NEET-PG 2015 - Internal Medicine Practice Questions

Q: Which one of the following is not an early complication of acute myocardial infarction?

Dressler's syndrome. ***Dressler's syndrome*** - **Dressler's syndrome** (post-myocardial infarction syndrome) is a **late complication** of acute myocardial infarction, typically occurring weeks to months after the event. - It is an **immune-mediated pericarditis**, characterized by chest pain, fever, and pericardial effusion, but is not seen immediately following an MI. *Papillary muscle dysfunction* - **Papillary muscle dysfunction** or rupture can occur as an **early complication** due to ischemia and necrosis of the muscle, leading to **mitral regurgitation** [1]. - This usually manifests within hours to days of the infarct, especially in **inferior MIs** affecting the posterior papillary muscle. *Ventricular septal defect* - A **ventricular septal defect (VSD)** is an **early mechanical complication** resulting from necrosis and rupture of the interventricular septum. - It typically presents within the **first week** after an MI, causing a new **holosystolic murmur** and signs of heart failure. *Pericarditis* - **Early pericarditis** (within a few days of MI) results from inflammation overlying the necrotic myocardial tissue [1]. - It presents with **pleuritic chest pain** that improves with leaning forward and a **pericardial friction rub**, and is distinct from Dressler's syndrome.

Q: Becks triad is seen in

Cardiac tamponade. ***Cardiac tamponade*** - **Beck's triad** is a set of three clinical signs associated with acute cardiac tamponade: **hypotension**, **jugular venous distension (JVD)**, and **muffled heart sounds**. [1] - These signs result from the accumulation of fluid in the pericardial sac, which compresses the heart and impairs its ability to fill. [1] *Constrictive pericarditis* - While it can manifest with JVD and signs of right heart failure, **muffled heart sounds** and acute **hypotension** as part of Beck's triad are not typical for its chronic nature. [2] - It involves a rigid, fibrotic pericardium that restricts diastolic filling, often with a **pericardial knock** rather than muffled sounds. [2] *Restrictive cardiomyopathy* - This condition involves impaired ventricular relaxation and filling, leading to signs of heart failure, including JVD. [3] - However, it does not typically present with the acute, severe **hypotension** or **muffled heart sounds** characteristic of cardiac tamponade. [3] *None of the options* - This option is incorrect as cardiac tamponade is the condition associated with Beck's triad.

Q: A patient with first-degree heart block presents with dizziness. What is the most appropriate management for this patient?

Observation and investigation of other causes. ***Observation and investigation of other causes*** - **First-degree heart block** is usually **asymptomatic** and benign, rarely causing dizziness or other symptoms. - The dizziness experienced by the patient is likely due to another underlying condition and warrants **further investigation** rather than direct intervention for the heart block [2], [3]. *Pacemaker insertion* - **Pacemaker insertion** is reserved for **symptomatic heart blocks** of higher degrees (e.g., Mobitz II or complete heart block) or those with significant hemodynamic compromise [1]. - Given that first-degree heart block is typically asymptomatic, inserting a pacemaker would be an **overtreatment** and unnecessary for this condition alone. *Isoprenaline* - **Isoprenaline** is a **beta-agonist** that increases heart rate and AV conduction, sometimes used in certain bradyarrhythmias. - However, for first-degree heart block, which is generally benign, pharmacologic intervention with agents like **isoprenaline** is not typically indicated and carries risks of adverse effects [2]. *Atropine* - **Atropine** is an anticholinergic drug used to **increase heart rate** by blocking vagal stimulation of the SA and AV nodes. - While it can improve AV conduction, it is not indicated for **asymptomatic first-degree heart block** or when symptoms like dizziness are unlikely to be directly caused by the block itself.

Q: In the context of ventricular tachycardia, what do extra systoles appear as on an electrocardiogram (ECG)?

QRS complex. ***QRS complex*** - Extra systoles, particularly **premature ventricular contractions (PVCs)**, originate in the ventricles and result in a **wide and bizarre QRS complex** on an ECG [2]. - The QRS complex represents **ventricular depolarization**, and in ventricular tachycardia, the *ventricular activity* dominates the ECG tracing [2]. *P wave* - The **P wave** represents **atrial depolarization** and is typically either absent or dissociated from the QRS complex in ventricular tachycardia [1], [2]. - Its presence or absence helps differentiate supraventricular from ventricular arrhythmias. *T wave* - The **T wave** represents **ventricular repolarization**, which typically follows the QRS complex [1]. - While it will be present, it often appears abnormal or discordant in ventricular tachycardia due to the altered ventricular depolarization. *R wave* - The **R wave** is part of the QRS complex, specifically the first positive deflection. - While an R wave is present within the QRS complex of an extrasystole, referring to the entire **QRS complex** is more accurate as it encompasses the complete ventricular depolarization in an abnormal morphology.

Q: Which of the following conditions is a direct indication for initiating dialysis?

Severe hyperkalemia. ### Severe hyperkalemia - **Severe hyperkalemia** (potassium levels typically >6.5 mEq/L or rapidly rising, especially with ECG changes) is an immediate life-threatening indication for dialysis when conservative measures fail or are insufficient [1]. - Dialysis effectively removes **excess potassium** from the blood, preventing fatal cardiac arrhythmias. *Severe metabolic acidosis* - While **severe metabolic acidosis** (pH <7.1-7.2) can be an indication, it is often managed first with bicarbonate administration and is typically not a stand-alone **direct** *emergency* indication for dialysis unless accompanied by other severe features or resistance to medical therapy. - The decision to dialyze for acidosis often depends on the underlying cause, degree of renal failure, and response to initial management [2]. *Fluid overload* - **Fluid overload** is a common complication of kidney failure, but it becomes a *direct* indication for dialysis when it is **refractory to diuretic therapy** and causes life-threatening symptoms such as **pulmonary edema** [2]. - Without such refractory state and immediate danger, fluid overload itself is not always an *immediate* trigger for dialysis compared to severe hyperkalemia. *Acute kidney injury* - **Acute kidney injury** (AKI) is the underlying *condition* that can lead to indications for dialysis, but AKI itself is not a *direct indication* for dialysis. - Dialysis is initiated for the *complications* of AKI, such as refractory hyperkalemia, severe metabolic acidosis, or fluid overload, rather than the diagnosis of AKI alone [2].

Q: What is the primary clinical application of the Rockall score?

Upper GI bleeding. ***Upper GI bleeding*** - The **Rockall score** is a clinical risk assessment tool specifically designed to predict **re-bleeding** and **mortality** in patients admitted with **acute upper gastrointestinal bleeding** [1]. - It uses clinical parameters (age, shock, comorbidities) and endoscopic findings (diagnosis, stigmata of recent hemorrhage) to stratify risk [1]. *Lower GI bleeding* - The Rockall score is **not validated** for assessing risk in **lower gastrointestinal bleeding**, which has different etiologies and clinical courses. - Other scoring systems, like the **Blatchford score** or **Glasgow-Blatchford score**, might be used for initial risk assessment in GI bleeding, but Rockall is specific to upper GI [1]. *Hepatic encephalopathy* - **Hepatic encephalopathy** is a neuropsychiatric complication of liver cirrhosis, for which the Rockall score has **no diagnostic or prognostic utility**. - Its assessment involves grading the severity of neurological symptoms and identifying precipitating factors. *IBD* - Inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, is a chronic inflammatory condition of the GI tract. - The Rockall score is **irrelevant** in the assessment or management of **IBD**, which uses specific disease activity indices.

Q: Most common cause of Addison's Disease in India is:

Tuberculosis. ***Tuberculosis*** - In India, **tuberculosis** is the most common cause of **Addison's disease** due to the high prevalence of TB infections. - Adrenal involvement in TB can lead to gradual destruction of the adrenal cortex, resulting in **adrenal insufficiency**. *Autoimmune* - **Autoimmune adrenalitis** is the leading cause of Addison's disease in developed Western countries. - It involves the destruction of adrenal cortical cells by the body's own immune system, often associated with other autoimmune conditions. *Malignancy* - **Malignancy**, particularly metastatic cancer to the adrenals, can cause adrenal insufficiency but is a less common primary cause of Addison's disease overall. - While possible, it is not the most prevalent cause in India compared to infectious etiologies. *HIV* - **HIV infection** can lead to adrenal dysfunction, but it's typically through opportunistic infections like CMV, cryptococcosis, or direct HIV effects, rather than being the direct cause of widespread adrenal destruction. - It increases the risk of adrenal insufficiency but is not the most common etiology in India for Addison's disease.

Q: Which of the following is not a characteristic of Zieve syndrome?

Chronic pancreatitis. ***Chronic pancreatitis*** - **Zieve syndrome** is an acute, not chronic, condition, and its primary feature is not chronic pancreatic inflammation, though severe alcohol use can cause both. - While **alcohol abuse** is a risk factor for both Zieve syndrome and chronic pancreatitis, **chronic pancreatitis** itself is not considered a characteristic component of Zieve syndrome [1]. *Alcohol abuse* - **Alcohol abuse** is the underlying cause for the development of Zieve syndrome, leading to the characteristic triad of hemolytic anemia, hyperlipidemia, and jaundice. - It triggers the **liver damage** and metabolic disturbances that define the syndrome. *Hemolysis* - **Hemolysis** (destruction of red blood cells) is a key feature of Zieve syndrome, leading to **hemolytic anemia** and jaundice. - It results from increased red blood cell fragility and splenic sequestration exacerbated by altered lipid metabolism. *Hypertriglyceridemia* - **Hypertriglyceridemia** is a hallmark of Zieve syndrome, arising from impaired lipid metabolism secondary to alcohol-induced liver damage. - Elevated **triglyceride levels** contribute to red blood cell membrane abnormalities, thereby promoting hemolysis.

Q: The severity of mitral stenosis can be judged by-

Loud S1. ***Loud S1*** - A **loud S1** in mitral stenosis indicates that the **mitral valve leaflets are still mobile** and able to snap shut forcefully, which is characteristic of early to moderate stenosis [2]. - As mitral stenosis becomes more severe and the valve becomes calcified and rigid, the S1 sound may become diminished or even absent due to reduced leaflet mobility [1]. *Intensity of murmur* - The **intensity (loudness)** of the diastolic murmur in mitral stenosis **does not directly correlate with the severity** of the stenosis. - A loud murmur can be heard with mild stenosis, while a soft murmur in severe stenosis may be due to reduced cardiac output or left atrial pressure. *Duration of murmur* - While a **longer duration of the diastolic murmur** can coincide with more severe mitral stenosis, it is not as reliable a single indicator as other findings. - The duration is influenced by the pressure gradient across the valve and the length of diastole [2]. *Presence of left ventricular S3* - A **left ventricular S3** is typically associated with **left ventricular dysfunction** and volume overload, as seen in conditions like mitral regurgitation or dilated cardiomyopathy [3]. - It is **not a feature of mitral stenosis**, where the primary issue is obstruction to left ventricular filling.

Question 1

Which one of the following is not an early complication of acute myocardial infarction?

Accepted Answer

Dressler's syndrome

Answer

Pericarditis

Answer

Papillary muscle dysfunction

Answer

Ventricular septal defect

Question 2

Becks triad is seen in

Accepted Answer

Cardiac tamponade

Answer

Restrictive cardiomyopathy

Answer

Constrictive pericarditis

Answer

None of the options

Question 3

A patient with first-degree heart block presents with dizziness. What is the most appropriate management for this patient?

Accepted Answer

Observation and investigation of other causes

Answer

Pacemaker insertion

Answer

Isoprenaline

Answer

Atropine

Question 4

In the context of ventricular tachycardia, what do extra systoles appear as on an electrocardiogram (ECG)?

Accepted Answer

QRS complex

Answer

P wave

Answer

T wave

Answer

R wave

Question 5

Which of the following conditions is a direct indication for initiating dialysis?

Accepted Answer

Severe hyperkalemia

Answer

Severe metabolic acidosis

Answer

Fluid overload

Answer

Acute kidney injury

Question 6

What is the primary clinical application of the Rockall score?

Accepted Answer

Upper GI bleeding

Answer

Lower GI bleeding

Answer

Hepatic encephalopathy

Answer

IBD

Question 7

Most common cause of Addison's Disease in India is:

Accepted Answer

Tuberculosis

Answer

Autoimmune

Answer

HIV

Answer

Malignancy

Question 8

What is the recommended regimen for post-exposure prophylaxis for HIV?

Accepted Answer

Tenofovir disoproxil fumarate + Emtricitabine + Dolutegravir for 28 days

Answer

Zidovudine + Lamivudine + Lopinavir/ritonavir for 28 days

Answer

Tenofovir disoproxil fumarate + Emtricitabine + Raltegravir for 28 days

Answer

Single dose Tenofovir + Emtricitabine + Raltegravir

Question 9

Which of the following is not a characteristic of Zieve syndrome?

Accepted Answer

Chronic pancreatitis

Answer

Alcohol abuse

Answer

Hemolysis

Answer

Hypertriglyceridemia

Question 10

The severity of mitral stenosis can be judged by-

Accepted Answer

Loud S1

Answer

Duration of murmur

Answer

Intensity of murmur

Answer

Presence of left ventricular S3

NEET-PG 2015 — Internal Medicine