FMGE 2017 - Internal Medicine PYQs Practice Questions

Q: Heberden's arthropathy affects:

Distal interphalangeal joint. ***Distal interphalangeal joint*** - **Heberden's nodes** are pathognomonic bony enlargements that occur on the **distal interphalangeal (DIP) joints** of the fingers [1]. - They are a classic sign of **osteoarthritis**, resulting from cartilage degeneration and new bone formation [1]. *Lumbar spine involvement* - While osteoarthritis can affect the **lumbar spine**, it presents as **back pain** and stiffness, not as nodules on the fingers [1]. - **Heberden's nodes** are specifically associated with peripheral joint involvement, not axial skeleton [1]. *Sacroiliac joint involvement* - **Sacroiliac joint involvement** is characteristic of **spondyloarthropathies** like ankylosing spondylitis, causing inflammatory back pain [1]. - It does not present with bony nodes on the fingers, which are typical of osteoarthritic changes [1]. *Knee joint involvement* - **Knee joint involvement** is common in osteoarthritis, causing pain, swelling, and reduced range of motion [1]. - However, **Heberden's nodes** are distinct from knee symptoms and refer specifically to changes in the DIP joints [1]. [Practice more Internal Medicine PYQs on OnCourse]

Q: Meningococcal meningitis is seen with which of the following complement deficiency?

C5. ***C5*** - Deficiencies in terminal complement components (C5-C9) lead to impaired formation of the **membrane attack complex (MAC)**, which is crucial for lysing Neisseria species [1]. - This significantly increases susceptibility to recurrent infections, particularly by **encapsulated bacteria** like *Neisseria meningitidis*, causing diseases such as meningococcal meningitis [2]. *C4* - C4 deficiency is primarily associated with **lupus-like syndromes** and **vasculitis**, due to impaired clearance of immune complexes. - While it can lead to some increased risk of infection, it is not specifically linked to a marked predisposition to meningococcal disease. *C1q* - C1q deficiency also leads to impaired **immune complex clearance** and is strongly associated with **systemic lupus erythematosus (SLE)**. - Like C4 deficiency, it does not typically present with recurrent meningococcal infections as the primary manifestation. *C2* - C2 deficiency is the **most common complement deficiency** and is associated with **lupus-like syndromes** and increased susceptibility to **pyogenic bacterial infections**. - Though it can lead to some increased infection risk, C2 deficiency is not as strongly or specifically linked to recurrent meningococcal meningitis as deficiencies in the terminal complement pathway [2]. [Practice more Internal Medicine PYQs on OnCourse]

Q: Which of the following is not associated with pulmonary arterial hypertension?

Left ventricular hypertrophy. ***Left ventricular hypertrophy*** - **Left ventricular hypertrophy** is typically caused by conditions that increase the workload on the left ventricle, such as **systemic hypertension** or **aortic stenosis** [1]. - Pulmonary arterial hypertension directly affects the **pulmonary vasculature**, leading to increased pressure in the pulmonary circuit and ultimately right heart strain, not left ventricular hypertrophy. *Cor pulmonale* - **Cor pulmonale** is defined as **right ventricular enlargement** secondary to lung disease or pulmonary vascular disease. - Pulmonary arterial hypertension increases the afterload on the right ventricle, causing it to dilate and hypertrophy, eventually leading to **right heart failure** (cor pulmonale) [2]. *Mitral Stenosis* - **Mitral stenosis** causes an obstruction to blood flow from the left atrium to the left ventricle, leading to increased pressure in the left atrium and pulmonary veins. - This elevated pressure can be transmitted backward into the pulmonary arteries, leading to **pulmonary arterial hypertension** [3]. *Interstitial lung disease* - **Interstitial lung disease** (ILD) can lead to destruction and remodeling of the pulmonary capillaries, increasing pulmonary vascular resistance [2]. - This increased resistance causes the pulmonary arterial pressure to rise, resulting in **pulmonary arterial hypertension**. [Practice more Internal Medicine PYQs on OnCourse]

Q: Which of these is least effective as first-line treatment for dangerous hyperkalemia?

Intravenous sodium bicarbonate. ***Intravenous sodium bicarbonate*** - While it can drive potassium into cells, its effect is often **delayed and unreliable** in acute, dangerous hyperkalemia, especially without concurrent acidosis. - Its efficacy is most pronounced when hyperkalemia is associated with **metabolic acidosis**, which is not always the primary driving factor of dangerous hyperkalemia. *Calcium chloride injection* - This is a **first-line treatment** for dangerous hyperkalemia, as it **stabilizes the cardiac membrane** by antagonizing the direct effects of potassium on myocardial excitability [1]. - It does not lower serum potassium levels but **protects the heart** from life-threatening arrhythmias, buying time for other therapies to reduce potassium [1]. *Beta-2 agonist (Salbutamol)* - **Beta-2 agonists** like salbutamol are effective in shifting potassium **intracellularly**, thereby lowering serum potassium levels. - This effect is mediated by stimulating the **Na+/K+-ATPase pump** on cell membranes. *Dialysis (Hemodialysis)* - **Hemodialysis** is the **most effective and rapid** method for removing excess potassium from the body, especially in cases of severe or refractory hyperkalemia. - It provides definitive treatment by directly **filtering potassium** from the blood, and is often considered when other measures fail or in patients with kidney failure. [Practice more Internal Medicine PYQs on OnCourse]

Q: All of the following syndromes are seen with obesity except:

Carcinoid syndrome. ***Carcinoid syndrome*** - Carcinoid syndrome is caused by **neuroendocrine tumors** that secrete **serotonin** and other vasoactive substances, leading to symptoms like flushing, diarrhea, and bronchospasm [2]. **Obesity is not a primary feature** of this syndrome. - The symptoms are directly related to the **hormonal effects** of the secreted substances, not to metabolic alterations associated with obesity. *Laurence Moon - Biedl syndrome* - This is a **rare genetic disorder** characterized by **obesity**, retinitis pigmentosa, polydactyly, intellectual disability, and hypogonadism [1]. - Obesity is a **consistent and prominent feature** of this syndrome, often present from childhood. *Cohen syndrome* - Cohen syndrome is a rare genetic disorder characterized by **obesity** (especially truncal obesity), intellectual disability, microcephaly, characteristic facial features, and hypotonia. - While not as universally severe as in some other syndromes, **obesity is a common clinical feature** of Cohen syndrome. *Prader - Willi syndrome* - Prader-Willi syndrome is a genetic disorder caused by a deletion on chromosome 15, leading to **insatiable hunger (hyperphagia)** and chronic overeating, which results in **severe obesity** [1]. - **Obesity is a cardinal feature** of this syndrome, developing in early childhood due to hypothalamic dysfunction affecting appetite control. [Practice more Internal Medicine PYQs on OnCourse]

Question 1

Heberden's arthropathy affects:

Accepted Answer

Distal interphalangeal joint

Answer

Lumbar spine involvement

Answer

Sacroiliac joint involvement

Answer

Knee joint involvement

Question 2

Meningococcal meningitis is seen with which of the following complement deficiency?

Accepted Answer

C5

Answer

C4

Answer

C1q

Answer

C2

Question 3

Which of the following is not associated with pulmonary arterial hypertension?

Accepted Answer

Left ventricular hypertrophy

Answer

Cor - pulmonale

Answer

Mitral Stenosis

Answer

Interstitial lung disease

Question 4

Which of these is least effective as first-line treatment for dangerous hyperkalemia?

Accepted Answer

Intravenous sodium bicarbonate

Answer

Calcium chloride injection

Answer

Beta-2 agonist (Salbutamol)

Answer

Dialysis (Hemodialysis)

Question 5

All of the following syndromes are seen with obesity except:

Accepted Answer

Carcinoid syndrome

Answer

Laurence Moon - Biedl syndrome

Answer

Cohen syndrome

Answer

Prader - Willi syndrome

Question 6

Tropical pulmonary eosinophilia is most characteristically seen due to which of the following infections?

Accepted Answer

Filaria

Answer

Roundworm

Answer

Trichinella

Answer

Ancylostoma

Question 7

Which of the following is true about carcinoid tumor?

Accepted Answer

Can occur throughout the gastrointestinal tract

Answer

Presentation is hypotension and diaphoresis

Answer

Intestinal carcinoids are of high malignant potential

Answer

Best diagnosed by elevated urinary vanillymandelic acid levels

Question 8

Fatty liver with hepatomegaly is seen in:

Accepted Answer

Metabolic syndrome

Answer

Marasmus

Answer

Nutmeg liver

Answer

Wilson disease

Question 9

Painless burn in hand is seen in:

Accepted Answer

Syringomyelia

Answer

SLE

Answer

Mononeuritis multiplex

Answer

Diabetes mellitus

Question 10

Which type of anemia is seen in patients of rheumatoid arthritis?

Accepted Answer

Normocytic and normochromic anemia

Answer

Normocytic and hypochromic anemia

Answer

Sideroblastic anemia

Answer

Macrocytic anemia

FMGE 2017 — Internal Medicine