INI-CET 2022 - Internal Medicine PYQs Practice Questions

Q: What does the given ECG show?

P-pulmonale. ***P-pulmonale*** - The ECG shows tall, peaked **P waves** with an amplitude of more than **2.5 mm in lead II**, which is characteristic of P-pulmonale. - P-pulmonale indicates **right atrial enlargement or hypertrophy**, often due to conditions like severe lung disease (e.g., COPD) or pulmonary hypertension. *Improper calibration* - Improper calibration would typically affect the amplitude of all ECG complexes globally or specific leads consistently, which is not the primary finding here. - The calibration mark (first beat in lead I) appears normal, indicating standard calibration (10mm/mV). *Electrical alternans* - **Electrical alternans** is characterized by beat-to-beat variation in the QRS complex amplitude, which is not visible in this ECG. - It is commonly associated with **pericardial effusion with cardiac tamponade**. *Ventricular bigeminy* - **Ventricular bigeminy** is a pattern where every normal sinus beat is followed by a premature ventricular contraction (PVC). - This ECG shows a regular rhythm with consistent P-QRS-T morphology, without alternating normal and PVC beats. [Practice more Internal Medicine PYQs on OnCourse]

Q: Which of the following statements are true about familial adenomatous polyposis? 1. It is autosomal recessive 2. If not treated, 100% of the cases progress to adenocarcinoma colon. 3. It is associated with a gene mutation in KRAS 4. It is associated with congenital hypertrophy of the retinal pigment epithelium.

2 and 4. ***2 and 4*** - Without treatment, **familial adenomatous polyposis (FAP)** leads to colorectal **adenocarcinoma** in 100% of cases, due to the accumulation of numerous adenomatous polyps throughout the colon. - FAP is strongly associated with **congenital hypertrophy of the retinal pigment epithelium (CHRPE)**, which can be an early diagnostic marker [1]. *None of the options* - This statement is incorrect because FAP does indeed involve the progression to adenocarcinoma and is associated with CHRPE. - The combination of these two true statements makes this option invalid. *1 and 4* - FAP is inherited in an **autosomal dominant** manner, not autosomal recessive [1]. - While statement 4 (association with CHRPE) is true, statement 1 being false makes this option incorrect. *2 and 3* - Although statement 2 (100% progression to adenocarcinoma) is true, statement 3 is incorrect. - FAP is primarily caused by mutations in the **APC gene**, not the KRAS gene [1]. KRAS is more commonly associated with sporadic colorectal cancer progression rather than FAP. [Practice more Internal Medicine PYQs on OnCourse]

Q: A patient presented with reduced levels of high-density lipoprotein, and ABCA1 mutation. On examination, tonsils appeared as shown in the image. What is the diagnosis?

Tangier disease. ***Tangier disease*** - This condition is characterized by **very low HDL levels** due to mutations in the **ABCA1 gene**, which impairs cholesterol efflux from cells. - The classic physical finding is **enlarged, orange-yellow tonsils** due to cholesterol ester deposition, seen in the provided image. *Fabry disease* - This is an **X-linked lysosomal storage disorder** caused by a deficiency of **alpha-galactosidase A**, leading to globotriaosylceramide accumulation. - Clinical features include **neuropathic pain**, **angiokeratomas**, **corneal opacities**, and early renal and cardiac disease, not orange-yellow tonsils. *Niemann-Pick disease* - This is a group of **autosomal recessive lysosomal storage disorders** caused by deficiencies in enzymes like acid sphingomyelinase or proteins involved in cholesterol processing. - It typically presents with **hepatosplenomegaly**, **neurodegeneration** (especially type A and B), and **lung involvement**, but not oral lesions as depicted. *Gaucher disease* - This is an **autosomal recessive lysosomal storage disease** resulting from a deficiency of the enzyme **beta-glucosidase**, leading to accumulation of glucocerebroside. - Characteristic features include **hepatosplenomegaly**, **bone pain** and crises, and **pancytopenia**, without any specific tonsillar findings. [Practice more Internal Medicine PYQs on OnCourse]

Q: Which of the following is not a first-line drug for the management of a patient with rheumatoid arthritis?

Azathioprine. ***Azathioprine*** - While an **immunosuppressant**, azathioprine is generally reserved for patients with **refractory rheumatoid arthritis (RA)** or those who cannot tolerate or have failed first-line DMARDs. - Its use often comes with a higher risk of side effects, making it less suitable as an initial agent compared to other conventional synthetic DMARDs. *Hydroxychloroquine* - This is a **first-line DMARD** for RA, particularly in patients with **mild disease**, due to its relatively favorable safety profile. - It is often used in combination with other DMARDs like methotrexate. *Sulfasalazine* - Sulfasalazine is a common **first-line conventional synthetic DMARD** for RA, especially effective in patients with peripheral arthritis. - It is frequently used when methotrexate is contraindicated or not tolerated, or as part of combination therapy. *Methotrexate* - **Methotrexate is considered the cornerstone** and **first-line treatment** for most patients with rheumatoid arthritis due to its efficacy and tolerability [1]. - It is recommended for early initiation in newly diagnosed patients to prevent joint damage and improve outcomes [2]. [Practice more Internal Medicine PYQs on OnCourse]

Question 1

What does the given ECG show?

Accepted Answer

P-pulmonale

Answer

Improper calibration

Answer

Electrical alternans

Answer

Ventricular bigeminy

Question 2

Which of the following statements are true about familial adenomatous polyposis?

1. It is autosomal recessive
2. If not treated, 100% of the cases progress to adenocarcinoma colon.
3. It is associated with a gene mutation in KRAS
4. It is associated with congenital hypertrophy of the retinal pigment epithelium.

Accepted Answer

2 and 4

Answer

None of the options

Answer

1 and 4

Answer

2 and 3

Question 3

A patient presented with reduced levels of high-density lipoprotein, and ABCA1 mutation. On examination, tonsils appeared as shown in the image. What is the diagnosis?

Accepted Answer

Tangier disease

Answer

Fabry disease

Answer

Niemann-Pick disease

Answer

Gaucher disease

Question 4

A diabetic patient's fasting blood glucose level is found to be $160 \mathrm{mg} / \mathrm{dL}$. What will you advise the patient regarding non-pharmacological management?

Accepted Answer

<30 % of the calories should come from fat

Answer

At least 25-35 g of dietary fibre

Answer

Dietary cholesterol <300 mg per day

Answer

<2.3 g sodium intake every day

Question 5

Which of the following is not a first-line drug for the management of a patient with rheumatoid arthritis?

Accepted Answer

Azathioprine

Answer

Hydroxychloroquine

Answer

Sulfasalazine

Answer

Methotrexate

Question 6

The following are parvovirus - related disease - population pairs. Identify the incorrect pair.

1. Aplastic anemia - Patient with hereditary hemolytic anemia
2. Non - immune hydrops - pregnant women
3. Erythema infectiosum - infants
4. Non - erosive arthritis - Patients of SLE

Accepted Answer

4

Answer

1

Answer

2

Answer

3

Question 7

Mark the correct statement regarding inflammatory bowel disease.

Accepted Answer

Skip lesions are present in Crohn's disease

Answer

Inflammatory bowel disease doesn't have a genetic predisposition

Answer

Crohn's is curable through surgical resection of the affected segment

Answer

Mucosal layers are involved in Crohn's while transmural involvement seen in ulcerative colitis

Question 8

A person presents to the hospital with fever and chills. Fever profile is ordered and is found to be negative for malaria and dengue. Rk39 test is found to be positive. What is the treatment of choice?

Accepted Answer

Amphotericin B

Answer

Dapsone

Answer

Hydroxychloroquine

Answer

Griseofulvin

Question 9

Incorrect statement regarding the management of frostbite:

Accepted Answer

Antibiotics and analgesics not used

Answer

Amputation in severe cases

Answer

Rewarming is done

Answer

The area is dried and cleaned

Question 10

A patient, who is a known case of HIV with a CD4 count of 200 cells/cu.mm, presents with 5 days of cough and high-grade fever without chills and rigors. There is no history of diarrhoea, vomiting, or nuchal rigidity. Chest x-ray is normal. What treatment will you give?

Accepted Answer

Co-trimoxazole only

Answer

Co-trimoxazole + steroids

Answer

Amoxicillin-clavulanic acid + Azithromycin

Answer

Antitubercular treatment

INI-CET 2022 — Internal Medicine