Which of the following is commonly seen in Pituitary apoplexy?
What is the cause of loss of pain and temperature sensation on the ipsilateral face and contralateral body due to thrombosis?
Which of the following statements regarding Huntington’s chorea is true?
A young man met with a motorbike accident and had injuries to ileum and jejunum. Therefore the entire ileum and partial jejunum were resected. Which of the following would the patient suffer from
MC location of gastrinoma in MEN-1 syndrome?
A female patient has been on lithium for bipolar disorder for 6 months. After fasting for several days due to religious reasons, she presents with seizures, tremors, confusion, and weakness. What is the most appropriate investigation to diagnose her condition?
Esophageal manometry was performed - it revealed panesophageal pressurization with distal contractile integrity as >450mm Hg pressure in the body. What will be the diagnosis?
The patient presents with unilateral proptosis and bilateral abducent nerve palsy. What is the most likely cause?
A Patient falls down often with behavioral change and enuresis. What is the condition associated with him?
Which is the most common pancreatic endocrine neoplasm?
NEET-PG 2020 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 11: Which of the following is commonly seen in Pituitary apoplexy?
- A. Headache (Correct Answer)
- B. Hypertension
- C. Hypotension
- D. Vomiting
Explanation: ***Headache*** - **Severe headache** is the most common symptom of pituitary apoplexy, resulting from the sudden expansion of a pituitary mass due to hemorrhage or infarction [1]. - The rapid increase in pressure within the sella turcica, especially on the **dura mater**, causes intense pain. *Hypertension* - While stress can elevate blood pressure, **hypertension** is not a characteristic or direct symptom of acute pituitary apoplexy itself. - Instead, the condition often leads to **adrenal insufficiency**, which is associated with hypotension [1]. *Hypotension* - **Hypotension** is a common and serious manifestation of pituitary apoplexy, often due to acute **adrenal insufficiency** caused by the destruction of ACTH-producing cells [1]. - Reduced ACTH leads to decreased cortisol production, impairing vascular tone and fluid balance. *Vomiting* - **Vomiting** is a common symptom in pituitary apoplexy, often accompanying the severe headache. - It results from the increased **intracranial pressure** and irritation of pathways in the brainstem.
Question 12: What is the cause of loss of pain and temperature sensation on the ipsilateral face and contralateral body due to thrombosis?
- A. Thrombosis of the superior cerebellar artery
- B. Thrombosis of the anterior inferior cerebellar artery (AICA)
- C. Thrombosis of the posterior inferior cerebellar artery (PICA) (Correct Answer)
- D. Thrombosis of the posterior cerebral artery
Explanation: ***Thrombosis of the posterior inferior cerebellar artery (PICA)*** - This pattern of **ipsilateral facial** and **contralateral body** pain and temperature loss is characteristic of **lateral medullary syndrome (Wallenberg syndrome)**, which is most often caused by PICA occlusion [1]. - The PICA supplies the **lateral medulla**, affecting the **spinal trigeminal nucleus and tract** (ipsilateral face) and the **spinothalamic tract** (contralateral body) [1]. *Thrombosis of the superior cerebellar artery* - Occlusion of the superior cerebellar artery typically causes **ipsilateral limb ataxia**, **dysarthria**, and **contralateral hemianesthesia**, primarily affecting the **cerebellum** and **midbrain**. - It does not involve the lateral medulla where the decussating pain and temperature fibers for the body and the trigeminal pathways for the face are located. *Thrombosis of the anterior inferior cerebellar artery (AICA)* - AICA occlusion typically leads to **ipsilateral deafness**, **vestibular symptoms**, **facial weakness**, and **cerebellar ataxia**, along with **contralateral loss of pain and temperature sensation** in the body, primarily due to involvement of the lower pons [2]. - While it can cause contralateral body sensory loss, it usually causes **ipsilateral facial sensory loss in a different pattern** (often involving touch and proprioception as well) or **facial paralysis**, and is less commonly associated with the classic lateral medullary syndrome sensory pattern [2]. *Thrombosis of the posterior cerebral artery* - PCA occlusion primarily affects the **occipital lobe** and parts of the **temporal lobe and thalamus**, leading to symptoms like **contralateral homonymous hemianopia**, and potentially **thalamic pain syndrome** or memory deficits. - It does not explain the combined ipsilateral facial and contralateral body pain and temperature loss pattern as seen in Wallenberg syndrome.
Question 13: Which of the following statements regarding Huntington’s chorea is true?
- A. It is a trinucleotide repeat expansion type of disorder (Correct Answer)
- B. There is a loss of function type of mutation.
- C. It is an autosomal recessive disorder.
- D. Increased number of CAA repeats.
Explanation: ***It is a trinucleotide repeat expansion type of disorder*** - Huntington's chorea is caused by an expansion of a **CAG trinucleotide repeat** in the **huntingtin gene (HTT)**. - This expansion leads to a misfolded protein and an **autosomal dominant** neurodegenerative disorder [1]. *There is a loss of function type of mutation.* - Huntington's chorea is primarily a **gain-of-function** mutation, where the expanded polyglutamine tract in the huntingtin protein leads to **toxic protein aggregation** and neuronal dysfunction. - While there might be some aspects of altered protein function, the core pathology is attributed to the **toxic effects** of the abnormal protein rather than a simple loss of its original function [1]. *It is an autosomal recessive disorder.* - Huntington's chorea is an **autosomal dominant** disorder, meaning only one copy of the mutated gene is sufficient to cause the disease. - Each child of an affected parent has a **50% chance** of inheriting the disease. *Increased number of CAA repeats.* - Huntington's chorea is characterized by an increased number of **CAG trinucleotide repeats**, not CAA repeats. - The expansion of these CAG repeats beyond a certain threshold (typically >35-40 repeats) in the huntingtin gene is directly responsible for the disease.
Question 14: A young man met with a motorbike accident and had injuries to ileum and jejunum. Therefore the entire ileum and partial jejunum were resected. Which of the following would the patient suffer from
- A. Vitamin B12 malabsorption due to ileal resection (Correct Answer)
- B. Atrophic gastritis unrelated to resection
- C. Constipation due to dietary changes
- D. No significant symptoms
Explanation: **Vitamin B12 malabsorption due to ileal resection** - The **terminal ileum** is the primary site for the absorption of **vitamin B12** (cobalamin) complexed with intrinsic factor [3]. - Its resection would directly lead to the inability to absorb this vitamin, resulting in **B12 deficiency** and associated symptoms like macrocytic anemia [3]. *Atrophic gastritis unrelated to resection* - **Atrophic gastritis** is a chronic inflammatory condition of the stomach lining leading to loss of glandular tissue and often impaired production of **intrinsic factor**. - While it can cause B12 malabsorption, it is an independent condition and not a direct consequence of ileum and jejunum resection. *Constipation due to dietary changes* - Resection of the ileum and jejunum primarily impacts **nutrient absorption** and can lead to diarrhea due or **short bowel syndrome** [1], rather than constipation. - While diet changes can affect bowel habits, prolonged **severe gastrointestinal resection** is more likely to cause malabsorption-related diarrhea [1], [2]. *No significant symptoms* - The **ileum** and **jejunum** are crucial for the absorption of most nutrients, including vitamins, minerals, fats, and carbohydrates [4]. - Resection of these segments, especially a significant portion, would lead to **malabsorption syndromes** with various severe symptoms, potentially including weight loss, diarrhea, and nutritional deficiencies [1], [4].
Question 15: MC location of gastrinoma in MEN-1 syndrome?
- A. Jejunum
- B. Ileum
- C. Duodenum
- D. Pancreas (Correct Answer)
Explanation: ***Pancreas*** - In **Multiple Endocrine Neoplasia type 1 (MEN-1) syndrome**, gastrinomas are most commonly found in the **pancreas**. - While sporadic gastrinomas are frequently duodenal, the **genetic predisposition of MEN-1** shifts the primary location to the pancreas. *Duodenum* - **Sporadic gastrinomas** without MEN-1 syndrome are most frequently located in the **duodenum**, particularly the first and second parts. - However, in the context of **MEN-1**, the pancreas becomes the predominant site for gastrinoma development. *Jejunum* - The jejunum is an **uncommon location** for gastrinomas in both sporadic cases and those associated with MEN-1. - Gastrinomas found in the jejunum are typically **rare** and often associated with more aggressive disease or disseminated metastasis. *Ileum* - The ileum is an **extremely rare site** for gastrinomas. - Gastrinomas developing in the ileum are usually **ectopic** and are not typically the primary location in either sporadic cases or MEN-1 syndrome.
Question 16: A female patient has been on lithium for bipolar disorder for 6 months. After fasting for several days due to religious reasons, she presents with seizures, tremors, confusion, and weakness. What is the most appropriate investigation to diagnose her condition?
- A. Serum electrolytes
- B. Serum lithium levels (Correct Answer)
- C. ECG
- D. MRI
Explanation: **Serum lithium levels** - The patient's symptoms (seizures, tremors, confusion, weakness) are classic for **lithium toxicity**. - **Fasting** can lead to dehydration and electrolyte imbalance, which can increase lithium concentrations and toxicity [1]. *Serum electrolytes* - While **electrolyte imbalances** can occur with fasting and contribute to symptoms, measuring serum electrolytes alone will not directly diagnose lithium toxicity. - Electrolyte disturbances might be a predisposing factor or a concomitant issue, but not the primary diagnostic test for lithium toxicity itself [1]. *ECG* - An **ECG** can reveal cardiac effects of lithium toxicity, such as T-wave flattening or inversion, but it is not the most appropriate direct diagnostic test for the condition itself. - ECG changes are secondary manifestations and may not always be present or specific. *MRI* - While an **MRI** of the brain might be considered to rule out other causes of neurological symptoms like a stroke or brain lesion, it is not the initial or most appropriate investigation for suspected lithium toxicity. - The clinical picture strongly points to a pharmacological cause, making laboratory tests more relevant first-line diagnostics than imaging.
Question 17: Esophageal manometry was performed - it revealed panesophageal pressurization with distal contractile integrity as >450mm Hg pressure in the body. What will be the diagnosis?
- A. Type 2 achalasia
- B. Type 3 achalasia (Correct Answer)
- C. Jackhammer esophagus
- D. Type 1 achalasia (classic achalasia)
Explanation: The diagnosis is Type 3 achalasia. This condition is characterized by panesophageal pressurization, indicating diffuse, simultaneous contractions throughout the esophagus. The high distal contractile integrity (>450 mmHg pressure) further supports Type 3 achalasia, which involves significant spastic contractions. In contrast, while high-resolution manometry allows for the accurate classification of these motility abnormalities [1], other types present differently. Type 1 achalasia (classic achalasia) is marked by failed esophageal peristalsis and absent or minimal esophageal pressurization [1]. The primary characteristic is incomplete or absent lower esophageal sphincter (LES) relaxation, not hypercontractility [1]. Type 2 achalasia is identified by esophageal panesophageal pressurization (simultaneous contractions), but with normal to high contractile pressures, not the extremely high values seen here. Jackhammer esophagus involves hypercontractility (distal contractile integral >8000 mmHg·cm·s) and is characterized by rapid, repetitive, and fragmented contractions, rather than the diffuse panesophageal pressurization and spasticity typical of Type 3 achalasia [2].
Question 18: The patient presents with unilateral proptosis and bilateral abducent nerve palsy. What is the most likely cause?
- A. Cavernous sinus pathology (Correct Answer)
- B. Orbital cellulitis
- C. Orbital pseudotumor
- D. Orbital lymphoma
Explanation: The patient presents with unilateral proptosis and bilateral abducent nerve palsy. What is the most likely cause? ***Cavernous sinus pathology*** - **Unilateral proptosis** combined with **bilateral abducens nerve palsy** is a classic presentation consistent with cavernous sinus involvement, as the abducens nerves (CN VI) pass through both cavernous sinuses and are vulnerable to pathology there. [1] - The cavernous sinus contains multiple cranial nerves (**III, IV, V1, V2, VI**) and the internal carotid artery, making it a critical anatomical location where lesions can cause complex neurological deficits affecting orbital structures and eye movements. [1] *Orbital cellulitis* - Typically presents with **unilateral proptosis**, pain, eyelid swelling, and fever, often following a sinus infection. - It primarily affects the **orbital contents anterior to the orbital septum** and would not explain bilateral abducens nerve palsy. *Orbital pseudotumor* - Characterized by **unilateral proptosis**, pain, and diplopia due to idiopathic inflammation of orbital tissues. - While it can cause ophthalmoplegia, **bilateral abducens nerve palsy** is not a typical presentation for a condition usually confined to one orbit. *Orbital lymphoma* - Presents with **painless, slowly progressive unilateral proptosis** or an orbital mass. - While it can cause compressive symptoms, **bilateral abducens nerve palsy** is an atypical presentation as the disease usually remains confined to a single orbit.
Question 19: A Patient falls down often with behavioral change and enuresis. What is the condition associated with him?
- A. Normal pressure hydrocephalus (NPH) (Correct Answer)
- B. Parkinson's disease (PD)
- C. Alzheimer's disease (AD)
- D. Frontotemporal dementia (FTD)
Explanation: ***Normal pressure hydrocephalus (NPH)*** - NPH is characterized by the classic triad of symptoms: **gait disturbance** (leading to falls), **dementia/behavioral changes**, and **urinary incontinence** (enuresis) [1]. - These symptoms arise from the accumulation of cerebrospinal fluid (CSF) in the brain's ventricles without a corresponding increase in intracranial pressure [2]. *Parkinson's disease (PD)* - While PD causes **gait instability** and falls, its primary symptoms include **bradykinesia**, **rigidity**, and **resting tremor**, which are not mentioned. - Behavioral changes can occur later in the disease, but **enuresis** is not a hallmark symptom. *Alzheimer's disease (AD)* - AD primarily presents with **progressive memory loss** and cognitive decline, not gait disturbances or enuresis as early or prominent features. - Falls usually occur much later due to advanced cognitive impairment and not as an initial triad component. *Frontotemporal dementia (FTD)* - FTD is characterized by early and prominent **behavioral and personality changes** or language difficulties. - While falls can occur due to executive dysfunction, **gait disturbance** and **enuresis** as part of a triad are not typical presenting features.
Question 20: Which is the most common pancreatic endocrine neoplasm?
- A. Insulinoma (Correct Answer)
- B. Gastrinoma
- C. VIPoma
- D. Glucagonoma
Explanation: ***Insulinoma*** - It is the **most common pancreatic endocrine neoplasm**, characterized by excessive insulin production leading to hypoglycemia. - Most patients present with **symptoms of hypoglycemia**, such as sweating, confusion, and palpitations due to overproduction of insulin [1]. *Gastrinoma* - Generally implicated in **Zollinger-Ellison syndrome**, it causes excessive gastric acid secretion, leading to severe ulcers but is less common than insulinoma. - Associated with **diarrhea and abdominal pain**, not typically causing hypoglycemia [1]. *Glucagonoma* - Rarely seen, it causes **hyperglycemia** and characteristic **necrotizing migratory erythema**, rather than hypoglycemic episodes. - Comprises a minority of pancreatic endocrine tumors and is not the most common type. *VIPoma* - Produces **vasoactive intestinal peptide**, leading to profuse watery diarrhea and severe electrolyte imbalance. - It is uncommon compared to insulinoma and primarily causes gastrointestinal symptoms rather than hypoglycemia.