FMGE 2019 - Internal Medicine PYQs Practice Questions

Q: Which of these conditions is classified as a nephritic syndrome?

Post Infectious Glomerulonephritis. ***Post infectious Glomerulonephritis*** - Characterized by **hematuria, hypertension, and edema**, typically following an infection, such as streptococcal pharyngitis [2]. - Immune-mediated response leads to **decreased GFR** and signs of nephritic syndrome [1][2]. *Focal segmental glomerulosclerosis* - Primarily causes **nephrotic syndrome**, characterized by proteinuria and edema rather than hematuria [2]. - Often associated with **secondary causes** like obesity or HIV, not typically post-infectious. *Membranous Glomerulopathy* - Results in significant **proteinuria** and is classified as a **nephrotic syndrome** rather than a nephritic one [2][3]. - It presents with **edema and hypoalbuminemia**, lacking the hallmark features of hematuria. *Minimal change disease* - Predominantly causes **nephrotic syndrome** with heavy proteinuria and little to no hematuria [2]. - Young children are commonly affected, and it responds well to **corticosteroid therapy** [1]. [Practice more Internal Medicine PYQs on OnCourse]

Q: A 20-year-old male presented with fatigue, weakness, and jaundice. What is the most likely diagnosis?

Acute myeloid leukemia. ***Acute myeloid leukemia*** - Presents with **fatigue** and **weakness** due to bone marrow infiltration and resultant cytopenias, typical in this age group [1]. - Often shows **myeloblasts** on peripheral blood smear, confirming the diagnosis [2]. *Chronic myeloid leukemia* - Usually occurs in **older adults** and characterized by **elevated white blood cell counts** with a predominance of mature neutrophils. - Symptoms like fatigue may arise, but there are distinct **Philadelphia chromosome** findings and typically a **longer symptom duration**. *Acute lymphoblastic leukemia* - More common in **younger children** and often associated with **lymphadenopathy** and **thrombocytopenia**, rather than fatigue alone. - Characteristically shows **lymphoblasts** in the blood, which are not mentioned in this patient's presentation. *Chronic lymphocytic leukemia* - Typically presents in adults over **50 years** and is characterized by **lymphocytosis** and often asymptomatic in early stages. - Fatigue may occur but lacks the acute presentation and findings seen in **acute leukemias**. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 607-608. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 621-622. [Practice more Internal Medicine PYQs on OnCourse]

Q: Hemolytic uraemic syndrome is associated with

E. coli 0157. ***E. coli O157*** - **Hemolytic uremic syndrome (HUS)** is most commonly associated with infection by **Shiga toxin-producing E. coli (STEC)**, particularly serotype O157:H7 [2]. - The Shiga toxin damages the **endothelium** of blood vessels, leading to **thrombotic microangiopathy**, which manifests as **hemolytic anemia**, **thrombocytopenia**, and **acute kidney injury** [1], [2]. *Bartonella henselae* - This bacterium is the causative agent of **cat scratch disease**, characterized by **lymphadenopathy** and sometimes systemic symptoms. - It is not typically associated with hemolytic uremic syndrome. *Malaria* - Malaria is a **parasitic infection** transmitted by mosquitoes, causing **fever**, **chills**, and **anemia** due to red blood cell lysis. - While it can cause anemia, it does not directly lead to the thrombotic microangiopathy of HUS. *Parvovirus B19* - **Parvovirus B19** causes **erythema infectiosum (fifth disease)** in children and can cause **aplastic crisis** in individuals with underlying hemolytic disorders. - It primarily targets erythroid precursors in the bone marrow but is not directly linked to HUS. [Practice more Internal Medicine PYQs on OnCourse]

Q: Which of the following is the earliest finding seen in Diabetic nephropathy?

Microalbuminuria. ***Microalbuminuria*** - **Microalbuminuria** is defined as the excretion of 30-300 mg of albumin in urine per 24 hours and is the **earliest detectable sign** of diabetic nephropathy, preceding overt proteinuria [1], [3]. - Early detection allows for interventions to slow the progression of kidney damage, such as **strict glycemic control** and **blood pressure management** with ACE inhibitors or ARBs [3]. *Hematuria* - **Hematuria** (blood in the urine) is not typically an early or primary finding in diabetic nephropathy [2]. - While it can occur in some kidney diseases, it is more characteristic of conditions like **glomerulonephritis** or **urinary tract infections** [4]. *Exudates* - **Exudates** refer to leakage of fluid, protein, or cells into tissues, often associated with inflammation or injury, and are not a measure of kidney function. - It's possible this term is being confused with **retinal exudates** (hard exudates) which are a finding in diabetic retinopathy, but not diabetic nephropathy. *Macroalbuminuria* - **Macroalbuminuria** (or overt proteinuria) is the excretion of more than 300 mg of albumin per 24 hours, indicating more advanced kidney damage. - It is a **later finding** than microalbuminuria in the progression of diabetic nephropathy, signifying established kidney disease [3]. [Practice more Internal Medicine PYQs on OnCourse]

Q: Which of the following is not true regarding Wolff-Parkinson-White (WPW) syndrome?

Prolonged PR interval. ***Prolonged PR interval*** - In WPW syndrome, the presence of an **accessory pathway (Bundle of Kent)** allows for **pre-excitation** of the ventricles, bypassing the AV node's normal delay [1]. - This results in a **shortened PR interval** (typically < 0.12 seconds), not a prolonged one [1]. *Delta wave is seen on ECG* - The **delta wave** is a characteristic finding in WPW, representing the slurred upstroke of the QRS complex due to early ventricular activation via the accessory pathway [1]. - It indicates **ventricular pre-excitation** and is a key diagnostic feature [1], [2]. *Bundle of Kent connects atria to ventricles* - The **Bundle of Kent** is an anomalous muscle fiber bundle that forms an **accessory pathway** directly connecting the atria to the ventricles [1]. - This pathway bypasses the AV node, leading to the characteristic ECG findings and potential re-entrant arrhythmias. *Pre-excitation occurs via accessory pathway* - **Pre-excitation** is the hallmark of WPW syndrome, where electrical impulses bypass the normal conduction system (AV node) and activate ventricular tissue prematurely via an **accessory pathway** [1]. - This leads to the characteristic short PR interval and delta wave on the ECG [2]. [Practice more Internal Medicine PYQs on OnCourse]

Question 1

Which of these conditions is classified as a nephritic syndrome?

Accepted Answer

Post Infectious Glomerulonephritis

Answer

Minimal Change Disease

Answer

Membranous Glomerulopathy

Answer

Focal Segmental Glomerulosclerosis

Question 2

A 20-year-old male presented with fatigue, weakness, and jaundice. What is the most likely diagnosis?

Accepted Answer

Acute myeloid leukemia

Answer

Acute lymphoblastic leukemia

Answer

Chronic myeloid leukemia

Answer

Chronic lymphocytic leukemia

Question 3

Hemolytic uraemic syndrome is associated with

Accepted Answer

E. coli 0157

Answer

Bartonella henselae

Answer

Malaria

Answer

Parvovirus B19

Question 4

Which of the following is the earliest finding seen in Diabetic nephropathy?

Accepted Answer

Microalbuminuria

Answer

Hematuria

Answer

Exudates

Answer

Macroalbuminuria

Question 5

Which of the following is not true regarding Wolff-Parkinson-White (WPW) syndrome?

Accepted Answer

Prolonged PR interval

Answer

Delta wave is seen on ECG

Answer

Bundle of Kent connects atria to ventricles

Answer

Pre-excitation occurs via accessory pathway

Question 6

An 85-year-old patient was brought to the ER, BP: 180/100, right hemiparesis was seen. What is the next best step in management?

Accepted Answer

NCCT

Answer

Reduce BP

Answer

MRI

Answer

Aspirin 300mg and anticoagulants

Question 7

A farmer with pinpoint pupils, increased secretions and urination. What is the most likely diagnosis?

Accepted Answer

Organophosphate poisoning

Answer

Alcohol poisoning

Answer

Opioid poisoning

Answer

Atropine poisoning

Question 8

All of the following are types of Primary headache except:

Accepted Answer

Temporal arteritis

Answer

Migraine

Answer

Tension

Answer

Cluster

Question 9

A patient is having a continuous tremor and he has tendency to fall. Lesion is most commonly seen in?

Accepted Answer

Substantia Nigra

Answer

Putamen

Answer

Globus pallidus

Answer

Caudate nucleus

Question 10

What is the most likely diagnosis in an individual with normal serum alkaline phosphatase, normal PTH, normal Vitamin D3, and elevated serum calcium?

Accepted Answer

Multiple myeloma

Answer

Nutritional rickets

Answer

Hyperparathyroidism

Answer

Vitamin D intoxication

FMGE 2019 — Internal Medicine