NEET-PG 2012 - Internal Medicine Practice Questions

Q: Which of the following is a renal-specific nephropathy associated with HIV?

Focal Segmental Glomerulosclerosis (FSGS). ### Focal Segmental Glomerulosclerosis - It is a common renal complication associated with **HIV infection**, characterized by **podocyte injury** and segmental sclerosis [1]. - Often results in **nephrotic syndrome**, presenting with significant **proteinuria** and edema, making it distinct in HIV renal pathology [1]. ### Membranous Glomerulonephritis - Typically presents with **subepithelial immune complex deposits**, leading to a different pathophysiological mechanism. - More commonly associated with other secondary causes, such as **drugs** or **infection**, rather than being specific to HIV. ### Mesangioproliferative Glomerulonephritis - Characterized by **mesangial cell proliferation and immune complex deposition**, often linked with various infections but not specifically with HIV. - Usually shows **hematuria** and mild proteinuria, lacking the severe nephrotic syndrome seen in focal segmental glomerulosclerosis. ### Membranoproliferative Glomerulonephritis - Features **proliferation of mesangial and endothelial cells**, leading to a distinctive pattern on renal biopsy, not specific to HIV. - Typically presents in other contexts such as **chronic infections** or **autoimmune diseases**, rather than predominantly with HIV.

Q: Which of the following is a characteristic of Wilson's disease?

Increased copper in liver. ***Increased copper in liver*** - Wilson's disease is characterized by **accumulation of copper** in liver tissues due to defective copper transport [1]. - This excess leads to **hepatocellular damage**, resulting in liver dysfunction and potential cirrhosis [1]. *Decreased copper excretion in urine* - In Wilson's disease, there is actually **decreased excretion of copper**, which results in accumulation in the liver [1]. - **Urine copper levels** are typically low to normal in early stages because the liver fails to excrete excess copper effectively. *Autosomal dominant* - Wilson's disease is inherited in an **autosomal recessive** pattern, not dominant. - It is caused by mutations in the gene responsible for copper transport (ATP7B) [1]. *Increased serum ceruloplasmin* - Serum ceruloplasmin levels are often **decreased** in Wilson's disease due to impaired copper incorporation into this protein [1]. - Low ceruloplasmin is a key laboratory finding, contrasting the assertion of this option.

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: 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].

Q: Which of the following is not a feature of Systemic Lupus Erythematosus (SLE)?

Sterility. ***Sterility*** - While SLE can affect fertility due to **gonadal dysfunction** or **treatment-related factors**, it is not a *direct* or *defining feature* of the disease itself. - Sterility is a less common manifestation compared to the widespread organ system involvement that characterizes SLE [2]. *Recurrent abortion* - **Recurrent abortions** are a well-recognized complication in SLE, particularly when associated with **antiphospholipid syndrome**, which frequently co-occurs with SLE [1]. - **Antiphospholipid antibodies** can lead to thrombosis in placental vessels, causing fetal loss. *Psychosis* - **Psychosis** is a significant neuropsychiatric manifestation of SLE, classified under **neuropsychiatric lupus (NPSLE)**. - It can result from **inflammation**, **autoantibody effects**, or **ischemia** within the central nervous system. *Coomb's positive hemolytic anemia* - **Coomb's positive hemolytic anemia** is a common hematological complication in SLE, indicating the presence of **autoantibodies** against red blood cells [3]. - This **autoimmune destruction** of red blood cells leads to anemia, and a positive direct Coombs test confirms antibody sensitization [3].

Q: Antibodies most commonly seen in drug induced lupus are:

Antihistone Antibodies. ***Antihistone Antibodies*** - **Antihistone antibodies** are the most common laboratory finding, present in 95% of patients with **drug-induced lupus erythematosus (DIL)**. - This type of lupus is often triggered by medications such as **procainamide**, **hydralazine**, and **isoniazid**. *Anti ds DNA Antibodies* - **Anti-double-stranded DNA (dsDNA) antibodies** are highly specific for **systemic lupus erythematosus (SLE)**, particularly severe cases, but are rarely seen in DIL. - High titers of anti-dsDNA often correlate with **lupus nephritis** and disease activity. *Anti Sm Antibodies* - **Anti-Sm antibodies** are highly specific for **SLE**, sometimes associated with neuropsychiatric manifestations, but are rarely identified in drug-induced lupus. - Their presence helps to confirm the diagnosis of SLE but not DIL. *Anti-Ro Antibodies* - **Anti-Ro (SSA) antibodies** are most commonly associated with **Sjögren's syndrome** and **neonatal lupus**, and can be seen in a subset of SLE patients, especially those with photosensitivity. - While they can be present in some forms of SLE, they are not the hallmark autoantibody for drug-induced lupus.

Q: Which of the following is a characteristic feature of Crohn's disease?

Sinus & fistula. ***Sinus & fistula*** - **Transmural inflammation**, a hallmark of Crohn's disease, can extend through the bowel wall, leading to the formation of **sinus tracts** and **fistulae** (abnormal connections between organs or to the skin). [1] - These complications include enteroenteric, enterovesical, and perianal fistulae, which are highly characteristic of Crohn's. [1] *Continuous involvement* - Crohn's disease is characterized by **skip lesions**, meaning there are healthy segments of bowel interspersed with diseased segments, not continuous involvement. [1] - **Ulcerative colitis** typically presents with continuous inflammation, starting from the rectum and extending proximally. [1] *Mesenteric lymphadenitis* - While mesenteric lymph nodes can be involved in Crohn's disease due to inflammation, **mesenteric lymphadenitis** is more commonly associated with infectious etiologies or other inflammatory conditions, and not a primary defining characteristic. - It refers to inflammation of lymph nodes in the mesentery, which can cause abdominal pain but does not specifically differentiate Crohn's from other conditions. *Crypt abscesses* - **Crypt abscesses** are a characteristic histological feature of **ulcerative colitis**, where neutrophils infiltrate the glandular crypts. [1] - While they can occasionally be seen in Crohn's, they are much more common and prominent in ulcerative colitis and are not a defining feature of Crohn's.

Q: In a patient with acute cholecystitis, referred pain to the shoulder is known as

Boas' sign. ***Boas' sign*** - **Boas' sign** refers to the presence of hyperesthesia below the right scapula, which can also manifest as referred pain to the **right shoulder** or back [1]. - This symptom in acute cholecystitis is due to the **irritation** of the **phrenic nerve**, which shares sensory pathways with the shoulder region. *Murphy's sign* - **Murphy's sign** is elicited by asking the patient to exhale, then placing the examiner's hand below the costal margin on the right mid-clavicular line, and then asking the patient to inhale deeply [1]. - A positive sign is indicated by a sudden cessation of inspiration due to pain, which is specific for **acute cholecystitis** and not referred shoulder pain [1]. *Gray Turner sign* - The **Gray Turner sign** involves ecchymosis or discoloration of the flanks. - It is a severe indicator of **retroperitoneal hemorrhage**, often associated with acute pancreatitis, not cholecystitis [2]. *Cullen's sign* - **Cullen's sign** presents as periumbilical ecchymosis or discoloration around the navel. - This sign is also indicative of **retroperitoneal hemorrhage**, typically seen in serious conditions like ruptured ectopic pregnancy or acute pancreatitis.

Question 1

Which of the following is a renal-specific nephropathy associated with HIV?

Accepted Answer

Focal Segmental Glomerulosclerosis (FSGS)

Answer

Mesangioproliferative Glomerulonephritis

Answer

Membranous Nephropathy

Answer

Membranoproliferative Glomerulonephritis (MPGN)

Question 2

Which of the following is a characteristic of Wilson's disease?

Accepted Answer

Increased copper in liver

Answer

Autosomal dominant

Answer

Increased serum ceruloplasmin

Answer

Decreased copper excretion in urine

Question 3

The most common cause of pontine hemorrhage is

Accepted Answer

Hypertension

Answer

Diabetes

Answer

Trauma

Answer

Aneurysmal rupture

Question 4

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

Question 5

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 6

Which of the following is not a feature of Systemic Lupus Erythematosus (SLE)?

Accepted Answer

Sterility

Answer

Recurrent abortion

Answer

Psychosis

Answer

Coomb's positive hemolytic anemia

Question 7

Antibodies most commonly seen in drug induced lupus are:

Accepted Answer

Antihistone Antibodies

Answer

Anti ds DNA Antibodies

Answer

Anti Sm Antibodies

Answer

Anti-Ro Antibodies

Question 8

Which of the following is a characteristic feature of Crohn's disease?

Accepted Answer

Sinus & fistula

Answer

Mesenteric lymphadenitis

Answer

Continuous involvement

Answer

Crypt abscesses

Question 9

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

Question 10

In a patient with acute cholecystitis, referred pain to the shoulder is known as

Accepted Answer

Boas' sign

Answer

Murphy's sign

Answer

Gray Turner sign

Answer

Cullen's sign

NEET-PG 2012 — Internal Medicine