NEET-PG 2012 - Internal Medicine Practice Questions

Q: Best provocative test for diagnosis of Gastrinoma is:

Secretin injection test. ***Secretin injection test*** - The **secretin injection test** is the most reliable provocative test for gastrinoma, leading to a paradoxical increase in gastrin levels [1]. - In normal individuals, secretin suppresses gastrin release, but in gastrinoma, it stimulates **gastrin secretion** [1]. *Ca++ infusion test* - The **calcium infusion test** can also stimulate gastrin release in gastrinoma patients, but it is less specific and potentially more risky than the secretin test due to potential side effects like cardiac arrhythmias. - It involves infusing calcium gluconate to observe any uncharacteristic rise in gastrin. *ACTH stimulation test* - The **ACTH stimulation test** is used to evaluate adrenal gland function, particularly in suspected cases of adrenal insufficiency or hypercortisolism [2]. - It does not have any direct relevance to the diagnosis of **gastrinoma**. *Steroid assay* - **Steroid assays** measure levels of various steroid hormones (e.g., cortisol, aldosterone) in the body to assess adrenal or gonadal function. - This test is not used for diagnosing **gastrinoma**.

Q: Which condition is associated with calcification of the intervertebral disc?

Alkaptonuria. ***Alkaptonuria*** - **Alkaptonuria** is a rare autosomal recessive disorder characterized by a deficiency of the enzyme **homogentisate 1,2-dioxygenase**, leading to the accumulation of **homogentisic acid**. - This accumulation results in the deposition of a **dark pigment (ochre pigment)** in connective tissues, including the intervertebral discs, causing **calcification (ochronosis)** and early degenerative arthritis. *Gout* - **Gout** is caused by the deposition of **monosodium urate crystals** in joints and soft tissues, leading to inflammation and pain [1]. - While it can affect various joints, it does not typically cause **calcification of intervertebral discs**; rather, it can form tophi in periarticular soft tissues [1]. *Rheumatoid* - **Rheumatoid arthritis** is a chronic autoimmune inflammatory disease primarily affecting the **synovial lining of joints**, leading to joint destruction and deformity. - It does not involve the **calcification of intervertebral discs**; spinal involvement is usually restricted to the cervical spine, particularly the atlantoaxial joint. *Psoriasis* - **Psoriasis** is a chronic inflammatory skin condition, which in some cases can be associated with **psoriatic arthritis**, an inflammatory arthritis. - Psoriatic arthritis primarily affects peripheral joints, the sacroiliac joints, and the spine, but it does not cause **calcification of the intervertebral discs** as seen in alkaptonuria.

Q: What is the best treatment for anemia in patients with Chronic Renal Failure (CRF)?

Erythropoietin Stimulating Agents. ***Erythropoietin Stimulating Agents*** - **Erythropoietin Stimulating Agents (ESAs)** are the cornerstone of anemia treatment in CRF because the primary cause of anemia in these patients is inadequate production of **endogenous erythropoietin** by the damaged kidneys [1]. - ESAs stimulate the bone marrow to produce red blood cells, effectively reversing the anemia and improving symptoms like fatigue and exercise intolerance [1]. *Oral Iron Therapy* - While **iron deficiency** often coexists with **anemia of chronic disease** in CRF patients, oral iron alone is usually insufficient to correct the anemia; it only addresses the iron component. - Many CRF patients have **functional iron deficiency** due to chronic inflammation, which impairs iron utilization, making oral iron less effective even with adequate stores. *Blood transfusion* - **Blood transfusions** provide a rapid increase in hemoglobin but are not the preferred long-term treatment for anemia in CRF due to risks of **iron overload**, **alloreactions**, and potential sensitization, which can complicate future transplantation. - Transfusions are typically reserved for acute, severe anemia or specific circumstances where ESAs are ineffective or contraindicated. *Androgenic Steroids* - **Androgenic steroids** can stimulate erythropoiesis, but their use is limited due to significant side effects such as **hepatotoxicity**, **virilization**, and **cardiac complications**, making them a less favorable option compared to ESAs. - They are considered a secondary or tertiary option, often in patients unresponsive to primary treatments or when other options are exhausted.

Q: Jaw tightness is typically seen in:

Giant cell arteritis (GCA). ***Giant cell arteritis (GCA)*** - **Jaw claudication** or tightness, difficulty chewing, and pain in the jaw are classic symptoms of GCA, resulting from **ischemia of the masticatory muscles**. [1] - This condition is a **large vessel vasculitis** that frequently affects the **temporal arteries** and can lead to blindness if untreated. [1] *Polyarteritis nodosa (PAN)* - PAN is a **necrotizing vasculitis** that typically affects **medium-sized arteries**, often sparing the pulmonary circulation. [1] - Common symptoms include **neuropathy**, abdominal pain, and skin lesions (e.g., livedo reticularis), but **jaw tightness is not a typical feature**. *Coarctation of aorta* - This is a **congenital narrowing of the aorta**, leading to symptoms like **upper extremity hypertension**, headache, and claudication in the lower extremities. - **Jaw tightness is not a symptom** associated with coarctation of the aorta. *Granulomatosis with Polyangiitis (GPA)* - GPA is a **small-vessel vasculitis** characterized by **granulomatous inflammation** involving the upper and lower respiratory tracts, and glomerulonephritis. - Symptoms often include **sinusitis**, lung nodules, and kidney disease, but **jaw claudication is not a characteristic presentation**.

Q: Which of the following electrolyte imbalances is least likely to be observed in Chronic Renal Failure (CRF)?

Hypercalcemia. ***Hypercalcemia*** - In **chronic renal failure (CRF)**, the kidneys' inability to activate vitamin D leads to impaired calcium absorption and **hypocalcemia** [1], [2]. - Additionally, the kidneys fail to excrete phosphate, leading to **hyperphosphatemia**, which further exacerbates hypocalcemia by forming calcium-phosphate precipitates [1]. *Hyperkalemia* - **Hyperkalemia** is a common and serious complication of CRF due to the kidneys' impaired ability to excrete **potassium**. - This is exacerbated by conditions like **metabolic acidosis** and certain medications. *Hyperphosphatemia* - In CRF, the kidneys are unable to adequately excrete **phosphate**, leading to an accumulation of **phosphate** in the blood [1]. - This condition directly contributes to **secondary hyperparathyroidism** and bone disease [1], [2]. *Hypocalcemia* - **Hypocalcemia** is very common in CRF, primarily due to decreased production of **calcitriol (active vitamin D)** by the failing kidneys [2]. - Reduced calcitriol leads to lower intestinal **calcium absorption** and impaired bone mineralization [1].

Q: An adult hypertensive male presented with sudden onset severe headache and vomiting. On examination, there is marked neck rigidity and no focal neurological deficit was found. The symptoms are most likely due to:

Subarachnoid hemorrhage. ***Subarachnoid hemorrhage*** - The sudden onset of a **"thunderclap" headache**, vomiting, and **neck rigidity** in a hypertensive patient are classic signs of subarachnoid hemorrhage [1]. - The absence of focal neurological deficits is common, as the bleeding is often in the subarachnoid space rather than directly in brain tissue. *Intracerebral hemorrhage* - While it can cause sudden headache and vomiting, an **intracerebral hemorrhage** would typically present with **focal neurological deficits** corresponding to the affected brain region. - Neck rigidity is less common unless there's significant mass effect or ventricular involvement. *Cerebral ischemia* - **Cerebral ischemia** (e.g., ischemic stroke) usually manifests with **focal neurological deficits** (e.g., weakness, aphasia), often without a severe headache or neck rigidity [2]. - Headache, if present, is usually less severe and not described as "thunderclap." *Bacterial meningitis* - **Bacterial meningitis** presents with headache, fever, and neck rigidity [1], but the onset is typically **gradual** over hours to days, not sudden. - While vomiting can occur, the acute, thunderclap nature linked to hypertension points away from infection as the primary cause.

Q: Investigation of choice in pheochromocytoma is:

Urinary catecholamines. ***Urinary catecholamines*** - Measurement of **24-hour urinary fractionated metanephrines and catecholamines** is the initial **biochemical test of choice**. - These biochemical tests are preferred over plasma levels due to the **episodic release** of hormones from a pheochromocytoma, which can lead to high false-negative rates in single plasma measurements. *CT scan* - While a **CT scan** is a crucial **imaging modality** for localizing a pheochromocytoma once the biochemical diagnosis is established [1], it is not the *initial* diagnostic investigation. - Imaging should be performed only after **biochemical confirmation** to avoid unnecessary investigations of incidental adrenal masses [1]. *MIBG scan* - An **MIBG scan** (metaiodobenzylguanidine scan) is a **functional imaging study** used primarily for **localizing metastatic pheochromocytomas** [1] or for cases where CT/MRI is equivocal. - It is not the initial investigation but rather a **secondary imaging test** [1]. *MRI Scan* - **MRI** is an alternative **imaging modality** to CT for localizing pheochromocytomas [1], especially in pregnant women or when radiation exposure is a concern. - Like CT, it serves as a **localization tool** after biochemical confirmation, not the diagnostic test itself.

Q: Most common symptom of genitourinary TB

Hematuria. ***Hematuria*** - **Gross or microscopic hematuria** is the most common symptom of genitourinary tuberculosis, often occurring early in the disease course. - It results from the **inflammatory and destructive changes** caused by Mycobacterium tuberculosis in the urinary tract. *Renal colic* - Renal colic is typically associated with **acute obstruction of the ureter**, often by a renal stone. - While TB can cause strictures leading to obstruction, **colic** itself is not the most common initial symptom. *Increased frequency* - Increased urinary frequency is a common symptom in genitourinary TB, especially with **bladder involvement**. - However, it ranks below hematuria in terms of overall prevalence as the *most common* symptom. *Painful micturition* - **Dysuria** or painful micturition is frequently observed in genitourinary TB, particularly with **bladder or urethral inflammation**. - While common, it is generally less prevalent than hematuria as the presenting complaint.

Q: Primary hyperparathyroidism is suggested by all of the following, except which of the following?

Low urinary calcium levels. ***Low urinary calcium*** - In primary hyperparathyroidism, **urinary calcium levels are typically elevated** due to increased calcium reabsorption in the kidneys [2]. - **Low urinary calcium levels** would suggest a different condition, such as **hypoparathyroidism** or a renal issue affecting calcium excretion [5]. *Increased PTH* - Primary hyperparathyroidism is characterized by **elevated parathyroid hormone (PTH)** levels, as the parathyroid glands are overactive [1][3]. - High PTH contributes to increased serum calcium and bone resorption [2]. *Increased serum calcium* - A hallmark of primary hyperparathyroidism is **hypercalcemia**, resulting from increased bone resorption and renal tubular reabsorption of calcium [1][2]. - The condition often leads to symptoms such as **kidney stones** and **bone pain** due to elevated serum calcium levels [3][4]. *Increased C-AMP* - Elevated levels of **cyclic AMP (C-AMP)** in urine are observed in primary hyperparathyroidism due to the stimulatory effect of PTH on renal tubular reabsorption of calcium. - Increased C-AMP correlates with the action of PTH in promoting calcium release from the bones [2].

Question 1

Best provocative test for diagnosis of Gastrinoma is:

Accepted Answer

Secretin injection test

Answer

Ca++ infusion test

Answer

ACTH stimulation test

Answer

Steroid assay

Question 2

Which condition is associated with calcification of the intervertebral disc?

Accepted Answer

Alkaptonuria

Answer

Gout

Answer

Rheumatoid

Answer

Psoriasis

Question 3

What is the best treatment for anemia in patients with Chronic Renal Failure (CRF)?

Accepted Answer

Erythropoietin Stimulating Agents

Answer

Oral Iron Therapy

Answer

Blood transfusion

Answer

Androgenic Steroids

Question 4

Jaw tightness is typically seen in:

Accepted Answer

Giant cell arteritis (GCA)

Answer

Coarctation of aorta

Answer

Polyarteritis nodosa (PAN)

Answer

Granulomatosis with Polyangiitis (GPA)

Question 5

Which of the following electrolyte imbalances is least likely to be observed in Chronic Renal Failure (CRF)?

Accepted Answer

Hypercalcemia

Answer

Hyperkalemia

Answer

Hyperphosphatemia

Answer

Hypocalcemia

Question 6

An adult hypertensive male presented with sudden onset severe headache and vomiting. On examination, there is marked neck rigidity and no focal neurological deficit was found. The symptoms are most likely due to:

Accepted Answer

Subarachnoid hemorrhage

Answer

Intracerebral hemorrhage

Answer

Cerebral ischemia

Answer

Bacterial meningitis

Question 7

Investigation of choice in pheochromocytoma is:

Accepted Answer

Urinary catecholamines

Answer

CT scan

Answer

MIBG scan

Answer

MRI Scan

Question 8

Most common symptom of genitourinary TB

Accepted Answer

Hematuria

Answer

Increased frequency

Answer

Renal colic

Answer

Painful micturition

Question 9

Primary hyperparathyroidism is suggested by all of the following, except which of the following?

Accepted Answer

Low urinary calcium levels

Answer

Increased serum calcium

Answer

Increased urinary calcium

Answer

Decreased PTH levels

Question 10

Thrombotic thrombocytopenic purpura is a syndrome characterized by which of the following?

Accepted Answer

Thrombocytopenia, anemia, neurological abnormalities, progressive renal failure and fever

Answer

Thrombocytopenia, anemia, neurological abnormalities, progressive hepatic failure and fever

Answer

Thrombocytopenia, normal anemia, neurological abnormalities, progressive renal failure and fever

Answer

Thrombocytopenia, anemia, no neurological abnormalities, progressive renal failure and fever

NEET-PG 2012 — Internal Medicine