NEET-PG 2015 - Internal Medicine Practice Questions

Q: Therapeutic phlebotomy is not done in which of the following conditions?

CML. 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].

Q: What is the most common cause of delirium?

Infection. ***Infection*** - **Infections**, particularly urinary tract infections (UTIs) or pneumonia, are a very common and often reversible cause of **delirium**, especially in elderly or immunocompromised patients [1]. - The systemic inflammatory response to infection can lead to neuroinflammation and direct effects on brain function, manifesting as acute changes in attention and cognition. *Liver failure* - While **liver failure** can cause **hepatic encephalopathy**, which presents with altered mental status, it typically has a more gradual onset and a different neurochemical profile than acute delirium caused by infection. - Hepatic encephalopathy is characterized by abnormal ammonia metabolism and often includes motor signs like **asterixis**, which are not universally present in delirium from infection. *Belladonna poisoning* - **Belladonna poisoning** (due to **anticholinergic toxicity**) can cause **delirium**, along with a constellation of symptoms like dilated pupils, dry mouth, and tachycardia. - However, it is a specific toxicological cause and not as broad or commonly encountered as infection as a general cause of new-onset delirium in hospitalized or elderly populations. *None of the options* - This option is incorrect because **infection** is indeed a very common and recognized cause of delirium [1].

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: 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 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: RULE OF HALVES RELATED TO-

HYPERTENSION. ***HYPERTENSION*** - The **rule of halves** in hypertension refers to the observation that often **only half of people** with hypertension are diagnosed, only half of those diagnosed are treated, and only half of those treated achieve adequate control. - This rule highlights challenges in the **diagnosis, treatment, and management** of hypertension at a population level. *OBESITY* - While obesity is a significant public health issue, the **rule of halves** is not a commonly used principle to describe its diagnosis and management. - Obesity is typically assessed using **Body Mass Index (BMI)** and associated health risks. *BLINDNESS* - The **rule of halves** is not a recognized concept in the context of blindness or visual impairment. - Blindness is often addressed through efforts in **prevention, treatment, and rehabilitation**. *BURNS* - The **rule of halves** is unrelated to the assessment or management of burns. - The severity of burns is commonly assessed using the **Rule of Nines** (Wallace Rule of Nines) [1] to estimate the percentage of total body surface area affected.

Q: Autosomal recessive Polycystic kidneys - all are true except -

USG shows salt and pepper appearance. ***USG shows salt and pepper appearance*** - The **"salt and pepper" appearance** on imaging is characteristic of **autosomal dominant polycystic kidney disease (ADPKD)** due to multiple renal cysts of varying sizes and associated vascular calcifications, not autosomal recessive polycystic kidney disease (ARPKD). - ARPKD typically presents with **enlarged, hyperechoic kidneys** with loss of corticomedullary differentiation on ultrasound due to numerous small cysts. *Defective gene is PKHD1* - The dysfunctional gene in **autosomal recessive polycystic kidney disease (ARPKD)** is indeed **PKHD1**, located on chromosome 6. - This gene encodes for **fibrocystin/polyductin**, a protein primarily found in renal and biliary epithelial cells, whose mutation leads to cyst formation. *Both kidneys show innumerable cysts* - ARPKD is characterized by **bilateral involvement** with diffuse dilation of the collecting ducts, leading to innumerable small cysts in both kidneys. - These cysts cause significant **renal enlargement** and can lead to severe renal dysfunction. *Seen in adults* - **Autosomal recessive polycystic kidney disease (ARPKD)** typically manifests in **infancy or childhood**, often prenatally or neonatally. - While some milder forms may present later in childhood, it is **not generally seen in adults**; adult-onset polycystic kidney disease is usually autosomal dominant (ADPKD) [1].

Question 1

Therapeutic phlebotomy is not done in which of the following conditions?

Accepted Answer

CML

Answer

Polycythemia vera

Answer

Hemochromatosis

Answer

Porphyria cutanea tarda

Question 2

What is the most common cause of delirium?

Accepted Answer

Infection

Answer

Liver failure

Answer

Belladonna poisoning

Answer

None of the options

Question 3

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 4

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

Accepted Answer

Psoriatic arthritis

Answer

Rickets

Answer

Hyperthyroidism

Answer

Addison's disease

Question 5

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 6

Rademecker complex in EEG is seen in -

Accepted Answer

SSPE

Answer

Kuru

Answer

cCJD

Answer

vCJD

Question 7

Lafora's disease presents with?

Accepted Answer

Myoclonic epilepsy

Answer

G.T.C.S

Answer

Petit mal epilepsy

Answer

Partial seizures

Question 8

Which of the following is a feature of crush syndrome -

Accepted Answer

Myoglobinuria

Answer

Hypophosphatemia

Answer

Hypokalemia

Answer

Hypercalcemia

Question 9

RULE OF HALVES RELATED TO-

Accepted Answer

HYPERTENSION

Answer

OBESITY

Answer

BLINDNESS

Answer

BURNS

Question 10

Autosomal recessive Polycystic kidneys - all are true except -

Accepted Answer

USG shows salt and pepper appearance

Answer

Defective gene is PKHD1

Answer

Both kidneys show innumerable cysts

Answer

Seen in adults

NEET-PG 2015 — Internal Medicine