Which of the following is NOT typically associated with Kallmann's syndrome?
Sausage finger appearance is associated with which of the following conditions?
What is the most common cause of delirium?
A 50 year old male presents with fever and malaise for 4 months and pain in the knees and ankles. Blood tests are normal apart from a raised ESR. Chest x-ray shows bilateral hilar adenopathy and pulmonary infiltrates most severe in the upper and mid zones. Mantoux test is negative. What is the most likely diagnosis?
A 50-year-old female presents with wrist drop. Which nerve is most likely involved?
Rademecker complex in EEG is seen in -
Lafora's disease presents with?
Which of the following is a feature of crush syndrome -
RULE OF HALVES RELATED TO-
Autosomal recessive Polycystic kidneys - all are true except -
NEET-PG 2015 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 161: Which of the following is NOT typically associated with Kallmann's syndrome?
- A. Hypogonadotropic hypogonadism
- B. Anosmia
- C. Amenorrhea
- D. Excess stimulation of the HPO axis (Correct Answer)
Explanation: ***Excess stimulation of the HPO axis*** - Kallmann's syndrome is characterized by **hypogonadotropic hypogonadism**, meaning there is a deficiency in the secretion of **gonadotropin-releasing hormone (GnRH)** [1] from the hypothalamus. - This deficiency leads to *reduced* stimulation of the **hypothalamic-pituitary-ovarian (HPO)** axis, not excess stimulation. *Amenorrhea* - **Amenorrhea** (absence of menstruation) is a common presentation in females with Kallmann's syndrome due to the **hypogonadotropic hypogonadism**. - The lack of GnRH results in insufficient **follicle-stimulating hormone (FSH)** and **luteinizing hormone (LH)**, preventing ovarian function and regular menstrual cycles. *Hypogonadotropic hypogonadism* - This is a **defining feature** of Kallmann's syndrome, where the **hypothalamus fails to produce enough GnRH**, leading to low levels of FSH and LH from the pituitary. - The low gonadotropin levels subsequently cause the gonads (testes or ovaries) to produce insufficient sex hormones, resulting in **delayed or absent puberty** [1]. *Anosmia* - **Anosmia** (the inability to smell) is a classic and diagnostic feature of Kallmann's syndrome, distinguishing it from other forms of hypogonadotropic hypogonadism. - It occurs because the **GnRH-producing neurons** originate in the olfactory placode and fail to migrate correctly into the hypothalamus during embryonic development, disrupting both smell and GnRH secretion.
Question 162: Sausage finger appearance is associated with which of the following conditions?
- A. Rickets
- B. Hyperthyroidism
- C. Addison's disease
- D. Psoriatic arthritis (Correct Answer)
Explanation: ***Psoriatic arthritis*** - **Dactylitis**, or "sausage finger," is a characteristic inflammatory finding in psoriatic arthritis, resulting from inflammation of the **entire digit** [1]. - This condition involves inflammation of tendons, joints, and soft tissues which leads to diffuse swelling of fingers or toes [1]. *Rickets* - Rickets is a bone-softening disease in children caused by **vitamin D deficiency**, leading to bone deformities like bowed legs or widened wrists. - It does not present with inflammatory dactylitis or "sausage digits." *Hyperthyroidism* - Hyperthyroidism is a condition of excessive thyroid hormone production, which can cause symptoms like **tremors**, **tachycardia**, and **weight loss** [2]. - It is not associated with dactylitis or changes in finger morphology. *Addison's disease* - Addison's disease results from **adrenal insufficiency**, leading to symptoms like **fatigue**, **skin hyperpigmentation**, and hypotension. - There is no clinical association between Addison's disease and "sausage finger" appearance.
Question 163: What is the most common cause of delirium?
- A. Infection (Correct Answer)
- B. Liver failure
- C. Belladonna poisoning
- D. None of the options
Explanation: ***Infection*** - **Infections**, particularly urinary tract infections (UTIs) or pneumonia, are a very common and often reversible cause of **delirium**, especially in elderly or immunocompromised patients [1]. - The systemic inflammatory response to infection can lead to neuroinflammation and direct effects on brain function, manifesting as acute changes in attention and cognition. *Liver failure* - While **liver failure** can cause **hepatic encephalopathy**, which presents with altered mental status, it typically has a more gradual onset and a different neurochemical profile than acute delirium caused by infection. - Hepatic encephalopathy is characterized by abnormal ammonia metabolism and often includes motor signs like **asterixis**, which are not universally present in delirium from infection. *Belladonna poisoning* - **Belladonna poisoning** (due to **anticholinergic toxicity**) can cause **delirium**, along with a constellation of symptoms like dilated pupils, dry mouth, and tachycardia. - However, it is a specific toxicological cause and not as broad or commonly encountered as infection as a general cause of new-onset delirium in hospitalized or elderly populations. *None of the options* - This option is incorrect because **infection** is indeed a very common and recognized cause of delirium [1].
Question 164: A 50 year old male presents with fever and malaise for 4 months and pain in the knees and ankles. Blood tests are normal apart from a raised ESR. Chest x-ray shows bilateral hilar adenopathy and pulmonary infiltrates most severe in the upper and mid zones. Mantoux test is negative. What is the most likely diagnosis?
- A. Tuberculosis
- B. Sarcoidosis (Correct Answer)
- C. Asbestosis
- D. Berylliosis
Explanation: ***Sarcoidosis*** - The constellation of **bilateral hilar adenopathy**, pulmonary infiltrates (especially in upper/mid zones), **arthralgia** (knees and ankles), and a **negative Mantoux test** in a patient with unexplained fever and malaise is highly suggestive of sarcoidosis [1]. - A **raised ESR** is a non-specific inflammatory marker often seen in sarcoidosis. *Tuberculosis* - While tuberculosis can cause fever, malaise, pulmonary infiltrates, and elevated ESR, a **negative Mantoux test** makes primary or active tuberculosis less likely in an immunocompetent individual. - **Bilateral hilar adenopathy** is also less typical of primary pulmonary tuberculosis compared to sarcoidosis. *Asbestosis* - This is an **occupational lung disease** caused by asbestos exposure, primarily presenting with **progressive dyspnea** and **restrictive lung disease**. - It characteristically involves the **lower lobes**, causes **pleural plaques**, and is not typically associated with acute arthralgia, fever, or prominent hilar adenopathy. *Berylliosis* - This is another **occupational lung disease** resulting from beryllium exposure, often mimicking sarcoidosis both clinically and pathologically [2]. - However, without a history of **beryllium exposure** and given the classic presentation, sarcoidosis is a more prevalent default diagnosis [2].
Question 165: A 50-year-old female presents with wrist drop. Which nerve is most likely involved?
- A. Ulnar Nerve
- B. Radial Nerve (Correct Answer)
- C. Median Nerve
- D. Musculocutaneous Nerve
Explanation: ***Radial Nerve*** - **Wrist drop** is a classic symptom of **radial nerve** injury, which compromises the innervation of the **extensor muscles** of the wrist and fingers. - The radial nerve supplies motor function to the **triceps brahii**, brachioradialis, supinator, and the wrist and finger extensors. *Ulnar Nerve* - Injury to the ulnar nerve typically causes a **claw hand deformity** due to paralysis of the **interossei** and **lumbricals 3 and 4**, with sparing of the finger extensors. - Patients experience weakness in **finger adduction and abduction**, as well as sensory loss over the medial 1.5 digits and hypothenar eminence. *Median Nerve* - Median nerve injury often results in an **ape hand deformity** or **hand of benediction** (when attempting to make a fist), affecting muscles responsible for **thumb opposition** and **flexion of digits 2 and 3**. - It would not cause wrist drop, as the wrist extensors are innervated by the radial nerve. *Musculocutaneous Nerve* - Injury to the musculocutaneous nerve primarily affects the **biceps brachii** and **brachialis muscles**, leading to weakness in **elbow flexion** and **supination of the forearm**. - It does not innervate any muscles responsible for wrist extension or flexion, therefore it would not cause wrist drop.
Question 166: Rademecker complex in EEG is seen in -
- A. Kuru
- B. cCJD
- C. SSPE (Correct Answer)
- D. vCJD
Explanation: ***SSPE*** - **Subacute sclerosing panencephalitis (SSPE)** is a rare, chronic, progressive encephalopathy characterized by a distinctive EEG pattern known as the **Rademecker complex**. - The **Rademecker complex** (also called Rademecker complexes or periodic stereotyped complexes) consists of high-amplitude, generalized, polyphasic delta waves that occur periodically every 4-15 seconds. *Kuru* - **Kuru** is a transmissible spongiform encephalopathy (TSE) with neurological symptoms like ataxia and tremors, but it does not typically show the **Rademecker complex** on EEG [1]. - EEG abnormalities in Kuru are generally non-specific and may include diffuse slowing, but not periodic complexes [1]. *cCJD* - **Classic Creutzfeldt-Jakob disease (cCJD)**, a prion disease, often shows characteristic **periodic sharp wave complexes (PSWCs)** on EEG. - These PSWCs are typically biphasic or triphasic, occurring at a frequency of 0.5-2 Hz, and are distinct from the slower, high-amplitude Rademecker complexes seen in SSPE. *vCJD* - **Variant Creutzfeldt-Jakob disease (vCJD)**, unlike cCJD, rarely or never shows the characteristic **periodic sharp wave complexes (PSWCs)** on EEG. - EEG findings in vCJD are usually non-specific, often showing generalized slowing without the unique periodic complexes seen in SSPE or cCJD.
Question 167: Lafora's disease presents with?
- A. Myoclonic epilepsy (Correct Answer)
- B. G.T.C.S
- C. Petit mal epilepsy
- D. Partial seizures
Explanation: ***Myoclonic epilepsy*** - Lafora disease is a rare, neurodegenerative inherited disorder characterized by **progressive myoclonic epilepsy**. - Patients typically experience spontaneous or reflex-induced **myoclonic seizures**, often accompanied by falls [1]. *G.T.C.S* - While generalized tonic-clonic seizures (GTCS) can occur in Lafora disease as the condition progresses, they are not the primary or defining seizure type [3]. - The hallmark presentation is **myoclonic epilepsy**, which may then evolve to include GTCS. *Petit mal epilepsy* - **Petit mal epilepsy**, also known as absence seizures, is characterized by brief, sudden lapses of consciousness without loss of postural tone [1]. - This is a distinct epilepsy syndrome and not the typical presentation of Lafora disease. *Partial seizures* - **Partial seizures** originate in a specific area of the brain and can be simple or complex [2]. - While some focal signs might be observed as the disease advances, Lafora disease is primarily a generalized epilepsy characterized by myoclonus [1].
Question 168: Which of the following is a feature of crush syndrome -
- A. Hypophosphatemia
- B. Hypokalemia
- C. Hypercalcemia
- D. Myoglobinuria (Correct Answer)
Explanation: Myoglobinuria - **Myoglobinuria** is a hallmark of crush syndrome, resulting from the massive release of **myoglobin** from damaged muscle cells into the bloodstream [2]. - This excess myoglobin can precipitate in the renal tubules, leading to **acute kidney injury (AKI)** [1]. *Hypophosphatemia* - Crush syndrome typically results in **hyperphosphatemia**, not hypophosphatemia, due to the release of intracellular phosphate from damaged muscular cells. - The elevated phosphate levels contribute to reciprocal **hypocalcemia** through precipitation. *Hypokalemia* - Crush syndrome is characterized by **hyperkalemia**, caused by the release of intracellular potassium from damaged muscle cells. - **Hyperkalemia** is a significant and life-threatening complication due to its potential for cardiac arrhythmias. *Hypercalcemia* - Crush syndrome typically presents with **hypocalcemia** due to the precipitation of calcium with released phosphate and fatty acids. - Initial **hypocalcemia** may later be followed by **hypercalcemia** during the recovery phase, especially in those with renal failure, but hypocalcemia is more acute.
Question 169: RULE OF HALVES RELATED TO-
- A. OBESITY
- B. BLINDNESS
- C. BURNS
- D. HYPERTENSION (Correct Answer)
Explanation: ***HYPERTENSION*** - The **rule of halves** in hypertension refers to the observation that often **only half of people** with hypertension are diagnosed, only half of those diagnosed are treated, and only half of those treated achieve adequate control. - This rule highlights challenges in the **diagnosis, treatment, and management** of hypertension at a population level. *OBESITY* - While obesity is a significant public health issue, the **rule of halves** is not a commonly used principle to describe its diagnosis and management. - Obesity is typically assessed using **Body Mass Index (BMI)** and associated health risks. *BLINDNESS* - The **rule of halves** is not a recognized concept in the context of blindness or visual impairment. - Blindness is often addressed through efforts in **prevention, treatment, and rehabilitation**. *BURNS* - The **rule of halves** is unrelated to the assessment or management of burns. - The severity of burns is commonly assessed using the **Rule of Nines** (Wallace Rule of Nines) [1] to estimate the percentage of total body surface area affected.
Question 170: Autosomal recessive Polycystic kidneys - all are true except -
- A. Defective gene is PKHD1
- B. Both kidneys show innumerable cysts
- C. USG shows salt and pepper appearance (Correct Answer)
- D. Seen in adults
Explanation: ***USG shows salt and pepper appearance*** - The **"salt and pepper" appearance** on imaging is characteristic of **autosomal dominant polycystic kidney disease (ADPKD)** due to multiple renal cysts of varying sizes and associated vascular calcifications, not autosomal recessive polycystic kidney disease (ARPKD). - ARPKD typically presents with **enlarged, hyperechoic kidneys** with loss of corticomedullary differentiation on ultrasound due to numerous small cysts. *Defective gene is PKHD1* - The dysfunctional gene in **autosomal recessive polycystic kidney disease (ARPKD)** is indeed **PKHD1**, located on chromosome 6. - This gene encodes for **fibrocystin/polyductin**, a protein primarily found in renal and biliary epithelial cells, whose mutation leads to cyst formation. *Both kidneys show innumerable cysts* - ARPKD is characterized by **bilateral involvement** with diffuse dilation of the collecting ducts, leading to innumerable small cysts in both kidneys. - These cysts cause significant **renal enlargement** and can lead to severe renal dysfunction. *Seen in adults* - **Autosomal recessive polycystic kidney disease (ARPKD)** typically manifests in **infancy or childhood**, often prenatally or neonatally. - While some milder forms may present later in childhood, it is **not generally seen in adults**; adult-onset polycystic kidney disease is usually autosomal dominant (ADPKD) [1].