NEET-PG 2013 Practice Questions

Q: In which condition is the Albumin to Globulin (A:G) ratio maintained?

Nephritic syndrome. ***Nephritic syndrome*** - In nephritic syndrome, the **glomerular filtration is often preserved**, allowing for the maintenance of A:G ratio despite the presence of hematuria and proteinuria [1]. - The condition typically leads to a **moderate degree of proteinuria**, retaining a relatively normal serum albumin level [1]. *Multiple myeloma* - In multiple myeloma, there is often a **high level of paraproteins** leading to a significant drop in albumin, affecting the A:G ratio. - Patients frequently exhibit **renal impairment**, resulting in a disrupted A:G ratio due to increased urinary protein loss. *Protein losing enteropathy* - This condition causes **loss of proteins** like albumin through the gastrointestinal tract, leading to **hypoalbuminemia** and altered A:G ratio. - It is characterized by **diarrhea** and fluid accumulation, further impacting the protein status in circulation. *Cirrhosis* - Cirrhosis leads to **decreased albumin synthesis**, resulting in a low serum albumin and an altered A:G ratio. - The condition is associated with **portal hypertension** and ascites, complicating the biochemical status.

Q: Which of the following statements about Maple Syrup Urine Disease (MSUD) is true?

Deficiency of branched chain amino acid enzymes. ***Deficiency of branched chain amino acid enzymes*** - MSUD is caused by a deficiency in the **branched-chain alpha-keto acid dehydrogenase complex (BCKDC)**, an enzyme responsible for metabolizing **leucine, isoleucine, and valine**. - This enzyme deficiency leads to the accumulation of these **branched-chain amino acids (BCAAs)** and their corresponding branched-chain alpha-keto acids in the body. *Asymptomatic* - MSUD is a severe metabolic disorder that is **not asymptomatic**; it typically presents with distinct neurological and metabolic symptoms shortly after birth. - Clinical manifestations can include **poor feeding, lethargy, seizures**, and a characteristic **maple syrup odor** in urine and earwax. *FeCl3 turns navy blue* - The **ferric chloride test (FeCl3 test)** in MSUD typically yields a **green-gray or dark-green color** when testing for the accumulation of alpha-keto acids (specifically alpha-ketoisocaproic acid). - A **navy blue color** with FeCl3 is more characteristic of **alkaptonuria** due to the presence of homogentisic acid. *Hyperaminoaciduria of aromatic amino acids* - MSUD is characterized by the accumulation and excretion of **branched-chain amino acids (leucine, isoleucine, valine)** and their corresponding keto acids. - **Hyperaminoaciduria of aromatic amino acids** (e.g., phenylalanine, tyrosine, tryptophan) is seen in other conditions like **phenylketonuria (PKU)**, not MSUD.

Q: Posterosuperior retraction pocket if allowed to progress will lead to?

Primary cholesteatoma. ***Primary cholesteatoma*** - A posterosuperior retraction pocket is a common precursor to the development of a **primary cholesteatoma**. - This pocket, formed by **negative pressure** in the middle ear, accumulates **desquamated keratin** and can erode surrounding bone. *SNHL* - While a cholesteatoma can ultimately cause **sensorineural hearing loss (SNHL)** due to extensive bone erosion affecting the inner ear, it is a later complication, not the direct outcome of the initial retraction pocket itself. - **SNHL** is more commonly associated with conditions directly damaging the **cochlea or auditory nerve**. *Secondary cholesteatoma* - A **secondary cholesteatoma** typically arises from a perforation in the tympanic membrane where skin migrates into the middle ear, not from an intact retraction pocket. - This condition is also known as a **'migratory'** or **'acquired'** cholesteatoma. *Tympanosclerosis* - **Tympanosclerosis** involves the formation of **hyalinized collagen and calcium deposits** within the tympanic membrane or middle ear mucosa, resulting from chronic inflammation or previous trauma. - It is a **fibrotic healing response** and does not directly result from a retraction pocket, although both can be sequelae of chronic otitis media.

Q: Calciphylaxis is a severe life-threatening condition. Which of the following is most commonly associated with it?

End stage Renal disease. ***End stage Renal disease*** - Calciphylaxis frequently occurs in patients with **end-stage renal disease**, primarily associated with **secondary hyperparathyroidism** [1] and **calcium-phosphate imbalance**. - It leads to **cutaneous ischemia** and necrosis, often requiring aggressive management due to its high **mortality rate**. *Parathyroidectomy* - While parathyroidectomy may affect calcium levels, it is not directly linked to calciphylaxis. - Calciphylaxis more commonly develops due to underlying **chronic renal failure** [1] rather than surgical interventions. *Hyperthyroidism* - Hyperthyroidism primarily causes symptoms related to metabolism, **thyroid hormone excess**, and does not lead to calciphylaxis. - There is no direct correlation between hyperthyroid states and the pathophysiology of calciphylaxis. *Medullary carcinoma thyroid* - This condition involves **medullary thyroid carcinoma**, associated with calcitonin production and does not cause calciphylaxis. - Patients typically experience **thyroid-related symptoms** rather than the vascular complications seen in calciphylaxis.

Q: What is the primary clinical feature of Henoch-Schonlein purpura?

Skin rash characterized by palpable purpura. ***Skin rash characterized by palpable purpura*** - **Palpable purpura** is the hallmark cutaneous manifestation of **Henoch-Schonlein purpura (HSP)**, a small-vessel vasculitis [1]. - This rash typically appears on the **lower extremities and buttocks**, reflecting the deposition of IgA in vessel walls [1]. *Abdominal pain due to vasculitis* - While **abdominal pain** is a common feature of HSP due to gastrointestinal vasculitis, it is not considered the primary clinical feature [1]. - Gastrointestinal involvement can manifest with pain, bleeding, and intussusception, but the **skin rash** is more consistently present and diagnostic. *Joint pain associated with the condition* - **Arthralgia** or **arthritis** (joint pain) is seen in a significant number of HSP patients, particularly in the knees and ankles. - However, it is a secondary manifestation, and not the **defining primary sign** of the disease. *Kidney involvement in the disease* - **Renal involvement**, presenting as hematuria and proteinuria, occurs in about one-third of HSP cases and can lead to serious long-term complications. - Despite its significance for prognosis, **kidney disease** is a later and not universally present feature, making the rash the most critical initial diagnostic clue.

Q: Which of the following is a feature of tumor lysis syndrome?

Hypocalcemia (a decrease in blood calcium levels). ***Hypocalcemia (a decrease in blood calcium levels)*** - **Hypocalcemia** in tumor lysis syndrome results from the precipitation of calcium with excessive phosphate released from lysed tumor cells. - The elevated phosphate levels bind to calcium, forming **calcium phosphate crystals** that can deposit in tissues, further lowering serum calcium. *Metabolic alkalosis (a rise in blood pH)* - Tumor lysis syndrome typically leads to **metabolic acidosis**, not alkalosis, due to the release of acidic intracellular metabolites like uric acid and phosphate. - The accumulation of these acidic compounds overwhelms the body's buffering systems, decreasing blood pH. *Hypokalemia (a decrease in blood potassium levels)* - Tumor lysis syndrome is characterized by **hyperkalemia**, an increase in blood potassium, as potassium is a major intracellular cation released during cell lysis. - The rapid breakdown of numerous tumor cells dumps vast amounts of intracellular potassium into the bloodstream. *Hypophosphatemia (a decrease in blood phosphate levels)* - Tumor lysis syndrome causes **hyperphosphatemia**, an elevation in blood phosphate levels, because phosphate is abundantly present within tumor cells and is released upon their destruction. - This excessive release of intracellular phosphate is a hallmark biochemical feature of the syndrome.

Q: Interstitial nephritis is common with

Nonsteroidal anti-inflammatory drugs (NSAIDs). ***Nonsteroidal anti-inflammatory drugs (NSAIDs)*** - **NSAIDs** are a known cause of **acute interstitial nephritis** (AIN), an inflammatory condition affecting the tubules and interstitium of the kidney [1]. - This adverse reaction often manifests as **fever**, **rash**, **eosinophilia**, and **acute kidney injury**, typically 7-10 days after drug exposure. *Black water fever* - **Blackwater fever** is a severe complication of **malaria**, characterized by massive hemolysis leading to **hemoglobinuria**, which darkens the urine. - It primarily causes **acute kidney injury** through **acute tubular necrosis** due to hemoglobin precipitation in the renal tubules, not interstitial nephritis. *Rhabdomyolysis* - **Rhabdomyolysis** involves the breakdown of muscle tissue, releasing myoglobin into the bloodstream, which is toxic to the kidneys. [1] - This condition leads to **acute kidney injury** predominantly through **acute tubular necrosis** due to myoglobin casts obstructing tubules and direct toxicity, not interstitial inflammation. *Tumor lysis syndrome* - **Tumor lysis syndrome** occurs when large numbers of cancer cells are rapidly destroyed, releasing intracellular contents like potassium, phosphate, and nucleic acids. - The high concentration of **uric acid** and **phosphate** in the renal tubules leads to crystal formation, causing **acute kidney injury** primarily through **acute uric acid nephropathy** and **phosphate nephropathy**, rather than interstitial nephritis [1].

Q: In inflammatory myopathy, which group of muscles is not affected

Ocular. ***Ocular*** - The **extraocular muscles** responsible for eye movement are generally spared in typical inflammatory myopathies, distinguishing them from other neuromuscular disorders. - Inflammatory myopathies primarily affect **skeletal muscles**, but **ocular muscles** have unique immunological and physiological properties that often protect them. *Facial* - While less commonly affected early in the disease, some inflammatory myopathies, particularly **dermatomyositis**, can eventually involve **facial muscles**, leading to weakness. - Involvement of **facial muscles** can manifest as difficulty with smiling, whistling, or closing the eyelids. *Proximal muscles of limb* - Inflammatory myopathies characteristically cause **proximal muscle weakness**, affecting muscles of the **shoulders, hips, and thighs** [1]. - This weakness often presents as difficulty climbing stairs, getting up from a chair, or lifting objects overhead [1]. *Distal muscles of limb* - While less common than proximal involvement, **distal muscle weakness** (affecting hands and feet) can occur in some subsets of inflammatory myopathies, such as **inclusion body myositis**. - This can lead to difficulties with fine motor tasks or foot drop.

Q: Which neurological condition is commonly associated with Alice in Wonderland Syndrome?

Epileptic seizures. ***Epileptic seizures*** - **Alice in Wonderland Syndrome (AIWS)**, characterized by distortions of visual perception, body image, and sense of time, is often reported as an **aura or part of focal epileptic seizures**, particularly those originating in the temporal or parietal lobes. - The **transient and episodic nature** of AIWS symptoms aligns well with the paroxysmal electrical activity seen in epilepsy. *Subacute sclerosing panencephalitis (SSPE)* - **SSPE** is a rare, fatal brain disorder caused by a persistent **measles virus infection**, primarily affecting children and young adults. - While it causes progressive neurological deterioration, including cognitive decline, motor dysfunction, and seizures, **Alice in Wonderland Syndrome** is not a characteristic or commonly associated symptom. *Cerebral hemorrhage* - A **cerebral hemorrhage** involves bleeding within the brain tissue, leading to acute neurological deficits depending on the location and size of the bleed. - Although it can cause a variety of symptoms, such as headache, weakness, and altered consciousness, **Alice in Wonderland Syndrome** is not a typical manifestation of acute hemorrhage. *Multiple sclerosis* - **Multiple sclerosis (MS)** is a chronic autoimmune disease affecting the central nervous system, leading to demyelination and neurological symptoms. - Common symptoms involve motor, sensory, visual, and cognitive deficits, but **Alice in Wonderland Syndrome** is not a recognized or common neurological manifestation of MS.

Q: Which of the following conditions is associated with megaloblastic anemia?

Pernicious anemia. a and b - Megaloblastic anemia is commonly associated with **vitamin B12** [1] and **folate deficiencies** [2], which can occur due to various causes. - Conditions leading to malabsorption (such as those related to the gastrointestinal tract) contribute significantly to megaloblastic anemia [1, 2]. *ileal resection* - Ileal resection can indeed lead to **malabsorption** of vitamin B12 [1], particularly if the distal ileum is removed. - However, it is important to note that megaloblastic anemia specifically reflects a broader range of potential deficiencies, thus it is not an exclusive answer. *Crohn's disease* - Crohn's disease can cause **malabsorption** and result in vitamin B12 deficiency but is not a direct cause of megaloblastic anemia on its own. - The anemia may occur due to complications like **ileo-pouch anastomosis** rather than the disease itself. *Intestinal lymphatic ectasia* - This condition leads to **protein-losing enteropathy**, potentially causing deficiencies but not specifically leading to megaloblastic anemia. - The anemia associated with this condition is typically due to **hypoalbuminemia** and not a result of any vitamin deficiency directly.

Question 1

In which condition is the Albumin to Globulin (A:G) ratio maintained?

Accepted Answer

Nephritic syndrome

Answer

Cirrhosis

Answer

Protein losing enteropathy

Answer

Multiple myeloma

Question 2

Which of the following statements about Maple Syrup Urine Disease (MSUD) is true?

Accepted Answer

Deficiency of branched chain amino acid enzymes

Answer

FeCl3 turns navy blue

Answer

Asymptomatic

Answer

Hyperaminoaciduria of aromatic amino acids

Question 3

Posterosuperior retraction pocket if allowed to progress will lead to?

Accepted Answer

Primary cholesteatoma

Answer

SNHL

Answer

Secondary cholesteatoma

Answer

Tympanosclerosis

Question 4

Calciphylaxis is a severe life-threatening condition. Which of the following is most commonly associated with it?

Accepted Answer

End stage Renal disease

Answer

Parathyroidectomy

Answer

Medullary carcinoma thyroid

Answer

Hyperthyroidism

Question 5

What is the primary clinical feature of Henoch-Schonlein purpura?

Accepted Answer

Skin rash characterized by palpable purpura

Answer

Abdominal pain due to vasculitis

Answer

Joint pain associated with the condition

Answer

Kidney involvement in the disease

Question 6

Which of the following is a feature of tumor lysis syndrome?

Accepted Answer

Hypocalcemia (a decrease in blood calcium levels)

Answer

Metabolic alkalosis (a rise in blood pH)

Answer

Hypokalemia (a decrease in blood potassium levels)

Answer

Hypophosphatemia (a decrease in blood phosphate levels)

Question 7

Interstitial nephritis is common with

Accepted Answer

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Answer

Black water fever

Answer

Rhabdomyolysis

Answer

Tumor lysis syndrome

Question 8

In inflammatory myopathy, which group of muscles is not affected

Accepted Answer

Ocular

Answer

Facial

Answer

Proximal muscles of limb

Answer

Distal muscles of limb

Question 9

Which neurological condition is commonly associated with Alice in Wonderland Syndrome?

Accepted Answer

Epileptic seizures

Answer

Subacute sclerosing panencephalitis (SSPE)

Answer

Cerebral hemorrhage

Answer

Multiple sclerosis

Question 10

Which of the following conditions is associated with megaloblastic anemia?

Accepted Answer

Pernicious anemia

Answer

Iron deficiency anemia

Answer

Intestinal lymphatic ectasia

Answer

Chronic kidney disease

NEET-PG 2013

Biochemistry

ENT

Internal Medicine