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Internal Medicine Resident Qbank

Internal Medicine Question Banks

Questions

Aligned with the American Board of Internal Medicine content blueprint. Authored & peer-reviewed by faculty, clinicians, and program directors.

Each question is written to resemble the format and topics on the exam, meaning you won’t see any negatively phrased questions, no “all of the following except,” no “A and B”…you know what we mean. Most importantly, all questions include selective distractors (incorrect answer choices), which will help you think critically.

  • Must address important content
  • Must be well structured

Question

A 50-year-old man presents to his primary care physician for intermittent episodes of tachycardia, hypertension, sweats, and headache. An extensive workup reveals the presence of increased 24-hour urinary fractionated metanephrines and catecholamines. A 4 cm adrenal mass without malignant features is visualized on CT scan. He is referred for surgical consultation. After surgical evaluation, a laparoscopic adrenalectomy is planned in 10 days. Past medical history is notable for hyperlipidemia, for which he takes atorvastatin, and he does not take any other medications. Which of the following is the most appropriate next step in management?

A Initiate both metoprolol and phenoxybenzamine now
B Initiate metoprolol now and phenoxybenzamine 3 days prior to surgery
C Initiate phenoxybenzamine now and metoprolol 3 days prior to surgery
D No medication therapy is necessary
Correct Answer Distractors
The most appropriate next step in management is to initiate phenoxybenzamine now and metoprolol 3 days prior to surgery. A pheochromocytoma is a neuroendocrine tumor originating from the chromaffin cells of the adrenal medulla. Pheochromocytomas are rare tumors that can arise sporadically from a de novo mutation or can be associated with a familial syndrome, such as von Hippel-Lindau syndrome or multiple endocrine neoplasia type 2. Pheochromocytomas produce at least one catecholamine (epinephrine, norepinephrine, or dopamine). Classic presentation involves intermittent tachycardia, sweats, and headache, in addition to episodic or persistent hypertension.

Biochemical testing, either with plasma metanephrines or 24-hour urinary metanephrines and catecholamines, should be performed in patients suspected of having a pheochromocytoma. Radiologic evaluation with CT or MRI scan should be performed in patients with biochemical testing indicative of a pheochromocytoma. Patients with pheochromocytomas should undergo surgical resection, with laparoscopic adrenalectomy preferred for patients with single, small intra-adrenal tumors without malignant features. Preoperative medical therapy is necessary to manage tachycardia and hypertension and to expand volume prior to surgery. An alpha-adrenergic blocker, such as phenoxybenzamine, is recommended for 7–10 days prior to surgery. A beta-blocker, such as metoprolol, is started 2–3 days prior to surgery, but only after an appropriate alpha-adrenergic blockade has been established.

Explanations

Written with a purpose

Understanding why an answer choice is incorrect is just as important as knowing why one is correct. That’s why every Rosh Review question includes detailed explanations for the correct and incorrect answer choices. These comprehensive summaries link the most important components of a topic—from risk factors to diagnostics and treatment—giving you the context to build relationships between them.

  • Created for optimal learning and recall
  • Help reinforce your knowledge
  • Focus on the essential information

Illustrations

Created to enhance learning

Custom illustrations and tables help further clarify the core concepts. When information is presented visually, you can focus on meaning, easily reorganize and group similar ideas, and make better use of your memory.

Powerful Analytics

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Deep insights to determine your strengths and weaknesses so you can spend your time on the subjects that matter

Compare with your peers

Discover how your answer choices align with those selected by learners across the country.

Find out your probability of passing

Using data generated by previous users, your Qbank gives a prediction of how likely you are to pass your exam.

One Step Further

Taking your learning to the next level

After each explanation is a straightforward question with a simple, memorizable answer that reinforces the corresponding topic.

  • Strengthens your knowledge
  • Stands alone from the main explanation so you’re not rereading content

Question

What are metanephrines?

Reveal Answer

Pheochromocytoma

  • Catecholamine-secreting tumor located in the adrenal glands
  • Sx: paroxysmal headaches, diaphoresis, palpitations, tremors, and vision changes
  • PE: hypertension, orthostasis
  • Dx: ↑ 24h urinary catecholamines and metanephrines, or ↑ plasma metanephrine levels, adrenal CT or MRI
  • Tx:
    • Alpha-blocker (phentolamine, phenoxybenzamine) prior to beta-blockade to prevent unopposed alpha-agonism
    • Surgical resection
  • Associated with MEN2 (medullary thyroid cancer, pheochromocytoma, +/- primary hyperparathyroidism)

Rapid Review

Keeping things simple

These bulleted reviews focus on condensed, high-yield concepts about the main topic, from patient presentation to preferred management.

  • Cover the fundamentals in one list
  • Allow you to quickly scan the must-know information

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