Internal Medicine
8 questionsWhat 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:
NEET-PG 2015 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 1181: 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 1182: 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 1183: 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 1184: 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 1185: 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 1186: 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 1187: 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 1188: 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.
Pathology
1 questionsAlzheimer type II astrocytes are seen in which condition?
NEET-PG 2015 - Pathology NEET-PG Practice Questions and MCQs
Question 1181: Alzheimer type II astrocytes are seen in which condition?
- A. Hepatic encephalopathy (Correct Answer)
- B. Parkinsonism
- C. Alzheimer's
- D. Binswanger disease
Explanation: ***Hepatic encephalopathy*** - **Alzheimer type II astrocytes** are characteristic histological findings in cases of **hepatic encephalopathy**, reflecting the brain's response to elevated ammonia levels. - These astrocytes show enlarged, pale nuclei with prominent nucleoli and marginal chromatin, indicating cellular stress from metabolic dysfunction in the setting of liver failure. *Alzheimer's* - Alzheimer's disease is characterized by the presence of **neurofibrillary tangles** (tau protein) and **amyloid plaques** (beta-amyloid protein), not Alzheimer type II astrocytes. - Astrocytes in Alzheimer's disease may show reactive changes, but they do not typically manifest as the specific "Alzheimer type II" morphology. *Parkinsonism* - Parkinsonism is primarily characterized by the degeneration of **dopaminergic neurons** in the substantia nigra and the presence of **Lewy bodies** (alpha-synuclein aggregates). - While glial cells (astrocytes and microglia) do play a role in neuroinflammation in Parkinson's, they do not exhibit the specific Alzheimer type II astrocytic change. *Binswanger disease* - Binswanger disease is a form of **vascular dementia** characterized by diffuse white matter lesions due to chronic ischemia and damage to small cerebral blood vessels. - The pathology primarily involves demyelination and axonal loss in the white matter, with reactive gliosis, but not the specific changes seen in Alzheimer type II astrocytes.
Pediatrics
1 questionsPolyarticular onset JRA involves more than how many joints?
NEET-PG 2015 - Pediatrics NEET-PG Practice Questions and MCQs
Question 1181: Polyarticular onset JRA involves more than how many joints?
- A. 5
- B. 3
- C. 4 (Correct Answer)
- D. 6
Explanation: ***4*** - **Polyarticular onset Juvenile Rheumatoid Arthritis (JRA)**, now often referred to as **Juvenile Idiopathic Arthritis (JIA)**, is defined by the involvement of **five or more joints** within the first six months of the disease. Therefore, "more than 4" correctly describes this threshold. - This subtype of JIA accounts for approximately 30% of all JIA cases and can be further classified into rheumatoid factor-positive and rheumatoid factor-negative forms. *3* - Involvement of **fewer than five joints** (i.e., four or fewer) within the first six months would classify the disease as **oligoarticular JIA**, a distinct and often milder subtype. - Oligoarticular JIA is the most common subtype and often affects large joints like the knees. *5* - While **five or more joints** is the diagnostic criterion for polyarticular JIA, stating "more than 5" would be incorrect as exactly five joints already falls within the polyarticular definition. - The threshold is **equal to or greater than five joints**, not strictly exceeding five. *6* - Specifying "more than 6" joints would exclude cases where 5 or 6 joints are involved, which are still considered polyarticular JIA. - The key diagnostic number is **five**, meaning "more than 4" encompasses the correct definition.