NEET-PG 2020 - Internal Medicine Practice Questions

Q: Urethritis in males is not caused by:

H. ducreyi. ***H. ducreyi*** - *Haemophilus ducreyi* is the causative agent of **chancroid**, a sexually transmitted infection characterized by **genital ulcers** [1] with painful regional lymphadenopathy. - It does not typically cause urethritis as its primary site of infection is the **skin and mucous membranes** of the external genitalia, forming ulcers rather than urethral inflammation. *Chlamydia* - **Chlamydia trachomatis** is a common cause of **non-gonococcal urethritis** in males [1]. - It often presents with **dysuria**, **urethral discharge**, and sometimes can be asymptomatic [1]. *Gonococcus* - **Neisseria gonorrhoeae** (gonococcus) is a well-known cause of urethritis, often referred to as **gonococcal urethritis** [1]. - It typically causes a **purulent urethral discharge** and **dysuria** [1]. *Trichomonas* - **Trichomonas vaginalis** can cause **urethritis** in males [1], although it is less common than in females. - Males may experience **dysuria**, **urethral discharge**, or can be asymptomatic carriers.

Q: Which of the following is not done in high altitude sickness?

Digoxin. ***Digoxin*** - **Digoxin** is a cardiac glycoside used for heart conditions like **atrial fibrillation** and **heart failure**. It has no role in the treatment of high altitude sickness. - Its primary actions are to increase **myocardial contractility** and decrease heart rate, which are not beneficial in addressing the hypobaric hypoxia of high altitude. *Rapid descent* - **Rapid descent** is the most effective and often immediate treatment for severe forms of high altitude sickness, such as **High Altitude Cerebral Edema (HACE)** or **High Altitude Pulmonary Edema (HAPE)** [2]. - It involves moving the affected individual to a significantly lower altitude to alleviate the effects of **hypoxia** [2]. *Acetazolamide* - **Acetazolamide** is a **carbonic anhydrase inhibitor** commonly used for the prevention and treatment of high altitude sickness [2]. - It works by inducing a **metabolic acidosis**, which stimulates **respiration** and increases **oxygenation**. *Oxygen* - Administering **supplemental oxygen** is a crucial treatment for high altitude sickness, especially in more severe cases [2]. - It directly counteracts the **hypoxia** experienced at high altitudes, improving symptoms and preventing progression [1], [2].

Q: Pulmonary Plethora is seen in -

TAPVC. ***TAPVC*** - **Total Anomalous Pulmonary Venous Connection (TAPVC)** leads to all pulmonary veins draining into the systemic circulation, causing a left-to-right shunt at the atrial level back into the right atrium. - This persistent shunting results in increased blood flow to the lungs, manifesting as **pulmonary plethora** on chest X-ray due to engorged pulmonary vessels [3]. *Tricuspid Atresia* - **Tricuspid atresia** results in an absence of the tricuspid valve, severely limiting blood flow from the right atrium to the right ventricle. - This condition typically leads to **pulmonary oligemia** (reduced blood flow to the lungs), not pulmonary plethora. *CoA* - **Coarctation of the aorta (CoA)** is a narrowing of the aorta, typically distal to the left subclavian artery [2]. - While it can lead to complications like heart failure, it generally does not directly cause **pulmonary plethora** unless there are associated shunts. *TOF* - **Tetralogy of Fallot (TOF)** is characterized by four defects: ventricular septal defect, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy [1]. - The most significant hemodynamic feature is **pulmonary stenosis**, which reduces blood flow to the lungs, leading to **pulmonary oligemia**, often described as a "boot-shaped" heart on X-ray [1].

Q: A patient presented with weakness of the right side of the face. There is associated ipsilateral loss of pain and temperature of face and contralateral body. The lesion is most likely located at

Lateral pons. ***Lateral pons*** - A lesion in the **lateral pons** would affect the **facial nerve nucleus** (VII) causing ipsilateral facial weakness. It would also damage the **spinal trigeminal nucleus** (V) leading to ipsilateral facial loss of pain and temperature [1]. - The involvement of the **spinothalamic tract** in the lateral pons would result in contralateral body loss of pain and temperature [1]. *Lateral medulla* - A lesion in the **lateral medulla** (Wallenberg syndrome) typically causes ipsilateral facial sensory loss (due to involvement of the spinal trigeminal nucleus), but would not affect the facial nerve nucleus directly to cause facial weakness [1]. - It also presents with **vertigo, nystagmus, ataxia**, and **dysphagia**, which are not mentioned in the patient's presentation. *Medial pons* - A lesion in the **medial pons** would primarily affect the **corticospinal tract** causing contralateral weakness and the **abducens nerve** (VI) causing ipsilateral gaze palsy, which are not described. - It would not typically involve the facial nerve directly to cause significant facial weakness or the spinal trigeminal nucleus for ipsilateral facial sensory loss. *Medial medulla* - A lesion in the **medial medulla** (Dejerine syndrome) usually affects the **pyramidal tract** causing contralateral hemiparesis and the **hypoglossal nerve** (XII) causing ipsilateral tongue deviation. - It does not explain the ipsilateral facial weakness or the ipsilateral facial loss of pain and temperature.

Q: A 26 year old female after her delivery develops features of headache, nausea, visual complaints, fatigue. What is the most probable diagnosis?

Sheehan's syndrome. ***Sheehan's syndrome*** - This syndrome is caused by **ischemic necrosis of the pituitary gland** due to severe postpartum hemorrhage or hypovolemic shock, leading to **pituitary dysfunction** [1]. - Symptoms like **headache, nausea, visual complaints, and fatigue** are consistent with panhypopituitarism developing after delivery, often presenting in the postpartum period due to the large, vulnerable pregnancy-enlarged pituitary [1]. *Waterhouse-Friderichsen syndrome* - This is a rare, life-threatening condition caused by overwhelming **bacterial infection (often meningococcal)**, leading to **adrenal gland hemorrhage** and acute adrenal insufficiency. - It presents with rapid onset of fever, petechial rash, hypotension, and shock, which are not described in the patient's symptoms. *Hyperprolactinemia* - While hyperprolactinemia can cause headaches and visual disturbances (if due to a pituitary tumor) [1], it typically presents with **galactorrhea**, **amenorrhea**, or **oligomenorrhea**, and is not directly linked to the postpartum period unless caused by a new or existing pituitary adenoma. - It does not account for the widespread pituitary failure implied by the patient's general fatigue and other symptoms after delivery, which is more characteristic of Sheehan's [2]. *Pituitary adenoma* - A pituitary adenoma can cause headaches, visual disturbances (due to **mass effect on the optic chiasm**) [1], and hormone deficiencies or excesses, but its onset is not specifically tied to the postpartum period like Sheehan's syndrome. - While it's a possibility for these symptoms, the history of recent delivery strongly points to Sheehan's syndrome over a newly symptomatic or pre-existing pituitary adenoma without specific features like galactorrhea or Cushing's symptoms that would hint at a specific type of adenoma.

Q: After a renal transplant, what is the most common opportunistic infection?

Cytomegalovirus (CMV). ***Cytomegalovirus (CMV)*** - **CMV** is the most common opportunistic infection after renal transplantation, particularly in the first 6 months due to immunosuppression [1]. - It can cause a range of clinical syndromes, including **fever**, **leukopenia**, **gastroenteritis**, **pneumonitis**, and **hepatitis**, and can also have indirect effects that increase the risk of graft rejection. *Varicella Zoster Virus (VZV)* - While VZV can cause opportunistic infections in transplant recipients (e.g., **shingles**), it is less common than CMV [1]. - VZV typically occurs later post-transplant and is characterized by a **vesicular rash** in a dermatomal distribution. *Coxsackie Virus* - **Coxsackie virus** infections are less frequently reported as significant opportunistic infections in renal transplant recipients compared to other viral pathogens. - They are generally associated with hand-foot-and-mouth disease, herpangina, or myocarditis, which are not the most common post-transplant complications. *Epstein-Barr Virus (EBV)* - **EBV** can cause post-transplant lymphoproliferative disorder (PTLD), which is a serious complication, but EBV infection itself is not the most common opportunistic infection overall [1]. - PTLD is more common in the first year after transplant and often presents with **lymphadenopathy**, **fever**, or **graft dysfunction**.

Q: What is the first line of treatment for osteoporosis in postmenopausal women?

Bisphosphonates. ***Bisphosphonates*** - **Bisphosphonates** are the **first-line therapy** for osteoporosis in postmenopausal women due to their proven efficacy in reducing the risk of fragility fractures [1]. - They work by inhibiting **osteoclast activity**, thereby decreasing bone resorption and increasing bone mineral density [1]. *Ulipristal* - **Ulipristal** is a **selective progesterone receptor modulator** primarily used as an emergency contraceptive or for the treatment of uterine fibroids. - It has no role in the direct treatment or prevention of osteoporosis. *Estrogen* - **Estrogen therapy** can prevent bone loss but is generally not considered first-line for osteoporosis due to potential risks like increased incidence of **venous thromboembolism**, stroke, and certain cancers [1]. - It is typically reserved for women with severe menopausal symptoms who also need osteoporosis prevention [1]. *Calcium and vitamin D supplementation* - While essential for **bone health**, **calcium and vitamin D supplementation** alone is not sufficient to treat established osteoporosis [2]. - They are crucial adjuncts to pharmacotherapy, ensuring adequate building blocks for bone formation, but do not directly address the underlying bone loss mechanism effectively enough as a monotherapy for osteoporosis [1].

Q: A 55 year old male presents with tachypnea and mental confusion. Blood glucose 350 mg/dl, pH = 7.0. What is the most likely acid base disorder?

Metabolic acidosis. Metabolic acidosis - A **pH of 7.0** indicates significant acidemia, and **hyperglycemia (350 mg/dL)** in conjunction with clinical symptoms (tachypnea, mental confusion) strongly suggests **diabetic ketoacidosis (DKA)**, a common cause of high anion gap metabolic acidosis [1]. - Tachypnea is often a **compensatory mechanism** (Kussmaul breathing) to blow off carbon dioxide and raise pH in metabolic acidosis [1], [2]. Metabolic alkalosis - This would present with an **elevated pH (alkalemia)**, which is opposite to the patient's measured pH of 7.0 [2]. - It is typically caused by conditions like severe vomiting or diuretic use, which are not suggested by the clinical presentation [3]. Respiratory alkalosis - This condition involves a **high pH** and a **low PCO2**, often due to hyperventilation [2]. - While the patient is tachypneic, the profound acidemia (pH 7.0) contradicts a primary respiratory alkalosis. Respiratory acidosis - While leading to a low pH, respiratory acidosis is characterized by **elevated PCO2** due to hypoventilation. - The patient's **tachypnea** indicates hyperventilation, which would tend to lower PCO2, making primary respiratory acidosis unlikely.

Q: Patient with clinical signs of DVT had tachycardia and history of bladder cancer. According to modified Well's scoring, the probability of pulmonary embolism would be :

Intermediate. **Intermediate** - Clinical signs of **DVT (3 points)**, **tachycardia (heart rate > 100 bpm, 1.5 points)**, and a history of **cancer (1 point)** sum up to 5.5 points, which falls within the range for an intermediate probability (2-6 points) on the modified Well's score for PE. - The modified Well's criteria assigns specific points for risk factors and clinical findings, guiding the diagnostic approach for pulmonary embolism [1]. *Low* - A low probability for PE according to the modified Well's score is indicated by a total score of **less than 2 points** [1]. - The patient's presentation accumulates significantly more points than this threshold due to multiple contributing factors. *High* - A high probability for PE according to the modified Well's score is indicated by a total score of **greater than 6 points** [1]. - The patient's score of 5.5 points does not meet this threshold, placing them in the intermediate category.

Question 1

Urethritis in males is not caused by:

Accepted Answer

H. ducreyi

Answer

Chlamydia

Answer

Gonococcus

Answer

Trichomonas

Question 2

Which of the following is not done in high altitude sickness?

Accepted Answer

Digoxin

Answer

Rapid descent

Answer

Acetazolamide

Answer

Oxygen

Question 3

Pulmonary Plethora is seen in -

Accepted Answer

TAPVC

Answer

Tricuspid Atresia

Answer

CoA

Answer

TOF

Question 4

A patient presented with weakness of the right side of the face. There is associated ipsilateral loss of pain and temperature of face and contralateral body. The lesion is most likely located at

Accepted Answer

Lateral pons

Answer

Lateral medulla

Answer

Medial pons

Answer

Medial medulla

Question 5

A 26 year old female after her delivery develops features of headache, nausea, visual complaints, fatigue. What is the most probable diagnosis?

Accepted Answer

Sheehan's syndrome

Answer

Waterhouse-Friderichsen syndrome

Answer

Hyperprolactinemia

Answer

Pituitary adenoma

Question 6

After a renal transplant, what is the most common opportunistic infection?

Accepted Answer

Cytomegalovirus (CMV)

Answer

Varicella Zoster Virus (VZV)

Answer

Coxsackie Virus

Answer

Epstein-Barr Virus (EBV)

Question 7

What is the first line of treatment for osteoporosis in postmenopausal women?

Accepted Answer

Bisphosphonates

Answer

Ulipristal

Answer

Estrogen

Answer

Calcium and vitamin D supplementation

Question 8

A 70-year-old man is having nasal regurgitation of fluids and hoarseness of voice. On sensory examination, numbness and loss of sensation over the left half of the face with impaired pain and temperature and contralateral pain and temperature loss of the body is noted. Motor examination shows left arm weakness, and cranial nerve examination shows a diminished gag reflex. Which of the following vessel thrombosis leads to this condition?

Accepted Answer

Posterior inferior cerebellar artery

Answer

Middle cerebral artery

Answer

Posterior cerebral artery

Answer

Anterior inferior cerebellar artery

Question 9

A 55 year old male presents with tachypnea and mental confusion. Blood glucose 350 mg/dl, pH = 7.0. What is the most likely acid base disorder?

Accepted Answer

Metabolic acidosis

Answer

Metabolic alkalosis

Answer

Respiratory alkalosis

Answer

Respiratory acidosis

Question 10

Patient with clinical signs of DVT had tachycardia and history of bladder cancer. According to modified Well's scoring, the probability of pulmonary embolism would be :

Accepted Answer

Intermediate

Answer

Low

Answer

High

NEET-PG 2020 — Internal Medicine