Original EMREE questions on internal medicine, with explanations.
Short answer: 10 original multiple-choice practice questions on internal medicine for EMREE, the Emirates Medical Residency Entrance Examination, each with the correct answer and a full explanation. The blueprint gives this subject 20 percent of the exam. They are original and are not real exam items.
About these questions
Every question here is original. Meddex wrote it for exam preparation. None is a real, recalled or leaked exam item, and none comes from DHA, Prometric, UAE University or the NIHS.
Meddex is independent and is not affiliated with DHA, Prometric, UAE University or the NIHS.
Clinical review of the question bank is not complete yet. Treat the explanations as study aids and check official guidance before you rely on a fact.
This is a sample, not the whole bank, and doing well on it does not predict an exam result.
What internal medicine covers
Cardiology, respiratory, gastroenterology, endocrinology, renal, haematology, infection, rheumatology and neurology.
Internal medicine has the largest share. Expect the most likely diagnosis, the best next investigation or the safest next treatment, usually with several plausible options, so read every number in the stem.
Where it fits in the exam
The organiser's EMREE blueprint (November 2025 edition) gives Internal Medicine 20 percent of the exam, which is about 24 of 120 questions. It says the distribution may differ by up to 5 percent in each category. These weights are official, and the question counts are our arithmetic.
The organiser does not state how many answer options its questions have or whether each has one best answer. Meddex practice items use four options with one best answer, as a practice format.
How to use these questions
Decide your answer before you press Show answer. Then read the reason for every option, including the ones you rejected. Note the idea you missed and come back to it in a few days.
Practice questions
Question 1
Internal MedicineMedium
A 70 kg man has been confused for 3 days with poor oral intake. His serum sodium is 160 mmol/L. Assume total body water is 60 percent of body weight and the target sodium is 140 mmol/L. What is his approximate free water deficit?
AOption A: About 3 L
BOption B: About 6 L
COption C: About 8 L
DOption D: About 4 L
Show answer for question 1
Correct answer: B. About 6 L
Free water deficit = total body water x (current sodium / target sodium - 1). Total body water = 0.6 x 70 = 42 L. Deficit = 42 x (160 / 140 - 1) = 42 x 0.143 = 6 L. Because the hypernatraemia has developed over days, the deficit should be replaced slowly, aiming to lower sodium by no more than about 10 mmol/L in 24 hours, using oral or enteral water or hypotonic intravenous fluid, with ongoing losses added.
Why A is wrong. This halves the result and would under-replace the deficit.
Why C is wrong. This overestimates the deficit and would risk correcting too fast.
Why D is wrong. This uses 40 percent of body weight as total body water, which is too low for this man.
Topic: Renal: free water deficit in hypernatraemia. Reference: Adrogue HJ, Madias NE. Hypernatremia. New England Journal of Medicine 2000
Question 2
Internal MedicineMedium
A 66-year-old woman with breast cancer and known bone metastases has 3 weeks of worsening thoracic back pain that is worse at night and on lying flat. She has no weakness, sensory change or bladder or bowel symptoms, and her neurological examination is normal. What is the most appropriate management?
AOption A: Plain radiograph of the spine and review in 4 weeks
BOption B: A bone scan at the next routine oncology clinic
COption C: MRI of the whole spine within 1 week, with analgesia and advice to report any new neurological symptom at once
DOption D: Immediate dexamethasone 16 mg and emergency MRI within 24 hours, as for confirmed cord compression
Show answer for question 2
Correct answer: C. MRI of the whole spine within 1 week, with analgesia and advice to report any new neurological symptom at once
Progressive spinal pain in a patient with known cancer raises suspicion of spinal metastases. Without neurological symptoms or signs this is not treated as established cord compression, so urgent MRI of the whole spine within about a week is arranged, with analgesia and early oncology involvement. She is told to report any new weakness, sensory loss or bladder or bowel disturbance immediately, because that would turn the pathway into an emergency with dexamethasone 16 mg and MRI within 24 hours. Plain films and bone scans are insensitive and do not show cord compromise.
Why A is wrong. A radiograph is insensitive for early metastases and a 4-week delay is unsafe.
Why B is wrong. A routine bone scan does not show the spinal canal and would delay assessment.
Why D is wrong. Emergency steroid and imaging are for neurological symptoms or signs, which she does not have.
Topic: Oncology: suspected spinal metastasis without neurological signs. Reference: NICE NG234 Spinal metastases and metastatic spinal cord compression
Question 3
Internal MedicineMedium
A 44-year-old woman who smokes 15 cigarettes a day has newly diagnosed Graves disease with mild active orbitopathy (lid retraction, gritty eyes and mild periorbital oedema). She prefers radioiodine to antithyroid drugs. Which is the most appropriate plan?
AOption A: Radioiodine with low-dose oral prednisolone cover and advice to stop smoking
BOption B: Radioiodine alone, because mild orbitopathy is not affected by it
COption C: Orbital radiotherapy first, to protect the eyes before radioiodine
DOption D: Radioiodine followed by high-dose intravenous methylprednisolone in every case
Show answer for question 3
Correct answer: A. Radioiodine with low-dose oral prednisolone cover and advice to stop smoking
Radioiodine can worsen Graves orbitopathy, and smoking is the strongest modifiable risk factor. When radioiodine is chosen in a patient with active orbitopathy, or with risk factors such as smoking, a short course of low-dose oral glucocorticoid cover is recommended, together with firm advice to stop smoking and prompt correction of any hypothyroidism afterwards. High-dose intravenous steroids are reserved for moderate-to-severe active disease, and orbital radiotherapy is not a routine protective step.
Why B is wrong. Radioiodine is a recognised trigger for worsening of orbitopathy, especially in smokers with active eye disease.
Why C is wrong. Orbital radiotherapy is a treatment for active moderate-to-severe disease and does not protect against radioiodine effects.
Why D is wrong. High-dose intravenous methylprednisolone is for moderate-to-severe active orbitopathy, not routine cover for mild disease.
Topic: Endocrinology: Graves disease with orbitopathy and radioiodine. Reference: The 2021 European Group on Graves Orbitopathy (EUGOGO) clinical practice guidelines for the medical management of Graves orbitopathy
Question 4
Internal MedicineMedium
A 48-year-old man is homozygous for the HFE C282Y variant. Ferritin is 1,350 micrograms/L and transferrin saturation is 82 percent. He has fatigue and arthralgia of the second and third metacarpophalangeal joints, and no clinical evidence of cirrhosis. Which treatment is most appropriate?
AOption A: A low-iron diet alone, without venesection
BOption B: Referral for liver transplantation assessment
COption C: Oral iron chelation with deferasirox as first-line treatment
DOption D: Regular venesection until ferritin is below about 50 micrograms/L, then maintenance venesection
Show answer for question 4
Correct answer: D. Regular venesection until ferritin is below about 50 micrograms/L, then maintenance venesection
Venesection is the standard treatment for iron-loaded C282Y homozygotes. During induction blood is removed regularly, usually weekly or fortnightly as tolerated, until ferritin is below about 50 micrograms/L, and maintenance venesection then keeps ferritin below about 100 micrograms/L. Chelation is reserved for patients who cannot tolerate venesection, diet alone does not remove stored iron, and transplantation is considered for decompensated cirrhosis. Because ferritin is above 1,000 micrograms/L, fibrosis should also be staged non-invasively.
Why A is wrong. Dietary measures do not remove the iron already stored and are not a substitute for venesection.
Why B is wrong. Transplant assessment is for decompensated cirrhosis, which this man does not have.
Why C is wrong. Chelation is a second-line option for patients who cannot have venesection.
Topic: Hepatology: treatment of C282Y homozygous haemochromatosis. Reference: EASL Clinical Practice Guidelines on haemochromatosis (2022)
Question 5
Internal MedicineMedium
A 46-year-old man has biochemically confirmed acromegaly. MRI shows a 14 mm intrasellar pituitary macroadenoma with no cavernous sinus invasion and no contact with the optic chiasm, and his visual fields are full. He is fit for surgery. Which is the most appropriate first-line treatment?
AOption A: Conventional pituitary radiotherapy as primary treatment
BOption B: Pegvisomant as the first treatment
COption C: Cabergoline alone, with MRI repeated after 5 years
DOption D: Transsphenoidal pituitary surgery
Show answer for question 5
Correct answer: D. Transsphenoidal pituitary surgery
Surgical removal of the adenoma by an experienced pituitary neurosurgeon is the first-line treatment for most patients with acromegaly, and is especially suitable for a resectable adenoma without extensive invasion, because it can give rapid biochemical control and relieve any mass effect. Medical therapy (somatostatin analogues, pegvisomant, cabergoline) is used when surgery is not curative, is declined or is not feasible. Radiotherapy acts slowly and is kept for residual or recurrent tumour.
Why A is wrong. Radiotherapy takes years to work and is reserved for tumour that remains after surgery.
Why B is wrong. Pegvisomant is a later medical option when surgery and somatostatin analogues do not control the disease.
Why C is wrong. Cabergoline is weakly effective in acromegaly, and leaving a growing macroadenoma without definitive treatment risks progression.
Topic: Endocrinology: first-line treatment of acromegaly. Reference: Acromegaly: An Endocrine Society Clinical Practice Guideline (Katznelson et al., 2014)
Question 6
Internal MedicineEasy
A 35-year-old farm worker is brought in drowsy after spraying pesticide without protection. He is vomiting, sweating and salivating, with pinpoint pupils, wheeze, a heart rate of 48 beats per minute and muscle fasciculations. Which is the most appropriate immediate treatment?
AOption A: Physostigmine to reverse the muscarinic effects
BOption B: Intravenous neostigmine
COption C: Activated charcoal followed by observation alone
DOption D: Atropine titrated to dry the chest secretions, after airway support and removal of contaminated clothing
Show answer for question 6
Correct answer: D. Atropine titrated to dry the chest secretions, after airway support and removal of contaminated clothing
The picture of cholinergic excess (salivation, sweating, miosis, bradycardia, bronchorrhoea and fasciculations) after pesticide exposure is organophosphate poisoning, from irreversible inhibition of acetylcholinesterase. Immediate care is airway and oxygen, removal of contaminated clothing and washing the skin, and atropine in repeated doubling doses until the chest is clear and the heart rate and blood pressure are adequate. Oximes such as pralidoxime may be added, and benzodiazepines are given for seizures. Neostigmine and physostigmine are anticholinesterases that would worsen cholinergic toxicity, and charcoal alone does not treat the life-threatening effects.
Why A is wrong. Physostigmine is also an anticholinesterase and would worsen the poisoning.
Why B is wrong. Neostigmine inhibits acetylcholinesterase and would add to the cholinergic crisis.
Why C is wrong. Charcoal may be considered after stabilisation, but it does not treat bronchorrhoea and bradycardia.
A 26-year-old woman with steroid-dependent ileocolonic Crohn disease is to start azathioprine. Before the first dose, which test is most important to reduce the risk of severe myelosuppression?
AOption A: Interferon-gamma release assay
BOption B: Faecal calprotectin
COption C: G6PD enzyme level
DOption D: TPMT testing
Show answer for question 7
Correct answer: D. TPMT testing
Azathioprine and mercaptopurine are metabolised by TPMT, and patients with low or absent activity (about 0.3 percent homozygous) can develop life-threatening myelosuppression on standard doses. TPMT status is checked before treatment, with NUDT15 testing useful in some populations, and the dose is reduced or the drug avoided. Full blood count and liver tests are monitored regularly.
Why A is wrong. Incorrect: It screens for latent tuberculosis before biologic therapy and does not predict thiopurine toxicity.
Why B is wrong. Incorrect: This monitors intestinal inflammation and does not predict drug toxicity.
Why C is wrong. Incorrect: G6PD deficiency matters for drugs such as dapsone and primaquine, not azathioprine.
Topic: Gastroenterology: thiopurine pharmacogenetics in Crohn disease. Reference: British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults (2019); ECCO Guidelines on Therapeutics in Crohn's Disease: Medical Treatment (2020)
Question 8
Internal MedicineMedium
A 52-year-old man with a duodenal ulcer had Helicobacter pylori confirmed by stool antigen and completed 14 days of bismuth quadruple therapy 5 days ago. He remains on omeprazole 20 mg daily for ulcer healing and asks whether he needs further testing. Which is the most appropriate advice?
AOption A: Test for cure 4 weeks or more after antibiotics, with the PPI stopped for 2 weeks beforehand
BOption B: No test is needed, because his symptoms have settled and the ulcer is healing on treatment
COption C: Check H. pylori serology 6 weeks after treatment, once antibody titres have fallen
DOption D: Perform a urea breath test next week, and continue omeprazole to protect the ulcer in the meantime
Show answer for question 8
Correct answer: A. Test for cure 4 weeks or more after antibiotics, with the PPI stopped for 2 weeks beforehand
Non-invasive tests of cure (urea breath test or monoclonal stool antigen) are done at least 4 weeks after antibiotics are completed and after PPIs have been stopped for at least 2 weeks, because both suppress bacterial load and cause false negatives. Serology is unsuitable. If eradication fails, a second-line regimen is chosen to avoid repeating the same antibiotics.
Why B is wrong. Incorrect: Symptom resolution does not prove eradication, and confirmation is advised after treatment, especially with ulcer disease.
Why C is wrong. Incorrect: Antibodies persist for months after successful eradication, so serology cannot confirm cure.
Why D is wrong. Incorrect: Testing so soon after antibiotics and during a PPI course makes a false-negative result likely.
Topic: Gastroenterology: confirming Helicobacter pylori eradication. Reference: ACG Clinical Guideline: Treatment of Helicobacter pylori Infection (2024); Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut 2022
Question 9
Internal MedicineMedium
A 52-year-old man had a first pulmonary embolism 3 months ago with no provoking factor (no surgery, immobility, cancer or hormone use). He is well on apixaban, has no history of bleeding, and his renal function and blood count are normal. He asks whether he can stop the tablets. Which is the most appropriate advice?
AOption A: Continue anticoagulation beyond 3 months, reviewing bleeding risk at least yearly
BOption B: Stop apixaban now, because 3 months is a full course for an event of this kind
COption C: Insert a permanent inferior vena cava filter and then stop the drug
DOption D: Test for inherited thrombophilia and stop if the results are normal
Show answer for question 9
Correct answer: A. Continue anticoagulation beyond 3 months, reviewing bleeding risk at least yearly
Three months of treatment is enough when a major transient risk factor caused the event. After a first unprovoked pulmonary embolism, the risk of recurrence after stopping is substantial, so extended anticoagulation is offered when the bleeding risk is acceptable, with regular review of the balance of benefit and harm. Thrombophilia testing does not reliably predict recurrence and is not routine. A filter is reserved for patients who cannot be anticoagulated.
Why B is wrong. A 3-month stop is for events with a major transient provoking factor, which he does not have.
Why C is wrong. A filter does not prevent clot formation and is for patients who cannot take anticoagulants.
Why D is wrong. Thrombophilia results do not reliably predict recurrence, so they should not decide whether to stop.
Topic: Respiratory: duration of anticoagulation after unprovoked pulmonary embolism. Reference: ESC Guidelines for the diagnosis and management of acute pulmonary embolism (2019); NICE NG158 Venous thromboembolic diseases: diagnosis, management and thrombophilia testing
Question 10
Internal MedicineMedium
A 44-year-old woman has biopsy-proven sarcoidosis (non-caseating granulomas). Over 8 months her breathlessness has increased to MRC grade 3, and her FVC has fallen from 3.4 L to 2.7 L over 6 months with reduced gas transfer. Chest radiography shows widespread upper-zone infiltrates and hilar nodes. Her calcium is normal and she has no eye, heart or skin involvement. Which is the most appropriate treatment?
AOption A: Further observation alone, with a repeat chest radiograph and spirometry in 12 months
BOption B: An oral corticosteroid with a planned dose reduction and specialist review
COption C: Inhaled budesonide as the only treatment for the lung disease
DOption D: Antituberculous therapy for 6 months
Show answer for question 10
Correct answer: B. An oral corticosteroid with a planned dose reduction and specialist review
Many patients with pulmonary sarcoidosis need no treatment, but oral corticosteroids are offered when symptoms are significant, lung function is falling or the disease is progressing. The dose is reduced gradually under specialist review, and a steroid-sparing drug such as methotrexate is added if long-term treatment is needed. Observation suits asymptomatic disease with stable lung function. Inhaled corticosteroids do not replace oral treatment for progressive parenchymal disease, and sarcoidosis is not treated with antituberculous drugs.
Why A is wrong. Observation is for stable, minimally symptomatic disease, and delay risks irreversible fibrosis.
Why C is wrong. Inhaled steroid is not enough for progressive parenchymal disease.
Why D is wrong. Granulomas here are non-caseating and the disease is not an infection, so antituberculous drugs have no role.
Topic: Respiratory: progressive pulmonary sarcoidosis. Reference: BTS Clinical Statement on Pulmonary Sarcoidosis; ERS clinical practice guidelines on treatment of sarcoidosis
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Frequently asked questions
The blueprint gives Internal Medicine 20 percent of the exam, about 24 of 120 questions, and says it may differ by up to 5 percent. It is the organiser's own figure from the November 2025 blueprint.
No. They are original practice questions written by Meddex for exam preparation. The organiser publishes a blueprint, not sample questions, and a confidentiality agreement covers the real exam, so we do not use or claim real or recalled items.
The Meddex app has the full bank, which you can practise by topic with a free account. These pages are a short sample, and the questions on them do not change.
No. Each question has a Show answer button. The answer, the explanation and the reason each wrong option is wrong are part of the page text, so they are there when you press it.