Daily Stat Review - Internal Medicine Board Prep

Daily Stat Review - Wide QRS, low EF: which device helps most?

Today's board question: Wide QRS, low EF: which device helps most?. Read the full explanation and clinical pearl on Daily Stat Review, free daily internal medicine practice for physicians. Read more...

daily-answers/07-31-2026

Today's board question: Wide QRS, low EF: which device helps most?. Read the full explanation and clinical pearl on Daily Stat Review, free daily internal medicine practice for physicians. Read more...

07/30/2026

The Question A 42-year-old woman is evaluated 10 days after a first unprovoked proximal deep vein thrombosis of the left leg, confirmed by compression ultrasonography. She has no prior thrombosis, no recent surgery, travel, estrogen use, or pregnancy. Her mother had a pulmonary embolism at age 48. She is taking apixaban and feels well. Hemoglobin, platelet count, creatinine, and liver tests are normal. She asks whether she should undergo blood testing now to determine if she has an inherited clotting disorder and whether that would change treatment. Which of the... Read more...

07/29/2026

The Question A 63-year-old woman with stage 3 chronic kidney disease and long-standing hypertension is evaluated for fatigue and diffuse bone pain. She takes lisinopril and hydrochlorothiazide. Examination shows no focal neurologic deficits or volume depletion. Laboratory studies show calcium 11.6 mg/dL, phosphorus 2.1 mg/dL, creatinine 1.5 mg/dL, intact parathyroid hormone 142 pg/mL, and 25-hydroxyvitamin D 31 ng/mL. Bone density testing shows low bone mass at the distal radius. She has no history of malignancy. Which of the following is the most appropriate next step in management? See the answer... Read more...

07/28/2026

The Question A 72 year old woman with rheumatoid arthritis treated with methotrexate and prednisone 5 mg daily comes in with a three day history of a painful, burning rash on the right side of her forehead and the tip of her nose. She describes tingling in the area for two days before the rash appeared. She also notes mild right eye redness and tearing but says her vision is unchanged. Temperature is 37.1°C, blood pressure 128/76 mmHg, pulse 78/min. Examination shows grouped vesicles on an erythematous base distributed over... Read more...

07/27/2026

The Question A 52-year-old man is referred for his first screening colonoscopy. He is asymptomatic and feels well. His family history is notable for a father who had "colon polyps" removed in his 60s but no known colorectal cancer. The patient takes no medications. On colonoscopy, he is found to have 35 adenomatous polyps, ranging from 3 mm to 8 mm in size, distributed throughout the colon from the cecum to the sigmoid. The rectum is relatively spared. All polyps are removed, and pathology confirms them as tubular adenomas, none... Read more...

07/26/2026

The Question A 64-year-old woman is diagnosed with dermatomyositis. The diagnosis is made based on a 4-month history of progressive proximal muscle weakness, a heliotrope rash, Gottron's papules on her knuckles, a creatine kinase level of 4,500 U/L, and a positive anti-TIF1-gamma antibody. She is initiated on therapy with high-dose oral prednisone. Which of the following is the most important additional step in her management at this time? See the answer and explanation below: Post-Call Recovery Reads Finished your notes? Time to swap the pager for a crown. Kingdoms of... Read more...

07/25/2026

The Question A 68-year-old man with a history of hypertension and hyperlipidemia presents to the emergency department after an episode of slurred speech and right-hand clumsiness that lasted approximately 30 minutes. His symptoms have completely resolved. He has not been taking his prescribed lisinopril or atorvastatin for several months. His blood pressure is 162/94 mmHg and heart rate is 78/min and regular. A neurologic examination is now normal. A non-contrast CT scan of the head shows no acute hemorrhage, but a subsequent MRI reveals a 6-mm focus of diffusion restriction... Read more...

07/24/2026

The Question A 58-year-old woman with a history of HER2-positive breast cancer, treated 5 years prior with a doxorubicin-based regimen followed by trastuzumab, presents with a three-month history of progressive dyspnea on exertion and lower extremity swelling. Her blood pressure is 128/76 mmHg and her heart rate is 105/min. Physical examination reveals jugular venous pressure elevated to 10 cm H2O, bibasilar crackles on lung auscultation, and 2+ pitting edema to the mid-shins. A transthoracic echocardiogram demonstrates a new global hypokinesis with a left ventricular ejection fraction of 35%; her pre-chemotherapy... Read more...

07/23/2026

The Question A 22-year-old female with a history of generalized anxiety disorder is brought to the emergency department by her roommate after a syncopal episode. The patient reports several months of progressive fatigue, dizziness upon standing, and cold intolerance. She states she is "very disciplined" with her diet, which consists mainly of vegetables and protein shakes, and she runs for 90 minutes daily. Her weight has decreased by 15 kg (33 lbs) over the past six months. On review of systems, she endorses constipation but denies vomiting. Physical examination reveals... Read more...

07/22/2026

The Question A 68-year-old man with a history of myelodysplastic syndrome is admitted for symptomatic anemia. His baseline hemoglobin is 6.5 g/dL. He is initiated on a transfusion of one unit of leukocyte-reduced packed red blood cells. Thirty minutes into the transfusion, the nurse is called to the bedside because the patient has developed shaking chills and feels unwell. His temperature is 101.8°F (38.8°C), up from 99.0°F (37.2°C) pre-transfusion. His blood pressure is 128/76 mmHg, heart rate is 102 beats/minute, and respiratory rate is 18 breaths/minute. His oxygen saturation is... Read more...

07/21/2026

The Question A 68-year-old man is recovering on the surgical ward 7 days after undergoing coronary artery bypass grafting for three-vessel disease. His postoperative course has been unremarkable, and he has been receiving subcutaneous unfractionated heparin for venous thromboembolism prophylaxis. The nurse calls to report that the patient's platelet count has decreased significantly. His medical history is notable for hypertension and hyperlipidemia. On examination, his temperature is 37.1°C (98.8°F), blood pressure is 128/76 mm Hg, pulse is 88/min, and respirations are 14/min. He is well-appearing and in no distress. Cardiopulmonary... Read more...

07/20/2026

The Question A 34-year-old woman presents to a new primary care physician for evaluation of multiple chronic symptoms. For the past 5 years, she has experienced intermittent, migrating joint pain, persistent headaches, and chronic abdominal bloating and discomfort. She reports that these symptoms are distressing and have caused her to quit her job as a librarian. She brings a large binder containing records of numerous specialist consultations, including with rheumatologists, neurologists, and gastroenterologists. Extensive workups have been performed, including normal brain and abdominal MRIs, normal upper and lower endoscopies, and... Read more...

07/19/2026

The Question A 38-year-old man with no known medical history is brought to the emergency department by his partner due to two weeks of worsening headache, fevers, and confusion. His temperature is 38.4°C (101.1°F), blood pressure is 122/78 mm Hg, and heart rate is 104/min. On examination, he is lethargic and has nuchal rigidity. A non-contrast head CT shows no acute intracranial process. A lumbar puncture is performed, revealing an opening pressure of 35 cm H2O, a white blood cell count of 80/µL with a lymphocytic predominance, glucose of 30... Read more...

07/18/2026

The Question A 58-year-old man comes to your office to establish care and review recent test results. He is asymptomatic. He recently underwent his first screening colonoscopy, which was recommended by his previous physician. He has no significant past medical history and takes no medications. He has no family history of gastrointestinal cancers. His vital signs and physical examination are unremarkable. The colonoscopy report states that the cecum was reached and the preparation was adequate. The endoscopist removed a 12-mm sessile polyp from the sigmoid colon and two 5-mm polyps... Read more...

07/17/2026

The Question A 68-year-old woman with a history of hypertension and hyperlipidemia presents to the emergency department with a two-hour history of recurrent, severe spinning sensations. She reports the episodes last for about 30 seconds and are provoked by rolling over to her right side in bed or looking up. She feels nauseated during the episodes but has not vomited. She denies any headache, hearing loss, tinnitus, double vision, or focal weakness. On examination, her vital signs are stable. Her neurologic examination, including a full cranial nerve assessment, motor and... Read more...

07/16/2026

The Question A 28-year-old woman comes to the office to discuss management of chronic abdominal symptoms. For the past two years, she has experienced crampy lower abdominal pain, bloating, and a sensation of incomplete evacuation. The pain is typically relieved with defecation. Her bowel habits fluctuate between periods of hard, pellet-like stools and loose, watery stools, with each pattern lasting for several weeks at a time. These symptoms occur 3 to 4 days per week and are causing her significant distress. She has not experienced weight loss, rectal bleeding, or... Read more...

07/15/2026

The Question A 78-year-old man at a skilled nursing facility is evaluated for a 3-day history of profuse watery diarrhea and lower abdominal cramping. He has had up to 10 non-bloody stools per day. His medical history is notable for COPD and hypertension. Two weeks ago, he completed a 5-day hospital course of intravenous ceftriaxone and oral azithromycin for community-acquired pneumonia. On examination, his temperature is 38.4°C (101.1°F), heart rate is 105/min, and blood pressure is 110/70 mm Hg. His abdomen is soft and diffusely tender without peritoneal signs. Laboratory... Read more...

07/14/2026

The Question A 28-year-old woman of Greek descent presents for a new patient visit. She feels well overall but reports mild, intermittent fatigue for the past year, which she attributes to a busy work schedule. She has a history of "mild anemia" but has never had a formal workup. She eats a varied diet and has regular menstrual cycles, lasting 4 days with moderate flow. She is not pregnant. On examination, her vital signs are normal. There is no conjunctival pallor, glossitis, or splenomegaly. A complete blood count is obtained,... Read more...

07/13/2026

The Question A 48-year-old man with a history of type 2 diabetes mellitus and social alcohol use presents to the emergency department with one day of severe, constant epigastric pain that radiates to his back. The pain is associated with nausea and several episodes of non-bilious vomiting. His temperature is 37.9°C (100.2°F), heart rate is 118 beats/minute, blood pressure is 112/74 mm Hg, and respiratory rate is 20 breaths/minute. On examination, he is in moderate distress. His abdomen is tender to palpation in the epigastrium without guarding or rebound. Laboratory... Read more...

07/12/2026

The Question A 45-year-old man presents for a new patient visit. He has no specific complaints and feels well. He has not had routine medical care for over a decade. His father was diagnosed with colon cancer at age 52. His mother is healthy. He does not smoke, drinks alcohol socially, and works a desk job. His temperature is 37.0°C (98.6°F), blood pressure is 125/78 mm Hg, pulse is 72/min, and respirations are 14/min. BMI is 26 kg/m². The physical examination is unremarkable. Which of the following is the most... Read more...

07/11/2026

The Question A 48-year-old woman is brought to the emergency department by her husband due to 3 days of worsening confusion, an unsteady gait, and seeing double. Her medical history is notable for obesity, for which she underwent a Roux-en-Y gastric bypass 5 years ago, with an initial weight loss of 90 lbs. For the past week, she has had a viral gastroenteritis with significant nausea, vomiting, and poor oral intake. On examination, she is afebrile with a heart rate of 105/min and blood pressure of 110/68 mm Hg. She... Read more...

07/10/2026

The Question A 68-year-old man is evaluated on postoperative day 7 after a coronary artery bypass grafting procedure. He reports the acute onset of swelling, pain, and redness in his right leg. His medical history is notable for hypertension and hyperlipidemia. Since surgery, he has been receiving prophylactic unfractionated heparin. His temperature is 37.6°C (99.7°F), blood pressure is 140/85 mm Hg, pulse is 92/min, and respirations are 16/min. Examination reveals a warm, erythematous, and swollen right lower extremity with calf tenderness. There are no skin lesions or signs of bleeding.... Read more...

07/09/2026

The Question A 24-year-old man presents to the emergency department with a 5-day history of joint pain. The pain began in his right knee and has since involved his left wrist and right ankle. He also reports pain and swelling along the tendons of his left wrist. He denies any recent trauma. He has felt generally unwell with subjective fevers. He is sexually active with a new partner for the past month and reports inconsistent condom use. He denies any penile discharge, dysuria, or genital lesions. Temperature is 37.9°C (100.2°F),... Read more...

07/08/2026

The Question A 28-year-old man presents to the clinic for evaluation of worsening leg swelling over the past three weeks. He has also noticed puffiness around his eyes in the morning and foamy urine. His medical history is notable for Hodgkin lymphoma, for which he was treated with chemotherapy 5 years ago and has been in complete remission. He takes no medications. On examination, his temperature is 37.0°C (98.6°F), blood pressure is 130/80 mmHg, pulse is 78/min, and respirations are 16/min. There is prominent periorbital edema and 3+ pitting edema... Read more...

07/08/2026

The Question A 28-year-old man presents to the clinic for evaluation of worsening leg swelling over the past three weeks. He has also noticed puffiness around his eyes in the morning and foamy urine. His medical history is notable for Hodgkin lymphoma, for which he was treated with chemotherapy 5 years ago and has been in complete remission. He takes no medications. On examination, his temperature is 37.0°C (98.6°F), blood pressure is 130/80 mmHg, pulse is 78/min, and respirations are 16/min. There is prominent periorbital edema and 3+ pitting edema... Read more...

07/08/2026

The Question A 28-year-old man presents to the clinic for evaluation of worsening leg swelling over the past three weeks. He has also noticed puffiness around his eyes in the morning and foamy urine. His medical history is notable for Hodgkin lymphoma, for which he was treated with chemotherapy 5 years ago and has been in complete remission. He takes no medications. On examination, his temperature is 37.0°C (98.6°F), blood pressure is 130/80 mmHg, pulse is 78/min, and respirations are 16/min. There is prominent periorbital edema and 3+ pitting edema... Read more...

07/07/2026

The Question A 38-year-old woman with a 10-year history of generalized tonic-clonic epilepsy, well-controlled on levetiracetam 1000 mg twice daily, presents for follow-up. She reports two breakthrough tonic-clonic seizures in the past three months, prior to which she had been seizure-free for over five years. She affirms medication adherence, and a levetiracetam level drawn one month ago was in the therapeutic range. Her medical history is also significant for migraine headaches without aura, for which she takes ibuprofen as needed. Her neurologic examination is non-focal. Vitals are stable. She expresses... Read more...

07/06/2026

The Question A 48-year-old woman with a history of Roux-en-Y gastric bypass 5 years ago presents to the emergency department with 3 weeks of progressive gait instability and confusion. Her husband reports that she has become increasingly apathetic and forgetful. For the past two months, she has had nausea and poor oral intake, and has been inconsistent with her prescribed nutritional supplements. On examination, she is lethargic and oriented only to person. Temperature is 37.1°C (98.8°F), blood pressure is 118/76 mmHg, heart rate is 88/min, and respirations are 16/min. Neurologic... Read more...

07/05/2026

The Question A 38-year-old woman presents with an 8-month history of crampy lower abdominal pain and changes in bowel habits. She reports abdominal pain that is relieved by defecation and associated with 3–5 loose, nonbloody stools per day; symptoms began gradually and have been intermittent but persistent. She has no fever, weight loss, nocturnal diarrhea, family history of inflammatory bowel disease or colorectal cancer, or rectal bleeding. Vital signs are normal. Physical exam is unremarkable without abdominal tenderness or perianal disease. Laboratory studies show hemoglobin 13.2 g/dL, WBC 6.4 x10^9/L,... Read more...

07/04/2026

The Question A 62-year-old man presents 7 days after elective total knee arthroplasty with acute left calf pain and swelling. His postoperative course included low-molecular-weight heparin prophylaxis. He is afebrile, HR 88 bpm, BP 132/78 mmHg, RR 16. Exam shows a tender swollen left calf with erythema. Laboratory data: platelet count was 250,000/µL preoperatively and is now 95,000/µL, hemoglobin 13.2 g/dL, creatinine 0.9 mg/dL; PT and aPTT are within reference range. Duplex ultrasound shows an occlusive left popliteal vein deep venous thrombosis. Peripheral smear demonstrates reduced platelets without schistocytes. He... Read more...

07/03/2026

The Question A 62-year-old man with a 50 pack-year smoking history, who quit 5 years ago, presents with progressive cough. Chest CT reveals a 3.1 cm spiculated peripheral right upper lobe mass. FDG-PET shows intense uptake in the mass (SUV 10) but no FDG-avid mediastinal or hilar lymph nodes. Pulmonary function testing shows FEV1 48% predicted and DLCO 50% predicted; he has coronary artery disease but preserved left ventricular function. Thoracic surgery considers him borderline for lobectomy because of reduced pulmonary reserve. Which of the following is the most appropriate... Read more...

07/02/2026

The Question A 68-year-old man presents with 9 months of progressive exertional dyspnea and a dry cough. He is a former smoker (40 pack-year, quit 5 years ago). On exam he has resting oxygen saturation 95% on room air, bibasilar fine inspiratory crackles and digital clubbing. Pulmonary function testing shows FVC 65% predicted, FEV1/FVC ratio normal, and DLCO 45% predicted. Autoimmune serologies including ANA, rheumatoid factor, and anti-CCP are negative. High-resolution chest CT demonstrates basal predominant subpleural reticulation with honeycombing and traction bronchiectasis, no significant ground-glass opacities, no mosaic attenuation,... Read more...

06/30/2026

The Question A 62-year-old man with type 2 diabetes and longstanding chronic hepatitis C is evaluated for antiviral therapy. He reports mild fatigue but no jaundice, ascites, or encephalopathy. Vitals are stable. Exam shows small non-tender hepatomegaly and no stigmata of chronic liver disease. Labs: ALT 85 U/L, AST 110 U/L, total bilirubin 0.9 mg/dL, albumin 3.8 g/dL, INR 1.1, platelets 130,000/microL, serum creatinine 2.2 mg/dL (eGFR ~25 mL/min/1.73 m2). HCV RNA 3.2 million IU/mL, genotype 1a. Hepatitis B surface antigen negative, HIV antibody negative. Abdominal ultrasound shows a nodular... Read more...

07/01/2026

The Question A 28-year-old man who has sex with men presents with 7 days of rectal pain, mucous discharge, and tenesmus after receptive anal intercourse with a new partner. He has no fever, denies urethral discharge, and reports intermittent adherence to condoms. Vitals: T 36.8°C, HR 78 bpm, BP 122/74 mmHg. On rectal exam there is mucopurulent discharge and mild erythema; anoscopy confirms mucosal inflammation. A rectal nucleic acid amplification test (NAAT) returns positive for Chlamydia trachomatis and negative for Neisseria gonorrhoeae; HIV fourth-generation test is negative. Which of the... Read more...