NEET-PG 2012 - Internal Medicine Practice Questions

Q: Secretory diarrhea is not typically associated with which of the following conditions?

Celiac disease. ***Celiac disease*** [1] - Characterized by **malabsorption** due to immune-mediated damage to the intestinal mucosa, leading to **osmotic diarrhea** rather than secretory diarrhea [1]. - Symptoms include **bloating**, **weight loss**, and **steatorrhea**, which are not consistent with secretory processes. *Cholera* - Caused by **Vibrio cholerae**, leading to **massive secretory diarrhea** due to the action of cholera toxin on intestinal epithelial cells. - Presents with **watery diarrhea**, potentially leading to **dehydration** and electrolyte imbalances. *Addison's Disease* - This condition may cause **diarrhea** but typically results in **non-secretory diarrhea**, often associated with adrenal insufficiency symptoms. - Presenting features include **fatigue**, **weight loss**, and **hyperpigmentation**, not primarily secretory processes. *Phenolphthalein* - A laxative that can induce **secretory diarrhea** through its stimulant effects on the bowel. - Its mechanism leads to increased fluid secretion in the intestines, thus contributing to secretory diarrhea.

Q: Which biomarker is typically elevated in the plasma of patients with chronic heart disease?

B-type natriuretic peptide (BNP). ***B-type natriuretic peptide (BNP)*** - **BNP** is a hormone secreted by **ventricular cardiomyocytes** in response to increased wall stretch and pressure overload, making it a strong indicator of **myocardial stress** and **chronic heart failure** [1]. - Elevated levels correlate with the **severity of heart failure**, aiding in diagnosis and prognosis [1]. *Endothelin-1* - **Endothelin-1** is a potent **vasoconstrictor** involved in vascular tone regulation and endothelial dysfunction. - While it can be elevated in conditions like **pulmonary hypertension** and **atherosclerosis**, it is not a primary diagnostic biomarker for chronic heart disease in general. *Troponin T* - **Troponin T** is a cardiac-specific protein that is released into the bloodstream following **myocardial injury or necrosis**. - While it is a crucial biomarker for **acute coronary syndromes** (e.g., heart attack), persistently elevated levels are not typical for stable chronic heart disease unless there is ongoing subclinical myocardial damage. *Cortisol* - **Cortisol** is a **stress hormone** produced by the adrenal glands, involved in metabolism, immune response, and blood pressure regulation. - While chronic stress can impact cardiovascular health, cortisol itself is not a specific diagnostic biomarker for chronic heart disease.

Q: The most common cause of pontine hemorrhage is

Hypertension. Hypertension - **Chronic hypertension** leads to the weakening and rupture of small perforating arteries in the pons, making it the most common cause of **pontine hemorrhage** [1]. - The elevated pressure damages the **endothelium** and smooth muscle layers of these vessels, predisposing them to bleeding. *Diabetes* - While diabetes can cause microvascular complications, it is not considered the most common cause of **pontine hemorrhage**. - Its primary cerebral vascular complications include increased risk of **ischemic stroke** rather than hemorrhagic stroke in the pons. *Trauma* - **Traumatic brain injury** can cause various types of intracranial hemorrhage, but isolated **pontine hemorrhage** directly due to trauma is less common than that due to hypertension [1]. - Trauma typically results in contusions, subdural, or epidural hematomas, often in superficial brain regions. *Aneurysmal rupture* - **Aneurysmal rupture** is a common cause of subarachnoid hemorrhage, particularly from the Circle of Willis, but pontine hemorrhages are rarely caused by aneurysms within the pons itself [1]. - The vessels supplying the pons are typically small and perforating, not commonly forming dissecting or saccular aneurysms.

Q: Tall T waves on ECG are seen in:

Hyperkalemia. ***Hyperkalemia*** - **Tall, peaked T waves** are a hallmark ECG finding in early to moderate **hyperkalemia**, reflecting altered repolarization due to elevated extracellular potassium [1]. - As potassium levels rise further, other ECG changes may include a **prolonged PR interval**, **widened QRS complex**, and ultimately a **sine wave pattern**, leading to ventricular arrhythmias [1]. *Hypokalemia* - This condition is typically associated with **flattened or inverted T waves**, prominent **U waves**, and a **prolonged QT interval** on the ECG [1]. - The ECG changes in hypokalemia reflect delayed repolarization and increased myocardial instability [1]. *Hypercalcemia* - **Hypercalcemia** is characterized by a **shortened QT interval** on the ECG due to accelerated ventricular repolarization. - T waves, if affected, are usually not tall or peaked but may be wider or slightly less prominent. *Hypocalcemia* - **Hypocalcemia** typically leads to a **prolonged QT interval** on the ECG, primarily due to a lengthened ST segment. - While it can manifest with various T wave morphologies, it does not typically cause the characteristic tall, peaked T waves seen in hyperkalemia.

Q: Anomic aphasia is due to defect in

Temporal occipital lobe. ***Temporal occipital lobe*** - Anomic aphasia, characterized by difficulty recalling **words or names (anomia)**, is most commonly associated with lesions in the **left temporo-occipital region**. - This area is crucial for **semantic processing** and word retrieval. *Left inferior parietal lobe* - Damage to the left inferior parietal lobe is more commonly associated with **conduction aphasia**, characterized by impaired repetition despite fluent speech and good comprehension. - It is also involved in aspects of **reading (alexia)** and **writing (agraphia)**. *Left temporal lobe* - While portions of the left temporal lobe (especially Wernicke's area) are critical for language comprehension, damage primarily to this area typically results in **Wernicke's aphasia**, where speech is fluent but meaningless, and comprehension is severely impaired. - Anomia can be a feature of Wernicke's aphasia, but the primary deficit is comprehension. *Cerebellum* - The cerebellum plays a significant role in **motor control**, balance, and coordination, but it is not directly involved in the **generation or comprehension of language** in the same way as cortical areas. - Damage to the cerebellum might lead to **dysarthria** (speech motor difficulties), but not typical aphasia.

Q: The most classical symptom of VIPOMA is:

Secretory diarrhea. The original text cannot be accurately enriched with the provided references to because none of the source materials directly address the pathophysiology or clinical presentation of VIPoma. The available references focus on general gastroenteropancreatic neuroendocrine tumors (NETs) , radiation-induced intestinal damage , arsenic poisoning , gastrointestinal bleeding , and the physiology of taste , but they do not provide the specific confirmation needed for the 'classical symptom' of VIPoma (secretory diarrhea).

Q: What is the most characteristic cerebrospinal fluid (CSF) finding in viral meningitis?

Lymphocytic pleocytosis in CSF. ***Lymphocytic pleocytosis in CSF*** - **Lymphocytic pleocytosis**, meaning an increase in lymphocytes in the CSF, is the hallmark of **viral meningitis**, reflecting the immune response to the viral pathogen. [1] - While other CSF parameters can be altered, the presence of predominantly lymphocytes is the most reliable distinguishing feature from bacterial meningitis. [1] *WBC count typically less than 1000/mL* - This statement is generally true for viral meningitis, as the **WBC count** is usually lower than in bacterial meningitis. - However, it is not the *most characteristic* finding because bacterial meningitis can sometimes present with a WBC count under 1000/mL, especially early in the disease, and the *predominance* of lymphocytes is more specific to viral infection. *Glucose levels normal or slightly decreased* - **Normal glucose levels** are typical in viral meningitis, but they can be slightly decreased in a minority of cases. - This finding is not as characteristic as lymphocytic pleocytosis because significantly decreased glucose levels are more indicative of **bacterial or fungal meningitis**. *Protein levels normal or slightly increased* - **Protein levels** in viral meningitis are often normal or mildly elevated, usually not exceeding **100-150 mg/dL**. - While consistent with viral meningitis, this finding is less specific than lymphocytic pleocytosis, as protein levels can also be elevated in other conditions, including early bacterial meningitis.

Q: A pregnant woman is diagnosed with Graves' disease. The most appropriate therapy for her would be:

Propylthiouracil oral. ***Propylthiouracil oral*** - **Propylthiouracil (PTU)** is the preferred antithyroid drug during the **first trimester** of pregnancy due to a lower risk of teratogenicity compared to methimazole/carbimazole [1]. - It works by inhibiting both the synthesis of thyroid hormones and the peripheral conversion of **T4 to T3**. *Radioiodine therapy* - **Radioactive iodine** is absolutely contraindicated in pregnancy as it can cross the placenta and cause **fetal hypothyroidism or athyreosis**. - It leads to permanent destruction of the thyroid gland and is not suitable for a temporary condition in a pregnant woman. *Total thyroidectomy* - While thyroidectomy can be considered for Graves' disease in pregnancy, it is generally reserved for cases where antithyroid drugs are not tolerated or ineffective, or for very large goiters causing compressive symptoms. - It carries risks associated with **surgery and anesthesia** during pregnancy, and requires **lifelong thyroid hormone replacement**. *Carbimazole parenteral* - **Carbimazole** (which is metabolized to methimazole) is generally avoided in the **first trimester** due to an increased risk of teratogenicity, particularly **aplasia cutis**, omphalocele, and choanal atresia [1]. - While it can be used in the second and third trimesters, **PTU is preferred in the first trimester**, and carbimazole is not typically administered parenterally.

Q: Which of the following is a characteristic feature of primary Sjogren's syndrome?

Enlargement of salivary glands. ***Enlargement of salivary glands*** - **Sjögren's syndrome** is characterized by chronic inflammation of **exocrine glands**, leading to swelling and dysfunction, most notably in the **parotid** and **submandibular glands**. - This glandular enlargement often presents as recurrent or persistent **bilateral swelling** of the major salivary glands. *Can occur in children* - While possible, Sjögren's syndrome is predominantly a disease of **adults**, with incidence peaking in individuals between **40 and 60 years old**. - **Juvenile Sjögren's syndrome** is rare and typically presents with more variable symptoms, making it less of a characteristic feature of the primary disease in the general population. *Increased complement C4 is associated with thymoma* - **Increased complement C4** levels are generally not associated with Sjögren's syndrome; instead, **hypocomplementemia** (low C4) can be seen in some patients, indicating immune complex activity. - **Thymoma** is primarily linked to **myasthenia gravis** and other paraneoplastic syndromes, not a direct or characteristic association with Sjögren's syndrome or C4 levels in this context. *Can be associated with rheumatoid arthritis* - Sjögren's syndrome can be classified as **primary** (occurring alone) or **secondary** (occurring in conjunction with another autoimmune disease). - Its association with **rheumatoid arthritis** defines **secondary Sjögren's syndrome**, meaning it's not a characteristic feature of the *primary* form of the disease itself.

Question 1

Secretory diarrhea is not typically associated with which of the following conditions?

Accepted Answer

Celiac disease

Answer

Phenolphthalein

Answer

Cholera

Answer

VIPoma

Question 2

Which biomarker is typically elevated in the plasma of patients with chronic heart disease?

Accepted Answer

B-type natriuretic peptide (BNP)

Answer

Endothelin-1

Answer

Troponin T

Answer

Cortisol

Question 3

The most common cause of pontine hemorrhage is

Accepted Answer

Hypertension

Answer

Diabetes

Answer

Trauma

Answer

Aneurysmal rupture

Question 4

Tall T waves on ECG are seen in:

Accepted Answer

Hyperkalemia

Answer

Hypokalemia

Answer

Hypercalcemia

Answer

Hypocalcemia

Question 5

Anomic aphasia is due to defect in

Accepted Answer

Temporal occipital lobe

Answer

Left inferior parietal lobe

Answer

Left temporal lobe

Answer

Cerebellum

Question 6

The most classical symptom of VIPOMA is:

Accepted Answer

Secretory diarrhea

Answer

Gall stones

Answer

Steatorrhea

Answer

Flushing

Question 7

What is the most characteristic cerebrospinal fluid (CSF) finding in viral meningitis?

Accepted Answer

Lymphocytic pleocytosis in CSF

Answer

WBC count typically less than 1000/mL

Answer

Glucose levels normal or slightly decreased

Answer

Protein levels normal or slightly increased

Question 8

A pregnant woman is diagnosed with Graves' disease. The most appropriate therapy for her would be:

Accepted Answer

Propylthiouracil oral

Answer

Radioiodine therapy

Answer

Total thyroidectomy

Answer

Carbimazole parenteral

Question 9

Which of the following is a characteristic feature of primary Sjogren's syndrome?

Accepted Answer

Enlargement of salivary glands

Answer

Can occur in children

Answer

Increased complement C4 is associated with thymoma

Answer

Can be associated with rheumatoid arthritis

Question 10

What is a feature of short bowel syndrome?

Accepted Answer

Malabsorption leading to diarrhea, dehydration, and malnutrition.

Answer

Hypergastrinemia & high gastric secretion is seen

Answer

Diarrhea, dehydration and malnutrition

Answer

Chronic TPN dependence

NEET-PG 2012 — Internal Medicine