DHA Internal Medicine Exam 2026: Syllabus, Eligibility, MCQs

A 68-year-old male with no prior cardiac history presents with palpitations. ECG shows an irregularly irregular rhythm with absent P waves, consistent with atrial fibrillation. He has a history of hypertension and diabetes. Using the CHA2 DS2-VASc score, which of the following is the most appropriate next step in management?

A) Aspirin alone
B) No antithrombotic therapy needed
C) Oral anticoagulation
D) Immediate electrical cardioversion without anticoagulation

Correct answer: C) Oral anticoagulation

With hypertension and diabetes as risk factors, this patient's CHA2 DS2-VASc score warrants oral anticoagulation to reduce stroke risk. Aspirin alone is no longer recommended for stroke prevention in atrial fibrillation, and cardioversion without first assessing/managing thromboembolic risk is unsafe in a patient with unclear AF duration.

A 24-year-old male with type 1 diabetes presents with nausea, vomiting, and abdominal pain. Blood glucose is 420 mg/dL, serum bicarbonate is 10 mEq/L, and urine ketones are strongly positive. Which of the following is the most important initial step in management?

A) Immediate IV insulin bolus before any fluids
B) IV isotonic fluid resuscitation before starting insulin
C) Oral rehydration only
D) Withhold potassium replacement until insulin is started

Correct answer: B) IV isotonic fluid resuscitation before starting insulin

In diabetic ketoacidosis, initial fluid resuscitation with isotonic saline is prioritized to correct volume depletion before starting insulin therapy, since insulin can drive potassium intracellularly and worsen hypotension if given before adequate volume repletion. Potassium levels must also be checked and, if low, replaced before or alongside insulin to avoid dangerous hypokalemia.

A 58-year-old woman with stage 4 chronic kidney disease presents with muscle weakness. ECG shows peaked T waves and a widened QRS complex. Serum potassium is 7.2 mEq/L. What is the most appropriate immediate treatment?

A) IV calcium gluconate
B) Oral potassium binder alone
C) Furosemide alone
D) Observation with repeat labs in 4 hours

Correct answer: A) IV calcium gluconate

With ECG changes suggesting severe hyperkalemia, IV calcium gluconate is given first to stabilize the cardiac membrane and reduce arrhythmia risk, before addressing potassium shifting (insulin/glucose, beta-agonists) and elimination (potassium binders, dialysis if needed). Oral binders act too slowly for this acute, ECG-positive presentation.

It covers clinical topics across Cardiovascular, Pulmonary, Gastrointestinal, Infectious Diseases, Hematology, Oncology, Nephrology, Rheumatology, Endocrinology, Neuroscience, Emergency Medicine, and Patient Safety — testing diagnosis, investigation, and management of adult patients.

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Specialist exams like Internal Medicine generally test deeper subject-specific knowledge than the General Practitioner exam, and passing thresholds can vary by specialty. Confirm the exact requirements for your category on your Sheryan eligibility notice.