Therapeutic phlebotomy is not done in which of the following conditions?
Tinel's sign is seen in which of the following conditions?
Which of the following is characterized by a solitary painless ulcer on genitalia?
What is the normal range for maximum phonation time in healthy adults?
Which of the following conditions is most commonly associated with cauda equina syndrome?
CAR-T cell therapy (Chimeric Antigen Receptor T-cell therapy) is being investigated for the treatment of which malignancy?
Crush Syndrome is associated with all of the following features except -
Which of the following types of kidney stones are commonly associated with urinary tract infections?
Which zone of the prostate is primarily involved in Benign Prostatic Hyperplasia (BPH)?
All of the following may lead to gall bladder carcinoma except which of the following?
NEET-PG 2015 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 151: 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 152: Tinel's sign is seen in which of the following conditions?
- A. Carpal tunnel syndrome (Correct Answer)
- B. Avascular necrosis of scaphoid
- C. Kienbock's Disease
- D. 1st carpometacarpal joint arthritis
Explanation: ***Carpal tunnel syndrome*** - **Tinel's sign** is elicited by lightly tapping over the median nerve at the wrist, which in carpal tunnel syndrome, reproduces tingling or pain in the median nerve distribution [1]. - This sign indicates **nerve compression** or irritation at the carpal tunnel, a hallmark of the condition [1]. *Avascular necrosis of scaphoid* - This condition involves **bone death** due to interrupted blood supply, leading to pain and reduced range of motion, but not nerve irritation. - Diagnosis is typically made with **imaging studies** like MRI, not by neurological signs like Tinel's. *Kienbock's Disease* - This is a form of **avascular necrosis of the lunate bone**, causing wrist pain and stiffness. - It does not involve nerve compression and therefore **Tinel's sign** would not be expected. *1st carpometacarpal joint arthritis* - This condition affects the **joint at the base of the thumb**, causing localized pain and stiffness during gripping or pinching. - Symptoms are related to **joint degeneration**, not nerve impingement, so Tinel's sign is not relevant.
Question 153: Which of the following is characterized by a solitary painless ulcer on genitalia?
- A. Genital herpes
- B. Syphilis (Correct Answer)
- C. Traumatic injury
- D. Chancroid
Explanation: ***Syphilis*** - Primary syphilis typically presents as a **painless chancre** (ulcer) at the site of infection, usually the **genitalia**. - The painless nature is a key differentiating feature as it often goes unnoticed, allowing the disease to progress. *Genital herpes* - Characterized by multiple, small, often painful vesicles or ulcers that may coalesce [1]. - Lesions are typically tender or painful, unlike the **painless chancre** of syphilis [1]. *Traumatic injury* - While a traumatic injury can cause a solitary ulcer, it is usually painful and often associated with a clear history of trauma. - The ulcer's morphology and healing process may differ from a classic syphilitic chancre. *Chancroid* - Caused by *Haemophilus ducreyi*, chancroid presents as one or more painful, tender ulcers with ragged, undermined borders. - This is a significant differentiator from the **painless ulcer** seen in primary syphilis.
Question 154: What is the normal range for maximum phonation time in healthy adults?
- A. 15-25 seconds
- B. 40-45 seconds
- C. 30-35 seconds (Correct Answer)
- D. 8-12 seconds
Explanation: ***30-35 seconds*** - The **maximum phonation time (MPT)** is a measure of the longest period a person can sustain a vowel sound on a single breath. - A healthy adult typically has an MPT in the range of **30-35 seconds**, reflecting good respiratory and phonatory control. *8-12 seconds* - This range is generally considered **below normal** for a healthy adult and may indicate compromised **respiratory support** or **laryngeal function**. - A short MPT could be a sign of **vocal fold pathology** or **reduced breath support**. *15-25 seconds* - While better than 8-12 seconds, this range is still often considered **slightly lower than optimal** for healthy adults. - It might suggest subtle inefficiencies in **breath control** or **vocal fold coaptation**, though it's not severely pathological. *40-45 seconds* - An MPT in this range is **unusually long** and exceeds the typical normal values for most healthy adults. - While seemingly good, excessively long MPTs are not standard and might suggest unusual respiratory capacity or an outlier measurement.
Question 155: Which of the following conditions is most commonly associated with cauda equina syndrome?
- A. Herniated disc (Correct Answer)
- B. Trauma
- C. Tumor
- D. Spinal stenosis
Explanation: ***Herniated disc*** - A **large central disc herniation**, especially at the L4-L5 or L5-S1 level, often compresses multiple nerve roots of the **cauda equina** [1]. - This compression leads to the characteristic symptoms of **saddle anesthesia**, **bowel/bladder dysfunction**, and **bilateral leg weakness**. *Trauma* - While **severe trauma** to the lumbar spine (e.g., fractures, dislocations) can cause cauda equina syndrome, it is a less common cause than disc herniation [1]. - Trauma typically involves an acute, high-energy injury, distinct from the more gradual onset seen with disc pathology. *Tumor* - **Spinal tumors**, both primary and metastatic, can compress the cauda equina, but they are relatively rare compared to disc herniations [1]. - Tumor-related cauda equina syndrome often presents with more insidious symptom progression and may include systemic symptoms or a history of malignancy. *Spinal stenosis* - **Spinal stenosis** can cause compression of nerve roots, typically leading to neurogenic claudication. - While severe stenosis can contribute to cauda equina symptoms, it generally involves diffuse narrowing over multiple levels and is less likely to cause acute, severe cauda equina syndrome than a single, large disc herniation.
Question 156: CAR-T cell therapy (Chimeric Antigen Receptor T-cell therapy) is being investigated for the treatment of which malignancy?
- A. Acute Lymphoblastic Leukemia (Correct Answer)
- B. Renal Cell Carcinoma
- C. Pancreatic Cancer
- D. Glioblastoma Multiforme
Explanation: ***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.
Question 157: Crush Syndrome is associated with all of the following features except -
- A. Hypercalcemia (Correct Answer)
- B. Hypocalcemia
- C. Hyperkalemia
- D. Increased serum creatinine
Explanation: ***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.
Question 158: Which of the following types of kidney stones are commonly associated with urinary tract infections?
- A. Struvite stones (Correct Answer)
- B. Cystine stones
- C. Xanthine stones
- D. Calcium oxalate stones
Explanation: ***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]
Question 159: Which zone of the prostate is primarily involved in Benign Prostatic Hyperplasia (BPH)?
- A. Central zone
- B. Peripheral zone
- C. Transitional zone (Correct Answer)
- D. Prostate capsule
Explanation: ***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.
Question 160: All of the following may lead to gall bladder carcinoma except which of the following?
- A. Gall Bladder Polyps
- B. Typhoid carriers
- C. Echinococcus Granulosus Infection (Correct Answer)
- D. Exposure to carcinogens like nitrosamine
Explanation: ***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.