Internal Medicine Exam Cheat Sheet 2026

The 30 highest-yield Internal Medicine Exam facts, distilled from real exam questions. Print it, save it as a PDF, or study it here — free, no sign-up.

1. A 50-year-old woman with atrial fibrillation has a CHA₂DS₂-VASc score of 3. She has no contraindications to anticoagulation. Which therapy is most appropriate? → Direct oral anticoagulant (DOAC)
2. Von Willebrand disease most characteristically presents with which bleeding pattern? → Mucocutaneous bleeding such as epistaxis and menorrhagia
3. A 72-year-old with COPD develops CAP. Which outpatient antibiotic regimen is recommended by IDSA guidelines? → Respiratory fluoroquinolone OR beta-lactam + macrolide
4. Which scoring system is currently used to prioritize liver transplant candidates in the United States? → MELD-Na score
5. What is the most common cause of secondary hypertension in adults under 40 years of age? → Renal artery stenosis due to fibromuscular dysplasia
6. Which of the following best describes the 'washout' appearance of hepatocellular carcinoma on contrast-enhanced MRI? → Arterial phase hyperenhancement followed by portal/delayed phase hypoenhancement
7. What is the most common cause of a transudative pleural effusion in the United States? → Congestive heart failure
8. A patient with known type 1 diabetes is NPO for surgery scheduled tomorrow morning. How should insulin be managed to prevent DKA? → Continue basal insulin at full dose; hold prandial insulin
9. A patient with DKA on insulin infusion develops glucose of 180 mg/dL but still has an anion gap of 20. What is the appropriate management? → Add dextrose to IV fluids and continue insulin infusion
10. A patient with primary biliary cholangitis (PBC) is started on ursodeoxycholic acid (UDCA). Which lab trend best indicates an adequate biochemical response? → Decrease in alkaline phosphatase by >40% from baseline
11. A 62-year-old woman presents with NSTEMI. Her creatinine is 2.8 mg/dL. Which anticoagulant requires the most careful dose adjustment in this setting? → Enoxaparin (LMWH)
12. Which occupational lung disease is associated with shipbuilding and insulation work, characterized by pleural plaques and increased risk of mesothelioma? → Asbestosis
13. A patient with DKA has a serum osmolality of 340 mOsm/kg and an altered mental status. What additional diagnosis should be considered? → Overlapping hyperosmolar hyperglycemic state (mixed DKA/HHS)
14. A patient in the ICU receives tobramycin for 10 days. On day 8, creatinine begins rising. Urine shows β2-microglobulinuria. What pattern of AKI is expected? → Proximal tubular necrosis with non-oliguric AKI
15. A patient with chronic stable heart failure (EF 25%) develops a 3-second pause on Holter monitoring and near-syncope. What is the most appropriate next step? → Implantable cardioverter-defibrillator (ICD) evaluation
16. Which laboratory test provides the most accurate real-time assessment of ketone clearance in DKA? → Serum beta-hydroxybutyrate level
17. A cirrhotic patient with known varices has not bled. What is the recommended primary prophylaxis approach for large varices? → Non-selective beta-blockers or endoscopic band ligation
18. It was shown for patients with A. Rate control outperformed rhythm control. → What did the AFFIRM trial show?
19. A 55-year-old man with multiple myeloma presents with AKI, hypercalcemia, and Bence Jones proteinuria. Which mechanism directly causes AKI in this condition? → Light chain cast nephropathy obstructing tubular lumens
20. Procalcitonin (PCT) is most useful in CAP management for which purpose? → Guiding antibiotic duration and de-escalation
21. A 70-year-old man with AKI, low complement (C3, C4), RBC casts, and a history of recent streptococcal skin infection is most likely experiencing: → Post-infectious (post-streptococcal) glomerulonephritis
22. Which scoring system is preferred in the ED to determine ICU admission criteria for CAP? → IDSA/ATS minor criteria
23. A 45-year-old with CAP has Na 128, BUN 28, RR 26, BP 88/60, age <65. What is his CURB-65 score? → 4
24. Which statement about the management of community-acquired pneumonia (CAP) requiring ICU admission is correct? → Beta-lactam plus macrolide or beta-lactam plus respiratory fluoroquinolone is recommended
25. Which criterion defines 'severe CAP' requiring ICU admission per IDSA/ATS major criteria? → Need for mechanical ventilation OR septic shock requiring vasopressors
26. Which of the following is a contraindication to fibrinolytic therapy in STEMI? → Ischemic stroke within the past 3 months
27. A patient with AKI has serum potassium of 6.8 mEq/L. ECG shows peaked T waves, widened QRS, and a sine wave pattern. What is the FIRST treatment to administer? → Calcium gluconate IV
28. Which Child-Pugh score component best correlates with the severity of synthetic liver dysfunction? → Prothrombin time/INR
29. Which of the following is a characteristic feature of Löfgren syndrome in the context of sarcoidosis? → Bilateral hilar adenopathy, erythema nodosum, and polyarthritis
30. Which spirometry pattern is consistent with a diagnosis of restrictive lung disease? → FEV1/FVC ≥ 0.70 with reduced TLC