What is the BMI range that defines preobesity?
Which of the following is NOT a symptom of mild dehydration?
Which of the following statements about polio is false?
Most common cause of death in diphtheria is due to
Which of the following is NOT a feature of Cushing's triad?
What are the key characteristics of Evans syndrome?
Which of the following is NOT a characteristic feature of systemic sclerosis?
In total parenteral nutrition, which of the following parameters is not routinely measured daily?
Prepyloric or channel ulcer in the stomach is termed as:
What is the volume of blood loss associated with Class III hemorrhagic shock?
NEET-PG 2013 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 51: What is the BMI range that defines preobesity?
- A. 18.5-24.9
- B. 30-34.9
- C. 35-39.9
- D. 25-29.9 (Correct Answer)
Explanation: ***25-29.9*** - A **Body Mass Index (BMI)** between 25 and 29.9 kg/m² is classified as **overweight** [1] or **preobesity**. - This range indicates an increased risk of developing various health problems associated with higher body weight [1]. *18.5-24.9* - This BMI range is considered **normal weight**, which is generally ideal for health [1]. - Individuals within this range typically have the lowest risk of weight-related health complications [1]. *30-34.9* - A BMI in this range is classified as **obesity class I** [1]. - This category indicates a significantly increased risk of developing co-morbidities such as type 2 diabetes and cardiovascular disease [1]. *35-39.9* - This BMI range represents **obesity class II** (severe obesity) [1]. - Individuals in this category face a high risk of serious health issues and often require more aggressive intervention strategies [1].
Question 52: Which of the following is NOT a symptom of mild dehydration?
- A. Thirst
- B. Restlessness
- C. Dry tongue
- D. Normal BP (Correct Answer)
Explanation: ***Normal BP*** - In **mild dehydration**, the body's compensatory mechanisms, such as increased heart rate and vasoconstriction, typically manage to maintain a **normal blood pressure**. [1] - A significant drop in **blood pressure** (hypotension) is usually indicative of **moderate to severe dehydration**, where these compensatory mechanisms begin to fail. [2] *Thirst* - **Thirst** is one of the **earliest and most reliable** indicators of dehydration, as the body signals a need for fluid intake. [3] - It arises in response to increased plasma osmolality and decreased blood volume, both occurring even in **mild dehydration**. [3] *Restlessness* - **Restlessness** can be an early sign of discomfort and altered mental status associated with **mild dehydration**, particularly in infants and young children. - As the body struggles to maintain fluid balance, individuals may experience irritability and general unease. *Dry tongue* - A **dry tongue** and **dry sticky mucous membranes** are common signs of mild to moderate dehydration. - This symptom results from reduced salivary production due to decreased fluid volume in the body.
Question 53: Which of the following statements about polio is false?
- A. 99% non paralytic
- B. Aseptic meningitis
- C. Flaccid paralysis
- D. Increased tendon reflexes (Correct Answer)
Explanation: ***Increased tendon reflexes*** - Polio causes **lower motor neuron damage**, specifically to the anterior horn cells of the spinal cord [1]. - This damage leads to **flaccid paralysis** and **decreased or absent deep tendon reflexes**, not increased reflexes [3]. *99% non paralytic* - The vast majority of poliovirus infections (approximately 95-99%) are **asymptomatic** or cause only mild, non-specific symptoms. - Only a small percentage of infected individuals develop the more severe paralytic form of the disease. *Flaccid paralysis* - Poliovirus directly attacks and destroys **motor neurons** in the anterior horn of the spinal cord [1]. - This damage results in **muscle weakness** and loss of muscle tone, leading to **flaccid paralysis** [3]. *Aseptic meningitis* - About 1-5% of poliovirus infections can manifest as **aseptic meningitis**, characterized by symptoms like fever, headache, neck stiffness, and vomiting without bacterial infection [2]. - This form of meningitis is typically **self-limiting** and does not lead to paralysis [2].
Question 54: Most common cause of death in diphtheria is due to
- A. Airway obstruction
- B. Septic shock
- C. Toxic cardiomyopathy (Correct Answer)
- D. Descending polyneuropathy (rare)
Explanation: ***Toxic cardiomyopathy*** - Diphtheria toxin primarily targets and damages the **myocardium**, leading to heart failure, arrhythmias, and ultimately death. - Myocardial damage can occur even in mild cases and is the most frequent cause of **fatality** in both treated and untreated diphtheria. *Airway obstruction* - While significant **pharyngeal and laryngeal pseudomembrane formation** can cause severe respiratory distress and obstruction, it is not the most common cause of death overall. - Prompt medical intervention, such as **tracheostomy** or antitoxin administration, can often alleviate acute airway issues. *Septic shock* - Diphtheria itself is a **toxin-mediated disease**, not typically characterized by overwhelming bacterial sepsis leading to septic shock as the primary cause of death. - While secondary infections can occur, direct **toxin-induced organ damage** is the main concern. *Descending polyneuropathy (rare)* - **Neurological complications**, such as polyneuropathy, can occur later in the course of diphtheria due to toxin effects. - However, these are generally less common and less immediately life-threatening than **cardiac complications**, and rarely the direct cause of death.
Question 55: Which of the following is NOT a feature of Cushing's triad?
- A. Hypertension
- B. Bradycardia
- C. Irregular breathing
- D. Hypotension (Correct Answer)
Explanation: ***Hypotension*** - Cushing's triad is an indicator of **increased intracranial pressure (ICP)** and classically presents with **hypertension**, not hypotension. - Hypotension would suggest a different problem, such as **spinal shock** or **hypovolemia**, which are not directly associated with Cushing's triad. *Bradycardia* - **Bradycardia** is a key component of Cushing's triad, resulting from vagal stimulation due to increased intracranial pressure. - This reflex reduces heart rate in an attempt to maintain cerebral perfusion. *Hypertension* - **Hypertension**, specifically a widened pulse pressure, is a cardinal feature of Cushing's triad, caused by systemic vasoconstriction to overcome increased ICP and maintain **cerebral perfusion pressure**. - It is a compensatory mechanism to push blood into the brain. *Irregular breathing* - **Irregular breathing patterns**, such as Cheyne-Stokes respiration or ataxic breathing, are characteristic of Cushing's triad, indicating brainstem compression [1]. - This irregular respiratory effort is due to direct pressure on the **respiratory centers** in the medulla [1].
Question 56: What are the key characteristics of Evans syndrome?
- A. Autoimmune hemolytic anemia and immune thrombocytopenia (Correct Answer)
- B. Low lymphocyte and red blood cell counts
- C. High platelet and lymphocyte counts
- D. A reduction in all blood cell types
Explanation: ***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.
Question 57: Which of the following is NOT a characteristic feature of systemic sclerosis?
- A. Calcinosis cutis
- B. Digital ulcers
- C. Acroosteolysis
- D. Gottron's papules (Correct Answer)
Explanation: ***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.
Question 58: In total parenteral nutrition, which of the following parameters is not routinely measured daily?
- A. Electrolyte
- B. Fluid intake and output
- C. Magnesium
- D. Liver function tests (LFTs) (Correct Answer)
Explanation: ***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].
Question 59: Prepyloric or channel ulcer in the stomach is termed as:
- A. Type 3 (Correct Answer)
- B. Type 1
- C. Type 4
- D. Type 2
Explanation: ***Type 3*** - **Type 3 ulcers** are located in the **prepyloric region** or within the **pyloric channel** of the stomach. - They are often associated with **duodenal ulcers** and are characterized by **normal to high acid secretion**. *Type 1* - **Type 1 ulcers** are typically found in the **lesser curvature of the stomach body**, not the prepyloric region. - These ulcers are usually associated with **low or normal acid secretion** and are often linked to *H. pylori* infection. *Type 2* - **Type 2 ulcers** involve both a **gastric ulcer** (usually in the body) and an **active or healed duodenal ulcer**. - They are associated with **normal to high acid secretion**, but the location is not exclusively prepyloric. *Type 4* - **Type 4 ulcers** are located high on the **lesser curvature near the gastroesophageal junction**. - They are associated with **low acid secretion** and are sometimes termed **juxta-esophageal ulcers**.
Question 60: What is the volume of blood loss associated with Class III hemorrhagic shock?
- A. 750 - 1500 ml
- B. 1500 - 2000 ml (Correct Answer)
- C. > 2000 ml
- D. < 750 ml
Explanation: ***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.