NEET-PG 2015 - Internal Medicine Practice Questions

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: Crush Syndrome is associated with all of the following features except -

Hypercalcemia. ***Hypercalcemia*** - Crush syndrome involves massive **muscle damage** leading to the release of intracellular contents, but hypercalcemia is not typically seen acutely. - While skeletal muscle contains calcium, its release, if any, is usually outweighed by other electrolyte shifts and renal dysfunction, often leading to **hypocalcemia** due to calcium binding to damaged tissues and phosphate. *Hypocalcemia* - This is a common feature of **crush syndrome** because calcium ions move into damaged cells and bind to free fatty acids and damaged tissue. - The elevated **phosphate levels** released from damaged cells can also bind to circulating calcium, further reducing serum calcium. *Hyperkalemia* - One of the most dangerous complications of **crush syndrome**, resulting from the massive release of **intracellular potassium** from damaged muscle cells. - Can lead to **life-threatening arrhythmias** if not promptly managed. *Increased serum creatinine* - Damaged muscle releases large amounts of **creatinine**, which is a byproduct of muscle metabolism; this, along with **myoglobin** (leading to acute kidney injury), causes a significant increase in serum creatinine levels. - **Acute kidney injury** due to rhabdomyolysis is a hallmark of crush syndrome, leading to impaired clearance of waste products.

Q: Which of the following types of kidney stones are commonly associated with urinary tract infections?

Struvite stones. ***Struvite stones*** - **Struvite stones** (magnesium ammonium phosphate) are strongly associated with **urinary tract infections (UTIs)** caused by urease-producing bacteria like *Proteus* and *Klebsiella*. - These bacteria hydrolyze urea into ammonia and carbon dioxide, increasing urine pH and promoting the precipitation of struvite, often forming **staghorn calculi** [1]. *Cystine stones* - **Cystine stones** are caused by a **genetic defect** in amino acid transport, leading to increased excretion of cystine, ornithine, lysine, and arginine (COLA) in the urine. - They are not directly associated with UTIs but rather with a rare inherited metabolic disorder called **cystinuria**. *Xanthine stones* - **Xanthine stones** are very rare and typically occur in individuals with **xanthinuria**, a genetic disorder characterized by a deficiency in xanthine oxidase. - They are also not linked to UTIs but are a consequence of abnormal purine metabolism. *Calcium oxalate stones* - **Calcium oxalate stones** are the most common type of kidney stone, resulting from high levels of calcium and oxalate in the urine, often due to dietary factors, malabsorption, or idiopathic hypercalciuria. - While UTIs can complicate any kidney stone, **calcium oxalate stones** are not primarily *caused* by UTIs. [1]

Q: Which zone of the prostate is primarily involved in Benign Prostatic Hyperplasia (BPH)?

Transitional zone. ***Transitional zone*** - The **transitional zone** surrounds the urethra and is the primary site of origin and enlargement in **Benign Prostatic Hyperplasia (BPH)**. - Its hypertrophy leads to compression of the urethra, causing **lower urinary tract symptoms (LUTS)**. *Central zone* - The **central zone** surrounds the ejaculatory ducts and is less commonly involved in BPH. - It is more frequently associated with the development of **prostate carcinoma**. *Peripheral zone* - The **peripheral zone** is the largest zone of the prostate and is where the majority of prostate cancers originate. - While it can be affected by BPH, it is not the primary zone for hypertrophy. *Prostate capsule* - The **prostate capsule** is the outer fibrous layer that encloses the prostate gland. - It does not undergo hyperplasia in BPH; rather, it encases the enlarging gland.

Q: All of the following may lead to gall bladder carcinoma except which of the following?

Echinococcus Granulosus Infection. ***Echinococcus Granulosus Infection*** - Echinococcus granulosus is primarily associated with **hydatid cyst formation**, not directly linked to gallbladder carcinoma. - This infection typically affects the **liver** rather than inducing malignant transformation in the gallbladder. *Typhoid carriers* - Chronic infection with **Salmonella typhi** in carriers can cause **gallbladder inflammation** and is a risk factor for gallbladder cancer. - Typhoid carriers retain the bacteria in the gallbladder, leading to chronic irritation and potentially malignant changes. *Gall Bladder Polyps* - Certain types of gallbladder polyps, especially those larger than **1 cm**, have a significant risk of undergoing malignant transformation. - They are associated with **chronic inflammation** and may progress to cancer if not monitored. *Exposure to carcinogens like nitrosamine* - Nitrosamines are known **carcinogens** that can induce protein modifications leading to DNA damage, contributing to gallbladder cancer. - Long-term exposure to such chemicals can result in **cellular mutations** in the gallbladder epithelial lining.

Q: Which of the following is NOT a common complication of acute pancreatitis?

Hypercalcemia. ***Hypercalcemia*** - Acute pancreatitis is primarily associated with **increased amylase levels** and **hyperlipidemia**, while hypercalcemia is generally a separate condition. - It is not a classical complication or result of acute pancreatitis, but rather might be a cause in cases like **hyperparathyroidism** [1]. *Subcutaneous fat necrosis* - This occurs as a result of **lipolysis** during acute pancreatitis due to the release of **lipases** into circulation [1]. - It is characterized by the presence of **fat necrosis** on the abdomen or buttocks. *Increased amylase level* - A hallmark of acute pancreatitis is **elevated levels of amylase** and sometimes lipase, indicating pancreatic inflammation [1]. - The rise typically occurs within the first 24 hours of the onset of pancreatitis. *Hyperlipidemia* - This is often found in acute pancreatitis due to excess **lipolysis**, leading to elevated triglycerides in the blood [1]. - It can be both a cause and a consequence of pancreatic inflammation, contributing to the disease process [1].

Q: Bilateral parotid enlargement occurs in all, Except:

Chronic pancreatitis. ***SLE*** - **Systemic Lupus Erythematosus (SLE)** typically does not present with **bilateral parotid enlargement**, which is more characteristic of other conditions. - Salivary gland involvement in SLE is less prevalent and usually not the primary clinical feature associated with the disease. *HIV* - **HIV** infection can lead to **bilateral parotid enlargement** due to associated conditions such as lymphadenopathy and infections like **salivary gland infections**. [1] - **Lymphoid tissue** hyperplasia in response to HIV is another factor contributing to this enlargement. *Sjogren's syndrome* - **Sjogren's syndrome** is a common cause of **bilateral parotid enlargement** due to inflammatory infiltrates affecting the salivary glands. - Patients typically experience **xerostomia** (dry mouth) and **xerophthalmia** (dry eyes) alongside gland enlargement [2]. *Chronic pancreatitis* - Patients with **chronic pancreatitis** may develop **bilateral parotid enlargement** due to associated changes such as **sialadenosis** from malnutrition and electrolyte imbalances. - The enlargement occurs as a **compensatory mechanism** related to the pancreatic pathology affecting nearby structures.

Q: Chronic hemolytic anaemia is associated with which of the following -

Black Pigment stone of the gall bladder. ***Black Pigment stone of the gall bladder*** - Chronic hemolytic anemia leads to increased **bilirubin**, particularly unconjugated bilirubin, which can result in the formation of **black pigment stones** [1]. - These stones are associated with conditions causing **excess bilirubin production**, such as sickle cell disease and thalassemia. *Brown Pigment stone of the gall bladder* - Brown pigment stones are primarily associated with **infection** and **biliary tract disorders**, not directly with chronic hemolytic anemia. - They are mainly composed of **calcium bilirubinate**, which arises in cases of **bacterial infections** or parasitic infestations. *Intestinal Obstruction* - While hemolytic anemia can have various complications, it is **not directly linked with intestinal obstruction**. - Obstruction typically arises from **mechanical causes** such as adhesions, tumors, or hernias, rather than from hemolytic processes. *Uric acid Renal Calculus* - Uric acid stones are formed due to conditions leading to **hyperuricemia** and are not a primary consequence of chronic hemolytic anemia. - They are often associated with **gout** and **certain metabolic disorders**, rather than hemolytic processes.

Q: All of the following are features of Zollinger Ellison syndrome except:

Beta cell tumours of the pancreas. ***Beta cell tumours of the pancreas*** - Zollinger-Ellison syndrome (ZES) is caused by **gastrinomas**, which are **neuroendocrine tumors** that typically arise from the **gastrin-producing G cells**, not the insulin-producing beta cells, of the pancreas or duodenum. - While pancreatic tumors are common in ZES, they are specifically **gastrinomas**, leading to excessive gastrin secretion. *Severe diarrhoea* - This is a common feature of ZES resulting from the **high acid output** reaching the small intestine. - The excessive acid inactivates pancreatic lipase, leading to **maldigestion** and stimulates fluid and electrolyte secretion, causing secretory diarrhea. *Very high acid output* - ZES is characterized by the **overproduction of gastrin**, which stimulates the parietal cells of the stomach to secrete large amounts of **hydrochloric acid**. - This leads to a significantly **increased basal and maximal acid output** in the stomach. *Intractable peptic ulcers* - The extremely high gastric acid secretion in ZES causes **multiple, recurrent, and often refractory peptic ulcers**, which can be located in atypical sites such as the jejunum. - These ulcers are typically difficult to treat with standard anti-ulcer medications due to the persistent gastric hypersecretion.

Question 1

In cobalamin deficiency which is not seen

Accepted Answer

Microcytic anemia

Answer

Loss of proprioception

Answer

Rhomberg sign

Answer

Long tract signs

Question 2

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 3

Crush Syndrome is associated with all of the following features except -

Accepted Answer

Hypercalcemia

Answer

Hypocalcemia

Answer

Hyperkalemia

Answer

Increased serum creatinine

Question 4

Which of the following types of kidney stones are commonly associated with urinary tract infections?

Accepted Answer

Struvite stones

Answer

Cystine stones

Answer

Xanthine stones

Answer

Calcium oxalate stones

Question 5

Which zone of the prostate is primarily involved in Benign Prostatic Hyperplasia (BPH)?

Accepted Answer

Transitional zone

Answer

Central zone

Answer

Peripheral zone

Answer

Prostate capsule

Question 6

All of the following may lead to gall bladder carcinoma except which of the following?

Accepted Answer

Echinococcus Granulosus Infection

Answer

Gall Bladder Polyps

Answer

Typhoid carriers

Answer

Exposure to carcinogens like nitrosamine

Question 7

Which of the following is NOT a common complication of acute pancreatitis?

Accepted Answer

Hypercalcemia

Answer

Subcutaneous fat necrosis

Answer

Hyperlipidemia

Answer

Increased amylase level

Question 8

Bilateral parotid enlargement occurs in all, Except:

Accepted Answer

Chronic pancreatitis

Answer

HIV

Answer

SLE

Answer

Mumps

Question 9

Chronic hemolytic anaemia is associated with which of the following -

Accepted Answer

Black Pigment stone of the gall bladder

Answer

Brown Pigment stone of the gall bladder

Answer

Uric acid Renal Calculus

Answer

Intestinal Obstruction

Question 10

All of the following are features of Zollinger Ellison syndrome except:

Accepted Answer

Beta cell tumours of the pancreas

Answer

Severe diarrhoea

Answer

Very high acid output

Answer

Intractable peptic ulcers

NEET-PG 2015 — Internal Medicine