NEET-PG 2019 - Internal Medicine PYQs Practice Questions

Q: Calcitonin levels increased in

Medullary thyroid carcinoma. Medullary thyroid carcinoma - Calcitonin is a hormone produced by the parafollicular C cells of the thyroid gland. - Medullary thyroid carcinoma is a neuroendocrine tumor arising from these C cells, leading to excessive and unregulated calcitonin production. Hyperparathyroidism - This condition involves increased production of parathyroid hormone (PTH), which acts to increase serum calcium levels [2]. - Calcitonin secretion is typically decreased or normal in hyperparathyroidism, as calcitonin works to lower serum calcium. Hypoparathyroidism - This condition is characterized by insufficient production of parathyroid hormone (PTH), leading to low serum calcium levels [1]. - Calcitonin levels are generally unaffected or may even be slightly decreased in response to the low calcium, as its primary role is to lower calcium. Cushing Syndrome - Cushing Syndrome is caused by prolonged exposure to high levels of cortisol, a glucocorticoid. - While cortisol can affect bone metabolism, it does not directly impact calcitonin production or secretion, which is primarily regulated by serum calcium levels and C-cell activity. [Practice more Internal Medicine PYQs on OnCourse]

Q: Which syndrome is associated with posterior inferior cerebellar artery thrombosis?

Wallenberg syndrome. No specific references from the provided list reached the relevance threshold (score >= 7) to be cited in the explanation. The original text remains unchanged. ***Wallenberg syndrome*** - Also known as **lateral medullary syndrome**, it is caused by **thrombosis of the posterior inferior cerebellar artery (PICA)** or its branches. - Symptoms include ipsilateral **ataxia**, **vertigo**, **nystagmus**, dysphagia, and contralateral loss of pain and temperature sensation. *Medial medullary syndrome* - This syndrome results from occlusion of the **anterior spinal artery** and paramedian branches of the **vertebral artery**. - Clinical features include contralateral **hemiparesis**, ipsilateral **tongue deviation**, and loss of position and vibration sensation. *Inferior alternating syndrome* - This is another name for **medial medullary syndrome**, caused by a lesion in the **medulla oblongata**. - It is characterized by ipsilateral cranial nerve signs and contralateral long tract signs, differentiating it from Wallenberg syndrome. *Dejerine syndrome* - Also known as **medial medullary syndrome**, it is linked to occlusion of the **anterior spinal artery**. - Symptoms primarily involve the **pyramidal tract**, **medial lemniscus**, and **hypoglossal nerve**. [Practice more Internal Medicine PYQs on OnCourse]

Q: Which of the following exocrine glandular ducts are not obstructed in cystic fibrosis?

Sweat gland. ***Sweat gland*** - In cystic fibrosis, the **CFTR protein** in sweat glands is defective, leading to **impaired chloride reabsorption** and excessively salty sweat [1]. - This defect causes dysfunctional sweat production but **does not result in obstruction** of the sweat gland ducts, which continue to secrete. *Pancreas* - The **exocrine pancreatic ducts** are frequently obstructed in cystic fibrosis due to the production of **thick, sticky mucus**. - This obstruction leads to maldigestion and **pancreatic insufficiency**, requiring enzyme replacement therapy. *Lung* - **Bronchial ducts** and airways in the lungs are severely affected by the accumulation of **viscous mucus**, leading to chronic obstruction [1]. - This obstruction impairs mucociliary clearance, making patients susceptible to recurrent **pulmonary infections** and progressive lung damage [1], [2]. *None of the options* - This option is incorrect because sweat glands are indeed not obstructed, making option C the appropriate answer. [Practice more Internal Medicine PYQs on OnCourse]

Q: A 25-year-old alcoholic presented with edema, hypertension, ocular disturbance, and changes in mental state. A diagnosis of high output cardiac failure was made with Wet Beri Beri. This condition is due to a deficiency of which vitamin?

Vitamin B1. Vitamin B1 - The constellation of **edema**, **hypertension**, **ocular disturbances**, and **mental status changes** in an **alcoholic** patient with **high-output cardiac failure** (Wet Beri Beri) is a classic presentation of **thiamine (Vitamin B1) deficiency** [2], [3]. - **Thiamine** is crucial for **carbohydrate metabolism** and **neurological function**, and a deficiency can lead to severe cardiovascular and neurological dysfunction, especially in chronic alcoholics due to poor absorption and increased metabolic demand [1], [3]. Vitamin B3 - Deficiency of Vitamin B3 (niacin) causes **pellagra**, characterized by the "4 D's": **dermatitis**, **diarrhea**, **dementia**, and death. - While it can cause psychiatric symptoms (dementia), it does not directly lead to the specific cardiovascular manifestations of high-output cardiac failure as seen in Wet Beri Beri. Vitamin B6 - Deficiency of Vitamin B6 (pyridoxine) can result in **peripheral neuropathy**, **anemia**, and **seizures**. - It is not directly linked to the cardiac and edematous symptoms characteristic of Wet Beri Beri. Vitamin B9 - Deficiency of Vitamin B9 (folate) primarily causes **megaloblastic anemia** and can lead to **neural tube defects** in developing fetuses. - While it can manifest with fatigue and weakness due to anemia, it does not typically present with the acute cardiovascular and neurological syndrome described. [Practice more Internal Medicine PYQs on OnCourse]

Q: What does a decreased FEV1/FVC ratio typically indicate in pulmonary function tests?

Obstructive lung disease. ***Obstructive lung disease*** - A decreased **FEV1/FVC ratio** indicates that the amount of air forcefully exhaled in one second (FEV1) is disproportionately low compared to the total forced vital capacity (FVC) [1]. This is a hallmark of **airflow limitation**, distinguishing obstructive lung diseases. - This pattern suggests a problem with **airway narrowing** or obstruction, making it difficult to exhale air quickly, which is characteristic of conditions like **COPD** (emphysema, chronic bronchitis) or **asthma** [1]. *Normal pulmonary function* - In normal pulmonary function, the **FEV1/FVC ratio** would be within the expected reference range, typically **above 70%** (or 0.7) for adults [1]. - A low ratio explicitly indicates a deviation from normal airflow dynamics, not a state of healthy lung function. *Restrictive lung disease* - **Restrictive lung diseases** are characterized by a **reduced total lung volume** (decreased FVC), but the FEV1/FVC ratio is typically **normal or even increased**. - This is because the airways are generally not obstructed; instead, the problem lies with the lungs' inability to expand fully, leading to a proportional reduction in FEV1 and FVC. *Both obstructive and restrictive lung disease* - While it is possible to have both conditions, a **decreased FEV1/FVC ratio** primarily points to an **obstructive pattern**. - A definitive diagnosis of both would require further interpretation of other PFT parameters such as **total lung capacity (TLC)**, which would be normal or increased in obstruction and reduced in restriction. [Practice more Internal Medicine PYQs on OnCourse]

Question 1

Calcitonin levels increased in

Accepted Answer

Medullary thyroid carcinoma

Answer

Hypoparathyroidism

Answer

Cushing Syndrome

Answer

Hyperparathyroidism

Question 2

Which syndrome is associated with posterior inferior cerebellar artery thrombosis?

Accepted Answer

Wallenberg syndrome

Answer

Medial medullary syndrome

Answer

Inferior alternating syndrome

Answer

Dejerine syndrome

Question 3

Which of the following exocrine glandular ducts are not obstructed in cystic fibrosis?

Accepted Answer

Sweat gland

Answer

Pancreas

Answer

Lung

Answer

None of the options

Question 4

A 25-year-old alcoholic presented with edema, hypertension, ocular disturbance, and changes in mental state. A diagnosis of high output cardiac failure was made with Wet Beri Beri. This condition is due to a deficiency of which vitamin?

Accepted Answer

Vitamin B1

Answer

Vitamin B3

Answer

Vitamin B6

Answer

Vitamin B9

Question 5

What does a decreased FEV1/FVC ratio typically indicate in pulmonary function tests?

Accepted Answer

Obstructive lung disease

Answer

Normal pulmonary function

Answer

Restrictive lung disease

Answer

Both obstructive and restrictive lung disease

Question 6

Identify the cardiac condition represented in the image.

Accepted Answer

Ventricular tachycardia

Answer

Atrial fibrillation

Answer

Atrial flutter

Answer

Supraventricular tachycardia

Question 7

Which type of cardiomyopathy is associated with alcohol abuse?

Accepted Answer

Dilated cardiomyopathy

Answer

Hypertrophic cardiomyopathy

Answer

Pericarditis

Answer

Myocarditis

Question 8

Type of sensation lost on same side of Brown Sequard syndrome?

Accepted Answer

Loss of proprioception

Answer

Loss of pain sensation

Answer

Loss of touch sensation

Answer

Loss of temperature sensation

Question 9

Which of the following statements about deep venous thrombosis (DVT) is incorrect?

Accepted Answer

Mostly bilateral

Answer

Most common clinically presents as pain and tenderness in calf

Answer

Some cases may directly present as pulmonary thromboembolism

Answer

Clinical assessment highly reliable

Question 10

A female patient of 26 years, presents with oral ulcers, photosensitivity and skin malar rash in face sparing the nasolabial folds of both side.

Accepted Answer

SLE

Answer

Sturge weber syndrome

Answer

Dermatitis

Answer

Psoriasis

NEET-PG 2019 — Internal Medicine