A chronic alcoholic patient presented to the casualty with confusion, ataxia, and painful eye movements. What vitamin deficiency is commonly associated with these symptoms?
Which of the following is a known risk factor for cholangiocarcinoma?
A patient presents with fever and jaundice after repairing sewers. What is the most appropriate test to diagnose the infection in this patient?
A patient presents with severe abdominal pain and jaundice. Imaging reveals calcified cysts in the liver, and serological testing is positive for Echinococcus. What is a potential complication of this infection?
Which of the following is not the component of qSOFA?
A 29-year-old patient presents with focal seizures. MRI shows frontal and temporal enhancement. What is the most probable diagnosis?
When resuscitating a patient in shock which of the following is not an adequate parameter to predict end point of resuscitation?
All the following nerves are involved in entrapment neuropathy except -
In HIV patients, Kaposi's sarcoma is most likely caused by which of the following?
Which of these is least effective as first-line treatment for dangerous hyperkalemia?
NEET-PG 2023 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 21: A chronic alcoholic patient presented to the casualty with confusion, ataxia, and painful eye movements. What vitamin deficiency is commonly associated with these symptoms?
- A. Hypocalcemia
- B. Thiamine (Vitamin B1) deficiency (Correct Answer)
- C. Subacute combined degeneration (Vitamin B12 deficiency)
- D. Pellagra (Niacin deficiency)
Explanation: ***Thiamine (Vitamin B1) deficiency*** - The constellation of **confusion**, **ataxia**, and **ophthalmoplegia** (often presenting as painful eye movements) in a chronic alcoholic patient is highly characteristic of **Wernicke encephalopathy**, which results from thiamine deficiency [1]. - Chronic alcohol abuse severely impairs the **absorption**, **utilization**, and **storage** of thiamine, making this population particularly vulnerable to deficiency [1]. *Hypocalcemia* - Symptoms of hypocalcemia typically include **tetany**, **muscle cramps**, **paresthesias**, and in severe cases, seizures or cardiac arrhythmias, which are not described here. - While chronic alcoholism can affect calcium metabolism, hypocalcemia does not primarily manifest with the neurological triad observed. *Subacute combined degeneration (Vitamin B12 deficiency)* - This condition primarily affects the **dorsal columns** and **corticospinal tracts** of the spinal cord, leading to ataxia, paresthesias, and weakness, but typically does not cause acute confusion or painful eye movements. - While alcohol abuse can also be associated with B12 deficiency, the presented symptoms are not classic for subacute combined degeneration. *Pellagra (Niacin deficiency)* - Pellagra is characterized by the "3 Ds": **dermatitis**, **diarrhea**, and **dementia** (which is a progressive cognitive decline rather than acute confusion). - The presence of ataxia and painful eye movements is not a primary feature of niacin deficiency.
Question 22: Which of the following is a known risk factor for cholangiocarcinoma?
- A. Giardia lamblia (intestinal protozoa) infection
- B. Ascaris lumbricoides (roundworm) infection
- C. Clonorchis sinensis infestation (Correct Answer)
- D. Paragonimus westermani infestation
Explanation: ***Clonorchis sinensis infestation*** - **Clonorchis sinensis**, also known as the Chinese liver fluke, is a well-established and significant risk factor for the development of **cholangiocarcinoma**. - Chronic inflammation and irritation of the bile ducts caused by the parasite are believed to promote malignant transformation. *Giardia lamblia (intestinal protozoa) infection* - **Giardia lamblia** is a common intestinal parasite causing giardiasis, characterized by diarrhea and malabsorption. - While it affects the gastrointestinal tract, there is **no known association** between *Giardia* infection and an increased risk of cholangiocarcinoma. *Paragonimus westermani infestation* - **Paragonimus westermani** is a lung fluke that primarily causes paragonimiasis, affecting the lungs and leading to cough and hemoptysis. - This parasite is not associated with direct bile duct inflammation or an increased risk of **cholangiocarcinoma**. *Ascaris lumbricoides (roundworm) infection* - **Ascaris lumbricoides** is a large intestinal roundworm that can cause intestinal obstruction or nutrient deficiencies. - Although it can occasionally migrate into the biliary tree, it is **not considered a risk factor** for cholangiocarcinoma [1].
Question 23: A patient presents with fever and jaundice after repairing sewers. What is the most appropriate test to diagnose the infection in this patient?
- A. Weil Felix test
- B. Paul Bunnell test
- C. Microscopic agglutination test (Correct Answer)
- D. Microimmunofluorescence test
Explanation: ***Microscopic agglutination test*** - The patient's presentation (fever, jaundice, history of repairing sewers) is highly suggestive of **leptospirosis** [1]. The **Microscopic Agglutination Test (MAT)** is considered the gold standard for diagnosing leptospirosis, as it directly detects antibodies against *Leptospira* serovars [1]. - MAT provides **serovar-specific results** and is highly sensitive and specific, especially when acute and convalescent phase sera are tested [1]. *Weil Felix test* - The Weil-Felix test is used to diagnose **rickettsial infections**, not leptospirosis. - It detects antibodies that cross-react with antigens of certain *Proteus* species. *Paul Bunnell test* - The Paul-Bunnell test is used to detect **heterophile antibodies** associated with **infectious mononucleosis** (Epstein-Barr virus infection). - This test is not relevant for diagnosing bacterial infections like leptospirosis. *Microimmunofluorescence test* - The microimmunofluorescence (MIF) test is primarily used for the diagnosis of **chlamydial infections** and sometimes for rickettsial diseases. - While an antibody-detection test, it is not the standard or preferred method for diagnosing leptospirosis.
Question 24: A patient presents with severe abdominal pain and jaundice. Imaging reveals calcified cysts in the liver, and serological testing is positive for Echinococcus. What is a potential complication of this infection?
- A. Portal hypertension due to cyst compression
- B. Rupture of cysts leading to anaphylactic shock
- C. No significant complications
- D. Secondary bacterial infection of cysts (Correct Answer)
Explanation: ***Secondary bacterial infection of cysts*** - **Hydatid cysts** can become secondarily infected, typically after rupture or surgical manipulation, leading to an **abscess formation** within the liver. - This complication can present with features like fever, worsening abdominal pain, and an elevated **white blood cell count**, distinct from the initial presentation. *Rupture of cysts leading to anaphylactic shock* - While rupture of **hydatid cysts** can lead to **anaphylactic shock** due to the release of hydatid fluid, it is not the *most common immediate complication* or the scenario implied by abdominal pain and jaundice. - **Anaphylaxis** implies a rapid, severe systemic allergic reaction, which is a life-threatening acute event. *Portal hypertension due to cyst compression* - While large cysts can compress structures, significant **portal hypertension** due to direct compression of the portal vein by **hydatid cysts** is rare. - More commonly, portal hypertension is a complication of advanced **cirrhosis**, not typically direct cyst compression in the early stages described. *No significant complications* - **Echinococcosis** (hydatid disease) is a serious parasitic infection that almost always leads to significant morbidity if left untreated. - Cysts grow over time and inevitably cause **organ dysfunction**, pain, obstruction, or other complications.
Question 25: Which of the following is not the component of qSOFA?
- A. Respiratory rate >22/min
- B. Altered mental status
- C. Unequally dilated pupils (Correct Answer)
- D. Systolic BP<100 mmHg
Explanation: ***Unequally dilated pupils*** - **Unequally dilated pupils** are not a component of the **qSOFA** score. This finding can be indicative of neurological issues such as increased **intracranial pressure** or **uncal herniation**, but not directly part of the sepsis screening tool [1]. - The qSOFA score focuses on easily obtainable clinical signs to rapidly identify patients at risk for poor outcomes from **sepsis**. *Respiratory rate >22/min* - A **respiratory rate greater than 22 breaths per minute** is one of the three criteria for the **qSOFA** score, indicating significant physiological stress. - This elevated respiratory rate suggests an increased work of breathing, often due to **metabolic acidosis** or **systemic inflammation** associated with sepsis. *Altered mental status* - **Altered mental status** (e.g., Glasgow Coma Scale score less than 15) is a core component of the **qSOFA** score [1]. - This sign reflects **cerebral hypoperfusion** or **encephalopathy** due to the systemic effects of sepsis [1]. *Systolic BP<100 mmHg* - A **systolic blood pressure less than 100 mmHg** is another key criterion of the **qSOFA** score. - This indicates **hypotension** and suggests inadequate tissue perfusion, a critical sign of **circulatory dysfunction** in sepsis [1].
Question 26: A 29-year-old patient presents with focal seizures. MRI shows frontal and temporal enhancement. What is the most probable diagnosis?
- A. Herpes simplex encephalitis (Correct Answer)
- B. Enterovirus encephalitis
- C. Japanese encephalitis
- D. Meningococcal meningitis
Explanation: ***Herpes simplex encephalitis*** - **Herpes simplex encephalitis (HSE)** characteristically causes inflammation and damage in the **frontal** and **temporal lobes**, leading to focal neurological deficits and seizures [1]. - MRI findings of **enhancement** in these specific brain regions are highly suggestive of HSE. *Enterovirus encephalitis* - **Enterovirus encephalitis** typically affects a broader range of brain regions and less commonly presents with the focal frontal and temporal enhancement seen in HSE. - While it can cause seizures, the MRI findings are not as specific for this diagnosis. *Japanese encephalitis* - **Japanese encephalitis** is geographically restricted to parts of Asia and is transmitted by mosquitoes. The clinical presentation typically includes diffuse encephalitic symptoms rather than focal frontal/temporal involvement and enhancement on MRI. - This diagnosis would be unlikely without a relevant travel history and exposure. *Meningococcal meningitis* - **Meningococcal meningitis** is an infection of the **meninges**, the membranes surrounding the brain and spinal cord, not primarily the brain tissue itself. - MRI would typically show inflammation and enhancement of the meninges, rather than focal parenchymal (brain tissue) enhancement in the frontal and temporal lobes.
Question 27: When resuscitating a patient in shock which of the following is not an adequate parameter to predict end point of resuscitation?
- A. Mixed venous oxygen saturation
- B. Base deficit
- C. Lactate
- D. Blood pressure (Correct Answer)
Explanation: ***Blood pressure*** - While essential for initial assessment and guiding treatment, **blood pressure** can be maintained within normal limits even in significant shock states due to compensatory mechanisms [1]. - Blood pressure alone does not reflect **tissue perfusion** or cellular oxygenation, which are the true endpoints of resuscitation [1]. *Mixed venous oxygen saturation* - **Mixed venous oxygen saturation (SvO2)** reflects the balance between oxygen delivery and consumption, providing insight into global tissue oxygenation. - A low SvO2 indicates inadequate oxygen delivery relative to demand, making it a valuable target for guiding resuscitation. *Base deficit* - **Base deficit** is a measure of metabolic acidosis and reflects the severity of tissue hypoperfusion and anaerobic metabolism. - Normalization of base deficit indicates correction of metabolic derangements and improved tissue perfusion. *Lactate* - **Lactate** is a product of anaerobic metabolism, which occurs when tissues are not adequately perfused or oxygenated. - Elevated lactate levels indicate tissue hypoperfusion, and serial measurements are crucial for monitoring the effectiveness of resuscitation and predicting outcomes.
Question 28: All the following nerves are involved in entrapment neuropathy except -
- A. Median nerve
- B. Femoral nerve (Correct Answer)
- C. Ulnar nerve
- D. Lateral cutaneous nerve of thigh
Explanation: ***Femoral nerve*** - While the femoral nerve can be injured, it is **uncommonly involved** in entrapment neuropathy compared to other nerves. - Entrapment of the femoral nerve is rare and typically occurs in the **pelvis** or **inguinal region**, often due to trauma or mass effect. *Median nerve* - The median nerve is classically involved in **carpal tunnel syndrome**, where it is compressed at the wrist [1], [2]. - Symptoms include pain, numbness, and tingling in the thumb, index, middle, and radial half of the ring finger [1]. *Ulnar nerve* - The ulnar nerve is commonly entrapped at the **cubital tunnel** (elbow) or the **Guyon's canal** (wrist) [1]. - This leads to symptoms such as numbness and weakness in the small finger and ulnar half of the ring finger [1]. *Lateral cutaneous nerve of thigh* - This nerve is frequently entrapped as it passes under the **inguinal ligament**, causing **meralgia paresthetica**. - Symptoms include burning pain and numbness on the lateral aspect of the thigh.
Question 29: In HIV patients, Kaposi's sarcoma is most likely caused by which of the following?
- A. Bacteria
- B. Parasite
- C. Fungus
- D. Virus (Correct Answer)
Explanation: ***Virus*** - The image likely depicts **Kaposi's sarcoma**, a common lesion in HIV patients, which is caused by **Human Herpesvirus 8 (HHV-8)**. - Other viral infections like **Herpes Simplex Virus (HSV)** can also cause mucocutaneous lesions in immunocompromised individuals. *Bacteria* - While HIV patients are susceptible to bacterial infections (e.g., **Staphylococcus aureus** causing skin abscesses), the described lesion type is not characteristic of common bacterial skin infections. - Bacterial lesions often present as pustules, cellulitis, or ulcers with purulent discharge, which differ from typical Kaposi's sarcoma. *Parasite* - Parasitic infections can occur in HIV patients (e.g., **scabies** or **leishmaniasis**), but these typically present with different dermatological features like intensely itchy papules or nodular ulcerative lesions. - Lesions caused by parasites do not usually manifest as the violaceous, nodular, or plaque-like appearances seen in Kaposi's sarcoma. *Fungus* - Fungal infections in HIV patients can cause skin lesions (e.g., **candidiasis** with oral thrush or esophagitis, or **cryptococcosis** with molluscum-like lesions). - However, the morphology of these fungal lesions generally differs from the classic appearance of Kaposi's sarcoma or other common viral lesions in HIV.
Question 30: Which of these is least effective as first-line treatment for dangerous hyperkalemia?
- A. Calcium chloride injection
- B. Beta-2 agonist (Salbutamol)
- C. Intravenous sodium bicarbonate (Correct Answer)
- D. Dialysis (Hemodialysis)
Explanation: ***Intravenous sodium bicarbonate*** - While it can drive potassium into cells, its effect is often **delayed and unreliable** in acute, dangerous hyperkalemia, especially without concurrent acidosis. - Its efficacy is most pronounced when hyperkalemia is associated with **metabolic acidosis**, which is not always the primary driving factor of dangerous hyperkalemia. *Calcium chloride injection* - This is a **first-line treatment** for dangerous hyperkalemia, as it **stabilizes the cardiac membrane** by antagonizing the direct effects of potassium on myocardial excitability [1]. - It does not lower serum potassium levels but **protects the heart** from life-threatening arrhythmias, buying time for other therapies to reduce potassium [1]. *Beta-2 agonist (Salbutamol)* - **Beta-2 agonists** like salbutamol are effective in shifting potassium **intracellularly**, thereby lowering serum potassium levels. - This effect is mediated by stimulating the **Na+/K+-ATPase pump** on cell membranes. *Dialysis (Hemodialysis)* - **Hemodialysis** is the **most effective and rapid** method for removing excess potassium from the body, especially in cases of severe or refractory hyperkalemia. - It provides definitive treatment by directly **filtering potassium** from the blood, and is often considered when other measures fail or in patients with kidney failure.