NEET-PG 2017 - General Medicine PYQs Practice Questions

Q: Which of the following finding is shown in the chest leads?

Digoxin. ***Digoxin*** - The ECG shows a characteristic **downward sloping ST segment depression** with a "sagging" or "scooped" appearance, often referred to as a **"Salvador Dali mustache"** appearance, which is typical of digoxin effect on the ECG. - This pattern is due to the drug's effect on **myocardial repolarization**, specifically shortening the QT interval and inducing these ST changes, even in the absence of toxicity. *Myocardial ischemia* - Myocardial ischemia typically manifests as **ST segment depression** that is **horizontal** or **downsloping** but usually not with the characteristic "scooped" appearance seen with digoxin. - T-wave inversions may also be present, which are not the primary finding here. *Myocardial injury* - Acute myocardial injury is characterized by **ST segment elevation** (in acute myocardial infarction) or **significant ST depression with T-wave inversions** (in NSTEMI) which differs from the morphology seen in this ECG. - The morphology of the ST segment in myocardial injury is usually more abrupt and not "scooped" like a digoxin effect. *Digoxin toxicity* - While this ECG shows a digoxin effect, **digoxin toxicity** usually presents with **arrhythmias** (e.g., ventricular premature beats, bradycardia, AV blocks) in addition to altered ST-T wave morphology. - The ECG alone, showing only repolarization changes characteristic of digoxin, does not confirm toxicity without clinical correlation or evidence of arrhythmias. [Practice more General Medicine PYQs on OnCourse]

Q: Cannon A waves are seen in the JVP of a patient. ECG shows:

Third degree heart block. ***Third degree heart block*** - **Cannon A waves** in the JVP occur when the right atrium contracts against a closed tricuspid valve, which happens when atrial and ventricular contractions are **dissociated** as seen in **complete heart block**. - In the provided ECG, there is complete dissociation between P waves (atrial activity) and QRS complexes (ventricular activity), with P waves occurring regularly but independently of the QRS complexes, which signifies a **third-degree (complete) heart block**. *First degree heart block* - Characterized by a **prolonged PR interval** (>0.20 seconds) where every P wave is followed by a QRS complex. - There is no dissociation of P waves and QRS complexes, and therefore no cannon A waves due to atrial contraction against a closed tricuspid valve. *Second degree heart block* - Involves some P waves not being followed by a QRS complex, indicating **intermittent conduction failure**. - There can be Wenckebach (Mobitz I) or Mobitz II, both of which involve some degree of P-wave-QRS coupling, usually not leading to constant or prominent cannon A waves. *Mobitz II heart block* - Defined by intermittently **dropped QRS complexes** without progressive PR lengthening, often with a constant PR interval before the drop. - While some dropped beats occur, there is still a clear relationship between the P waves and the conducted QRS complexes, which differs from the continuous and complete AV dissociation seen with cannon A waves in third-degree block. [Practice more General Medicine PYQs on OnCourse]

Q: A patient develops missed beats after thrombolysis for MI. ECG shows:

Mobitz I heart block. ***Mobitz I heart block*** - The ECG shows a **progressive lengthening of the PR interval** before a QRS complex is dropped (missed beat), which is characteristic of Mobitz type I (Wenckebach) heart block. - This type of block is often **benign** and located in the AV node, frequently resolving spontaneously, especially after thrombolysis for an inferior MI. *Mobitz II heart block* - Characterized by **sudden, unexpected dropped QRS complexes** without prior PR interval lengthening. - Mobitz II usually indicates a block below the AV node (infranodal) and is considered more serious, often requiring a pacemaker. *Complete heart block* - In complete (third-degree) heart block, there is **no conduction between the atria and ventricles**, meaning P waves and QRS complexes are completely dissociated. - The ventricular rhythm is typically slow and independent of the atrial rhythm, which is not seen here as some P waves conduct. *Sick sinus syndrome* - Sick sinus syndrome is a **dysfunction of the SA node**, leading to various arrhythmias such as sinus bradycardia, sinus arrest, or sinoatrial block. - While it can cause missed beats, the ECG pattern here specifically points to a problem with AV conduction (PR interval changes and dropped QRS), not primary sinus node dysfunction. [Practice more General Medicine PYQs on OnCourse]

Q: A 12-year-old child with renal tubular acidosis type I is having muscle cramps and weakness. ECG shows all except:

Absent P waves. ***Absent P waves*** - **Hypokalemia (low potassium)**, common in renal tubular acidosis type I, does not typically cause absent P waves. Absent P waves are characteristic of certain **atrial arrhythmias** or severe **hyperkalemia** with sine wave formation. - The image provided clearly shows visible P waves before each QRS complex, indicating **sinus rhythm** and normal atrial depolarization. *T wave inversion with U waves* - **Hypokalemia** can cause characteristic ECG changes including **T wave flattening**, **T wave inversion**, and prominent **U waves**, especially in leads V2-V4. - The provided ECG shows evidence of T wave flattening or inversion and visible U waves, which are consistent with hypokalemia. *ST depression* - **ST depression** can occur in cases of significant **hypokalemia**, particularly when potassium levels are very low. - The ECG shows some subtle **ST segment depression**, especially in leads like V3, which is a recognized finding in hypokalemia. *Heart rate of 75 beats per minute* - To calculate the heart rate, count the number of large squares between two R waves (e.g., in V5, there are approximately 4 large squares). The heart rate is 300 / number of large squares = 300 / 4 = **75 bpm**. - A heart rate of 75 bpm is a **normal sinus rhythm** and is not inconsistent with hypokalemia. [Practice more General Medicine PYQs on OnCourse]

Q: The patient with the following hematological abnormality presents with severe chest pain and difficulty in breathing. All are useful for managing this emergency except:

Packed RBC. ***Packed RBC*** - Transfusing **packed red blood cells** will increase the overall hemoglobin concentration, which can paradoxically increase blood viscosity and worsen vaso-occlusion in sickle cell crisis, especially in the setting of acute chest syndrome where fluid overload is a concern. - This is generally avoided as a first-line treatment for acute chest syndrome in sickle cell anemia unless the patient has severe anemia with a hemoglobin level significantly below their baseline. *Partial exchange transfusion* - **Partial exchange transfusion** is a critical intervention during sickle cell crises with severe complications like acute chest syndrome. - It rapidly reduces the percentage of **sickle hemoglobin (HbS)** and concurrently provides normal red blood cells, improving oxygen-carrying capacity and reducing blood viscosity without significantly increasing total red blood cell mass. *Morphine* - **Morphine** is essential for effective pain management in sickle cell crisis, including the severe chest pain associated with acute chest syndrome. - Adequate pain control helps reduce patient distress and can indirectly prevent worsening of the crisis by reducing stress-induced sympathetic activation. *Hydroxyurea* - **Hydroxyurea** is a long-term disease-modifying therapy for sickle cell anemia, increasing the production of **fetal hemoglobin (HbF)**, which reduces sickling. - While crucial for preventing future crises and complications, it is not an acute treatment for an emergency like acute chest syndrome, as its effects take weeks to months to manifest. [Practice more General Medicine PYQs on OnCourse]

Question 1

Which of the following finding is shown in the chest leads?

Accepted Answer

Digoxin

Answer

Myocardial ischemia

Answer

Myocardial injury

Answer

Digoxin toxicity

Question 2

Cannon A waves are seen in the JVP of a patient. ECG shows:

Accepted Answer

Third degree heart block

Answer

First degree heart block

Answer

Second degree heart block

Answer

Mobitz II heart block

Question 3

A patient develops missed beats after thrombolysis for MI. ECG shows:

Accepted Answer

Mobitz I heart block

Answer

Mobitz II heart block

Answer

Complete heart block

Answer

Sick sinus syndrome

Question 4

A 12-year-old child with renal tubular acidosis type I is having muscle cramps and weakness. ECG shows all except:

Accepted Answer

Absent P waves

Answer

T wave inversion with U waves

Answer

ST depression

Answer

Heart rate of 75 beats per minute

Question 5

The patient with the following hematological abnormality presents with severe chest pain and difficulty in breathing. All are useful for managing this emergency except:

Accepted Answer

Packed RBC

Answer

Partial exchange transfusion

Answer

Morphine

Answer

Hydroxyurea

Question 6

All of the following statements regarding this image are true except:

Accepted Answer

High fiber diet will reduce the incidence of this defect

Answer

Defect occurs usually between tenia coli and the blood vessel entering colonic wall

Answer

They are a result of tractional force

Answer

Most common site for this defect is sigmoid colon

Question 7

A 79-year-old male presented to the emergency department after a facial trauma. The patient had Parkinson's disease and atrial fibrillation and was on treatment with acetylsalicylic acid for AF. The image shows? (Recent NEET Pattern 2016-17)

Accepted Answer

Pneumocephalus

Answer

Hydrocephalus

Answer

Intraventricular bleed

Answer

Subarachnoid hemorrhage

Question 8

Identify the lesion. (Recent NEET Pattern 2016-17)

Accepted Answer

Right supranuclear lesion

Answer

Left supranuclear lesion

Answer

Right infranuclear lesion

Answer

Left infranuclear lesion

Question 9

A 55-year-old diabetic patient develops sudden onset hemiparesis and facial asymmetry. NCCT scan shows:

Accepted Answer

Hyperdense MCA sign

Answer

Cystic encephalomalacia

Answer

Subarachnoid hemorrhage

Answer

Lobar hemorrhage

Question 10

A 35-year-old woman presents with breathlessness at rest. She also complains of a skin lesion on nose which has increased in size for last 6 months. What is the diagnosis?

Accepted Answer

Sarcoidosis

Answer

Phakomatosis

Answer

Pulmonary lymphagiomatosis

Answer

DRESS syndrome

NEET-PG 2017 — General Medicine