NEET-PG 2017 - Internal Medicine PYQs Practice Questions

Q: A 68-year-old postoperative patient who has undergone thyroidectomy presents with muscle cramps. ECG shows?

Prolonged QT interval. ***Prolonged QT interval*** - A patient who has undergone thyroidectomy and presents with muscle cramps likely has **hypocalcemia** due to inadvertent parathyroid gland removal. - Hypocalcemia is well-known to cause a **prolonged QT interval** on EKG, increasing the risk of arrhythmias. *Short QT interval* - A short QT interval is typically associated with **hypercalcemia** or genetic disorders. - This patient's presentation of muscle cramps is inconsistent with hypercalcemia. *ST elevation* - ST elevation is a hallmark of **acute myocardial infarction** or **pericarditis**. - This finding is unrelated to hypocalcemia or the patient's immediate postoperative and symptoms. *ST depression* - ST depression often indicates **myocardial ischemia** or **digoxin effect**. - It is not a characteristic ECG change associated with hypocalcemia or muscle cramps. [Practice more Internal Medicine PYQs on OnCourse]

Q: MRI was performed on a 35-year-old man with progressive myoclonus and apathy. What is the diagnosis? (Recent NEET Pattern 2016-17)

Prion disease. ***Prion disease*** - The MRI shows **cortical ribboning** (hyperintensity in the cortex) and possible signal changes in the basal ganglia, which are characteristic findings in prion diseases such as **Creutzfeldt-Jakob disease (CJD)**. - The clinical presentation of **progressive myoclonus** (sudden, involuntary muscle jerks) and **apathy** (lack of emotion or motivation), especially in a relatively young individual (35 years old), is highly suggestive of CJD or another prion disease. *Herpes simplex encephalitis* - This typically presents with **fever, headache, and focal neurological deficits**, often affecting the **temporal lobes**. - While it can cause FLAIR hyperintensities, it usually begins acutely with more prominent edema and may have hemorrhagic components, and myoclonus is not a primary defining symptom. *SSPE* - **Subacute sclerosing panencephalitis (SSPE)** is a rare, fatal, progressive brain disorder caused by the **measles virus**, primarily affecting children and young adults. - While it can cause progressive neurological deterioration and cognitive decline, myoclonus is often a late feature, and MRI findings often show **white matter demyelination** in later stages, which is not the predominant finding here. *Mesial temporal sclerosis* - This condition is characterized by **atrophy and signal changes in the hippocampus and amygdala** on MRI, typically associated with **temporal lobe epilepsy**. - While it can cause cognitive issues, it usually does not account for widespread cortical ribboning or prominent myoclonus in this age group, and the image does not specifically highlight mesial temporal lobe changes. [Practice more Internal Medicine PYQs on OnCourse]

Q: A 50-year-old hypertensive patient develops sudden onset drooping of right face and hemiplegia. What is the diagnosis?

MCA area hemorrhage. ***MCA area hemorrhage*** - The **hyperdense lesion** on CT scan indicates **acute hemorrhage** in the MCA territory, which correlates with the sudden onset right facial droop and hemiplegia. - **Hypertension** is the most common risk factor for primary **intracerebral hemorrhage**, and MCA territory involvement typically causes contralateral face and arm weakness. *MCA area infarction* - **Infarctions** appear as **hypodense (dark) areas** on CT scan, not hyperdense lesions as described in this case. - While MCA infarction can cause similar clinical symptoms, the imaging findings clearly show hemorrhage rather than ischemic changes. *ACA area infarction* - **ACA infarction** typically presents with **leg weakness** more prominent than face/arm weakness, as the ACA supplies the medial motor cortex for lower limbs. - The imaging shows a **hyperdense hemorrhage**, not the **hypodense appearance** characteristic of infarction. *ACA area hemorrhage* - **ACA territory hemorrhage** would affect the **frontal lobe**, causing symptoms like leg weakness, **abulia** (lack of motivation), and urinary incontinence. - The clinical presentation of **facial droop and hemiplegia** involving face and arm is more characteristic of **MCA involvement** rather than ACA territory. [Practice more Internal Medicine PYQs on OnCourse]

Q: A patient presents with GCS of 7 with nuchal rigidity and bloody CSF. Which is incorrect regarding this condition? (Recent NEET Pattern 2016-17)

IV ceftriaxone. **IV ceftriaxone** - The clinical presentation of **GCS of 7**, **nuchal rigidity**, and **bloody CSF** is highly suggestive of a **subarachnoid hemorrhage (SAH)**, not a bacterial infection like meningitis. - **Ceftriaxone** is an antibiotic commonly used to treat bacterial meningitis, which is not indicated here as the primary issue is hemorrhage, not infection. *Blood in sylvian fissure* - **Blood in the sylvian fissure** is a common finding in **subarachnoid hemorrhage**, as this area contains major cerebral arteries susceptible to aneurysm rupture. - CT scans often show hyperdense (bright) blood within the sulci and cisterns, including the sylvian fissure. *Seizures* - **Seizures** are a relatively common complication of **subarachnoid hemorrhage**, especially in the acute phase due to blood irritating the cerebral cortex. - They can occur in up to 10-20% of SAH patients and are a significant predictor of poorer outcomes. *Intraventricular extension* - **Intraventricular extension** of blood indicates a more severe hemorrhage and is often associated with a worse prognosis in **subarachnoid hemorrhage**. - The presence of blood within the ventricles can lead to **hydrocephalus** and increased intracranial pressure. [Practice more Internal Medicine PYQs on OnCourse]

Question 1

A 68-year-old postoperative patient who has undergone thyroidectomy presents with muscle cramps. ECG shows?

Accepted Answer

Prolonged QT interval

Answer

Short QT interval

Answer

ST elevation

Answer

ST depression

Question 2

MRI was performed on a 35-year-old man with progressive myoclonus and apathy. What is the diagnosis? (Recent NEET Pattern 2016-17)

Accepted Answer

Prion disease

Answer

Herpes simplex encephalitis

Answer

SSPE

Answer

Mesial temporal sclerosis

Question 3

A 35-year-old woman presents with thunderclap headache. NCCT was done. All are true about the condition except:

Accepted Answer

Most common cause of death is rebleeding

Answer

Hyponatremia

Answer

Prolonged QT interval

Answer

Nimodipine is drug of choice

Question 4

A 50-year-old hypertensive patient develops sudden onset drooping of right face and hemiplegia. What is the diagnosis?

Accepted Answer

MCA area hemorrhage

Answer

ACA area infarction

Answer

ACA area hemorrhage

Answer

MCA area infarction

Question 5

A patient presents with GCS of 7 with nuchal rigidity and bloody CSF. Which is incorrect regarding this condition? (Recent NEET Pattern 2016-17)

Accepted Answer

IV ceftriaxone

Answer

Blood in sylvian fissure

Answer

Seizures

Answer

Intraventricular extension

Question 6

A patient of swine flu has developed severe respiratory distress. Which of the following findings confirm the diagnosis of ARDS in this patient?

Accepted Answer

PaO₂/FiO₂ ratio < 300 and PCWP < 18 mm Hg

Answer

PaO₂/FiO₂ ratio < 200 and PCWP > 18 mm Hg

Answer

PaO₂/FiO₂ ratio < 400 and PCWP > 18 mm Hg

Answer

PaO₂/FiO₂ ratio < 100 and PCWP < 18 mm Hg

Question 7

A 40-year-old woman with history of progressive shortness of breath has lesions on her legs as shown. HbA1C of the patient is 5.8%. Lipid profile shows serum cholesterol 175 mg%. What is the diagnosis? (Recent NEET Pattem 2016-17)

Accepted Answer

Erythema nodosum

Answer

Necrobiosis lipidoica diabeticorum

Answer

Xanthoma

Answer

Carotenemia

Question 8

The EEG of the patient shows which of the following? (Recent NEET Pattern 2016-17)

Accepted Answer

Burst suppression pattern

Answer

Rademecker complex

Answer

3/sec spike and slow wave pattern

Answer

4-6 Hz Polyspike

Question 9

The EEG of a 16-year-old boy with early morning involuntary movements of hands in his sleep noticed by parents, was performed. Immunization is complete. What does EEG show? (Recent NEET Pattern 2016-17)

Accepted Answer

Juvenile myoclonic epilepsy

Answer

SSPE

Answer

Benign rolandic epilepsy

Answer

Huntington chorea

Question 10

Which of the following infections in most commonly seen in this transfusion dependant child shown below?

Accepted Answer

Yersinia enterocolitica

Answer

Listeria monocytogenes

Answer

Acinetobacter

Answer

Pneumococcus

NEET-PG 2017 — Internal Medicine