NEET-PG 2022 - Internal Medicine PYQs Practice Questions

Q: Which of the following is NOT typically seen in cerebrospinal fluid (CSF) in tubercular meningitis?

Low opening pressure. ***Low opening pressure*** - While **elevated opening pressure** is common in tubercular meningitis due to inflammation and impaired CSF absorption, **low opening pressure** is not a typical finding. - Low opening pressure can occur with conditions like **CSF leak** or **spinal tap headache**, which are not directly characteristic of tubercular meningitis. *Low sugar* - **Low CSF glucose** (hypoglycorrhachia) is highly characteristic of bacterial and tubercular meningitis, as the bacteria or mycobacteria consume glucose. - The **CSF-to-blood glucose ratio** is typically less than 0.4 in tubercular meningitis. *High protein* - **Elevated CSF protein** is a consistent finding in tubercular meningitis, resulting from inflammation, increased vascular permeability, and breakdown of the blood-brain barrier. - Protein levels often range from **100-500 mg/dL** or even higher. *Lymphocytic Pleocytosis* - **Lymphocytic pleocytosis** (increased lymphocytes in CSF) is a hallmark of tubercular meningitis, although early stages might show a mixed cellular response. - The cell count typically ranges from **100-500 cells/µL**, predominantly lymphocytes. [Practice more Internal Medicine PYQs on OnCourse]

Q: Which one of the following is an autosomal recessive disorder?

Cystic fibrosis. ***Cystic fibrosis*** - **Cystic fibrosis** is caused by mutations in the **CFTR gene**, leading to defective **chloride channel** function. - It is an **autosomal recessive disorder**, meaning an individual must inherit two copies of the mutated gene (one from each parent) to be affected. *Huntington's disease* - **Huntington's disease** is an **autosomal dominant disorder** caused by a mutation in the HTT gene. - Only one copy of the mutated gene is sufficient to cause the disease, resulting in progressive neurodegeneration. *Marfan syndrome* - **Marfan syndrome** is an **autosomal dominant disorder** affecting connective tissue, caused by mutations in the FBN1 gene. - It results in skeletal, ocular, and cardiovascular abnormalities due to defective **fibrillin-1**. *Neurofibromatosis type 1* - **Neurofibromatosis type 1** is an **autosomal dominant disorder** caused by mutations in the NF1 gene. - It is characterized by multiple neurofibromas, café-au-lait macules, and Lisch nodules. [Practice more Internal Medicine PYQs on OnCourse]

Q: Which of the following is not seen in MEN 2B syndrome?

Parathyroid adenoma. ***Parathyroid adenoma*** - **Parathyroid adenomas**, leading to hyperparathyroidism, are characteristic of **MEN 2A syndrome**, not MEN 2B [1]. - While both MEN 2A and 2B involve mutations in the **RET proto-oncogene**, the specific clinical manifestations differ significantly. *Megacolon* - **Megacolon** (due to intestinal ganglioneuromatosis) is a recognized feature of **MEN 2B syndrome**. - This condition involves abnormal nerve ganglion cells in the intestine, leading to motility issues. *Mucosal neuroma* - **Mucosal neuromas** on the tongue, lips, and eyelids are a hallmark clinical sign of **MEN 2B syndrome**. - These benign growths are often one of the earliest and most recognizable features. *Marfanoid habitus* - **Marfanoid habitus**, characterized by a tall, slender build with long limbs and arachnodactyly, is a common physical finding in **MEN 2B syndrome**. - This connective tissue abnormality helps distinguish MEN 2B from other MEN syndromes. [Practice more Internal Medicine PYQs on OnCourse]

Q: A patient presents to you with fever, night sweats, ptosis, and bilateral facial nerve palsy. Investigations showed leukocytosis and bilateral hilar lymphadenopathy. Which of the following is the most likely diagnosis?

Sarcoidosis. ***Sarcoidosis*** - The combination of **fever**, **night sweats**, **bilateral facial nerve palsy**, **ptosis**, and **bilateral hilar lymphadenopathy** is highly suggestive of **neurosarcoidosis** manifesting as Heerfordt's syndrome (uveoparotid fever) [1]. - **Leukocytosis** is a non-specific finding but can be present due to inflammatory processes in sarcoidosis. *Tuberculosis* - While tuberculosis can cause **fever**, **night sweats**, and **hilar lymphadenopathy** [2] [3], it is less likely to present with **bilateral facial nerve palsy** and **ptosis** simultaneously. - Pulmonary tuberculosis often shows specific patterns like **apical infiltrates** or cavitations, rather than solely bilateral hilar lymphadenopathy, especially without other classic symptoms like productive cough. *Lymphoma* - Lymphoma can cause **fever**, **night sweats**, and **lymphadenopathy** (including hilar) [4]. - However, **bilateral facial nerve palsy** and **ptosis** are not typical primary manifestations of lymphoma and would require other evidence of direct mass effect or widespread infiltration. *Hypersensitive pneumonitis* - This condition is characterized by **inflammation of the lung alveoli** and small airways due to repeated exposure to inhaled antigens, leading to symptoms like cough, dyspnea, and fever. - It typically does **not cause neurological symptoms** such as facial nerve palsy or ptosis, nor is it prominently associated with hilar lymphadenopathy. [Practice more Internal Medicine PYQs on OnCourse]

Q: A patient with a history of chronic liver disease presents with abdominal distension, jaundice, and pruritis. Ascitic fluid analysis revealed a neutrophil count >650 per cubic mm. What is the most likely diagnosis?

Spontaneous bacterial peritonitis. ***Spontaneous bacterial peritonitis*** - The combination of **chronic liver disease**, **ascites**, and a significantly elevated ascitic fluid **neutrophil count (>250 cells/mm³ is diagnostic)**, in this case, >650 cells/mm³, is highly indicative of spontaneous bacterial peritonitis (SBP). - SBP is a common and serious complication in patients with **cirrhosis** and ascites, characterized by bacterial infection of ascitic fluid without an obvious source. *Malignant ascites* - While malignant ascites can occur in chronic liver disease (e.g., from hepatocellular carcinoma), the ascitic fluid analysis would typically show **cytology positive for malignant cells** and often a **low neutrophil count** unless secondarily infected. - The primary differentiator here is the very high neutrophil count suggesting an acute inflammatory/infectious process. *Tubercular ascites* - Tubercular ascites might present with ascites and abdominal distension, but the ascitic fluid analysis usually shows a **lymphocytic predominance** (high lymphocyte count) rather than a high neutrophil count. - Diagnosis typically involves **adenosine deaminase (ADA) levels**, acid-fast bacilli smear, or culture of ascitic fluid. *Intestinal obstruction* - Intestinal obstruction primarily causes **abdominal pain, distension, nausea, vomiting**, and constipation, with a clinical picture distinct from SBP. - While it can lead to ascites in rare cases (e.g., from bowel ischemia or perforation), the ascitic fluid would not characteristically show such a high neutrophil count unless there was associated perforation and peritonitis. [Practice more Internal Medicine PYQs on OnCourse]

Question 1

Which of the following is NOT typically seen in cerebrospinal fluid (CSF) in tubercular meningitis?

Accepted Answer

Low opening pressure

Answer

Low sugar

Answer

High protein

Answer

Lymphocytic Pleocytosis

Question 2

Which one of the following is an autosomal recessive disorder?

Accepted Answer

Cystic fibrosis

Answer

Huntington's disease

Answer

Marfan syndrome

Answer

Neurofibromatosis type 1

Question 3

Which of the following is not seen in MEN 2B syndrome?

Accepted Answer

Parathyroid adenoma

Answer

Mucosal neuroma

Answer

Marfanoid habitus

Answer

Megacolon

Question 4

A patient presents to you with fever, night sweats, ptosis, and bilateral facial nerve palsy.    Investigations showed leukocytosis and bilateral hilar lymphadenopathy. Which of the    following is the most likely diagnosis?

Accepted Answer

Sarcoidosis

Answer

Tuberculosis

Answer

Lymphoma

Answer

Hypersensitive pneumonitis

Question 5

A patient with a history of chronic liver disease presents with abdominal distension, jaundice,    and pruritis. Ascitic fluid analysis revealed a neutrophil count >650 per cubic mm. What is the    most likely diagnosis?

Accepted Answer

Spontaneous bacterial peritonitis

Answer

Malignant ascites

Answer

Tubercular ascites

Answer

Intestinal obstruction

Question 6

A patient presents with a unilateral throbbing headache, photophobia, and excessive lacrimation. He also complains of hemifacial pain on the clenching of teeth. On examination, pupillary reaction, light reflex, and accommodation reflex are normal. Which of the following marked nerves is most likely involved in the above scenario?

Accepted Answer

Trigeminal nerve

Answer

Hypoglossal nerve

Answer

Oculomotor nerve

Answer

Facial nerve

Question 7

A patient presents to you with an irregularly irregular pulse of 120/minutes and a pulse deficit    of 20. Which of the following would be the jugular venous pressure (JVP) finding?

Accepted Answer

Absent a wave

Answer

Normal JVP

Answer

Cannon a wave

Answer

Raised JVP with normal waveform

Question 8

A woman presents to you with fever, arthralgia, ulcers, fatigue for the past six months, and    new-onset hematuria. Urine examination reveals RBC casts and proteinuria. What is the likely    diagnosis?

Accepted Answer

Lupus nephritis

Answer

Acute interstitial nephritis

Answer

Poststreptococcal glomerulonephritis

Answer

IgA nephropathy

Question 9

A male patient diagnosed with tuberculosis took complete treatment. Sputum examination was done after the completion of the intensive and the continuation phases. It was found to be negative. What is the status of the patient?

Accepted Answer

Cured

Answer

Treatment completed

Answer

Lost to follow up

Answer

Treatment failed

Question 10

A woman with recurrent diarrhea is prescribed a broad-spectrum antibiotic. Which of the following statements is not true regarding Clostridium difficile infection?

Accepted Answer

IgM assay is used to confirm the diagnosis of Clostridium difficile infection.

Answer

Pseudomembrane is a layer of inflammatory debris

Answer

Oral fidaxomicin is used for treatment

Answer

It is toxin mediated

NEET-PG 2022 — Internal Medicine