NEET-PG 2018 - Internal Medicine PYQs Practice Questions

Q: Cyroglobulinemia is associated with:

Hepatitis C. ***Hepatitis C*** - **Cryoglobulinemia** is most strongly associated with chronic **Hepatitis C virus (HCV)** infection [1]. - HCV infection can lead to the formation of **cryoglobulins**, which are immunoglobulins that precipitate in the cold and can cause systemic vasculitis [1]. *Hepatitis A* - **Hepatitis A** is an acute, self-limiting viral infection that is not typically associated with chronic complications like cryoglobulinemia. - It primarily causes **acute hepatitis** and does not lead to chronic carrier states or immune complex diseases. *Hepatitis B* - While **Hepatitis B virus (HBV)** can be associated with immune complex diseases, such as **polyarteritis nodosa (PAN)** and **glomerulonephritis**, it is less commonly linked to cryoglobulinemia than HCV. - HBV-associated immune complex diseases generally involve different pathogenesis and clinical presentations than HCV-associated cryoglobulinemia. *Hepatitis D* - **Hepatitis D virus (HDV)** infection occurs only in individuals already infected with HBV. - While HDV can worsen the progression of HBV-related liver disease, it is not independently associated with cryoglobulinemia. [Practice more Internal Medicine PYQs on OnCourse]

Q: Calculate the GCS of a 25-year-old head injury patient who is confused, opens their eyes in response to pain, and localizes pain. What is the GCS score?

11. ***11*** - **Eye-opening response**: The patient opens eyes in response to pain, which scores 2 points on the GCS. - **Verbal response**: The patient is confused, which scores 4 points on the GCS. - **Motor response**: The patient localizes pain, which scores 5 points on the GCS. - The total GCS is 2 (eyes) + 4 (verbal) + 5 (motor) = **11**. *6* - A GCS of 6 would imply much lower scores in at least two categories (e.g., eye opening to pain (2), incomprehensible sounds (2), abnormal extension (2)), indicating a more severe coma. - This option incorrectly sums the individual components given in the scenario. *12* - A GCS of 12 would suggest a higher level of consciousness than described (e.g., eyes to speech (3), confused (4), moves to localize pain (5)), or other combinations that do not match the specific patient presentation. - This option overestimates the patient's neurological status based on the given symptoms. *7* - A GCS of 7 also represents a significantly lower level of consciousness than the patient's description. For example, it could be eye opening to pain (2), incomprehensible sounds (2), and withdrawal from pain (3), which is not consistent with the patient's specific responses. - This option significantly underestimates the patient's GCS score. [Practice more Internal Medicine PYQs on OnCourse]

Q: Which condition is associated with congenital adrenal hyperplasia?

Female pseudohermaphroditism. ***Female pseudohermaphroditism*** - In **21-hydroxylase deficiency**, the most common form of CAH, virilization of a female fetus occurs due to excessive **androgen production** [2], [3]. - This leads to ambiguous genitalia in genetically female (XX) infants, presenting as **female pseudohermaphroditism** [2]. *Male pseudohermaphroditism* - This condition occurs when a **genetically male individual (XY)** has external genitalia that are undervirilized or ambiguous. - It is typically caused by inadequate **androgen synthesis** or action, such as in **androgen insensitivity syndrome**, which is not the primary presentation of CAH [2]. *True pseudohermaphroditism* - This term refers to individuals who possess both **ovarian and testicular tissue**, either in separate gonads or as ovotestes [1], [2]. - It is distinct from CAH, where gonadal tissue is uniform (either ovaries or testes), but the external genitalia are ambiguous due to hormonal imbalances [2]. *Sequential pseudohermaphroditism* - This term is not a recognized medical classification for conditions like CAH. - It does not describe a specific developmental anomaly of the reproductive system related to adrenal function. [Practice more Internal Medicine PYQs on OnCourse]

Q: Which drug is used as an adjunct to epinephrine in refractory ventricular fibrillation/ventricular tachycardia during cardiac arrest?

Amiodarone infusion. ***Amiodarone infusion*** - **Amiodarone** is a **Class III antiarrhythmic** drug commonly used in advanced cardiac life support (ACLS) protocols for refractory **ventricular fibrillation (VF)** or **pulseless ventricular tachycardia (VT)** that persists despite defibrillation and epinephrine [1]. - It works by blocking potassium channels, prolonging repolarization and the refractory period, which helps to stabilize the electrical activity of the heart. *Atropine* - **Atropine** is an anticholinergic drug primarily used to treat **symptomatic bradycardia** by increasing heart rate. - It is not indicated for the treatment of **ventricular fibrillation** or **ventricular tachycardia** during cardiac arrest. *High dose vasopressin* - **Vasopressin** was previously included in some ACLS algorithms as an alternative to epinephrine for **vasoconstrictive effects**, but recent guidelines do not support its routine use in cardiac arrest. - While it can cause **vasoconstriction**, there is no evidence that high-dose vasopressin improves outcomes in refractory VF/VT over epinephrine. *Adenosine* - **Adenosine** is an antiarrhythmic drug used to treat **supraventricular tachycardias (SVTs)** by transiently blocking the AV node. - It is not effective for **ventricular fibrillation** or **ventricular tachycardia** and can even be harmful in these rhythms. [Practice more Internal Medicine PYQs on OnCourse]

Q: A boy presented with multiple non suppurative osteomyelitis with sickle cell anaemia. What will be the causative organism?

Salmonella. ***Salmonella*** - **Salmonella species** are a well-known cause of **osteomyelitis** in patients with **sickle cell anemia**, due to factors like gut mucosal damage and functional asplenia. [1] - The unique pathophysiology of sickle cell disease, including areas of bone infarction and compromised reticulendothelial system function, predisposes these patients to **Salmonella infections**. [1] *Staphylococcus aureus* - While **Staphylococcus aureus** is the most common cause of osteomyelitis in the general population, it is less likely to be the causative organism in patients with **sickle cell anemia** compared to Salmonella. - Its presence usually indicates other predisposing factors like trauma or prosthetic devices. *H. influenzae* - **Haemophilus influenzae** was a common cause of osteomyelitis in children before widespread vaccination but is now rare, especially with routine immunizations. - It is not specifically associated with a higher risk in patients with **sickle cell disease** for osteomyelitis compared to other pathogens. *Enterobacter species* - **Enterobacter species** can cause osteomyelitis, particularly in immunocompromised individuals or following surgery, but they are not uniquely associated with **sickle cell anemia** as a primary cause compared to Salmonella. - Their involvement in non-suppurative osteomyelitis in this specific patient population is less common. [Practice more Internal Medicine PYQs on OnCourse]

Question 1

Cyroglobulinemia is associated with:

Accepted Answer

Hepatitis C

Answer

Hepatitis A

Answer

Hepatitis B

Answer

Hepatitis D

Question 2

Calculate the GCS of a 25-year-old head injury patient who is confused, opens their eyes in response to pain, and localizes pain. What is the GCS score?

Accepted Answer

11

Answer

6

Answer

12

Answer

7

Question 3

Which condition is associated with congenital adrenal hyperplasia?

Accepted Answer

Female pseudohermaphroditism

Answer

Male pseudohermaphroditism

Answer

True pseudohermaphroditism

Answer

Sequential pseudohermaphroditism

Question 4

Which drug is used as an adjunct to epinephrine in refractory ventricular fibrillation/ventricular tachycardia during cardiac arrest?

Accepted Answer

Amiodarone infusion

Answer

Atropine

Answer

Adenosine

Answer

High dose vasopressin

Question 5

A boy presented with multiple non suppurative osteomyelitis with sickle cell anaemia. What will be the causative organism?

Accepted Answer

Salmonella

Answer

H. influenzae

Answer

Enterobacter species

Answer

Staphylococcus aureus

Question 6

Patient presenting with cutaneous vasculitis, glomerulonephritis, peripheral neuropathy, Which investigation is to be performed next that will help you diagnose the condition?

Accepted Answer

ANCA

Answer

RA factor

Answer

Hbsag

Answer

MIF

Question 7

Which of the following is a cause of hypokalemic metabolic alkalosis with hypertension?

Accepted Answer

Liddle syndrome

Answer

Bartter syndrome

Answer

Gitelman syndrome

Answer

Renal tubular acidosis

Question 8

Which is not included in AIDS related complex?

Accepted Answer

Ectopic pregnancy

Answer

Recurrent genital candidiasis

Answer

Generalised lymphadenopathy

Answer

Chronic diarrhea

Question 9

TRALI occurs within how many hours of transfusion?

Accepted Answer

6 hours

Answer

48 hours

Answer

72 hours

Answer

12 hours

Question 10

Which one of the following statements about Graves' disease is FALSE?

Accepted Answer

Common in male

Answer

Referred to as toxic diffuse goiter

Answer

Results in hyperthyroidism

Answer

Autoimmune disorder

NEET-PG 2018 — Internal Medicine