FMGE 2025 - Internal Medicine PYQs Practice Questions

Q: A patient presents with breathlessness and is diagnosed with a Pancoast tumor. Which of the following findings is not typically associated with this condition?

Exophthalmos. ***Exophthalmos***- This finding, characterized by the **protrusion of the eyeball**, is typically associated with conditions like **Graves' disease** (hyperthyroidism) or orbital tumors.- It is *not* a component of **Horner's syndrome**, which is the classic neurological manifestation of a Pancoast tumor due to damage to the sympathetic chain.*Anhidrosis*- Pancoast tumors (superior sulcus tumors) often invade the **stellate ganglion** or other parts of the sympathetic chain.- Damage to sympathetic fibers causes reduced or absent sweating on the ipsilateral face and neck, manifesting as **anhidrosis**.*Miosis*- This refers to the **constriction of the pupil** and is a classic sign resulting from the loss of sympathetic input, which normally causes pupillary dilation.- The resulting unopposed action of the parasympathetic system leads to **miosis**.*Ptosis*- Ptosis, or the **drooping of the upper eyelid**, occurs due to paralysis of the **superior tarsal muscle** (Müller's muscle).- This small muscle is innervated by the sympathetic pathway, and its dysfunction results in mild **ptosis**, a core component of Horner's syndrome. [Practice more Internal Medicine PYQs on OnCourse]

Q: A young male presented with weakness in the lower half of the right side of his face, with drooping of the angle of his mouth. He is unable to raise his eyebrows and close his eyes on the right side. Which of the following is the most appropriate diagnosis?

Infranuclear facial palsy on right side. ***Infranuclear facial palsy on right side*** - **Infranuclear (peripheral) facial palsy** involves the facial nerve (CN VII) distal to the nucleus, causing complete paralysis of the entire ipsilateral side of the face including both upper and lower facial muscles. - The inability to raise eyebrows, close eyes, and drooping of the mouth on the **right side** indicates complete paralysis of the **right facial nerve**, characteristic of infranuclear lesions. *Supranuclear facial palsy on left side* - A **supranuclear (central) lesion** affects the face contralaterally, so a left-sided lesion would cause weakness on the **right face**, but the **upper face (forehead) would be spared**. - The patient's inability to raise eyebrows and close eyes contradicts supranuclear palsy, where **bilateral cortical input** to the upper facial nucleus preserves forehead function. *Infranuclear facial palsy on left side* - This diagnosis would cause complete paralysis of both upper and lower facial muscles on the **left side**. - The patient presents with weakness on the **right side** (drooping mouth, inability to raise eyebrow and close eye), making a left-sided lesion anatomically incorrect. *Supranuclear facial palsy on right side* - A **supranuclear lesion** on the right side would cause weakness of the **left lower face** due to contralateral presentation of central lesions. - Supranuclear lesions **never involve upper facial muscles** (forehead sparing) due to bilateral cortical innervation, contradicting this patient's inability to raise eyebrows and close eyes. [Practice more Internal Medicine PYQs on OnCourse]

Q: A patient presents with the palsy of the face as shown. Which of the following is most likely involved?

7th nerve palsy. ***7th nerve palsy*** - The image shows features of a **lower motor neuron (LMN) lesion** of the **7th cranial (facial) nerve**, affecting both the upper and lower face. Note the inability to wrinkle the left forehead, incomplete eye closure, and drooping of the left corner of the mouth. - This condition, often idiopathic and termed **Bell's palsy**, results in paralysis of all ipsilateral muscles of facial expression, which are innervated by the facial nerve. *3rd nerve palsy* - A **3rd cranial nerve (oculomotor)** palsy would present with **ptosis** (drooping eyelid), a dilated pupil, and the eye positioned "down and out" due to unopposed action of the superior oblique and lateral rectus muscles. - It does not cause paralysis of the lower facial muscles, such as those involved in smiling. *Erb's palsy* - This is an injury to the **upper trunk (C5-C6)** of the **brachial plexus**, typically occurring at birth, which affects the muscles of the shoulder and arm. - It results in the characteristic "**waiter's tip**" posture of the arm and has no effect on the facial muscles. *Orbicularis oculi palsy* - This describes an isolated paralysis of the muscle that closes the eyelids. While this is a component of 7th nerve palsy, it is not the complete diagnosis. - The patient clearly has paralysis of other facial muscles, such as the **frontalis** (forehead) and **zygomaticus** (mouth), indicating a lesion of the main facial nerve trunk, not just a single branch. [Practice more Internal Medicine PYQs on OnCourse]

Q: A patient presents with respiratory difficulty and a history of chronic smoking. Pulmonary function testing shows a decrease in FEV1/FVC ratio. What is the most probable diagnosis?

Chronic Obstructive Pulmonary Disease (COPD). ***Chronic Obstructive Pulmonary Disease (COPD)*** - COPD is the most likely diagnosis given the history of **chronic smoking** and pulmonary function tests showing a **decreased FEV1%**, which is a hallmark of an **obstructive lung disease**. - The pathophysiology involves **bronchiolar obstruction** leading to **air trapping**, which results in an elevated **Residual Volume (RV)** and **Total Lung Capacity (TLC)**, consistent with the provided flowchart. *Pulmonary Fibrosis* - This is a **restrictive lung disease**, characterized by scarring of the lung tissue, which would cause a **decrease**, not an increase, in Total Lung Capacity (TLC). - Spirometry in pulmonary fibrosis typically shows a **normal or increased FEV1/FVC ratio**, as both FEV1 and FVC are reduced proportionally. *Interstitial Lung Disease* - This is a broad category of **restrictive lung diseases**, which includes pulmonary fibrosis. These conditions make the lungs stiff and difficult to expand. - The characteristic PFT finding is a **restrictive pattern** (decreased TLC, FVC, and FEV1) with a normal or high FEV1/FVC ratio, which contradicts the patient's results. *Asthma* - Although asthma is an **obstructive disease** that can cause a low FEV1%, the airflow limitation is typically **reversible** with bronchodilators. - While both can present similarly, the patient's history of **chronic smoking** makes COPD, a progressive and largely irreversible condition, the more probable diagnosis. [Practice more Internal Medicine PYQs on OnCourse]

Q: Which drug is preferred for management of diabetes in a patient with cardiac and renal failure?

SGLT2 inhibitors. ***SGLT2 inhibitors*** - These agents are strongly recommended due to their proven benefits in reducing **heart failure (HF)** hospitalizations and **cardiovascular (CV) mortality**. - They also offer robust **reno-protection**, slowing the decline of **eGFR** and reducing albuminuria, making them ideal when both cardiac and renal failure coexist. *Pioglitazone* - This drug class (**thiazolidinediones**) is known to cause **fluid retention** and peripheral edema, thus potentially exacerbating or precipitating **congestive heart failure (CHF)**; it is therefore generally avoided [1]. - It is not associated with improved long-term renal or cardiovascular outcomes in the way that SGLT2 inhibitors are. *Metformin* - While a foundational drug, Metformin is contraindicated in severe **renal failure** (e.g., eGFR <30 mL/min/1.73m²) due to the increased risk of potentially fatal **lactic acidosis**. - Although safe in mild to moderate CKD, it lacks the specific, compelling evidence for reducing progression of **heart failure** or **CKD** compared to SGLT2 inhibitors. *Sulfonylureas* - These drugs primarily increase the risk of **hypoglycemia**, which is heightened in patients with **renal insufficiency** due to altered drug metabolism and clearance. - They provide no demonstrated **cardiovascular** or **renal protective benefits** and may be associated with weight gain. [Practice more Internal Medicine PYQs on OnCourse]

Question 1

A patient presents with breathlessness and is diagnosed with a Pancoast tumor. Which of the following findings is not typically associated with this condition?

Accepted Answer

Exophthalmos

Answer

Ptosis

Answer

Miosis

Answer

Anhidrosis

Question 2

A young male presented with weakness in the lower half of the right side of his face, with drooping of the angle of his mouth. He is unable to raise his eyebrows and close his eyes on the right side. Which of the following is the most appropriate diagnosis?

Accepted Answer

Infranuclear facial palsy on right side

Answer

Supranuclear facial palsy on left side

Answer

Infranuclear facial palsy on left side

Answer

Supranuclear facial palsy on right side

Question 3

A patient presents with the palsy of the face as shown. Which of the following is most likely involved?

Accepted Answer

7th nerve palsy

Answer

Erb's palsy

Answer

3rd nerve palsy

Answer

Orbicularis oculi palsy

Question 4

A patient presents with respiratory difficulty and a history of chronic smoking. Pulmonary function testing shows a decrease in FEV1/FVC ratio. What is the most probable diagnosis?

Accepted Answer

Chronic Obstructive Pulmonary Disease (COPD)

Answer

Interstitial Lung Disease

Answer

Pulmonary Fibrosis

Answer

Asthma

Question 5

Which drug is preferred for management of diabetes in a patient with cardiac and renal failure?

Accepted Answer

SGLT2 inhibitors

Answer

Pioglitazone

Answer

Metformin

Answer

Sulfonylureas

Question 6

A TB patient with HIV begins ART and experiences deterioration in health after 2 months. What is the likely cause?

Accepted Answer

Immunological changes in the body

Answer

Development of drug resistance to ART

Answer

Development of drug resistance to TB drugs

Answer

Drug-drug interactions between TB and ART medications

Question 7

A patient presents with acute onset symmetric lower limb flaccid paralysis and absent deep tendon reflexes. Which condition is most likely?

Accepted Answer

Guillain-Barré syndrome

Answer

Multiple sclerosis

Answer

Spinal cord injury

Answer

Amyotrophic lateral sclerosis

Question 8

In a patient with electric burns and stable vital signs, red-colored urine is observed. What is the most likely finding in the patient's blood work?

Accepted Answer

Increased potassium levels

Answer

Decreased hemoglobin levels

Answer

Increased creatinine levels

Answer

RBCs in urine

Question 9

A patient admitted with fever and nuchal rigidity. CSF analysis shows decreased glucose and increased protein and neutrophils. Which is the MOST IMPORTANT antibiotic for initial empirical treatment?

Accepted Answer

Ceftriaxone

Answer

Vancomycin

Answer

Penicillin

Answer

Ampicillin

Question 10

A 62-year-old male presents with left leg swelling and pain for 5 days and has a positive D-dimer test. Duplex ultrasonography confirms an extensive DVT involving the left popliteal and femoral veins. Which of the following is the most appropriate initial management strategy?

Accepted Answer

LMWH followed by oral anticoagulant

Answer

Unfractionated heparin followed by warfarin

Answer

Catheter-directed thrombolysis

Answer

IVC filter placement

FMGE 2025 — Internal Medicine