NEET-PG 2022 — Internal Medicine

Q: A 40-year-old woman with rheumatoid arthritis presents with eye pain and redness. Examination reveals scleritis. What is the most likely associated systemic complication?

Interstitial lung disease. ***Interstitial lung disease*** - **Scleritis** in a patient with **rheumatoid arthritis** often indicates a more severe, systemic form of the disease. - **Interstitial lung disease (ILD)** is a common and serious **extra-articular manifestation** of rheumatoid arthritis, associated with higher disease activity and worse prognosis. *Cardiomyopathy* - While cardiac involvement can occur in RA (e.g., pericarditis, myocarditis), **cardiomyopathy** is less directly correlated with scleritis as a linked severe systemic complication. - **Rheumatoid arthritis** can increase the risk of cardiovascular disease due to accelerated atherosclerosis and systemic inflammation, but cardiomyopathy itself is not typically the direct systemic complication associated with scleritis. *Renal failure* - **Renal involvement** in rheumatoid arthritis is uncommon, usually related to complications from treatment (e.g., NSAID-induced nephropathy) or secondary amyloidosis, not directly with scleritis. - Scleritis itself does not directly predispose to **renal failure** as a primary systemic complication of RA. *Peripheral neuropathy* - **Peripheral neuropathy** can be a complication of rheumatoid arthritis, particularly in severe cases or vasculitis. - However, it is not as strongly or directly linked to the presence of **scleritis** as **interstitial lung disease** is, in terms of signifying systemic disease severity.

Q: A patient is having a continuous tremor and he has tendency to fall. Lesion is most commonly seen in?

Substantia Nigra. ***Substantia Nigra*** - A lesion in the **substantia nigra** leads to a deficiency of **dopamine**, which is characteristic of **Parkinson's disease** [1]. - Symptoms like **continuous tremor (resting tremor)**, **postural instability (tendency to fall)**, rigidity, and bradykinesia are hallmark features of Parkinson's disease, linked to substantia nigra degeneration [1], [2]. *Putamen* - While the putamen is part of the basal ganglia and involved in motor control, its primary lesion is not typically associated with the classic triad of **Parkinsonian symptoms** (tremor, rigidity, bradykinesia) [1]. - Lesions here might instead contribute to involuntary movements like **dystonia** or **chorea**, which are not described. *Globus pallidus* - The globus pallidus is involved in regulating voluntary movement, and lesions here can cause various movement disorders, including **dystonia**, **chorea**, or **hemiballismus** [2]. - However, isolated pallidal lesions are less commonly the primary cause of the specific combination of **resting tremor** and **falls** seen in Parkinson's. *Caudate nucleus* - The caudate nucleus plays a crucial role in cognitive and motor functions and is primarily affected in diseases like **Huntington's disease**, leading to **chorea** and cognitive decline [2]. - Lesions in the caudate nucleus do not typically present with a **continuous tremor** and **tendency to fall** as the predominant symptoms.

22 Questions — Page 3 of 3

Q21

A 40-year-old woman with rheumatoid arthritis presents with eye pain and redness. Examination reveals scleritis. What is the most likely associated systemic complication?

Q22

A patient is having a continuous tremor and he has tendency to fall. Lesion is most commonly seen in?