturation is 92% on room air.

Which laboratory marker is often elevated in the presence of right ventricular dysfunction associated with pulmonary embolism (PE)?

A 55-year-old female is diagnosed with a pulmonary embolism (PE) based on CT angiography findings. She has no contraindications to anticoagulation.

What is a suitable anticoagulation option for the initial treatment of this patient’s pulmonary embolism (PE)?

A 60-year-old male with a confirmed pulmonary embolism (PE) is being transitioned from heparin to warfarin therapy.

What is the recommended duration of parenteral overlap when transitioning from heparin to warfarin in the treatment of pulmonary embolism (PE)?

A 45-year-old female with a history of recent intracranial hemorrhage presents with acute dyspnea and chest pain. Imaging reveals a pulmonary embolism (PE) and evidence of right ventricular dysfunction.

Which of the following is a contraindication for systemic thrombolysis in the treatment of pulmonary embolism (PE)?

A 70-year-old male with renal dysfunction presents with sudden-onset dyspnea and pleuritic chest pain. Imaging confirms the diagnosis of pulmonary embolism (PE).

Which anticoagulation option is preferable in the treatment of pulmonary embolism (PE) for this patient with renal dysfunction?

A 58-year-old male with a confirmed pulmonary embolism (PE) has been receiving anticoagulation therapy. He suddenly becomes hypotensive and exhibits signs of worsening hypoxemia.

What warning signs are indicative of potential deterioration and recurrence of pulmonary embolism (PE) in this patient?

A critically ill patient is admitted to the ICU with multiple trauma injuries. On the second day of admission, the patient’s blood glucose levels are elevated.

What is the primary mechanism underlying stress hyperglycemia in critical illness?

A critically ill patient in the ICU has recently undergone major surgery. The healthcare team is determining the optimal glycemic target to prevent complications.

What is the evidence-based glycemic target range for critically ill patients to balance glycemic control and avoid hypoglycemia?

A non-critically ill patient with type 2 diabetes is admitted to the hospital for a surgical procedure. The medical team is considering appropriate glycemic targets for the patient.

What is the evidence-based glycemic target range for non-critically ill patients with type 2 diabetes during hospitalization?

A patient is admitted to the ICU following a severe cardiac event. The medical team is devising a strategy for glucose monitoring.

What is the optimal frequency and method for glucose monitoring in critically ill patients in the ICU?

A critically ill patient requires intravenous regular insulin therapy in the ICU.

What is a characteristic of the pharmacokinetics of intravenous regular insulin?

A patient with diabetes and hyperglycemia is admitted to the hospital. The medical team is considering insulin therapy for glycemic control.

Which type of insulin therapy includes both basal, nutritional, and correctional insulin components to cover different aspects of glucose management?

A patient with type 2 diabetes is admitted to the hospital and is currently taking oral antihyperglycemic agents.

What is a potential risk associated with the use of oral antihyperglycemic agents in the inpatient setting?

A hospitalized patient with diabetes experiences confusion, tremors, and diaphoresis. The medical team suspects hypoglycemia.

What is the recommended approach for treating hypoglycemia in hospitalized patients?

A patient with deep vein thrombosis (DVT) is admitted to the hospital. The medical team is assessing the patient’s renal function.

How should the dosing of anticoagulant therapy be adjusted in a patient with renal dysfunction?

A patient with deep vein thrombosis is nearing discharge. The medical team is planning for a smooth transition to outpatient care.

What should be included in the discharge planning for patients with deep vein thrombosis?

A 30-year-old patient with type 1 diabetes presents with polyuria, polydipsia, and deep labored breathing. Lab results reveal elevated blood glucose levels and ketones.

What are the key factors contributing to the development of diabetic ketoacidosis (DKA)?

A 45-year-old patient with type 2 diabetes presents with confusion, extreme dehydration, and very high blood glucose levels.

Which of the following presentations is more characteristic of hyperosmolar hyperglycemic syndrome (HHS) compared to typical diabetic ketoacidosis (DKA)?

A 25-year-old patient with type 1 diabetes is admitted with abdominal pain, vomiting, and elevated blood glucose levels.

What diagnostic criteria are essential for confirming the diagnosis of diabetic ketoacidosis (DKA)?

A 20-year-old patient with type 1 diabetes is admitted with DKA. Lab results show pH 7.25, bicarbonate 12 mEq/L, anion gap 20, and mental status changes.

According to ADA criteria, how would you classify the severity of this DKA episode?

A 35-year-old patient with type 2 diabetes presents with DKA. The patient is tachycardic and hypotensive.

What is the initial fluid therapy of choice in managing DKA, especially in patients with signs of hypoperfusion?

A 28-year-old patient with type 1 diabetes is admitted with DKA. Initial lab results show serum potassium of 5.8 mEq/L.

What is the appropriate approach for managing hyperkalemia during the treatment of diabetic ketoacidosis (DKA)?

A 22-year-old patient with type 1 diabetes is admitted with DKA. The patient’s pH is 7.15, bicarbonate is 10 mEq/L, and anio

What is the recommended insulin therapy for treating DKA in this patient?

n gap is 25.

A 32-year-old patient with type 1 diabetes is undergoing DKA treatment in the intensive care unit.

Which parameters should be closely monitored and at what frequency during the treatment of diabetic ketoacidosis?

A 10-year-old patient with type 1 diabetes is admitted with DKA. The patient develops altered mental status.

What are the risk factors for cerebral edema in patients with diabetic ketoacidosis, and how can it be prevented and managed?

A 40-year-old patient with type 2 diabetes is recovering from a DKA episode.

As part of the discharge plan, what important aspects of diabetes education should be emphasized to prevent future diabetic ketoacidosis episodes?

A 65-year-old male with a history of COPD presents with increased dyspnea, cough, and sputum production over the past few days. He is a former smoker with a significant smoking history. On examination, he has decreased breath sounds and wheezing. Arterial blood gas analysis shows hypoxemia and hypercapnia.

What underlying mechanisms contribute to the pathophysiology of COPD exacerbation in this patient?

A 72-year-old female with COPD presents to the emergency department with increased cough, purulent sputum, and shortness of breath. She has a history of frequent exacerbations.

What factors are commonly associated with an increased risk of COPD exacerbation in this patient?

A 58-year-old male with a history of smoking presents with increased breathlessness, cough, and sputum production. He reports these symptoms have worsened over the past few days.

Which diagnostic criteria are commonly used to identify a COPD exacerbation in this patient?

A 60-year-old patient with a known history of COPD presents with acute worsening of symptoms, including increased cough and difficulty breathing. The patient’s oxygen saturation is 90%.

What is the appropriate pharmacological management strategy for this patient’s COPD exacerbation?

A 68-year-old patient with severe COPD presents with increased breathlessness, confusion, and a respiratory rate of 30 breaths per minute. Oxygen saturation is 86%.

What is the appropriate approach to oxygen therapy for this patient during a COPD exacerbation?

A 50-year-old patient with a history of COPD is discharged after successful management of a recent exacerbation.

What is a crucial aspect of monitoring and follow-up for this patient after a COPD exacerbation?

A 62-year-old patient with COPD is admitted to the intensive care unit due to severe exacerbation, requiring mechanical ventilation.

What potential complications should be closely monitored and managed in this patient?

A 55-year-old patient with COPD is being discharged after successful management of an exacerbation.

What is a key component of discharge planning for this patient?

A 45-year-old patient with COPD presents to the emergency department with increased dyspnea and wheezing.

How can clinical pharmacists contribute to the management of this patient’s COPD exacerbation?

A 70-year-old patient with COPD presents with acute worsening of symptoms and is hospitalized for management.

What is the primary source of evidence-based guidelines and best practices for managing COPD exacerbations?

Sarah, a 32-year-old woman with a history of asthma, presents to the emergency department with worsening shortness of breath, wheezing, and coughing. She reports exposure to a strong odor earlier today.

What is the underlying mechanism that contributes to asthma exacerbation?

John, a 45-year-old man with a history of asthma, experiences recurrent exacerbations during the spring season.

Which of the following is a common trigger for asthma exacerbation in susceptible individuals?

Michael, a 28-year-old man, presents with cough, wheezing, and shortness of breath. He reports a previous diagnosis of asthma.

Which diagnostic tool is essential for assessing the severity of Michael’s asthma exacerbation?

Emily, a 50-year-old woman with a history of asthma, presents with increased shortness of breath and chest tightness.

Which class of medications provides rapid relief by relaxing the bronchial smooth muscles in asthma exacerbation?

David, a 22-year-old man with asthma, experiences exacerbations triggered by pollen exposure.

What non-pharmacological approach can David use to minimize his asthma exacerbation triggers?

Lisa, a 35-year-old woman, is discharged from the hospital after treatment for a severe asthma exacerbation.

What is a crucial aspect of monitoring for Lisa after her asthma exacerbation?

Robert, a 60-year-old man with a history of asthma, presents with severe difficulty breathing, limited speech due to breathlessness, and use of accessory muscles for breathing.

What complication of asthma exacerbation does Robert’s presentation indicate?

Maria, a 28-year-old woman, is being discharged after treatment for an asthma exacerbation.

What key aspect should be included in Maria’s discharge plan to prevent future exacerbations?

Mark, a 42-year-old man, visits the pharmacy with questions about his recent asthma exacerbation.

How can a clinical pharmacist contribute to the management of Mark’s asthma exacerbation?

Jessica, a 19-year-old woman, is seeking information about the most effective treatment for her asthma exacerbations.

What should be the primary source of guidance for evidence-based treatment of asthma exacerbations?