ENT
1 questions65-year-old person with hearing loss with normal speech discrimination is suffering from?
NEET-PG 2012 - ENT NEET-PG Practice Questions and MCQs
Question 1111: 65-year-old person with hearing loss with normal speech discrimination is suffering from?
- A. Noise induced hearing loss
- B. Presbycusis (Correct Answer)
- C. Ototoxic drug
- D. NOHL
Explanation: ***Presbycusis*** - **Presbycusis**, or age-related hearing loss, is characterized by a gradual, symmetrical, **sensorineural hearing loss** primarily affecting high frequencies. - Importantly, **speech discrimination** is typically preserved in the early and moderate stages of presbycusis, which aligns with the normal speech discrimination in a 65-year-old. *Noise induced hearing loss* - **Noise-induced hearing loss** is caused by exposure to loud noise and often presents with a characteristic **4 kHz notch** in the audiogram. - While it can cause sensorineural hearing loss, it's not exclusively defined by the age-related onset and might involve more significant **speech discrimination difficulties** depending on the severity and frequency range affected. *Ototoxic drug* - Hearing loss due to **ototoxic drugs** (e.g., aminoglycosides, cisplatin) typically manifests as a **bilateral, high-frequency sensorineural hearing loss** that can progress rapidly. - The history of **drug exposure** would be a key differentiating factor, and while speech discrimination can be affected, the lack of other specific details makes this less likely without further information. *NOHL* - **NOHL** is not a standard, recognized medical acronym for a specific type of hearing loss. - This option is likely a distractor and does not represent a known diagnosis fitting the described clinical picture.
Internal Medicine
8 questionsPrimary hyperparathyroidism is suggested by all of the following, except which of the following?
Thrombotic thrombocytopenic purpura is a syndrome characterized by which of the following?
The most common cause of pontine hemorrhage is
Which of the following is a characteristic of Wilson's disease?
Which of the following is a renal-specific nephropathy associated with HIV?
A person experiences asthma attacks more than twice during the day and at least once during the night. What is the most likely classification of their asthma?
Which biomarker is typically elevated in the plasma of patients with chronic heart disease?
What is a characteristic finding in athletes' hearts, also known as athletic syndrome?
NEET-PG 2012 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 1111: Primary hyperparathyroidism is suggested by all of the following, except which of the following?
- A. Increased serum calcium
- B. Low urinary calcium levels (Correct Answer)
- C. Increased urinary calcium
- D. Decreased PTH levels
Explanation: ***Low urinary calcium*** - In primary hyperparathyroidism, **urinary calcium levels are typically elevated** due to increased calcium reabsorption in the kidneys [2]. - **Low urinary calcium levels** would suggest a different condition, such as **hypoparathyroidism** or a renal issue affecting calcium excretion [5]. *Increased PTH* - Primary hyperparathyroidism is characterized by **elevated parathyroid hormone (PTH)** levels, as the parathyroid glands are overactive [1][3]. - High PTH contributes to increased serum calcium and bone resorption [2]. *Increased serum calcium* - A hallmark of primary hyperparathyroidism is **hypercalcemia**, resulting from increased bone resorption and renal tubular reabsorption of calcium [1][2]. - The condition often leads to symptoms such as **kidney stones** and **bone pain** due to elevated serum calcium levels [3][4]. *Increased C-AMP* - Elevated levels of **cyclic AMP (C-AMP)** in urine are observed in primary hyperparathyroidism due to the stimulatory effect of PTH on renal tubular reabsorption of calcium. - Increased C-AMP correlates with the action of PTH in promoting calcium release from the bones [2].
Question 1112: Thrombotic thrombocytopenic purpura is a syndrome characterized by which of the following?
- A. Thrombocytopenia, anemia, neurological abnormalities, progressive renal failure and fever (Correct Answer)
- B. Thrombocytopenia, anemia, neurological abnormalities, progressive hepatic failure and fever
- C. Thrombocytopenia, normal anemia, neurological abnormalities, progressive renal failure and fever
- D. Thrombocytopenia, anemia, no neurological abnormalities, progressive renal failure and fever
Explanation: ***Thrombocytopenia, anemia, neurological abnormalities, progressive renal failure and fever*** - Thrombotic thrombocytopenic purpura is characterized by **thrombocytopenia** and **microangiopathic hemolytic anemia**, along with neurological and renal complications [1][2]. - The presence of **fever** and other systemic symptoms is consistent with this **thrombotic microangiopathy** syndrome [1]. *Thrombocytosis, anemia, neurologic abnormalities, progressive renal failure and fever* - This option incorrectly lists **thrombocytosis** rather than **thrombocytopenia**, which is a hallmark of thrombotic thrombocytopenic purpura (TTP) [1]. - While it includes anemia, the absence of thrombocytopenia makes it inconsistent with TTP's classic presentation [2]. *Thrombocytopenia, anemia, neurologic abnormalities, progressive hepatic failure and fever* - Although it correctly states **thrombocytopenia** and **anemia**, it incorrectly identifies **progressive hepatic failure** instead of **renal failure**, which is a key feature of TTP [1]. - The presence of neurological abnormalities and fever does align with TTP; however, the hepatic failure aspect is misleading. *Thrombocytosis, anemia neurologic abnormalities, progressive renal failure and fever* - Again, this option incorrectly notes **thrombocytosis**, contradicting the characteristic finding of **thrombocytopenia** found in TTP [1]. - While other features align with TTP's clinical picture, the thrombocytosis excludes this option from being correct [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 947-948. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 667-668.
Question 1113: The most common cause of pontine hemorrhage is
- A. Hypertension (Correct Answer)
- B. Diabetes
- C. Trauma
- D. Aneurysmal rupture
Explanation: Hypertension - **Chronic hypertension** leads to the weakening and rupture of small perforating arteries in the pons, making it the most common cause of **pontine hemorrhage** [1]. - The elevated pressure damages the **endothelium** and smooth muscle layers of these vessels, predisposing them to bleeding. *Diabetes* - While diabetes can cause microvascular complications, it is not considered the most common cause of **pontine hemorrhage**. - Its primary cerebral vascular complications include increased risk of **ischemic stroke** rather than hemorrhagic stroke in the pons. *Trauma* - **Traumatic brain injury** can cause various types of intracranial hemorrhage, but isolated **pontine hemorrhage** directly due to trauma is less common than that due to hypertension [1]. - Trauma typically results in contusions, subdural, or epidural hematomas, often in superficial brain regions. *Aneurysmal rupture* - **Aneurysmal rupture** is a common cause of subarachnoid hemorrhage, particularly from the Circle of Willis, but pontine hemorrhages are rarely caused by aneurysms within the pons itself [1]. - The vessels supplying the pons are typically small and perforating, not commonly forming dissecting or saccular aneurysms.
Question 1114: Which of the following is a characteristic of Wilson's disease?
- A. Increased copper in liver (Correct Answer)
- B. Autosomal dominant
- C. Increased serum ceruloplasmin
- D. Decreased copper excretion in urine
Explanation: ***Increased copper in liver*** - Wilson's disease is characterized by **accumulation of copper** in liver tissues due to defective copper transport [1]. - This excess leads to **hepatocellular damage**, resulting in liver dysfunction and potential cirrhosis [1]. *Decreased copper excretion in urine* - In Wilson's disease, there is actually **decreased excretion of copper**, which results in accumulation in the liver [1]. - **Urine copper levels** are typically low to normal in early stages because the liver fails to excrete excess copper effectively. *Autosomal dominant* - Wilson's disease is inherited in an **autosomal recessive** pattern, not dominant. - It is caused by mutations in the gene responsible for copper transport (ATP7B) [1]. *Increased serum ceruloplasmin* - Serum ceruloplasmin levels are often **decreased** in Wilson's disease due to impaired copper incorporation into this protein [1]. - Low ceruloplasmin is a key laboratory finding, contrasting the assertion of this option.
Question 1115: Which of the following is a renal-specific nephropathy associated with HIV?
- A. Focal Segmental Glomerulosclerosis (FSGS) (Correct Answer)
- B. Mesangioproliferative Glomerulonephritis
- C. Membranous Nephropathy
- D. Membranoproliferative Glomerulonephritis (MPGN)
Explanation: ### Focal Segmental Glomerulosclerosis - It is a common renal complication associated with **HIV infection**, characterized by **podocyte injury** and segmental sclerosis [1]. - Often results in **nephrotic syndrome**, presenting with significant **proteinuria** and edema, making it distinct in HIV renal pathology [1]. ### Membranous Glomerulonephritis - Typically presents with **subepithelial immune complex deposits**, leading to a different pathophysiological mechanism. - More commonly associated with other secondary causes, such as **drugs** or **infection**, rather than being specific to HIV. ### Mesangioproliferative Glomerulonephritis - Characterized by **mesangial cell proliferation and immune complex deposition**, often linked with various infections but not specifically with HIV. - Usually shows **hematuria** and mild proteinuria, lacking the severe nephrotic syndrome seen in focal segmental glomerulosclerosis. ### Membranoproliferative Glomerulonephritis - Features **proliferation of mesangial and endothelial cells**, leading to a distinctive pattern on renal biopsy, not specific to HIV. - Typically presents in other contexts such as **chronic infections** or **autoimmune diseases**, rather than predominantly with HIV.
Question 1116: A person experiences asthma attacks more than twice during the day and at least once during the night. What is the most likely classification of their asthma?
- A. Intermittent asthma
- B. Mild persistent asthma
- C. Moderate persistent asthma
- D. Severe persistent asthma (Correct Answer)
Explanation: ***Severe persistent asthma*** - This classification is characterized by **frequent symptoms**, specifically asthma attacks occurring more than twice daily and at least once nightly. - Individuals with severe persistent asthma often experience significant limitations in their daily activities and may have a **FEV1 (forced expiratory volume in 1 second)** less than 60% of predicted. *Intermittent asthma* - This classification is characterized by symptoms occurring less than two days per week and **nighttime awakenings less than two times per month**. - Symptoms are generally well-controlled with a short-acting beta-agonist (SABA) as needed. *Mild persistent asthma* - Patients with mild persistent asthma typically experience symptoms more than twice a week but **less than once a day**, and **nighttime awakenings 3-4 times per month**. - Their lung function (FEV1) is usually 80% or more of predicted. *Moderate persistent asthma* - This category involves daily symptoms and **nighttime awakenings more than once per week but not nightly**. - Lung function (FEV1) in moderate persistent asthma typically falls between 60% and 80% of predicted.
Question 1117: Which biomarker is typically elevated in the plasma of patients with chronic heart disease?
- A. Endothelin-1
- B. Troponin T
- C. B-type natriuretic peptide (BNP) (Correct Answer)
- D. Cortisol
Explanation: ***B-type natriuretic peptide (BNP)*** - **BNP** is a hormone secreted by **ventricular cardiomyocytes** in response to increased wall stretch and pressure overload, making it a strong indicator of **myocardial stress** and **chronic heart failure** [1]. - Elevated levels correlate with the **severity of heart failure**, aiding in diagnosis and prognosis [1]. *Endothelin-1* - **Endothelin-1** is a potent **vasoconstrictor** involved in vascular tone regulation and endothelial dysfunction. - While it can be elevated in conditions like **pulmonary hypertension** and **atherosclerosis**, it is not a primary diagnostic biomarker for chronic heart disease in general. *Troponin T* - **Troponin T** is a cardiac-specific protein that is released into the bloodstream following **myocardial injury or necrosis**. - While it is a crucial biomarker for **acute coronary syndromes** (e.g., heart attack), persistently elevated levels are not typical for stable chronic heart disease unless there is ongoing subclinical myocardial damage. *Cortisol* - **Cortisol** is a **stress hormone** produced by the adrenal glands, involved in metabolism, immune response, and blood pressure regulation. - While chronic stress can impact cardiovascular health, cortisol itself is not a specific diagnostic biomarker for chronic heart disease.
Question 1118: What is a characteristic finding in athletes' hearts, also known as athletic syndrome?
- A. Increased amplitude of QRS (Correct Answer)
- B. Decreased QT interval
- C. U-waves
- D. Bradycardia
Explanation: ***Increased amplitude of QRS*** - In **athletes' hearts**, the heart muscle (myocardium) undergoes physiological adaptations, including **left ventricular hypertrophy**, which leads to an **increased amplitude of the QRS complex** on an ECG. - This is a normal and beneficial adaptation that enhances cardiac output and efficiency during exercise. *Bradycardia* - While **bradycardia** (a slower heart rate) is very common in athletes due to increased **vagal tone** and improved cardiac efficiency, it is not the most direct characteristic finding *on an ECG* reflecting the structural changes of athletic heart syndrome. - Bradycardia is a rate finding, not a waveform amplitude change reflecting myocardial mass. *Decreased QT interval* - A **decreased QT interval** is not a typical characteristic of an athlete's heart; in fact, there is usually no significant change or a slight prolongation due to bradycardia, but it remains within normal limits. - A pathologically short QT interval can indicate specific genetic channelopathies, which are unrelated to athletic adaptation. *U-waves* - **U-waves** are small positive deflections sometimes seen after the T wave, often associated with **bradycardia** or **hypokalemia**. - While athletes can have bradycardia, U-waves are not a consistent or defining feature of an athlete's heart syndrome itself, and their presence can also indicate other conditions.
Pathology
1 questionsMost common CNS tumor associated with NF1
NEET-PG 2012 - Pathology NEET-PG Practice Questions and MCQs
Question 1111: Most common CNS tumor associated with NF1
- A. Optic glioma (Correct Answer)
- B. Astrocytoma
- C. Bilateral acoustic neuroma
- D. Optic nerve schwannoma
Explanation: ***Optic glioma*** - **Optic gliomas** (specifically **pilocytic astrocytomas**) are the most common CNS tumor found in association with **Neurofibromatosis type 1 (NF1)** [1]. - These tumors typically affect the **optic nerve** and can cause vision impairment. *Optic nerve schwannoma* - **Schwannomas** are tumors arising from Schwann cells, and while they can affect cranial nerves, an **optic nerve schwannoma** is very rare and not characteristic of NF1. - The most common schwannoma associated with neurofibromatosis is a **vestibular schwannoma** (acoustic neuroma) in NF2, not NF1 [2]. *Astrocytoma* - While optic gliomas are a type of astrocytoma, simply stating "astrocytoma" is too broad; the specific location (optic nerve) and type (pilocytic) are key in NF1 [1]. - Other types of astrocytomas (e.g., glioblastoma) are not typically associated with NF1 as the *most common* CNS tumor. *Bilateral acoustic neuroma* - **Bilateral acoustic neuromas** (vestibular schwannomas) are the hallmark CNS tumor of **Neurofibromatosis type 2 (NF2)**, not NF1 [2]. - This symptom strongly points to NF2, a distinct genetic disorder from NF1 [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1319-1320. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 727-728.