NEET-PG 2015 - Internal Medicine Practice Questions

Q: Which of the following is NOT a common complication of acute pancreatitis?

Hypercalcemia. ***Hypercalcemia*** - Acute pancreatitis is primarily associated with **increased amylase levels** and **hyperlipidemia**, while hypercalcemia is generally a separate condition. - It is not a classical complication or result of acute pancreatitis, but rather might be a cause in cases like **hyperparathyroidism** [1]. *Subcutaneous fat necrosis* - This occurs as a result of **lipolysis** during acute pancreatitis due to the release of **lipases** into circulation [1]. - It is characterized by the presence of **fat necrosis** on the abdomen or buttocks. *Increased amylase level* - A hallmark of acute pancreatitis is **elevated levels of amylase** and sometimes lipase, indicating pancreatic inflammation [1]. - The rise typically occurs within the first 24 hours of the onset of pancreatitis. *Hyperlipidemia* - This is often found in acute pancreatitis due to excess **lipolysis**, leading to elevated triglycerides in the blood [1]. - It can be both a cause and a consequence of pancreatic inflammation, contributing to the disease process [1].

Q: Chronic hemolytic anaemia is associated with which of the following -

Black Pigment stone of the gall bladder. ***Black Pigment stone of the gall bladder*** - Chronic hemolytic anemia leads to increased **bilirubin**, particularly unconjugated bilirubin, which can result in the formation of **black pigment stones** [1]. - These stones are associated with conditions causing **excess bilirubin production**, such as sickle cell disease and thalassemia. *Brown Pigment stone of the gall bladder* - Brown pigment stones are primarily associated with **infection** and **biliary tract disorders**, not directly with chronic hemolytic anemia. - They are mainly composed of **calcium bilirubinate**, which arises in cases of **bacterial infections** or parasitic infestations. *Intestinal Obstruction* - While hemolytic anemia can have various complications, it is **not directly linked with intestinal obstruction**. - Obstruction typically arises from **mechanical causes** such as adhesions, tumors, or hernias, rather than from hemolytic processes. *Uric acid Renal Calculus* - Uric acid stones are formed due to conditions leading to **hyperuricemia** and are not a primary consequence of chronic hemolytic anemia. - They are often associated with **gout** and **certain metabolic disorders**, rather than hemolytic processes.

Q: All of the following are features of Zollinger Ellison syndrome except:

Beta cell tumours of the pancreas. ***Beta cell tumours of the pancreas*** - Zollinger-Ellison syndrome (ZES) is caused by **gastrinomas**, which are **neuroendocrine tumors** that typically arise from the **gastrin-producing G cells**, not the insulin-producing beta cells, of the pancreas or duodenum. - While pancreatic tumors are common in ZES, they are specifically **gastrinomas**, leading to excessive gastrin secretion. *Severe diarrhoea* - This is a common feature of ZES resulting from the **high acid output** reaching the small intestine. - The excessive acid inactivates pancreatic lipase, leading to **maldigestion** and stimulates fluid and electrolyte secretion, causing secretory diarrhea. *Very high acid output* - ZES is characterized by the **overproduction of gastrin**, which stimulates the parietal cells of the stomach to secrete large amounts of **hydrochloric acid**. - This leads to a significantly **increased basal and maximal acid output** in the stomach. *Intractable peptic ulcers* - The extremely high gastric acid secretion in ZES causes **multiple, recurrent, and often refractory peptic ulcers**, which can be located in atypical sites such as the jejunum. - These ulcers are typically difficult to treat with standard anti-ulcer medications due to the persistent gastric hypersecretion.

Q: Thyroid nodule in a 65 year old male who is clinically euthyroid is most likely to be

Follicular adenoma. ***Follicular adenoma*** - Typically presents as a **solitary, well-defined nodule** in euthyroid patients, making it a common finding in this demographic. - It is often **benign** and can be differentiated from malignancies through imaging and cytological evaluation. *Multinodular goiter* - Usually involves multiple nodules rather than a **single nodule**, and patients often present with thyroid dysfunction [1]. - More common in women, and does not fit the profile of a solitary nodule in a euthyroid male. *Follicular Carcinoma* - While it can present as a nodule, it typically involves **elevated risk factors** such as family history and certain genetic mutations. - Euthyroid status alone is insufficient for a diagnosis of malignancy without further alarming features. *Thyroid Cyst* - Cysts are usually **fluid-filled** and may not present as solid nodules, which are common in cases described. - They tend to be **asymptomatic** and are generally **benign**, lacking the solid characteristics of a follicular adenoma.

Q: A 65 year old female presents with a swelling in the neck diagnosed as a solitary thyroid nodule. The patient is investigated and a scan shows increased uptake of iodine. Serum T3 and T4 are elevated . Most probabe diagnosis is

Solitary Toxic Adenoma. A **solitary toxic adenoma** is a single thyroid nodule that autonomously produces thyroid hormones, leading to **hyperthyroidism**. The increased iodine uptake on scan reflects its hyperfunctional state, and elevated **T3/T4** confirms hyperthyroidism. [2] - The combination of a **solitary nodule**, **increased iodine uptake**, and **elevated thyroid hormone levels** is pathognomonic for a solitary toxic adenoma. [2] *Benign Thyroid Nodule* - A **benign thyroid nodule** without hyperfunction would typically show **normal or decreased iodine uptake** and **normal T3/T4** levels. [2] - While benign, such a nodule alone does not explain the **elevated T3/T4** or **increased iodine uptake**. *Follicular Carcinoma* - **Follicular carcinoma** is a type of thyroid cancer that typically presents as a **cold nodule** (decreased iodine uptake) and is usually **non-functional**, meaning it does not cause hyperthyroidism with elevated T3/T4. [2] - The presence of **increased iodine uptake** and **hyperthyroidism** makes follicular carcinoma highly unlikely. *Toxic Multinodular Goiter* - A **toxic multinodular goiter** involves **multiple nodules**, not a solitary one, that are autonomously functional and cause hyperthyroidism. [1] - While it causes **hyperthyroidism** and **increased iodine uptake**, the key differentiating factor here is the presentation as a **solitary nodule**.

Q: All of the following may lead to pneumatocele formation except which of the following?

ARDS. ***ARDS*** - **Acute Respiratory Distress Syndrome (ARDS)** is primarily characterized by **inflammatory lung injury**, leading to **alveolar edema**, but does not typically cause pneumatocele formation [1]. - Pneumatoceles are more likely associated with infections or mechanical ventilation, not with ARDS itself. *Staphylococcal pneumonia* - **Staphylococcal pneumonia** can lead to pneumatocele formation due to **necrotizing pneumonia**, where the formation of air-filled cysts occurs from lung tissue damage. - This type of pneumonia is associated with **Staphylococcus aureus** and can cause cavitary lesions. *Positive pressure ventilation* - **Positive pressure ventilation** can increase the risk of barotrauma, leading to the formation of pneumatocele through excess air entering lung tissue. - It is often used in cases of respiratory distress but can inadvertently contribute to pneumatocele development. *Hydrocarbon inhalation* - **Hydrocarbon inhalation** is linked to pneumonitis and can cause lung injury, leading to the formation of **pneumatoceles** as a result of **lung inflammation**. - Such inhalation can create **alveolar damage**, allowing for air-filled spaces to develop.

Q: Most common precipitant of Raynaud's phenomenon is

Exposure to cold. ***Exposure to cold*** - **Exposure to cold temperatures**, even mild cold, is the most frequent and characteristic trigger for **vasoconstriction** in Raynaud's phenomenon. - This leads to the classic **triphasic color changes** (white, blue, red) in the digits due to restricted blood flow. *Exposure to heat* - **Exposure to heat** generally causes **vasodilation**, which would alleviate rather than precipitate the symptoms of Raynaud's phenomenon. - While sudden temperature changes can sometimes be a factor, direct heat exposure is not a primary recognized trigger. *Psychosocial triggers* - **Emotional stress** and anxiety can indeed precipitate Raynaud's episodes in some individuals, as the **sympathetic nervous system** plays a role in vasoconstriction. - However, **cold exposure** remains the most common and potent precipitating factor across the majority of cases. *Exertion* - **Physical exertion** typically leads to **vasodilation** in working muscles and increased blood flow to the skin for heat dissipation. - It is not a common or direct precipitant of the localized vasoconstrictive attacks seen in Raynaud's phenomenon.

Q: Sausage finger appearance is associated with which of the following conditions?

Psoriatic arthritis. ***Psoriatic arthritis*** - **Dactylitis**, or "sausage finger," is a characteristic inflammatory finding in psoriatic arthritis, resulting from inflammation of the **entire digit** [1]. - This condition involves inflammation of tendons, joints, and soft tissues which leads to diffuse swelling of fingers or toes [1]. *Rickets* - Rickets is a bone-softening disease in children caused by **vitamin D deficiency**, leading to bone deformities like bowed legs or widened wrists. - It does not present with inflammatory dactylitis or "sausage digits." *Hyperthyroidism* - Hyperthyroidism is a condition of excessive thyroid hormone production, which can cause symptoms like **tremors**, **tachycardia**, and **weight loss** [2]. - It is not associated with dactylitis or changes in finger morphology. *Addison's disease* - Addison's disease results from **adrenal insufficiency**, leading to symptoms like **fatigue**, **skin hyperpigmentation**, and hypotension. - There is no clinical association between Addison's disease and "sausage finger" appearance.

Q: A 50 year old male presents with fever and malaise for 4 months and pain in the knees and ankles. Blood tests are normal apart from a raised ESR. Chest x-ray shows bilateral hilar adenopathy and pulmonary infiltrates most severe in the upper and mid zones. Mantoux test is negative. What is the most likely diagnosis?

Sarcoidosis. ***Sarcoidosis*** - The constellation of **bilateral hilar adenopathy**, pulmonary infiltrates (especially in upper/mid zones), **arthralgia** (knees and ankles), and a **negative Mantoux test** in a patient with unexplained fever and malaise is highly suggestive of sarcoidosis [1]. - A **raised ESR** is a non-specific inflammatory marker often seen in sarcoidosis. *Tuberculosis* - While tuberculosis can cause fever, malaise, pulmonary infiltrates, and elevated ESR, a **negative Mantoux test** makes primary or active tuberculosis less likely in an immunocompetent individual. - **Bilateral hilar adenopathy** is also less typical of primary pulmonary tuberculosis compared to sarcoidosis. *Asbestosis* - This is an **occupational lung disease** caused by asbestos exposure, primarily presenting with **progressive dyspnea** and **restrictive lung disease**. - It characteristically involves the **lower lobes**, causes **pleural plaques**, and is not typically associated with acute arthralgia, fever, or prominent hilar adenopathy. *Berylliosis* - This is another **occupational lung disease** resulting from beryllium exposure, often mimicking sarcoidosis both clinically and pathologically [2]. - However, without a history of **beryllium exposure** and given the classic presentation, sarcoidosis is a more prevalent default diagnosis [2].

Q: Which of the following syndromes is least likely to be associated with obesity?

Sipple syndrome. ***Sipple syndrome*** - Sipple syndrome, also known as **multiple endocrine neoplasia type 2**, is primarily associated with **medullary thyroid carcinoma** and does not typically correlate with obesity. - It includes signs like **pheochromocytoma** and **hyperparathyroidism**, but obesity is not a prominent feature. *Cushing syndrome* - Cushing syndrome leads to **excess cortisol**, commonly resulting in weight gain and central obesity [1]. - Characteristic features include **moon facies**, **buffalo hump**, and easy bruising, all associated with obesity [1]. *Pickwinian syndrome* - Pickwinian syndrome, characterized by **severe obesity**, is a condition primarily affecting physical stature and weight. - It is linked to **hypoventilation** and sleep apnea, reinforcing the presence of obesity. *Prader willi syndrome* - Prader-Willi syndrome is marked by **insatiable hunger** leading to **obesity** due to hypothalamic dysfunction [2]. - Individuals with this condition also demonstrate **hypotonia** and developmental delays, commonly accompanied by obesity [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1127-1129. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Central Nervous System Synapse, pp. 454-455.

Question 1

Which of the following is NOT a common complication of acute pancreatitis?

Accepted Answer

Hypercalcemia

Answer

Subcutaneous fat necrosis

Answer

Hyperlipidemia

Answer

Increased amylase level

Question 2

Chronic hemolytic anaemia is associated with which of the following -

Accepted Answer

Black Pigment stone of the gall bladder

Answer

Brown Pigment stone of the gall bladder

Answer

Uric acid Renal Calculus

Answer

Intestinal Obstruction

Question 3

All of the following are features of Zollinger Ellison syndrome except:

Accepted Answer

Beta cell tumours of the pancreas

Answer

Severe diarrhoea

Answer

Very high acid output

Answer

Intractable peptic ulcers

Question 4

Thyroid nodule in a 65 year old male who is clinically euthyroid is most likely to be

Accepted Answer

Follicular adenoma

Answer

Multinodular goiter

Answer

Thyroid cyst

Answer

Follicular carcinoma

Question 5

A 65 year old female presents with a swelling in the neck diagnosed as a solitary thyroid nodule. The patient is investigated and a scan shows increased uptake of iodine. Serum T3 and T4 are elevated . Most probabe diagnosis is

Accepted Answer

Solitary Toxic Adenoma

Answer

Benign Thyroid Nodule

Answer

Follicular Carcinoma

Answer

Toxic Multinodular Goiter

Question 6

All of the following may lead to pneumatocele formation except which of the following?

Accepted Answer

ARDS

Answer

Staphylococcal pneumonia

Answer

Positive pressure ventilation

Answer

Hydrocarbon inhalation

Question 7

Most common precipitant of Raynaud's phenomenon is

Accepted Answer

Exposure to cold

Answer

Exposure to heat

Answer

Psychosocial triggers

Answer

Exertion

Question 8

Sausage finger appearance is associated with which of the following conditions?

Accepted Answer

Psoriatic arthritis

Answer

Rickets

Answer

Hyperthyroidism

Answer

Addison's disease

Question 9

A 50 year old male presents with fever and malaise for 4 months and pain in the knees and ankles. Blood tests are normal apart from a raised ESR. Chest x-ray shows bilateral hilar adenopathy and pulmonary infiltrates most severe in the upper and mid zones. Mantoux test is negative. What is the most likely diagnosis?

Accepted Answer

Sarcoidosis

Answer

Tuberculosis

Answer

Asbestosis

Answer

Berylliosis

Question 10

Which of the following syndromes is least likely to be associated with obesity?

Accepted Answer

Sipple syndrome

Answer

Cushing syndrome

Answer

Prader willi syndrome

Answer

Pickwickian syndrome

NEET-PG 2015 — Internal Medicine