NEET-PG 2012 - Internal Medicine Practice Questions

Q: Which of the following is the most characteristic symptom of obstruction of the inferior vena cava?

Paraumblical dilatation. ***Paraumbilical dilatation*** - Obstruction of the **inferior vena cava (IVC)** leads to collateral circulation through superficial veins, especially around the umbilicus, causing **paraumbilical dilatation** (caput medusae). - This collateral flow bypasses the obstructed IVC to return blood to the superior vena cava system. *Thoraco-epigastric dilatation* - This pattern of collateral circulation is more characteristic of **superior vena cava (SVC) obstruction**, where blood from the upper body needs to bypass the SVC. - The dilated veins would typically be seen on the chest and upper abdomen, draining towards the femoral veins. *Oesophageal varices* - **Oesophageal varices** are typically caused by **portal hypertension** [1], often secondary to liver cirrhosis, not directly by IVC obstruction. - They represent portosystemic collateral veins, diverging from the portal system to the systemic circulation [1]. *Haemorrhoids* - **Haemorrhoids** are dilated veins in the anal canal, most commonly caused by **straining** during defecation or conditions that increase intra-abdominal pressure [2]. - While they can be a sign of portal hypertension [1], **IVC obstruction** is not their primary or most characteristic cause.

Q: Renal vein thrombosis is associated with all of the following conditions except:

Trauma. **Trauma** - While trauma to the abdomen can cause **renal injury** and other vascular issues, isolated **renal vein thrombosis** is not a common direct association or complication [1]. - Renal vein thrombosis typically results from conditions that lead to a **hypercoagulable state** or local vascular stasis. *Sickle cell anemia* - Individuals with **sickle cell anemia** are prone to **vaso-occlusive crises** from sickled red blood cells obstructing blood flow [2]. - This can lead to **renal medullary ischemia** and infarction, making them highly susceptible to **renal vein thrombosis**. *Nephrotic syndrome* - **Nephrotic syndrome** is a significant risk factor for **renal vein thrombosis** due to the urinary loss of **antithrombin III**, a natural anticoagulant. - This loss creates a **hypercoagulable state**, increasing the likelihood of thrombus formation in renal veins. *Dehydration* - Severe **dehydration** leads to **hemoconcentration** (increased blood viscosity) and reduced blood flow. - These factors promote a **hypercoagulable state**, increasing the risk of thrombotic events, including **renal vein thrombosis**, especially in vulnerable populations like infants or the elderly.

Q: Among the following, most reliable test for screening of diabetes mellitus?

Fasting sugar. ***Fasting sugar*** - A **fasting plasma glucose** (FPG) test is the most common and reliable initial test for screening for **diabetes mellitus** because it measures blood glucose after an overnight fast (typically 8-12 hours), providing a baseline level unaffected by recent food intake [1]. - A fasting glucose level of **≥ 126 mg/dL** (7.0 mmol/L) on two separate occasions is diagnostic of diabetes, making it an excellent screening tool for identifying individuals with impaired glucose metabolism [1]. *Random sugar* - A random plasma glucose test can be used to diagnose diabetes if the level is **≥ 200 mg/dL** (11.1 mmol/L) in a symptomatic individual, but it is less reliable for screening asymptomatic individuals due to its variability depending on recent food intake [1]. - Because it can be measured at any time of day without regard to the last meal, it has a **lower sensitivity** for detecting early stages of diabetes compared to fasting glucose. *Glucose tolerance test* - An **oral glucose tolerance test** (OGTT) is highly sensitive and specific for diagnosing diabetes and impaired glucose tolerance, but it is more cumbersome and time-consuming, involving multiple blood draws over two hours after consuming a sugary drink. - While it is a definitive diagnostic test, its complexity makes it **less practical for routine screening** in large populations compared to simpler tests like fasting plasma glucose. *Urine sugar* - The presence of glucose in urine (glycosuria) indicates that blood glucose levels have exceeded the **renal threshold** (typically around 180 mg/dL), meaning the kidneys are unable to reabsorb all the glucose. - This is a **less sensitive and specific** method for screening, as it only becomes positive once blood glucose is significantly elevated, and it does not detect milder forms of impaired glucose metabolism or early diabetes.

Q: What condition is caused by the intake of exogenous steroids?

Cushing's syndrome. ***Cushing's syndrome*** - **Exogenous steroid intake** is the most common cause of Cushing's syndrome, leading to symptoms associated with **excess cortisol** [1]. - This occurs because the steroids mimic the effects of **cortisol**, suppressing the body's natural production and leading to its characteristic signs and symptoms [2]. *Addison's disease* - This condition is characterized by **adrenal insufficiency**, meaning the adrenal glands produce too little **cortisol** and often **aldosterone**. - It is typically caused by autoimmune destruction of the adrenal glands, not by exogenous steroid intake. *Pheochromocytoma* - This is a rare tumor of the **adrenal medulla** that causes the overproduction of **catecholamines** (epinephrine and norepinephrine). - Symptoms include sudden, severe episodes of hypertension, palpitations, and sweating, unrelated to steroid intake. *Conn's syndrome* - Also known as **primary hyperaldosteronism**, this condition involves the overproduction of **aldosterone** by the adrenal glands. - It typically results in hypertension and hypokalemia and is not directly caused by exogenous steroid administration.

Q: Which species of malaria is associated with nephrotic syndrome?

P. malariae. ***P. malariae*** - *P. malariae* infection is classically associated with **quartan fever** and can lead to **nephrotic syndrome**, particularly in children [1]. - The mechanism involves the deposition of immune complexes in the glomeruli, causing **membranoproliferative glomerulonephritis**. *P. vivax* - *P. vivax* is known for causing **benign tertian malaria** and frequently leads to **relapses** due to hypnozoites in the liver [1]. - While it can cause renal dysfunction, **nephrotic syndrome** is not a characteristic complication. *P. falciparum* - *P. falciparum* is responsible for the most severe form of malaria, often complicated by **cerebral malaria**, **acute renal failure**, and **blackwater fever** [1]. - Renal complications typically present as **acute tubular necrosis** rather than nephrotic syndrome. *P. ovale* - *P. ovale* causes **mild tertian malaria** similar to *P. vivax* and is also known for **relapses** due to hypnozoites [1]. - It is the least common form of malaria and is not typically associated with **nephrotic syndrome**.

Q: Madarosis is seen in ?

Hypothyroidism. ***Hypothyroidism*** - **Madarosis**, specifically the loss of the **outer third of the eyebrows**, is a classic sign of **hypothyroidism** due to decreased thyroid hormone levels affecting hair follicle growth [1]. - Other common symptoms include **fatigue**, **weight gain**, **cold intolerance**, and **dry skin**. *Addison's disease* - This condition involves **adrenal insufficiency**, primarily causing symptoms like **hyperpigmentation**, low blood pressure, and fatigue. - **Hair loss** is generally not a prominent feature, and madarosis is not typically seen. *Acromegaly* - Characterized by excessive **growth hormone** production, leading to enlargement of hands, feet, and facial features. - While it can cause some changes in hair texture, **madarosis** is not a common clinical manifestation. *None of the options* - This option is incorrect because **Hypothyroidism** is a direct cause of madarosis due to its impact on **hair follicle metabolism** [1]. - The other conditions listed do not typically present with this specific type of eyebrow hair loss.

Q: What is the most likely diagnosis for a young patient presenting with iritis and joint pain?

AS. ***AS (Ankylosing Spondylitis)*** - **Iritis** (anterior uveitis) is a common extra-articular manifestation of **ankylosing spondylitis**, affecting up to 40% of patients [1]. - **Joint pain**, particularly in the axial skeleton (spine and sacroiliac joints), is a hallmark feature in young patients with AS [1]. *Gout* - Characterized by **recurrent attacks of acute inflammatory arthritis** due to **monosodium urate crystal deposition**. - While it causes severe joint pain, **iritis is not a typical manifestation** of gout. *RA (Rheumatoid Arthritis)* - RA is a **chronic autoimmune inflammatory disease** primarily affecting the **synovial joints** symmetrically, mostly in older adults. - While ocular manifestations like **scleritis** or **episcleritis** can occur, **iritis is less common** compared to AS. *Toxoplasma* - **Toxoplasmosis** primarily causes **chorioretinitis** (inflammation of the choroid and retina), not typically isolated iritis. - Although it can cause **arthralgia** (joint pain), it does not cause inflammatory arthritis like the spondyloarthropathies.

Q: HIV post exposure prophylaxis should be started within?

72 hrs. ***72 hrs*** - **Post-exposure prophylaxis (PEP)** aims to prevent HIV infection after potential exposure and should ideally be initiated as soon as possible, but no later than **72 hours** after exposure [1]. - Starting PEP within this window significantly increases its effectiveness in preventing HIV seroconversion. *1-2 hrs* - While initiating PEP as soon as possible is crucial, stating it must be within **1-2 hours** can be misleading as the window of effectiveness extends beyond this. - This timeframe might be an ideal, but not the absolute crucial limit for efficacy. *14 hrs* - This timeframe is **too restrictive** for the recommended window for PEP initiation. - Missing the opportunity within **14 hours** does not negate the effectiveness of PEP if started within the broader 72-hour window. *18 hrs* - Similar to **14 hours**, **18 hours** is an unnecessarily strict limit for PEP initiation. - Guidelines universally support starting PEP up to **72 hours** post-exposure for optimal benefit [1].

Q: What is the most common cause of ophthalmoplegia in adults?

Cranial nerve palsy. ***Cranial nerve palsy*** - **Cranial nerve palsies**, particularly those affecting cranial nerves III, IV, or VI, are the most frequent causes of isolated ophthalmoplegia in adults [1]. - They can result from various etiologies like **ischemia**, **compression**, or **inflammation**, directly impairing the nerves responsible for eye movement [1]. *Myasthenia gravis* - While it frequently causes **ocular symptoms** (ptosis and diplopia), it typically presents with **fluctuating weakness** that worsens with sustained effort [1]. - It's a neuromuscular junction disorder, not a primary cranial nerve issue, and often affects other muscle groups beyond the eyes. *Diabetes mellitus* - **Diabetic ophthalmoplegia** is a specific type of cranial nerve palsy (often CN III or VI) caused by microvascular ischemia. - While common in diabetics, it is a *cause* of cranial nerve palsy, not the overarching most common cause of ophthalmoplegia itself. *Trauma* - **Trauma** can certainly cause ophthalmoplegia, often due to direct damage to **extraocular muscles**, **orbital fractures**, or **cranial nerve injury**. - However, in the general adult population, non-traumatic cranial nerve palsies are more frequently encountered as the cause of ophthalmoplegia.

Q: A 45-year-old patient presents with progressive dyspnea, orthopnea, and bilateral pedal edema. On examination, there is elevated JVP, S3 gallop, and hepatomegaly. What is the most likely underlying pathophysiology?

HALE. ***HALE*** - This acronym stands for **Heart-failure Associated Lung Edema**. The symptoms of **progressive dyspnea**, **orthopnea**, **bilateral pedal edema**, **elevated JVP**, **S3 gallop**, and **hepatomegaly** are classic signs of **congestive heart failure** leading to fluid overload and pulmonary congestion [1]. - The pathophysiology involves the heart's inability to pump blood effectively, causing a buildup of pressure in the pulmonary and systemic circulations, leading to the observed symptoms [1]. *DALEY* - This is not a recognized acronym in medical pathophysiology. The symptoms presented are strongly indicative of a specific cardiovascular condition. - There is no clinical scenario where "DALEY" would accurately describe the underlying pathophysiology of dyspnea, edema, and heart failure signs. *OALY* - This is not a recognized acronym in medical pathophysiology. The presented clinical picture requires a well-established and specific pathophysiological explanation. - Using an unrecognized term would not provide an accurate or helpful description of the patient's condition. *None of the options* - The acronym HALE (Heart-failure Associated Lung Edema) accurately captures the core pathophysiology evident from the patient's symptoms and signs. - Given the strong clinical presentation of congestive heart failure with pulmonary and systemic congestion, one of the provided options *does* accurately describe the situation.

Question 1

Which of the following is the most characteristic symptom of obstruction of the inferior vena cava?

Accepted Answer

Paraumblical dilatation

Answer

Thoraco-epigastric dilatation

Answer

Haemorrhoides

Answer

Oesophageal varices

Question 2

Renal vein thrombosis is associated with all of the following conditions except:

Accepted Answer

Trauma

Answer

Nephrotic syndrome

Answer

Dehydration

Answer

Sickle cell anemia

Question 3

Among the following, most reliable test for screening of diabetes mellitus?

Accepted Answer

Fasting sugar

Answer

Urine sugar

Answer

Random sugar

Answer

Glucose tolerance test

Question 4

What condition is caused by the intake of exogenous steroids?

Accepted Answer

Cushing's syndrome

Answer

Addison's disease

Answer

Pheochromocytoma

Answer

Conn's syndrome

Question 5

Which species of malaria is associated with nephrotic syndrome?

Accepted Answer

P. malariae

Answer

P. vivax

Answer

P. falciparum

Answer

P. ovale

Question 6

Madarosis is seen in ?

Accepted Answer

Hypothyroidism

Answer

None of the options

Answer

Addison's disease

Answer

Acromegaly

Question 7

What is the most likely diagnosis for a young patient presenting with iritis and joint pain?

Accepted Answer

AS

Answer

Gout

Answer

RA

Answer

Toxoplasma

Question 8

HIV post exposure prophylaxis should be started within?

Accepted Answer

72 hrs

Answer

1-2 hrs

Answer

14 hrs

Answer

18 hrs

Question 9

What is the most common cause of ophthalmoplegia in adults?

Accepted Answer

Cranial nerve palsy

Answer

Myasthenia gravis

Answer

Diabetes mellitus

Answer

Trauma

Question 10

A 45-year-old patient presents with progressive dyspnea, orthopnea, and bilateral pedal edema. On examination, there is elevated JVP, S3 gallop, and hepatomegaly. What is the most likely underlying pathophysiology?

Accepted Answer

HALE

Answer

DALEY

Answer

OALY

Answer

None of the options

NEET-PG 2012 — Internal Medicine