Internal Medicine
2 questionsPseudomembranous colitis, all are true except:
Which of the following conditions is least commonly associated with Pneumocystis carinii in AIDS?
NEET-PG 2013 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 661: Pseudomembranous colitis, all are true except:
- A. Blood in stools is a common feature (Correct Answer)
- B. Toxin A is responsible for clinical manifestation
- C. Summit lesions are early histopathological findings
- D. Toxin B is responsible for clinical manifestation
Explanation: ***Blood in stools is a common feature*** - While diarrhea is a hallmark of **pseudomembranous colitis**, **bloody stools** are uncommon and, if present, suggest severe disease or an alternative diagnosis [1]. - The typical presentation involves **watery diarrhea**, abdominal cramps, and fever, not usually overt bleeding [1]. *Toxin A is responsible for clinical manifestation* - **Toxin A (TcdA)** is one of the primary exotoxins produced by *Clostridioides difficile* and contributes significantly to the **inflammation** and fluid secretion seen in pseudomembranous colitis. - It acts as an **enterotoxin**, causing fluid secretion and mucosal damage in the colon [1]. *Summit lesions are early histopathological findings* - **Summit lesions**, also known as "summit pseudomembranes" or **"volcano lesions"**, refer to characteristic histological findings where inflammatory exudates effuse from the tips of damaged crypts. - These are typical early findings in pseudomembranous colitis, demonstrating the focal nature of the **mucosal injury**. *Toxin B is responsible for clinical manifestation* - **Toxin B (TcdB)** is another key exotoxin produced by *Clostridioides difficile*, and it is considered even more **cytotoxic** than Toxin A [1]. - It causes significant **cell damage** and **apoptosis**, playing a crucial role in the development of the pseudomembranes and clinical symptoms [1].
Question 662: Which of the following conditions is least commonly associated with Pneumocystis carinii in AIDS?
- A. Meningitis
- B. Otic polypoid mass (Correct Answer)
- C. Pneumonia
- D. Ophthalmic choroid lesion
Explanation: ***Otic polypoid mass*** - While *Pneumocystis jirovecii* (formerly *carinii*) can cause **extrapulmonary disease** in immunocompromised patients, an **otic polypoid mass** is an extremely rare and atypical presentation. - Extrapulmonary manifestations usually involve organs with rich vascular supply, but ear involvement in this form is not a characteristic feature. *Pneumonia* - **Pneumocystis pneumonia (PCP)** is the **most common opportunistic infection** and AIDS-defining illness caused by *Pneumocystis jirovecii* in individuals with AIDS [1]. - It typically manifests as **fever, cough, and dyspnea** with characteristic imaging findings [1]. *Ophthalmic choroid lesion* - **Choroid lesions** due to *Pneumocystis jirovecii* are a recognized, albeit less common, **extrapulmonary manifestation** in immunocompromised patients, particularly those with AIDS. - These lesions are usually **asymptomatic** and discovered incidentally on funduscopic examination. *Meningitis* - Although *Pneumocystis jirovecii* causing **meningitis** is rare, it has been reported in severely immunocompromised individuals with AIDS, often as part of disseminated disease. - Central nervous system involvement signifies **widespread dissemination** and advanced immunosuppression.
Microbiology
7 questions'String of pearl' colonies on penicillin-containing nutrient agar are produced by:
Boutonneuse fever is caused by which of the following?
Inclusion body containing glycogen is seen in which of the following organisms?
Which gene of Hepatitis B virus (HBV) is most commonly associated with mutations causing antiviral drug resistance?
Which of the following statements about malaria transmission is correct?
Amoebic liver abscess can be diagnosed by demonstrating-
Who discovered the bacterium Treponema pallidum?
NEET-PG 2013 - Microbiology NEET-PG Practice Questions and MCQs
Question 661: 'String of pearl' colonies on penicillin-containing nutrient agar are produced by:
- A. Salmonella
- B. Bacillus (Correct Answer)
- C. Proteus
- D. Klebsiella
Explanation: ***Bacillus*** - The "string of pearls" morphology is a classic characteristic of *Bacillus anthracis* when grown on a nutrient agar containing penicillin. - This appearance is due to the bacterium's cell wall being weakened by penicillin, leading to swollen, elongated cells that remain attached in a chain. *Proteus* - *Proteus* species are known for their characteristic **swarming motility** on agar, not a "string of pearls" appearance. - They are typically **resistant to penicillin** and would not show this inhibited growth pattern. *Salmonella* - *Salmonella* typically forms **smooth, round colonies** on agar and does not exhibit a "string of pearls" morphology. - While some species can be inhibited by penicillin, they do not develop this specific appearance. *Klebsiella* - *Klebsiella* species are typically **mucoid** due to their polysaccharide capsule, forming large, glistening colonies. - They are also often **resistant to penicillin** and would not show the "string of pearls" effect.
Question 662: Boutonneuse fever is caused by which of the following?
- A. A. Rickettsia japonica
- B. B. Rickettsia conorii (Correct Answer)
- C. C. Rickettsia sibirica
- D. D. Rickettsia australis
Explanation: ***Rickettsia conorii*** - **Boutonneuse fever**, also known as Mediterranean spotted fever, is specifically caused by the bacterium **Rickettsia conorii**. - This zoonotic disease is transmitted to humans through the bite of infected ticks, primarily the **dog tick** (Rhipicephalus sanguineus). *Rickettsia japonica* - **Rickettsia japonica** is the causative agent of **oriental spotted fever**, a tick-borne illness primarily found in Japan. - This Rickettsial disease is distinct from Boutonneuse fever, having a different geographical distribution and primary vector. *Rickettsia sibirica* - **Rickettsia sibirica** is responsible for **Siberian tick typhus** (North Asian tick typhus), which is prevalent in Siberia, Mongolia, and Northern China. - While also a tick-borne Rickettsial infection, its clinical presentation and geographic range differ from Boutonneuse fever. *Rickettsia australis* - **Rickettsia australis** causes **Queensland tick typhus**, an indigenous Rickettsial disease found in Australia. - This pathogen is distinct from Rickettsia conorii and causes a localized form of tick typhus.
Question 663: Inclusion body containing glycogen is seen in which of the following organisms?
- A. Chlamydia trachomatis (Correct Answer)
- B. Chlamydia pneumoniae
- C. Chlamydia psittaci
- D. None of the options
Explanation: ***Chlamydia trachomatis*** - This species is known to form **intracytoplasmic inclusion bodies** that contain **glycogen**. - The presence of this glycogen allows these inclusions to be stained by **iodine**, aiding in laboratory identification. *Chlamydia pneumoniae* - Inclusion bodies of *Chlamydia pneumoniae* are typically **round or pear-shaped** and **do not contain glycogen**. - They are often **vacuolated** and stain poorly with iodine, unlike those of *C. trachomatis*. *Chlamydia psittaci* - The inclusion bodies of *Chlamydia psittaci* are usually **dense and pleiomorphic**, but they **do not contain glycogen**. - They tend to be **larger** and are often found near the host cell nucleus. *None of the options* - This option is incorrect because *Chlamydia trachomatis* specifically forms **glycogen-containing inclusion bodies**. - The presence of glycogen within inclusions is a key distinguishing feature of this species.
Question 664: Which gene of Hepatitis B virus (HBV) is most commonly associated with mutations causing antiviral drug resistance?
- A. X gene
- B. S gene
- C. C gene
- D. P gene (Correct Answer)
Explanation: ***P gene*** - The **P gene** (polymerase gene) of HBV encodes the viral reverse transcriptase which is essential for viral replication. - Mutations in the P gene can lead to **antiviral drug resistance**, particularly to nucleos(t)ide analogues. *X gene* - The **X gene** encodes the X protein (HBx), a **transcriptional transactivator** involved in viral replication and pathogenesis. - While important for viral function, it is not the primary target for antiviral therapy, and mutations are less frequently associated with drug resistance. *S gene* - The **S gene** encodes the **surface antigens (HBsAg)**, which are crucial for viral entry and immune evasion. - Mutations in the S gene can lead to **vaccine escape mutants** or alter HBsAg detection, but not directly responsible for antiviral resistance. *C gene* - The **C gene** encodes the **core protein (HBcAg)** and the precore protein (HBeAg). - These proteins are involved in **viral particle assembly** and immune modulation, but mutations in this gene are not typically associated with resistance to antiviral drugs.
Question 665: Which of the following statements about malaria transmission is correct?
- A. Individuals harboring gametocytes can transmit malaria. (Correct Answer)
- B. P. vivax always completely fills the infected RBC with schizonts.
- C. Malaria can only be transmitted through blood transfusions.
- D. All stages of P. falciparum are commonly seen in peripheral blood smears.
Explanation: ***Individuals harboring gametocytes can transmit malaria.*** - **Gametocytes** are the sexual stage of the malaria parasite that circulate in the human bloodstream and are infectious to mosquitos. - When an *Anopheles* mosquito feeds on an infected human, it ingests these gametocytes, allowing the parasite's life cycle to continue in the mosquito vector, leading to transmission. *P. vivax always completely fills the infected RBC with schizonts.* - While *P. vivax* does infect **reticulocytes** (young RBCs) and can enlarge them, the **schizonts** typically occupy a significant portion but not always completely fill the host cell. - The infected RBCs are often enlarged to about 1.5 to 2 times their normal size and contain numerous **Schüffner's dots**. *Malaria can only be transmitted through blood transfusions.* - The primary mode of malaria transmission is through the bite of an **infected female *Anopheles* mosquito**. - While **blood transfusions** can transmit malaria, it is a less common and secondary route compared to vector-borne transmission. *All stages of P. falciparum are commonly seen in peripheral blood smears.* - In *P. falciparum* infections, only the **ring forms** and **gametocytes** are commonly observed in the peripheral blood smear. - The more mature asexual stages (trophozoites and schizonts) typically sequester in the capillaries of internal organs, where they are not readily visible in peripheral circulation.
Question 666: Amoebic liver abscess can be diagnosed by demonstrating-
- A. Trophozoites in the pus (Correct Answer)
- B. Trophozoites in the feces
- C. Cysts in the pus
- D. Cysts in the liver
Explanation: ***Trophozoites in the pus*** - **Amoebic liver abscesses** are caused by the invasive **trophozoite stage** of *Entamoeba histolytica*. - Demonstrating **trophozoites** in the characteristic **'anchovy paste' pus** aspirated from the abscess cavity is diagnostic. *Cysts in the pus* - **Cysts** are the **infective stage** of *Entamoeba histolytica* and are typically found in the **feces**, not in an abscess. - Cysts are responsible for transmission and survival outside the host, but they do not cause invasive disease. *Cysts in the liver* - The disease in the liver is caused by **trophozoites**, which invade the intestinal wall and then spread to the liver. - **Cysts** are never found within the liver parenchyma or abscesses. *Trophozoites in the feces* - While **trophozoites** can be found in the feces during acute amoebic dysentery, their presence alone does not confirm a liver abscess. - Furthermore, **trophozoites** are fragile and often difficult to detect in stool samples, especially once the stool has cooled.
Question 667: Who discovered the bacterium Treponema pallidum?
- A. Robert Koch
- B. Twort
- C. Ellerman
- D. Fritz Schaudinn and Erich Hoffmann (Correct Answer)
Explanation: ***Fritz Schaudinn and Erich Hoffmann*** - **Fritz Schaudinn** was a German zoologist, and **Erich Hoffmann** was a German dermatologist; they jointly discovered **Treponema pallidum** in **1905**. - Their discovery of the spirochete was a crucial step in understanding the etiology of **syphilis**. *Robert Koch* - **Robert Koch** is renowned for identifying the causative agents of **tuberculosis**, **cholera**, and **anthrax**. - He developed Koch's postulates, a fundamental set of criteria for establishing the causal relationship between a microbe and a disease. *Twort* - **Frederick Twort** was a British bacteriologist who is credited with the discovery of **bacteriophages** in **1915**. - His work involved examining transparent areas in bacterial cultures, leading to the identification of lytic viruses that infect bacteria. *Ellerman* - **Vilhelm Ellerman** was a Danish pathologist known for his work in **hematology** and **virology**. - Alongside **Olaf Bang**, he demonstrated that avian leukemia (erythroleukemia) could be transmitted by a filterable agent, indicating a viral etiology for some cancers.
Pathology
1 questionsThe most common subtype of Non-Hodgkin's lymphoma in India is:
NEET-PG 2013 - Pathology NEET-PG Practice Questions and MCQs
Question 661: The most common subtype of Non-Hodgkin's lymphoma in India is:
- A. Diffuse small cell lymphocytic lymphoma
- B. Diffuse large B cell lymphoma (Correct Answer)
- C. Follicular lymphoma
- D. Burkitt's lymphoma
Explanation: ***Diffuse large B cell lymphoma*** - It is the most common subtype of **Non-Hodgkin's lymphoma** observed in India, reflecting a higher prevalence in the population. - Characterized by **aggressive clinical behavior** [1] and typically presents as a rapidly enlarging mass, often involving lymph nodes or extranodal sites. *Burkitt's lymphoma* - This subtype is known for its **high proliferation rate** and is more common in specific demographics, such as children and immunocompromised individuals. - It typically presents with **jaw lesions** or abdominal masses, which is not typical in the broader Indian population. *Diffuse small cell lymphocytic lymphoma* - More accurately classified as **chronic lymphocytic leukemia** (CLL), it is not the most common subtype of Non-Hodgkin's lymphoma. - Characterized by a **milder clinical course** and presents with lymphocytosis in peripheral blood, lacking aggressive features. *Follicular lymphoma* - This is usually a **low-grade lymphoma** associated with **indolent behavior** and may not be the most commonly diagnosed subtype in India. - It typically involves multiple lymph nodes and is characterized by **nodular patterns on histology**, making it less prevalent than diffuse large B cell lymphoma. Follicular lymphoma is rare in Asian populations [2]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 563-564. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 602-604.