Are you prepared for the internal medicine (IM) final exam as a resident physician?

From the Guidelines

I will assess your preparedness for your internal medicine final exam with 10 questions that have alternating directions, focusing on key areas of internal medicine to evaluate your knowledge and clinical decision-making skills. The questions will cover a range of topics, from cardiovascular and respiratory diseases to endocrinology and nephrology, to ensure a comprehensive assessment of your knowledge and abilities 1.

Question 1: Cardiovascular Disease

1. Describe the appropriate management of a patient with newly diagnosed heart failure with reduced ejection fraction (HFrEF), including lifestyle modifications, medications, and device therapy.

Question 2: Endocrinology

1. Explain the pathophysiology of diabetic ketoacidosis and outline your initial management approach, including fluid replacement, insulin therapy, and electrolyte management.

Question 3: Cardiovascular Disease

1. A 65-year-old patient presents with new-onset atrial fibrillation. Calculate their CHA₂DS₂-VASc score and recommend appropriate anticoagulation therapy, considering their stroke risk and bleeding risk.

Question 4: Endocrinology

1. Compare and contrast the mechanisms of action and side effect profiles of SGLT2 inhibitors versus GLP-1 receptor agonists in type 2 diabetes management, including their effects on glucose control, weight, and cardiovascular outcomes.

Question 5: Infectious Disease

1. A 45-year-old presents with severe community-acquired pneumonia requiring hospitalization. Outline your empiric antibiotic regimen and explain your reasoning, considering the patient's severity of illness, comorbidities, and local antibiotic resistance patterns.

Question 6: Rheumatology

1. Discuss the diagnostic criteria for systemic lupus erythematosus and describe first-line treatment options for a patient with newly diagnosed disease, including non-pharmacologic interventions and pharmacologic therapies.

Question 7: Pulmonology

1. A 70-year-old with COPD presents with an acute exacerbation. Detail your management approach, including specific medications and dosages, such as bronchodilators, corticosteroids, and antibiotics, and explain your rationale for each treatment decision.

Question 8: Nephrology

1. Explain the pathophysiology of hepatorenal syndrome and outline your diagnostic and treatment approach, including the use of vasoconstrictors, albumin, and renal replacement therapy.

Question 9: Cardiovascular Disease

1. A 55-year-old with hypertension presents with a blood pressure of 180/110 mmHg but no end-organ damage. Describe your step-by-step management plan, including lifestyle modifications, medication initiation, and monitoring, to achieve blood pressure control and reduce cardiovascular risk.

Question 10: Gastroenterology

1. Discuss the differential diagnosis for a patient presenting with acute pancreatitis and explain how you would determine the etiology, including laboratory tests, imaging studies, and clinical evaluation, to guide treatment decisions and management. These questions are designed to test your knowledge, critical thinking, and clinical decision-making skills in internal medicine, with a focus on morbidity, mortality, and quality of life outcomes 1.

From the Research

Questions to Assess Preparedness for Internal Medicine Exam

To assess your preparedness for the internal medicine exam, we will ask you a series of questions with alternating directions. Please answer the following questions to the best of your ability.

• What are the common causes of hyperthyroidism, and how do they affect the diagnosis and treatment of the condition? 2, 3
• A 35-year-old female patient presents with symptoms of anxiety, insomnia, and palpitations. What are the possible diagnoses, and how would you approach the diagnosis and treatment of this patient?
• What are the risks and benefits of using antithyroid medications, radioactive iodine, and surgery to treat hyperthyroidism, and how do you determine the best treatment option for a patient? 4
• A patient with hyperthyroidism is experiencing cardiovascular manifestations such as hypertension and tachycardia. How would you manage these symptoms, and what are the potential consequences of not treating them promptly? 2
• What are the differences in medical school experiences that may affect how prepared residents feel themselves to be as they enter general surgery residency, and how may these differences contribute to resident burnout? 5
• A patient presents with symptoms of thyrotoxicosis, including unintentional weight loss and heat intolerance. What are the possible causes of thyrotoxicosis, and how would you approach the diagnosis and treatment of this patient? 3
• How do you assess the clinical preparedness of a new graduate for independent clinical practice, and what are the key indicators of readiness for independent practice? 6
• What are the potential consequences of not treating hyperthyroidism promptly, and how do you determine the best treatment option for a patient with hyperthyroidism? 4
• A patient with hyperthyroidism is considering treatment options, including antithyroid medications, radioactive iodine, and surgery. How would you counsel this patient on the risks and benefits of each treatment option? 4
• What are the common symptoms of hyperthyroidism, and how do you approach the diagnosis and treatment of a patient with hyperthyroidism? 2, 3