What is the most common cause of death in patients with advanced cancer?
All of the following are true about Gout, except which of the following?
Most common organism associated with reactive arthritis is:
In long standing rheumatoid arthritis, which condition is commonly observed?
Which is the most common tumor leading to death in adults?
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 -
Which of the following antibodies is highly specific for systemic lupus erythematosus?
Gaisbock syndrome is known as:
Which condition is associated with Streptococcus bovis infection?
In which condition is Chvostek's sign typically observed?
NEET-PG 2015 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 121: What is the most common cause of death in patients with advanced cancer?
- A. Bleeding
- B. Infection (Correct Answer)
- C. Respiratory failure
- D. Renal failure
Explanation: ***Infection*** - **Immunosuppression** from cancer itself and its treatments (e.g., chemotherapy, radiation) significantly increases susceptibility to infections. - Many patients with advanced cancer die from **sepsis** or opportunistic infections due to their weakened immune systems [1]. *Bleeding* - While bleeding can be a significant complication in advanced cancer (e.g., from tumor erosion, thrombocytopenia), it is less common as a direct cause of death compared to infection. - Life-threatening hemorrhages are typically managed, and other factors often contribute to mortality. *Respiratory failure* - **Respiratory failure** can occur due to **lung metastases**, direct tumor invasion, or complications like pneumonia in advanced cancer patients. - However, the underlying cause of such pneumonia or decline is often infectious or a result of systemic weakness. *Renal failure* - **Renal failure** can be caused by tumor obstruction of the urinary tract, **nephrotoxic chemotherapy**, or paraneoplastic syndromes. - Although serious, it is not the most frequent immediate cause of death in the broad population of advanced cancer patients.
Question 122: All of the following are true about Gout, except which of the following?
- A. Can be precipitated by pyrazinamide
- B. Birefringent crystals are present in the joint
- C. Occurs due to accumulation of urate crystals in joint
- D. Occurs more in females (Correct Answer)
Explanation: ***Occurs more in females*** - **Gout** is more prevalent in **males** than in females, especially before menopause, due to hormonal differences and lifestyle factors. - After menopause, the incidence in females increases but generally remains lower than in males. *Occurs due to accumulation of urate crystals in joint* - **Gout** is precisely characterized by the **deposition of monosodium urate crystals** in joints and surrounding tissues, leading to inflammation [1], [2]. - This accumulation is a direct consequence of **hyperuricemia**, either from overproduction or underexcretion of uric acid [2], [3]. *Can be precipitated by pyrazinamide* - **Pyrazinamide** is an anti-tuberculosis drug known to **inhibit uric acid excretion** by the kidneys. - This leads to **hyperuricemia**, thereby increasing the risk of acute gout attacks. *Birefringent crystals are present in the joint* - Microscopic examination of **synovial fluid** from a gouty joint reveals **needle-shaped, negatively birefringent crystals** of monosodium urate [1], [4]. - This finding is a definitive diagnostic criterion for **gout**.
Question 123: Most common organism associated with reactive arthritis is:
- A. Staphylococcus
- B. Shigella
- C. Chlamydia (Correct Answer)
- D. Yersinia
Explanation: ***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.
Question 124: In long standing rheumatoid arthritis, which condition is commonly observed?
- A. Milk alkali syndrome
- B. Nephrolithiasis
- C. Paradoxical aciduria
- D. Secondary amyloidosis (Correct Answer)
Explanation: ***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.
Question 125: Which is the most common tumor leading to death in adults?
- A. Lung cancer (Correct Answer)
- B. Prostate cancer
- C. Colorectal cancer
- D. Leukemia
Explanation: ***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.
Question 126: 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 -
- A. Erythrocyte sedimentation rate
- B. Antinuclear antibody (Correct Answer)
- C. Assay for thyroid hormones
- D. CD4/CD8 lymphocyte count
Explanation: ***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.
Question 127: Which of the following antibodies is highly specific for systemic lupus erythematosus?
- A. Anti-Sm (Correct Answer)
- B. Anti-RO-1
- C. Anti-Centromere
- D. Anti-U1RNP
Explanation: ***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.
Question 128: Gaisbock syndrome is known as:
- A. Primary Familial Polycythemia
- B. High Altitude Erythrocytosis
- C. Spurious Polycythemia (Correct Answer)
- D. Polycythemia Vera
Explanation: ***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.
Question 129: Which condition is associated with Streptococcus bovis infection?
- A. Colorectal cancer (Correct Answer)
- B. Chronic lymphocytic leukemia (CLL)
- C. Hairy cell leukemia (HCL)
- D. Multiple myeloma (MM)
Explanation: ***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.
Question 130: In which condition is Chvostek's sign typically observed?
- A. Hypercalcemia
- B. Hypoparathyroidism (Correct Answer)
- C. Insulinoma
- D. Diabetes mellitus
Explanation: 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.