NEET-PG 2012 Practice Questions

Q: What is the most common presentation for IgA nephropathy?

Repeated gross hematuria. ***Repeated gross hematuria*** - The hallmark of **IgA nephropathy** is recurrent episodes of **gross hematuria**, particularly following **respiratory infections** [1]. - It is often associated with **renal impairment** but can present initially with **visible blood** in the urine [1]. *Nephritic syndrome* - While IgA nephropathy can lead to nephritic features, it does not commonly present primarily as **nephritic syndrome**, which includes hypertension and edema. - Nephritic syndrome is characterized by significant **proteinuria** and acute renal failure, rather than the classic presentation of hematuria [2]. *Microscopic hematuria* - Although **microscopic hematuria** can occur in IgA nephropathy, it is not the most common and noticeable presentation; **gross hematuria** is more characteristic [1]. - Microscopic hematuria lacks the acute visual symptoms seen in cases proving the diagnosis. *Nephritic syndrome* - This option is a repetition of and does not provide any additional unique characteristics specific to **IgA nephropathy**. - It shares the same clinical features discussed previously and is thus not representative of the most common presentation.

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: Chemotherapeutic Agent of Choice for the treatment of CML?

Imatinib. ***Imatinib*** - **Imatinib** is a **tyrosine kinase inhibitor** specifically targeting the **BCR-ABL fusion protein**, which is the hallmark of CML [1][2]. - It dramatically improved the prognosis of CML patients, making it the **first-line therapy** and agent of choice due to its high efficacy and relatively low toxicity compared to conventional chemotherapy [2]. *Vincristine* - **Vincristine** is a **vinca alkaloid** that inhibits microtubule formation, primarily used in acute leukemias and lymphomas. - It is not the agent of choice for CML due to its different mechanism of action and the availability of more targeted therapies for CML. *Cyclophosphamide* - **Cyclophosphamide** is an **alkylating agent** that causes DNA damage, used in various cancers and autoimmune diseases. - While it can be used in some hematologic malignancies, it is not the preferred or most effective treatment for CML, especially given the success of targeted therapies. *Methotrexate* - **Methotrexate** is an **antimetabolite** that interferes with DNA synthesis, commonly used in acute leukemias, lymphomas, and autoimmune conditions. - It is not considered the chemotherapeutic agent of choice for CML, as its mechanism of action is not specific to the BCR-ABL anomaly characteristic of CML.

Q: What is the initial drug of choice for a suspected case of acute adrenal insufficiency?

Hydrocortisone. ***Hydrocortisone*** - This is the initial drug of choice due to its **combined mineralocorticoid and glucocorticoid activity**, which effectively replaces the deficient hormones in acute adrenal insufficiency. - It also has a **rapid onset of action** crucial for stabilizing patients in an adrenal crisis. *Norepinephrine* - This is a **vasopressor** used to manage **severe hypotension or shock** by increasing peripheral vascular resistance. - While hypotension is a feature of adrenal insufficiency, norepinephrine does not address the underlying hormonal deficiency directly and is not the primary treatment. *Dexamethasone* - Dexamethasone is a **potent glucocorticoid** and can be used in adrenal insufficiency, but it lacks significant **mineralocorticoid activity**. - Its longer half-life might make it less ideal for immediate, titratable replacement compared to hydrocortisone in an acute setting. *Fludrocortisone* - Fludrocortisone is a **pure mineralocorticoid** primarily used for long-term replacement therapy to manage sodium and potassium balance in adrenal insufficiency. - It does not have sufficient glucocorticoid activity to address the immediate, life-threatening aspects of acute adrenal crisis.

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: Hypophosphatemia is seen in:

Hyperparathyroidism. ***Hyperparathyroidism*** - In **primary hyperparathyroidism**, the excess **parathyroid hormone (PTH)** leads to increased phosphate excretion by the kidneys [1], [4]. - This results in **hypophosphatemia** as the body attempts to maintain **calcium-phosphate balance**, often at the expense of phosphate levels [1]. *Hyperthyroidism* - While hyperthyroidism can affect **bone metabolism**, it is typically associated with **normal or slightly elevated phosphate levels**, not hypophosphatemia [3]. - The main electrolyte disturbances are usually related to **calcium** (e.g., hypercalcemia) due to increased bone turnover [3]. *Hypoparathyroidism* - **Hypoparathyroidism** is characterized by **low or absent PTH**, leading to decreased renal phosphate excretion. - This results in **hyperphosphatemia**, along with **hypocalcemia** [2]. *Pseudohypoparathyroidism* - In **pseudohypoparathyroidism**, there is **PTH resistance** at target tissues, even with high or normal PTH levels [2]. - This leads to symptoms resembling hypoparathyroidism, including **hyperphosphatemia** and **hypocalcemia** [2].

Q: Which of the following diseases is NOT associated with Anti-Neutrophil Cytoplasmic Antibodies (ANCA)?

Henoch schonlein purpura. ***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].

Q: Unable to consolidate long-term memory. Which lobe of the brain is involved?

Temporal. ***Temporal*** - The **temporal lobe**, particularly the **hippocampus** within it, is critically involved in the formation and consolidation of new long-term memories [1]. - Damage to the temporal lobe can result in **anterograde amnesia**, the inability to form new memories after the injury [1]. *Frontal* - The **frontal lobe** is primarily responsible for executive functions, **planning**, decision-making, and working memory [1]. - While it contributes to memory retrieval and strategic memory processes, it is not the primary site for the consolidation of long-term memories. *Parietal* - The **parietal lobe** is involved in processing **sensory information**, spatial awareness, and navigation. - It plays a role in attention and short-term memory, but not in the consolidation of long-term memory. *Occipital* - The **occipital lobe** is dedicated to **visual processing** and interpretation of visual information. - It has no direct primary role in the consolidation of long-term memories.

Q: Lesion of globus pallidus causes

Athetosis. ***Athetosis*** - **Athetosis** is the **classic movement disorder** associated with lesions of the **globus pallidus**, often occurring with **putamen** involvement. - It is characterized by **slow, writhing, involuntary movements**, particularly affecting the **distal extremities** (hands and feet). - Commonly seen in **kernicterus** (bilirubin-induced damage to basal ganglia), **cerebral palsy**, and **status marmoratus** of the basal ganglia. - When combined with chorea, it forms **choreoathetosis**. *Chorea* - **Chorea** is predominantly associated with dysfunction of the **caudate nucleus** and **putamen**, as seen in **Huntington's disease**. - It involves brief, irregular, unpredictable, **involuntary movements** that flow from one body part to another. *Hemibalismus* - **Hemibalismus** is most commonly caused by a lesion in the **subthalamic nucleus** (nucleus of Luys), often due to a **lacunar stroke**. - It involves large-amplitude, **involuntary flinging movements** of the limbs on **one side of the body**. *Dystonia* - **Dystonia** involves sustained or repetitive muscle contractions leading to twisting movements or abnormal fixed postures. - It results from dysfunction of **multiple basal ganglia structures** including the globus pallidus internal segment, putamen, and thalamus, but is **not the classic presentation** of isolated globus pallidus lesions.

Q: In the context of blunt trauma affecting the entire body, what is the estimated daily nitrogen loss in grams due to protein metabolism?

Approximately 35 grams. ***Approximately 35 grams*** - In **severe trauma**, such as blunt trauma affecting the entire body, the body undergoes a significant stress response leading to marked **protein catabolism**. Approximately **35 grams of nitrogen** can be lost daily under such conditions. - This represents a highly catabolic state where muscle protein is broken down to provide amino acids for energy and synthesis of acute-phase proteins, impacting overall nitrogen balance. *Approximately 45 grams* - While severe trauma does lead to substantial nitrogen loss, **45 grams** would typically indicate an even more extreme or prolonged catabolic state, which is less common in the initial stages of post-trauma protein metabolism than 35 grams. - Such a high nitrogen loss might be seen in very extensive burns or sepsis, which are different clinical contexts. *Approximately 55 grams* - A daily nitrogen loss of **55 grams** is beyond what is commonly observed even in severe, whole-body blunt trauma. This level of catabolism would likely be unsustainable or indicative of a rare, super-catabolic condition. - This magnitude of protein breakdown would lead to rapid and severe muscle wasting and organ dysfunction if sustained. *Approximately 65 grams* - Losing **65 grams of nitrogen** per day is an exceptionally high rate of protein catabolism, rarely, if ever, observed in blunt trauma alone. - This level of protein breakdown would represent a profound and life-threatening metabolic derangement, far exceeding typical post-trauma responses.

Question 1

What is the most common presentation for IgA nephropathy?

Accepted Answer

Repeated gross hematuria

Answer

Nephritic syndrome

Answer

Nephrotic syndrome

Answer

Microscopic hematuria

Question 2

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 3

Chemotherapeutic Agent of Choice for the treatment of CML?

Accepted Answer

Imatinib

Answer

Vincristine

Answer

Cyclophosphamide

Answer

Methotrexate

Question 4

What is the initial drug of choice for a suspected case of acute adrenal insufficiency?

Accepted Answer

Hydrocortisone

Answer

Norepinephrine

Answer

Dexamethasone

Answer

Fludrocortisone

Question 5

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 6

Hypophosphatemia is seen in:

Accepted Answer

Hyperparathyroidism

Answer

Hyperthyroidism

Answer

Hypoparathyroidism

Answer

Pseudohypoparathyroidism

Question 7

Which of the following diseases is NOT associated with Anti-Neutrophil Cytoplasmic Antibodies (ANCA)?

Accepted Answer

Henoch schonlein purpura

Answer

Wegener's granulomatosis

Answer

Microscopic PAN

Answer

Churg Strauss syndrome

Question 8

Unable to consolidate long-term memory. Which lobe of the brain is involved?

Accepted Answer

Temporal

Answer

Frontal

Answer

Parietal

Answer

Occipital

Question 9

Lesion of globus pallidus causes

Accepted Answer

Athetosis

Answer

Chorea

Answer

Hemibalismus

Answer

Dystonia

Question 10

In the context of blunt trauma affecting the entire body, what is the estimated daily nitrogen loss in grams due to protein metabolism?

Accepted Answer

Approximately 35 grams

Answer

Approximately 45 grams

Answer

Approximately 55 grams

Answer

Approximately 65 grams

NEET-PG 2012

Internal Medicine

Pathology

Physiology

Surgery