Last 5 Year PYQs in Medicine for INI-CET

Q1. A 40-year-old man presents with daytime sleepiness and impaired concentration and memory. On examination, his BMI is 41 kg/m2, and his BP is 160/100 mm Hg. His awake ABG analysis is given: PaO2 = 66 mm Hg, PaCO2 = 50 mm Hg, and HCO3 = 28 mEq/L. What is the most likely diagnosis?

1. Obstructive sleep apnea
2. Narcolepsy
3. Obesity hypo-ventilation syndrome
4. Central sleep apnea

Ans. 3) Obesity hypoventilation syndrome

• OHS is defined by raised 'awake' arterial pressure of carbon dioxide levels in patients with obesity in whom alternative causes of hypercapnia and hypoventilation have been excluded.
• This is caused by obesity causing a restriction in lung filling. This causes hypoventilation.
• In this patient with hypercapnia while awake, with compensatory metabolic alkalosis, the diagnosis is likely OHS.

Also read: Last 5 Year PYQs in OBG for INI-CET

Q2. What is the antibody linked to the condition in which a 35-year-old woman experiences skin thickening, muscle weakness, pale peripheries upon cold exposure, increased creatine kinase with positive ANA, and biopsy revealing scl-70 positivity and perifascicular infiltration?

1. Anti PM scl antibody
2. Anti Jo1 antibody
3. Anti centromere antibody
4. Antinuclear antibody

Ans. 1) Anti PM scl antibody

• The likely diagnosis in this patient with skin thickening, scl positivity, and perifascicular infiltration is overlap syndrome. This overlap syndrome is characteristic of systemic sclerosis + dermatomyositis/polymyositis.
• The characteristic antibody in this scenario is the anti-PM scl antibody.

Q3. An elderly patient was brought to the OPD with complaints of tremors, stoop posture and slow movements. His son also gives a history of forgetting day-to-day activities. What is the possible cause of this condition?

1. NPH
2. Hypothyroidism
3. Lewy body
4. Vitamin B12 deficiency

Ans. 3) Lewy body

Lewy body dementia neurodegenerative disorder is clinically characterised by dementia and signs of Parkinson’s disease.

• It is generally considered a progressive condition with irreversible cognitive decline.
• Other causes of irreversible dementia:

• Alzheimer's disease.
• Vascular dementia.
• Huntington's disease.
• Creutzfeldt-Jakob disease.
• Chronic traumatic encephalopathy.

Q4. All of the following are tests done for screening in patients with Turner's syndrome, except?

1. ANA
2. Audiometry
3. Echocardiography
4. Fasting blood glucose

Ans. 1) (Antinuclear antibody) test

• The ANA test is not typically performed as part of Turner mosaic screening. ANA testing is primarily used to help diagnose autoimmune conditions such as systemic lupus erythematosus (SLE) or other connective tissue diseases.

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Q5. What immunological abnormality is observed due to the absence of CD40 in B cells?

1. Total lack of NK cells
2. Lack of CD8-mediated cytotoxicity
3. Decreased IgG and increase in IgM
4. Inability of neutrophil to act against infections

Ans. 3) Decreased IgG and increase in IgM

• Hyper IgM syndrome is a rare B cell primary immunodeficiency disorder characterized by defective Ig CSR.
• It results in very low serum levels of IgG and IgA and elevated or normal serum IgM levels.
• The lack of CD40 in B cells results in decreased IgG and IgA production, and an increase in IgM production, which leads to an immunological abnormality characterized by a decreased ability to mount an effective immune response against infections.

Q6. What recommendations would you give to a diabetic patient with a fasting blood glucose level of 160 mg/dL in terms of non-pharmacological management?

1. At least 80 mg of dietary fibre
2. <5 g sodium intake every day
3. <30% of the calories should come from fat
4. Cholesterol <100 mg

Ans. 3) <30% of the calories should come from fat

Explanation:

• Dietary fat intake plays a crucial role in managing blood glucose levels in diabetic patients. Consuming a diet where less than 30% of the total calories come from fat helps in controlling blood sugar levels and reducing the risk of cardiovascular complications.
• It's essential for diabetic patients to focus on healthy fats such as monounsaturated and polyunsaturated fats while limiting saturated and trans fats.
• Lowering fat intake can also aid in weight management, which is important for overall glycemic control in diabetic individuals.

Q7.  A chronic cigarette smoker has now joined a construction company. His pulmonary function test results are given below. What is the most likely diagnosis for this patient?

Initial lung volumes were:

• FEV1-0.9L
• FVC-1.9L
• FEV1/FVC-0.4

After bronchodilation:

• FEV1-1.9L
• FVC-3.9L
• FEV1/FVC-0.4

1. Vascular disease with bronchodilator reversibility
2. Restrictive lung disease with bronchodilator reversibility
3. Restrictive lung disease without bronchodilator reversibility
4. Obstructive disease with bronchodilator reversibility

Ans. 4) Obstructive disease with bronchodilator reversibility

• In people with asthma or chronic obstructive pulmonary disease (COPD), a bronchodilator reversibility test is commonly used. The purpose of the test is to determine whether the subject's airflow has improved as a result of taking the bronchodilator medication. The given pulmonary function test results indicate a diagnosis of obstructive lung disease with bronchodilator reversibility, as the FEV1/FVC is less than 0.7 so it is an obstructive disease and after bronchodilation there is an increase of >12% in FEV1, hence it is reversible. Improved lung volumes after bronchodilation indicate a response to the bronchodilator, which is a feature of COPD.

Also read: Last 5 Year PYQs in ENT for INI-CET

Q8. Which of the following is not a first-line drug for the management of a patient with rheumatoid arthritis?

1. Sulfasalazine
2. Hydroxychloroquine
3. Methotrexate
4. Azathioprine

Ans. 4) Azathioprine

• Azathioprine is not considered a first-line drug for the management of rheumatoid arthritis (RA). It is primarily used as an immunosuppressant in organ transplantation and certain autoimmune conditions but is not typically recommended as an initial treatment for RA due to it’s inconsistent efficacy and high toxicity.

Q9. Mark the correct statement regarding inflammatory bowel disease.

1. Skip lesions are present in Crohn’s disease
2. Mucosal layers are involved in Crohn's, while transmural involvement seen in ulcerative colitis
3. Inflammatory bowel disease doesn’t have a genetic predisposition
4. Crohn’s is curable through surgical resection of the affected segment

Ans. 1) Skip lesions are present in Crohn’s disease

• Skip lesions refer to the characteristic feature of Crohn's disease where there are areas of inflammation that are separated by normal or unaffected segments of the bowel. This pattern of involvement is not seen in ulcerative colitis. Skip lesions can occur throughout the entire gastrointestinal tract, from the mouth to the anus, in Crohn's disease.

Q10. A patient arrives at the hospital with symptoms of fever and chills. A fever profile test is conducted, which rules out malaria and dengue as the cause. However, the rK39 test comes back positive. What is the preferred treatment for this condition?

1. Amphotericin B
2. Griseofulvin
3. Dapsone
4. Hydroxychloroquine

Ans. 1) Amphotericin B

• The given scenario is suggestive of Kala azar, and Amphotericin B is the drug of choice. K39 is an epitope present on amastigotes of Leishmania spp that cause visceral leishmaniasis. Dipstick tests that test for the recombinant K39(rK39) protein are available for the rapid diagnosis of Kala Azar.
• Amphotericin B is the correct answer for the treatment of visceral leishmaniasis (kala-azar). Visceral leishmaniasis is caused by the parasite Leishmania donovani and is transmitted by sandflies. Amphotericin B is the treatment of choice for this disease due to its high efficacy against Leishmania parasites.

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Q11. For hairy cell leukemia, which drug is considered the preferred choice?

1. Rituximab
2. Vemurafenib
3. Cladribine
4. Interferon-alpha

Ans. 3) Cladribine

• Cladribine (also known as 2-chlorodeoxyadenosine or 2-CdA) is a purine analog chemotherapy drug that has shown high efficacy in the treatment of hairy cell leukemia.
• It is considered the drug of choice for HCL because it achieves high response rates and durable remissions in most patients.
• Deoxycoformycin is also shown to have a good remission rate.

Q12. Following is a graphic representation of a patient admitted in the medicine ward with a fever. What could be the possible diagnosis?

1. Cerebral malaria
2. Brucellosis
3. Leptospirosis
4. Typhoid

Ans. 3) Leptospirosis

• Leptospirosis is a bacterial infection caused by the bacteria of the genus Leptospira. It is commonly transmitted to humans through contact with water, soil, or food contaminated with the urine of infected animals. Leptospirosis can present with symptoms such as fever, headache, and muscle ache and can progress to more severe manifestations, including liver and kidney involvement. 
• The graphical representation in the vignette gives us the following information:

• Over time, this disease can lead to complications such as uveitis and interstitial nephritis.
• CSF is a reservoir for the causative organism and it is shed through urine.
• These findings point towards a diagnosis of leptospirosis.

Q13. Which of the following statements correctly describes an ideal candidate for a renal graft transplant in a patient with diabetic nephropathy?

1. The survival rate of graft is 95% in the first year
2. The transplantation is cost effective after the second transplant year
3. The life expectancy is doubled in a diabetic patient with renal transplant
4. The treatment of chronic rejection has improved over the last 10 years

Ans. 2) The transplantation is cost-effective after the second transplant year:

• Renal transplantation is considered the treatment of choice for end-stage renal disease (ESRD) in patients with diabetic nephropathy with eGFR <20 ml/min.

Also read: Last 5 Years PYQs in Physiology for NEET PG

Q14. A diabetic patient walks into your clinic and does "namaste.". The image is given below. What could be the probable cause?

1. Flexor tenosynovitis
2. Cheiroarthropathy
3. Dupuytrens contracture
4. Ankyloses

Ans. 2) Cheiroarthropathy

• Cheiroarthropathy is thought to be related to long-standing poor glycemic control and the accumulation of advanced glycation end-products (AGEs) in the skin and soft tissues.
• This condition can cause difficulty in fully extending the fingers, leading to a characteristic hand posture resembling the "namaste" gesture.

Q15. Which of the following is false about Mycoplasma pneumoniae?

1. Responds well to amoxiclav
2. Antibodies are useful in diagnosis
3. Chest X-ray shows bilateral infiltrates
4. Can be cultured in a cell-free medium

Ans. 1) Responds well to amoxiclav

• Mycoplasma pneumonia is caused by the bacterium Mycoplasma pneumoniae, and it is typically treated with antibiotics such as macrolides (e.g., azithromycin) or tetracyclines (e.g., doxycycline). Amoxiclav, which is a combination of amoxicillin and clavulanic acid, is not considered a first-line treatment for Mycoplasma pneumonia. Therefore, the statement that Mycoplasma pneumonia responds well to amoxiclav is false.

Q16. What is not a characteristic feature of Wilson's disease?

1. Autosomal recessive disease
2. No free radical injury
3. ATP7B gene involved
4. Presents before age 40 with liver disease

Ans. 2) No Free radical injury

• This statement is incorrect. Free radical injury due to an excess of copper ions is seen in patients with Wilson's disease.

Also read: Last 5 Year PYQs in Medicine for NEET PG

Q17. In a patient with HIV, the incorrect statement regarding prophylaxis for various organisms is:

• PCP-Pneumocystis pneumonia

1. MAC-Mycobacterium avium complex
2. Prophylaxis for PCP is indicated when CD4 count is <200 cells/µL
3. Stop prophylaxis for Coccidioides if CD4 count is >250 cells/µL for 6 months
4. Prophylaxis for MAC is indicated when CD4 count is <50 cells/µL.
5. Prophylaxis for cryptococcus is indicated when CD4 count is >150 cells/µL

Ans. 4) Prophylaxis for cryptococcus is indicated when CD4 count is >150 cells/µL

• Prophylaxis for cryptococcus is indicated when CD4 count is >150 cells/µL: This statement is incorrect. Prophylaxis for cryptococcal meningitis is indicated in HIV patients with a CD4 count below 100 cells/µL, not >150 cells/µL. Cryptococcus is an opportunistic fungal infection commonly seen in individuals with advanced HIV disease.

Q18. Match the following?

a. Trisomy 13	1. Huntington disease
b. Trisomy 18	2. Patau syndrome
c. Trinucleotide repeat sequence	3. Sickle disease
d. Hb point mutation of glutamate to valine	4. Edward syndrome

1. a2-b4-c1-d3
2. b1-a3-d2-c4
3. a2-b1-c4-d3
4. a4-b1-c3-d2

Ans. 1) a2-b4-c1-d3

a. Trisomy 13	2. Patau syndrome
b. Trisomy 18	4. Edward syndrome
c. Trinucleotide repeat sequence	1. Huntington disease
d. Hb point mutation of glutamate to valine	3. Sickle disease

Also read: NEET PG Previous Year Question Papers of Last 7 Years

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