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?
Adrenal reserve is best tested by means of infusion with
What is the recommended time frame for completing a blood transfusion after initiation?
What is the recommended rate of correction for sodium deficit in patients with chronic hyponatremia?
All are seen in Samters triad except?
What is the purpose of the Queckenstedt test?
NEET-PG 2013 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 71: 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 72: 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 73: 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 74: 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 75: 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.
Question 76: Adrenal reserve is best tested by means of infusion with
- A. ACTH (Correct Answer)
- B. Metyrapone
- C. Corticosteroids
- D. LHRH
Explanation: ACTH - The **ACTH stimulation test**, also known as the **cosyntropin test**, is the most common dynamic test for assessing adrenal reserve. - Exogenous ACTH (cosyntropin) stimulates the adrenal glands to produce cortisol; a subnormal response indicates adrenal insufficiency. *Corticosteroids* - **Corticosteroids** are hormones (like cortisol) produced by the adrenal glands, or synthetic versions used as medications; they do not test adrenal reserve but rather *replace* adrenal function. - Administering corticosteroids would interfere with, rather than assess, the adrenal gland's ability to produce its own hormones. *LHRH* - **Luteinizing hormone-releasing hormone (LHRH)** is used to assess the function of the anterior pituitary gland and gonads, not the adrenal glands. - An LHRH stimulation test evaluates the pituitary's ability to release LH and FSH, which in turn stimulate gonadal hormone production. *Metyrapone* - The **metyrapone test** assesses the integrity of the **hypothalamic-pituitary-adrenal axis** by blocking cortisol synthesis, which should lead to an increase in ACTH and 11-deoxycortisol [1]. - While it evaluates a part of adrenal function, it is primarily used to differentiate between primary and secondary adrenal insufficiency, and not a direct measure of cortisol production capacity in response to stimulation.
Question 77: What is the recommended time frame for completing a blood transfusion after initiation?
- A. 1-4 hours (Correct Answer)
- B. 3-6 hours
- C. 4-8 hours
- D. 8-12 hours
Explanation: ***1-4 hours*** - This timeframe is recommended to **minimize the risk of bacterial growth** in the blood product, as bacteria can multiply quickly at room temperature. - Completing the transfusion within 4 hours also reduces the likelihood of **red blood cell degeneration** and loss of efficacy. *3-6 hours* - This period extends beyond the recommended maximum of 4 hours, increasing the risk of **bacterial proliferation** in the blood product. - Prolonged infusion times can also lead to a **decrease in the viability and function** of transfused cells. *4-8 hours* - Transfusing over 4-8 hours significantly elevates the risk of **bacterial contamination** and potential septic reactions. - The extended duration compromises the **quality and safety** of the blood product. *8-12 hours* - This timeframe is unacceptably long for a blood transfusion, posing a **critical risk of severe bacterial growth** and infection. - Blood products should not be administered beyond 4 hours due to the rapid decline in **cell integrity and increased adverse reaction potential**.
Question 78: What is the recommended rate of correction for sodium deficit in patients with chronic hyponatremia?
- A. 0.5 mmol/hour (Correct Answer)
- B. 1 mmol/hour
- C. 1.5 mmol/hour
- D. 2.0 mmol/hour
Explanation: ***0.5 mmol/hour*** [1] - This rate of correction is recommended to avoid **osmotic demyelination syndrome (ODS)**, also known as central pontine myelinolysis [1]. - The aim is to correct the sodium deficit gradually, with a maximum increase not exceeding **8-10 mmol/L in any 24-hour period** [1]. *1 mmol/hour* - This rate is generally considered too rapid for chronic hyponatremia and increases the risk of **osmotic demyelination syndrome**. - While acceptable in some acute severe cases, it is typically avoided in chronic settings where the brain has adapted to lower osmolality. *1.5 mmol/hour* - This rate would lead to an even faster correction of sodium, significantly elevating the risk of **osmotic demyelination syndrome**. - It would result in a correction of 36 mmol/L over 24 hours, far exceeding the recommended daily limit of 8-10 mmol/L. *2.0 mmol/hour* - Such a rapid correction rate is highly dangerous and almost guarantees the development of **osmotic demyelination syndrome**. - This aggressive correction would lead to severe brain injury due to rapid osmotic shifts.
Question 79: All are seen in Samters triad except?
- A. Nasal polyp
- B. Aspirin sensitivity
- C. Asthma
- D. Bacterial infection (Correct Answer)
Explanation: ***Bacterial infection*** - **Samter's triad**, also known as aspirin-exacerbated respiratory disease (AERD), consists of **asthma**, **nasal polyps**, and **aspirin sensitivity** (or NSAID sensitivity) [1]. - **Bacterial infection** is not a component of Samter's triad, although patients with nasal polyps may be more prone to secondary bacterial sinusitis. *Asthma* - **Asthma** is one of the three main components of Samter's triad, typically becoming more symptomatic after aspirin ingestion [1]. - Patients experience **bronchoconstriction** and worsening respiratory symptoms. *Nasal polyp* - **Nasal polyps** are a characteristic feature of Samter's triad, often extensive and recurrent [1]. - They contribute to nasal obstruction and chronic rhinosinusitis. *Aspirin sensitivity* - **Aspirin sensitivity** (or NSAID sensitivity) is the third key component, where ingestion of aspirin or other NSAIDs triggers severe respiratory reactions [1]. - This sensitivity is due to an abnormal arachidonic acid metabolism pathway involving **leukotrienes**.
Question 80: What is the purpose of the Queckenstedt test?
- A. Spinal block (Correct Answer)
- B. Glomus tumor
- C. Otosclerosis
- D. Acoustic neuroma
Explanation: ***Spinal block*** - The Queckenstedt test was historically used to evaluate for a **spinal block**, which is an obstruction to the free flow of **cerebrospinal fluid (CSF)** in the subarachnoid space. - It involves observing the rise in **CSF pressure** in response to compression of the jugular veins; a blunted or absent rise suggests a block. *Glomus tumor* - **Glomus tumors** are usually benign and arise from glomus bodies, often presenting as painful lesions in the nail bed. - Their diagnosis is typically made through **imaging** and **biopsy**, not specific pressure tests. *Otosclerosis* - **Otosclerosis** is a condition causing progressive hearing loss due to abnormal bone growth in the middle ear. - Diagnosis involves **audiometry** and **tympanometry**, and it is unrelated to CSF flow or spinal blocks. *Acoustic neuroma* - An **acoustic neuroma** is a benign tumor of the vestibulocochlear nerve (cranial nerve VIII) that causes hearing loss, tinnitus, and balance issues. - Diagnosis relies on **MRI of the brain**, and the Queckenstedt test has no role in its evaluation.