Which of the following is used to decrease the duration and severity of acute diarrhea?
Reduced osmolarity ORS does not contain which of the following ions?
Therapeutic phlebotomy is not done in which of the following conditions?
Tinel's sign is seen in which of the following conditions?
Which of the following is NOT typically associated with Kallmann's syndrome?
Which of the following is characterized by a solitary painless ulcer on genitalia?
What is the normal range for maximum phonation time in healthy adults?
Which of the following conditions is most commonly associated with cauda equina syndrome?
What does a motor score of 4 on the Glasgow Coma Scale indicate?
Increased ICP is shown by
NEET-PG 2015 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 101: Which of the following is used to decrease the duration and severity of acute diarrhea?
- A. Zn (Correct Answer)
- B. Mg
- C. Fe
- D. Ca
Explanation: ***Zn*** - **Zinc supplementation** has been shown to reduce the **duration** and **severity** of acute diarrhea, particularly in children in developing countries [1]. - It plays a crucial role in **immune function** and **intestinal integrity**, which helps in recovery from diarrheal episodes [1]. *Mg* - **Magnesium** is an essential mineral, but it is not directly used to decrease the duration or severity of acute diarrhea. - In fact, high doses of magnesium can act as a **laxative** and may worsen diarrhea. *Fe* - **Iron** is vital for red blood cell formation and oxygen transport, but it does not directly impact the duration or severity of acute diarrhea. - Iron supplementation is primarily used to treat **anemia**. *Ca* - **Calcium** is important for bone health and various metabolic processes, but it is not a primary intervention for reducing the duration or severity of acute diarrhea. - While sometimes used for mild digestive issues, it does not have the same evidence base as zinc for acute diarrhea.
Question 102: Reduced osmolarity ORS does not contain which of the following ions?
- A. Sodium
- B. Potassium
- C. Lactate (Correct Answer)
- D. Citrate
Explanation: ***Lactate*** - The **reduced osmolarity ORS** formulation replaced **bicarbonate** with **citrate** and does not contain lactate. - **Citrate** is preferred over lactate / bicarbonate due to its stability, longer shelf life, and ease of dissolution. *Sodium* - **Sodium** is a crucial component of ORS, as it is co-transported with glucose into enterocytes, facilitating water absorption through **solvent drag**. - Reduced osmolarity ORS has a **lower sodium concentration** (75 mEq/L) compared to standard ORS (90 mEq/L) to minimize hypernatremia risk and enhance water absorption. *Potassium* - **Potassium** is included in ORS to replace intestinal losses, as **diarrhea** leads to significant potassium depletion. - Maintaining adequate **potassium levels** is essential for normal cellular function and preventing hypokalemia-related complications. *Citrate* - **Citrate** is a component of ORS that serves as an **alkalinizing agent** to correct metabolic acidosis often associated with dehydration in diarrheal diseases. - It also enhances the absorption of sodium and water in the intestine.
Question 103: Therapeutic phlebotomy is not done in which of the following conditions?
- A. CML (Correct Answer)
- B. Polycythemia vera
- C. Hemochromatosis
- D. Porphyria cutanea tarda
Explanation: CML - **Chronic Myeloid Leukemia (CML)** is typically treated with targeted therapies like **Tyrosine Kinase Inhibitors** (e.g., Imatinib), not phlebotomy [1]. - Therapeutic phlebotomy is ineffective in managing the **hypercellularity** or symptoms associated with this condition compared to other conditions [1]. *Polycythemia vera* - Therapeutic phlebotomy is a key treatment in **Polycythemia vera** to reduce **hyperviscosity** symptoms. - This condition features increased red blood cell mass, which is directly addressed by phlebotomy. *Hemochromatosis* - In **Hemochromatosis**, phlebotomy is employed to lower **iron overload** by removing excess iron from the body. - This reduces the risk of complications such as **liver cirrhosis** and **diabetes** associated with iron excess. *Porphyria cutanea tarda* - Therapeutic phlebotomy is sometimes used in cases of **Porphyria cutanea tarda** to manage iron levels as a potential precipitating factor [2]. - It helps alleviate symptoms and prevent complications associated with **photosensitivity** and skin lesions [2].
Question 104: Tinel's sign is seen in which of the following conditions?
- A. Carpal tunnel syndrome (Correct Answer)
- B. Avascular necrosis of scaphoid
- C. Kienbock's Disease
- D. 1st carpometacarpal joint arthritis
Explanation: ***Carpal tunnel syndrome*** - **Tinel's sign** is elicited by lightly tapping over the median nerve at the wrist, which in carpal tunnel syndrome, reproduces tingling or pain in the median nerve distribution [1]. - This sign indicates **nerve compression** or irritation at the carpal tunnel, a hallmark of the condition [1]. *Avascular necrosis of scaphoid* - This condition involves **bone death** due to interrupted blood supply, leading to pain and reduced range of motion, but not nerve irritation. - Diagnosis is typically made with **imaging studies** like MRI, not by neurological signs like Tinel's. *Kienbock's Disease* - This is a form of **avascular necrosis of the lunate bone**, causing wrist pain and stiffness. - It does not involve nerve compression and therefore **Tinel's sign** would not be expected. *1st carpometacarpal joint arthritis* - This condition affects the **joint at the base of the thumb**, causing localized pain and stiffness during gripping or pinching. - Symptoms are related to **joint degeneration**, not nerve impingement, so Tinel's sign is not relevant.
Question 105: Which of the following is NOT typically associated with Kallmann's syndrome?
- A. Hypogonadotropic hypogonadism
- B. Anosmia
- C. Amenorrhea
- D. Excess stimulation of the HPO axis (Correct Answer)
Explanation: ***Excess stimulation of the HPO axis*** - Kallmann's syndrome is characterized by **hypogonadotropic hypogonadism**, meaning there is a deficiency in the secretion of **gonadotropin-releasing hormone (GnRH)** [1] from the hypothalamus. - This deficiency leads to *reduced* stimulation of the **hypothalamic-pituitary-ovarian (HPO)** axis, not excess stimulation. *Amenorrhea* - **Amenorrhea** (absence of menstruation) is a common presentation in females with Kallmann's syndrome due to the **hypogonadotropic hypogonadism**. - The lack of GnRH results in insufficient **follicle-stimulating hormone (FSH)** and **luteinizing hormone (LH)**, preventing ovarian function and regular menstrual cycles. *Hypogonadotropic hypogonadism* - This is a **defining feature** of Kallmann's syndrome, where the **hypothalamus fails to produce enough GnRH**, leading to low levels of FSH and LH from the pituitary. - The low gonadotropin levels subsequently cause the gonads (testes or ovaries) to produce insufficient sex hormones, resulting in **delayed or absent puberty** [1]. *Anosmia* - **Anosmia** (the inability to smell) is a classic and diagnostic feature of Kallmann's syndrome, distinguishing it from other forms of hypogonadotropic hypogonadism. - It occurs because the **GnRH-producing neurons** originate in the olfactory placode and fail to migrate correctly into the hypothalamus during embryonic development, disrupting both smell and GnRH secretion.
Question 106: Which of the following is characterized by a solitary painless ulcer on genitalia?
- A. Genital herpes
- B. Syphilis (Correct Answer)
- C. Traumatic injury
- D. Chancroid
Explanation: ***Syphilis*** - Primary syphilis typically presents as a **painless chancre** (ulcer) at the site of infection, usually the **genitalia**. - The painless nature is a key differentiating feature as it often goes unnoticed, allowing the disease to progress. *Genital herpes* - Characterized by multiple, small, often painful vesicles or ulcers that may coalesce [1]. - Lesions are typically tender or painful, unlike the **painless chancre** of syphilis [1]. *Traumatic injury* - While a traumatic injury can cause a solitary ulcer, it is usually painful and often associated with a clear history of trauma. - The ulcer's morphology and healing process may differ from a classic syphilitic chancre. *Chancroid* - Caused by *Haemophilus ducreyi*, chancroid presents as one or more painful, tender ulcers with ragged, undermined borders. - This is a significant differentiator from the **painless ulcer** seen in primary syphilis.
Question 107: What is the normal range for maximum phonation time in healthy adults?
- A. 15-25 seconds
- B. 40-45 seconds
- C. 30-35 seconds (Correct Answer)
- D. 8-12 seconds
Explanation: ***30-35 seconds*** - The **maximum phonation time (MPT)** is a measure of the longest period a person can sustain a vowel sound on a single breath. - A healthy adult typically has an MPT in the range of **30-35 seconds**, reflecting good respiratory and phonatory control. *8-12 seconds* - This range is generally considered **below normal** for a healthy adult and may indicate compromised **respiratory support** or **laryngeal function**. - A short MPT could be a sign of **vocal fold pathology** or **reduced breath support**. *15-25 seconds* - While better than 8-12 seconds, this range is still often considered **slightly lower than optimal** for healthy adults. - It might suggest subtle inefficiencies in **breath control** or **vocal fold coaptation**, though it's not severely pathological. *40-45 seconds* - An MPT in this range is **unusually long** and exceeds the typical normal values for most healthy adults. - While seemingly good, excessively long MPTs are not standard and might suggest unusual respiratory capacity or an outlier measurement.
Question 108: Which of the following conditions is most commonly associated with cauda equina syndrome?
- A. Herniated disc (Correct Answer)
- B. Trauma
- C. Tumor
- D. Spinal stenosis
Explanation: ***Herniated disc*** - A **large central disc herniation**, especially at the L4-L5 or L5-S1 level, often compresses multiple nerve roots of the **cauda equina** [1]. - This compression leads to the characteristic symptoms of **saddle anesthesia**, **bowel/bladder dysfunction**, and **bilateral leg weakness**. *Trauma* - While **severe trauma** to the lumbar spine (e.g., fractures, dislocations) can cause cauda equina syndrome, it is a less common cause than disc herniation [1]. - Trauma typically involves an acute, high-energy injury, distinct from the more gradual onset seen with disc pathology. *Tumor* - **Spinal tumors**, both primary and metastatic, can compress the cauda equina, but they are relatively rare compared to disc herniations [1]. - Tumor-related cauda equina syndrome often presents with more insidious symptom progression and may include systemic symptoms or a history of malignancy. *Spinal stenosis* - **Spinal stenosis** can cause compression of nerve roots, typically leading to neurogenic claudication. - While severe stenosis can contribute to cauda equina symptoms, it generally involves diffuse narrowing over multiple levels and is less likely to cause acute, severe cauda equina syndrome than a single, large disc herniation.
Question 109: What does a motor score of 4 on the Glasgow Coma Scale indicate?
- A. Decorticate posturing
- B. Withdrawal or flexion to pain (Correct Answer)
- C. Decerebrate posturing
- D. Localizes to pain
Explanation: A motor score of 4 on the **Glasgow Coma Scale (GCS)** signifies that the patient **withdraws or flexes their limb** away from a painful stimulus. - This response indicates a degree of purposeful movement but is not considered localization to the pain. *Decerebrate posturing* - This represents a GCS motor score of **2**, characterized by **extension and internal rotation of the arms** and extension of the legs in response to pain [1]. - It suggests severe damage to the **brainstem**, specifically below the red nucleus [1]. *Decorticate posturing* - This corresponds to a GCS motor score of **3**, where the patient exhibits **flexion and adduction of the arms** with extension of the legs to painful stimuli [1]. - It often indicates damage to the **corticospinal tracts** above the red nucleus [1]. *Localizes to pain* - This is a GCS motor score of **5**, where the patient **moves their hand beyond the chin** attempting to remove the painful stimulus. - It indicates a higher level of conscious response and purposeful movement compared to withdrawal.
Question 110: Increased ICP is shown by
- A. Reduction in GCS (Correct Answer)
- B. Pupil constriction (Miosis)
- C. Systemic hypotension
- D. Tachycardia
Explanation: ***Reduction in GCS*** - A **decrease in Glasgow Coma Scale (GCS)** score is a primary indicator of increased intracranial pressure (ICP) due to compromised brain function [1], [2]. - Increased ICP can lead to **cerebral ischemia** and neuronal damage, manifesting as altered consciousness and lower GCS scores [1]. *Pupil constriction (Miosis)* - **Miosis**, or pupil constriction, is typically associated with **pontine lesions** or **opioid use**, and rarely directly with increased ICP unless it specifically involves brainstem compression at the pontine level. - Increased ICP more commonly causes **pupil dilation (mydriasis)**, especially unilateral, due to compression of the oculomotor nerve (CN III) [1]. *Systemic hypotension* - **Systemic hypotension** is generally *not* a direct sign of increased ICP; rather, increased ICP often results in **systemic hypertension** as part of Cushing's triad. - Hypotension in the context of brain injury might indicate **spinal shock** or other systemic issues, but generally not directly elevated ICP. *Tachycardia* - **Tachycardia** is also *not* typically associated with increased ICP; instead, **bradycardia** (slow heart rate) is a hallmark sign, forming part of Cushing's triad. - Tachycardia might suggest **hypovolemia**, **pain**, or other systemic stressors, but not directly increased ICP.