Which of the following is associated with WPW syndrome?
Which of the following is a symptom of protein deficiency?
Which of the following conditions is associated with male pseudohermaphroditism?
Which of the following is NOT a feature of Refsum disease?
What condition is associated with copper deposition in the cornea?
What is Reifenstein syndrome?
Which of the following is not an absolute indication for hemodialysis?
Which of the following is NOT a feature of scleroderma?
A 40-year-old male patient presents to the Emergency department with central chest pain for 2 hours. The ECG shows ST segment depression and cardiac troponins are elevated. The patient has a positive history of previous PCI 3 months back. He is administered Aspirin, Clopidogrel, Nitrates, and LMWH in the Emergency Department and shifted to the coronary care unit. What is the best recommended course of further action?
What is the best immediate management strategy for a patient experiencing respiratory alkalosis due to anxiety-induced hyperventilation?
NEET-PG 2013 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 91: Which of the following is associated with WPW syndrome?
- A. Ebstein anomaly (Correct Answer)
- B. TOF
- C. VSD
- D. TAPVC
Explanation: ***Ebstein anomaly*** - **Ebstein anomaly** is a congenital heart defect characterized by apical displacement of the septal and posterior leaflets of the tricuspid valve, which is strongly associated with **Wolff-Parkinson-White (WPW) syndrome.** - WPW syndrome, involving an **accessory pathway** that bypasses the AV node [1], is found in 5-25% of patients with Ebstein anomaly, predisposing them to re-entrant tachycardias [3]. *TOF* - **Tetralogy of Fallot (TOF)** is a complex cyanotic congenital heart defect that includes four main features: VSD, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy [2]. - There is no direct or strong association between TOF and WPW syndrome. *VSD* - A **Ventricular Septal Defect (VSD)** is a common congenital heart defect where there is an opening in the interventricular septum, allowing blood to flow between the ventricles [4]. - While VSDs can occur with other cardiac anomalies, there is no specific or frequent association with WPW syndrome. *TAPVC* - **Total Anomalous Pulmonary Venous Connection (TAPVC)** is a rare congenital heart defect where all four pulmonary veins connect to the systemic venous circulation instead of the left atrium. - This condition does not have a recognized association with WPW syndrome.
Question 92: Which of the following is a symptom of protein deficiency?
- A. Cherry like skin
- B. Flaky paint like skin (Correct Answer)
- C. Glossitis
- D. Nail change
Explanation: ***Flaky paint like skin*** - This dermatological manifestation, known as **"flaky paint" dermatosis** or **crazy pavement dermatosis**, is a classic sign of **severe protein-energy malnutrition** (PEM), particularly **kwashiorkor**. - It results from **altered skin keratinization** and **desquamation** due to inadequate protein synthesis, leading to patches of hyperpigmentation and peeling skin that resemble peeling paint. *Glossitis* - **Glossitis**, or inflammation of the tongue, is primarily associated with deficiencies of **B vitamins** (especially B12, folate, niacin, and riboflavin) and **iron deficiency**. - While protein deficiency can broadly affect cell turnover, glossitis is not a primary or specific symptom directly attributable to it. *Nail change* - Various **nail changes** can indicate nutritional deficiencies, but they are more commonly linked to deficiencies in **iron** (e.g., koilonychia or "spoon nails"), **zinc** (e.g., Beau's lines, white spots), or certain **vitamins**. - While chronic malnutrition can impact nail health, there isn't a specific, characteristic nail change solely indicative of protein deficiency. *Cherry like skin* - "Cherry-like skin" is not a recognized dermatological symptom associated with any specific nutritional deficiency in medical literature. - Skin manifestations like **cherry angiomas** are benign vascular proliferations and are generally not linked to nutritional status.
Question 93: Which of the following conditions is associated with male pseudohermaphroditism?
- A. 21-hydroxylase deficiency
- B. Androgen insensitivity syndrome
- C. 17-hydroxylase deficiency
- D. 5-alpha reductase deficiency (Correct Answer)
Explanation: ***5-alpha reductase deficiency*** - This deficiency prevents the conversion of **testosterone into dihydrotestosterone (DHT)**, which is essential for external male genitalia development. - Individuals with XY chromosomes are born with **ambiguous genitalia** that may appear female-like, leading to male pseudohermaphroditism. *21-hydroxylase deficiency* - This is the most common cause of **congenital adrenal hyperplasia (CAH)**, leading to overproduction of androgens. [1] - In XX individuals, it causes **virilization**, resulting in female pseudohermaphroditism, not male. [1] *17-hydroxylase deficiency* - This leads to impaired synthesis of **cortisol and sex steroids**, thus affecting adrenal and gonadal functions. [1] - XY individuals with this deficiency typically present with **female external genitalia** due to a lack of androgens, but it's a different mechanism than 5-alpha reductase deficiency. [1] *Androgen insensitivity syndrome* - In this condition, individuals with XY chromosomes have **non-functional androgen receptors**, making their bodies unable to respond to testosterone. [1] - They develop **female external genitalia** despite having testes and usually present as phenotypic females. [1]
Question 94: Which of the following is NOT a feature of Refsum disease?
- A. Retinitis pigmentosa
- B. Ataxia
- C. CCF (Correct Answer)
- D. Ichthyosis
Explanation: ***CCF*** - **Congestive cardiac failure (CCF)** is generally **not a primary feature** or common complication of Refsum disease. While some cardiac abnormalities can occur, severe CCF is rare. - Refsum disease is characterized by the accumulation of **phytanic acid**, which primarily affects the nervous system, skin, and eyes. *Ataxia* - **Cerebellar ataxia** is a very common and prominent neurological symptom in Refsum disease, due to damage to the cerebellum. - Patients often present with **unsteady gait and poor coordination**. *Ichthyosis* - **Ichthyosis** (dry, scaly skin) is a characteristic dermatological manifestation of Refsum disease, occurring in nearly all patients. - It is caused by the disruption of **lipid metabolism** in the skin due to phytanic acid accumulation. *Retinitis pigmentosa* - **Retinitis pigmentosa** is one of the classic ocular features of Refsum disease, leading to **night blindness** and progressive **visual field loss**. - It involves the degeneration of photoreceptor cells in the retina.
Question 95: What condition is associated with copper deposition in the cornea?
- A. Keratoglobus
- B. Keratoconus
- C. Siderosis
- D. Wilson's disease (Correct Answer)
Explanation: ***Wilson's disease*** - Wilson's disease is a genetic disorder of **copper metabolism** leading to excess copper accumulation in various tissues, including the cornea [1]. - This copper deposition in the posterior Descemet's membrane of the cornea forms a distinctive golden-brown or greenish-brown ring known as the **Kayser-Fleischer ring**. *Keratoconus* - This condition is characterized by progressive thinning and steepening of the cornea, causing it to bulge into a **cone-like shape**. - It primarily affects vision due to irregular astigmatism and does not involve copper deposition. *Keratoglobus* - Keratoglobus is a rare corneal ectatic disorder where the entire cornea is thinned and bulges forward, giving it a **globe-like appearance**. - It is congenital and typically runs in families, and it is not associated with copper deposition. *Siderosis* - Siderosis refers to the deposition of **iron** in various tissues, often due to chronic hemorrhage or metallic foreign bodies. - In the eye, it can occur after intraocular iron foreign bodies, leading to retinal degeneration and other ocular complications, but it does not involve copper.
Question 96: What is Reifenstein syndrome?
- A. Partial androgen insensitivity syndrome due to receptor mutation. (Correct Answer)
- B. Complete androgen insensitivity syndrome with female external genitalia
- C. 5-alpha reductase deficiency causing ambiguous genitalia
- D. Gonadal dysgenesis with streak gonads
Explanation: Partial androgen insensitivity syndrome due to receptor mutation. - **Reifenstein syndrome** is a form of **partial androgen insensitivity syndrome (PAIS)**, characterized by varying degrees of undervirilization in 46,XY individuals. [4] - It results from mutations in the **androgen receptor (AR) gene**, leading to impaired androgen signaling. [4] *Complete androgen insensitivity syndrome with female external genitalia* - This describes **complete androgen insensitivity syndrome (CAIS)**, where affected individuals are 46,XY with completely female external genitalia, normal breast development, but no uterus. [4] - Unlike Reifenstein syndrome, there are no signs of virilization. [4] *5-alpha reductase deficiency causing ambiguous genitalia* - **5-alpha reductase deficiency** impedes the conversion of testosterone to the more potent **dihydrotestosterone (DHT)**, which is crucial for external male genital development. - While it causes **ambiguous genitalia**, it's a defect in hormone metabolism, not the androgen receptor itself. *Gonadal dysgenesis with streak gonads* - **Gonadal dysgenesis** refers to conditions where the gonads (testes or ovaries) fail to develop or develop abnormally, often leading to **streak gonads**. [3] - This is a primary gonadal developmental defect, distinct from disorders of androgen action or synthesis. [1], [2]
Question 97: Which of the following is not an absolute indication for hemodialysis?
- A. GI bleeding (Correct Answer)
- B. Convulsions
- C. Pericarditis
- D. Hyperkalemia of 6.5 mEq/L
Explanation: ***GI bleeding*** - While patients on dialysis may experience gastrointestinal bleeding, it is not a direct indication for initiating or continuing **hemodialysis**. - **GI bleeding** in end-stage renal disease (ESRD) patients can be due to various causes and requires specific management of the bleeding itself, not necessarily an alteration in dialysis prescription. *Convulsions* - **Convulsions** in patients with renal failure, especially due to uremia, are a severe manifestation of **uremic encephalopathy**. - This is an absolute indication for **hemodialysis** as it rapidly removes uremic toxins causing central nervous system dysfunction. *Pericarditis* - **Uremic pericarditis**, characterized by inflammation of the pericardium due to accumulation of uremic toxins, is a serious complication of renal failure. - It is an absolute indication for **hemodialysis** to prevent further cardiac complications like cardiac tamponade. *Hyperkalemia of 6.5 mEq/L* - Severe **hyperkalemia** (typically > 6.0-6.5 mEq/L) is a life-threatening electrolyte imbalance that can cause cardiac arrhythmias. - **Hemodialysis** is highly effective in rapidly removing potassium from the body and is an absolute indication, especially if unresponsive to other medical therapies.
Question 98: Which of the following is NOT a feature of scleroderma?
- A. Restrictive cardiomyopathy
- B. Halitosis
- C. Syndactyly (Correct Answer)
- D. Decrease in tone of LES
Explanation: ***Syndactyly*** - **Syndactyly** (fusion of digits) is a congenital anomaly and is **not** a typical feature of scleroderma. - Scleroderma primarily involves **fibrosis** and vascular changes, leading to skin thickening, not digit fusion [1]. *Decrease in tone of LES* - A **decrease in tone of the lower esophageal sphincter (LES)** is a common gastrointestinal manifestation of scleroderma. - This leads to **gastroesophageal reflux disease (GERD)** and related symptoms due to smooth muscle atrophy and fibrosis. *Restrictive cardiomyopathy* - **Restrictive cardiomyopathy** can occur in scleroderma due to **myocardial fibrosis**, leading to impaired diastolic filling. - This is a serious cardiac complication that can cause **heart failure**. *Halitosis* - **Halitosis** (bad breath) can be an indirect manifestation of scleroderma, often associated with severe **GERD**. - Impaired esophageal motility and reflux are common in scleroderma and can contribute to dental problems and **oral dysbiosis**, which can cause halitosis.
Question 99: A 40-year-old male patient presents to the Emergency department with central chest pain for 2 hours. The ECG shows ST segment depression and cardiac troponins are elevated. The patient has a positive history of previous PCI 3 months back. He is administered Aspirin, Clopidogrel, Nitrates, and LMWH in the Emergency Department and shifted to the coronary care unit. What is the best recommended course of further action?
- A. Early Revascularization with PCI (Correct Answer)
- B. Continue conservative management and monitoring of cardiac enzymes and ECG
- C. Continue conservative management and plan for outpatient follow-up
- D. Immediate Revascularization with Coronary Angiography
Explanation: ***Early Revascularization with PCI*** - The patient presents with **NSTEMI** (ST depression, elevated troponins) and is already on antiplatelet and anticoagulant therapy. **Early revascularization** (ideally within 24 hours for high-risk NSTEMI) is indicated to restore blood flow and prevent further myocardial damage [1]. - Given the patient's history of prior **PCI** and the current NSTEMI presentation, this suggests possible **in-stent restenosis** or progression of coronary artery disease, making revascularization crucial. *Continue conservative management and monitoring of cardiac enzymes and ECG* - While initial conservative management with medications is appropriate, simply continuing monitoring without definitive intervention is insufficient for a **high-risk NSTEMI** patient. - The elevated troponins and ST depression indicate ongoing myocardial injury that requires active management beyond just observation [1]. *Continue conservative management and plan for outpatient follow-up* - This approach is entirely inappropriate for a patient presenting with an **acute coronary syndrome (NSTEMI)**. - Outpatient follow-up is for stable conditions, not for an ongoing cardiac event that requires urgent hospital-based intervention. *Immediate Revascularization with Coronary Angiography* - **Immediate revascularization** (within 90 minutes) is primarily indicated for **STEMI** (ST elevation myocardial infarction). - While coronary angiography will precede PCI, the term "immediate" in this context usually refers to the urgency seen in STEMI; NSTEMI typically warrants "early" rather than "immediate" intervention (within 12-24 hours for high-risk patients like this one) [1].
Question 100: What is the best immediate management strategy for a patient experiencing respiratory alkalosis due to anxiety-induced hyperventilation?
- A. Rebreathing in paper bag (Correct Answer)
- B. IPPV
- C. Normal saline
- D. Acetazolamide
Explanation: ***Rebreathing in paper bag*** - This helps to **increase the inspired CO2 concentration**, thereby correcting the hypocapnia (low CO2) caused by hyperventilation. - It's a simple, non-invasive method to raise arterial PCO2 and normalize blood pH in acute respiratory alkalosis. *IPPV* - **Intermittent positive pressure ventilation (IPPV)** would further reduce CO2 by assisting ventilation and is typically used for respiratory *acidosis* or failure [1]. - This intervention would worsen the patient's respiratory alkalosis rather than alleviating it. *Normal saline* - **Normal saline** administration is primarily used for volume expansion or to correct electrolyte imbalances; it does not directly address respiratory alkalosis. - It would not correct the underlying issue of excessive CO2 exhalation. *Acetazolamide* - **Acetazolamide** is a carbonic anhydrase inhibitor that reduces bicarbonate reabsorption and is used to treat metabolic alkalosis or as a diuretic. - It would not be an immediate or appropriate solution for acute respiratory alkalosis and might even worsen the acid-base balance if used improperly.