Therapeutic phlebotomy is not done in which of the following conditions?
Which of the following is NOT typically associated with Kallmann's syndrome?
In cobalamin deficiency which is not seen
Which of the following is used to decrease the duration and severity of acute diarrhea?
Reduced osmolarity ORS does not contain which of the following ions?
Classic triad in Renal cell carcinoma includes all of the following, Except:
Which of the following is the most common type of multiple sclerosis?
What does a motor score of 4 on the Glasgow Coma Scale indicate?
Increased ICP is shown by
Most common site of hypertensive intraparenchymal hemorrhage in the brain?
NEET-PG 2015 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 101: Therapeutic phlebotomy is not done in which of the following conditions?
- A. CML (Correct Answer)
- B. Polycythemia vera
- C. Hemochromatosis
- D. Porphyria cutanea tarda
Explanation: CML - **Chronic Myeloid Leukemia (CML)** is typically treated with targeted therapies like **Tyrosine Kinase Inhibitors** (e.g., Imatinib), not phlebotomy [1]. - Therapeutic phlebotomy is ineffective in managing the **hypercellularity** or symptoms associated with this condition compared to other conditions [1]. *Polycythemia vera* - Therapeutic phlebotomy is a key treatment in **Polycythemia vera** to reduce **hyperviscosity** symptoms. - This condition features increased red blood cell mass, which is directly addressed by phlebotomy. *Hemochromatosis* - In **Hemochromatosis**, phlebotomy is employed to lower **iron overload** by removing excess iron from the body. - This reduces the risk of complications such as **liver cirrhosis** and **diabetes** associated with iron excess. *Porphyria cutanea tarda* - Therapeutic phlebotomy is sometimes used in cases of **Porphyria cutanea tarda** to manage iron levels as a potential precipitating factor [2]. - It helps alleviate symptoms and prevent complications associated with **photosensitivity** and skin lesions [2].
Question 102: Which of the following is NOT typically associated with Kallmann's syndrome?
- A. Hypogonadotropic hypogonadism
- B. Anosmia
- C. Amenorrhea
- D. Excess stimulation of the HPO axis (Correct Answer)
Explanation: ***Excess stimulation of the HPO axis*** - Kallmann's syndrome is characterized by **hypogonadotropic hypogonadism**, meaning there is a deficiency in the secretion of **gonadotropin-releasing hormone (GnRH)** [1] from the hypothalamus. - This deficiency leads to *reduced* stimulation of the **hypothalamic-pituitary-ovarian (HPO)** axis, not excess stimulation. *Amenorrhea* - **Amenorrhea** (absence of menstruation) is a common presentation in females with Kallmann's syndrome due to the **hypogonadotropic hypogonadism**. - The lack of GnRH results in insufficient **follicle-stimulating hormone (FSH)** and **luteinizing hormone (LH)**, preventing ovarian function and regular menstrual cycles. *Hypogonadotropic hypogonadism* - This is a **defining feature** of Kallmann's syndrome, where the **hypothalamus fails to produce enough GnRH**, leading to low levels of FSH and LH from the pituitary. - The low gonadotropin levels subsequently cause the gonads (testes or ovaries) to produce insufficient sex hormones, resulting in **delayed or absent puberty** [1]. *Anosmia* - **Anosmia** (the inability to smell) is a classic and diagnostic feature of Kallmann's syndrome, distinguishing it from other forms of hypogonadotropic hypogonadism. - It occurs because the **GnRH-producing neurons** originate in the olfactory placode and fail to migrate correctly into the hypothalamus during embryonic development, disrupting both smell and GnRH secretion.
Question 103: In cobalamin deficiency which is not seen
- A. Loss of proprioception
- B. Rhomberg sign
- C. Microcytic anemia (Correct Answer)
- D. Long tract signs
Explanation: Microcytic anemia - Cobalamin deficiency typically leads to macrocytic anemia due to impaired DNA synthesis, not microcytic anemia [1]. - Microcytic anemia is usually associated with iron deficiency, thalassemia, or anemia of chronic disease [1]. Long tract signs - Long tract signs are common in cobalamin deficiency due to posterior column and corticospinal tract involvement leading to symptoms like spasticity. - They indicate involvement of pathways that are affected by vitamin B12 deficiency. Loss of proprioception - Loss of proprioception can occur in cobalamin deficiency due to damage to the dorsal columns of the spinal cord. - It is a common clinical finding indicating the involvement of sensory pathways. Rhomberg sign - A positive Rhomberg sign indicates impaired proprioception, which can happen in cobalamin deficiency. - It reflects difficulty maintaining balance, emphasizing sensory dysfunction associated with the deficiency.
Question 104: Which of the following is used to decrease the duration and severity of acute diarrhea?
- A. Zn (Correct Answer)
- B. Mg
- C. Fe
- D. Ca
Explanation: ***Zn*** - **Zinc supplementation** has been shown to reduce the **duration** and **severity** of acute diarrhea, particularly in children in developing countries [1]. - It plays a crucial role in **immune function** and **intestinal integrity**, which helps in recovery from diarrheal episodes [1]. *Mg* - **Magnesium** is an essential mineral, but it is not directly used to decrease the duration or severity of acute diarrhea. - In fact, high doses of magnesium can act as a **laxative** and may worsen diarrhea. *Fe* - **Iron** is vital for red blood cell formation and oxygen transport, but it does not directly impact the duration or severity of acute diarrhea. - Iron supplementation is primarily used to treat **anemia**. *Ca* - **Calcium** is important for bone health and various metabolic processes, but it is not a primary intervention for reducing the duration or severity of acute diarrhea. - While sometimes used for mild digestive issues, it does not have the same evidence base as zinc for acute diarrhea.
Question 105: Reduced osmolarity ORS does not contain which of the following ions?
- A. Sodium
- B. Potassium
- C. Lactate (Correct Answer)
- D. Citrate
Explanation: ***Lactate*** - The **reduced osmolarity ORS** formulation replaced **bicarbonate** with **citrate** and does not contain lactate. - **Citrate** is preferred over lactate / bicarbonate due to its stability, longer shelf life, and ease of dissolution. *Sodium* - **Sodium** is a crucial component of ORS, as it is co-transported with glucose into enterocytes, facilitating water absorption through **solvent drag**. - Reduced osmolarity ORS has a **lower sodium concentration** (75 mEq/L) compared to standard ORS (90 mEq/L) to minimize hypernatremia risk and enhance water absorption. *Potassium* - **Potassium** is included in ORS to replace intestinal losses, as **diarrhea** leads to significant potassium depletion. - Maintaining adequate **potassium levels** is essential for normal cellular function and preventing hypokalemia-related complications. *Citrate* - **Citrate** is a component of ORS that serves as an **alkalinizing agent** to correct metabolic acidosis often associated with dehydration in diarrheal diseases. - It also enhances the absorption of sodium and water in the intestine.
Question 106: Classic triad in Renal cell carcinoma includes all of the following, Except:
- A. Hematuria
- B. Hypertension (Correct Answer)
- C. Flank mass
- D. Abdominal Pain
Explanation: ***Hypertension*** - While hypertension can occur in patients with renal cell carcinoma due to **renin secretion** or other mechanisms, it is **not considered one of the classic triad symptoms**. - The classic triad represents symptoms that historically led to diagnosis, though most RCCs are now discovered incidentally. *Hematuria* - **Gross or microscopic hematuria** is a common symptom of renal cell carcinoma [1], resulting from tumor invasion into the collecting system. - It is one of the **three classic symptoms** associated with advanced disease. *Flank mass* - A palpable **flank mass** indicates a sizable tumor infiltrating the renal parenchyma and is a classic sign of renal cell carcinoma [1]. - This symptom is often associated with later-stage disease. *Abdominal Pain* - **Flank pain** or abdominal pain is a frequent symptom of renal cell carcinoma, which may be caused by tumor growth, hemorrhage, or obstruction. - This symptom, along with hematuria and a flank mass, constitutes the **classic diagnostic triad**.
Question 107: Which of the following is the most common type of multiple sclerosis?
- A. Relapsing remitting type (Correct Answer)
- B. Progressive relapsing multiple sclerosis
- C. Primary progressive multiple sclerosis
- D. Secondary progressive multiple sclerosis
Explanation: ***Relapsing remitting type*** - **Relapsing-remitting multiple sclerosis (RRMS)** is characterized by clearly defined attacks of worsening neurological function (relapses) followed by periods of partial or complete recovery (remissions). - Approximately **85%** of people with MS are initially diagnosed with RRMS, making it the most common form [1]. *Progressive relapsing multiple sclerosis* - This is a rare form of MS characterized by a **steady neurological decline** from the onset, with superimposed acute relapses. - Unlike RRMS, there are **no periods of remission** in PRMS. *Primary progressive multiple sclerosis* - **Primary progressive multiple sclerosis (PPMS)** is characterized by slowly worsening neurological function from the onset, without early relapses or remissions [1]. - It accounts for roughly **15%** of all MS cases, making it less common than RRMS [1]. *Secondary progressive multiple sclerosis* - **Secondary progressive multiple sclerosis (SPMS)** typically develops in individuals who initially had RRMS, where the disease begins to progress steadily, with or without occasional relapses. - It is a **later stage** of MS and not the most common initial presentation.
Question 108: What does a motor score of 4 on the Glasgow Coma Scale indicate?
- A. Decorticate posturing
- B. Withdrawal or flexion to pain (Correct Answer)
- C. Decerebrate posturing
- D. Localizes to pain
Explanation: A motor score of 4 on the **Glasgow Coma Scale (GCS)** signifies that the patient **withdraws or flexes their limb** away from a painful stimulus. - This response indicates a degree of purposeful movement but is not considered localization to the pain. *Decerebrate posturing* - This represents a GCS motor score of **2**, characterized by **extension and internal rotation of the arms** and extension of the legs in response to pain [1]. - It suggests severe damage to the **brainstem**, specifically below the red nucleus [1]. *Decorticate posturing* - This corresponds to a GCS motor score of **3**, where the patient exhibits **flexion and adduction of the arms** with extension of the legs to painful stimuli [1]. - It often indicates damage to the **corticospinal tracts** above the red nucleus [1]. *Localizes to pain* - This is a GCS motor score of **5**, where the patient **moves their hand beyond the chin** attempting to remove the painful stimulus. - It indicates a higher level of conscious response and purposeful movement compared to withdrawal.
Question 109: Increased ICP is shown by
- A. Reduction in GCS (Correct Answer)
- B. Pupil constriction (Miosis)
- C. Systemic hypotension
- D. Tachycardia
Explanation: ***Reduction in GCS*** - A **decrease in Glasgow Coma Scale (GCS)** score is a primary indicator of increased intracranial pressure (ICP) due to compromised brain function [1], [2]. - Increased ICP can lead to **cerebral ischemia** and neuronal damage, manifesting as altered consciousness and lower GCS scores [1]. *Pupil constriction (Miosis)* - **Miosis**, or pupil constriction, is typically associated with **pontine lesions** or **opioid use**, and rarely directly with increased ICP unless it specifically involves brainstem compression at the pontine level. - Increased ICP more commonly causes **pupil dilation (mydriasis)**, especially unilateral, due to compression of the oculomotor nerve (CN III) [1]. *Systemic hypotension* - **Systemic hypotension** is generally *not* a direct sign of increased ICP; rather, increased ICP often results in **systemic hypertension** as part of Cushing's triad. - Hypotension in the context of brain injury might indicate **spinal shock** or other systemic issues, but generally not directly elevated ICP. *Tachycardia* - **Tachycardia** is also *not* typically associated with increased ICP; instead, **bradycardia** (slow heart rate) is a hallmark sign, forming part of Cushing's triad. - Tachycardia might suggest **hypovolemia**, **pain**, or other systemic stressors, but not directly increased ICP.
Question 110: Most common site of hypertensive intraparenchymal hemorrhage in the brain?
- A. Putamen (Correct Answer)
- B. Thalamus
- C. Cerebellum
- D. Pons
Explanation: ***Putamen*** - The **putamen** is the most frequent site for **hypertensive intraparenchymal hemorrhages** [1] due to the presence of numerous small, thin-walled arterioles (lenticulostriate arteries) that are highly susceptible to damage from chronic hypertension [1]. - Hemorrhages in this region often cause **contralateral hemiparesis**, **hemianesthesia**, and **gaze deviation** towards the side of the lesion due to involvement of nearby motor and sensory pathways [1]. *Thalamus* - While the **thalamus** is a common site for hypertensive hemorrhages, it is less common than the putamen [1], [2]. - Thalamic hemorrhages typically cause **contralateral sensory loss**, **oculomotor dysfunction**, and sometimes **aphasia** if the dominant hemisphere is affected. *Cerebellum* - **Cerebellar hemorrhages** are less frequent than those in the basal ganglia or thalamus [1]. - Symptoms usually include **ataxia**, **nystagmus**, vomiting, and potential brainstem compression if large. *Pons* - **Pontine hemorrhages** are among the most severe and are often rapidly fatal due to damage to vital brainstem structures [1], [2]. - They typically present with **coma**, **quadriparesis**, **pinpoint pupils**, and rapid progression to respiratory arrest.