NEET-PG 2013 - Internal Medicine Practice Questions

Q: A 40-year-old male with gastroesophageal reflux disease (GERD) is found to have Barrett's esophagus with low-grade dysplasia on endoscopy. What is the most appropriate initial pharmacological treatment for this condition?

PPI. ***PPI*** - In patients with **GERD** and **low-grade dysplasia**, high-dose **proton pump inhibitors (PPIs)** are the initial treatment of choice to suppress acid reflux. - Continuous acid suppression can help in the regression of dysplasia and prevent its progression to higher grades. *Fundoplication* - **Fundoplication** is a surgical procedure to treat severe GERD, but it is not the primary initial treatment for low-grade dysplasia. - It might be considered if medical therapy with PPIs fails or if there are significant anatomical defects. *Esophageal resection* - **Esophageal resection** is a major surgical procedure typically reserved for **high-grade dysplasia** or **esophageal adenocarcinoma**. - It is an overly aggressive and unnecessary intervention for initial management of low-grade dysplasia. *Diet modification* - **Diet modification** is an important adjunctive therapy for GERD symptoms and overall gastric health. - However, it is generally insufficient as a standalone initial treatment for documented **low-grade dysplasia** without concurrent pharmacotherapy.

Q: Isolated painful third nerve palsy is a feature of aneurysms of:

Aneurysm of the posterior communicating artery. ***Aneurysm of the posterior communicating artery*** - An aneurysm of the **posterior communicating artery (PCOM)** can compress the ipsilateral **oculomotor nerve (CN III)** as it exits the brainstem. - This compression typically affects the **superficial parasympathetic fibers** first, leading to a **dilated pupil** (mydriasis) along with ophthalmoplegia and ptosis, making the third nerve palsy "painful" and "isolated" without other focal neurological deficits. *Aneurysm of the anterior communicating artery* - Aneurysms of the **anterior communicating artery (ACoM)** are more commonly associated with **subarachnoid hemorrhage** and can cause **visual field defects** or **frontal lobe dysfunction**, but generally not isolated CN III palsy. - While rupture can lead to various neurological deficits, isolated painful third nerve palsy due to ACoM aneurysm is atypical. *Aneurysm of the vertebrobasillary artery* - Aneurysms in the **vertebrobasillar system** typically present with symptoms related to **brainstem compression** or ischemia, such as cranial nerve palsies beyond the third nerve, ataxia, or motor/sensory deficits. - Isolated third nerve palsy is an uncommon presentation for vertebrobasilar aneurysms compared to PCOM aneurysms. *Aneurysm of the ophthalmic artery* - **Ophthalmic artery aneurysms** are usually **intraorbital** and can cause **visual loss** due to direct compression of the **optic nerve (CN II)** or orbital structures. - They are less likely to cause isolated painful third nerve palsy, as the third nerve's course is generally not directly compromised by ophthalmic artery aneurysms.

Q: Which of the following is not a recognized complication of chronic pancreatitis?

Renal artery thrombosis. ***Renal artery thrombosis*** - **Renal artery thrombosis** is generally associated with conditions like **atherosclerosis**, atrial fibrillation, or vasculitis, not directly with chronic pancreatitis. - While chronic pancreatitis can lead to systemic complications, direct renal arterial clotting is an atypical and **uncommon sequela**. *Pancreatic pseudocyst* - **Pancreatic pseudocysts** are common complications of chronic pancreatitis, occurring when fluid collections around the pancreas become walled off by fibrous tissue [1]. - They can cause pain, obstruction, and even rupture if left untreated [2]. *Splenic vein thrombosis* - **Splenic vein thrombosis** can result from inflammation and compression of the splenic vein by the diseased pancreatic tissue in chronic pancreatitis [1]. - This can lead to **splenomegaly** and **gastric varices** due to increased pressure in the portal system. *Pancreatic fistula* - A **pancreatic fistula** occurs when pancreatic fluid leaks from the gland, often forming a connection to another organ or the skin [2]. - This is a well-recognized complication of both acute and chronic pancreatitis, usually due to ductal disruption.

Q: Impotence is a feature of which of the following:

Multiple sclerosis. ***Multiple sclerosis*** - **Erectile dysfunction** (impotence) is a common symptom in men with multiple sclerosis, often resulting from **demyelination** in nerve pathways controlling sexual function [1], [2]. - MS can affect various neurological functions, leading to problems with **autonomic nervous system** control, sensation, and motor coordination, all of which can impact sexual health. *Poliomyelitis* - Poliomyelitis primarily affects the **anterior horn cells** of the spinal cord, leading to acute **flaccid paralysis** of muscles. - While it can cause muscle weakness and atrophy, it is not typically associated with chronic impotence or sexual dysfunction as a primary feature. *Amyotrophic lateral sclerosis* - ALS is a progressive neurodegenerative disease affecting **motor neurons**, leading to muscle weakness, atrophy, and spasticity. - It primarily impacts voluntary muscle movement and does not directly cause impotence, although the physical limitations and psychological stress can indirectly affect sexual function. *Meningitis* - Meningitis is an inflammation of the **meninges** (membranes surrounding the brain and spinal cord) caused by infection. - Its symptoms include headache, fever, and neck stiffness, and while severe cases can lead to neurological complications, impotence is not a typical direct consequence.

Q: All of the following are features of Obstructive jaundice except:

Normal alkaline phosphatase. ***Normal alkaline phosphatase*** - In obstructive jaundice, alkaline phosphatase is typically **elevated** due to bile duct obstruction [2]. - A **normal level** suggests that the jaundice may not be of obstructive origin. *Pruritis* - Often seen in obstructive jaundice due to **bile salts** accumulating in the bloodstream, leading to itching. - It is a common symptom associated with **cholestasis**. *Mildly elevated serum aminotransferases level* - In obstructive jaundice, serum aminotransferases are usually elevated, though may be mildly in early cases [1]. - This reflects liver involvement, which is consistent with biliary obstruction [2]. *Clay colour stools* - Clay-colored stools arise from the absence of **bile** in the intestines, indicative of obstruction [3]. - This is a direct result of blockage in the bile duct system affecting stool pigmentation [3].

Q: Most common hematological malignancy associated with Rheumatoid Arthritis (RA)?

Large granular lymphocytic leukemia (LGLL). ***Large granular lymphocytic leukemia (LGLL)*** - **LGLL** is the most common hematological malignancy strongly associated with **rheumatoid arthritis (RA)**, often presenting with features such as **neutropenia** and splenomegaly. - Approximately 80% of patients with LGLL have a **T-cell phenotype**, and a significant subset experiences **autoimmune diseases**, with RA being the most frequent. *Diffuse large B cell lymphoma* - While patients with **RA** have an increased risk of **lymphoma**, **diffuse large B-cell lymphoma (DLBCL)** is a more aggressive type but not the most common hematologic malignancy directly associated with the disease itself in terms of prevalence [3]. - Inflammatory conditions like **RA** can contribute to chronic immune stimulation, increasing the risk of certain lymphomas, but LGLL holds a more direct and prevalent association [1]. *Chronic lymphocytic leukemia* - **Chronic lymphocytic leukemia (CLL)** is a lymphoproliferative disorder of **B lymphocytes**, but it does not have a particularly strong or common association with **RA** compared to LGLL [2]. - The elevated risk of hematological malignancies in RA patients typically points more towards lymphoproliferative disorders driven by specific immune dysregulations characteristic of RA. *T-cell prolymphocytic leukemia* - **T-cell prolymphocytic leukemia (T-PLL)** is a rare and aggressive **T-cell leukemia** that generally presents with a high white blood cell count and splenomegaly, but it is not commonly linked with **RA**. - Its clinical presentation and biology are distinct from the more indolent leukemias like LGLL that are often seen in conjunction with autoimmune conditions.

Q: What are the key characteristics of Evans syndrome?

Autoimmune hemolytic anemia and immune thrombocytopenia. ***Autoimmune hemolytic anemia and immune thrombocytopenia*** - **Evans syndrome** is defined by the simultaneous or sequential occurrence of **autoimmune hemolytic anemia (AIHA)** and **immune thrombocytopenia (ITP)** [1], [2]. - Both conditions involve the immune system mistakenly attacking and destroying **red blood cells** and **platelets**, respectively [1], [2]. *Low lymphocyte and red blood cell counts* - While **red blood cell counts** are low in Evans syndrome due to AIHA, **lymphocyte counts** are not a defining characteristic; they can vary. - This option does not fully capture the dual autoimmune destruction of red blood cells and platelets specific to Evans syndrome. *High platelet and lymphocyte counts* - **Platelet counts** are **low** in Evans syndrome due to ITP, not high. - **Lymphocyte counts** are not characteristically high; a high count might suggest other conditions like leukemias or lymphomas. *A reduction in all blood cell types* - A reduction in all (red blood cells, white blood cells, and platelets) is known as **pancytopenia**, which is not the defining feature of Evans syndrome. - Evans syndrome specifically involves the destruction of **red blood cells** and **platelets**, but not necessarily all white blood cell types.

Q: Which of the following is NOT a characteristic feature of systemic sclerosis?

Gottron's papules. ***Gottron's papules*** - **Gottron's papules** are pathognomonic for **dermatomyositis**, not systemic sclerosis. They are red, scaling papules found over the extensor surfaces of the metacarpophalangeal (MCP) and interphalangeal (IP) joints. - While both systemic sclerosis and dermatomyositis are connective tissue diseases, their distinct cutaneous manifestations aid in differentiation. *Acroosteolysis* - **Acroosteolysis** refers to the resorption of the distal phalanges, a common feature in systemic sclerosis, particularly in severe cases. - This symptom contributes to the characteristic digital abnormalities seen in the disease. *Calcinosis cutis* - **Calcinosis cutis** is the deposition of calcium in the skin and subcutaneous tissues, often seen in subsets of systemic sclerosis, especially the CREST syndrome. - It can manifest as firm, white-yellow nodules or plaques and contribute to skin breakdown. *Digital ulcers* - **Digital ulcers** are a frequent and debilitating complication of systemic sclerosis, resulting from severe **vasculopathy** [1] and **ischemia** [1]. - They are often painful and can lead to significant tissue loss and infection.

Q: In total parenteral nutrition, which of the following parameters is not routinely measured daily?

Liver function tests (LFTs). ***Liver function tests (LFTs)*** - **LFTs** are typically monitored periodically (e.g., weekly or bi-weekly) in patients on TPN, not daily, unless there are specific concerns about liver dysfunction [1]. - Daily monitoring is generally not required because changes in liver function due to TPN are usually insidious and not acutely life-threatening in hours. *Electrolyte* - **Electrolytes** (e.g., sodium, potassium, chloride) are crucial for cellular function and fluid balance [2]. They can fluctuate rapidly with TPN administration and patient's clinical status. - Daily measurement ensures prompt correction of imbalances to prevent serious complications like **cardiac arrhythmias** or neurological disturbances [2]. *Fluid intake and output* - **Fluid intake and output** are essential for assessing **hydration status** and preventing fluid overload or dehydration, which can change rapidly [2]. - Daily monitoring helps guide adjustments to fluid administration in TPN and other intravenous fluids. *Magnesium* - **Magnesium** is an important electrolyte involved in numerous enzymatic reactions and neuromuscular function, and its levels can be significantly affected by TPN [2]. - Daily or frequent monitoring is often necessary, especially in the initial phases of TPN or in patients with pre-existing deficiencies, to prevent complications such as **cardiac arrhythmias** or **weakness** [2].

Q: What is the volume of blood loss associated with Class III hemorrhagic shock?

1500 - 2000 ml. ***1500 - 2000 ml*** - **Class III hemorrhagic shock** is characterized by a significant loss of blood volume, typically ranging from **30-40%** of total blood volume. - For an average adult, this translates to an estimated **1500-2000 ml** of blood loss, leading to marked physiological compromise. *750 - 1500 ml* - This range of blood loss corresponds to **Class II hemorrhagic shock**, where physiological changes are moderate, but compensatory mechanisms are still largely effective. - Patients in Class II shock typically present with **tachycardia** and a slight decrease in pulse pressure but generally normal blood pressure. *> 2000 ml* - A blood loss exceeding **2000 ml** (or >40% of total blood volume) is indicative of **Class IV hemorrhagic shock**, the most severe category. - This level of blood loss results in pronounced **hypotension**, severe tachycardia, and often requires immediate massive transfusion to prevent irreversible organ damage. *< 750 ml* - This range represents **Class I hemorrhagic shock**, which involves a minimal blood loss of up to 15% of total blood volume. - Patients in Class I shock typically show **minimal to no clinical signs of shock**, as compensatory mechanisms are highly effective in maintaining vital signs.

Question 1

A 40-year-old male with gastroesophageal reflux disease (GERD) is found to have Barrett's esophagus with low-grade dysplasia on endoscopy. What is the most appropriate initial pharmacological treatment for this condition?

Accepted Answer

PPI

Answer

Fundoplication

Answer

Esophageal resection

Answer

Diet modification

Question 2

Isolated painful third nerve palsy is a feature of aneurysms of:

Accepted Answer

Aneurysm of the posterior communicating artery

Answer

Aneurysm of the anterior communicating artery

Answer

Aneurysm of the vertebrobasillary artery

Answer

Aneurysm of the ophthalmic artery

Question 3

Which of the following is not a recognized complication of chronic pancreatitis?

Accepted Answer

Renal artery thrombosis

Answer

Pancreatic pseudocyst

Answer

Splenic vein thrombosis

Answer

Pancreatic fistula

Question 4

Impotence is a feature of which of the following:

Accepted Answer

Multiple sclerosis

Answer

Poliomyelitis

Answer

Amyotrophic lateral sclerosis

Answer

Meningitis

Question 5

All of the following are features of Obstructive jaundice except:

Accepted Answer

Normal alkaline phosphatase

Answer

Clay colour stools

Answer

Pruritis

Answer

Elevated serum aminotransferases level

Question 6

Most common hematological malignancy associated with Rheumatoid Arthritis (RA)?

Accepted Answer

Large granular lymphocytic leukemia (LGLL)

Answer

Diffuse large B cell lymphoma

Answer

Chronic lymphocytic leukemia

Answer

T-cell prolymphocytic leukemia

Question 7

What are the key characteristics of Evans syndrome?

Accepted Answer

Autoimmune hemolytic anemia and immune thrombocytopenia

Answer

Low lymphocyte and red blood cell counts

Answer

High platelet and lymphocyte counts

Answer

A reduction in all blood cell types

Question 8

Which of the following is NOT a characteristic feature of systemic sclerosis?

Accepted Answer

Gottron's papules

Answer

Calcinosis cutis

Answer

Digital ulcers

Answer

Acroosteolysis

Question 9

In total parenteral nutrition, which of the following parameters is not routinely measured daily?

Accepted Answer

Liver function tests (LFTs)

Answer

Electrolyte

Answer

Fluid intake and output

Answer

Magnesium

Question 10

What is the volume of blood loss associated with Class III hemorrhagic shock?

Accepted Answer

1500 - 2000 ml

Answer

750 - 1500 ml

Answer

> 2000 ml

Answer

< 750 ml

NEET-PG 2013 — Internal Medicine