NEET-PG 2015 - Internal Medicine Practice Questions

Q: What is the immediate emergency treatment for carbon monoxide (CO) poisoning?

High flow O2. ***High flow O2*** - **High-flow oxygen** is the immediate emergency treatment for CO poisoning because it helps to displace CO from **hemoglobin**, thereby increasing oxygen delivery to tissues [1], [2]. - CO has a much **higher affinity** for hemoglobin than oxygen, so administering high concentrations of oxygen helps to reverse this binding and accelerate CO elimination [2]. *5% CO2 inhalation* - Administering **CO2** would worsen the patient's condition as it can cause **respiratory acidosis** and increase cerebral blood flow, potentially exacerbating CO toxicity. - CO2 inhalation would not effectively displace **carbon monoxide** from hemoglobin. *10% CO2 inhalation* - Similar to 5% CO2, **10% CO2 inhalation** would be detrimental, leading to significant **acidosis** and further compromising respiratory function. - This treatment does not address the primary issue of **carbon monoxide** binding to **hemoglobin** [2]. *Nitroglycerine* - **Nitroglycerine** is a vasodilator primarily used for conditions like **angina** or **heart failure**; it has no role in treating CO poisoning. - It would not help in displacing **carbon monoxide** or improving tissue oxygenation.

Q: Which of the following is not a feature of Poststreptococcal Glomerulonephritis (PSGN)?

Normal C3 level. ***Normal C3 level*** - In Post-streptococcal glomerulonephritis (PSGN), **C3 levels are typically decreased** due to complement consumption during the inflammatory process. [1] - A **normal C3 level** would not be consistent with PSGN, as it suggests no significant complement activation. *Increased urea* - Increased urea can occur due to **impaired renal function**, which is common in PSGN due to glomerular inflammation. [1] - It's a typical finding reflecting the kidneys' inability to excrete waste products properly. *HTN* - Hypertension is frequently associated with PSGN due to **volume overload** and activation of the renin-angiotensin system. [1] [2] - It is a common clinical feature that results from increased fluid retention. *Increased creatinine* - Increased creatinine levels indicate **renal impairment**, which is characteristic of PSGN as kidney function is affected during this condition. [1] - This finding highlights the reduction in glomerular filtration rate (GFR), typical in glomerulonephritis. [2]

Q: Which type of thyroid cancer is associated with primary hyperparathyroidism and phaeochromocytoma?

Medullary carcinoma of the thyroid. ***Medullary carcinoma of the thyroid*** - Associated with **multiple endocrine neoplasia (MEN) syndrome type 2**, which includes primary hyperparathyroidism and phaeochromocytoma [1]. - Medullary carcinoma arises from **C cells** (parafollicular cells) and is linked with **elevated calcitonin** levels. *Papillary carcinoma of the thyroid* - The most common type of thyroid cancer, but **not associated** with MEN syndromes. - Typically presents as a solitary **nodule** and is linked with **radiation exposure** rather than endocrine syndromes. *Anaplastic carcinoma of the thyroid* - A highly aggressive and undifferentiated form of thyroid cancer, often associated with **poor prognosis**. - Usually arises in older adults and does not have associations with **hyperparathyroidism** or phaeochromocytoma. *Follicular carcinoma of the thyroid* - Characterized by **thyroid follicle formation** and can be associated with **iodine deficiency**, but not with MEN syndromes. - It usually presents as a **solitary thyroid nodule** and lacks connection with **primary hyperparathyroidism**.

Q: A patient presents with skin involvement and collar stud ulceration in the intestine observed on radiography. What is the most likely diagnosis?

Ulcerative colitis. ***Ulcerative colitis*** - **Collar stud ulcers** are a classic radiographic finding in **ulcerative colitis**, occurring when superficial ulcers undermine the mucosa. - While skin involvement can occur in ulcerative colitis (e.g., **erythema nodosum**, **pyoderma gangrenosum**), the characteristic intestinal ulcers are a strong indicator. *TB intestine* - Intestinal tuberculosis typically presents with **transverse ulcers** and **strictures**, often in the ileocecal region, rather than collar stud ulcers. - Skin involvement is less common and usually manifests as **lupus vulgaris** or **scrofuloderma**, which are distinct from the general "skin involvement" mentioned. *Intestinal Amebiasis* - Amebic colitis causes characteristic **flask-shaped ulcers** in the colon due to the parasite invading the submucosa, which are distinct from collar stud ulcers. - Skin involvement is rare but can occur as **cutaneous amebiasis**, presenting as chronic ulcers, which is not suggested by the general term. *Crohn's disease* - Crohn's disease is characterized by **skip lesions**, **transmural inflammation**, and **cobblestoning**, with deep, linear ulcers and fissures. - While skin manifestations like **erythema nodosum** and **pyoderma gangrenosum** can occur, classical collar stud ulcers are not typical for Crohn's disease.

Q: In which condition is the Doll's Eye Reflex tested?

Unconscious patients. ***Unconscious patients*** - The **Doll's Eye Reflex**, also known as the **oculocephalic reflex**, is a brainstem reflex used to assess brainstem function in **comatose or unconscious patients** [1]. - It is positive if the eyes move in the opposite direction to the head turn, indicating intact brainstem pathways [1]. *Hemiplegic* - **Hemiplegia** refers to paralysis on one side of the body, often due to stroke or brain injury. - While it can be associated with altered consciousness, the Doll's Eye Reflex specifically tests brainstem integrity in unconscious states, not the motor deficits of hemiplegia itself. *Paraplegic* - **Paraplegia** is paralysis affecting the lower half of the body. - This condition primarily involves spinal cord damage and does not directly relate to the assessment of brainstem function using the Doll's Eye Reflex. *Cerebral palsy* - **Cerebral palsy** is a group of disorders affecting movement, muscle tone, or posture, caused by damage to the developing brain. - While individuals with cerebral palsy may have neurological impairments, the Doll's Eye Reflex is not a primary diagnostic or assessment tool for this chronic condition; it is used acutely in unconscious states.

Q: Which subtype of Acute Myeloid Leukemia (AML) is associated with the best prognosis?

Acute promyeloblastic leukemia (M3). ***Acute promyeloblastic leukemia (M.3)*** [1] - **Best prognosis** in acute myeloid leukemia (AML) is associated with acute promyeloblastic leukemia due to its responsiveness to **all-trans retinoic acid (ATRA)** treatment. [1] - This type often presents with a **prominent coagulopathy**, but successful treatment can lead to **long-term remission**. *Acute monocytic leukemia* - Generally associated with **poor prognosis** and is characterized by a high white blood cell count and organ infiltration. - It lacks the favorable features seen in acute promyeloblastic leukemia, such as effective treatment outcomes. *Erythroleukemia* - Known for having a **poor prognosis** due to its aggressive nature and frequent association with complex chromosomal abnormalities. [1] - Treatment responses are often suboptimal compared to that of acute promyeloblastic leukemia. *Acute myelomonocytic leukemia* - Typically has an **intermediate prognosis** [1] and presents with a mixture of myeloid and monocytic features. - It does not have the same treatment responsiveness and favorable outcomes as seen in acute promyeloblastic leukemia.

Q: In which condition is Serum Amyloid Associated (SAA) protein most commonly found?

Chronic inflammatory states. ***Chronic inflammatory states*** [1][2] - Serum amyloid-associated protein is elevated in response to **chronic inflammation**, such as in rheumatic diseases and infections [1][2]. - It serves as a **biomarker** indicating systemic inflammation and is part of the **acute-phase response** [1]. *Chronic renal failure* - While renal failure can lead to amyloidosis, it is not a direct cause of serum amyloid-associated protein elevation. - **Renal impairment** is more associated with a decrease in clearance rather than production of amyloid proteins. *Alzheimer's disease* - Although amyloid plaques are a hallmark of Alzheimer's, they are related to **A-beta peptide**, not serum amyloid-associated protein. - Alzheimer's pathology primarily involves **neurodegeneration** rather than inflammatory response. *Malignant hypertension* - Malignant hypertension primarily affects the **vascular system** and does not directly involve the production of serum amyloid-associated protein. - It is characterized by end-organ damage, rather than a state of chronic inflammation. *Chronic inflammatory conditions like RA, TB & leprosy, osteomyelitis, ankylosing spondylitis, IBD, bronchiectasis, some tumors* [1][2] - While these conditions can be associated with systemic inflammation, they are too specific and do not comprehensively encompass the broader concept of **chronic inflammatory states**. - This option fails to highlight that serum amyloid-associated protein is a marker for **various chronic inflammatory states** beyond just those listed [1].

Q: Shrinking Lung Syndrome is seen in:

SLE. ***SLE*** - **Shrinking lung syndrome (SLS)** is a rare but recognized pulmonary manifestation of **systemic lupus erythematosus (SLE)** [1]. - It is characterized by **dyspnea**, **pleuritic chest pain**, and elevated diaphragms with reduced lung volumes, often without significant interstitial lung disease [1]. *Rheumatoid Arthritis* - While **rheumatoid arthritis** can cause various lung manifestations like **interstitial lung disease (ILD)**, pleural effusions, and rheumatoid nodules, **shrinking lung syndrome** is not typically associated with it [2]. - Lung disease in RA often involves **pulmonary fibrosis** or bronchiolitis, differing from the restrictive physiology of SLS. *Scleroderma* - **Scleroderma (Systemic Sclerosis)** commonly affects the lungs, primarily leading to **interstitial lung disease (ILD)** and **pulmonary hypertension** [1]. - **Shrinking lung syndrome**, with its characteristic restrictive pattern and elevated diaphragms, is not a typical presentation of lung involvement in scleroderma. *Sarcoidosis* - **Sarcoidosis** is characterized by the formation of **non-caseating granulomas**, primarily affecting the lungs and lymph nodes. - Lung involvement in sarcoidosis typically presents as **interstitial lung disease** or nodular infiltrates, not the distinct features of **shrinking lung syndrome** [3].

Q: What is the primary effect of beta blockers in the management of thyroid storm?

Provides rapid relief of symptoms. Detailed management of thyrotoxic crisis (thyroid storm) is a medical emergency where patients should be given propranolol, either oral or intravenous, to manage life-threatening symptoms [1]. ***Provides rapid relief of symptoms*** - Beta blockers primarily address the **adrenergic manifestations** of thyroid storm, such as **tachycardia**, **tremors**, anxiety, and palpitations [1]. - By blocking **beta-adrenergic receptors**, they provide rapid symptomatic relief and reduce cardiovascular stress, without affecting hormone levels [2]. Thyroid hormones normally increase the expression of genes for beta-adrenergic receptors and G-proteins, leading to increased heart rate and force of contraction [2]. *Increases metabolism of thyroxine* - Beta blockers do not increase the **metabolism** or breakdown of thyroxine; their action is primarily on the **peripheral effects** of thyroid hormones. - While some beta blockers like **propranolol** can inhibit the peripheral conversion of T4 to T3, this is a secondary effect and not their primary role in providing rapid symptomatic relief [1]. *Blocks thyroxine receptors* - Beta blockers do not block **thyroxine receptors**; thyroid hormones exert their effects by binding to intracellular receptors, not adrenergic receptors [2]. - Their action is on the **adrenergic system**, which is overstimulated by the high levels of thyroid hormones. *Decreases synthesis of thyroxine* - Beta blockers do not directly decrease the **synthesis of thyroxine** by the thyroid gland. - That action is performed by **antithyroid drugs** like methimazole and propylthiouracil, which inhibit hormone production [1].

Q: Extremities are warm in which type of shock

Neurogenic shock. ***Neurogenic shock*** - This type of shock is caused by a loss of **sympathetic tone**, leading to widespread **vasodilation** and a relative hypovolemia, resulting in warm, flushed extremities. - The decreased systemic vascular resistance causes **blood pooling** in the periphery rather than being shunted to vital organs, contributing to the warm skin. *Hypovolemic shock* - Characterized by **decreased blood volume**, leading to activation of the sympathetic nervous system and **vasoconstriction** to shunt blood to vital organs. - This results in **cold, clammy extremities** due to reduced peripheral perfusion. *Anaphylactic shock* - An acute, life-threatening hypersensitivity reaction involving massive release of inflammatory mediators, causing widespread **vasodilation** and increased vascular permeability. - While it can cause flushing and warmth initially due to vasodilation, it often leads to significant fluid shifts and can present with both warm and then cool, clammy skin as shock progresses. *Cardiogenic shock* - Caused by **severe cardiac pump failure**, leading to decreased cardiac output and poor tissue perfusion. - The body's compensatory mechanisms, including sympathetic activation, cause **peripheral vasoconstriction**, leading to **cold, clammy extremities**.

Question 1

What is the immediate emergency treatment for carbon monoxide (CO) poisoning?

Accepted Answer

High flow O2

Answer

5% CO2 inhalation

Answer

10% CO2 inhalation

Answer

Nitroglycerine

Question 2

Which of the following is not a feature of Poststreptococcal Glomerulonephritis (PSGN)?

Accepted Answer

Normal C3 level

Answer

HTN

Answer

Increased urea

Answer

Increased creatinine

Question 3

Which type of thyroid cancer is associated with primary hyperparathyroidism and phaeochromocytoma?

Accepted Answer

Medullary carcinoma of the thyroid

Answer

Papillary carcinoma of the thyroid

Answer

Anaplastic carcinoma of the thyroid

Answer

Follicular carcinoma of the thyroid

Question 4

A patient presents with skin involvement and collar stud ulceration in the intestine observed on radiography. What is the most likely diagnosis?

Accepted Answer

Ulcerative colitis

Answer

TB intestine

Answer

Intestinal Amebiasis

Answer

Crohn's disease

Question 5

In which condition is the Doll's Eye Reflex tested?

Accepted Answer

Unconscious patients

Answer

Hemiplegic

Answer

Paraplegic

Answer

Cerebral palsy

Question 6

Which subtype of Acute Myeloid Leukemia (AML) is associated with the best prognosis?

Accepted Answer

Acute promyeloblastic leukemia (M3)

Answer

Acute myelo monocytic leukemia.

Answer

Acute monocytic leukemia.

Answer

Erythro leukemia

Question 7

In which condition is Serum Amyloid Associated (SAA) protein most commonly found?

Accepted Answer

Chronic inflammatory states

Answer

Alzheimer's disease

Answer

Malignant hypertension

Answer

Chronic renal failure

Answer

Acute myocardial infarction

Question 8

Shrinking Lung Syndrome is seen in:

Accepted Answer

SLE

Answer

Rheumatoid Arthritis

Answer

Scleroderma

Answer

Sarcoidosis

Question 9

What is the primary effect of beta blockers in the management of thyroid storm?

Accepted Answer

Provides rapid relief of symptoms

Answer

Increases metabolism of thyroxine

Answer

Blocks thyroxine receptors

Answer

Decreases synthesis of thyroxine

Question 10

Extremities are warm in which type of shock

Accepted Answer

Neurogenic shock

Answer

Hypovolemic shock

Answer

Anaphylactic shock

Answer

Cardiogenic shock

NEET-PG 2015 — Internal Medicine