Which condition is most commonly associated with systemic amyloidosis?
Most common cause of nephrotic syndrome in adults?
Progressive distal-to-proximal motor recovery following nerve regeneration is most characteristic of which type of nerve injury?
Which components of cigarette smoke are known to contribute to coronary artery disease?
What is the primary electrolyte found in Oral Rehydration Salts (ORS) at a concentration of 75 mEq/L?
What is the most common cause of ophthalmoplegia in adults?
What is the most likely diagnosis for a young patient presenting with iritis and joint pain?
What condition is caused by the intake of exogenous steroids?
Serological testing of patient shows HBsAg, IgM anti-HBc and HBeAg positive. The patient has -
Which type of malaria is most commonly associated with renal failure?
NEET-PG 2012 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 21: Which condition is most commonly associated with systemic amyloidosis?
- A. Chronic Kidney Disease (Correct Answer)
- B. Multiple Myeloma
- C. Rheumatoid Arthritis
- D. Familial Mediterranean Fever
Explanation: Type II DM - Amyloidosis is commonly associated with **chronic diseases** like type II diabetes mellitus due to insulin resistance leading to amyloid deposition [4]. - The presence of **amiloid in the pancreas** often correlates with the complications of this type of diabetes [3]. *Maturity onset DM* - While maturity-onset diabetes can lead to complications, it is often synonymous with **type II DM**, making this distinction inaccurate regarding amyloidosis. - This term is less commonly used and does not emphasize the direct link to amyloidosis seen in type II diabetes. *HTN* - Hypertension itself is not a direct cause of amyloidosis; it typically results from other underlying conditions. - The association of amyloidosis with hypertension is usually **secondary**, not a primary condition leading to amyloid deposits [2]. *Type I DM* - Type I diabetes is primarily **autoimmune**, resulting in insulin-deficient states and does not strongly associate with amyloidosis like type II [1]. - The amyloid deposits seen in type I are much less common compared to type II or associated chronic conditions.
Question 22: Most common cause of nephrotic syndrome in adults?
- A. Minimal change disease
- B. Acute GN
- C. Membranous glomerulonephritis
- D. Focal Segmental Glomerulosclerosis (FSGS) (Correct Answer)
Explanation: ***Membranous glomerulonephritis*** - Membranous glomerulonephritis is the **most common cause of nephrotic syndrome** in adults, often associated with **autoimmune diseases** or certain medications. [1] - Patients typically present with **heavy proteinuria**, edema, and a normal renal function in early stages. *Focal GN* - Focal glomerulosclerosis typically affects young individuals and may not usually present as nephrotic syndrome. - It is associated with **obesity** and **HIV**, often leading to more significant renal impairment compared to membranous glomerulonephritis. [1] *Acute GN* - Acute glomerulonephritis generally presents with **hematuria**, **hypertension**, and **renal failure**, rather than nephrotic syndrome. [1] - It can have different causes, such as infections or systemic diseases, but is not the primary condition leading to nephrotic syndrome in adults. *Minimal change disease* - Minimal change disease is more prevalent in **children** [1], and while it can occur in adults, it is less common as a cause of nephrotic syndrome in this demographic. - It is characterized by **responsive edema** to steroids, but its incidence is not as high as membranous glomerulonephritis in adults.
Question 23: Progressive distal-to-proximal motor recovery following nerve regeneration is most characteristic of which type of nerve injury?
- A. Axonotmesis (Correct Answer)
- B. Neurotmesis
- C. Neuropraxia
- D. Nerve injury
Explanation: ***Axonotmesis*** - Involves damage to the **axon** and myelin sheath, while the surrounding **epineurium** remains intact. - This preservation of the connective tissue allows for guided **regeneration** of axons from distal to proximal, leading to a good prognosis for recovery [1]. *Neurotmesis* - Refers to the **complete transection** of the nerve, including the axon, myelin, and all connective tissue sheaths. - Recovery is often **incomplete** or requires surgical repair, as significant misdirection of regenerating axons is common. *Neuropraxia* - Characterized by a **temporary block** in nerve conduction, typically due to **demyelination**, with the axon remaining intact. - Recovery is usually **rapid** and complete, occurring within days to weeks, as no axonal regeneration is needed. *Nerve injury* - This is a **general term** that encompasses all types of nerve damage, from mild to severe. - It does not specify a particular mechanism or pattern of recovery, making it less precise than the more specific classifications.
Question 24: Which components of cigarette smoke are known to contribute to coronary artery disease?
- A. Nicotine, carbon monoxide, and tar (Correct Answer)
- B. Carbon monoxide and tar
- C. Carbon dioxide
- D. Tar and nicotine
Explanation: ***Nicotine, carbon monoxide, and tar*** - **Nicotine** directly affects the cardiovascular system by increasing **heart rate**, **blood pressure**, and causing **vasoconstriction**, as well as promoting atherogenesis [2]. - **Carbon monoxide** binds to hemoglobin with higher affinity than oxygen, forming **carboxyhemoglobin**, which reduces oxygen delivery to tissues, leading to **endothelial damage** and contributing to atherosclerosis [1]. - **Tar** contains various **carcinogens** and toxic chemicals that contribute to inflammation, oxidative stress, and lipid peroxidation, all of which are implicated in the development and progression of **atherosclerosis**. *Carbon monoxide and tar* - While both contribute significantly, this option **omits nicotine**, which is a major contributor to the cardiovascular effects of smoking. - Nicotine's direct impact on **vasoconstriction** and **atherogenesis** is a critical factor in coronary artery disease [2]. *Carbon dioxide* - **Carbon dioxide** is a product of respiration and combustion but is not considered a primary direct contributor to the pathogenesis of **coronary artery disease** from cigarette smoke in the same way as nicotine, carbon monoxide, and tar. - Its presence in smoke primarily relates to its role in **respiratory physiology** rather than direct vascular damage. *Tar and nicotine* - This option correctly identifies **tar** and **nicotine** as contributors but **omits carbon monoxide**, which plays a crucial role in reducing oxygen-carrying capacity and directly damaging the endothelium [1]. - The impact of **carbon monoxide** on cardiac oxygen supply is a significant mechanism in smoking-related cardiovascular disease [1].
Question 25: What is the primary electrolyte found in Oral Rehydration Salts (ORS) at a concentration of 75 mEq/L?
- A. Sodium (Correct Answer)
- B. Potassium
- C. Glucose
- D. Chloride
Explanation: ***Sodium*** - The primary electrolyte in **Oral Rehydration Salts (ORS)** is **sodium**, which is crucial for replacing losses due to diarrhea and facilitating water absorption in the intestines [1]. - The standard ORS formulation, recommended by the WHO, contains **75 mEq/L of sodium** to effectively rehydrate individuals with acute watery diarrhea [1]. *Potassium* - While **potassium** is an essential electrolyte found in ORS, its concentration is typically lower than sodium, usually around **20 mEq/L**. - Potassium helps replenish intracellular losses and supports normal cellular function, but it is not the primary electrolyte at the 75 mEq/L concentration. *Glucose* - **Glucose** is a crucial component of ORS, but it is a sugar, not an electrolyte. - Its role is to facilitate the co-transport of **sodium and water** across the intestinal wall, enhancing fluid absorption, but it does not contribute to the electrolyte concentration in mEq/L [1]. *Chloride* - **Chloride** is an electrolyte present in ORS, primarily to balance the charge of **sodium** and prevent hyynatremia. - Its concentration is typically around **65 mEq/L**, making it slightly less concentrated than sodium but still vital for maintaining electrolyte balance.
Question 26: What is the most common cause of ophthalmoplegia in adults?
- A. Cranial nerve palsy (Correct Answer)
- B. Myasthenia gravis
- C. Diabetes mellitus
- D. Trauma
Explanation: ***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.
Question 27: What is the most likely diagnosis for a young patient presenting with iritis and joint pain?
- A. Gout
- B. RA
- C. AS (Correct Answer)
- D. Toxoplasma
Explanation: ***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.
Question 28: What condition is caused by the intake of exogenous steroids?
- A. Addison's disease
- B. Cushing's syndrome (Correct Answer)
- C. Pheochromocytoma
- D. Conn's syndrome
Explanation: ***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.
Question 29: Serological testing of patient shows HBsAg, IgM anti-HBc and HBeAg positive. The patient has -
- A. Acute hepatitis B with high infectivity (Correct Answer)
- B. Chronic hepatitis with high infectivity
- C. Acute on chronic hepatitis
- D. Chronic hepatitis B with low infectivity (not acute)
Explanation: ***Acute hepatitis B with high infectivity*** - The presence of **HBsAg** (hepatitis B surface antigen) indicates active infection, while **IgM anti-HBc** (IgM antibody to hepatitis B core antigen) is a marker of recent or acute infection [1]. - **HBeAg** (hepatitis B e-antigen) positivity signifies active viral replication and a high likelihood of infectivity [1]. *Chronic hepatitis B with low infectivity (not acute)* - **Chronic hepatitis B** is characterized by the presence of **HBsAg for more than six months**, but **IgM anti-HBc** would typically be negative; instead, **IgG anti-HBc** would be positive [1]. - **Low infectivity** would be indicated by the absence of **HBeAg**, replaced by **anti-HBe** (antibody to HBeAg) [1]. *Chronic hepatitis with high infectivity* - This diagnosis would show positive **HBsAg and HBeAg**, but the absence of **IgM anti-HBc** (presence of **IgG anti-HBc** instead) would distinguish it from acute infection [1]. - The presence of **IgM anti-HBc** is a crucial marker for an acute phase of hepatitis B rather than chronic. *Acute on chronic hepatitis* - This scenario would involve a patient with pre-existing **chronic hepatitis B** (positive HBsAg, IgG anti-HBc) experiencing a new acute flare-up, which could involve a resurgence of **HBeAg** or a new acute viral insult. - While **HBsAg** and **HBeAg** would be positive, the key differentiator would be the presence of both **IgM anti-HBc** (indicating the acute component) and **IgG anti-HBc** (indicating the chronic component), which is not fully described here to confirm acute on chronic.
Question 30: Which type of malaria is most commonly associated with renal failure?
- A. Falciparum (Correct Answer)
- B. Vivax
- C. Malariae
- D. Ovale
Explanation: ***Falciparum*** - **Plasmodium falciparum** is notorious for its ability to cause severe and complicated malaria, including **renal failure** due to its high parasitic biomass and tendency to block microvasculature [1]. - The parasite causes red blood cells to become **sticky**, leading to sequestration in capillaries of vital organs, including the kidneys, resulting in acute tubular necrosis [1]. *Vivax* - **Plasmodium vivax** typically causes milder forms of malaria, though it can occasionally lead to severe manifestations, **renal complications are rare** compared to P. falciparum [1]. - While it can cause some organ dysfunction, it generally does not cause the severe multi-organ involvement, particularly **acute renal failure**, that P. falciparum is known for [1]. *Malariae* - **Plasmodium malariae** is associated with a chronic form of malaria and is known to cause **nephrotic syndrome** (specifically malarial nephropathy) due to immune complex deposition, rather than acute renal failure [1]. - The renal pathology in P. malariae infection is typically a **glomerulonephritis** that develops after repeated infections, which is distinct from the acute renal failure seen with P. falciparum [1]. *Ovale* - **Plasmodium ovale** is the least common type of malaria and causes a benign form of the disease, similar to P. vivax [1]. - It rarely, if ever, causes severe complications like **renal failure** [1].