NEET-PG 2023 - Internal Medicine PYQs Practice Questions

Q: A 50-year-old HIV-positive patient presents with a painless, purple lesion on the skin. What is the most likely diagnosis?

Kaposi's sarcoma. ***Kaposi's sarcoma*** - The presentation of **painless, purple skin lesions** in an **HIV-positive patient** is highly characteristic of Kaposi's sarcoma. - This is a vascular tumor caused by **Human Herpesvirus 8 (HHV-8)**, often seen in immunocompromised individuals. *Malignant melanoma* - Malignant melanoma typically presents as a **dark, irregularly shaped lesion** with varying colors and often exhibits change in size, shape, or color over time (**ABCDEs of melanoma**). - While it can be purple or dark, the multiple, widespread nature and association with HIV points away from typical melanoma. *Squamous cell carcinoma* - Squamous cell carcinoma usually presents as a **red, scaly patch, nodule, or an open sore** that doesn't heal, often found in sun-exposed areas. - It is not typically described as a painless purple lesion, and while HIV patients have increased risk, the lesion morphology is more consistent with Kaposi's. *Basal cell carcinoma* - Basal cell carcinoma commonly appears as a **pearly or waxy bump**, a **flat, flesh-colored lesion**, or a **brown, scar-like lesion**, often with a rolled border and telangiectasias. - Unlike the description, it is not typically purple and painless, and while common, the clinical picture with HIV is not classic for BCC. [Practice more Internal Medicine PYQs on OnCourse]

Q: What type of murmur is most likely associated with a patient presenting with elevated JVP, large v-waves, and a loud systolic murmur?

Tricuspid regurgitation. ***Tricuspid regurgitation*** - **Elevated JVP** with prominent **v-waves** and a **loud systolic murmur** are classic findings for tricuspid regurgitation. [1] The large v-waves are due to blood regurgitating into the right atrium during ventricular systole. - The murmur is typically **holosystolic** and may increase with inspiration (Carvallo's sign). *Functional murmur* - Functional murmurs are generally **benign**, not associated with significant hemodynamic compromise, and rarely present with elevated JVP or prominent v-waves. - They are typically **soft**, early or mid-systolic, and often change intensity with position. *Tricuspid stenosis* - Tricuspid stenosis would cause an **elevated JVP**, but the prominent wave would be an **a-wave** (due to increased right atrial pressure during atrial contraction), not a v-wave. - The murmur associated with tricuspid stenosis is a **diastolic rumble**, not a systolic murmur. [3] *Pulmonary stenosis* - Pulmonary stenosis presents with a **systolic ejection murmur** at the upper left sternal border and can cause elevated JVP due to right ventricular hypertrophy and failure. [2] - However, it typically does not cause prominent **v-waves** in the JVP, as the issue is outflow obstruction from the right ventricle, not regurgitation into the right atrium. [Practice more Internal Medicine PYQs on OnCourse]

Q: A bronchial asthma patient on inhalational steroids presented with white patchy lesions on the tongue and buccal mucosa. What condition is likely to be present in this patient?

Oral candidiasis. **Oral candidiasis** - **Inhaled corticosteroids** can suppress the local immune response in the oral cavity, creating an environment conducive to the overgrowth of *Candida albicans*. - The classic presentation includes **white patchy lesions** on the tongue and buccal mucosa, which can often be scraped off. *Oral lichen planus* - Characterized by **reticular (Wickham's striae)**, papular, or erosive lesions, which are often bilateral and symmetric [1]. - While it can present with white lesions, they are typically not easily scraped off and are not primarily associated with inhaled corticosteroid use [1]. *Aphthous ulcers* - These are typically **painful, solitary, or multiple ulcers** with a red halo and a yellowish-gray center [2]. - They are distinct from widespread white patchy lesions and are not directly caused by inhaled corticosteroid use [2]. *Oral leukoplakia* - Defined as a **white patch or plaque** on the oral mucosa that cannot be characterized clinically or pathologically as any other disease, and which is not removable by scraping. - It is often associated with tobacco use and alcohol consumption, and carries a risk of malignancy; it does not typically appear as a direct side effect of inhaled corticosteroids. [Practice more Internal Medicine PYQs on OnCourse]

Q: A patient with a history of alcohol dependence syndrome presents with sudden and unintentional weight loss. What is the most likely diagnosis?

Hepatocellular carcinoma. ***Hepatocellular carcinoma*** - The **alpha-fetoprotein (AFP)** level of **600 ng/mL** is significantly elevated, suggesting a diagnosis of hepatocellular carcinoma, especially in a patient with a history of **alcohol dependence syndrome** [1]. - The **AST/ALT ratio of 0.5** indicates significant liver damage, commonly seen in chronic liver disease leading to **hepatocellular cancer**. *Alcoholic hepatitis* - Typically presents with **elevated AST and ALT**, usually with a ratio >2:1, which is not the case here [2]. - May cause weight loss, as alcoholic patients often lose weight due to self-neglect and poor dietary intake, but the **elevated AFP** is not characteristic of merely alcoholic hepatitis [3]. *Cholangiocarcinoma* - This type of cancer primarily presents with **biliary obstruction** symptoms, such as jaundice, which is not indicated here given **normal bilirubin levels**. - Does not typically lead to such high levels of **AFP**, making it less likely with the provided lab results. *Hepatic adenoma* - More commonly associated with **oral contraceptive use** or anabolic steroid use, not primarily alcohol dependence. - AFP levels are usually normal or only mildly elevated in hepatic adenoma, making this option less viable with an **AFP level of 600 ng/mL**. [Practice more Internal Medicine PYQs on OnCourse]

Q: A chronic alcoholic is brought to the emergency department with confusion, ataxia, and painful eye movements, including nystagmus. The 6th cranial nerve is also involved. What is the likely diagnosis?

Wernicke's encephalopathy. ***Wernicke's encephalopathy*** - This diagnosis aligns perfectly with the classic triad of **confusion, ataxia, and ophthalmoplegia** (manifested as painful eye movements, nystagmus, and 6th cranial nerve involvement) in the setting of chronic alcoholism [1], [2]. - It is caused by **thiamine (vitamin B1) deficiency**, common in chronic alcoholics due to malnutrition and impaired absorption [1]. *Korsakoff psychosis* - This condition is typically a **later complication** of Wernicke's encephalopathy, characterized by profound **anterograde and retrograde amnesia**, confabulation, and apathy [2]. - While an alcoholic patient might develop this, the immediate presentation with acute confusion, ataxia, and cranial nerve signs points to Wernicke's encephalopathy being the more acute and primary diagnosis in this scenario. *Delirium tremens* - This is a severe form of **alcohol withdrawal**, typically occurring 48-96 hours after the last drink, and is characterized by **global confusion, hallucinations (often visual), severe autonomic instability** (tachycardia, hypertension, fever, sweating), and seizures [3]. - While confusion is present, the specific neurological signs like ataxia and ophthalmoplegia are not typical of delirium tremens. *De Clerambault syndrome* - Also known as **erotomania**, this is a rare delusional disorder where an individual has a fixed, false belief that another person, usually of higher social status, is in love with them. - This is a **psychiatric disorder** with no relation to the neurological symptoms or alcohol-related complications described in the patient. [Practice more Internal Medicine PYQs on OnCourse]

Question 1

A 50-year-old HIV-positive patient presents with a painless, purple lesion on the skin. What is the most likely diagnosis?

Accepted Answer

Kaposi's sarcoma

Answer

Squamous cell carcinoma

Answer

Malignant melanoma

Answer

Basal cell carcinoma

Question 2

What type of murmur is most likely associated with a patient presenting with elevated JVP, large v-waves, and a loud systolic murmur?

Accepted Answer

Tricuspid regurgitation

Answer

Functional murmur

Answer

Tricuspid stenosis

Answer

Pulmonary stenosis

Question 3

A bronchial asthma patient on inhalational steroids presented with white patchy lesions on the tongue and buccal mucosa. What condition is likely to be present in this patient?

Accepted Answer

Oral candidiasis

Answer

Oral lichen planus

Answer

Aphthous ulcers

Answer

Oral leukoplakia

Question 4

A patient with a history of alcohol dependence syndrome presents with sudden and unintentional weight loss. What is the most likely diagnosis?

Accepted Answer

Hepatocellular carcinoma

Answer

Hepatic adenoma

Answer

Cholangiocarcinoma

Answer

Alcoholic hepatitis

Question 5

A chronic alcoholic is brought to the emergency department with confusion, ataxia, and painful eye movements, including nystagmus. The 6th cranial nerve is also involved. What is the likely diagnosis?

Accepted Answer

Wernicke's encephalopathy

Answer

Korsakoff psychosis

Answer

Delirium tremens

Answer

De Clerambault syndrome

Question 6

A male patient presents with sensory loss and weakness of limbs for 3 months. He also has    angular stomatitis. On examination, there is loss of proprioception, vibration sensations, UMN    type of lower limb weakness, and absent ankle reflex. What is the most probable diagnosis?

Accepted Answer

Subacute combined degeneration of cord

Answer

Extradural compression of the spinal cord

Answer

Progressive muscular atrophy

Answer

Cervical spondylotic myelopathy

Question 7

A young male came to the hospital with a clean-cut wound without any bleeding. The patient    received a full course of tetanus vaccination 10 years ago. What is the best management for    this patient?

Accepted Answer

Single-dose tetanus toxoid

Answer

Human tetanus immunoglobulin only

Answer

Human tetanus immunoglobulin and a full course of vaccine

Answer

No treatment required

Question 8

A 30-year-old male is found to be positive for HBsAg and HBeAg and is diagnosed with chronic hepatitis B. The patient's viral load is 2 × 10^5 IU/mL and ALT is elevated (2× upper limit of normal). What is the appropriate management in this patient?

Accepted Answer

Tenofovir

Answer

Combined pegylated interferon with lamivudine

Answer

Pegylated interferon

Answer

Lamivudine

Question 9

A patient hailing from Delhi presents with fever, arthralgia, and extensive petechial rash for 3    days. Lab investigations revealed a hemoglobin of 9 g/ dL, a white blood cell count of 9000    cells/mm3, a platelet count of 20000 cells/mm3, and a prolonged bleeding time. The clotting    time was normal. What is the most likely diagnosis?

Accepted Answer

Dengue

Answer

Malaria

Answer

Scrub typhus

Answer

Typhoid

Question 10

A patient presents with polyuria following total hypophysectomy. Laboratory results show Na+ levels at 155 mEq/L and urine osmolarity at 200 mOsm/L. What is the definitive management for this patient?

Accepted Answer

Lifelong DDAVP supplementation

Answer

No treatment required as receptors are upset

Answer

Thiazides for a limited duration of 2 weeks

Answer

DDAVP for a limited duration of 2 weeks

NEET-PG 2023 — Internal Medicine