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: A young man sustained a scorpion sting 2 hours ago. On examination, his blood pressure is $108 / 60 \mathrm{~mm} \mathrm{Hg} ; \mathrm{HR}, 72$ beats / minute and respiratory rate, 32 breaths/ minute. He also complains of breathlessness. How do you manage this patient?

Prazosin. ***Prazosin*** - The patient's presentation with scorpion sting complicated by **breathlessness** and a respiratory rate of 32 breaths/minute suggests a **neurotoxic reaction** leading to **pulmonary edema** or **myocardial dysfunction**. - **Prazosin**, an alpha-1 adrenergic blocker, is recommended in such cases to counteract the **sympathomimetic effects** of scorpion venom, particularly reducing pulmonary and systemic vascular resistance, thereby alleviating pulmonary edema and improving cardiac function. *Frusemide* - While frusemide is a diuretic used to treat pulmonary edema, its use in scorpion envenomation is controversial and generally not recommended as a primary treatment. - The underlying cause is sympathetic overactivity, and diuresis alone without addressing the root cause may not be sufficient and could exacerbate hypovolemia in some settings. *Ivabradine* - Ivabradine is a **heart rate-lowering agent** that acts by selectively inhibiting the funny current (If) in the sinoatrial node. - It is primarily used for the treatment of **stable chronic heart failure** with reduced ejection fraction and stable angina, not for acute scorpion envenomation. *Metoprolol* - Metoprolol, a beta-blocker, could potentially worsen bronchoconstriction in patients with underlying respiratory issues and is generally not recommended in the acute management of severe scorpion envenomation, especially if there are signs of respiratory distress or cardiogenic shock. - While scorpion venom can cause tachycardia, directly blocking beta-receptors without addressing alpha-adrenergic overactivity may not be beneficial and could lead to adverse effects. [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: 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

A young man sustained a scorpion sting 2 hours ago. On examination, his blood pressure is $108 / 60 \mathrm{~mm} \mathrm{Hg} ; \mathrm{HR}, 72$ beats / minute and respiratory rate, 32 breaths/ minute. He also complains of breathlessness. How do you manage this patient?

Accepted Answer

Prazosin

Answer

Frusemide

Answer

lvabradine

Answer

Metoprolol

Question 3

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 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

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 7

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

Question 8

Thrombolysis can be considered in all of these conditions, except:

Accepted Answer

Blood pressure of more than 185/110 mmHg

Answer

Ischemic stroke within 2 hours

Answer

Onset of symptoms <4 hours

Answer

MRI showing density in less than 1/3rd of the area supplied by MCA

Question 9

A young patient presents to the clinic with erythematous lesions over the exposed areas of the skin like hands, arms, chest, etc. she also complaints of arthralgia and breathlessness. Which among the following antibodies will be useful in diagnosing this condition?

Accepted Answer

Anti-dsDNA antibodies

Answer

Anti-centromere antibodies

Answer

Anti-RNP antibodies

Answer

Anti-Scl 70 antibodies

Question 10

A patient presented with violent, flinging movements. Where is the lesion causing the hemiballismus seen?

Accepted Answer

Subthalamic nucleus

Answer

Putamen

Answer

Globus pallidus

Answer

Caudate nucleus

INI-CET 2022 — Internal Medicine