INI-CET 2025 - Internal Medicine PYQs Practice Questions

Q: Which of the following is not a recognised cause of recurrent renal stone formation?

Hypercitraturia. ***Hypercitraturia*** - It is generally **protective** against calcium stone formation because **citrate** binds to calcium in the urine, making it more soluble and inhibiting crystal nucleation. [1] - **Hypocitraturia** (low urinary citrate), not hypercitraturia, is a well-recognized metabolic risk factor for the formation of **calcium oxalate stones**. *Hyperoxaluria* - **Oxalate** readily binds with calcium to form **calcium oxalate stones**, the most common type of kidney stone. - Both primary and secondary hyperoxaluria significantly increase the degree of urinary **supersaturation**, driving stone formation. *Hypercalciuria* - High levels of urinary calcium increases urine saturation, leading to the precipitation of calcium salts, primarily forming **calcium oxalate** or **calcium phosphate** stones. [1] - It is the most frequent metabolic abnormality observed in patients with **recurrent nephrolithiasis**. *Hyperuricosuria* - Excess urinary **uric acid** directly causes **uric acid stones**, especially in acidic urine. [1] - Importantly, uric acid crystals can also serve as a **nidus** for the heterogeneous nucleation of **calcium oxalate** stones, increasing overall stone risk. [1] [Practice more Internal Medicine PYQs on OnCourse]

Q: Which of the following is one of the earliest presenting symptoms in a patient with Multiple Sclerosis?

Sensory disturbances. ***Sensory disturbances*** - **Sensory symptoms**, such as numbness, tingling (paresthesias), or hypoesthesia, are among the most common **initial complaints** (up to 40% of patients) in Multiple Sclerosis, often affecting the limbs or trunk [1]. - These symptoms occur due to demyelination in the **spinal cord** or **sensory pathways** in the brainstem. *Ataxia* - While **ataxia** (coordination problems) is a characteristic symptom of MS, usually resulting from cerebellar or posterior column involvement, it is less frequently the **absolute earliest** presentation [1]. - Ataxia often signifies later-stage progression or a focus of demyelination within the cerebellum or its connections [1]. *Vertigo* - **Vertigo** can occur in MS due to demyelination of the **vestibular pathways** in the brainstem (e.g., lesions affecting the **Medial Longitudinal Fasciculus (MLF)**) [1]. - However, isolated vertigo is typically a less common initial symptom compared to **sensory changes** or optic neuritis. *Facial palsy* - **Facial palsy** (Cranial Nerve VII involvement) can result from a plaque in the pons, but it is a relatively **rare** initial manifestation of Multiple Sclerosis. - Early cranial nerve involvement is more classically presented as **Optic Neuritis** or Diplopia (e.g., Internuclear Ophthalmoplegia). [Practice more Internal Medicine PYQs on OnCourse]

Q: Which of the following is the most common clinical feature observed during the progression of systemic lupus erythematosus (SLE)?

Arthralgia & myalgia. ### Arthralgia & myalgia - **Arthralgia (joint pain)** and **myalgia (muscle pain)** are documented as the most common initial and persistent clinical features, occurring in over 90% of SLE patients [1]. - The arthritis in SLE is typically non-erosive and symmetrical, often affecting the small joints of the hands, wrists, and knees. *Photosensitivity* - While very common and a key diagnostic criterion, it occurs in about 40-50% of patients, making it less frequent than diffuse joint and muscle pain [1]. - It is a prominent feature of cutaneous involvement, often leading to the characteristic **malar rash** or discoid lesions after sun exposure [1]. *Nephrotic syndrome* - Renal involvement (**Lupus nephritis**) is serious, but clinically overt nephrotic syndrome (heavy proteinuria, edema) is found only in a subset of patients with Type III, IV, or V nephritis. - Overall, symptomatic renal disease affects about 50-60% of patients, less frequent than musculoskeletal symptoms. *Anemia and thrombocytopenia* - **Hematologic abnormalities** (anemia, leukopenia, and thrombocytopenia) are common and considered diagnostic criteria but occur in roughly 50% or less of patients. - **Anemia of chronic disease** is the most frequent hematologic finding, while **thrombocytopenia** is less common than arthralgia. [Practice more Internal Medicine PYQs on OnCourse]

Q: According to WHO, which of the following is the recommended diagnostic test for spinal tuberculosis?

CB-NAAT. ***CB-NAAT*** - **WHO Consolidated Guidelines on TB (2021)** recommend **CB-NAAT/Xpert MTB/RIF** as the initial diagnostic test for all forms of TB, including **extrapulmonary and spinal tuberculosis**. - It provides **rapid diagnosis** within 2 hours and simultaneously detects **rifampicin resistance**, making it the preferred first-line diagnostic tool. *X-ray* - X-rays are useful for **initial screening** and assessing **bony destruction** like vertebral collapse (**Pott's spine**), but cannot confirm TB diagnosis. - They lack the ability to provide **bacteriological evidence** or detect **M. tuberculosis organisms** required for definitive diagnosis. *CT scan* - CT scans provide detailed imaging of **bony morphology**, **disc involvement**, and **soft tissue pathology** like paraspinal abscesses. - It remains an **imaging modality** and cannot replace the need for **microbiological confirmation** or **drug susceptibility testing**. *Culture and Sensitivity* - While considered the **gold standard** for TB confirmation and comprehensive **drug susceptibility testing**, it is not WHO's recommended **first-line diagnostic test**. - Culture takes **weeks to months** for results, whereas WHO emphasizes **rapid diagnosis** for timely treatment initiation. [Practice more Internal Medicine PYQs on OnCourse]

Q: Which of the following is the most common inherited bleeding disorder?

Von Willebrand Disease. ***Von Willebrand Disease*** - VWD is the most common inherited bleeding disorder, with a prevalence estimated to be as high as 1% of the population, often showing an **autosomal dominant** inheritance pattern. - It results from a quantitative or qualitative defect in **von Willebrand factor (vWF)**, which impairs platelet adhesion and stabilizes **Factor VIII** [1][2]. *Disseminated Intravascular Coagulation* - DIC is an **acquired** life-threatening condition caused by systemic activation of coagulation, usually triggered by underlying severe diseases like **sepsis** or trauma, not inheritance. - It is characterized by simultaneous widespread thrombosis and severe bleeding due to the consumption of clotting factors and platelets. *Factor V Deficiency* - Factor V deficiency (Parahemophilia) is an extremely rare inherited bleeding disorder, transmitted in an **autosomal recessive** manner. - While inherited, its overall prevalence is substantially lower compared to VWD, making it not the most common. *Hemophilia* - Hemophilia (A and B) is the most common severe inherited bleeding disorder, known for causing deep tissue bleeding (e.g., **hemarthroses**). - It is an **X-linked recessive** condition, meaning it is less prevalent overall in the population compared to the high frequency of mild, often undiagnosed, VWD cases. [Practice more Internal Medicine PYQs on OnCourse]

Question 1

Which of the following is not a recognised cause of recurrent renal stone formation?

Accepted Answer

Hypercitraturia

Answer

Hypercalciuria

Answer

Hyperuricosuria

Answer

Hyperoxaluria

Question 2

Which of the following is one of the earliest presenting symptoms in a patient with Multiple Sclerosis?

Accepted Answer

Sensory disturbances

Answer

Ataxia

Answer

Vertigo

Answer

Facial palsy

Question 3

Which of the following is the most common clinical feature observed during the progression of systemic lupus erythematosus (SLE)?

Accepted Answer

Arthralgia & myalgia

Answer

Nephrotic syndrome

Answer

Anemia and thrombocytopenia

Answer

Photosensitivity

Question 4

According to WHO, which of the following is the recommended diagnostic test for spinal tuberculosis?

Accepted Answer

CB-NAAT

Answer

CT scan

Answer

Culture and Sensitivity

Answer

X-ray

Question 5

Which of the following is the most common inherited bleeding disorder?

Accepted Answer

Von Willebrand Disease

Answer

Hemophilia

Answer

Factor V Deficiency

Answer

Disseminated Intravascular Coagulation

Question 6

A male patient presents with chronic diarrhea for 8 months. CT shows ahaustral appearance of the right colon. What is the most likely diagnosis?

Accepted Answer

Crohns disease

Answer

Ulcerative colitis

Answer

Tubercular colitis

Answer

Pseudomembranous enterocolitis

Question 7

Which of the following about lumbar puncture is incorrect?

Accepted Answer

Post-tap headache is more common in females and old age

Answer

Urgent indication if suspected SAH with inconclusive CT

Answer

Can be done in thrombocytopenia (platelet count >10,000 )

Answer

Meningitis is an unusual complication

Question 8

In a septic shock patient who remains hypotensive despite adequate fluid resuscitation, what would be the next drug of choice?

Accepted Answer

Noradrenaline

Answer

Adrenaline

Answer

Dopamine

Answer

Hydrocortisone

Question 9

A patient with rheumatoid arthritis presents with neck pain and clinical signs of myelopathy. What is the most likely diagnosis?

Accepted Answer

Atlantoaxial dislocation

Answer

Osteoarthritis of vertebrae

Answer

Disc herniation

Answer

C2-C3 intervertebral stenosis

Question 10

A 58-year-old male presents to a PHC for a routine check-up. His blood pressure readings on two separate occasions are 148 / 90 mmHg and 152 / 96 mmHg. He is asymptomatic and has no known comorbidities. What is the most appropriate next step in management according to current hypertension guidelines?

Accepted Answer

Start Amlodipine 5 mg once daily and advise follow-up after a month

Answer

Initiate treatment only if BP exceeds 160 / 100 mmHg

Answer

Start the patient on IV anti-hypertensive drugs

Answer

Refer to a higher center for further evaluation

INI-CET 2025 — Internal Medicine