Free NEET PG & INI-CET General Medicine MCQs

Explanation

ST elevation in II, III and aVF indicates an inferior-wall MI, usually from right coronary artery occlusion. Right ventricular involvement should be checked, as nitrates can cause hypotension in that setting.

Explanation

Hyperkalaemia produces peaked T waves, then PR prolongation, QRS widening and eventually a sine-wave pattern. Intravenous calcium gluconate stabilises the myocardium while insulin-dextrose and salbutamol shift potassium intracellularly.

Explanation

The modified Duke criteria combine major criteria, such as positive blood cultures and echocardiographic evidence of endocardial involvement, with minor criteria to diagnose infective endocarditis.

Explanation

The revised Jones criteria diagnose acute rheumatic fever, with major criteria including carditis, migratory polyarthritis, Sydenham chorea, erythema marginatum and subcutaneous nodules, plus evidence of preceding streptococcal infection.

Explanation

Atrial fibrillation shows an irregularly irregular rhythm with absent P waves and a fibrillating baseline. Management addresses rate or rhythm control and stroke prevention with anticoagulation guided by CHA2DS2-VASc.

Explanation

BNP, or NT-proBNP, is released from ventricular myocardium under wall stress and is raised in heart failure. It aids diagnosis in breathless patients and correlates with severity.

Explanation

Beck's triad is hypotension, muffled heart sounds and raised JVP. Tamponade also shows pulsus paradoxus. Echocardiography confirms the effusion and pericardiocentesis is the emergency treatment.

Explanation

In younger patients, under 55, ACE inhibitors or ARBs are typically first-line because renin-driven hypertension predominates. Calcium channel blockers or thiazides are preferred first in older patients.

Explanation

The triad of hyperglycaemia, ketosis and high anion-gap metabolic acidosis defines DKA. Management is intravenous fluids, an insulin infusion and careful potassium replacement while treating the precipitating cause.

Explanation

An HbA1c of 6.5%, or 48 mmol/mol, or higher is diagnostic of diabetes. The range 5.7 to 6.4% indicates prediabetes. HbA1c reflects average glycaemia over the preceding two to three months.

Explanation

Hashimoto, or autoimmune, thyroiditis with anti-thyroid peroxidase antibodies is the leading cause of hypothyroidism in iodine-sufficient regions. It shows a raised TSH with low free T4.

Explanation

Ophthalmopathy and pretibial myxoedema are specific to Graves disease, an autoimmune condition driven by TSH-receptor stimulating antibodies. Weight loss, tachycardia and tremor are common to all hyperthyroid states.

Explanation

Screening for Cushing syndrome uses the overnight, low-dose dexamethasone suppression test, late-night salivary cortisol or 24-hour urinary free cortisol. Failure to suppress cortisol suggests Cushing syndrome, after which ACTH helps localise the cause.

Explanation

Addison disease causes cortisol and aldosterone deficiency, producing hyponatraemia, hyperkalaemia, hypotension and hyperpigmentation from raised ACTH. The short Synacthen test confirms the diagnosis.

Explanation

The intensive phase for new tuberculosis uses isoniazid, rifampicin, pyrazinamide and ethambutol for two months, followed by isoniazid and rifampicin in the continuation phase. Directly observed therapy improves adherence.

Explanation

Intravenous artesunate is first-line for severe falciparum malaria and is superior to quinine. Uncomplicated falciparum malaria is treated with artemisinin-based combination therapy, and primaquine clears vivax hypnozoites.

Explanation

Severe dengue features plasma leakage, shown by rising haematocrit, falling platelets, effusions and ascites, along with bleeding and organ impairment. Careful fluid management is central; there is no specific antiviral.

Explanation

Salmonella enterica serotype Typhi causes typhoid fever, presenting with stepwise fever, relative bradycardia, rose spots and splenomegaly. Blood culture is diagnostic, and ceftriaxone or azithromycin are commonly used.

Explanation

A CD4 count below 200 cells per microlitre defines AIDS and indicates prophylaxis against Pneumocystis jirovecii pneumonia with cotrimoxazole. Below 50, additional prophylaxis such as against Mycobacterium avium complex is considered.

Explanation

Adjunctive dexamethasone reduces mortality and neurological sequelae, particularly hearing loss in pneumococcal meningitis, when given with or just before the first antibiotic dose. Empiric antibiotics should not be delayed for imaging.

Explanation

Weil disease, or severe leptospirosis, presents with fever, jaundice, conjunctival suffusion, myalgia and renal failure after water or animal exposure. Doxycycline or penicillin is used, and severe cases need supportive care.

Explanation

The anterior cerebral artery supplies the medial motor cortex representing the leg, so its occlusion causes contralateral leg-predominant weakness. Middle cerebral artery strokes cause arm and face-predominant deficits.

Explanation

Multiple sclerosis is characterised by central nervous system demyelination disseminated in time and space, with CSF oligoclonal bands. MRI and the McDonald criteria support the diagnosis.

Explanation

Guillain-Barre syndrome is an acute inflammatory demyelinating polyneuropathy, often post-infectious, for example after Campylobacter. CSF shows albuminocytological dissociation, meaning high protein with normal cells. Treatment is IVIG or plasma exchange.

Explanation

Myasthenia gravis is caused by antibodies against the postsynaptic acetylcholine receptor, producing fatiguable weakness such as ptosis and diplopia. It is associated with thymic abnormalities, and acetylcholinesterase inhibitors improve symptoms.

Explanation

Parkinson disease features bradykinesia, cogwheel rigidity and a resting pill-rolling tremor, from dopamine loss in the substantia nigra. Levodopa is the mainstay of treatment.

Explanation

Intravenous lorazepam is first-line for status epilepticus. If seizures persist, phenytoin, fosphenytoin or valproate follow. Prolonged seizures cause neuronal injury, so prompt treatment is essential.

Explanation

COPD is defined by persistent, not fully reversible airflow limitation, with a post-bronchodilator FEV1/FVC below 0.70, usually from smoking. Asthma is characteristically reversible.

Explanation

CURB-65, covering Confusion, Urea, Respiratory rate, Blood pressure and age 65 or over, grades pneumonia severity and guides the decision on inpatient versus outpatient care.

Explanation

CT pulmonary angiography is the definitive imaging test for pulmonary embolism. D-dimer is useful to exclude PE in low-probability cases but is not confirmatory. The Wells score guides the pathway.

Explanation

Short-acting beta-2 agonists such as salbutamol provide rapid bronchodilation for acute symptoms. Inhaled corticosteroids are the preventer therapy addressing underlying inflammation.

Explanation

Light's criteria classify a pleural effusion as an exudate if the pleural to serum protein ratio exceeds 0.5, the pleural to serum LDH ratio exceeds 0.6, or pleural LDH exceeds two-thirds of the upper serum limit. Exudates suggest infection, malignancy or inflammation.

Explanation

Triple therapy with a proton pump inhibitor plus two antibiotics, commonly amoxicillin and clarithromycin, eradicates H. pylori. Successful eradication heals ulcers and reduces recurrence.

Explanation

The Child-Pugh score, using bilirubin, albumin, INR, ascites and encephalopathy, grades cirrhosis severity and prognosis. The MELD score is also used, particularly for transplant prioritisation.

Explanation

Crohn disease shows discontinuous skip lesions with transmural inflammation anywhere from mouth to anus, along with granulomas. Ulcerative colitis causes continuous mucosal inflammation starting from the rectum.

Explanation

Gallstones and alcohol account for most acute pancreatitis. Diagnosis needs two of characteristic pain, amylase or lipase over three times normal, or imaging evidence. Lipase is more specific than amylase.

Explanation

Pre-renal AKI from hypovolaemia shows avid sodium and water retention: concentrated urine with high osmolality and a fractional excretion of sodium below 1%. In acute tubular necrosis the tubules cannot conserve sodium, so it exceeds 2%.

Explanation

Emergency dialysis indications, remembered as AEIOU, include severe Acidosis, Electrolyte disturbance such as refractory hyperkalaemia, Intoxication, fluid Overload with pulmonary oedema, and Uraemic complications such as pericarditis or encephalopathy.

Explanation

Post-streptococcal glomerulonephritis presents one to three weeks after streptococcal infection with a nephritic picture of haematuria, red-cell casts, hypertension and oedema, with low complement C3 and a raised ASO titre.

Explanation

Anti-CCP antibodies are highly specific for rheumatoid arthritis and predict erosive disease. Rheumatoid factor is sensitive but less specific. RA typically causes symmetrical small-joint synovitis with morning stiffness.

Explanation

Anti-dsDNA antibodies are specific for SLE and their titres correlate with disease activity, especially lupus nephritis. Anti-Smith is also specific. ANA is sensitive but not specific.

Explanation

Gout is confirmed by needle-shaped, negatively birefringent monosodium urate crystals in joint fluid. Pseudogout shows rhomboid, positively birefringent calcium pyrophosphate crystals.

Explanation

A low MCV defines microcytic anaemia, most commonly iron deficiency, followed by thalassaemia and anaemia of chronic disease. A high MCV indicates macrocytic anaemia, for example from B12 or folate deficiency.

Explanation

Pernicious anaemia is autoimmune destruction of gastric parietal cells causing intrinsic factor loss and B12 deficiency, with megaloblastic anaemia and subacute combined degeneration of the cord. Folate deficiency lacks neurological signs.

Explanation

Acute sickle cell crises are managed with analgesia, hydration, oxygen and treating precipitants such as infection. Hydroxyurea reduces crisis frequency by raising fetal haemoglobin.

Explanation

The JAK2 V617F mutation is present in the majority of polycythaemia vera cases and in many with essential thrombocythaemia and primary myelofibrosis. It causes constitutive activation of erythropoietin signalling.

Explanation

Immune thrombocytopenic purpura causes isolated thrombocytopenia from antibody-mediated platelet destruction, often after a viral illness. The rest of the blood count is normal, and first-line treatment is corticosteroids or IVIG.

Explanation

Haemophilia A is an X-linked deficiency of factor VIII, causing a prolonged aPTT with normal PT and bleeding into joints and muscles. Haemophilia B, or Christmas disease, is factor IX deficiency.

Explanation

Multiple myeloma features the CRAB criteria of hyperCalcaemia, Renal impairment, Anaemia and Bone lesions, with a monoclonal paraprotein and Bence-Jones protein in urine. Marrow shows excess plasma cells.

Explanation

Febrile non-haemolytic transfusion reactions, caused by cytokines and recipient antibodies against donor leukocytes, are the most common reaction. They are treated with antipyretics, and leukoreduction reduces their frequency.