Antibodies most commonly seen in drug induced lupus are:
Which of the following is a characteristic feature of Crohn's disease?
What is a feature of short bowel syndrome?
In a patient with acute cholecystitis, referred pain to the shoulder is known as
In Marfan's syndrome, Aortic aneurysm occurs most commonly in:
Distal renal tubular acidosis is associated with:
What is the preferred test for confirming H. pylori eradication?
Anomic aphasia is due to defect in
Which of the following is a characteristic feature of myasthenia gravis?
All the following are true about multiple myeloma except for which of the following?
NEET-PG 2012 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 81: Antibodies most commonly seen in drug induced lupus are:
- A. Anti ds DNA Antibodies
- B. Anti Sm Antibodies
- C. Anti-Ro Antibodies
- D. Antihistone Antibodies (Correct Answer)
Explanation: ***Antihistone Antibodies*** - **Antihistone antibodies** are the most common laboratory finding, present in 95% of patients with **drug-induced lupus erythematosus (DIL)**. - This type of lupus is often triggered by medications such as **procainamide**, **hydralazine**, and **isoniazid**. *Anti ds DNA Antibodies* - **Anti-double-stranded DNA (dsDNA) antibodies** are highly specific for **systemic lupus erythematosus (SLE)**, particularly severe cases, but are rarely seen in DIL. - High titers of anti-dsDNA often correlate with **lupus nephritis** and disease activity. *Anti Sm Antibodies* - **Anti-Sm antibodies** are highly specific for **SLE**, sometimes associated with neuropsychiatric manifestations, but are rarely identified in drug-induced lupus. - Their presence helps to confirm the diagnosis of SLE but not DIL. *Anti-Ro Antibodies* - **Anti-Ro (SSA) antibodies** are most commonly associated with **Sjögren's syndrome** and **neonatal lupus**, and can be seen in a subset of SLE patients, especially those with photosensitivity. - While they can be present in some forms of SLE, they are not the hallmark autoantibody for drug-induced lupus.
Question 82: Which of the following is a characteristic feature of Crohn's disease?
- A. Sinus & fistula (Correct Answer)
- B. Mesenteric lymphadenitis
- C. Continuous involvement
- D. Crypt abscesses
Explanation: ***Sinus & fistula*** - **Transmural inflammation**, a hallmark of Crohn's disease, can extend through the bowel wall, leading to the formation of **sinus tracts** and **fistulae** (abnormal connections between organs or to the skin). [1] - These complications include enteroenteric, enterovesical, and perianal fistulae, which are highly characteristic of Crohn's. [1] *Continuous involvement* - Crohn's disease is characterized by **skip lesions**, meaning there are healthy segments of bowel interspersed with diseased segments, not continuous involvement. [1] - **Ulcerative colitis** typically presents with continuous inflammation, starting from the rectum and extending proximally. [1] *Mesenteric lymphadenitis* - While mesenteric lymph nodes can be involved in Crohn's disease due to inflammation, **mesenteric lymphadenitis** is more commonly associated with infectious etiologies or other inflammatory conditions, and not a primary defining characteristic. - It refers to inflammation of lymph nodes in the mesentery, which can cause abdominal pain but does not specifically differentiate Crohn's from other conditions. *Crypt abscesses* - **Crypt abscesses** are a characteristic histological feature of **ulcerative colitis**, where neutrophils infiltrate the glandular crypts. [1] - While they can occasionally be seen in Crohn's, they are much more common and prominent in ulcerative colitis and are not a defining feature of Crohn's.
Question 83: What is a feature of short bowel syndrome?
- A. Hypergastrinemia & high gastric secretion is seen
- B. Diarrhea, dehydration and malnutrition
- C. Chronic TPN dependence
- D. Malabsorption leading to diarrhea, dehydration, and malnutrition. (Correct Answer)
Explanation: ***Malabsorption leading to diarrhea, dehydration, and malnutrition.*** [1], [2] - The primary characteristic of short bowel syndrome is **reduced intestinal surface area**, leading to inadequate absorption of nutrients, water, and electrolytes [1]. - This malabsorption manifests as **chronic diarrhea**, which can cause significant **dehydration** and **malnutrition** due to nutrient deficiencies [2]. *Diarrhea, dehydration and malnutrition* - While these are prominent symptoms, they are consequences of the underlying **malabsorption**, which is the fundamental process. - This option describes symptoms but doesn't fully explain the root physiological mechanism as comprehensively as the correct answer. *Chronic TPN dependence* - **Total Parenteral Nutrition (TPN)** dependence can be a severe consequence for patients with very short or severely damaged bowel segments, but it is not a feature inherent to all cases of short bowel syndrome. - Many patients can manage with oral or enteral nutrition, especially if a significant portion of the small bowel remains functional. *Hypergastrinemia & high gastric secretion is seen* - This can occur in certain cases of short bowel syndrome, particularly if there is a loss of the **duodenum** (which normally inhibits gastrin release) or if there's extensive ileal resection. - However, it's not a universal or defining feature for all patients and is secondary to the primary problem of malabsorption.
Question 84: In a patient with acute cholecystitis, referred pain to the shoulder is known as
- A. Murphy's sign
- B. Gray Turner sign
- C. Boas' sign (Correct Answer)
- D. Cullen's sign
Explanation: ***Boas' sign*** - **Boas' sign** refers to the presence of hyperesthesia below the right scapula, which can also manifest as referred pain to the **right shoulder** or back [1]. - This symptom in acute cholecystitis is due to the **irritation** of the **phrenic nerve**, which shares sensory pathways with the shoulder region. *Murphy's sign* - **Murphy's sign** is elicited by asking the patient to exhale, then placing the examiner's hand below the costal margin on the right mid-clavicular line, and then asking the patient to inhale deeply [1]. - A positive sign is indicated by a sudden cessation of inspiration due to pain, which is specific for **acute cholecystitis** and not referred shoulder pain [1]. *Gray Turner sign* - The **Gray Turner sign** involves ecchymosis or discoloration of the flanks. - It is a severe indicator of **retroperitoneal hemorrhage**, often associated with acute pancreatitis, not cholecystitis [2]. *Cullen's sign* - **Cullen's sign** presents as periumbilical ecchymosis or discoloration around the navel. - This sign is also indicative of **retroperitoneal hemorrhage**, typically seen in serious conditions like ruptured ectopic pregnancy or acute pancreatitis.
Question 85: In Marfan's syndrome, Aortic aneurysm occurs most commonly in:
- A. Ascending aorta (Correct Answer)
- B. Descending aorta
- C. Abdominal aorta
- D. Arch of aorta
Explanation: ***Ascending aorta*** - The **ascending aorta** is the most common site for aortic aneurysm and dissection in Marfan syndrome due to cystic medial degeneration weakening the vessel wall [1]. - This predisposition is linked to defects in the **fibrillin-1 gene (FBN1)**, severely impacting the structural integrity of the arterial media primarily in the ascending aorta [1]. *Descending aorta* - While possible, **descending aortic** involvement is less common than ascending aortic involvement in Marfan syndrome [2]. - Aneurysms here are more frequently associated with atherosclerosis or other connective tissue disorders. *Abdominal aorta* - **Abdominal aortic aneurysms** are relatively rare in Marfan syndrome and are more typically seen in older patients with atherosclerosis [3]. - The disease primarily affects the elastic tissue content, which is most abundant in the proximal aorta. *Arch of aorta* - Aortic arch aneurysms can occur, but they are still less frequent than those in the **ascending aorta** as the primary initial site of dilation and dissection in Marfan syndrome. - Arch involvement often represents an extension of a more proximal ascending aortic pathology.
Question 86: Distal renal tubular acidosis is associated with:
- A. Hypocitraturia
- B. Oxalate stones
- C. Calcium stones (Correct Answer)
- D. Uric acid stones
Explanation: ***Calcium stones*** - Distal renal tubular acidosis (Type 1 RTA) causes metabolic acidosis due to impaired distal tubular **hydrogen ion secretion**. - This leads to **increased urinary calcium excretion** (hypercalciuria) and decreased urinary citrate, creating an environment favorable for the formation of **calcium phosphate renal stones**. *Oxalate stones* - While oxalate is a component of some calcium stones (calcium oxalate), **primary hyperoxaluria** or dietary excess of oxalate are the main causes, not directly distal RTA. - Distal RTA specifically promotes **calcium phosphate stone formation** due to pH changes and hypercalciuria. *Hypocitraturia* - **Hypocitraturia** is indeed a feature of distal RTA as the kidney attempts to excrete acid by reabsorbing citrate, making the urine less inhibitory to stone formation. - However, the most direct and common clinically observed consequence in stone formation is the development of **calcium stones**, as hypocitraturia combined with hypercalciuria facilitates their formation. *Uric acid stones* - **Uric acid stones** typically form in persistently **acidic urine** and are associated with conditions like gout or myeloproliferative disorders. - While distal RTA results in systemic acidosis, the urine pH in distal RTA is typically **alkaline or inappropriately neutral**, which does not favor uric acid stone formation.
Question 87: What is the preferred test for confirming H. pylori eradication?
- A. Urease breath test (Correct Answer)
- B. Culture
- C. Serological test
- D. Biopsy urease test
Explanation: ***Urease breath test*** - The **urea breath test** is highly sensitive and specific for detecting active *H. pylori* infection and its eradication by measuring radioactive or non-radioactive labeled carbon dioxide released from metabolizing urea. - It is a non-invasive test preferred after treatment to confirm eradication, as it directly detects bacterial urease activity. *Culture* - **Culture** requires an invasive endoscopic biopsy, is expensive, and takes several days to yield results; therefore, it is not the preferred method for routine eradication confirmation. - While it offers the advantage of **antibiotic susceptibility testing**, its invasiveness and turnaround time make it less practical for post-treatment assessment. *Serological test* - **Serological tests** (blood tests for antibodies) remain positive for **H. pylori antibodies** for extended periods even after successful eradication, rendering them unsuitable for confirming eradication. - These tests primarily indicate past exposure rather than current, active infection. *Biopsy urease test* - A **biopsy urease test** involves an invasive endoscopy to obtain a tissue sample, which is then tested for urease activity. - Although useful for initial diagnosis, its invasiveness makes it less preferred for confirming eradication compared to the non-invasive breath test.
Question 88: Anomic aphasia is due to defect in
- A. Left inferior parietal lobe
- B. Left temporal lobe
- C. Temporal occipital lobe (Correct Answer)
- D. Cerebellum
Explanation: ***Temporal occipital lobe*** - Anomic aphasia, characterized by difficulty recalling **words or names (anomia)**, is most commonly associated with lesions in the **left temporo-occipital region**. - This area is crucial for **semantic processing** and word retrieval. *Left inferior parietal lobe* - Damage to the left inferior parietal lobe is more commonly associated with **conduction aphasia**, characterized by impaired repetition despite fluent speech and good comprehension. - It is also involved in aspects of **reading (alexia)** and **writing (agraphia)**. *Left temporal lobe* - While portions of the left temporal lobe (especially Wernicke's area) are critical for language comprehension, damage primarily to this area typically results in **Wernicke's aphasia**, where speech is fluent but meaningless, and comprehension is severely impaired. - Anomia can be a feature of Wernicke's aphasia, but the primary deficit is comprehension. *Cerebellum* - The cerebellum plays a significant role in **motor control**, balance, and coordination, but it is not directly involved in the **generation or comprehension of language** in the same way as cortical areas. - Damage to the cerebellum might lead to **dysarthria** (speech motor difficulties), but not typical aphasia.
Question 89: Which of the following is a characteristic feature of myasthenia gravis?
- A. Decreased levels of myosin in muscle fibers
- B. Absence of troponin C in muscle fibers
- C. Increased transmission at the myoneural junction
- D. Presence of antibodies against acetylcholine receptors (Correct Answer)
Explanation: ***Presence of antibodies against acetylcholine receptors*** - **Myasthenia gravis** is an **autoimmune disorder** characterized by the production of **antibodies against acetylcholine receptors** at the neuromuscular junction [1]. - These antibodies block, alter, or destroy the acetylcholine receptors, leading to impaired nerve-to-muscle communication and **muscle weakness** [2]. *Decreased levels of myosin in muscle fibers* - Myosin is a **motor protein** crucial for muscle contraction, and its decreased levels are not a primary feature of myasthenia gravis, but rather other **myopathies** or muscle wasting conditions. - The disease mechanism in myasthenia gravis is primarily at the **neuromuscular junction**, not within the muscle fibers themselves. *Absence of troponin C in muscle fibers* - **Troponin C** is a component of the troponin complex essential for **calcium-mediated muscle contraction**, found inside muscle fibers. - Its absence would lead to severe and widespread muscle dysfunction, unlike the specific and fluctuating weakness seen in **myasthenia gravis**. *Increased transmission at the myoneural junction* - Myasthenia gravis is characterized by **decreased** or **impaired transmission** at the myoneural (neuromuscular) junction due to the destruction or blockade of acetylcholine receptors [2]. - Increased transmission would lead to **muscle hyperactivity** or spasms, which is contrary to the **fatigable weakness** observed in myasthenia gravis.
Question 90: All the following are true about multiple myeloma except for which of the following?
- A. Hypercalcemia
- B. Presence of Bence-Jones proteins in urine
- C. Osteolytic bone disease
- D. Chromosomal translocation t(8;14), commonly seen in Burkitt's lymphoma (Correct Answer)
Explanation: ***t(8-14) translocation*** - The **t(8;14) translocation** is not typically associated with multiple myeloma; rather, it is commonly seen in **Burkitt lymphoma** [2]. - Multiple myeloma is primarily linked with chromosomal abnormalities such as **deletions** and **translocations involving different chromosomes**. *Osteolytic bone disease* - A hallmark feature of multiple myeloma, **osteolytic lesions** result from increased osteoclastic activity and are often seen in the skull, spine, and ribs [1]. - Patients frequently present with **bone pain** due to these lesions, which are characteristic of the disease [1]. *Light chain proliferation* - In multiple myeloma, a significant feature is the overproduction of **monoclonal light chains** [1]. - This leads to **light chain disease** or **renal impairment**, further supporting the diagnosis [1]. *Bence-Jones proteins in urine* - The presence of **Bence-Jones proteins**, which are free light chains, is a classic finding in multiple myeloma [1]. - They are often detected in the **urine** and can be used to monitor disease progression or response to treatment [1].