FMGE 2018 - Internal Medicine PYQs Practice Questions

Q: How many blood samples should be drawn in cases of fever of unknown origin to optimize detection of intermittent bacteremia?

3. ***3*** - Drawing **three separate blood samples** significantly increases the likelihood of detecting intermittent bacteremia, as bacteria may not always be present in high concentrations in the bloodstream. - This practice maximizes the diagnostic yield while minimizing the risk of false positives from contamination. *1* - A single blood sample has a **low sensitivity** for detecting intermittent bacteremia, as transient presence of bacteria might be missed. - Relying on one sample increases the chance of a **false negative**, delaying appropriate treatment. *2* - While two samples are better than one, they still may not be sufficient to reliably detect **intermittent bacteremia** which can fluctuate. - This quantity might be acceptable for some conditions but is suboptimal for robust exclusion of **bacteremia in FUO** [1]. *4* - While four samples might slightly increase sensitivity over three, the **incremental benefit** in diagnostic yield is often negligible. - This approach adds to the **patient discomfort** and increases resource utilization without substantial additional diagnostic value. [Practice more Internal Medicine PYQs on OnCourse]

Q: Which of the following diseases is MOST likely to present with proteinuria?

Diabetic nephropathy. ***Glomerulonephritis*** [1], [2] - It is characterized by **inflammation of the glomeruli**, leading to significant **proteinuria** due to increased permeability [1]. - Commonly associated with **hematuria** and **edema**, which further supports its presence in renal pathology [1], [2]. *Polycystic kidney disease* - Mainly presents with **renal cysts** and may have **hematuria** but does not typically cause significant proteinuria early on. - Proteinuria can occur later due to renal insufficiency, but is not a hallmark feature of the disease. *Pyelonephritis* - This condition primarily causes **inflammatory changes** in the kidney due to infection, leading to **fever** and **flank pain**, rather than proteinuria. - While mild proteinuria may occur, it is usually characterized by **white blood cells** and bacteria in the urine rather than significant protein loss. *Ateriitis* - Typically refers to **inflammation of the arteries**, which does not involve kidney structures directly related to proteinuria [3]. - This condition is associated with other systemic symptoms but rarely presents with notable **urinary protein loss** [3]. [Practice more Internal Medicine PYQs on OnCourse]

Q: All of the following are features of Zollinger Ellison syndrome except:

Beta cell tumours of the pancreas. ***Beta cell tumours of the pancreas*** - Zollinger-Ellison syndrome (ZES) is caused by **gastrinomas**, which are **neuroendocrine tumors** that typically arise from the **gastrin-producing G cells**, not the insulin-producing beta cells, of the pancreas or duodenum. - While pancreatic tumors are common in ZES, they are specifically **gastrinomas**, leading to excessive gastrin secretion. *Severe diarrhoea* - This is a common feature of ZES resulting from the **high acid output** reaching the small intestine. - The excessive acid inactivates pancreatic lipase, leading to **maldigestion** and stimulates fluid and electrolyte secretion, causing secretory diarrhea. *Very high acid output* - ZES is characterized by the **overproduction of gastrin**, which stimulates the parietal cells of the stomach to secrete large amounts of **hydrochloric acid**. - This leads to a significantly **increased basal and maximal acid output** in the stomach. *Intractable peptic ulcers* - The extremely high gastric acid secretion in ZES causes **multiple, recurrent, and often refractory peptic ulcers**, which can be located in atypical sites such as the jejunum. - These ulcers are typically difficult to treat with standard anti-ulcer medications due to the persistent gastric hypersecretion. [Practice more Internal Medicine PYQs on OnCourse]

Question 1

How many blood samples should be drawn in cases of fever of unknown origin to optimize detection of intermittent bacteremia?

Accepted Answer

3

Answer

2

Answer

1

Answer

4

Question 2

Which of the following diseases is MOST likely to present with proteinuria?

Accepted Answer

Diabetic nephropathy

Answer

Aneurysms

Answer

Polycystic kidney disease

Answer

Glomerulonephritis

Question 3

Which of the following statements is true regarding von Willebrand disease?

Accepted Answer

Bleeding time is prolonged due to impaired platelet adhesion.

Answer

Factor VIII levels are always normal.

Answer

Platelet count is consistently decreased.

Answer

Activated partial thromboplastin time (aPTT) is always normal.

Question 4

All of the following are features of Zollinger Ellison syndrome except:

Accepted Answer

Beta cell tumours of the pancreas

Answer

Severe diarrhoea

Answer

Very high acid output

Answer

Intractable peptic ulcers

Question 5

Refractory Septic shock is defined as?

Accepted Answer

Shock persisting despite adequate fluid resuscitation and vasopressor support

Answer

Shock requiring mechanical ventilation and inotropic support

Answer

Shock with lactate levels >4 mmol/L despite treatment

Answer

Shock that does not respond to initial fluid bolus within 1 hour

Question 6

On ECG, ST segment elevation is seen in all of the following conditions EXCEPT:

Accepted Answer

Hypocalcemia

Answer

Acute pericarditis

Answer

Myocardial infarction

Answer

Left ventricular aneurysm

Question 7

Single heart sound (S2) is heard in:

Accepted Answer

Tetralogy of Fallot

Answer

Transposition of great vessels

Answer

Ebstein's anomaly

Answer

TAPVC

Question 8

Most common site of intracranial metastasis is from primary carcinoma of

Accepted Answer

Lungs

Answer

Testes

Answer

Stomach

Answer

Breast

Question 9

Irreversible obstructive lung function is seen in which of the following conditions?

Accepted Answer

COPD

Answer

Asthma

Answer

Pleural effusion

Answer

Kyphoscoliosis

Question 10

Syndrome of inappropriate ADH secretion is characterized by all of the following EXCEPT:-

Accepted Answer

Hypo-osmolar urine

Answer

Expanded fluid volume

Answer

Hyponatremia

Answer

Water intoxication

FMGE 2018 — Internal Medicine