Which of the following is not associated with Carney's triad?
Which of the following conditions is least likely to cause multiple painful ulcers on the tongue?
Which fluid is ideally given for a patient experiencing dehydration?
What is the appropriate fluid management in the case of an intracerebral hemorrhage?
Which of the following statements about drug-induced SLE is NOT true?
A man working in a hot environment and consuming large amounts of water without replacing salts is likely to develop -
After a road traffic accident, a patient presented to casualty with vitals showing BP of 90/60 mm Hg and heart rate of 56 bpm. Which kind of shock occurs?
Classic triad in Renal cell carcinoma includes all of the following, Except:
All of the following are paraneoplastic syndromes for renal cell carcinoma except which of the following?
Pseudoclaudication is caused by
NEET-PG 2015 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 131: Which of the following is not associated with Carney's triad?
- A. Atrial myxoma (Correct Answer)
- B. GIST
- C. Chondroma
- D. Paraganglioma
Explanation: ***Atrial myxoma*** - Atriomyxoma is not part of **Carney's triad**, which primarily includes **paraganglioma**, **chondroma**, and **gastrointestinal stromal tumors (GIST)**. - Carney's triad is a rare genetic condition associated with **multiple neoplasms**, and atrial myxomas are cardiac tumors, not part of this triad. *Paraganglioma* - Paragangliomas are tumors derived from **neuroendocrine cells**, and they are one of the key components of **Carney's triad**. - They typically arise in **chromaffin tissue**, which is involved in catecholamine secretion. *Chondroma* - Chondromas are benign tumors of **cartilage**, also recognized as a component of **Carney's triad**. - They are often found in the **bones** or soft tissues, but they are part of the neoplasms associated with this condition. *GIST* - Gastrointestinal stromal tumors (GISTs) are significant neoplasms linked to **Carney's triad**, arising from **interstitial cells of Cajal** in the GI tract. - They are characterized by specific mutations and can be a source of gastrointestinal symptoms in affected individuals.
Question 132: Which of the following conditions is least likely to cause multiple painful ulcers on the tongue?
- A. TB
- B. Herpes
- C. Behcet disease
- D. Sarcoidosis (Correct Answer)
Explanation: ***Sarcoidosis*** - While sarcoidosis can affect any organ, **oral involvement is rare** and typically presents as **nodules, plaques, or generalized swelling**, not usually multiple painful ulcers on the tongue. - The lesions, when they occur, are often **painless** and appear as submucosal nodules, red patches, or diffuse swelling. *TB* - Oral tuberculosis can present as **multiple painful ulcers** on the tongue, often with a **granulomatous appearance** mimicking squamous cell carcinoma. - These ulcers are typically **irregular, undermined, and persistent**, often associated with pulmonary TB. *Herpes* - **Herpes simplex virus (HSV)** infection, particularly primary herpetic gingivostomatitis, commonly causes **multiple painful ulcers** on the tongue, gums, and other oral mucosa. - These ulcers begin as vesicles that **rupture to form painful erosions** and are a classic presentation of oral herpes. *Behcet disease* - **Oral aphthous ulcers** are a hallmark feature of Behcet disease, commonly presenting as **multiple, recurrent, painful ulcers** on the tongue and other oral mucosal surfaces. - These ulcers are clinically indistinguishable from common aphthous stomatitis but are more frequent and often associated with genital ulcers, skin lesions, and ocular inflammation.
Question 133: Which fluid is ideally given for a patient experiencing dehydration?
- A. Plasma
- B. Normal Saline (Correct Answer)
- C. Blood
- D. 5% dextrose
Explanation: ***Normal Saline*** - **Normal saline (0.9% sodium chloride)** is an **isotonic solution** that effectively increases **extracellular fluid volume**, making it ideal for treating **dehydration** and hypovolemia [1]. - It closely mimics the **osmolality of plasma** and stays predominantly in the intravascular space, helping to restore circulating volume [1]. *Plasma* - **Plasma** is primarily used for **coagulation factor deficiencies** or volume expansion in cases of severe **hypoproteinemia**, not routine dehydration. - It contains **proteins and clotting factors** that are not typically needed for simple dehydration and carries risks of **allergic reactions and transfusion-related acute lung injury (TRALI)**. *Blood* - **Blood transfusions** are indicated for patients with **significant anemia** or **acute blood loss**, not for generalized dehydration. - Using blood for dehydration would be inappropriate due to risks such as **transfusion reactions**, **infections**, and **iron overload**. *5% dextrose* - **5% dextrose in water (D5W)** is an **isotonic solution initially**, but once the dextrose is metabolized, it becomes **hypotonic**, causing free water to shift into the cells [1]. - While it provides some free water, it is not ideal for primary rehydration in cases of significant volume depletion due to its lack of electrolytes and potential for causing **hyponatremia** if given in large quantities [1].
Question 134: What is the appropriate fluid management in the case of an intracerebral hemorrhage?
- A. Normal saline (Correct Answer)
- B. Colloids
- C. Blood transfusion
- D. Hypertonic fluids
Explanation: **Normal saline** - **Normal saline (0.9% NaCl)** is the preferred fluid for volume maintenance in patients with **intracerebral hemorrhage (ICH)** as it is an isotonic crystalloid. - It helps maintain an adequate **cerebral perfusion pressure (CPP)** and avoids hypotonic effects that could worsen cerebral edema. *Colloids* - **Colloids** are generally avoided in ICH as they can potentially **increase intracranial pressure (ICP)** due to their osmotic effects within the damaged blood-brain barrier. - They are also associated with **increased risk of cerebral edema** and poor neurological outcomes in stroke patients. *Blood transfusion* - **Blood transfusions** are indicated only in cases of significant **anemia** (typically hemoglobin < 7-8 g/dL) or active bleeding where oxygen delivery to the brain is compromised. - Routine blood transfusion without clear indication is not part of standard fluid management for ICH and carries risks. *Hypertonic fluids* - **Hypertonic saline (e.g., 3% NaCl)** or **mannitol** are used specifically for the acute management of **elevated intracranial pressure (ICP)**, not for routine fluid maintenance. - While they improve cerebral perfusion by reducing brain edema, their continuous use as maintenance fluid can lead to severe electrolyte imbalances and dehydration.
Question 135: Which of the following statements about drug-induced SLE is NOT true?
- A. Female: Male ratio=1:9 (Correct Answer)
- B. CNS involvement not common
- C. Renal involvement not common
- D. Anti-histone antibodies are negative
Explanation: ***Female: Male ratio=1:9*** - Drug-induced lupus erythematosus (DILE) typically has no significant **gender predilection**, unlike idiopathic SLE which has a marked female predominance (9:1 female: male ratio) [1]. - This statement is incorrect because the male:female ratio is closer to 1:1, or even male predominance, making the given ratio of 1:9 (female:male) false. *Anti-histone antibodies are negative* - **Anti-histone antibodies** are positive in 95% of patients with drug-induced lupus, making this statement incorrect. - The presence of anti-histone antibodies is a hallmark diagnostic feature of drug-induced lupus. *CNS involvement not common* - **Central nervous system (CNS) manifestations** are indeed uncommon in drug-induced lupus erythematosus. - This statement accurately reflects a key differentiating feature from idiopathic systemic lupus erythematosus (SLE), where CNS involvement can be significant [1]. *Renal involvement not common* - **Renal involvement** is rare in drug-induced lupus erythematosus. - This statement is true and helps distinguish drug-induced lupus from idiopathic SLE, where renal disease (lupus nephritis) is a frequent and serious complication [1].
Question 136: A man working in a hot environment and consuming large amounts of water without replacing salts is likely to develop -
- A. Heat hyperpyrexia
- B. Heat cramps (Correct Answer)
- C. Heat stroke
- D. Heat encephalopathy
Explanation: ***Heat cramps*** - **Heat cramps** are painful, involuntary muscle spasms that occur during or after strenuous activity in a hot environment, especially when there is excessive sweating and **inadequate salt replacement**. - The consumption of **large amounts of water** without replacing electrolytes further dilutes the remaining electrolytes, exacerbating the problem. *Heat hyperpyrexia* - **Heat hyperpyrexia** is characterized by a very high core body temperature (typically >106°F or 41.1°C) without central nervous system dysfunction [1]. - While it involves extreme heat exposure, the primary problem described (muscle cramps due to fluid and **electrolyte imbalance**) is not hyperpyrexia itself but a milder heat illness. *Heat stroke* - **Heat stroke** is a severe, life-threatening condition involving a dangerously elevated body temperature (>104°F or 40°C) along with **central nervous system dysfunction** (e.g., altered mental status, seizures) [1], [2]. - Although strenuous activity and heat exposure contribute, the predominant symptoms described are muscle cramps, not the systemic collapse characteristic of heat stroke. *Heat encephalopathy* - **Heat encephalopathy** refers to the neurological manifestations of severe heat illness, particularly **heat stroke**, involving altered mental status, confusion, and possibly seizures. - While heat cramps are a form of heat illness, they primarily involve muscle symptoms and do not typically include direct brain dysfunction as the primary feature.
Question 137: After a road traffic accident, a patient presented to casualty with vitals showing BP of 90/60 mm Hg and heart rate of 56 bpm. Which kind of shock occurs?
- A. Cardiogenic
- B. Neurogenic (Correct Answer)
- C. Hypovolemic shock
- D. Septic shock
Explanation: ***Neurogenic*** - This patient presents with **hypotension** (BP 90/60 mm Hg) and **bradycardia** (heart rate 56 bpm), which is a classic presentation of neurogenic shock due to **loss of sympathetic tone** following a spinal cord injury [2]. - The road traffic accident suggests a potential **spinal cord injury**, leading to disruption of the autonomic nervous system's control over heart rate and vascular tone. *Cardiogenic* - Cardiogenic shock is characterized by **hypotension** and **tachycardia**, often due to the heart's inability to pump blood effectively, such as in a myocardial infarction [1]. - The reported **bradycardia** in this patient makes cardiogenic shock unlikely. *Hypovolemic shock* - Hypovolemic shock results from significant **fluid loss**, leading to **hypotension** and a compensatory **tachycardia**. - The presence of **bradycardia** rules out hypovolemic shock, as the body would typically try to increase heart rate to compensate for volume depletion. *Septic shock* - Septic shock is caused by a severe **infection**, leading to widespread vasodilation, **hypotension**, and often **tachycardia** with signs of systemic inflammation. - There is no indication of infection, and the **bradycardia** is inconsistent with the typical presentation of septic shock.
Question 138: Classic triad in Renal cell carcinoma includes all of the following, Except:
- A. Hematuria
- B. Hypertension (Correct Answer)
- C. Flank mass
- D. Abdominal Pain
Explanation: ***Hypertension*** - While hypertension can occur in patients with renal cell carcinoma due to **renin secretion** or other mechanisms, it is **not considered one of the classic triad symptoms**. - The classic triad represents symptoms that historically led to diagnosis, though most RCCs are now discovered incidentally. *Hematuria* - **Gross or microscopic hematuria** is a common symptom of renal cell carcinoma [1], resulting from tumor invasion into the collecting system. - It is one of the **three classic symptoms** associated with advanced disease. *Flank mass* - A palpable **flank mass** indicates a sizable tumor infiltrating the renal parenchyma and is a classic sign of renal cell carcinoma [1]. - This symptom is often associated with later-stage disease. *Abdominal Pain* - **Flank pain** or abdominal pain is a frequent symptom of renal cell carcinoma, which may be caused by tumor growth, hemorrhage, or obstruction. - This symptom, along with hematuria and a flank mass, constitutes the **classic diagnostic triad**.
Question 139: All of the following are paraneoplastic syndromes for renal cell carcinoma except which of the following?
- A. Fever
- B. Amyloidosis
- C. Anaemia
- D. Acanthosis Nigricans (Correct Answer)
Explanation: Acanthosis Nigricans - Acanthosis nigricans is primarily associated with **insulin resistance** and is not a known paraneoplastic syndrome related to renal cell carcinoma. - Paraneoplastic syndromes typically involve **systemic effects** of tumors rather than dermatological manifestations like acanthosis nigricans. *Fever* - Fever can occur as a result of the body's response to tumors, including renal cell carcinoma, and is classified as a **paraneoplastic syndrome**. - It reflects the **systemic inflammatory response** often seen with malignancies. *Anaemia* - Anaemia is a common paraneoplastic syndrome associated with renal cell carcinoma due to the production of **erythropoietin** or as a result of **chronic disease** [1]. - It can lead to **fatigue** and pallor in affected individuals, making it relevant to renal cancers [1]. *Amyloidosis* - Amyloidosis can occur as a paraneoplastic syndrome in various malignancies, including renal cell carcinoma, due to **protein misfolding** states. - It can lead to complications affecting **kidney function** and other organs, aligning it with renal cell carcinoma, though kidney tumors also frequently present with hypercalcemia [1].
Question 140: Pseudoclaudication is caused by
- A. Femoral Artery stenosis
- B. Popliteal Artery stenosis
- C. Lumbar canal stenosis (Correct Answer)
- D. Radial Artery stenosis
Explanation: ***Lumbar canal stenosis*** - **Pseudoclaudication**, also known as **neurogenic claudication**, is a characteristic symptom of **lumbar canal stenosis**. - It is caused by **compression of spinal nerve roots** in the lumbar spine, leading to pain, numbness, or weakness in the legs, often exacerbated by standing or walking and relieved by sitting or stooping forward [1]. *Femoral Artery stenosis* - **Femoral artery stenosis** causes **vascular claudication**, which is pain in the leg muscles due to insufficient blood flow during exercise [2]. - Unlike pseudoclaudication, vascular claudication is typically relieved by rest and is not influenced by spinal position [2]. *Popliteal Artery stenosis* - **Popliteal artery stenosis** also leads to **vascular claudication**, presenting as calf pain during walking due to reduced blood supply to the distal leg [2]. - This condition is related to **peripheral artery disease**, distinct from neurological compression [2]. *Radial Artery stenosis* - **Radial artery stenosis** typically affects blood flow to the **hand and forearm**, potentially causing symptoms of ischemia in those areas. - It is not associated with leg pain or claudication.