NEET-PG 2018 - Internal Medicine PYQs Practice Questions

Q: Cyroglobulinemia is associated with:

Hepatitis C. ***Hepatitis C*** - **Cryoglobulinemia** is most strongly associated with chronic **Hepatitis C virus (HCV)** infection [1]. - HCV infection can lead to the formation of **cryoglobulins**, which are immunoglobulins that precipitate in the cold and can cause systemic vasculitis [1]. *Hepatitis A* - **Hepatitis A** is an acute, self-limiting viral infection that is not typically associated with chronic complications like cryoglobulinemia. - It primarily causes **acute hepatitis** and does not lead to chronic carrier states or immune complex diseases. *Hepatitis B* - While **Hepatitis B virus (HBV)** can be associated with immune complex diseases, such as **polyarteritis nodosa (PAN)** and **glomerulonephritis**, it is less commonly linked to cryoglobulinemia than HCV. - HBV-associated immune complex diseases generally involve different pathogenesis and clinical presentations than HCV-associated cryoglobulinemia. *Hepatitis D* - **Hepatitis D virus (HDV)** infection occurs only in individuals already infected with HBV. - While HDV can worsen the progression of HBV-related liver disease, it is not independently associated with cryoglobulinemia. [Practice more Internal Medicine PYQs on OnCourse]

Q: Calculate the GCS of a 25-year-old head injury patient who is confused, opens their eyes in response to pain, and localizes pain. What is the GCS score?

11. ***11*** - **Eye-opening response**: The patient opens eyes in response to pain, which scores 2 points on the GCS. - **Verbal response**: The patient is confused, which scores 4 points on the GCS. - **Motor response**: The patient localizes pain, which scores 5 points on the GCS. - The total GCS is 2 (eyes) + 4 (verbal) + 5 (motor) = **11**. *6* - A GCS of 6 would imply much lower scores in at least two categories (e.g., eye opening to pain (2), incomprehensible sounds (2), abnormal extension (2)), indicating a more severe coma. - This option incorrectly sums the individual components given in the scenario. *12* - A GCS of 12 would suggest a higher level of consciousness than described (e.g., eyes to speech (3), confused (4), moves to localize pain (5)), or other combinations that do not match the specific patient presentation. - This option overestimates the patient's neurological status based on the given symptoms. *7* - A GCS of 7 also represents a significantly lower level of consciousness than the patient's description. For example, it could be eye opening to pain (2), incomprehensible sounds (2), and withdrawal from pain (3), which is not consistent with the patient's specific responses. - This option significantly underestimates the patient's GCS score. [Practice more Internal Medicine PYQs on OnCourse]

Q: Patient presenting with cutaneous vasculitis, glomerulonephritis, peripheral neuropathy, Which investigation is to be performed next that will help you diagnose the condition?

ANCA. ### ANCA - The combination of **cutaneous vasculitis**, **glomerulonephritis**, and **peripheral neuropathy** points towards a small-vessel vasculitis, for which **ANCA (anti-neutrophil cytoplasmic antibodies)** testing is crucial [1]. - ANCA is highly specific for conditions like **Granulomatosis with Polyangiitis (GPA)** and **Microscopic Polyangiitis (MPA)** [1]. ### RA factor - **Rheumatoid factor (RF)** is primarily associated with **rheumatoid arthritis**, which typically presents with symmetrical polyarthritis, not the constellation of symptoms described. - While RF can be positive in some vasculitides, it is not the most specific initial test for the given clinical presentation. ### Hbsag - **Hepatitis B surface antigen (HbsAg)** typically screens for **Hepatitis B infection**, which can cause **polyarteritis nodosa (PAN)**, a medium-vessel vasculitis. - However, the patient's symptoms (cutaneous vasculitis, glomerulonephritis) are more characteristic of **small-vessel vasculitis**, making ANCA a more direct investigation [1]. ### MIF - **MIF (Macrophage Migration Inhibitory Factor)** is a cytokine involved in inflammation, but it is not a routine diagnostic marker for vasculitis. - It is not used as a primary investigation to diagnose specific autoimmune or inflammatory conditions like vasculitis. [Practice more Internal Medicine PYQs on OnCourse]

Q: Which one of the following statements about Graves' disease is FALSE?

Common in male. ***Common in male*** - Graves' disease is significantly **more common in females** than males, with a female-to-male ratio of approximately 7:1 [1]. It is a female predominant disease [2]. - The peak incidence is between the ages of 20 and 50 years, and it is the most common cause of **hyperthyroidism** in women [1], [2]. *Results in hyperthyroidism* - Graves' disease is characterized by the production of **autoantibodies** against the TSH receptor, leading to excessive stimulation of the thyroid gland [1]. - This overstimulation results in **increased synthesis and release of thyroid hormones**, causing a state of hyperthyroidism [2]. *Autoimmune disorder* - Graves' disease is a classic example of an **organ-specific autoimmune disease** [2]. - The immune system mistakenly produces antibodies that mimic the action of TSH, leading to thyroid overactivity [1]. *Referred to as toxic diffuse goiter* - The term "toxic" refers to the **hyperthyroid state** (thyrotoxicosis), and "diffuse goiter" describes the generally uniform enlargement of the entire thyroid gland [1]. - This terminology accurately reflects the typical presentation of Graves' disease, which involves an overactive, diffusely enlarged thyroid gland [2]. [Practice more Internal Medicine PYQs on OnCourse]

Q: Which of the following is a cause of hypokalemic metabolic alkalosis with hypertension?

Liddle syndrome. ***Liddle syndrome*** - It is an **autosomal dominant** disorder characterized by a mutation in the **ENaC channel**, leading to increased sodium reabsorption and potassium excretion, thus causing **hypokalemia**, **metabolic alkalosis**, and **hypertension**. [1] - This condition mimics **primary hyperaldosteronism** but has **low plasma renin activity** and **low aldosterone levels**. [1] *Bartter syndrome* - This is a genetic disorder affecting the **Na-K-2Cl cotransporter** in the **thick ascending limb** of the loop of Henle, leading to **salt wasting** and compensatory **renin-angiotensin-aldosterone system activation**. - It presents with **hypokalemia**, **metabolic alkalosis**, but typically with **normal or low blood pressure**, not hypertension. *Gitelman syndrome* - This is an autosomal recessive disorder affecting the **thiazide-sensitive Na-Cl cotransporter** in the **distal convoluted tubule**. - It causes **hypokalemic metabolic alkalosis**, hypomagnesemia, and hypocalciuria, but patients are typically **normotensive** or **hypotensive**, distinguishing it from Liddle syndrome. *Renal tubular acidosis* - This is a group of disorders characterized by the **kidneys' inability to excrete acid** or **reabsorb bicarbonate**, leading to **metabolic acidosis**. [2] - While it can cause electrolyte abnormalities, hypokalemia is a feature of certain types (e.g., RTA type 1 and 2), but the defining feature is **metabolic acidosis**, not metabolic alkalosis, and it is not typically associated with hypertension from the primary tubular defect. [2] [Practice more Internal Medicine PYQs on OnCourse]

Question 1

Cyroglobulinemia is associated with:

Accepted Answer

Hepatitis C

Answer

Hepatitis A

Answer

Hepatitis B

Answer

Hepatitis D

Question 2

Calculate the GCS of a 25-year-old head injury patient who is confused, opens their eyes in response to pain, and localizes pain. What is the GCS score?

Accepted Answer

11

Answer

6

Answer

12

Answer

7

Question 3

Patient presenting with cutaneous vasculitis, glomerulonephritis, peripheral neuropathy, Which investigation is to be performed next that will help you diagnose the condition?

Accepted Answer

ANCA

Answer

RA factor

Answer

Hbsag

Answer

MIF

Question 4

Which one of the following statements about Graves' disease is FALSE?

Accepted Answer

Common in male

Answer

Referred to as toxic diffuse goiter

Answer

Results in hyperthyroidism

Answer

Autoimmune disorder

Question 5

Which of the following is a cause of hypokalemic metabolic alkalosis with hypertension?

Accepted Answer

Liddle syndrome

Answer

Bartter syndrome

Answer

Gitelman syndrome

Answer

Renal tubular acidosis

Question 6

Which is not included in AIDS related complex?

Accepted Answer

Ectopic pregnancy

Answer

Recurrent genital candidiasis

Answer

Generalised lymphadenopathy

Answer

Chronic diarrhea

Question 7

What is Prosopagnosia?

Accepted Answer

Difficulty in identifying known faces

Answer

Impairment of consciousness

Answer

Being unaware of one's problems

Answer

Failure to identify objects

Question 8

Which drug is used as an adjunct to epinephrine in refractory ventricular fibrillation/ventricular tachycardia during cardiac arrest?

Accepted Answer

Amiodarone infusion

Answer

Atropine

Answer

Adenosine

Answer

High dose vasopressin

Question 9

In a patient presenting with an ECG that shows ST-segment elevation but with a myocardial stunning pattern that does not correspond to a single coronary artery territory, what is the most likely diagnosis?

Accepted Answer

Takotsubo cardiomyopathy

Answer

Restrictive cardiomyopathy

Answer

Brugada syndrome

Answer

Pericarditis

Question 10

Which of the following statements is true regarding Hemophilia A?

Accepted Answer

Deficiency of factor VIII

Answer

PT is typically prolonged

Answer

PTT is typically normal

Answer

Serum levels of factor VIII are increased

NEET-PG 2018 — Internal Medicine