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Internal medicine medical question bank

Practise every internal medicine topic with explained SBAs.

Recall Engine has 5,000+ internal medicine questions across 300+ topics in 10+ body systems. Every question explains each option.

questions
5,000+
topics
300+
topic notes
250+
clinical skills guides
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Internal medicine by body system

Internal medicine has 300+ topics in 10+ body systems. Each section shows how many questions it has and every topic it covers.

Cardiology

400+ questions across 30+ topics. It also has 20+ topic notes and 10+ clinical skills guides.

  • Acute coronary syndrome
  • Acute coronary syndrome: ABCDE management
  • Acute coronary syndromes and bradyarrhythmias
  • Acute coronary syndromes: immediate and subsequent care
  • Acute heart failure
  • Adult resting ECG: placement and recording
  • Atrial fibrillation: rate control and anticoagulation prescribing
  • Atrial fibrillation: stroke prevention and medicine review
  • Blood pressure and pulse assessment
  • Blood pressure measurement
  • Cardiac examination
  • Cardiac history taking
  • Cardiology history taking
  • Cardiology history: structured approach
  • Cardiovascular drugs: uses and adverse effects
  • Clinical approach to a patient with generalised oedema
  • Clinical approach to a patient with palpitations and syncope
  • Coronary disease: presentation and investigation
  • ECG interpretation
  • ECG interpretation and principles of cardiac monitoring
  • ECG reporting
  • Emergency ECGs: chest pain, arrhythmias, and hyperkalaemia
  • Heart failure
  • Heart failure: prescribing and monitoring
  • Infective endocarditis
  • Leg swelling history and DVT risk assessment
  • Lipid profile interpretation
  • Neck veins examination
  • Pericardial diseases
  • Postural blood pressure measurement
  • Pulmonary oedema: ABCDE management
  • Secondary hypertension
  • Stable angina: prescribing and escalation

Respiratory medicine

700+ questions across 30+ topics. It also has 30+ topic notes and 5 clinical skills guides.

  • Acute respiratory failure: oxygen and ventilation
  • Adult asthma assessment
  • Adult community-acquired pneumonia: place of care and antibiotic review
  • Adult pneumonia: assessment and severity
  • Adult pneumonia: treatment and prevention
  • Asthma
  • Bacterial infections of the lower respiratory tract
  • Breathlessness, cough, and haemoptysis: clinical approach
  • Bronchiectasis
  • Cardinal symptoms of respiratory disease
  • Chest examination
  • Chest examination: technique and findings
  • Chest history and examination
  • Chest history taking
  • Chronic obstructive pulmonary disease
  • COPD exacerbation: emergency prescribing
  • COPD: maintenance prescribing
  • Lung abscess
  • Lung abscess and bronchiectasis
  • Lung cancer: diagnosis and staging
  • Lung cancer: presentation and paraneoplastic syndromes
  • Lung cancer: treatment by stage
  • Mediastinal masses: compartments and work-up
  • Non-tuberculous mycobacteria
  • Obstructive lung disease
  • Obstructive sleep apnoea: diagnosis and treatment
  • Occupational and interstitial lung disease
  • Pleural effusion, haemothorax, and pneumothorax
  • Pneumonia
  • Pulmonary embolism: ABCDE management
  • Pulmonary embolism: diagnosis and treatment
  • Pulmonary hypertension: diagnosis and treatment
  • Pulmonary tuberculosis
  • Respiratory examination
  • Respiratory history
  • Wheezy chest

Gastroenterology and hepatology

600+ questions across 40+ topics. It also has 30+ topic notes and 10+ clinical skills guides.

  • Abdominal examination
  • Abdominal history taking
  • Abdominal history taking and symptoms
  • Acute liver failure
  • Cholestatic liver disease
  • Clinical approach to a patient with abdominal pain
  • Clinical approach to a patient with constipation
  • Clinical approach to a patient with GI bleeding
  • Clinical approach to a patient with nausea and vomiting
  • Constipation
  • Digital rectal examination
  • Dysphagia history taking
  • Functional GI tract disorders
  • Gastrointestinal stromal and neuroendocrine tumours
  • GI tract examination
  • Hepatobiliary malignancies
  • Hepatocellular carcinoma: staging and treatment
  • Hernia history taking
  • History taking and symptoms in gastrointestinal disease
  • History taking for an abdominal complaint
  • History taking in gastrointestinal disease
  • History taking in lower GI disease
  • Hydatid liver disease
  • Inflammatory bowel disease
  • Intestinal failure
  • Jaundice history taking
  • Jaundice: bilirubin metabolism and classification
  • Liver cirrhosis
  • Liver function test interpretation
  • Liver transplantation: selection and complications
  • Malabsorption
  • Malnutrition
  • Metabolic liver disorders
  • Metastatic colorectal cancer
  • Non-viral hepatitis
  • Pancreatic exocrine insufficiency
  • Peptic ulcer disease
  • Peptic ulcer: PPI prescribing
  • Stoma examination
  • Stool analysis for parasites
  • Upper GI bleeding: ABCDE management
  • Viral hepatitis: hepatitis B and D
  • Viral hepatitis: hepatitis C

Nephrology

350+ questions across 20+ topics. It also has 20+ topic notes and 5 clinical skills guides.

  • Acute kidney injury: causes and early care
  • Acute kidney injury: recognition, escalation, and recovery
  • Chronic kidney disease: mineral bone disorder and anaemia
  • Chronic kidney disease: staging and complications
  • Clinical approach to a patient with azotaemia
  • Clinical approach to a patient with proteinuria
  • Dialysis and kidney transplant
  • Hyperkalaemia in CKD: treatment and dose review
  • Hyperkalaemia: spurious or true
  • Hypokalaemia and hyperkalaemia
  • Hyponatraemia and hypernatraemia
  • Introduction to kidney disease
  • Male urethral catheterisation
  • Nephrology clinical examination
  • Nephrology history taking and examination
  • Polycystic kidney disease
  • Renal drug safety: nephrotoxicity and dosing
  • Renal examination
  • Renal history
  • Renal tests: GFR and albuminuria
  • Renal tumours
  • Sodium and potassium disorders, RRT, and glomerulonephritis
  • Systemic disease and the kidney
  • Tubulointerstitial nephritis
  • Urinary microscopic examination
  • Urinary tract infection and kidney stones
  • Urological problems and the kidney

Endocrinology and diabetes

550+ questions across 40+ topics. It also has 30+ topic notes and 10+ clinical skills guides.

  • Acromegaly assessment
  • Adrenal insufficiency history
  • Adrenal therapeutics and replacement
  • Adult diabetic ketoacidosis
  • Blood glucose measurement
  • Calcium and bone medicines
  • Clinical approach to a patient with gynaecomastia and hirsutism
  • Cushing syndrome assessment
  • Diabetes and hypothyroidism: dose adjustment
  • Diabetes history taking
  • Diabetes: microvascular and foot complications
  • Diabetic foot examination
  • Diabetic lower limb examination
  • Disorders of calcium metabolism
  • Dynamic endocrine testing
  • Endocrine disorders: pituitary and gonads
  • Endocrine history taking
  • Endocrine history: pituitary and adrenal presentations
  • Gonadal replacement and insulin prescribing
  • History taking in diabetes mellitus
  • Hyperlipidaemia
  • Hyperosmolar states and treatment-related hypoglycaemia
  • Hyperthyroidism
  • Hypothyroidism and thyroid function tests
  • Management of patients with growth disorders
  • Osteoporosis and disorders of bone metabolism
  • Phaeochromocytoma
  • Pituitary adenoma: prolactin and mass effect
  • Pituitary and adrenal disorders
  • Pituitary medicines and water balance
  • Refeeding syndrome: risk and monitoring
  • Thyroid and eye examination
  • Thyroid disorders
  • Thyroid examination
  • Thyroid function test interpretation
  • Thyroid history
  • Thyroid hypofunction
  • Thyroid therapeutics and monitoring
  • Unexplained hypoglycaemia in adults
  • Venous blood gas interpretation

Reproductive and breast

10+ questions across 1 topic. It also has 1 topic note.

  • Breast cancer: diagnosis and staging

Rheumatology

400+ questions across 20+ topics. It also has 20+ topic notes and 6 clinical skills guides.

  • Acute monoarthritis: septic versus crystal arthritis
  • Acute swollen joint: crystals, haemarthrosis, and mimics
  • Autoantibody and inflammatory marker testing
  • Chronic pain syndromes: CRPS, fibromyalgia, and hypermobility
  • Familial Mediterranean fever
  • Focused history in rheumatology
  • GALS examination
  • Gout and pseudogout
  • History taking in rheumatology
  • Inflammatory arthritis, systemic sclerosis, and dermatomyositis
  • Inflammatory myopathies
  • Low back pain: red flags and serious causes
  • Lupus rashes, crystal arthritis, osteoarthritis, and spondyloarthritis
  • Lupus: classification, nephritis, and pregnancy
  • Methotrexate: starting and monitoring
  • Musculoskeletal screening examination
  • Osteoarthritis
  • Raynaud phenomenon and systemic sclerosis
  • Rheumatoid arthritis
  • Rheumatology drugs: NSAIDs, glucocorticoids, and DMARDs
  • Rheumatology examination
  • Rheumatology examination: GALS screen
  • Rheumatology history taking
  • Small-joint symptoms: history and GALS
  • Spondyloarthritis: axial, psoriatic, reactive, and enteropathic
  • Systemic lupus erythematosus: assessment and mimics
  • Systemic sclerosis, myositis, and spondyloarthritis
  • Vasculitis

Haematology and oncology

1,000+ questions across 60+ topics. It also has 50+ topic notes and 10+ clinical skills guides.

  • ABO grouping and blood-bank workflow
  • Anticoagulant and antiplatelet therapy
  • Antiplatelets and anticoagulant therapy
  • Approach to symptom management
  • B12 and folate deficiency
  • Bedside transfusion check: patient identity and a safe start
  • Blood components and complications of blood transfusion
  • Blood components: collection, storage, and use
  • Blood donor assessment and donation
  • Blood film: preparation, staining, and microscopy
  • Bone marrow failure
  • Bone marrow failure syndromes
  • Cancer haematology
  • Cancer in older adults: assessment and treatment choices
  • Cancer pain: drug management
  • Cancer pain: starting a strong opioid
  • Cancer presentation and diagnosis
  • Cancer prevention
  • Cancer screening
  • Coagulation screen interpretation
  • Complete blood picture
  • Crossmatch: sample identity, antibody screen, and compatibility testing
  • Factor V Leiden, antiphospholipid syndrome, and haemolytic anaemia
  • Febrile neutropenia
  • Haematological changes in systemic disease
  • Haematological emergencies: DIC, TTP, and hyperviscosity
  • Haematological examination
  • Haematology history taking
  • Haematology history: social history to closing
  • Haemoglobin assay
  • Haemoglobin disorders
  • Haemoglobin estimation assay
  • Haemoglobinopathies: thalassaemia and sickle cell testing
  • Haemolytic anaemia: acquired causes and investigation
  • Haemophilia: physiology, diagnosis, and prevention
  • Hereditary anaemias: membrane and enzyme defects
  • Iron deficiency anaemia
  • Iron deficiency and microcytic anaemia
  • Leukaemias and lymphomas
  • Lymphadenopathy: assessment and biopsy
  • Lymphadenopathy: focused history, examination, and discussion
  • Lymphomas
  • Management of problems at the end of life
  • Megaloblastic anaemia: B12 and folate deficiency
  • Multiple myeloma: diagnosis and treatment
  • Myeloma and chronic lymphocytic leukaemia: complications
  • Oncological emergencies: hypercalcaemia and acute uraemia
  • Oncology history taking
  • Palliative care history and symptom assessment (ESAS-R)
  • Palliative care: symptom assessment and management
  • Paraproteinaemia and multiple myeloma
  • Preoperative management of sickle cell anaemia
  • Pretransfusion testing
  • Radiotherapy and its toxicity
  • Recruitment criteria of blood donation
  • Red cell antigens: ABO and Rh
  • Serum proteins and paraproteinaemia
  • Sickle cell disease
  • Spinal cord compression
  • Spiritual assessment (FICA)
  • Splenic structure, function, and disorders
  • Stem cell transplant
  • Thalassaemia examination
  • Thalassaemia history
  • Thrombocytopenia: classification, evaluation, and ITP
  • Thrombocytopenia: DIC, TTP, and platelet dysfunction
  • Thrombophilia: causes and testing
  • Transfusion reactions and component modification
  • Von Willebrand disease

Infectious diseases

250+ questions across 10+ topics. It also has 10+ topic notes and 1 clinical skills guide.

  • Allergy and hypersensitivity
  • Autoimmunity
  • Chlamydia: treatment and partner notification
  • Community-based infection
  • Extrapulmonary tuberculosis
  • Fever in returning travellers
  • Fever of unknown origin
  • Genital ulcers and warts
  • HIV outpatient monitoring and antiretroviral therapy
  • HIV: immunopathogenesis and natural history
  • Newly diagnosed HIV: first assessment
  • Syphilis
  • Urethral discharge and urethritis

Geriatrics

100+ questions across 9 topics. It also has 8 topic notes and 6 clinical skills guides.

  • Acute confusion: 4AT screening
  • Assessing older adults: common issues
  • Atypical presentation of illness in older adults
  • Caring for caregivers and an elderly-friendly environment
  • Comprehensive geriatric assessment
  • Older adult nutrition: MNA-SF
  • Older adults: function, risk, and elder abuse
  • Older people in hospital: risks, discharge, and care settings
  • Rehabilitation of older adults

General medicine

100+ questions across 6 topics. It also has 6 topic notes.

  • Chronic disease after discharge
  • Diagnostic uncertainty: tests and explanations
  • Haematology, endocrine, neurology, and renal history and examination
  • Pathophysiology of pain
  • Unexplained fatigue: assessment and first-line tests
  • Unintentional weight loss: causes and work-up

Internal medicine sample questions

These 5 are published internal medicine questions shown exactly as students see them. Open an answer to see why it is right and why every other option is wrong.

Question 1 · Internal medicine, Clinical

An adult with DKA has marked ketonaemia and a low bicarbonate. Which process most directly explains the bicarbonate depletion?

  1. A. Compensatory deep respiration during acidosis
  2. B. Residual insulin limiting ketogenesis
  3. C. Inadequate brain glucose availability
  4. D. Ketone-acid buffering consumes bicarbonate
  5. E. Glucose-related osmotic urinary losses
Show the answer and explanation

Answer: D. Ketone-acid buffering consumes bicarbonate

Ketone acids are buffered at the expense of bicarbonate. Insulin deficiency and counter-regulatory stress drive their production.

Why the other options are wrong

  • A. Compensatory deep respiration during acidosis: Deep breathing is a response to the acidosis rather than its bicarbonate-consuming cause.
  • B. Residual insulin limiting ketogenesis: Residual ketone suppression describes HHS rather than this marked ketotic state.
  • C. Inadequate brain glucose availability: Brain glucose deficiency describes hypoglycaemia rather than ketone-acid generation.
  • E. Glucose-related osmotic urinary losses: Urinary losses contribute to dehydration but do not directly describe buffering of ketone acids.

Key point: Explain low bicarbonate in DKA through buffering of excess ketone acids.

Question 2 · Internal medicine, Clinical

In CKD-MBD, production of FGF23 from osteocytes increases. What does FGF23 do?

  1. A. Stimulates osteoclastic bone resorption
  2. B. Increases conversion of 25(OH)D to 1,25(OH)2D
  3. C. Increases intestinal calcium absorption
  4. D. Promotes renal phosphate excretion
  5. E. Stimulates parathyroid gland hyperplasia
Show the answer and explanation

Answer: D. Promotes renal phosphate excretion

FGF23 production from osteocytes increases and promotes phosphate excretion (with a fall in 1,25(OH)2D), although this is insufficient to prevent the rise in plasma phosphate in CKD-MBD.

Why the other options are wrong

  • A. Stimulates osteoclastic bone resorption: A raised PTH increases osteoclastic bone resorption and bone formation.
  • B. Increases conversion of 25(OH)D to 1,25(OH)2D: Impaired renal function causes decreased conversion of 25(OH)D to 1,25(OH)2D.
  • C. Increases intestinal calcium absorption: Low 1,25(OH)2D causes calcium malabsorption.
  • E. Stimulates parathyroid gland hyperplasia: A raised plasma phosphate and low plasma calcium stimulate the parathyroid glands, leading to hyperplasia.

Key point: FGF23 rises in CKD-MBD and promotes phosphate excretion.

Question 3 · Internal medicine, Clinical

A 34-year-old accountant has had a pressing, band-like headache on both sides of his head on about 8 days a month for a year, worse at deadlines, with no nausea, aura, or night waking. Neurological examination, fundoscopy, and blood pressure are normal. He asks for a CT scan of his head just to be sure. What is the most appropriate response?

  1. A. Refer him to neurology for specialist assessment before discussing the diagnosis
  2. B. Check ESR and CRP first, and scan only if the inflammatory markers are raised
  3. C. Explain tension-type headache and that a scan would not change his management
  4. D. Arrange a CT head scan now, since a normal result is the quickest way to reassure him
  5. E. Arrange an MRI brain instead, since it avoids radiation and shows more detail
Show the answer and explanation

Answer: C. Explain tension-type headache and that a scan would not change his management

A bilateral, pressing headache on 8 days a month without nausea or aura, with a normal examination, is episodic tension-type headache (fewer than 15 days a month, NICE CG150). CG150 says do not refer for neuroimaging solely for reassurance, and recommends a positive diagnosis with an explanation. A test is worth doing only if its result will change management; here a normal CT changes nothing, while a CT head adds about 2 mSv (about a year of natural background, UKHSA 2026) and may show incidental findings that lead to further investigations.

Why the other options are wrong

  • A. Refer him to neurology for specialist assessment before discussing the diagnosis: His history and examination already give a clear primary headache diagnosis; referral delays explanation and treatment without changing management.
  • B. Check ESR and CRP first, and scan only if the inflammatory markers are raised: Inflammatory markers screen for giant cell arteritis, which is very unlikely at 34 years without jaw claudication or scalp tenderness.
  • D. Arrange a CT head scan now, since a normal result is the quickest way to reassure him: NICE advises against neuroimaging solely for reassurance in tension-type headache; a CT adds radiation and may find incidental lesions that need more tests.
  • E. Arrange an MRI brain instead, since it avoids radiation and shows more detail: Avoiding radiation does not make an unneeded scan useful; MRI still finds incidental findings and does not alter the plan for his typical headache.

Key point: Request a test only when its result is likely to change management; for a typical primary headache with a normal examination, give a positive diagnosis and explanation instead of imaging for reassurance.

References

Question 4 · Internal medicine, Clinical

After complete reassessment, a heparin-treated patient has a reliable low 4Ts score and a clear alternative cause of mild thrombocytopenia. Which principle best matches current ASH guidance?

  1. A. Use routine indicated heparin care without an empiric HIT switch
  2. B. Stop heparin and start an appropriate non-heparin anticoagulant while testing
  3. C. Plan contextual reassessment of a confounded natural-anticoagulant result
  4. D. Repeat relevant aPL testing after the required persistence interval
  5. E. Use targeted genetic testing when its result will change a decision
Show the answer and explanation

Answer: A. Use routine indicated heparin care without an empiric HIT switch

A reliable low probability supports avoiding unnecessary HIT testing and an empiric switch. Recalculate if the clinical information or course changes.

Why the other options are wrong

  • B. Stop heparin and start an appropriate non-heparin anticoagulant while testing: This fits high clinical probability, with treatment tailored to risk and organs.
  • C. Plan contextual reassessment of a confounded natural-anticoagulant result: This fits a protein assay question without an urgent HIT pattern.
  • D. Repeat relevant aPL testing after the required persistence interval: This fits an antibody-persistence question.
  • E. Use targeted genetic testing when its result will change a decision: This fits a molecular thrombophilia question.

Key point: Avoid unnecessary HIT testing/treatment with a reliable low 4Ts score.

References

Question 5 · Internal medicine, Clinical

Which drug has a dual benefit in patients who have both SLE and antiphospholipid syndrome?

  1. A. Azathioprine
  2. B. Hydroxychloroquine
  3. C. Aspirin
  4. D. Cyclophosphamide
  5. E. Heparin
Show the answer and explanation

Answer: B. Hydroxychloroquine

Hydroxychloroquine, an antimalarial DMARD, has a dual benefit in patients with both SLE and APL syndrome.

Why the other options are wrong

  • A. Azathioprine: Azathioprine is an immunosuppressive used in SLE.
  • C. Aspirin: Aspirin is used alone, with oral anticoagulants, or with heparin in antiphospholipid syndrome.
  • D. Cyclophosphamide: Cyclophosphamide is an immunosuppressive used in SLE.
  • E. Heparin: Heparin is given with aspirin, usually in pregnant females.

Key point: Hydroxychloroquine has a dual benefit in patients with SLE and APL syndrome.

References

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