NEET-PG 2012 - Internal Medicine Practice Questions

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: Tuberculosis of the spine; what is the most common site affected?

Dorsolumbar. ***94ed055d-c7da-4d18-a2fd-52720dfe8b6e*** - The **dorsolumbar (thoracolumbar)** region is the most common site of **spinal tuberculosis (Pott's disease)** [1] due to its high vascularity, facilitating hematogenous spread. - **Spinal tuberculosis** typically affects the vertebral bodies, leading to their destruction, kyphosis (angular deformity), and potentially neurological deficits [1]. *aebdfe6c-98dc-4073-892f-bb24d047bab4* - The **sacral** region can be affected by **tuberculosis**, but it is considerably less common than the thoracolumbar region. - Involvement of the sacrum is often associated with **direct extension** from adjacent structures, such as the sacroiliac joint, rather than primary vertebral involvement. *15c1feef-e3ca-496f-a180-127d52b77bfa* - **Cervical spine tuberculosis** is relatively rare, accounting for a small percentage of all spinal tuberculosis cases. - While possible, it presents with specific challenges due to the proximity of vital neurological and vascular structures. *d05d4d13-bb83-4f26-aa2d-c9c0203d299c* - The **lumbosacral region** (L5-S1) can be involved in **tuberculosis**, but it is less frequently affected than the thoracolumbar region. - While the lumbar spine is a common site, the entire lumbosacral region as a single entity is not the most common spot for spinal TB.

Q: Oculoorogenital ulcers are associated with which of the following conditions?

Behcet's disease. ***Behcet's disease*** - This condition is characterized by **recurrent oral and genital ulcers**, along with **ocular inflammation** (e.g., uveitis), perfectly matching the "Oculoorogenital ulcers" description. - It is a **chronic, relapsing inflammatory disease** of unknown etiology involving vasculitis affecting various organ systems. *Lichen planus* - This is a chronic inflammatory condition affecting the **skin, hair, nails, and mucous membranes**. - While it can cause oral lesions, it typically presents as **purple, polygonal, pruritic papules** on the skin and does not cause genital ulcers or significant ocular involvement like Behcet's. *Systemic lupus erythematosus (SLE)* - SLE is a **systemic autoimmune disease** with diverse manifestations, including skin rashes, arthritis, and internal organ involvement. - Oral ulcers can occur, but **genital ulcers and severe ocular inflammation** as a prominent triad are not typical diagnostic features of SLE. *Psoriasis* - This is a common **chronic inflammatory skin disease** characterized by well-demarcated erythematous plaques with silvery scales. - Psoriasis primarily affects the skin and joints, and **does not typically present with oral, genital, or ocular ulcers** as described.

Q: Which of the following conditions is most commonly associated with resorption of the distal phalanx?

Scleroderma. ***Scleroderma*** - **Scleroderma** (systemic sclerosis) can cause characteristic changes in the distal phalanges, specifically **acro-osteolysis**, leading to resorption of the **distal tufts** [1]. - This is often associated with **Raynaud's phenomenon**, **digital ischemia**, and **calcinosis**, leading to severe circulatory compromise in the digits [1]. *Hyperparathyroidism* - **Primary hyperparathyroidism** causes bone resorption due to increased parathyroid hormone, primarily affecting the **subperiosteal bone** (especially in the radial aspect of the middle phalanges), leading to a "lace-like" appearance on X-ray. - While it causes bone resorption, **distal phalanx tuft resorption** is not its most common or prominent skeletal feature compared to scleroderma. *Reiter's syndrome* - **Reiter's syndrome** (now known as reactive arthritis) is an inflammatory arthropathy usually involving large joints of the lower extremities in an **asymmetric** pattern. - It does not typically cause **resorption of the distal phalanx**; instead, it's associated with enthesitis, dactylitis, and periostitis. *Osteitis deformans (Paget's disease)* - **Paget's disease** is characterized by abnormal bone remodeling, leading to enlarged, deformed bones that are prone to fracture, predominantly affecting the **pelvis, spine, skull, and long bones**. - It causes areas of localized bone destruction and excessive bone formation, but **distal phalanx resorption** is not a feature of this condition.

Q: In an EMG/NCV study, which radiculopathy is most closely associated with the H. reflex?

S1 radiculopathy. ***S1 radiculopathy*** - The **H-reflex (Hoffmann reflex)** primarily assesses the integrity of the **S1 nerve root** and the **tibial nerve** pathway. - A diminished or absent H-reflex is a sensitive indicator of **S1 radiculopathy**, often correlating with **Achilles reflex loss** [1]. *L3 radiculopathy* - **L3 radiculopathy** typically affects the **quadriceps muscle** and the **patellar reflex** [1]. - The H-reflex is not a primary diagnostic tool for isolated L3 nerve root involvement. *L4 radiculopathy* - **L4 radiculopathy** usually presents with weakness in **tibialis anterior** and altered sensation over the medial leg/foot [1]. - While it can sometimes impact the patellar reflex, the H-reflex is not the most direct or specific measure for L4 involvement. *L5 radiculopathy* - **L5 radiculopathy** often leads to weakness in **foot dorsiflexion** and **toe extension**, with sensory loss over the dorsum of the foot [1]. - It does not directly involve the reflex arc assessed by the H-reflex.

Q: What is true about HER2/neu overexpression in cancer?

Responds well to monoclonal antibodies. ***Responds well to monoclonal antibodies*** - HER2/neu overexpression is targeted by **monoclonal antibodies** like trastuzumab (Herceptin), improving treatment outcomes [1]. - These therapies are specifically designed to **inhibit HER2-positive** tumors, leading to better overall prognosis compared to those without such therapies [1]. *Good prognosis* - HER2/neu overexpression is generally associated with a **poor prognosis** due to increased aggressiveness of the cancer. - It correlates with **higher rates of recurrence** and metastasis compared to HER2-negative breast cancers. *Responds well to taxanes* - While taxanes are commonly used in breast cancer treatment, HER2/neu positivity does not specifically imply a good response. - Response rates may not significantly differ based on HER2 status for taxane-based therapies alone. *Seen only in breast cancer* - HER2/neu overexpression can also occur in other cancers, such as **gastric and gastroesophageal junction cancers**. - It is not exclusive to breast cancer, though it is most commonly studied in this context [1].

Q: What is a characteristic finding in athletes' hearts, also known as athletic syndrome?

Increased amplitude of QRS. ***Increased amplitude of QRS*** - In **athletes' hearts**, the heart muscle (myocardium) undergoes physiological adaptations, including **left ventricular hypertrophy**, which leads to an **increased amplitude of the QRS complex** on an ECG. - This is a normal and beneficial adaptation that enhances cardiac output and efficiency during exercise. *Bradycardia* - While **bradycardia** (a slower heart rate) is very common in athletes due to increased **vagal tone** and improved cardiac efficiency, it is not the most direct characteristic finding *on an ECG* reflecting the structural changes of athletic heart syndrome. - Bradycardia is a rate finding, not a waveform amplitude change reflecting myocardial mass. *Decreased QT interval* - A **decreased QT interval** is not a typical characteristic of an athlete's heart; in fact, there is usually no significant change or a slight prolongation due to bradycardia, but it remains within normal limits. - A pathologically short QT interval can indicate specific genetic channelopathies, which are unrelated to athletic adaptation. *U-waves* - **U-waves** are small positive deflections sometimes seen after the T wave, often associated with **bradycardia** or **hypokalemia**. - While athletes can have bradycardia, U-waves are not a consistent or defining feature of an athlete's heart syndrome itself, and their presence can also indicate other conditions.

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: A person experiences asthma attacks more than twice during the day and at least once during the night. What is the most likely classification of their asthma?

Severe persistent asthma. ***Severe persistent asthma*** - This classification is characterized by **frequent symptoms**, specifically asthma attacks occurring more than twice daily and at least once nightly. - Individuals with severe persistent asthma often experience significant limitations in their daily activities and may have a **FEV1 (forced expiratory volume in 1 second)** less than 60% of predicted. *Intermittent asthma* - This classification is characterized by symptoms occurring less than two days per week and **nighttime awakenings less than two times per month**. - Symptoms are generally well-controlled with a short-acting beta-agonist (SABA) as needed. *Mild persistent asthma* - Patients with mild persistent asthma typically experience symptoms more than twice a week but **less than once a day**, and **nighttime awakenings 3-4 times per month**. - Their lung function (FEV1) is usually 80% or more of predicted. *Moderate persistent asthma* - This category involves daily symptoms and **nighttime awakenings more than once per week but not nightly**. - Lung function (FEV1) in moderate persistent asthma typically falls between 60% and 80% of predicted.

Question 1

Investigation of choice in pheochromocytoma is:

Accepted Answer

Urinary catecholamines

Answer

CT scan

Answer

MIBG scan

Answer

MRI Scan

Question 2

Which of the following is a characteristic of Yellow-nail syndrome?

Accepted Answer

Pleural effusion and lymphedema, associated with discolored nails

Answer

Knee joint effusion and lymphedema, associated with discolored nails

Answer

Pericardial effusion and lymphedema, associated with discolored nails

Answer

Peritoneal effusion and lymphedema, associated with discolored nails

Question 3

Tuberculosis of the spine; what is the most common site affected?

Accepted Answer

Dorsolumbar

Answer

Sacral

Answer

Lumbosacral

Answer

Cervical

Question 4

Oculoorogenital ulcers are associated with which of the following conditions?

Accepted Answer

Behcet's disease

Answer

Lichen planus

Answer

Systemic lupus erythematosus (SLE)

Answer

Psoriasis

Question 5

Which of the following conditions is most commonly associated with resorption of the distal phalanx?

Accepted Answer

Scleroderma

Answer

Hyperparathyroidism

Answer

Reiter's syndrome

Answer

Osteitis deformans (Paget's disease)

Question 6

In an EMG/NCV study, which radiculopathy is most closely associated with the H. reflex?

Accepted Answer

S1 radiculopathy

Answer

L3 radiculopathy

Answer

L4 radiculopathy

Answer

L5 radiculopathy

Question 7

What is true about HER2/neu overexpression in cancer?

Accepted Answer

Responds well to monoclonal antibodies

Answer

Good prognosis

Answer

Responds well to taxanes

Answer

Seen in various cancers, including breast cancer

Question 8

What is a characteristic finding in athletes' hearts, also known as athletic syndrome?

Accepted Answer

Increased amplitude of QRS

Answer

Decreased QT interval

Answer

U-waves

Answer

Bradycardia

Question 9

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 10

A person experiences asthma attacks more than twice during the day and at least once during the night. What is the most likely classification of their asthma?

Accepted Answer

Severe persistent asthma

Answer

Intermittent asthma

Answer

Mild persistent asthma

Answer

Moderate persistent asthma

NEET-PG 2012 — Internal Medicine