Which of the following diseases is NOT associated with Anti-Neutrophil Cytoplasmic Antibodies (ANCA)?
Which of the following statements about Sickle Cell Anemia is FALSE?
What is the initial treatment of choice for managing secondary hyperparathyroidism in patients with renal osteodystrophy?
In which of the following conditions is hypomagnesemia not typically observed?
What is true about HER2/neu overexpression in cancer?
Jaw tightness is typically seen in:
Most common symptom of genitourinary TB
In a patient with suspected vitamin B12 deficiency, which condition would result in an abnormal Schilling test?
Secretory diarrhea is not typically associated with which of the following conditions?
What is the daily temperature variation in remittent fever?
NEET-PG 2012 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 61: Which of the following diseases is NOT associated with Anti-Neutrophil Cytoplasmic Antibodies (ANCA)?
- A. Wegener's granulomatosis
- B. Henoch schonlein purpura (Correct Answer)
- C. Microscopic PAN
- D. Churg Strauss syndrome
Explanation: ***Henoch schonlein purpura*** - **Henoch-Schönlein purpura (HSP)** is not associated with **ANCA**; it primarily involves IgA deposition [1]. - Commonly presents with **purpura**, **abdominal pain**, and **glomerulonephritis**, differentiating it from ANCA-associated vasculitides [1]. *Wegener's granulomatosis* - **Wegener's granulomatosis**, now known as **Granulomatosis with polyangiitis**, is strongly associated with **c-ANCA** and anti-PR3 antibodies. - It typically presents with **respiratory** and **renal symptoms** due to vasculitis [2]. *Microscopic PAN* - **Microscopic polyangiitis (PAN)** is associated with **p-ANCA** and myeloperoxidase (MPO) antibodies. - It leads to **glomerulonephritis** and **pulmonary hemorrhage**, indicating its vasculitic nature. *Churg Strauss syndrome* - **Churg-Strauss syndrome**, or **Eosinophilic Granulomatosis with Polyangiitis**, is associated with **p-ANCA** and perinuclear staining [1]. - Often presents with **asthma**, **eosinophilia**, and systemic vasculitis affecting multiple organs [1].
Question 62: Which of the following statements about Sickle Cell Anemia is FALSE?
- A. There is a positive correlation between HBS and polymerization of HBS (Correct Answer)
- B. Recurrent infections is the most common cause of death
- C. Patients require frequent blood transfusions
- D. Patients usually present before the age of 6 months
Explanation: ***There is a positive correlation between HBS and polymerization of HBS*** - This statement is false because the polymerization of **hemoglobin S (HbS)** is reduced as HbS levels decrease and is increased as HbS levels increase. Therefore, there is a **direct correlation**, not a positive one, where higher levels of HbS lead to more polymerization and sickling. - The disease is caused by the **polymerization of deoxyhemoglobin S**, which distorts red blood cells into a sickle shape, leading to vaso-occlusion and hemolysis [1]. *Recurrent infections is the most common cause of death* - **Recurrent infections** are indeed a leading cause of morbidity and mortality in sickle cell anemia patients, particularly in children due to **functional asplenia**. [1] - **Splenic dysfunction** impairs the ability to clear encapsulated bacteria, increasing the risk of severe infections like **pneumonia** and **meningitis**. *Patients require frequent blood transfusions* - **Frequent blood transfusions** are a common treatment strategy for sickle cell anemia to manage complications such as severe anemia, acute chest syndrome, and stroke prevention [1]. - **Chronic transfusion therapy** helps to suppress abnormal sickle cell production and dilute existing sickle cells, thereby reducing vaso-occlusive crises. *Patients usually present before the age of 6 months* - Patients with sickle cell anemia typically become symptomatic after 6 months of age, when **fetal hemoglobin (HbF)** levels decline. - **HbF protects** against sickling, so symptoms like **dactylitis** and **splenic sequestration** usually manifest once HbF is replaced by HbS [1].
Question 63: What is the initial treatment of choice for managing secondary hyperparathyroidism in patients with renal osteodystrophy?
- A. Cinacalcet
- B. Bisphosphonates
- C. Calcium restriction
- D. Phosphate binders (Correct Answer)
Explanation: ***Phosphate binders*** - **Phosphate binders** are the initial treatment because **hyperphosphatemia** is the primary driver of secondary hyperparathyroidism in renal disease, triggering parathyroid hormone (PTH) release [1]. - They work by binding dietary phosphate in the gastrointestinal tract, preventing its absorption and thus lowering serum phosphate levels [1]. *Cinacalcet* - **Cinacalcet** is a calcimimetic that increases the sensitivity of calcium-sensing receptors on the parathyroid gland, reducing **PTH secretion** [1]. - It is often used if **phosphate binders** and **vitamin D analogs** are insufficient in controlling PTH, making it a second-line treatment [1]. *Bisphosphonates* - **Bisphosphonates** are used to treat osteoporosis by inhibiting osteoclast activity and reducing bone resorption. - They are generally contraindicated in advanced renal osteodystrophy due to concerns about adynamic bone disease and are not an initial treatment for **secondary hyperparathyroidism**. *Calcium restriction* - While restricting dietary calcium might seem intuitive, **hypocalcemia** is often a problem in renal disease due to impaired vitamin D activation [1]. - Overly restricting calcium can worsen hypocalcemia, which would further stimulate PTH release, thus it is not an initial treatment for **secondary hyperparathyroidism**.
Question 64: In which of the following conditions is hypomagnesemia not typically observed?
- A. Diarrhea
- B. Gitelman syndrome
- C. Diabetes mellitus (Correct Answer)
- D. Bartter syndrome
Explanation: Diabetes mellitus - While hypomagnesemia can occur in poorly controlled diabetes due to osmotic diuresis, it is not a typical or defining feature of the condition itself in the same way as other options. - Many individuals with controlled diabetes may have normal magnesium levels, and it's often associated with complications rather than the primary disease process. Diarrhea - Chronic or severe diarrhea leads to significant gastrointestinal losses of electrolytes, including magnesium. - This is a common cause of hypomagnesemia, as the body loses fluids and minerals before they can be absorbed. Gitelman syndrome - This is a renal tubular disorder characterized by a defect in the thiazide-sensitive Na-Cl cotransporter in the distal convoluted tubule. - It leads to hypomagnesemia (due to increased renal excretion) and hypokalemia, along with metabolic alkalosis. Bartter syndrome - This syndrome involves a defect in the Na-K-2Cl cotransporter in the thick ascending limb of the loop of Henle. - It results in significant renal wasting of magnesium [1], leading to hypomagnesemia, along with hypokalemia and metabolic alkalosis.
Question 65: What is true about HER2/neu overexpression in cancer?
- A. Good prognosis
- B. Responds well to taxanes
- C. Responds well to monoclonal antibodies (Correct Answer)
- D. Seen in various cancers, including breast cancer
Explanation: ***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].
Question 66: Jaw tightness is typically seen in:
- A. Coarctation of aorta
- B. Giant cell arteritis (GCA) (Correct Answer)
- C. Polyarteritis nodosa (PAN)
- D. Granulomatosis with Polyangiitis (GPA)
Explanation: ***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**.
Question 67: Most common symptom of genitourinary TB
- A. Increased frequency
- B. Renal colic
- C. Painful micturition
- D. Hematuria (Correct Answer)
Explanation: ***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.
Question 68: In a patient with suspected vitamin B12 deficiency, which condition would result in an abnormal Schilling test?
- A. Amylase deficiency
- B. Pancreatic endocrine insufficiency
- C. Lipase deficiency
- D. Intrinsic factor deficiency (Correct Answer)
Explanation: ***Intrinsic factor deficiency*** - The Schilling test assesses the absorption of **vitamin B12**. **Intrinsic factor** is crucial for B12 absorption in the ileum. - Deficiency of intrinsic factor, as seen in **pernicious anemia**, directly impairs B12 absorption, leading to an abnormal Schilling test result [1]. *Amylase deficiency* - **Amylase** is an enzyme involved in the digestion of carbohydrates, not vitamin B12 absorption [2]. - Its deficiency would primarily cause carbohydrate malabsorption symptoms, not an abnormal Schilling test. *Pancreatic endocrine insufficiency* - **Pancreatic endocrine function** relates to hormone production (e.g., insulin, glucagon), while exocrine function involves digestive enzymes. - Impairment of endocrine function does not directly affect vitamin B12 absorption or the Schilling test. *Lipase deficiency* - **Lipase** is an enzyme essential for the digestion of fats [2]. - Its deficiency would lead to fat malabsorption (steatorrhea) but would not affect vitamin B12 absorption or the Schilling test results.
Question 69: Secretory diarrhea is not typically associated with which of the following conditions?
- A. Phenolphthalein
- B. Cholera
- C. Celiac disease (Correct Answer)
- D. VIPoma
Explanation: ***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.
Question 70: What is the daily temperature variation in remittent fever?
- A. < 0.5 °C
- B. > 1.0 °C (Correct Answer)
- C. < 1.0 °C
- D. > 2.0 °C
Explanation: ***> 1.0 °C*** - In **remittent fever**, the temperature fluctuates by **more than 1.0 °C** (or 2°F) over a 24-hour period. [1] - Despite the significant variation, the temperature **never returns to normal** during the day. [1] *< 0.5 °C* - A variation of less than 0.5 °C (or 1°F) is more characteristic of a **sustained or continuous fever**, where the temperature remains elevated with minimal fluctuation. [1] - This pattern is seen in conditions like **typhoid fever** or **pneumonia**. *< 1.0 °C* - While reflecting some fluctuation, a variation of less than 1.0 °C is not sufficient to classify a fever as remittent. - Remittent fever specifically requires a **larger daily swing** in temperature. *> 2.0 °C* - While a variation greater than 2.0 °C would certainly fall under the definition of remittent fever (as it's > 1.0 °C), the defining lower limit for remittent fever is typically **> 1.0 °C (or 2°F)**. - A larger fluctuation might occur, but > 1.0 °C is the minimum threshold.