NEET-PG 2015 - Internal Medicine Practice Questions

Q: Which of the following statements about drug-induced SLE is NOT true?

Female: Male ratio=1:9. ***Female: Male ratio=1:9*** - Drug-induced lupus erythematosus (DILE) typically has no significant **gender predilection**, unlike idiopathic SLE which has a marked female predominance (9:1 female: male ratio) [1]. - This statement is incorrect because the male:female ratio is closer to 1:1, or even male predominance, making the given ratio of 1:9 (female:male) false. *Anti-histone antibodies are negative* - **Anti-histone antibodies** are positive in 95% of patients with drug-induced lupus, making this statement incorrect. - The presence of anti-histone antibodies is a hallmark diagnostic feature of drug-induced lupus. *CNS involvement not common* - **Central nervous system (CNS) manifestations** are indeed uncommon in drug-induced lupus erythematosus. - This statement accurately reflects a key differentiating feature from idiopathic systemic lupus erythematosus (SLE), where CNS involvement can be significant [1]. *Renal involvement not common* - **Renal involvement** is rare in drug-induced lupus erythematosus. - This statement is true and helps distinguish drug-induced lupus from idiopathic SLE, where renal disease (lupus nephritis) is a frequent and serious complication [1].

Q: A man working in a hot environment and consuming large amounts of water without replacing salts is likely to develop -

Heat cramps. ***Heat cramps*** - **Heat cramps** are painful, involuntary muscle spasms that occur during or after strenuous activity in a hot environment, especially when there is excessive sweating and **inadequate salt replacement**. - The consumption of **large amounts of water** without replacing electrolytes further dilutes the remaining electrolytes, exacerbating the problem. *Heat hyperpyrexia* - **Heat hyperpyrexia** is characterized by a very high core body temperature (typically >106°F or 41.1°C) without central nervous system dysfunction [1]. - While it involves extreme heat exposure, the primary problem described (muscle cramps due to fluid and **electrolyte imbalance**) is not hyperpyrexia itself but a milder heat illness. *Heat stroke* - **Heat stroke** is a severe, life-threatening condition involving a dangerously elevated body temperature (>104°F or 40°C) along with **central nervous system dysfunction** (e.g., altered mental status, seizures) [1], [2]. - Although strenuous activity and heat exposure contribute, the predominant symptoms described are muscle cramps, not the systemic collapse characteristic of heat stroke. *Heat encephalopathy* - **Heat encephalopathy** refers to the neurological manifestations of severe heat illness, particularly **heat stroke**, involving altered mental status, confusion, and possibly seizures. - While heat cramps are a form of heat illness, they primarily involve muscle symptoms and do not typically include direct brain dysfunction as the primary feature.

Q: After a road traffic accident, a patient presented to casualty with vitals showing BP of 90/60 mm Hg and heart rate of 56 bpm. Which kind of shock occurs?

Neurogenic. ***Neurogenic*** - This patient presents with **hypotension** (BP 90/60 mm Hg) and **bradycardia** (heart rate 56 bpm), which is a classic presentation of neurogenic shock due to **loss of sympathetic tone** following a spinal cord injury [2]. - The road traffic accident suggests a potential **spinal cord injury**, leading to disruption of the autonomic nervous system's control over heart rate and vascular tone. *Cardiogenic* - Cardiogenic shock is characterized by **hypotension** and **tachycardia**, often due to the heart's inability to pump blood effectively, such as in a myocardial infarction [1]. - The reported **bradycardia** in this patient makes cardiogenic shock unlikely. *Hypovolemic shock* - Hypovolemic shock results from significant **fluid loss**, leading to **hypotension** and a compensatory **tachycardia**. - The presence of **bradycardia** rules out hypovolemic shock, as the body would typically try to increase heart rate to compensate for volume depletion. *Septic shock* - Septic shock is caused by a severe **infection**, leading to widespread vasodilation, **hypotension**, and often **tachycardia** with signs of systemic inflammation. - There is no indication of infection, and the **bradycardia** is inconsistent with the typical presentation of septic shock.

Q: Classic triad in Renal cell carcinoma includes all of the following, Except:

Hypertension. ***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**.

Q: All of the following are paraneoplastic syndromes for renal cell carcinoma except which of the following?

Acanthosis Nigricans. Acanthosis Nigricans - Acanthosis nigricans is primarily associated with **insulin resistance** and is not a known paraneoplastic syndrome related to renal cell carcinoma. - Paraneoplastic syndromes typically involve **systemic effects** of tumors rather than dermatological manifestations like acanthosis nigricans. *Fever* - Fever can occur as a result of the body's response to tumors, including renal cell carcinoma, and is classified as a **paraneoplastic syndrome**. - It reflects the **systemic inflammatory response** often seen with malignancies. *Anaemia* - Anaemia is a common paraneoplastic syndrome associated with renal cell carcinoma due to the production of **erythropoietin** or as a result of **chronic disease** [1]. - It can lead to **fatigue** and pallor in affected individuals, making it relevant to renal cancers [1]. *Amyloidosis* - Amyloidosis can occur as a paraneoplastic syndrome in various malignancies, including renal cell carcinoma, due to **protein misfolding** states. - It can lead to complications affecting **kidney function** and other organs, aligning it with renal cell carcinoma, though kidney tumors also frequently present with hypercalcemia [1].

Q: Pseudoclaudication is caused by

Lumbar canal stenosis. ***Lumbar canal stenosis*** - **Pseudoclaudication**, also known as **neurogenic claudication**, is a characteristic symptom of **lumbar canal stenosis**. - It is caused by **compression of spinal nerve roots** in the lumbar spine, leading to pain, numbness, or weakness in the legs, often exacerbated by standing or walking and relieved by sitting or stooping forward [1]. *Femoral Artery stenosis* - **Femoral artery stenosis** causes **vascular claudication**, which is pain in the leg muscles due to insufficient blood flow during exercise [2]. - Unlike pseudoclaudication, vascular claudication is typically relieved by rest and is not influenced by spinal position [2]. *Popliteal Artery stenosis* - **Popliteal artery stenosis** also leads to **vascular claudication**, presenting as calf pain during walking due to reduced blood supply to the distal leg [2]. - This condition is related to **peripheral artery disease**, distinct from neurological compression [2]. *Radial Artery stenosis* - **Radial artery stenosis** typically affects blood flow to the **hand and forearm**, potentially causing symptoms of ischemia in those areas. - It is not associated with leg pain or claudication.

Q: In cobalamin deficiency which is not seen

Microcytic anemia. 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.

Q: CAR-T cell therapy (Chimeric Antigen Receptor T-cell therapy) is being investigated for the treatment of which malignancy?

Acute Lymphoblastic Leukemia. ***Acute Lymphoblastic Leukemia*** - **CAR T-cell therapy** has shown remarkable success, particularly in treating refractory or relapsed **B-cell acute lymphoblastic leukemia (ALL)** in children and young adults. - The therapy targets the **CD19 antigen** found on malignant B-cells, leading to their destruction by engineered T-cells. *Renal Cell Carcinoma* - While immune therapies are used for **renal cell carcinoma (RCC)**, traditional CAR T-cell therapy targeting specific antigens has not yet achieved widespread clinical success for this solid tumor. - RCC often presents with a **heterogeneous antigenic landscape**, making it challenging for single-target CAR T-cells. *Pancreatic Cancer* - **Pancreatic cancer** is a challenging malignancy due to its dense stroma and immunosuppressive microenvironment, which limits T-cell infiltration and efficacy. - CAR T-cell therapy for pancreatic cancer is still largely in **early-stage clinical trials**, facing significant hurdles in solid tumor treatment. *Glioblastoma Multiforme* - **Glioblastoma multiforme (GBM)** is an aggressive brain tumor with unique challenges for CAR T-cell therapy, including the **blood-brain barrier** and tumor heterogeneity. - Research is ongoing to develop CAR T-cells that can effectively target GBM, often using **regional delivery methods** or targeting multiple antigens.

Q: A 55 years old male with a known history of gallstones presents with chief complaints of severe abdominal pain and elevated levels of serum lipase with periumbilical ecchymosis. All of the following are prognostic criteria to predict the severity of acute pancreatitis except:

Serum GGT. ***Serum GGT*** - **Serum GGT (gamma-glutamyl transpeptidase)** is primarily used to evaluate liver and bile duct function and cholestasis, not as a direct prognostic indicator for acute pancreatitis severity. - While gallstones are mentioned, GGT elevation in this context would suggest the cause of pancreatitis rather than its severity. *Age* - **Age older than 55 years** is a significant prognostic factor in various scoring systems like Ranson's criteria and the APACHE II score, indicating a higher risk of severe disease and complications [1]. - Older patients generally have less physiologic reserve and are more prone to organ failure during severe pancreatitis [1]. *Serum LDH* - **Elevated serum LDH (lactate dehydrogenase)**, specifically above 350 IU/L, is one of Ranson's criteria for assessing the severity of acute pancreatitis within the first 48 hours. - It suggests significant tissue damage and necrosis, which correlates with worse outcomes. *Base deficit* - A **base deficit greater than 4 mEq/L** is an indicator of metabolic acidosis and is included in prognostic scoring systems for acute pancreatitis, such as the modified Glasgow criteria. - It reflects poor tissue perfusion, hypovolemia, and potentially severe systemic inflammation.

Q: A 45 year old lawyer presents with pain in the abdomen more so in the epigastric region that worsens with eating spicy food and is relieved by bending forward. Complications of the above mentioned condition could be all except:

Splenic Vein Thrombosis. ***Splenic Vein Thrombosis*** - The patient's symptoms (epigastric pain worsening with spicy food, relieved by bending forward) are highly suggestive of **pancreatitis**, not peptic ulcer disease [1]. **Splenic vein thrombosis** is a known complication of chronic pancreatitis due to inflammation and compression of the splenic vein [2]. - While pancreatitis can cause significant morbidity, **splenic vein thrombosis** is a specific vascular complication associated with prolonged inflammation of the pancreas, leading to localized portal hypertension and potentially isolated gastric varices. *Perforation* - **Perforation** (specifically of a peptic ulcer or potentially surrounding bowel in severe pancreatitis) is a severe complication that can occur in conditions causing abdominal pain, but it is not the *exception* among the given options for the likely underlying condition indicated by the patient's symptoms (pancreatitis) [3]. - This complication typically leads to **peritonitis**, a medical emergency requiring immediate surgical intervention [3]. *Bleeding* - **Bleeding** (e.g., from a pancreatic pseudocyst rupturing into the gastrointestinal tract or from localized varices secondary to portal hypertension in pancreatitis) is a recognized complication of the patient's likely underlying condition [1]. - Gastrointestinal bleeding can also result from **gastric erosions** or ulcers exacerbated by ongoing inflammation. *Gastric Outlet Obstruction* - **Gastric outlet obstruction** can occur as a complication of severe or chronic pancreatitis, often due to **inflammation**, **fibrosis**, or **pseudocyst formation** compressing the duodenum [1]. - This typically presents with **postprandial vomiting** and early satiety, which can arise in the context of chronic pancreatic inflammation.

Question 1

Which of the following statements about drug-induced SLE is NOT true?

Accepted Answer

Female: Male ratio=1:9

Answer

CNS involvement not common

Answer

Renal involvement not common

Answer

Anti-histone antibodies are negative

Question 2

A man working in a hot environment and consuming large amounts of water without replacing salts is likely to develop -

Accepted Answer

Heat cramps

Answer

Heat hyperpyrexia

Answer

Heat stroke

Answer

Heat encephalopathy

Question 3

After a road traffic accident, a patient presented to casualty with vitals showing BP of 90/60 mm Hg and heart rate of 56 bpm. Which kind of shock occurs?

Accepted Answer

Neurogenic

Answer

Cardiogenic

Answer

Hypovolemic shock

Answer

Septic shock

Question 4

Classic triad in Renal cell carcinoma includes all of the following, Except:

Accepted Answer

Hypertension

Answer

Hematuria

Answer

Flank mass

Answer

Abdominal Pain

Question 5

All of the following are paraneoplastic syndromes for renal cell carcinoma except which of the following?

Accepted Answer

Acanthosis Nigricans

Answer

Fever

Answer

Amyloidosis

Answer

Anaemia

Question 6

Pseudoclaudication is caused by

Accepted Answer

Lumbar canal stenosis

Answer

Femoral Artery stenosis

Answer

Popliteal Artery stenosis

Answer

Radial Artery stenosis

Question 7

In cobalamin deficiency which is not seen

Accepted Answer

Microcytic anemia

Answer

Loss of proprioception

Answer

Rhomberg sign

Answer

Long tract signs

Question 8

CAR-T cell therapy (Chimeric Antigen Receptor T-cell therapy) is being investigated for the treatment of which malignancy?

Accepted Answer

Acute Lymphoblastic Leukemia

Answer

Renal Cell Carcinoma

Answer

Pancreatic Cancer

Answer

Glioblastoma Multiforme

Question 9

A 55 years old male with a known history of gallstones presents with chief complaints of severe abdominal pain and elevated levels of serum lipase with periumbilical ecchymosis. All of the following are prognostic criteria to predict the severity of acute pancreatitis except:

Accepted Answer

Serum GGT

Answer

Serum LDH

Answer

Base deficit

Answer

Age

Question 10

A 45 year old lawyer presents with pain in the abdomen more so in the epigastric region that worsens with eating spicy food and is relieved by bending forward. Complications of the above mentioned condition could be all except:

Accepted Answer

Splenic Vein Thrombosis

Answer

Bleeding

Answer

Gastric Outlet Obstruction

Answer

Perforation

NEET-PG 2015 — Internal Medicine