Duroziez's sign is associated with which of the following conditions?
Which of the following is NOT a common cause of acute renal failure?
Which condition is not associated with complement deficiency?
Which of the following conditions is a direct indication for initiating dialysis?
Which of the following statements about atrial myxomas is correct?
Which disease does not recur in the kidney after a renal transplant?
Murmur heard in aortic stenosis
According to standard clinical practice guidelines, significant weight loss requiring medical evaluation is defined as:
In the context of chest pain evaluation, which is the best way to differentiate between stable angina and NSTEMI?
Recrudescences are commonly seen in which type of malaria:
NEET-PG 2015 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 71: Duroziez's sign is associated with which of the following conditions?
- A. Aortic Regurgitation (Correct Answer)
- B. Pericardial effusion
- C. Tricuspid Regurgitation
- D. Mitral Stenosis
Explanation: ***Aortic Regurgitation*** - **Duroziez's sign** is a characteristic **systolic and diastolic bruit** heard over the femoral artery, indicative of significant **aortic regurgitation**. [1], [2] - This sign occurs due to the rapid antegrade and retrograde flow of blood during systole and diastole, respectively, caused by the incompetent aortic valve. [2] *Tricuspid Regurgitation* - **Tricuspid regurgitation** is primarily associated with **holosystolic murmur** best heard at the left lower sternal border, often increasing with inspiration (Carvallo's sign). - It does not produce arterial bruits like Duroziez's sign. *Pericardial effusion* - **Pericardial effusion** is characterized by the accumulation of fluid in the pericardial sac, which can lead to distant heart sounds, **pulsus paradoxus**, and electrical alternans on ECG. - It does not involve vascular bruits in peripheral arteries. *Mitral Stenosis* - **Mitral stenosis** classically presents with a **diastolic rumble** and an **opening snap**, typically heard at the apex. - It is a left-sided heart valve condition that does not cause peripheral arterial bruits.
Question 72: Which of the following is NOT a common cause of acute renal failure?
- A. Chronic kidney disease due to analgesic nephropathy (Correct Answer)
- B. Acute pyelonephritis
- C. Acute kidney injury from snakebite
- D. Acute kidney injury due to rhabdomyolysis
Explanation: Chronic kidney disease due to analgesic nephropathy - This is a cause of chronic kidney disease, characterized by gradual, irreversible kidney damage over a long period due to prolonged use of certain analgesics. [1] - It does not present as an acute, sudden decline in kidney function, which is the hallmark of acute renal failure. [1] Acute pyelonephritis - Severe cases of acute pyelonephritis (kidney infection) can lead to acute kidney injury due to sepsis, inflammation, and potential obstruction. [1] - The systemic inflammatory response and direct tissue damage can impair kidney function rapidly. [1] Acute kidney injury from snakebite - Snake envenomation can cause acute kidney injury through various mechanisms, including hemolysis, rhabdomyolysis, direct nephrotoxicity, and systemic hypotension. - These effects can lead to rapid and severe kidney damage. Acute kidney injury due to rhabdomyolysis - Rhabdomyolysis involves the breakdown of skeletal muscle tissue, releasing large amounts of myoglobin into the bloodstream. [1] - Myoglobin is toxic to the renal tubules, leading to acute tubular necrosis and rapid onset of acute kidney injury. [1]
Question 73: Which condition is not associated with complement deficiency?
- A. SLE
- B. PNH
- C. Membranous nephritis (Correct Answer)
- D. Hereditary angioedema
Explanation: Membranous nephritis - Membranous nephritis is associated with immune complex deposition rather than complement deficiencies. [1] - The disease is characterized by thickening of the glomerular basement membrane without significant complement involvement. [1] PNH - Paroxysmal nocturnal hemoglobinuria (PNH) is due to a defect in the GPI-anchor leading to complement-mediated hemolysis. - Complement activation plays a critical role in the destruction of red blood cells in this condition. Hereditary angioedema - Hereditary angioedema is caused by deficiencies in C1 inhibitor, leading to uncontrolled activation of complement. - This results in edema episodes, directly linked to complement pathway dysregulation. SLE - Systemic lupus erythematosus (SLE) involves complement consumption due to autoantibody formation against nuclear antigens. - The disease often presents with hypocomplementemia, indicating complement system involvement.
Question 74: Which of the following conditions is a direct indication for initiating dialysis?
- A. Severe metabolic acidosis
- B. Fluid overload
- C. Severe hyperkalemia (Correct Answer)
- D. Acute kidney injury
Explanation: ### Severe hyperkalemia - **Severe hyperkalemia** (potassium levels typically >6.5 mEq/L or rapidly rising, especially with ECG changes) is an immediate life-threatening indication for dialysis when conservative measures fail or are insufficient [1]. - Dialysis effectively removes **excess potassium** from the blood, preventing fatal cardiac arrhythmias. *Severe metabolic acidosis* - While **severe metabolic acidosis** (pH <7.1-7.2) can be an indication, it is often managed first with bicarbonate administration and is typically not a stand-alone **direct** *emergency* indication for dialysis unless accompanied by other severe features or resistance to medical therapy. - The decision to dialyze for acidosis often depends on the underlying cause, degree of renal failure, and response to initial management [2]. *Fluid overload* - **Fluid overload** is a common complication of kidney failure, but it becomes a *direct* indication for dialysis when it is **refractory to diuretic therapy** and causes life-threatening symptoms such as **pulmonary edema** [2]. - Without such refractory state and immediate danger, fluid overload itself is not always an *immediate* trigger for dialysis compared to severe hyperkalemia. *Acute kidney injury* - **Acute kidney injury** (AKI) is the underlying *condition* that can lead to indications for dialysis, but AKI itself is not a *direct indication* for dialysis. - Dialysis is initiated for the *complications* of AKI, such as refractory hyperkalemia, severe metabolic acidosis, or fluid overload, rather than the diagnosis of AKI alone [2].
Question 75: Which of the following statements about atrial myxomas is correct?
- A. More prevalent in males.
- B. Most myxomas are hereditary.
- C. Most commonly found in the Left Atrium. (Correct Answer)
- D. Distant metastasis is commonly observed.
Explanation: ***Most commonly found in the Left Atrium.*** - **Atrial myxomas** are typically found in the **left atrium** (approximately 75-80% of cases), often attached to the **interatrial septum** near the fossa ovalis. - Their presence in the left atrium can lead to **obstruction of the mitral valve**, causing symptoms mimicking mitral stenosis [1]. *More prevalent in males.* - **Atrial myxomas** are more common in **females** than males, with a female-to-male ratio of approximately 2:1. - This higher prevalence in women is a consistent finding in epidemiological studies of cardiac myxomas [2]. *Most myxomas are hereditary.* - The vast majority of **atrial myxomas** are **sporadic** (non-hereditary), accounting for about 90-95% of cases. - A small percentage (5-10%) are part of a familial syndrome known as **Carney complex**, which is an autosomal dominant disorder. *Distant metastasis is commonly observed.* - **Atrial myxomas** are generally **benign tumors** and do not metastasize to distant sites. - While they can embolize fragments, leading to systemic effects, these are not true metastases.
Question 76: Which disease does not recur in the kidney after a renal transplant?
- A. Alport syndrome (Correct Answer)
- B. Amyloidosis
- C. Goodpasture's syndrome
- D. Diabetic nephropathy (due to uncontrolled diabetes)
Explanation: **Alport syndrome** * **Alport syndrome** is a genetic disorder affecting type IV collagen, primarily in the kidney; recurrence is not observed in a renal allograft because the transplanted kidney provides new, healthy type IV collagen [2]. * The disease is due to a genetic defect in the recipient's collagen genes, so the transplanted kidney, which is genetically distinct, is not susceptible to the same primary disease process [2]. *Amyloidosis* * **Amyloidosis** can recur in the transplanted kidney, as it is a systemic disease where abnormal proteins continue to deposit in various organs, including the new kidney. * The underlying cause of amyloid production is typically not cured by a kidney transplant, making the new organ vulnerable to recurrence. *Goodpasture's syndrome* * **Goodpasture's syndrome** is an autoimmune disease where antibodies target type IV collagen in the glomerular basement membrane; these autoantibodies can attack the new kidney if they are still present at the time of transplant or re-emerge [1]. * Recurrence is a significant concern, although it can often be prevented by ensuring the patient is antibody-negative before transplantation and through immunosuppression [1]. *Diabetic nephropathy (due to uncontrolled diabetes)* * **Diabetic nephropathy** almost invariably recurs in the transplanted kidney if the recipient's diabetes remains uncontrolled after transplantation. * The metabolic environment, characterized by hyperglycemia, directly contributes to the damage of the new kidney, leading to the development of diabetic nephropathy over time.
Question 77: Murmur heard in aortic stenosis
- A. Apex, low pitch murmur associated with mitral valve issues
- B. Pan-systolic murmur, high pitch murmur associated with mitral regurgitation
- C. Left Sternal area, murmur indicating mitral regurgitation
- D. Right 2nd intercostal, high pitch systolic ejection murmur (Correct Answer)
Explanation: ***Right 2nd intercostal, high pitch systolic ejection murmur*** - The murmur of **aortic stenosis** is classically heard loudest at the **right second intercostal space** (aortic area) due to turbulent flow through the stenosed aortic valve. - It is a **high-pitched, systolic ejection murmur** with a crescendo-decrescendo pattern, often radiating to the carotid arteries [2]. *Apex, low pitch murmur associated with mitral valve issues* - A murmur heard at the **apex** that is low-pitched typically suggests **mitral stenosis**, which is a diastolic rumble, not an aortic stenosis murmur [1]. - This option refers to characteristics associated with **mitral valve disease**, not aortic stenosis. *Pan-systolic murmur, high pitch murmur associated with mitral regurgitation* - A **pan-systolic murmur** is characteristic of conditions like **mitral regurgitation** or tricuspid regurgitation, where blood flows throughout the entire systole [3]. - While it can be high-pitched, its pan-systolic nature and association with mitral regurgitation make it distinct from aortic stenosis. *Left Sternal area, murmur indicating mitral regurgitation* - Murmurs heard primarily at the **left sternal area** can indicate various conditions, but this option specifically points to **mitral regurgitation**. - **Mitral regurgitation** is better heard at the apex and usually radiates to the axilla, and the description does not fit the typical presentation of aortic stenosis [3].
Question 78: According to standard clinical practice guidelines, significant weight loss requiring medical evaluation is defined as:
- A. 5% weight loss in 1-2 months
- B. 10% weight loss in 2-3 months (Correct Answer)
- C. 5% weight loss in 2-3 months
- D. 10% weight loss in 1-2 months
Explanation: ***10% weight loss in 2-3 months*** - **Unexplained weight loss** of **10%** or more of usual body weight over a period of **2-3 months** is generally considered a significant amount requiring medical evaluation. - This degree of weight loss can be indicative of underlying serious medical conditions like cancer, gastrointestinal disorders, endocrine disorders, or chronic infections [1]. *5% weight loss in 1-2 months* - While any unexplained weight loss should be noted, a **5% loss** in this timeframe is usually not considered immediately "significant" enough to warrant an aggressive workup unless other concerning symptoms are present. - It might be due to minor lifestyle changes, temporary illness, or benign factors. *5% weight loss in 2-3 months* - A **5% weight loss** over **2-3 months** is a less critical threshold than 10% for initiating an extensive medical evaluation for serious underlying disease. - This level of weight change could be due to a variety of less severe causes or even normal fluctuations. *10% weight loss in 1-2 months* - While a **10% weight loss** is significant, the **1-2 month** timeframe is generally considered slightly too short to immediately classify it as "requiring medical evaluation" in the strictest sense compared to the 2-3 month period which allows for better observation. - Rapid weight loss over a very short period might sometimes be related to acute illness or dehydration rather than chronic underlying conditions, though still warrants attention.
Question 79: In the context of chest pain evaluation, which is the best way to differentiate between stable angina and NSTEMI?
- A. ECG
- B. Cardiac-biomarker (Correct Answer)
- C. Trans thoracic Echocardiography
- D. Multi uptake gated Acquisition scan
Explanation: **Cardiac-biomarker** - **Cardiac biomarkers**, particularly **troponin**, are crucial for differentiating between **unstable angina** and **NSTEMI** [1], [2]. In NSTEMI, there is evidence of **myocardial necrosis**, leading to elevated cardiac troponins [2]. - **Stable angina** and **unstable angina** do not involve myocardial necrosis, so troponin levels remain within the normal range [1]. *ECG* - While an **ECG** is essential in the initial assessment of chest pain, it may show **non-specific changes** in both **unstable angina** and **NSTEMI**, such as T-wave inversions or ST-segment depression [2]. - The definitive distinction of **NSTEMI** often relies on **sequential biomarker measurements**, as ECG changes alone may not be sufficient for diagnosis or differentiation from unstable angina [2]. *Trans thoracic Echocardiography* - **Echocardiography** can show **regional wall motion abnormalities** that might suggest ischemia, but these findings are not specific enough to differentiate between **stable angina** and **NSTEMI** immediately. - It is more useful for assessing **ventricular function**, identifying **valvular disease**, or detecting other causes of chest pain, rather than acute differentiation of coronary syndromes. *Multi uptake gated Acquisition scan* - A **MUGA scan** assesses **left ventricular ejection fraction** and wall motion, primarily used in evaluating global cardiac function and monitoring cardiotoxicity from chemotherapy. - It is **not a first-line diagnostic tool** for differentiating between acute coronary syndromes like **stable angina** and **NSTEMI** because it does not directly detect acute myocardial injury.
Question 80: Recrudescences are commonly seen in which type of malaria:
- A. P. vivax
- B. P. falciparum (Correct Answer)
- C. P. malariae
- D. P. ovale
Explanation: ***P. falciparum*** - **Recrudescence** refers to the reappearance of malaria symptoms after a period of remission, due to the survival and subsequent increase of asexual parasites in the blood [1]. - This is common in *P. falciparum* due to the high parasite burden and its ability to sequester in deep capillaries, evading splenic clearance and developing drug resistance. *P. vivax* - *P. vivax* is known for **relapses**, which are caused by the activation of dormant liver stages called **hypnozoites**, rather than a recrudescence of blood-stage parasites [1]. - Relapses can occur months or years after the initial infection, even after the blood-stage parasites have been cleared. *P. malariae* - *P. malariae* is uniquely characterized by infections that can persist for many years, even decades, causing symptoms of **recrudescence**, although less frequently than *P. falciparum* [1]. - It has a prolonged erythrocytic cycle, which can lead to chronic low-level parasitemia and sporadic symptomatic episodes. *P. ovale* - Similar to *P. vivax*, *P. ovale* also causes **relapses** due to the presence of **hypnozoites** in the liver [1]. - While it can manifest with symptoms similar to *P. vivax*, it is generally less common and causes milder disease.