INI-CET 2015 - Internal Medicine PYQs Practice Questions

Q: Identify the ECG given in the figure below.

Normal sinus rhythm. ***Normal sinus rhythm*** - The ECG shows regular **P waves** followed by **QRS complexes**, with a consistent PR interval and a heart rate between 60-100 beats per minute, which are all characteristics of a normal sinus rhythm. - The QRS complexes are narrow, indicating normal ventricular depolarization, and the T waves are appropriately configured. *Paroxysmal supraventricular tachycardia* - This rhythm would typically show a **very rapid heart rate** (150-250 bpm) with narrow QRS complexes and often obscured or absent P waves. - The rate in this ECG is clearly within the normal range, and P waves are distinctly visible before each QRS. *Atrial fibrillation* - Atrial fibrillation is characterized by an **irregularly irregular rhythm**, absence of distinct P waves, and an erratic baseline due to chaotic atrial activity. - This ECG clearly shows a regular rhythm with discernible P waves. *Ventricular fibrillation* - Ventricular fibrillation is a life-threatening arrhythmia characterized by completely **chaotic and irregular electrical activity** in the ventricles, resulting in no identifiable P waves, QRS complexes, or T waves. - The ECG in the image shows clearly defined, organized waveforms, making ventricular fibrillation incorrect. [Practice more Internal Medicine PYQs on OnCourse]

Q: A patient presents with neck pain and rigidity which gets relieved after bathing in hot water and exercise. Cervical X-ray is shown below. What is your diagnosis?

Spondylitis. ***Spondylitis (Ankylosing Spondylitis)*** - The image shows **fusion of vertebral bodies** (ankylosis) and an appearance consistent with a **bamboo spine**, which is characteristic of advanced **Ankylosing Spondylitis**. - The clinical presentation is pathognomonic: **inflammatory back pain with morning stiffness** that is **relieved by activity and hot water bathing** (as opposed to mechanical pain which worsens with activity). - This is a classic presentation of inflammatory spondyloarthropathy, specifically ankylosing spondylitis. *Spondylolisthesis* - This condition involves the **slippage of one vertebra over another**, which is not the primary finding on this X-ray. - While spondylolisthesis can cause neck pain, it does **not typically present with diffuse vertebral fusion** as seen here, and the pain would worsen with activity (mechanical pattern), not improve. *Spondylosis* - Spondylosis refers to **degenerative changes** of the spine, often involving **osteophytes** and **disc space narrowing**. - While some degenerative changes may be present, the pronounced fusion and **"bamboo spine" appearance** go beyond typical spondylosis and indicate an inflammatory process. - Degenerative pain typically **worsens with activity**, unlike the relief with exercise seen in this patient. *Spondyloptosis* - Spondyloptosis is an **extreme form of spondylolisthesis** where one vertebra has completely slipped off the one below it (Grade V slip). - This severe displacement is not apparent on the X-ray; instead, there is **fusion rather than translational instability**. [Practice more Internal Medicine PYQs on OnCourse]

Q: A 60-year-old hypertension patient presents with palpitations and pre-syncope. ECG was done. All drugs can be used for management of this condition except:

Adenosine. ***Adenosine*** - The ECG shows **atrial fibrillation with rapid ventricular response** and evidence of **pre-excitation** (short PR interval, delta wave), suggesting **Wolff-Parkinson-White (WPW) syndrome** complicated by atrial fibrillation. - Adenosine is **absolutely contraindicated** in AF with WPW syndrome because it causes profound AV nodal blockade, forcing all conduction down the accessory pathway, which can precipitate **life-threatening ventricular fibrillation**. - Among AV nodal blockers, **adenosine poses the greatest risk** due to its rapid, complete AV nodal blockade and is the classic teaching example of drugs to avoid in this condition. *Diltiazem* - **Calcium channel blockers** like diltiazem should generally be avoided in AF with WPW because they block the AV node and can worsen conduction via the accessory pathway, potentially leading to VF. - However, their effect is less abrupt than adenosine, making them somewhat less immediately dangerous. *Esmolol* - **Beta-blockers** like esmolol should also be avoided in AF with WPW syndrome because they block the AV node and can increase conduction through the accessory pathway. - Like calcium channel blockers, the risk is real but less catastrophic than with adenosine. *Amiodarone* - Amiodarone is a **Class III antiarrhythmic** that **can be safely used** for rhythm control in AF with WPW syndrome. - Unlike pure AV nodal blockers, it affects **both the AV node and accessory pathway**, helping to slow conduction through both routes without preferentially shunting impulses down the dangerous accessory pathway. - It is considered appropriate for pharmacological management of this condition. [Practice more Internal Medicine PYQs on OnCourse]

Question 1

Identify the ECG given in the figure below.

Accepted Answer

Normal sinus rhythm

Answer

Paroxysmal supraventricular tachycardia

Answer

Atrial fibrillation

Answer

Ventricular fibrillation

Question 2

A patient presents with neck pain and rigidity which gets relieved after bathing in hot water and exercise. Cervical X-ray is shown below. What is your diagnosis?

Accepted Answer

Spondylitis

Answer

Spondylolisthesis

Answer

Spondylosis

Answer

Spondyloptosis

Question 3

A 60-year-old hypertension patient presents with palpitations and pre-syncope. ECG was done. All drugs can be used for management of this condition except:

Accepted Answer

Adenosine

Answer

Diltiazem

Answer

Esmolol

Answer

Amiodarone

INI-CET 2015 — Internal Medicine