INI-CET 2023 - Internal Medicine PYQs Practice Questions

Q: Calculate Anion Gap? Na: 145 K: 4 CI: 90 HCO3 : 15

40. ***40*** - The anion gap is calculated using the formula: **Na - (Cl + HCO3)**. - Plugging in the values: **145 - (90 + 15) = 145 - 105 = 40**. *28* - This value would result if there were a different **bicarbonate** or **chloride** level or a miscalculation. - For example, if the bicarbonate was 30 instead of 15, the calculation would be 145 - (90 + 30) = 145 - 120 = 25, which is closer but still not 28. *35* - This value is obtained if there's an error in summing the **anions** or subtracting from **sodium**. - For instance, if the bicarbonate was incorrectly taken as 20, the calculation would be 145 - (90 + 20) = 145 - 110 = 35. *12* - A value of 12 represents a **normal anion gap**, indicating that the patient in this scenario has a high anion gap [1]. - This result would only occur if the sum of **chloride and bicarbonate** were around 133, which is not the case here. [Practice more Internal Medicine PYQs on OnCourse]

Q: History of a woman with skin features like limited cutaneous systemic sclerosis (scleroderma) was given. What is the most specific marker?

Anti centromere. ***Anti centromere*** - **Anti-centromere antibodies** are highly specific for **limited cutaneous systemic sclerosis** (lcSSc), also known as CREST syndrome. - Their presence correlates with a higher risk of **pulmonary hypertension** and less severe organ involvement compared to diffuse SSc [1]. *Anti U1 Rnp* - **Anti-U1 RNP antibodies** are primarily associated with **mixed connective tissue disease** (MCTD) [2]. - While MCTD can have features overlapping with scleroderma, anti-U1 RNP is not the most specific marker for a pure scleroderma presentation. *Anti Jo* - **Anti-Jo-1 antibodies** are characteristic of **polymyositis** and **dermatomyositis**, diseases involving muscle inflammation [2]. - They are primarily associated with the **anti-synthetase syndrome**, which includes myositis, interstitial lung disease, and Raynaud's phenomenon, not directly limited cutaneous systemic sclerosis. *Anti La* - **Anti-La (SS-B) antibodies** are commonly found in patients with **Sjögren's syndrome**, an autoimmune disorder affecting moisture-producing glands [2]. - They can also be present in systemic lupus erythematosus, but are not specific for scleroderma. [Practice more Internal Medicine PYQs on OnCourse]

Q: Which type of amyloidosis is seen in the patients going through dialysis?

A-beta 2. ***A-beta 2*** - **A-beta 2 microglobulin amyloidosis** (also known as dialysis-related amyloidosis) occurs because **beta-2 microglobulin** is not effectively cleared by dialysis and accumulates in tissues [1]. - This condition primarily affects **joints, bones**, and **tendons** in long-term dialysis patients, leading to carpal tunnel syndrome, arthropathy, and bone cysts. *A-beta* - **A-beta amyloidosis** refers to the accumulation of **amyloid-beta peptides** that are characteristic of **Alzheimer's disease**, primarily affecting the brain. - This type of amyloidosis is not directly associated with renal dialysis or systemic amyloid deposits in other organs. *AL* - **AL (light chain) amyloidosis** results from the deposition of **monoclonal immunoglobulin light chains** produced by plasma cells, often associated with multiple myeloma. - While it can affect the kidneys, it is a primary amyloidosis and not caused by dialysis itself, though it can occur in patients who also have kidney failure. *aTTR* - **aTTR (transthyretin) amyloidosis** involves the deposition of **abnormal transthyretin protein**, which can be hereditary (mutated TTR) or wild-type (aging-related) [1]. - This form primarily affects the heart and nervous system and is not typically associated with chronic dialysis as its direct cause. [Practice more Internal Medicine PYQs on OnCourse]

Q: A 62-year-old patient presents with pain in the calf muscles while walking. The pain subsides with rest. Which of the following is not typically seen in intermittent claudication?

Rest pain at night in advanced stages. ***Rest pain at night in advanced stages*** - Intermittent claudication is defined by pain with exercise that resolves with rest [1]. **Rest pain** indicates critical limb ischemia, a more advanced stage of peripheral artery disease, and is distinct from intermittent claudication itself, although it can develop from it [1]. - While rest pain can occur in patients with severe peripheral artery disease, it is **not typically seen in intermittent claudication**, but rather represents progression to a more severe form of the disease. *Pain gradually increases* - The pain of intermittent claudication typically **gradually increases** during physical activity as the oxygen demand of the muscles exceeds the compromised blood supply. - This progressive pain forces the patient to stop activity, at which point the pain subsides with rest. *Caused most commonly by atherosclerosis* - **Atherosclerosis** is the underlying pathology in the vast majority of cases of peripheral artery disease, leading to stenosis or occlusion of the arteries that supply the lower limbs [1]. - This narrowing of the arterial lumen restricts blood flow, causing inadequate oxygen delivery to muscles during exertion. *Level of occlusion cannot be decided based on symptoms* - The **anatomical level of arterial occlusion** can often be inferred to some extent by the location of the claudication pain (e.g., buttock claudication suggests aortoiliac disease, calf claudication suggests femoropopliteal disease) [1]. - However, the precise extent and severity of the occlusion cannot be solely determined by symptoms, and imaging studies like **duplex ultrasound** or angiography are required for definitive diagnosis. [Practice more Internal Medicine PYQs on OnCourse]

Q: A 55-year-old female smoker presents with a breast lump and is seeking medical evaluation. On examination, a palpable mass is detected in the breast. The patient's smoking history is significant, with a 30-year smoking habit. Which of the following conditions is strongly associated with smoking in relation to breast health?

Breast cancer. ***Breast cancer*** - **Smoking** is a well-established risk factor for various cancers, including **breast cancer**, due to the presence of carcinogens in tobacco smoke [1]. - The patient's age and palpable lump further raise suspicion for malignancy, prompting thorough investigation. [1] *Duct ectasia* - Characterized by widening and inflammation of the **milk ducts**, which can cause nipple discharge, tenderness, and a palpable mass. - While smoking can be a risk factor, the more significant association in this age group and with a palpable lump leans towards malignancy. *Fibroadenoma* - These are **benign breast tumors** composed of glandular and stromal tissue, most common in younger women. - They are typically rubbery, mobile masses and are not strongly linked to smoking. *Mondor disease* - This is a rare, **benign condition** characterized by thrombophlebitis of the superficial veins of the breast or chest wall. - It typically presents as a painful, cord-like structure and is not directly associated with smoking. [Practice more Internal Medicine PYQs on OnCourse]

Question 1

Calculate Anion Gap?
Na: 145 K: 4 CI: 90 HCO3 : 15

Accepted Answer

40

Answer

28

Answer

35

Answer

12

Question 2

History of a woman with skin features like limited cutaneous systemic sclerosis (scleroderma) was given. What is the most specific marker?

Accepted Answer

Anti centromere

Answer

Anti U1 Rnp

Answer

Anti Jo

Answer

Anti La

Question 3

Which type of amyloidosis is seen in the patients going through dialysis?

Accepted Answer

A-beta 2

Answer

A-beta

Answer

AL

Answer

aTTR

Question 4

A 62-year-old patient presents with pain in the calf muscles while walking. The pain subsides with rest. Which of the following is not typically seen in intermittent claudication?

Accepted Answer

Rest pain at night in advanced stages

Answer

Pain gradually increases

Answer

Caused most commonly by atherosclerosis

Answer

Level of occlusion cannot be decided based on symptoms

Question 5

A 55-year-old female smoker presents with a breast lump and is seeking medical evaluation. On examination, a palpable mass is detected in the breast. The patient's smoking history is significant, with a 30-year smoking habit. Which of the following conditions is strongly associated with smoking in relation to breast health?

Accepted Answer

Breast cancer

Answer

Duct ectasia

Answer

Fibroadenoma

Answer

Mondor disease

Question 6

What is/are the characterstics of Iron defficiency Anemaia(IDA)?

Accepted Answer

All of the options

Answer

Increased TIBC

Answer

Low serum ferritin

Answer

Low serum iron

Answer

Low transferrin saturation

Question 7

Patient presented with following features:

- ipsilateral loss of pain and temperature sensation in the face
- Contralateral loss of pain and temperature sensation in the body
- Horner's syndrome
- Dysphagia and hoarseness
- Ataxia and vertigo

Which artery is involved in syndrome based on above clinical features?

Accepted Answer

Posterior inferior cerebellar artery

Answer

Basilar artery.

Answer

Superior cerebellar artery

Answer

Anterior inferior cerebellar artery

Question 8

An ICU patient is suffering from Rhinovirus infection. How do we treat the patient?

Accepted Answer

Supportive care only

Answer

Piperacillin + Tazobactam + Azithromycin

Answer

Clarithromycin

Answer

Cephalosporin + Ganciclovir

Question 9

A 40-year-old man presents with daytime sleepiness and impaired concentration and memory. On examination his BMI is 41 kg/m2, BP is 160/100 mm Hg. His awake ABG analysis is given: PaO2=66 mm Hg, PaCO2=50 mm Hg, HCO3=28 mEq/L. What is the most likely diagnosis?

Accepted Answer

Obstructive sleep apnea

Answer

Narcolepsy

Answer

Obesity hypoventilation syndrome

Answer

Central sleep apnea

Question 10

A 35-year-old female presents with skin thickening and muscle weakness. Her peripheries became pale on exposure to cold. Her ANA is positive and creatine kinase is increased. Scl-70 is positive and perifascicular infiltration is noted in biopsy. What is the antibody associated with this condition?

Accepted Answer

Anti PM scl antibody

Answer

Anti Jo1 antibody

Answer

Anti centromere antibody

Answer

Antinuclear antibody

INI-CET 2023 — Internal Medicine