NEET-PG 2015 - Internal Medicine Practice Questions

Q: Most common organism associated with reactive arthritis is:

Chlamydia. ***Chlamydia*** - **Chlamydia trachomatis** is a commonly identified pathogen causing **genitourinary infections** that can trigger reactive arthritis [1]. - The organism itself is not present in the joint, but its antigens trigger an immune response leading to sterile arthritis [1]. *Staphylococcus* - **Staphylococcus aureus** is a common cause of septic arthritis, which involves direct bacterial invasion of the joint. - Reactive arthritis is a **sterile arthritis** triggered by an infection elsewhere, not directly caused by staphylococcal joint infection. *Shigella* - While **Shigella** is a known enteric pathogen that can trigger reactive arthritis, it is less commonly associated with the condition globally compared to Chlamydia [1]. - Reactive arthritis often follows episodes of **dysentery** caused by Shigella species [1]. *Yersinia* - **Yersinia enterocolitica** is another enteric bacterium that can induce reactive arthritis, typically after **gastrointestinal infections**. - Its prevalence as a trigger for reactive arthritis is generally lower than that of Chlamydia.

Q: In long standing rheumatoid arthritis, which condition is commonly observed?

Secondary amyloidosis. ***Secondary amyloidosis*** - Chronic inflammation in **rheumatoid arthritis** can lead to the production and deposition of **amyloid A protein**, which is the hallmark of secondary (AA) amyloidosis [1]. - **Secondary amyloidosis** can affect various organs, including the kidneys, heart, and gastrointestinal tract, leading to organ dysfunction [1]. *Milk alkali syndrome* - This condition is caused by excessive intake of **calcium** and absorbable alkali, resulting in **hypercalcemia** and **metabolic alkalosis**. - It is not directly associated with the chronic inflammatory process of rheumatoid arthritis. *Nephrolithiasis* - **Kidney stones** (nephrolithiasis) are often associated with genetic predispositions, dietary factors, and certain metabolic conditions like **hypercalciuria** or **hyperoxaluria**. - There is no direct causal link between **rheumatoid arthritis** and an increased risk of common types of kidney stones. *Paradoxical aciduria* - This condition is characterized by the excretion of acidic urine in the presence of **metabolic alkalosis**, typically due to **volume depletion** and **hypokalemia**. - While it reflects a disturbance in acid-base balance and renal function, it is not a direct or commonly observed complication of long-standing rheumatoid arthritis itself.

Q: Which is the most common tumor leading to death in adults?

Lung cancer. ***Lung cancer*** - **Lung cancer** is the most common cause of cancer-related death in both men and women worldwide [1], [2]. - Its high mortality is attributed to its aggressive nature, late diagnosis, and limited treatment options for advanced stages [3]. *Prostate cancer* - While **prostate cancer** is very common in men, it typically has a slower progression and a relatively high survival rate compared to lung cancer. - Early detection through screening often leads to successful treatment and a good prognosis. *Colorectal cancer* - **Colorectal cancer** is a significant cause of cancer mortality but ranks behind lung cancer in overall deaths [2]. - Improved screening methods like colonoscopies allow for early detection and removal of precancerous polyps, reducing mortality. *Leukemia* - **Leukemia** refers to cancers of the blood and bone marrow, and while serious, they are less common causes of cancer death than solid tumors like lung, colorectal, or prostate cancer [2]. - Advances in chemotherapy, stem cell transplantation, and targeted therapies have significantly improved survival rates for many types of leukemia.

Q: A 23-year old woman has experienced episodes of myalgias, pleural effusion, pericarditis and arthralgias without joint deformity over course of several years. The best laboratory screening test to diagnose her disease would be -

Antinuclear antibody. ***Antinuclear antibody*** - The constellation of **myalgias**, **pleural effusion**, **pericarditis**, and **arthralgias without joint deformity** is highly suggestive of **systemic lupus erythematosus (SLE)**. - **Antinuclear antibodies (ANA)** are present in over 95% of patients with SLE and are the primary screening test for this condition [1]. *CD4/CD8 lymphocyte count* - This count is more relevant for monitoring **immunodeficiency** conditions like **HIV infection**, where it helps assess immune status. - While lymphocytes can be affected in autoimmune diseases, a CD4/CD8 count is not a primary screening test for SLE. *Erythrocyte sedimentation rate* - An **elevated ESR** indicates general inflammation and is a **non-specific marker** [2]. - While it is often elevated in SLE, it doesn't confirm the diagnosis and can be high in numerous other inflammatory conditions [1]. *Assay for thyroid hormones* - An assay for thyroid hormones is used to diagnose **thyroid disorders** like **hypothyroidism** or **hyperthyroidism**. - There is no direct link between thyroid hormone levels and the symptoms described in the patient.

Q: Which of the following antibodies is highly specific for systemic lupus erythematosus?

Anti-Sm. ***Anti-Sm*** - The **Anti-Sm antibody** is highly specific for **systemic lupus erythematosus (SLE)**, with a specificity of over 99% [1]. - It is often associated with **renal involvement** and more severe disease manifestations [1]. *Anti-Centromere* - Mostly associated with **limited scleroderma**, not SLE, and indicates **creatodermal** changes. - Often found in patients with **Raynaud's phenomenon** and **pulmonary hypertension**, distinct from SLE features. *Anti-U1RNP* - Typically seen in **mixed connective tissue disease (MCTD)**, indicating a combination of features from various autoimmune diseases [1]. - While it can be present in SLE patients, it is not specific to SLE and can be found in other conditions as well. *Anti-RO-1* - Also known as **Anti-SSA**, these antibodies are associated with Sjögren's syndrome, as well as SLE [1]. - They are not specific for SLE as they can appear in other autoimmune diseases, marking their lack of specificity.

Q: Gaisbock syndrome is known as:

Spurious Polycythemia. ***Spurious Polycythemia*** - Gaisbock syndrome is characterized by an increase in **red blood cells** due to **dehydration** and is a form of **spurious or relative polycythemia** [1]. - It typically occurs in individuals with **high hematocrit levels** without true pathological erythrocytosis [1]. *High Altitude Erythrocytosis* - This condition is caused by **hypoxia** at high altitudes leading to increased **erythropoietin**, resulting in genuine **erythrocytosis** [2]. - Unlike Gaisbock syndrome, it reflects a true physiological response to reduced oxygen levels [2]. *Polycythemia Vera* - Polycythemia vera is a **myeloproliferative disorder** characterized by increased red blood cell mass due to intrinsic bone marrow changes. - It entails elevated **erythropoietin** levels and features such as **splenomegaly** and other cytogenetic changes, which are not present in Gaisbock syndrome [1][3]. *Primary Familial Polycythemia* - This hereditary condition results in increased red blood cells due to genetic mutations leading to overproduction of erythrocytes. - It is distinct from Gaisbock syndrome as it typically manifests from genetic predisposition rather than environmental factors such as dehydration.

Q: Which condition is associated with Streptococcus bovis infection?

Colorectal cancer. ***Colorectal cancer*** - *Streptococcus gallolyticus* (formerly known as *Streptococcus bovis* biotype I) infection, particularly **bacteremia** or **endocarditis**, has a strong association with underlying **colorectal cancer**. - It is hypothesized that the bacteria may play a role in **tumorigenesis** or that the cancerous lesions provide an entry point for the bacteria into the bloodstream. *Chronic lymphocytic leukemia (CLL)* - While patients with CLL are **immunocompromised** and prone to infections, there is no specific association between *Streptococcus bovis* and CLL. - Infections in CLL patients are typically due to encapsulated bacteria, such as *Streptococcus pneumoniae* or *Haemophilus influenzae*. *Hairy cell leukemia (HCL)* - Patients with HCL often experience **immunosuppression** due to neutropenia and monocytopenia, leading to increased susceptibility to infections. - However, there is no direct or specific link between *Streptococcus bovis* infection and HCL itself. *Multiple myeloma (MM)* - Patients with multiple myeloma have **impaired humoral immunity** and are at risk for infections, especially from encapsulated bacteria. - There is no established specific association between *Streptococcus bovis* infection and multiple myeloma.

Q: In which condition is Chvostek's sign typically observed?

Hypoparathyroidism. Hypoparathyroidism - **Chvostek's sign** is a clinical manifestation of **hypocalcemia**, which is a hallmark of hypoparathyroidism [1]. - It involves a twitch of facial muscles elicited by tapping the **facial nerve** anterior to the ear. Hypercalcemia - **Hypercalcemia** is the opposite of hypocalcemia and would not cause increased neuromuscular excitability [2]. - Patients with hypercalcemia might experience symptoms like **fatigue**, **constipation**, and **bone pain** [2]. Insulinoma - An **insulinoma** is a tumor that produces excessive insulin, leading to **hypoglycemia**, not issues with calcium balance. - Symptoms are primarily related to low blood sugar, such as **confusion** and **tachycardia**. Diabetes mellitus - **Diabetes mellitus** is a metabolic disorder characterized by **high blood glucose levels** due to insulin deficiency or resistance. - It is not directly associated with calcium imbalances that would cause Chvostek's sign.

Q: Blood transfusion associated acute lung injury occurs due to -

HLA-mediated reaction. ***HLA-mediated reaction*** - Transfusion-related acute lung injury (TRALI) is primarily caused by **antibodies** in the donor plasma (usually anti-HLA or anti-HNA antibodies) reacting with the recipient's **neutrophils** [1]. - This interaction leads to neutrophil activation and sequestration in the pulmonary vasculature, causing **endothelial damage** and increased capillary permeability [1]. *Nosocomial infections* - Nosocomial infections are **hospital-acquired infections** and are not a direct cause of TRALI. - While infections can lead to lung injury, the mechanism of TRALI is distinct and immunologically mediated by donor antibodies. *Auto-immune disorder* - An autoimmune disorder involves the body's immune system attacking its own tissues, which is not the primary mechanism of TRALI. - TRALI is an **alloimmune reaction** where donor antibodies react with host antigens, rather than a pre-existing autoimmune condition. *Genetic susceptibility* - While genetic factors might sometimes play a role in an individual's general inflammatory response or susceptibility to certain conditions, they are **not the direct or primary cause** of TRALI. - The acute lung injury in TRALI is triggered by specific **antibody-antigen interactions** during the transfusion.

Q: In a patient presenting with a painful swollen joint and a history of high uric acid levels, which condition is most likely indicated by this clinical presentation?

Gout. ***Gout*** - **Gout** is characterized by sudden, severe attacks of pain, swelling, redness, and tenderness in one or more joints, most often the **big toe** [1],[2]. - A history of **high uric acid levels** (hyperuricemia) is a primary risk factor, as it leads to the formation of **uric acid crystals** in the joint [1],[3]. *Ankylosing spondylitis* - This condition is a chronic inflammatory disease primarily affecting the **spine and sacroiliac joints**, causing stiffness and pain, especially in the morning. - It is not directly associated with **high uric acid levels** or generally presenting as an acute, single swollen joint attack. *Osteoarthritis* - **Osteoarthritis** is a degenerative joint disease characterized by the breakdown of cartilage over time, leading to pain and stiffness, especially with activity. - While it can cause joint swelling, it is typically a gradual process, not an acute, intensely painful attack, and is not linked to **uric acid levels**. *Rheumatoid arthritis* - **Rheumatoid arthritis** is an autoimmune disease causing chronic inflammation, primarily affecting multiple small joints symmetrically. - It presents with prolonged morning stiffness and is not directly caused by **high uric acid levels**, nor is its typical presentation an acute monoarthritis.

Question 1

Most common organism associated with reactive arthritis is:

Accepted Answer

Chlamydia

Answer

Staphylococcus

Answer

Shigella

Answer

Yersinia

Question 2

In long standing rheumatoid arthritis, which condition is commonly observed?

Accepted Answer

Secondary amyloidosis

Answer

Milk alkali syndrome

Answer

Nephrolithiasis

Answer

Paradoxical aciduria

Question 3

Which is the most common tumor leading to death in adults?

Accepted Answer

Lung cancer

Answer

Prostate cancer

Answer

Colorectal cancer

Answer

Leukemia

Question 4

A 23-year old woman has experienced episodes of myalgias, pleural effusion, pericarditis and arthralgias without joint deformity over course of several years. The best laboratory screening test to diagnose her disease would be -

Accepted Answer

Antinuclear antibody

Answer

Erythrocyte sedimentation rate

Answer

Assay for thyroid hormones

Answer

CD4/CD8 lymphocyte count

Question 5

Which of the following antibodies is highly specific for systemic lupus erythematosus?

Accepted Answer

Anti-Sm

Answer

Anti-RO-1

Answer

Anti-Centromere

Answer

Anti-U1RNP

Question 6

Gaisbock syndrome is known as:

Accepted Answer

Spurious Polycythemia

Answer

Primary Familial Polycythemia

Answer

High Altitude Erythrocytosis

Answer

Polycythemia Vera

Question 7

Which condition is associated with Streptococcus bovis infection?

Accepted Answer

Colorectal cancer

Answer

Chronic lymphocytic leukemia (CLL)

Answer

Hairy cell leukemia (HCL)

Answer

Multiple myeloma (MM)

Question 8

In which condition is Chvostek's sign typically observed?

Accepted Answer

Hypoparathyroidism

Answer

Hypercalcemia

Answer

Insulinoma

Answer

Diabetes mellitus

Question 9

Blood transfusion associated acute lung injury occurs due to -

Accepted Answer

HLA-mediated reaction

Answer

Nosocomial infections

Answer

Auto-immune disorder

Answer

Genetic susceptibility

Question 10

In a patient presenting with a painful swollen joint and a history of high uric acid levels, which condition is most likely indicated by this clinical presentation?

Accepted Answer

Gout

Answer

Ankylosing spondylitis

Answer

Osteoarthritis

Answer

Rheumatoid arthritis

NEET-PG 2015 — Internal Medicine