NEET-PG 2015 - Internal Medicine Practice Questions

Q: A 50-year-old female presents with wrist drop. Which nerve is most likely involved?

Radial Nerve. ***Radial Nerve*** - **Wrist drop** is a classic symptom of **radial nerve** injury, which compromises the innervation of the **extensor muscles** of the wrist and fingers. - The radial nerve supplies motor function to the **triceps brahii**, brachioradialis, supinator, and the wrist and finger extensors. *Ulnar Nerve* - Injury to the ulnar nerve typically causes a **claw hand deformity** due to paralysis of the **interossei** and **lumbricals 3 and 4**, with sparing of the finger extensors. - Patients experience weakness in **finger adduction and abduction**, as well as sensory loss over the medial 1.5 digits and hypothenar eminence. *Median Nerve* - Median nerve injury often results in an **ape hand deformity** or **hand of benediction** (when attempting to make a fist), affecting muscles responsible for **thumb opposition** and **flexion of digits 2 and 3**. - It would not cause wrist drop, as the wrist extensors are innervated by the radial nerve. *Musculocutaneous Nerve* - Injury to the musculocutaneous nerve primarily affects the **biceps brachii** and **brachialis muscles**, leading to weakness in **elbow flexion** and **supination of the forearm**. - It does not innervate any muscles responsible for wrist extension or flexion, therefore it would not cause wrist drop.

Q: Rademecker complex in EEG is seen in -

SSPE. ***SSPE*** - **Subacute sclerosing panencephalitis (SSPE)** is a rare, chronic, progressive encephalopathy characterized by a distinctive EEG pattern known as the **Rademecker complex**. - The **Rademecker complex** (also called Rademecker complexes or periodic stereotyped complexes) consists of high-amplitude, generalized, polyphasic delta waves that occur periodically every 4-15 seconds. *Kuru* - **Kuru** is a transmissible spongiform encephalopathy (TSE) with neurological symptoms like ataxia and tremors, but it does not typically show the **Rademecker complex** on EEG [1]. - EEG abnormalities in Kuru are generally non-specific and may include diffuse slowing, but not periodic complexes [1]. *cCJD* - **Classic Creutzfeldt-Jakob disease (cCJD)**, a prion disease, often shows characteristic **periodic sharp wave complexes (PSWCs)** on EEG. - These PSWCs are typically biphasic or triphasic, occurring at a frequency of 0.5-2 Hz, and are distinct from the slower, high-amplitude Rademecker complexes seen in SSPE. *vCJD* - **Variant Creutzfeldt-Jakob disease (vCJD)**, unlike cCJD, rarely or never shows the characteristic **periodic sharp wave complexes (PSWCs)** on EEG. - EEG findings in vCJD are usually non-specific, often showing generalized slowing without the unique periodic complexes seen in SSPE or cCJD.

Q: Lafora's disease presents with?

Myoclonic epilepsy. ***Myoclonic epilepsy*** - Lafora disease is a rare, neurodegenerative inherited disorder characterized by **progressive myoclonic epilepsy**. - Patients typically experience spontaneous or reflex-induced **myoclonic seizures**, often accompanied by falls [1]. *G.T.C.S* - While generalized tonic-clonic seizures (GTCS) can occur in Lafora disease as the condition progresses, they are not the primary or defining seizure type [3]. - The hallmark presentation is **myoclonic epilepsy**, which may then evolve to include GTCS. *Petit mal epilepsy* - **Petit mal epilepsy**, also known as absence seizures, is characterized by brief, sudden lapses of consciousness without loss of postural tone [1]. - This is a distinct epilepsy syndrome and not the typical presentation of Lafora disease. *Partial seizures* - **Partial seizures** originate in a specific area of the brain and can be simple or complex [2]. - While some focal signs might be observed as the disease advances, Lafora disease is primarily a generalized epilepsy characterized by myoclonus [1].

Q: Which of the following is a feature of crush syndrome -

Myoglobinuria. Myoglobinuria - **Myoglobinuria** is a hallmark of crush syndrome, resulting from the massive release of **myoglobin** from damaged muscle cells into the bloodstream [2]. - This excess myoglobin can precipitate in the renal tubules, leading to **acute kidney injury (AKI)** [1]. *Hypophosphatemia* - Crush syndrome typically results in **hyperphosphatemia**, not hypophosphatemia, due to the release of intracellular phosphate from damaged muscular cells. - The elevated phosphate levels contribute to reciprocal **hypocalcemia** through precipitation. *Hypokalemia* - Crush syndrome is characterized by **hyperkalemia**, caused by the release of intracellular potassium from damaged muscle cells. - **Hyperkalemia** is a significant and life-threatening complication due to its potential for cardiac arrhythmias. *Hypercalcemia* - Crush syndrome typically presents with **hypocalcemia** due to the precipitation of calcium with released phosphate and fatty acids. - Initial **hypocalcemia** may later be followed by **hypercalcemia** during the recovery phase, especially in those with renal failure, but hypocalcemia is more acute.

Q: Locomotor ataxia, a late manifestation of syphilis due to parenchymatous involvement of the spinal cord, is called

Tabes dorsalis. ***Tabes dorsalis*** - This condition is a **late manifestation of tertiary syphilis** caused by the demyelination and degeneration of the posterior columns and dorsal roots of the spinal cord [1], [2]. - It specifically leads to **locomotor ataxia** due to the loss of proprioception and vibration sense, characteristic of parenchymatous involvement [2]. *Syphilitic amyotrophy* - This is a rare form of neurosyphilis that presents with neurological symptoms primarily affecting **motor neurons**, leading to muscle weakness and atrophy. - It does not typically present as **locomotor ataxia** with sensory deficits as the primary feature. *Meningovascular syphilis* - This form of neurosyphilis predominantly affects the **blood vessels and meninges of the brain and spinal cord**, leading to infarcts and stroke-like symptoms. - While it can cause neurological deficits, it does not typically manifest as the specific sensory ataxia described as **tabes dorsalis**. *General paralysis of insane* - Also known as **general paresis**, this is another late manifestation of neurosyphilis primarily affecting the brain, leading to **dementia, personality changes, and psychiatric symptoms**. - While it involves parenchymatous brain damage, it does not present with **locomotor ataxia** as its defining feature.

Q: Prosopagnosia is:

Inability to recognize face. ***Inability to recognize face*** - **Prosopagnosia**, or **face blindness**, is a cognitive disorder characterized by an impaired ability to recognize familiar faces, including one's own. - This condition is often associated with damage to the **fusiform face area** in the brain, typically in the right hemisphere. *Inability to read* - The inability to read is known as **alexia** or **dyslexia**, which is distinct from the visual recognition deficit seen in prosopagnosia. - Alexia primarily involves difficulties with processing written language, not the visual recognition of faces. *Anosmia* - **Anosmia** refers to the complete or partial loss of the sense of smell and is a disorder affecting the olfactory system. - It is unrelated to visual processing or face recognition. *Inability to write* - The inability to write is termed **agraphia** or **dysgraphia**, a neurological condition that impairs writing ability. - This condition affects motor skills and language processing related to writing, not visual face recognition.

Question 1

A 50-year-old female presents with wrist drop. Which nerve is most likely involved?

Accepted Answer

Radial Nerve

Answer

Ulnar Nerve

Answer

Median Nerve

Answer

Musculocutaneous Nerve

Question 2

Rademecker complex in EEG is seen in -

Accepted Answer

SSPE

Answer

Kuru

Answer

cCJD

Answer

vCJD

Question 3

Lafora's disease presents with?

Accepted Answer

Myoclonic epilepsy

Answer

G.T.C.S

Answer

Petit mal epilepsy

Answer

Partial seizures

Question 4

Which of the following is a feature of crush syndrome -

Accepted Answer

Myoglobinuria

Answer

Hypophosphatemia

Answer

Hypokalemia

Answer

Hypercalcemia

Question 5

Locomotor ataxia, a late manifestation of syphilis due to parenchymatous involvement of the spinal cord, is called

Accepted Answer

Tabes dorsalis

Answer

Syphilitic amyotrophy

Answer

Meningo vascular syphilis

Answer

General paralysis of insane

Question 6

Prosopagnosia is:

Accepted Answer

Inability to recognize face

Answer

Inability to read

Answer

Anosmia

Answer

Inability to write

NEET-PG 2015 — Internal Medicine