Internal Medicine
5 questionsWhat condition is associated with copper deposition in the cornea?
The common cause of subarachnoid hemorrhage is:
Extraintestinal manifestations of Inflammatory bowel disease include all of the following, Except:
Which of the following is NOT an indication for a liver biopsy?
Which of the following is a common finding in patients with Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)?
NEET-PG 2013 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 781: What condition is associated with copper deposition in the cornea?
- A. Keratoglobus
- B. Keratoconus
- C. Siderosis
- D. Wilson's disease (Correct Answer)
Explanation: ***Wilson's disease*** - Wilson's disease is a genetic disorder of **copper metabolism** leading to excess copper accumulation in various tissues, including the cornea [1]. - This copper deposition in the posterior Descemet's membrane of the cornea forms a distinctive golden-brown or greenish-brown ring known as the **Kayser-Fleischer ring**. *Keratoconus* - This condition is characterized by progressive thinning and steepening of the cornea, causing it to bulge into a **cone-like shape**. - It primarily affects vision due to irregular astigmatism and does not involve copper deposition. *Keratoglobus* - Keratoglobus is a rare corneal ectatic disorder where the entire cornea is thinned and bulges forward, giving it a **globe-like appearance**. - It is congenital and typically runs in families, and it is not associated with copper deposition. *Siderosis* - Siderosis refers to the deposition of **iron** in various tissues, often due to chronic hemorrhage or metallic foreign bodies. - In the eye, it can occur after intraocular iron foreign bodies, leading to retinal degeneration and other ocular complications, but it does not involve copper.
Question 782: The common cause of subarachnoid hemorrhage is:
- A. Arterio-venous malformation
- B. Cavernous angioma
- C. Aneurysm (Correct Answer)
- D. Hypertension
Explanation: ***Aneurysm*** - Aneurysms, particularly **saccular** or **berry aneurysms**, are the most frequent cause of **spontaneous subarachnoid hemorrhage (SAH)**, accounting for about 80-85% of cases [2]. - The sudden rupture of an intracranial aneurysm leads to blood spilling into the **subarachnoid space**, causing characteristic symptoms like a "thunderclap headache" [1]. *Arterio-venous malformation* - While AV malformations (AVMs) can cause SAH, they are a less common cause than aneurysms, accounting for approximately 5-10% of cases. - AVMs are abnormal direct connections between arteries and veins that bypass the capillary system and can rupture, leading to SAH or intraparenchymal hemorrhage. *Cavernous angioma* - Cavernous angiomas are abnormal clusters of dilated, thin-walled capillaries that can lead to hemorrhage, but they primarily cause **intraparenchymal hemorrhage** rather than SAH. - They are much less likely to result in diffuse bleeding into the subarachnoid space compared to ruptured aneurysms. *Hypertension* - Hypertension is a significant risk factor for the formation and rupture of aneurysms [1], but it is not a direct cause of SAH itself in the same way an aneurysm rupture is. - While uncontrolled hypertension is often associated with **intracerebral hemorrhage** (bleeding within the brain tissue), its direct role in causing SAH is usually secondary to an underlying vascular abnormality like an aneurysm.
Question 783: Extraintestinal manifestations of Inflammatory bowel disease include all of the following, Except:
- A. Sclerosing cholangitis
- B. Skin nodules
- C. Osteoarthritis (Correct Answer)
- D. Uveitis
Explanation: ***Osteoarthritis*** - **Osteoarthritis** is a **degenerative joint disease** caused by wear and tear on cartilage, and it is **not** an extraintestinal manifestation of IBD [3]. - While patients with IBD can develop osteoarthritis, it does not share the same **pathophysiological link** to the inflammatory process of IBD as other extraintestinal manifestations. *Uveitis* - **Uveitis** is an inflammation of the **uvea** (middle layer of the eye) and is a well-recognized ocular extraintestinal manifestation of IBD [2]. - It can cause eye pain, redness, and blurred vision, and its severity may correlate with IBD disease activity. *Sclerosing cholangitis* - **Primary sclerosing cholangitis (PSC)** is a chronic cholestatic liver disease characterized by inflammation and fibrosis of the **bile ducts**, and it is strongly associated with **ulcerative colitis** [1]. - It often progresses to **cirrhosis** and liver failure and is a significant extraintestinal manifestation. *Skin nodules* - **Erythema nodosum** and **pyoderma gangrenosum** are common cutaneous extraintestinal manifestations of IBD, often presenting as **painful red nodules** or ulcers on the skin [2]. - These skin conditions are thought to be immune-mediated and often parallel the activity of the underlying inflammatory bowel disease.
Question 784: Which of the following is NOT an indication for a liver biopsy?
- A. Amoebic hepatitis (Correct Answer)
- B. Chronic hepatitis B and C
- C. Autoimmune hepatitis
- D. Wilson's disease
Explanation: ***Amoebic hepatitis*** - Liver biopsy is **not routinely indicated** for amoebic hepatitis as diagnosis is typically made through clinical history and serological tests. - The condition is usually managed with **medications** rather than requiring invasive procedures like a biopsy. *Wilson's disease* - Liver biopsy is important for assessing **copper accumulation** in Wilson's disease, establishing a diagnosis. - It may also provide information regarding the extent of **hepatocellular damage**. *Chronic hepatitis B and C* - In chronic hepatitis B and C, liver biopsy is crucial to evaluate the **degree of fibrosis** and hepatic inflammation. - It assists in determining the need for **antiviral therapy** and prognostication. *Autoimmune hepatitis* - Liver biopsy helps confirm the diagnosis of autoimmune hepatitis and assess the **severity of liver damage**. [1] - It also aids in monitoring the response to **immunosuppressive therapy**. [1] **Note on technique:** Percutaneous liver biopsy requires specific conditions for safety, such as cooperative patients and adequate coagulation profiles. [2]
Question 785: Which of the following is a common finding in patients with Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)?
- A. Ascites
- B. Normal BP (Correct Answer)
- C. Generalized edema
- D. Dry mucous membrane
Explanation: ***Normal BP*** - In SIADH, patients are typically **euvolemic** due to the primary issue being water retention rather than salt retention or frank dehydration [2]. - While hyponatremia occurs, the body's compensatory mechanisms usually prevent significant changes in blood pressure, maintaining it within the **normal range**. *Generalized edema* - Generalized edema is uncommon in SIADH because the excessive water retention is initially within the **intravascular compartment**, and the body attempts to excrete the additional volume of water [1]. - Although the patient is effectively retaining water, the osmolality is low, leading to fluid shifts rather than overt edema unless severe, protracted fluid overload occurs. *Ascites* - **Ascites**, which is the accumulation of fluid in the peritoneal cavity, is not a characteristic feature of SIADH [2]. - Ascites is more commonly associated with conditions like **liver cirrhosis**, heart failure, or malignancy. *Dry mucous membrane* - **Dry mucous membranes** are a sign of dehydration and fluid volume deficit. - In contrast, SIADH involves **fluid overload** (though euvolemic), making dry mucous membranes an unlikely finding [2].
Microbiology
3 questionsWhich MRSA strain type is most commonly associated with hospital-acquired infections?
Which is the most common bacterial organism causing bacterial upper respiratory tract infections (including sinusitis, otitis media, and pharyngitis) in adults?
What component is included in the vaccine against N-meningitidis?
NEET-PG 2013 - Microbiology NEET-PG Practice Questions and MCQs
Question 781: Which MRSA strain type is most commonly associated with hospital-acquired infections?
- A. Phage type 83A
- B. Phage type 85
- C. Phage type 84
- D. Phage type 80/81 (Correct Answer)
Explanation: ***Phage type 80/81*** - This **phage type**, particularly **epidemic methicillin-resistant *Staphylococcus aureus* (EMRSA) 15 and 16**, is historically and currently the most common cause of **hospital-acquired MRSA infections** worldwide. - It rapidly diversified and spread globally, becoming a significant nosocomial pathogen. *Phage type 83A* - While this phage type has been associated with **MRSA outbreaks**, it is not the most common strain type globally for hospital-acquired infections. - Its prevalence is more regional and sporadic compared to the widespread dominance of EMRSA 15/16. *Phage type 84* - **Phage type 84** is not widely recognized as a predominant strain associated with the majority of **hospital-acquired MRSA infections**. - Other, more virulent and successful clonal types have outcompeted it to become the most prevalent. *Phage type 85* - Similar to other less common types, **phage type 85** does not represent the major lineage responsible for the bulk of **hospital-acquired MRSA cases**. - The landscape of MRSA epidemiology is dominated by a few highly successful clonal complexes, of which 80/81 is a prime example.
Question 782: Which is the most common bacterial organism causing bacterial upper respiratory tract infections (including sinusitis, otitis media, and pharyngitis) in adults?
- A. Staphylococcus aureus
- B. Haemophilus influenzae
- C. Streptococcus pyogenes
- D. Streptococcus pneumoniae (Correct Answer)
Explanation: ***Streptococcus pneumoniae*** - *Streptococcus pneumoniae* is the **most common bacterial pathogen** causing upper respiratory tract infections overall, including **bacterial sinusitis**, **otitis media**, and **community-acquired pneumonia**. - It is a frequent colonizer of the nasopharynx and leads to infection when host immunity is compromised. - Accounts for the highest burden of bacterial URTIs when considering all anatomical sites. *Haemophilus influenzae* - *Haemophilus influenzae* (particularly non-typeable strains) is the **second most common** cause of bacterial sinusitis and otitis media in adults. - While significant, it is less prevalent overall than *S. pneumoniae* across all URTI types. *Staphylococcus aureus* - *Staphylococcus aureus* primarily causes **skin and soft tissue infections** and device-related infections. - It is **not a common primary pathogen** in typical acute bacterial URTIs, though it may cause secondary infections or colonize the anterior nares. *Streptococcus pyogenes* - *Streptococcus pyogenes* (Group A Streptococcus) is the **most common cause of bacterial pharyngitis** (strep throat) in adults. - However, when considering the **full spectrum of bacterial URTIs** (pharyngitis, sinusitis, otitis media), *S. pneumoniae* has a broader overall impact and higher prevalence across multiple sites.
Question 783: What component is included in the vaccine against N-meningitidis?
- A. Killed whole-cell vaccine
- B. Capsular polysaccharide (polysaccharide vaccine) (Correct Answer)
- C. Outer membrane protein (OMP)
- D. Live attenuated vaccine
Explanation: ***Capsular polysaccharide (polysaccharide vaccine)*** - *Neisseria meningitidis* vaccines commonly include **capsular polysaccharides** from different serogroups (A, C, Y, W-135) to elicit a protective immune response. - These polysaccharides act as antigens, stimulating the production of **antibodies** that can neutralize the bacteria. - **Conjugate vaccines** combine polysaccharides with carrier proteins to improve immunogenicity, especially in infants and young children. *Killed whole-cell vaccine* - **Killed whole-cell vaccines** are not used for *N. meningitidis* due to potential reactogenicity and the availability of more effective targeted antigens. - **Polysaccharide and conjugate vaccines** are the established formulations for meningococcal disease prevention. *Outer membrane protein (OMP)* - **Outer membrane proteins (OMPs)** are specifically used in **serogroup B vaccines** (e.g., Bexsero, Trumenba) due to the poor immunogenicity of the serogroup B polysaccharide capsule. - However, for serogroups A, C, Y, and W-135, **capsular polysaccharide** remains the primary vaccine component. *Live attenuated vaccine* - **Live attenuated vaccines** are not used for *N. meningitidis* as they pose risks of reversion to virulence and are unnecessary given the effectiveness of polysaccharide-based vaccines. - Meningococcal vaccines rely on **subunit approaches** (polysaccharides, conjugates, OMPs) rather than live organisms.
Pharmacology
1 questionsA patient has Cushing syndrome due to an adrenal tumor. Which drug should be given?
NEET-PG 2013 - Pharmacology NEET-PG Practice Questions and MCQs
Question 781: A patient has Cushing syndrome due to an adrenal tumor. Which drug should be given?
- A. Ketoconazole (Correct Answer)
- B. Spironolactone
- C. Hydrocortisone
- D. Dexamethasone
Explanation: ***Ketoconazole*** - **Ketoconazole** is an antifungal agent that also inhibits several enzymes involved in **steroidogenesis**, including 17α-hydroxylase and 11β-hydroxylase. - This action helps to reduce the overproduction of **cortisol** in Cushing syndrome caused by an adrenal tumor. *Hydrocortisone* - **Hydrocortisone** is a glucocorticoid itself and would exacerbate the symptoms of **Cushing syndrome** by adding to the already elevated cortisol levels. - It is used for **cortisol replacement therapy** in conditions like Addison's disease, where cortisol levels are low. *Dexamethasone* - **Dexamethasone** is a potent synthetic glucocorticoid used to suppress **ACTH production** in cases of ACTH-dependent Cushing's syndrome (e.g., Cushing's disease) or to diagnose Cushing's syndrome. - In an adrenal tumor, which is **ACTH-independent**, dexamethasone would not reduce cortisol production but could instead worsen the hypercortisolism. *Spironolactone* - **Spironolactone** is an **aldosterone antagonist** and a weak antiandrogen, primarily used for conditions like hyperaldosteronism, heart failure, and hirsutism. - It has no direct effect on the overproduction of **cortisol** from an adrenal tumor in Cushing syndrome.
Psychiatry
1 questionsWhich neurological condition is commonly associated with Alice in Wonderland Syndrome?
NEET-PG 2013 - Psychiatry NEET-PG Practice Questions and MCQs
Question 781: Which neurological condition is commonly associated with Alice in Wonderland Syndrome?
- A. Subacute sclerosing panencephalitis (SSPE)
- B. Epileptic seizures (Correct Answer)
- C. Cerebral hemorrhage
- D. Multiple sclerosis
Explanation: ***Epileptic seizures*** - **Alice in Wonderland Syndrome (AIWS)**, characterized by distortions of visual perception, body image, and sense of time, is often reported as an **aura or part of focal epileptic seizures**, particularly those originating in the temporal or parietal lobes. - The **transient and episodic nature** of AIWS symptoms aligns well with the paroxysmal electrical activity seen in epilepsy. *Subacute sclerosing panencephalitis (SSPE)* - **SSPE** is a rare, fatal brain disorder caused by a persistent **measles virus infection**, primarily affecting children and young adults. - While it causes progressive neurological deterioration, including cognitive decline, motor dysfunction, and seizures, **Alice in Wonderland Syndrome** is not a characteristic or commonly associated symptom. *Cerebral hemorrhage* - A **cerebral hemorrhage** involves bleeding within the brain tissue, leading to acute neurological deficits depending on the location and size of the bleed. - Although it can cause a variety of symptoms, such as headache, weakness, and altered consciousness, **Alice in Wonderland Syndrome** is not a typical manifestation of acute hemorrhage. *Multiple sclerosis* - **Multiple sclerosis (MS)** is a chronic autoimmune disease affecting the central nervous system, leading to demyelination and neurological symptoms. - Common symptoms involve motor, sensory, visual, and cognitive deficits, but **Alice in Wonderland Syndrome** is not a recognized or common neurological manifestation of MS.