NEET-PG 2015 - Internal Medicine PYQs Practice Questions

Q: All are reversible causes of dementia except one.

Alzheimer's disease. ### Alzheimer's disease - Alzheimer's disease is the most common cause of **irreversible, progressive neurodegenerative dementia**, characterized by the accumulation of **amyloid plaques** and **neurofibrillary tangles**. - There is currently no cure for Alzheimer's disease, and treatments focus on symptom management rather than reversal. *Hypothyroidism* - **Severe or untreated hypothyroidism** can cause cognitive impairment and dementia-like symptoms, which are often reversible with **thyroid hormone replacement therapy**. - Symptoms like **memory loss**, **slowed thinking**, and confusion can improve significantly once **euthyroid state** is achieved. *Hydrocephalus* - **Normal pressure hydrocephalus (NPH)** can cause a triad of symptoms including **gait disturbance**, **urinary incontinence**, and **dementia**, which can be reversible with a **shunt placement** [1]. - The cognitive decline in NPH is due to increased intracranial pressure affecting brain function, and surgical intervention can alleviate this pressure [1]. *Meningoencephalitis* - **Inflammation of the brain and its surrounding membranes** due to infection can lead to cognitive dysfunction and dementia, which may be reversible with **appropriate antimicrobial or antiviral treatment** [1]. - Early and aggressive treatment of the underlying infection is crucial for potential recovery of cognitive function and prevention of permanent damage. [Practice more Internal Medicine PYQs on OnCourse]

Q: Which of the following statements about Wilson's disease is true?

Low serum ceruloplasmin and high urinary copper. ***Low serum ceruloplasmin and high urinary copper*** - In **Wilson's disease**, there is a defect in **copper transport**, leading to impaired incorporation of copper into ceruloplasmin and reduced biliary excretion. - This results in **low serum ceruloplasmin** levels (since ceruloplasmin is the main copper-carrying protein in the blood) and **increased urinary copper excretion** as the body attempts to eliminate excess free copper. *Low serum ceruloplasmin and low urinary copper* - While **low serum ceruloplasmin** is characteristic, **low urinary copper** would indicate adequate copper elimination or a different condition, which is not the case for Wilson's disease. - Patients with Wilson's disease have **excess copper accumulation**, and increased urinary excretion is a compensatory mechanism [1]. *High serum ceruloplasmin and low urinary copper* - **High serum ceruloplasmin** is inconsistent with Wilson's disease, as ceruloplasmin levels are typically low due to the impaired copper binding. - **Low urinary copper** excretion would indicate normal or low total body copper, which contradicts the copper overload seen in Wilson's disease. *High serum ceruloplasmin and high urinary copper* - **High serum ceruloplasmin** would suggest normal or increased ceruloplasmin synthesis or release, which is contrary to the pathophysiology of Wilson's disease. - Although **high urinary copper** is a feature, it isn't accompanied by high ceruloplasmin in this condition, as ceruloplasmin is primarily involved in carrying copper in the blood rather than excreting excess copper [1]. [Practice more Internal Medicine PYQs on OnCourse]

Q: Which of the following statements about Alport's syndrome is incorrect?

Autosomal dominant. ***Autosomal dominant*** - While there are rare autosomal dominant forms, the most common and classic presentation of **Alport's syndrome is X-linked recessive**, affecting males more severely. - This statement is incorrect because it implies that autosomal dominant inheritance is the primary or typical mode, which is not true for the majority of cases. *Nerve deafness* - **Sensorineural hearing loss**, particularly for high frequencies, is a common and characteristic extra-renal manifestation of Alport's syndrome. - This symptom typically progresses with age and is a key diagnostic feature. *Glomerulonephritis* - **Progressive glomerulonephritis** is the hallmark renal feature of Alport's syndrome, leading to hematuria, proteinuria, and eventually end-stage renal disease. - It is caused by mutations in collagen type IV genes, which disrupt the integrity of the glomerular basement membrane. *X-linked* - The majority of Alport's syndrome cases (about 85%) are **X-linked recessive**, caused by mutations in the *COL4A5* gene located on the X chromosome. - This explains why males are more severely affected and typically present with earlier onset and more rapid progression of renal disease. [Practice more Internal Medicine PYQs on OnCourse]

Q: In which portion of the esophagus do esophageal varices primarily occur?

Lower. **Lower** - Esophageal varices are most commonly found in the **distal (lower) third of the esophagus** [1] because this is where the portal venous system (short gastric and left gastric veins) anastomoses with the systemic venous system (white esophageal veins draining into the azygous system) [1]. - Increased portal pressure (e.g., in **portal hypertension** due to liver cirrhosis) causes blood to back up into these collateral vessels, leading to their dilation and formation of varices, particularly prominent in the lower esophagus [1]. *Upper* - While some collateral circulation exists throughout the esophagus, varices are not predominantly found in the upper portion as the primary portosystemic anastomoses responsible for variceal formation are more distal. - Varices in the upper esophagus are less common and typically less clinically significant in terms of bleeding risk. *Middle* - The middle portion of the esophagus has some venous drainage, but it is not the primary site for the significant portosystemic collaterals that lead to the formation of large, high-risk varices. - Varices can extend into the middle esophagus, but their origin and highest concentration are usually in the lower third. *All sites* - While varices can technically be found at various points along the esophagus, stating "all sites" is inaccurate because they have a **marked predilection for the lower third** due to specific anatomical venous connections [1]. - The risk of rupture and bleeding is also highest in the larger varices found in the lower esophagus [1]. [Practice more Internal Medicine PYQs on OnCourse]

Q: Extremities are warm in which type of shock

Neurogenic shock. ***Neurogenic shock*** - This type of shock is caused by a loss of **sympathetic tone**, leading to widespread **vasodilation** and a relative hypovolemia, resulting in warm, flushed extremities. - The decreased systemic vascular resistance causes **blood pooling** in the periphery rather than being shunted to vital organs, contributing to the warm skin. *Hypovolemic shock* - Characterized by **decreased blood volume**, leading to activation of the sympathetic nervous system and **vasoconstriction** to shunt blood to vital organs. - This results in **cold, clammy extremities** due to reduced peripheral perfusion. *Anaphylactic shock* - An acute, life-threatening hypersensitivity reaction involving massive release of inflammatory mediators, causing widespread **vasodilation** and increased vascular permeability. - While it can cause flushing and warmth initially due to vasodilation, it often leads to significant fluid shifts and can present with both warm and then cool, clammy skin as shock progresses. *Cardiogenic shock* - Caused by **severe cardiac pump failure**, leading to decreased cardiac output and poor tissue perfusion. - The body's compensatory mechanisms, including sympathetic activation, cause **peripheral vasoconstriction**, leading to **cold, clammy extremities**. [Practice more Internal Medicine PYQs on OnCourse]

Question 1

All are reversible causes of dementia except one.

Accepted Answer

Alzheimer's disease

Answer

Hydrocephalus

Answer

Meningoencephalitis

Answer

Hypothyroidism

Question 2

Which of the following statements about Wilson's disease is true?

Accepted Answer

Low serum ceruloplasmin and high urinary copper

Answer

Low serum ceruloplasmin and low urinary copper

Answer

High serum ceruloplasmin and low urinary copper

Answer

High serum ceruloplasmin and high urinary copper

Question 3

Which of the following statements about Alport's syndrome is incorrect?

Accepted Answer

Autosomal dominant

Answer

Nerve deafness

Answer

Glomerulonephritis

Answer

X-linked

Question 4

In which portion of the esophagus do esophageal varices primarily occur?

Accepted Answer

Lower

Answer

All sites

Answer

Upper

Answer

Middle

Question 5

Extremities are warm in which type of shock

Accepted Answer

Neurogenic shock

Answer

Hypovolemic shock

Answer

Anaphylactic shock

Answer

Cardiogenic shock

Question 6

In which condition is Serum Amyloid Associated (SAA) protein most commonly found?

Accepted Answer

Chronic inflammatory states

Answer

Alzheimer's disease

Answer

Malignant hypertension

Answer

Chronic renal failure

Answer

Acute myocardial infarction

Question 7

In which condition is the Doll's Eye Reflex tested?

Accepted Answer

Unconscious patients

Answer

Hemiplegic

Answer

Paraplegic

Answer

Cerebral palsy

Question 8

Major contribution to cachexia with advanced cancer?

Accepted Answer

Tumor-necrosis-factor (TNF)

Answer

Histamine

Answer

Interferon

Answer

Clathrin

Question 9

What is the immediate emergency treatment for carbon monoxide (CO) poisoning?

Accepted Answer

High flow O2

Answer

5% CO2 inhalation

Answer

10% CO2 inhalation

Answer

Nitroglycerine

Question 10

In which non-neoplastic condition is CEA commonly elevated?

Accepted Answer

Inflammatory bowel disease

Answer

Pancreatitis

Answer

Hemolytic anemia

Answer

Liver disease

NEET-PG 2015 — Internal Medicine