FMGE 2019 - Internal Medicine Practice Questions

Q: A 32-year-old lady presents with shoulder tip pain. She is diagnosed with Pancoast tumor and presents with miosis. What is the most likely associated diagnosis?

Horner syndrome. Horner syndrome - The presence of miosis (constricted pupil) in a patient with a Pancoast tumor is a classic sign of Horner syndrome. - Pancoast tumors are apical lung tumors that can invade the sympathetic chain, leading to the triad of ptosis, miosis, and anhidrosis. Upper trunk of brachial plexus injury - While Pancoast tumors can involve the brachial plexus, an injury to the upper trunk (C5-C6) typically causes symptoms like weakness in shoulder abduction and external rotation, and sensory loss over the lateral arm. - It does not directly explain miosis unless the sympathetic chain is also involved, which is characteristic of Horner syndrome. Thoracic outlet syndrome - This syndrome involves compression of the neurovascular structures as they exit the thoracic outlet, often causing pain, paresthesias, and weakness in the arm and hand. - It does not directly account for the symptom of miosis, which points to sympathetic nerve involvement. Aberrant right subclavian artery - An aberrant right subclavian artery is a congenital anomaly where the right subclavian artery arises from the distal aortic arch, often causing dysphagia lusoria or being asymptomatic. - It has no direct association with Pancoast tumors or the development of miosis.

Q: MC cause of atypical pneumonia?

Mycoplasma pneumoniae. ***Mycoplasma pneumoniae*** - *M. pneumoniae* is the most common cause of **atypical pneumonia**, often referred to as **"walking pneumonia"** due to milder symptoms compared to typical bacterial pneumonia. - It lacks a **cell wall**, making it resistant to many common antibiotics like penicillin and cephalosporins. *Klebsiella pneumoniae* - *Klebsiella pneumoniae* typically causes **lobar pneumonia**, particularly in individuals with compromised immune systems or alcoholism. - It is associated with **severe symptoms**, such as thick, "currant jelly" sputum, and often forms dense consolidated infiltrates on chest X-rays. [1] *Hemophilus influenzae* - *Haemophilus influenzae* is a common cause of **bacterial pneumonia**, especially in children and adults with underlying lung disease (e.g., COPD). - It usually presents as **typical pneumonia** with more acute and severe symptoms, rather than the milder, atypical presentation. *Chlamydia* - While *Chlamydia pneumoniae* can cause a form of atypical pneumonia, it is **less common** than *Mycoplasma pneumoniae* as the primary cause. [1] - *Chlamydia* infections can also cause other conditions, such as **urethritis** and **cervicitis**, depending on the species involved.

Q: Which of the following is an Autosomal Dominant disease?

Von Willebrand disease. ***Von Willebrand disease*** - This is an **autosomal dominant** inherited disorder caused by a deficiency or dysfunction of **von Willebrand factor**, crucial for normal hemostasis [1], [2]. - It often presents with **mucocutaneous bleeding** like nosebleeds, easy bruising, and heavy menstrual bleeding [2]. *Wilson's disease* - This is an **autosomal recessive** disorder characterized by defective copper metabolism and accumulation in various organs, most notably the liver and brain. - Clinical features include **hepatic dysfunction**, neurologic symptoms like **tremors**, and **Kayser-Fleischer rings** in the eyes. *Cystic fibrosis* - This is an **autosomal recessive** disorder caused by mutations in the **CFTR gene**, leading to abnormal chloride transport. - It primarily affects the lungs and digestive system, causing **thick mucus production** and recurrent infections. *Friedreich's ataxia* - This is an **autosomal recessive** neurodegenerative disorder typically caused by a **GAA trinucleotide repeat expansion** in the FXN gene. - Key symptoms include progressive **ataxia**, dysarthria, and often heart problems.

Q: Reversible dementia is seen in?

Hypothyroidism. ***Hypothyroidism*** - **Hypothyroidism** can lead to cognitive impairment, including memory loss, slowed thinking, and executive dysfunction, which are reversible with appropriate **thyroid hormone replacement therapy**. - This condition is often characterized by other systemic symptoms like fatigue, weight gain, and cold intolerance, which also improve with treatment. *Pick's disease* - **Pick's disease** is a type of **frontotemporal dementia** caused by progressive degeneration of brain cells, primarily in the frontal and temporal lobes. - It is a **neurodegenerative** disorder, meaning it is progressive and irreversible. *Alzheimer's disease* - **Alzheimer's disease** is the most common cause of dementia, characterized by the accumulation of **amyloid plaques** and **neurofibrillary tangles** in the brain [1]. - It is a **progressive and irreversible neurodegenerative disease** with no cure [2]. *Subacute demyelination of spinal cord* - **Subacute demyelination of the spinal cord** typically refers to conditions like **subacute combined degeneration** due to **vitamin B12 deficiency** [1]. - While this can cause neurological symptoms, including cognitive changes, its primary impact is on the spinal cord and peripheral nerves, and "dementia" in the classic sense is not the primary or defining feature of spinal cord demyelination itself, although B12 deficiency can cause broader cognitive issues [1].

Q: Which of the following is a feature of Vit B12 deficiency anemia?

All of the options. **All of the options** - **Vitamin B12 deficiency anemia** is a type of **megaloblastic anemia** characterized by impaired DNA synthesis, leading to large, immature red blood cells and neutrophils [1]. - The presence of **macro-ovalocytes** and **hypersegmented neutrophils** are classic hematological features seen on a peripheral blood smear [1]. *Macro-ovalocytes* - **Macro-ovalocytes** are abnormally large, oval-shaped red blood cells, which result from arrested maturation due to the deficiency. - While a hallmark of B12 deficiency, it is not the sole identifying feature, as other megaloblastic anemias can also present with them [2]. *Megaloblastic anemia* - **Megaloblastic anemia** is a broad category of anemia characterized by large, immature, and dysfunctional red blood cells, which is the primary classification for B12 deficiency [2]. - While accurate, it doesn't encompass the specific morphological findings seen in the blood smear of B12 deficiency, unlike the other options. *Hypersegmented neutrophils* - **Hypersegmented neutrophils** are neutrophils with five or more nuclear lobes, a characteristic sign of impaired DNA synthesis affecting granulopoiesis [1]. - This feature is highly specific to **megaloblastic anemias**, distinguishing them from other causes of macrocytosis.

Q: A patient after valve replacement will require follow up treatment with

Warfarin. ***Warfarin*** - Patients with **mechanical prosthetic heart valves** require lifelong anticoagulation with **warfarin** to prevent life-threatening thromboembolic complications [1]. - The target **international normalized ratio (INR)** typically ranges from 2.5 to 3.5, depending on the valve type and position. *ACE inhibitors* - **ACE inhibitors** are primarily used for managing **hypertension**, **heart failure**, and **renal protection**, not as routine post-valve replacement prophylaxis [2]. - While they may be used if these co-morbidities exist, they are not a universal requirement after valve surgery. *Beta blockers* - **Beta blockers** are often prescribed to control heart rate, manage **hypertension**, or reduce myocardial oxygen demand, but they are not the primary follow-up treatment for all valve replacement patients. - They do not address the critical need for **anticoagulation** in mechanical valve recipients. *Thiazide* - **Thiazide diuretics** are used to treat **hypertension** and **edema** by increasing salt and water excretion. - They do not play a direct role in preventing **thromboembolism** post-valve replacement and are not generally indicated unless chronic heart failure or hypertension is present.

Q: Which of the following is seen in mitral stenosis?

Diastolic murmur. ***Diastolic murmur*** - **Mitral stenosis** is characterized by a narrowing of the mitral valve, impeding blood flow from the left atrium to the left ventricle during **diastole**. - This turbulent flow during ventricular filling produces a characteristic **diastolic murmur**, often described as a low-pitched, rumbling sound [1], [3]. *None of the options* - This option is incorrect because **mitral stenosis** is indeed associated with a specific heart sound abnormality [1]. - The presence of a **diastolic murmur** is a hallmark physical finding in patients with mitral stenosis [1]. *Systolic murmur* - A **systolic murmur** is produced during ventricular contraction (systole), typically associated with **mitral regurgitation** or **aortic stenosis** [2]. - In **mitral stenosis**, the primary pathology is during diastole, making a systolic murmur less characteristic unless there's concomitant mitral regurgitation. *Loud S2* - A **loud S2** (second heart sound) can be heard in conditions like **pulmonary hypertension** or **systemic hypertension**. - While pulmonary hypertension can be a complication of severe **mitral stenosis** due to elevated left atrial pressure, a loud S2 is not the most direct or specific auscultatory finding for mitral stenosis itself; the distinct diastolic murmur is more characteristic [1].

Q: The contraceptive which is contraindicated in DVT is?

OCP. ***OCP*** - **Oral contraceptive pills (OCPs)**, especially those containing estrogen, increase the risk of **venous thromboembolism (VTE)**, including deep vein thrombosis (DVT). - Estrogen promotes a **hypercoagulable state** by increasing clotting factors and decreasing natural anticoagulants. *Barrier method* - **Barrier methods** like condoms or diaphragms are non-hormonal and act physically to prevent sperm from reaching the egg. - They have **no systemic effects** on coagulation and are safe for individuals with DVT. *Non hormonal IUCD* - **Non-hormonal intrauterine contraceptive devices (IUCDs)**, such as copper IUCDs, prevent conception primarily by causing a local inflammatory reaction in the uterus. - They do not release hormones and therefore **do not affect coagulation** or increase DVT risk. *Billing's method* - The **Billing's ovulation method** (cervical mucus method) is a natural family planning technique based on observing changes in cervical mucus. - It involves no medications or devices and thus has **no impact on DVT risk**.

Question 1

A 32-year-old lady presents with shoulder tip pain. She is diagnosed with Pancoast tumor and presents with miosis. What is the most likely associated diagnosis?

Accepted Answer

Horner syndrome

Answer

Upper trunk of brachial plexus injury

Answer

Thoracic outlet syndrome

Answer

Aberrant right subclavian artery

Question 2

MC cause of atypical pneumonia?

Accepted Answer

Mycoplasma pneumoniae

Answer

Klebsiella pneumoniae

Answer

Hemophilus influenzae

Answer

Chlamydia

Question 3

Following statement are true about tremors except:

Accepted Answer

Essential tremor is an uncommon movement disorder affecting 5%of population

Answer

Normal individuals can have physiologic tremor that manifest as mild high frequency, postural or action tremors.

Answer

PD is characterised by resting tremor

Answer

Tremor consist of alternate contraction of agonist and antagonist muscle in oscillating rhythmic manner

Question 4

Which of the following is an Autosomal Dominant disease?

Accepted Answer

Von Willebrand disease

Answer

Wilson's disease

Answer

Cystic fibrosis

Answer

Friedreich's ataxia

Question 5

Reversible dementia is seen in?

Accepted Answer

Hypothyroidism

Answer

Pick's disease

Answer

Alzheimer's disease

Answer

Subacute demyelination of spinal cord

Question 6

Which of the following is a feature of Vit B12 deficiency anemia?

Accepted Answer

All of the options

Answer

Macro-ovalocytes

Answer

Megaloblastic anemia

Answer

Hypersegmented neutrophils

Question 7

A patient after valve replacement will require follow up treatment with

Accepted Answer

Warfarin

Answer

ACE inhibitors

Answer

Beta blockers

Answer

Thiazide

Question 8

Gynecomastia is seen in all except;

Accepted Answer

Leprosy

Answer

Kidney failure

Answer

Liver failure

Answer

Stilbestrol therapy for prostate cancer

Answer

Teratoma of the testis

Answer

Hormonal

Answer

Idiopathic

Answer

Anorchism and After castration

Answer

Klinefelter's syndrome

Question 9

Which of the following is seen in mitral stenosis?

Accepted Answer

Diastolic murmur

Answer

None of the options

Answer

Systolic murmur

Answer

Loud S2

Question 10

The contraceptive which is contraindicated in DVT is?

Accepted Answer

OCP

Answer

Barrier method

Answer

Non hormonal IUCD

Answer

Billing's method

FMGE 2019 — Internal Medicine