NEET-PG 2012 - Internal Medicine PYQs Practice Questions

Q: Haemoglobin F is raised in which condition?

Juvenile chronic myeloid leukemia. ***Juvenile chronic myeloid leukemia*** - This condition is characterized by a high proportion of **fetal hemoglobin (HbF)**, often exceeding 50%, alongside other typical myeloproliferative features. - The elevated HbF is a distinguishing feature of **juvenile CML** from adult CML, which typically presents with normal or only slightly elevated HbF levels. *Beta-thalassemia major* - While patients with **beta-thalassemia major** can have elevated HbF, it is typically in response to a severe deficiency in beta-globin chain production, leading to compensatory gamma-chain synthesis. - However, the primary genetic defect lies in the beta-globin genes, and the HbF increase is usually not as universally high or definitive as in HPFH or juvenile CML. *Sickle cell disease* - Patients with **sickle cell disease** can have variable levels of HbF, and higher levels are associated with a milder disease course [1]. - HbF acts as a protective factor by inhibiting hemoglobin S polymerization, but the presence of high HbF is not a diagnostic marker in the same way it is for HPFH or juvenile CML [1]. *Hereditary persistence of fetal hemoglobin (HPFH)* - This is a benign condition characterized by the **continued production of high levels of HbF into adulthood** due to genetic mutations that prevent the normal developmental switch from gamma-globin to beta-globin synthesis. - While it features significantly raised HbF, HPFH is typically **asymptomatic** and does not present with the myeloproliferative features seen in juvenile CML. [Practice more Internal Medicine PYQs on OnCourse]

Q: All are seen in pheochromocytoma except which of the following?

Hypotension. ***Hypotension*** - Pheochromocytoma is characterized by the **overproduction of catecholamines** (epinephrine and norepinephrine), which typically cause **hypertension** rather than hypotension. - The classic symptoms of pheochromocytoma, often described as the "5 Ps," are **pain (headache)**, **palpitations**, **perspiration**, **pallor**, and **paroxysmal hypertension**. *Headaches* - **Severe, throbbing headaches** are a very common symptom in pheochromocytoma due to the **vasospastic effects** of high circulating catecholamines. - These headaches are often sudden in onset and can be debilitating. *Weight loss* - The **hypermetabolic state** induced by excessive catecholamines can lead to **increased caloric expenditure** and subsequently, **weight loss**. - Catecholamines increase **basal metabolic rate** and breakdown of fat stores. *Sweating attacks* - **Diaphoresis** or profuse sweating attacks are a hallmark symptom, caused by **sympathetic nervous system activation** due to high catecholamine levels. - These attacks are often paroxysmal and can be accompanied by an exacerbation of other symptoms. [Practice more Internal Medicine PYQs on OnCourse]

Q: Which of the following is the most characteristic symptom of obstruction of the inferior vena cava?

Paraumblical dilatation. ***Paraumbilical dilatation*** - Obstruction of the **inferior vena cava (IVC)** leads to collateral circulation through superficial veins, especially around the umbilicus, causing **paraumbilical dilatation** (caput medusae). - This collateral flow bypasses the obstructed IVC to return blood to the superior vena cava system. *Thoraco-epigastric dilatation* - This pattern of collateral circulation is more characteristic of **superior vena cava (SVC) obstruction**, where blood from the upper body needs to bypass the SVC. - The dilated veins would typically be seen on the chest and upper abdomen, draining towards the femoral veins. *Oesophageal varices* - **Oesophageal varices** are typically caused by **portal hypertension** [1], often secondary to liver cirrhosis, not directly by IVC obstruction. - They represent portosystemic collateral veins, diverging from the portal system to the systemic circulation [1]. *Haemorrhoids* - **Haemorrhoids** are dilated veins in the anal canal, most commonly caused by **straining** during defecation or conditions that increase intra-abdominal pressure [2]. - While they can be a sign of portal hypertension [1], **IVC obstruction** is not their primary or most characteristic cause. [Practice more Internal Medicine PYQs on OnCourse]

Q: All of the following statements about the third heart sound (S3) are true, except:

Seen in Constrictive Pericarditis. ***Seen in Constrictive Pericarditis*** - While constrictive pericarditis can lead to a diastolic sound, it's typically a **pericardial knock**, which is sharper and occurs earlier than an S3, due to abrupt halting of ventricular filling. - A true S3 is a low-pitched sound caused by turbulent blood flow into an overly compliant or volume-overloaded ventricle, which is not the primary mechanism in constrictive pericarditis. *Occurs due to rapid filling of the ventricles during early diastole.* - The S3 heart sound is precisely caused by the **rapid inflow of blood** into a dilated or poorly compliant ventricle during the early, rapid filling phase of diastole [1]. - This rapid distension causes vibrations in the ventricular wall, audible as S3, and is often associated with conditions causing **volume overload** or **ventricular dysfunction**. *Seen in Atrial Septal Defect (ASD)* - Patients with a large ASD have increased blood flow through the tricuspid valve, leading to **right ventricular volume overload** [2]. - This increased volume can cause an **S3** sound, particularly a **right ventricular S3**, due to rapid filling of the overloaded right ventricle [2]. *Seen in Ventricular Septal Defect (VSD)* - A significant VSD leads to a **left-to-right shunt**, increasing blood flow to the pulmonary circulation and subsequently returning to the left atrium and left ventricle. - This **left ventricular volume overload** can result in an audible **left ventricular S3**, reflecting rapid filling of the dilated left ventricle. [Practice more Internal Medicine PYQs on OnCourse]

Q: Progressive distal-to-proximal motor recovery following nerve regeneration is most characteristic of which type of nerve injury?

Axonotmesis. ***Axonotmesis*** - Involves damage to the **axon** and myelin sheath, while the surrounding **epineurium** remains intact. - This preservation of the connective tissue allows for guided **regeneration** of axons from distal to proximal, leading to a good prognosis for recovery [1]. *Neurotmesis* - Refers to the **complete transection** of the nerve, including the axon, myelin, and all connective tissue sheaths. - Recovery is often **incomplete** or requires surgical repair, as significant misdirection of regenerating axons is common. *Neuropraxia* - Characterized by a **temporary block** in nerve conduction, typically due to **demyelination**, with the axon remaining intact. - Recovery is usually **rapid** and complete, occurring within days to weeks, as no axonal regeneration is needed. *Nerve injury* - This is a **general term** that encompasses all types of nerve damage, from mild to severe. - It does not specify a particular mechanism or pattern of recovery, making it less precise than the more specific classifications. [Practice more Internal Medicine PYQs on OnCourse]

Question 1

Haemoglobin F is raised in which condition?

Accepted Answer

Juvenile chronic myeloid leukemia

Answer

Hereditary persistence of fetal hemoglobin (HPFH)

Answer

Beta-thalassemia major

Answer

Sickle cell disease

Question 2

All are seen in pheochromocytoma except which of the following?

Accepted Answer

Hypotension

Answer

Headaches

Answer

Weight loss

Answer

Sweating attacks

Question 3

Which of the following is the most characteristic symptom of obstruction of the inferior vena cava?

Accepted Answer

Paraumblical dilatation

Answer

Thoraco-epigastric dilatation

Answer

Haemorrhoides

Answer

Oesophageal varices

Question 4

All of the following statements about the third heart sound (S3) are true, except:

Accepted Answer

Seen in Constrictive Pericarditis

Answer

Seen in Atrial Septal Defect (ASD)

Answer

Seen in Ventricular Septal Defect (VSD)

Answer

Occurs due to rapid filling of the ventricles during early diastole.

Question 5

Progressive distal-to-proximal motor recovery following nerve regeneration is most characteristic of which type of nerve injury?

Accepted Answer

Axonotmesis

Answer

Neurotmesis

Answer

Neuropraxia

Answer

Nerve injury

Question 6

Which of the following complications is commonly associated with mitral valve prolapse?

Accepted Answer

Infective endocarditis

Answer

Ventricular arrhythmia

Answer

Stroke

Answer

Mitral stenosis

Question 7

Which of the following is an acquired condition?

Accepted Answer

Mastitis

Answer

Polymastia (supernumerary breasts)

Answer

Polythelia (extra nipples)

Answer

Amastia (absence of breast tissue)

Question 8

In which condition is venous blood most commonly observed to have a high hematocrit in routine clinical practice?

Accepted Answer

Dehydration

Answer

Anemia

Answer

Hypervolemia

Answer

Acute blood loss

Question 9

Renal vein thrombosis is associated with all of the following conditions except:

Accepted Answer

Trauma

Answer

Nephrotic syndrome

Answer

Dehydration

Answer

Sickle cell anemia

Question 10

Which type of fatty acids should be included in the diet to manage chyluria?

Accepted Answer

Medium-chain fatty acids

Answer

Short-chain fatty acids

Answer

Long-chain fatty acids

Answer

Omega-3 fatty acids

NEET-PG 2012 — Internal Medicine