FMGE 2025 - Internal Medicine PYQs Practice Questions

Q: A patient presents with breathlessness and is diagnosed with a Pancoast tumor. Which of the following findings is not typically associated with this condition?

Exophthalmos. ***Exophthalmos***- This finding, characterized by the **protrusion of the eyeball**, is typically associated with conditions like **Graves' disease** (hyperthyroidism) or orbital tumors.- It is *not* a component of **Horner's syndrome**, which is the classic neurological manifestation of a Pancoast tumor due to damage to the sympathetic chain.*Anhidrosis*- Pancoast tumors (superior sulcus tumors) often invade the **stellate ganglion** or other parts of the sympathetic chain.- Damage to sympathetic fibers causes reduced or absent sweating on the ipsilateral face and neck, manifesting as **anhidrosis**.*Miosis*- This refers to the **constriction of the pupil** and is a classic sign resulting from the loss of sympathetic input, which normally causes pupillary dilation.- The resulting unopposed action of the parasympathetic system leads to **miosis**.*Ptosis*- Ptosis, or the **drooping of the upper eyelid**, occurs due to paralysis of the **superior tarsal muscle** (Müller's muscle).- This small muscle is innervated by the sympathetic pathway, and its dysfunction results in mild **ptosis**, a core component of Horner's syndrome. [Practice more Internal Medicine PYQs on OnCourse]

Q: A young male presented with weakness in the lower half of the right side of his face, with drooping of the angle of his mouth. He is unable to raise his eyebrows and close his eyes on the right side. Which of the following is the most appropriate diagnosis?

Infranuclear facial palsy on right side. ***Infranuclear facial palsy on right side***- **Infranuclear (peripheral) facial palsy** involves the facial nerve (CN VII) distal to the nucleus, causing paralysis of the entire ipsilateral side of the face.- The inability to move the upper facial muscles (closing the eye, raising the eyebrow) combined with lower face weakness (mouth drooping) on the right side indicates complete paralysis of the **right facial nerve**.*Supranuclear facial palsy on left side*- A **supranuclear (central) lesion** (e.g., stroke) affects the face contralaterally, leading to weakness on the right face, but the upper face (forehead) would be spared [1].- The ability to move the forehead is preserved in supranuclear palsy because the upper facial nucleus receives bilateral cortical input, which contradicts the bilateral/right upper face involvement described here [1].*Infranuclear facial on left side*- This diagnosis would cause complete paralysis (upper and lower face) on the **left side**.- The patient presents with clinical signs of paralysis (drooping mouth, inability to raise eyebrow) primarily on the **right side**, making a left-sided lesion incorrect.*Supranuclear facial on right side*- A **supranuclear lesion** on the right side would cause weakness of the muscles of the **left lower face** (contralateral presentation).- Supranuclear lesions never cause involvement of the upper facial muscles (unable to raise eyebrows) as seen in this patient [1]. [Practice more Internal Medicine PYQs on OnCourse]

Q: A patient presents with the palsy of the face as shown. Which of the following is most likely involved?

7th nerve palsy. ***7th nerve palsy*** - The image shows features of a **lower motor neuron (LMN) lesion** of the **7th cranial (facial) nerve**, affecting both the upper and lower face. Note the inability to wrinkle the left forehead, incomplete eye closure, and drooping of the left corner of the mouth. - This condition, often idiopathic and termed **Bell's palsy**, results in paralysis of all ipsilateral muscles of facial expression, which are innervated by the facial nerve. *3rd nerve palsy* - A **3rd cranial nerve (oculomotor)** palsy would present with **ptosis** (drooping eyelid), a dilated pupil, and the eye positioned "down and out" due to unopposed action of the superior oblique and lateral rectus muscles. - It does not cause paralysis of the lower facial muscles, such as those involved in smiling. *Erb's palsy* - This is an injury to the **upper trunk (C5-C6)** of the **brachial plexus**, typically occurring at birth, which affects the muscles of the shoulder and arm. - It results in the characteristic "**waiter's tip**" posture of the arm and has no effect on the facial muscles. *Orbicularis oculi palsy* - This describes an isolated paralysis of the muscle that closes the eyelids. While this is a component of 7th nerve palsy, it is not the complete diagnosis. - The patient clearly has paralysis of other facial muscles, such as the **frontalis** (forehead) and **zygomaticus** (mouth), indicating a lesion of the main facial nerve trunk, not just a single branch. [Practice more Internal Medicine PYQs on OnCourse]

Q: A patient presents with respiratory difficulty and a history of chronic smoking. Pulmonary function testing shows a decrease in FEV1/FVC ratio. What is the most probable diagnosis?

Chronic Obstructive Pulmonary Disease (COPD). ***Chronic Obstructive Pulmonary Disease (COPD)*** - COPD is the most likely diagnosis given the history of **chronic smoking** and pulmonary function tests showing a **decreased FEV1%**, which is a hallmark of an **obstructive lung disease**. - The pathophysiology involves **bronchiolar obstruction** leading to **air trapping**, which results in an elevated **Residual Volume (RV)** and **Total Lung Capacity (TLC)**, consistent with the provided flowchart. *Pulmonary Fibrosis* - This is a **restrictive lung disease**, characterized by scarring of the lung tissue, which would cause a **decrease**, not an increase, in Total Lung Capacity (TLC). - Spirometry in pulmonary fibrosis typically shows a **normal or increased FEV1/FVC ratio**, as both FEV1 and FVC are reduced proportionally. *Interstitial Lung Disease* - This is a broad category of **restrictive lung diseases**, which includes pulmonary fibrosis. These conditions make the lungs stiff and difficult to expand. - The characteristic PFT finding is a **restrictive pattern** (decreased TLC, FVC, and FEV1) with a normal or high FEV1/FVC ratio, which contradicts the patient's results. *Asthma* - Although asthma is an **obstructive disease** that can cause a low FEV1%, the airflow limitation is typically **reversible** with bronchodilators. - While both can present similarly, the patient's history of **chronic smoking** makes COPD, a progressive and largely irreversible condition, the more probable diagnosis. [Practice more Internal Medicine PYQs on OnCourse]

Q: A young female has episodes of binge eating followed by self-induced vomiting. Which of the following acid- base disturbance is she likely to have?

Metabolic alkalosis. ***Metabolic alkalosis***- Self-induced vomiting results in the significant loss of **gastric hydrochloric acid (HCl)**, leading to a net gain of bicarbonate (HCO3-) in the blood, causing metabolic alkalosis [1, 2].- This condition is often exacerbated by **volume depletion** (due to fluid loss), leading to a state known as "**contraction alkalosis**," where the kidneys attempt to conserve volume even at the expense of excreting bicarbonate [1].*Respiratory acidosis*- This condition is characterized by **hypoventilation** leading to the retention of **carbon dioxide (CO2)** and an increase in carbonic acid, lowering the pH [2].- It is typically seen in conditions compromising respiratory drive or function, such as COPD exacerbations, narcotic overdose, or severe pneumonia.*Respiratory alkalosis*- This disturbance is caused by **hyperventilation**, which results in excessive loss of **carbon dioxide (CO2)**, leading to low PCO2 and elevated pH [3].- While anxiety may be a component of eating disorders, the primary physiologic effect of vomiting is related to acid loss, not sustained hyperventilation causing respiratory alkalosis.*Metabolic acidosis*- This is caused by either the **addition of fixed acids** (e.g., lactic acidosis, diabetic ketoacidosis) or the **loss of bicarbonate** (e.g., severe diarrhea or renal tubular dysfunction) [2].- Vomiting directly causes loss of acid, which is the opposite mechanism needed to induce metabolic acidosis [2]. [Practice more Internal Medicine PYQs on OnCourse]

Question 1

A patient presents with breathlessness and is diagnosed with a Pancoast tumor. Which of the following findings is not typically associated with this condition?

Accepted Answer

Exophthalmos

Answer

Ptosis

Answer

Miosis

Answer

Anhidrosis

Question 2

A young male presented with weakness in the lower half of the right side of his face, with drooping of the angle of his mouth. He is unable to raise his eyebrows and close his eyes on the right side. Which of the following is the most appropriate diagnosis?

Accepted Answer

Infranuclear facial palsy on right side

Answer

Supranuclear facial palsy on left side

Answer

Infranuclear facial on left side

Answer

Supranuclear facial on right side

Question 3

A patient presents with the palsy of the face as shown. Which of the following is most likely involved?

Accepted Answer

7th nerve palsy

Answer

Erb's palsy

Answer

3rd nerve palsy

Answer

Orbicularis oculi palsy

Question 4

A patient presents with respiratory difficulty and a history of chronic smoking. Pulmonary function testing shows a decrease in FEV1/FVC ratio. What is the most probable diagnosis?

Accepted Answer

Chronic Obstructive Pulmonary Disease (COPD)

Answer

Interstitial Lung Disease

Answer

Pulmonary Fibrosis

Answer

Asthma

Question 5

A young female has episodes of binge eating followed by self-induced vomiting. Which of the following acid- base disturbance is she likely to have?

Accepted Answer

Metabolic alkalosis

Answer

Respiratory acidosis

Answer

Metabolic acidosis

Answer

Respiratory alkalosis

Question 6

Which drug is preferred for management of diabetes in a patient with cardiac and renal failure?

Accepted Answer

SGLT2 inhibitors

Answer

Pioglitazone

Answer

Metformin

Answer

Sulfonylureas

Question 7

A TB patient with HIV begins ART and experiences deterioration in health after 2 months. What is the likely cause?

Accepted Answer

Immunological changes in the body

Answer

Development of drug resistance to ART

Answer

Development of drug resistance to TB drugs

Answer

Drug-drug interactions between TB and ART medications

Question 8

A patient presents with acute onset symmetric lower limb flaccid paralysis and absent deep tendon reflexes. Which condition is most likely?

Accepted Answer

Guillain-Barré syndrome

Answer

Multiple sclerosis

Answer

Spinal cord injury

Answer

Amyotrophic lateral sclerosis

Question 9

In a patient with electric burns and stable vital signs, red-colored urine is observed. What is the most likely finding in the patient's blood work?

Accepted Answer

Increased potassium levels

Answer

Decreased hemoglobin levels

Answer

Increased creatinine levels

Answer

RBCs in urine

Question 10

A patient admitted with fever and nuchal rigidity. CSF analysis shows decreased glucose and increased protein and neutrophils. Which is the MOST IMPORTANT antibiotic for initial empirical treatment?

Accepted Answer

Ceftriaxone

Answer

Vancomycin

Answer

Penicillin

Answer

Ampicillin

FMGE 2025 — Internal Medicine