NEET-PG 2015 - Internal Medicine Practice Questions

Q: Which of the following does not predispose to leukemia?

Alcohol. ***Alcohol*** - Alcohol consumption does not have a well-established association with an increased risk of leukemia compared to other factors. - While excessive alcohol can impact overall health, it is not considered a primary risk factor for developing leukemia. *Chemical exposure* - Certain chemicals, such as **benzene** and **formaldehyde**, are known to be **leukemogenic** and can increase the risk of leukemia. [1] - Occupational exposure to these chemicals has been linked to **acute myeloid leukemia (AML)** and other types of leukemia. [1] *Smoking* - Smoking has been clearly associated with an increased risk of **acute myeloid leukemia (AML)** and other hematologic malignancies. [1] - The toxins in tobacco smoke can cause **DNA damage**, contributing to the development of leukemia. *Genetic disorder* - Certain genetic disorders, like **Down syndrome** and **Fanconi anemia**, are associated with an increased risk of leukemia. - Individuals with these genetic predispositions have a higher likelihood of developing various forms of leukemia.

Q: Which of the following statements is false regarding the declaration of brain stem death in a hospital?

All of the above. ***All of the above*** - This option indicates that all the preceding statements are false. Let's analyze why each individual statement is indeed false in the context of brain stem death declaration [1]. - This implies there is a misunderstanding regarding each aspect of brain stem death criteria, which often requires specific conditions like a neurologist's involvement (though not always strictly mandatory in all protocols), ruling out drug overdose, and the patient being in a coma. *Presence of neurologist is not required* - This statement is false because while it's not universally mandated that a neurologist be one of the two certifying doctors, one of them must be a **senior physician (consultant)** and both must be experienced in brain stem death diagnosis. - In many settings, especially for complex cases or where local protocols specify, a neurologist or neurosurgeon's involvement is highly recommended or required to confirm brain stem death. *Drug overdose should be ruled out* - This statement is false because the absence of drugs that could **mimic brain stem death (e.g., sedatives, muscle relaxants)** is a crucial precondition for testing [3]. - It is essential to ensure that the patient's neurological state is not confounded by reversible causes like drug intoxication before proceeding with brain stem death tests [3]. *Patient must be in coma* - This statement is false because while a patient declared brain stem dead will indeed be in a coma, the criteria for **brain stem death** specifically focus on the irreversible cessation of brainstem function [1], not merely a comatose state [2]. - A coma is a precondition for assessing brain stem death, but the declaration itself requires specific tests demonstrating the absence of **brainstem reflexes** [4] and **apnea** [3], confirming the permanent loss of brainstem activity.

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: Which of the following findings is diagnostic of iron deficiency anemia?

Increased TIBC, decreased serum ferritin. ***Increased TIBC, decreased serum ferritin*** - **Iron deficiency anemia** is characterized by depleted iron stores, leading to a **decreased serum ferritin** level, which is the most sensitive and specific marker for iron deficiency [4]. - In response to low iron stores, the body upregulates iron absorption and transport mechanisms, resulting in an **increased Total Iron Binding Capacity (TIBC)**, as there are more transferrin molecules available to bind iron [1]. *Decreased TIBC, decreased serum ferritin* - While a **decreased serum ferritin** is consistent with iron deficiency, a **decreased TIBC** is more indicative of **anemia of chronic disease** [1], where the body sequesters iron, leading to reduced iron availability for binding. - In **anemia of chronic disease**, both ferritin (an acute phase reactant) and TIBC can be reduced due to the inflammatory state [1], [2]. *Increased TIBC, increased serum ferritin* - An **increased TIBC** is seen in iron deficiency, but an **increased serum ferritin** indicates adequate or even **overloaded iron stores**, which contradicts the diagnosis of iron deficiency anemia. - High ferritin levels can be seen in conditions like **hemochromatosis** (iron overload) or **inflammation**, where ferritin acts as an acute phase reactant [5]. *Decreased TIBC, increased serum ferritin* - This combination is typical of **anemia of chronic disease**, where inflammation causes **increased serum ferritin** (as an acute phase reactant) and a **decreased TIBC** due to reduced production of transferrin [1]. - In this type of anemia, iron is often trapped within macrophages, making it unavailable for erythropoiesis despite seemingly normal or elevated stores [3].

Q: Which of the following is true regarding carcinoid tumor?

Neuroendocrine tumor. ### Most common site is lung - Carcinoid tumors are more commonly found in the **gastrointestinal tract**, specifically the appendix and ileum, rather than the lungs [1]. - This statement is false as they can occur in the lungs but are not the most common site overall. ### Potentially malignant tumor - Carcinoid tumors can be classified as **malignant,** especially if they show aggressive behavior or metastasis. - Many carcinoid tumors, particularly those in the gastrointestinal tract, can be **non-functional** and less aggressive [1]. ### Neuroendocrine tumor - Carcinoid tumors are indeed a type of **neuroendocrine tumor**, arising from **neuroendocrine cells**. - This classification emphasizes their origin and potential for secretion of hormones like **serotonin**. ### Associated with serotonin production - Many carcinoid tumors produce **serotonin**, leading to symptoms like **carcinoid syndrome** when they metastasize, particularly to the liver [1]. - This statement is true, indicating their involvement in neuroendocrine secretions.

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: Which of the following statements about sickle cell disease is true?

Fetal hemoglobin inhibits sickling.. ***Sickling is reversible with oxygenation*** - When oxygen tension is restored, hemoglobin S can re-hydrate and revert to its normal shape, reducing sickling. - This reversible process is essential for managing episodes of vaso-occlusive crisis in sickle cell disease. *Fetal hemoglobin facilitates Sickling* - Fetal hemoglobin (HbF) actually inhibits sickling by stabilizing the erythrocyte shape and reducing the proportion of hemoglobin S [1]. - Individuals with higher levels of HbF experience fewer sickling-related complications [1]. *Sickling occurs both in heterozygous and homozygous state* - Sickling primarily occurs in the homozygous state (HbSS); heterozygotes (HbAS) usually do not experience significant sickling effects [1]. - Heterozygous individuals may have a selective advantage against malaria, but they are not prone to sickle cell crises. *Sickling Leads to decreased MCHC* - Sickling does not directly lead to decreased mean corpuscular hemoglobin concentration (MCHC); MCHC is typically normal in sickle cell patients. - In fact, sickle cell disease often results in hemolysis and can lead to increased MCHC in some cases.

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: In which condition is Tau protein primarily implicated?

Picks disease. Pick's disease - Pick's disease is a **frontotemporal dementia** characterized by aggregates of **hyperphosphorylated tau protein** within neurons, forming **Pick bodies**. - These tau inclusions lead to neuronal degeneration, particularly in the **frontal and temporal lobes**, causing distinct behavioral and language deficits. *Alzheimer's disease* - While **tau protein** is implicated in Alzheimer's disease through the formation of **neurofibrillary tangles**, the primary protein is **beta-amyloid**, which forms plaques [1]. - Alzheimer's disease typically presents with **memory loss** as the predominant initial symptom, unlike Pick's disease [1]. *Lewy body dementia* - Lewy body dementia is primarily characterized by the aggregation of **alpha-synuclein protein** into Lewy bodies within neurons. - While tau pathology can sometimes co-exist, it is not the **primary diagnostic hallmark** of this condition. *Amyloidosis* - Amyloidosis refers to a group of diseases characterized by the abnormal extracellular deposition of **insoluble fibrillar proteins** called amyloids. - The amyloid protein can be derived from various precursors, such as **amyloid light chains** or **serum amyloid A**, which is distinct from tau.

Q: What does ristocetin testing indicate in von Willebrand disease?

Decreased agglutination. ***Decreased agglutination*** - In von Willebrand disease, **ristocetin induces less agglutination** due to a deficiency or dysfunction of von Willebrand factor. - This results in **impaired platelet adhesion** [1], crucial for effective hemostasis. *Increased agglutination* - Would suggest an increased platelet interaction, which is **not characteristic of von Willebrand disease**. - It can occur in conditions with enhanced von Willebrand factor, unlike in this case. *No agglutination* - Suggests complete lack of platelet interaction, which is **not typical** in von Willebrand disease. - There is often some level of interaction, albeit reduced, not a total absence of agglutination. *Normal agglutination* - Indicates no abnormalities, which **contradicts the known pathology** of von Willebrand disease. - Patients typically demonstrate decreased levels of agglutination, not normal findings in this test.

Question 1

Which of the following does not predispose to leukemia?

Accepted Answer

Alcohol

Answer

Smoking

Answer

Chemical exposure

Answer

Genetic disorder

Question 2

Which of the following statements is false regarding the declaration of brain stem death in a hospital?

Accepted Answer

All of the above

Answer

Presence of neurologist is not required

Answer

Drug overdose should be ruled out

Answer

Patient must be in coma

Question 3

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 4

Which of the following findings is diagnostic of iron deficiency anemia?

Accepted Answer

Increased TIBC, decreased serum ferritin

Answer

Decreased TIBC, decreased serum ferritin

Answer

Increased TIBC, increased serum ferritin

Answer

Decreased TIBC, increased serum ferritin

Question 5

Which of the following is true regarding carcinoid tumor?

Accepted Answer

Neuroendocrine tumor

Answer

Associated with serotonin production

Answer

Potentially malignant tumor

Answer

Most common site is lung

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

Which of the following statements about sickle cell disease is true?

Accepted Answer

Fetal hemoglobin inhibits sickling.

Answer

Sickling is completely reversible with oxygenation, making it clinically insignificant.

Answer

Sickling leads to a significant increase in overall MCHC levels in the blood.

Answer

Sickling occurs exclusively in the homozygous state and never in the heterozygous state.

Question 8

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 9

In which condition is Tau protein primarily implicated?

Accepted Answer

Picks disease

Answer

Lewy body dementia

Answer

Amyloidosis

Answer

Alzheimer's disease

Question 10

What does ristocetin testing indicate in von Willebrand disease?

Accepted Answer

Decreased agglutination

Answer

Normal agglutination

Answer

Increased agglutination

Answer

No agglutination

NEET-PG 2015 — Internal Medicine