NEET-PG 2015 - Internal Medicine Practice Questions

Q: Which of the following symptoms is least likely to be associated with hyponatremia?

Myalgia. Myalgia - While muscle cramps can occur with electrolyte imbalances, generalized myalgia (muscle pain) is not a typical or primary symptom of hyponatremia. - Hyponatremia primarily affects neurological function due to osmotic shifts in the brain. anorexia - Anorexia (loss of appetite) is a common, non-specific symptom of many metabolic disturbances, including hyponatremia, and often accompanies nausea and vomiting. - It arises from the general malaise and gastrointestinal upset associated with the condition. Convulsions - Convulsions are a severe neurological symptom of acute and profound hyponatremia, resulting from cerebral edema and increased intracranial pressure [1]. - This occurs when the brain swells due to the osmotic shift of water into brain cells. Drowsiness - Drowsiness is a frequent neurological manifestation of hyponatremia, indicative of altered mental status [1]. - It reflects impaired brain function due to the osmotic disturbances and potential cerebral edema [1].

Q: Macular sparing is associated with lesions in:

Lesions in the occipital cortex. ***Lesions in the occipital cortex*** - **Macular sparing** occurs when the central visual field (macula) is preserved despite damage to the occipital cortex, often due to its dual blood supply from the **middle cerebral artery** and the **posterior cerebral artery**. [2] - This phenomenon typically results from a **vascular lesion** in the occipital lobe, leading to a **homonymous hemianopia** with a distinct sparing of the foveal region. [2], [3] *Lesions in the optic nerve* - Lesions in the optic nerve cause **monocular vision loss** or central scotomas, rather than the homonymous visual field defects associated with macular sparing. [2] - Damage here affects the visual pathway **before** the optic chiasm, impacting the entire visual input from one eye. [2] *Lesions in the lateral geniculate body* - Lesions in the **lateral geniculate body (LGB)** produce **contralateral homonymous hemianopia** or quadrantanopia, but typically **do not exhibit macular sparing** as consistently as cortical lesions. - The LGB processes visual information from both eyes before relaying it to the visual cortex. [1] *Lesions in the optic chiasma* - Lesions in the **optic chiasma** classically cause **bitemporal hemianopia**, affecting the temporal visual fields of both eyes. [2] - This type of visual field defect is distinct from the homonymous defects seen with macular sparing, as it results from damage to the **crossing nasal fibers**. [2]

Q: Anisocoria in Horner's syndrome is due to

Disruption of the oculosympathetic pathway. ***Disruption of the oculosympathetic pathway*** - Horner's syndrome results from a lesion interrupting the **oculosympathetic pathway**, leading to classic symptoms of **miosis**, **ptosis**, and **anhidrosis** [1]. - The **miosis** (constricted pupil) specifically arises from the unopposed action of the **parasympathetic innervation** to the pupil dilatory muscles when sympathetic innervation is disrupted. *Disruption of the oculoparasympathetic pathway* - Disruption of the oculoparasympathetic pathway would result in **mydriasis** (dilated pupil), not miosis as seen in Horner's syndrome [2]. - This pathway is responsible for stimulating the **pupillary constrictor muscles**, and its disruption would lead to an inability to constrict the pupil [3]. *Disruption of the oculomotor nerve* - The **oculomotor nerve** (CN III) carries parasympathetic fibers to the eye, and its disruption typically causes a **fixed and dilated pupil** due to unopposed sympathetic action [3]. - Oculomotor nerve palsy also presents with **ptosis** and **down-and-out deviation** of the eye, which are not characteristic of isolated Horner's syndrome [1], [4]. *Disruption of the abducens nerve* - The **abducens nerve** (CN VI) solely innervates the **lateral rectus muscle**, responsible for abducting the eye. - Disruption of the abducens nerve causes **diplopia** and an inability to abduct the affected eye, with no direct impact on pupil size.

Q: Buboes form is which stage of LGV?

Secondary. ***Secondary*** - Buboes, which are swollen, painful lymph nodes, are a hallmark of the **secondary stage** of **Lymphogranuloma Venereum (LGV)** [1]. - This stage typically develops weeks after the initial infection, following the unnoticed or transient primary lesion. *Primary* - The primary stage of LGV is characterized by a **small, painless papule or ulcer** at the site of inoculation, which often goes unnoticed. - **Buboes are not formed** during this initial, often asymptomatic, phase. *Tertiary* - The tertiary stage of LGV involves **chronic inflammation** and **tissue destruction**, leading to complications like **genital elephantiasis**, rectal strictures, and fistulas. - While there is chronic lymphedema, the acute, painful buboes are characteristic of the secondary stage, not this late, destructive phase. *Latent* - The concept of a latent stage is not typically used to describe the progression of LGV in the same way as other infections like syphilis. - LGV progresses through distinct symptomatic primary, secondary, and potentially tertiary stages without a prolonged asymptomatic latency period between symptom presentations.

Q: What is the primary cause of Common Variable Immunodeficiency (CVID)?

Defective B cell differentiation. ***Defective B cell differentiation*** - CVID is characterized primarily by a failure of **B cells** to differentiate into **plasma cells**, which are responsible for producing antibodies [1]. - This defective differentiation leads to **hypogammaglobulinemia**, or low levels of immunoglobulins [1]. *Absent B cells* - Complete absence of B cells is characteristic of severe combined immunodeficiency (SCID) or X-linked agammaglobulinemia (XLA), not CVID [1]. - In CVID, B cells are typically present, but they are dysfunctional. *Reduced number of B cells* - While some patients with CVID may have reduced B cell numbers, this is not the primary or defining defect. - The key issue is the inability of existing B cells to mature and produce antibodies effectively. *Defective B cell function* - While B cell function is indeed defective in CVID, the root cause of this malfunction is specifically the **failure of differentiation** into mature plasma cells. - The B cells are unable to perform their primary function of antibody production due to this arrest in their development.

Q: Which of the following is the common cause of respiratory failure type 2 ?

Chronic bronchitis exacerbation. ***Chronic bronchitis exacerbation*** - **Chronic bronchitis** is a common cause of **Type 2 respiratory failure**, characterized by **hypercapnia** (elevated CO2) due to impaired alveolar ventilation [1]. - An exacerbation worsens **airflow obstruction** and leads to increased work of breathing and CO2 retention [1]. *Acute attack asthma* - While severe asthma can cause respiratory failure, it typically presents initially as **Type 1 (hypoxemic)**, with severe bronchospasm and V/Q mismatch [2]. - **Hypercapnia** in asthma is a sign of **severe, impending respiratory collapse** rather than the primary cause of respiratory failure. *ARDS* - **Acute Respiratory Distress Syndrome (ARDS)** is a classic cause of **Type 1 (hypoxemic) respiratory failure**, characterized by widespread inflammation and fluid accumulation in the lungs [2]. - ARDS primarily involves impaired oxygenation rather than CO2 elimination issues, unless it progresses to severe stages with significant muscle fatigue. *Pneumonia* - **Pneumonia** predominantly causes **Type 1 (hypoxemic) respiratory failure** due to consolidation and V/Q mismatch in affected lung areas, leading to impaired oxygen diffusion [2]. - While severe, widespread pneumonia can eventually lead to ventilatory failure, its initial and primary impact is on oxygenation.

Q: Saddle nose deformity is seen in?

Tertiary Syphilis. ***Tertiary Syphilis*** - **Saddle nose deformity** is a characteristic late manifestation of **tertiary syphilis** due to destructive lesions (gummas) affecting the nasal cartilage and bone [1], [2]. - It results from the **collapse of the nasal bridge**, leading to a flattened appearance [2]. *Primary Syphilis* - Characterized by a **chancre**, a painless ulcer, usually at the site of infection [1]. - This stage does not involve destructive lesions of the nose. *Secondary Syphilis* - Presents with a **widespread rash**, lymphadenopathy, and mucous patches [1]. - While systemic, it typically does not cause structural damage like saddle nose deformity. *Lupus Vulgaris* - This is a **cutaneous form of tuberculosis**, characterized by chronic, destructive skin lesions. - While it can cause facial disfigurement, saddle nose deformity is not a typical feature of lupus vulgaris.

Q: What is the PRIMARY evidence-based intervention for preventing catheter-associated urinary tract infections (CAUTIs)?

Closed drainage technique to minimize bacterial entry. ***Closed drainage technique to minimize bacterial entry*** - Maintaining a **closed drainage system** prevents the entry of bacteria into the urinary tract, which is a primary cause of CAUTIs. - This technique involves ensuring the connection between the catheter and the drainage bag remains sealed at all times, minimizing **environmental contamination**. *Prophylactic antibiotics are effective* - **Prophylactic antibiotics** are generally not recommended for routine CAUTI prevention due to concerns about **antibiotic resistance** and limited evidence of effectiveness [1]. - Their use is typically reserved for specific high-risk procedures or patient populations. *Use of face mask during catheter insertion* - While maintaining **asepsis** during catheter insertion is crucial, the use of a face mask specifically addresses **respiratory droplet transmission**, which is not the primary route of bacterial entry into the urinary system during catheterization. - **Sterile gloves** and a **sterile field** are more directly relevant for preventing contamination during insertion [1]. *Early catheter removal when clinically appropriate* - While **early catheter removal** is a critical strategy for CAUTI prevention by reducing dwell time, the question asks for the *primary* evidence-based intervention [1]. A **closed drainage system** directly addresses the mechanism of bacterial entry while the catheter is in place. - Reducing catheter duration minimizes risk, but the closed system ensures safety during the necessary period of catheterization.

Question 1

Which of the following is a cause of post-transplantation hypertension? I. Rejection II. Cyclosporine nephrotoxicity III. Renal transplant artery stenosis (RTAS) IV. Recurrent disease in the allograft. Select the correct option.

Accepted Answer

All of the options are correct causes of post-transplantation hypertension.

Answer

None of the above are correct causes.

Answer

I, II, and IV are correct causes.

Answer

I and III are correct causes.

Question 2

Which of the following symptoms is least likely to be associated with hyponatremia?

Accepted Answer

Myalgia

Answer

anorexia

Answer

Drowsiness

Answer

Convulsions

Question 3

Macular sparing is associated with lesions in:

Accepted Answer

Lesions in the occipital cortex

Answer

Lesions in the optic nerve

Answer

Lesions in the lateral geniculate body

Answer

Lesions in the optic chiasma

Question 4

Anisocoria in Horner's syndrome is due to

Accepted Answer

Disruption of the oculosympathetic pathway

Answer

Disruption of the oculoparasympathetic pathway

Answer

Disruption of the oculomotor nerve

Answer

Disruption of the abducens nerve

Question 5

Buboes form is which stage of LGV?

Accepted Answer

Secondary

Answer

Tertiary

Answer

Latent

Answer

Primary

Question 6

What is the recommended regimen for post-exposure prophylaxis for HIV?

Accepted Answer

Tenofovir disoproxil fumarate + Emtricitabine + Dolutegravir for 28 days

Answer

Zidovudine + Lamivudine + Lopinavir/ritonavir for 28 days

Answer

Tenofovir disoproxil fumarate + Emtricitabine + Raltegravir for 28 days

Answer

Single dose Tenofovir + Emtricitabine + Raltegravir

Question 7

What is the primary cause of Common Variable Immunodeficiency (CVID)?

Accepted Answer

Defective B cell differentiation

Answer

Defective B cell function

Answer

Absent B cells

Answer

Reduced number of B cells

Question 8

Which of the following is the common cause of respiratory failure type 2 ?

Accepted Answer

Chronic bronchitis exacerbation

Answer

Acute attack asthma

Answer

ARDS

Answer

Pneumonia

Question 9

Saddle nose deformity is seen in?

Accepted Answer

Tertiary Syphilis

Answer

Primary Syphilis

Answer

Secondary Syphilis

Answer

Lupus Vulgaris

Question 10

What is the PRIMARY evidence-based intervention for preventing catheter-associated urinary tract infections (CAUTIs)?

Accepted Answer

Closed drainage technique to minimize bacterial entry

Answer

Use of face mask during catheter insertion

Answer

Prophylactic antibiotics are effective

Answer

Early catheter removal when clinically appropriate

NEET-PG 2015 — Internal Medicine