NEET-PG 2024 - Internal Medicine PYQs Practice Questions

Q: Match the following ECG findings (1-4) with their corresponding arrhythmias (A-D): 1. Sawtooth pattern in leads II, III, aVF with regular ventricular response 2. Irregularly irregular rhythm with absent P waves 3. Narrow QRS tachycardia with abrupt onset/termination 4. Wide QRS tachycardia with AV dissociation A. Atrial fibrillation B. PSVT (Paroxysmal Supraventricular Tachycardia) C. Atrial flutter D. Ventricular tachycardia What is the correct matching?

A-2, B-3, C-1, D-4. The correct matching is **A-2, B-3, C-1, D-4**: ***C-1: Atrial flutter - Sawtooth pattern*** - Atrial flutter is characterized by a **sawtooth pattern** of flutter waves, particularly prominent in leads II, III, and aVF - Represents rapid, organized atrial depolarization at 250-350 bpm - Regular ventricular response due to **AV block** (commonly 2:1 or 4:1) - The sawtooth pattern is the pathognomonic feature ***A-2: Atrial fibrillation - Irregularly irregular rhythm*** - Identified by an **irregularly irregular rhythm** with absent distinct P waves - Replaced by chaotic fibrillatory waves showing disorganized atrial activity - Ventricular rate is rapid and unpredictable - No organized atrial pattern unlike the regular flutter waves ***B-3: PSVT - Narrow QRS with abrupt onset/termination*** - Presents with **narrow QRS complex tachycardia** (QRS 0.12 seconds) - **AV dissociation** is a key diagnostic feature showing independent atrial and ventricular activity - Originates from ventricular tissue, not supraventricular structures - Lacks the organized P wave patterns seen in atrial arrhythmias [Practice more Internal Medicine PYQs on OnCourse]

Q: A patient is pulseless with the following rhythm shown in the ECG. What is the next best step in management?

Defibrillate and continue chest compression. ***Defibrillate and continue chest compression*** - This scenario describes a **pulseless ventricular tachycardia (pVT)**, which is a **shockable rhythm**. - Immediate defibrillation is crucial, followed by resuming **chest compressions** without delay, as per advanced cardiac life support (ACLS) guidelines. - The correct sequence is: shock → immediate CPR for 2 minutes → rhythm/pulse check. *Defibrillate and check pulse* - While defibrillation is the correct initial intervention for a shockable rhythm, checking the pulse immediately after is incorrect. - Chest compressions should be resumed immediately after a shock for 2 minutes before stopping to check a pulse. - Minimizing interruptions in chest compressions is critical for survival. *Check pulse and give synchronized DC* - Checking a pulse before any intervention wastes critical time in a pulseless patient with a shockable rhythm; immediate defibrillation is indicated. - Synchronized direct current (DC) cardioversion is used for unstable patients **with a pulse** (e.g., unstable ventricular tachycardia with a pulse), not for pulseless rhythms. *Give synchronized DC and continue chest compressions* - Synchronized DC cardioversion is inappropriate for a **pulseless rhythm**; unsynchronized defibrillation is required. - Synchronization requires an R wave to time the shock, which is not feasible in pulseless VT management. *Start chest compressions and give epinephrine* - While chest compressions are essential, the **immediate priority** for a shockable rhythm (pVT/VF) is **defibrillation**. - Epinephrine is given during CPR cycles (after the first shock), but defibrillation must come first for shockable rhythms. - This would be the approach for **non-shockable rhythms** (PEA/asystole), not pulseless VT. [Practice more Internal Medicine PYQs on OnCourse]

Q: A patient presents with wheezing that improves with as-needed use of albuterol. Spirometry shows FEV1 ranging from 70 % to 83 %, and the patient experiences nighttime chest tightening twice a week. What is the most appropriate treatment?

Add an inhaled corticosteroid. ***Add an inhaled corticosteroid*** * The patient has persistent asthma as evidenced by symptoms occurring twice a week (nighttime chest tightening), and **FEV1 variability** despite current albuterol use. * Adding a **low-dose inhaled corticosteroid** is the recommended *first-line controller treatment* for persistent asthma to reduce inflammation and prevent exacerbations per **GINA guidelines**. *Continue with albuterol* * Continuing albuterol alone is insufficient for persistent asthma, as it only provides **symptomatic relief** and does not address the underlying inflammation. * This approach would lead to continued symptoms and potential **asthma exacerbations**. *Replace with salmeterol twice daily* * Salmeterol is a **long-acting beta-agonist (LABA)**, and while it provides prolonged bronchodilation, it should never be used as monotherapy in asthma due to the risk of severe exacerbations. * LABAs should always be prescribed in combination with an **inhaled corticosteroid**. *Start Tab prednisolone* * **Oral prednisolone** is a systemic corticosteroid typically reserved for **severe asthma exacerbations** or for patients whose symptoms are not controlled by high-dose inhaled corticosteroids and other controller medications. * It carries more significant **side effects** with long-term use compared to inhaled corticosteroids. *Add a leukotriene modifier* * While **leukotriene receptor antagonists** (e.g., montelukast) can be used as alternative controller therapy for mild persistent asthma, they are considered **less effective** than inhaled corticosteroids. * They are typically reserved as an alternative for patients who cannot use or tolerate inhaled corticosteroids, or as **add-on therapy** in more severe cases. [Practice more Internal Medicine PYQs on OnCourse]

Question 1

Match the following ECG findings (1-4) with their corresponding arrhythmias (A-D):

1. Sawtooth pattern in leads II, III, aVF with regular ventricular response
2. Irregularly irregular rhythm with absent P waves
3. Narrow QRS tachycardia with abrupt onset/termination
4. Wide QRS tachycardia with AV dissociation

A. Atrial fibrillation
B. PSVT (Paroxysmal Supraventricular Tachycardia)
C. Atrial flutter
D. Ventricular tachycardia

What is the correct matching?

Accepted Answer

A-2, B-3, C-1, D-4

Answer

A-2, B-1, C-3, D-4

Answer

A-1, B-2, C-4, D-3

Answer

A-4, B-3, C-2, D-1

Answer

A-1, B-2, C-3, D-4

Question 2

A patient is pulseless with the following rhythm shown in the ECG. What is the next best step in management?

Accepted Answer

Defibrillate and continue chest compression

Answer

Defibrillate and check pulse

Answer

Check pulse and give synchronized DC

Answer

Give synchronized DC and continue chest compressions

Answer

Start chest compressions and give epinephrine

Question 3

A hypertensive patient presents with an irregularly irregular pulse and a loud P2 on auscultation. Which JVP finding is likely to be seen in this patient?

Accepted Answer

Absent a wave

Answer

Cannon a wave

Answer

Rapid $x$ descent

Answer

Rapid $y$ descent

Answer

Prominent v wave

Question 4

A 60-year-old lady presents with shortness of breath (SOB) and episodes of angina pectoris. Work-up reveals aortic stenosis. Which of the following is the most likely reason behind these chest pain episodes?

Accepted Answer

Increased oxygen consumption in the heart

Answer

Increased pressure in aorta

Answer

Decreased pressure in aorta

Answer

Increase in volume overload of the heart

Answer

Decreased coronary blood flow

Question 5

A patient presents with wheezing that improves with as-needed use of albuterol. Spirometry shows FEV1 ranging from 70 % to 83 %, and the patient experiences nighttime chest tightening twice a week. What is the most appropriate treatment?

Accepted Answer

Add an inhaled corticosteroid

Answer

Continue with albuterol

Answer

Replace with salmeterol twice daily

Answer

Start Tab prednisolone

Answer

Add a leukotriene modifier

Question 6

A patient presents with hypotension, hyponatremia, and blackening of the palmar creases. Which of the following conditions is most likely associated with these symptoms?

Accepted Answer

Addison disease

Answer

Conn syndrome

Answer

Cushing's syndrome

Answer

Primary ACTH deficiency

Answer

Sheehan syndrome

Question 7

A young patient in an endemic area presents with pleural fluid showing LDH level greater than 0.6 times the serum LDH, protein level greater than 0.5 times the serum protein, and lymphocytic predominance. What is the most likely diagnosis?

Accepted Answer

Tuberculosis

Answer

Heart failure

Answer

Hepatic failure

Answer

Renal failure

Answer

Malignancy

Question 8

A patient presents with acute epigastric pain and an increase in serum lipase. Several days after stabilization, a chest X-ray shows bilateral diffuse infiltrates. What is the most common pathology explaining the chest X-ray findings?

Accepted Answer

Non-cardiogenic pulmonary edema

Answer

Increased PCWP

Answer

Pulmonary thromboembolism

Answer

Aspiration pneumonitis

Answer

Pleural effusion

Question 9

A patient with a history of hypertension presents with atrial fibrillation, shortness of breath, and bilateral basal crackles on auscultation. Which of the following would be the least important in the management of this patient?

Accepted Answer

IV Digoxin for control rate

Answer

Start on anticoagulants

Answer

Start β-blocker

Answer

Cardioversion to correct rhythm if hemodynamically remains unstable even after medical management

Answer

Administer diuretics for fluid overload

Question 10

In Type 1 Diabetes Mellitus (DM) stage 3 beta cell destruction, which of the following is the most likely presentation?

Accepted Answer

Hyperglycemia symptomatic

Answer

Dysglycemic symptomatic

Answer

Normoglycemic symptomatic

Answer

Dysglycemic asymptomatic

Answer

Normoglycemic asymptomatic

NEET-PG 2024 — Internal Medicine