Internal Medicine
7 questionsWhich disease does not recur in the kidney after a renal transplant?
According to standard clinical practice guidelines, significant weight loss requiring medical evaluation is defined as:
Hepatic Encephalopathy is predisposed by all, Except:
Which of the following statements about alcoholic hepatitis is false?
What is the primary clinical application of the Rockall score?
Which of the following statements is true regarding amoebic liver abscess?
Which of the following is not a characteristic of Zieve syndrome?
NEET-PG 2015 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 931: 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 932: 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 933: Hepatic Encephalopathy is predisposed by all, Except:
- A. Constipation
- B. GI Bleeding
- C. Dehydration
- D. Hyperkalemia (Correct Answer)
Explanation: ***Hyperkalemia*** - **Hyperkalemia** is not a known trigger for hepatic encephalopathy; in fact, **hypokalemia** is a more common electrolyte disturbance that can precipitate it due to its effect on renal ammonia excretion. - Electrolyte imbalances that contribute to hepatic encephalopathy usually involve **hypokalemia**, **hyponatremia**, or **alkalosis**, which affect **ammonia metabolism** and neuronal excitability [1]. *Dehydration* - **Dehydration** can lead to **reduced renal perfusion**, impairing the kidneys' ability to clear **ammonia** and other toxins, thus increasing their concentration in the blood. - It also contributes to **hemoconcentration**, elevating blood **ammonia levels** and increasing the risk of hepatic encephalopathy [1]. *Constipation* - **Constipation** allows for a longer transit time of stool in the colon, providing more opportunity for **intestinal bacteria** to produce **ammonia** from protein breakdown [1]. - The increased production and absorption of ammonia from the gut contribute significantly to the **nitrogenous load** in the bloodstream, predisposing to hepatic encephalopathy [1]. *GI Bleeding* - **Gastrointestinal bleeding** (GI bleeding) introduces a large protein load (blood) into the GI tract, which is then broken down by bacterial action. - This breakdown generates a significant amount of **ammonia** and other nitrogenous compounds, which are then absorbed into the bloodstream, overwhelming the impaired liver's ability to detoxify them and precipitating hepatic encephalopathy [1].
Question 934: Which of the following statements about alcoholic hepatitis is false?
- A. Gamma glutamyl transferase is raised
- B. Alkaline phosphatase is raised
- C. SGOT is raised > SGPT
- D. SGPT is raised > SGOT (Correct Answer)
Explanation: ***SGPT is raised > SGOT*** - In **alcoholic hepatitis**, the ratio of **AST (SGOT)** to **ALT (SGPT)** is typically **2:1 or higher**, meaning SGOT is usually significantly higher than SGPT. - This is because alcohol depletes **pyridoxal phosphate**, a cofactor for ALT, leading to relatively lower ALT levels. *Gamma glutamyl transferase is raised* - **Gamma-glutamyl transferase (GGT)** is frequently elevated in **alcoholic liver disease**, including alcoholic hepatitis [1]. - It serves as a sensitive marker for **biliary tract injury** and **alcohol consumption** [1]. *SGOT is raised > SGPT* - This statement is **true** for alcoholic hepatitis, as the **AST (SGOT)** to **ALT (SGPT)** ratio is typically **2:1 or greater**. - The disproportionately high AST is a characteristic feature reflecting the **mitochondrial damage** caused by alcohol within hepatocytes [2]. *Alkaline phosphatase is raised* - **Alkaline phosphatase (ALP)** can be elevated in alcoholic hepatitis, although usually to a lesser extent than in obstructive jaundice [1]. - Its elevation often reflects superimposed **cholestasis** or **biliary inflammation** [1].
Question 935: What is the primary clinical application of the Rockall score?
- A. Upper GI bleeding (Correct Answer)
- B. Lower GI bleeding
- C. Hepatic encephalopathy
- D. IBD
Explanation: ***Upper GI bleeding*** - The **Rockall score** is a clinical risk assessment tool specifically designed to predict **re-bleeding** and **mortality** in patients admitted with **acute upper gastrointestinal bleeding** [1]. - It uses clinical parameters (age, shock, comorbidities) and endoscopic findings (diagnosis, stigmata of recent hemorrhage) to stratify risk [1]. *Lower GI bleeding* - The Rockall score is **not validated** for assessing risk in **lower gastrointestinal bleeding**, which has different etiologies and clinical courses. - Other scoring systems, like the **Blatchford score** or **Glasgow-Blatchford score**, might be used for initial risk assessment in GI bleeding, but Rockall is specific to upper GI [1]. *Hepatic encephalopathy* - **Hepatic encephalopathy** is a neuropsychiatric complication of liver cirrhosis, for which the Rockall score has **no diagnostic or prognostic utility**. - Its assessment involves grading the severity of neurological symptoms and identifying precipitating factors. *IBD* - Inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, is a chronic inflammatory condition of the GI tract. - The Rockall score is **irrelevant** in the assessment or management of **IBD**, which uses specific disease activity indices.
Question 936: Which of the following statements is true regarding amoebic liver abscess?
- A. May rupture into the pleural cavity.
- B. Mostly involving the right lobe of the liver. (Correct Answer)
- C. For asymptomatic luminal carriers, metronidazole is the drug of choice.
- D. Multiple abscesses is less common than a single abscess.
Explanation: ***Mostly involving the right lobe of the liver*** - The **right lobe** of the liver is the most common site for an amoebic liver abscess due to its larger size and preferential blood flow from the portal venous system, which drains the intestines where *Entamoeba histolytica* resides. - The **superior mesenteric vein**, draining the cecum and ascending colon (common sites for amebiasis), primarily feeds the right hepatic lobe. *May rupture into the pleural cavity* - While rupture can occur, the **peritoneal cavity** is a more common site of rupture for amoebic liver abscesses. - Rupture into the pleural cavity or lung is less frequent but can lead to **empyema** or **bronchopleural fistula** [1]. *For asymptomatic luminal carriers, metronidazole is the drug of choice* - **Metronidazole** is effective against invasive amoebiasis (like liver abscess or dysentery) but is not the drug of choice for asymptomatic luminal carriers. - For **asymptomatic luminal carriers**, **luminal amebicides** such as **paromomycin** or **diloxanide furoate** are used to eradicate cysts from the intestine [1]. *Multiple abscesses is less common than a single abscess* - **A single amoebic liver abscess** is more common than multiple abscesses [1]. - Multiple abscesses are typically seen in disseminated disease or immunocompromised individuals, though even then a solitary lesion is more frequent.
Question 937: Which of the following is not a characteristic of Zieve syndrome?
- A. Alcohol abuse
- B. Chronic pancreatitis (Correct Answer)
- C. Hemolysis
- D. Hypertriglyceridemia
Explanation: ***Chronic pancreatitis*** - **Zieve syndrome** is an acute, not chronic, condition, and its primary feature is not chronic pancreatic inflammation, though severe alcohol use can cause both. - While **alcohol abuse** is a risk factor for both Zieve syndrome and chronic pancreatitis, **chronic pancreatitis** itself is not considered a characteristic component of Zieve syndrome [1]. *Alcohol abuse* - **Alcohol abuse** is the underlying cause for the development of Zieve syndrome, leading to the characteristic triad of hemolytic anemia, hyperlipidemia, and jaundice. - It triggers the **liver damage** and metabolic disturbances that define the syndrome. *Hemolysis* - **Hemolysis** (destruction of red blood cells) is a key feature of Zieve syndrome, leading to **hemolytic anemia** and jaundice. - It results from increased red blood cell fragility and splenic sequestration exacerbated by altered lipid metabolism. *Hypertriglyceridemia* - **Hypertriglyceridemia** is a hallmark of Zieve syndrome, arising from impaired lipid metabolism secondary to alcohol-induced liver damage. - Elevated **triglyceride levels** contribute to red blood cell membrane abnormalities, thereby promoting hemolysis.
Pathology
2 questionsWhich is a hormone dependent liver tumor?
Which type of anemia is most commonly characterized by marked poikilocytosis and anisocytosis on peripheral blood smear?
NEET-PG 2015 - Pathology NEET-PG Practice Questions and MCQs
Question 931: Which is a hormone dependent liver tumor?
- A. Adenoma (Correct Answer)
- B. Hemangioma
- C. Hepatocellular carcinoma
- D. Hemangiopericytoma
Explanation: ***Adenoma*** - Hepatic adenomas are **hormone-dependent tumors** commonly associated with conditions like **oral contraceptive use** and are influenced by estrogen [1]. - These tumors can present as **benign liver masses**, but they have a risk of hemorrhage and malignant transformation [1]. *Hepatocellular carcinoma* - This is a **malignant tumor** of the liver primarily associated with cirrhosis and chronic liver disease, not directly hormone-dependent. - Risk factors include **viral hepatitis** and **alcohol exposure**, rather than hormonal influences. *Hemangioma* - Liver hemangiomas are **vascular lesions** that are usually asymptomatic and are **not hormone-dependent**. - They are the most common benign liver tumors, often discovered incidentally during imaging. *Hemangiopericytoma* - A rare tumor, hemangiopericytoma originates from **pericytes** around blood vessels and is not specifically associated with liver tissue or hormones. - It can arise in various organs but lacks the dependency on hormones seen in hepatic adenomas. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, p. 874.
Question 932: Which type of anemia is most commonly characterized by marked poikilocytosis and anisocytosis on peripheral blood smear?
- A. Megaloblastic anemia
- B. Iron deficiency anemia (Correct Answer)
- C. Nutritional anemia
- D. Thalassemia
Explanation: ***Iron deficiency anaemia*** - Characterized by **poikilocytosis** (abnormal shapes) and **anisocytosis** (variation in red blood cell sizes), which are common findings in iron deficiency [1]. - Typically results in **microcytic hypochromic anemia** [1], distinguishing it from other types of anemia. *Nutritional deficiency anaemia* - May present with various blood cell morphology but does not specifically exhibit **poikilocytosis** and **anisocytosis** characteristic of iron deficiency anemia. - Usually includes deficiencies like **vitamin B12** or **folate**, which result in **macrocytic anemia** instead. *Megaloblastic anaemia* - Primarily caused by deficiency of **vitamin B12** or **folate**, leading to large, immature red blood cells (megaloblasts) rather than varied shapes and sizes. - Associated with **hypersegmented neutrophils** in the blood smear, which differentiates it from iron deficiency anemia. *Thalassemia* - Characterized by **microcytic hypochromic red blood cells** and often involves **target cells** rather than generalized poikilocytosis and anisocytosis. - Typically presents with **hemolytic anemia** but does not show the same variability in cell shapes and sizes as seen in iron deficiency anemia. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 590-591.
Pharmacology
1 questionsAll of the following are characteristic features of treatment of iron deficiency anemia with oral iron supplements, except which of the following?
NEET-PG 2015 - Pharmacology NEET-PG Practice Questions and MCQs
Question 931: All of the following are characteristic features of treatment of iron deficiency anemia with oral iron supplements, except which of the following?
- A. Bioavailability is enhanced with vitamin C
- B. The proportion of iron absorbed reduces as hemoglobin improves
- C. The reticulocyte count should begin to increase within 7-10 days and peak at 2-4 weeks; this suggests good response to treatment
- D. The treatment should be discontinued immediately once hemoglobin normalizes to prevent side effects of iron (Correct Answer)
Explanation: ***The treatment should be discontinued immediately once hemoglobin normalizes to prevent side effects of iron*** - Treatment of **iron deficiency anemia** with oral iron supplements should continue for at least **3-6 months** after hemoglobin normalizes to replenish **iron stores**. - Premature cessation can lead to a rapid **recurrence of anemia** due to depleted iron reserves, despite normal hemoglobin levels. *Bioavailability is enhanced with vitamin C* - **Ascorbic acid (vitamin C)** creates an acidic environment in the stomach and reduces ferric iron (Fe3+) to ferrous iron (Fe2+), which is more readily absorbed. - This enhancement of **ferrous iron absorption** is a common practice to improve the efficacy of oral iron supplements. *The proportion of iron absorbed reduces as hemoglobin improves* - The body's **iron absorption mechanism** is tightly regulated by **hepcidin**, a hormone that increases when iron stores are sufficient. - As hemoglobin levels improve and iron stores are replenished, hepcidin levels rise, leading to a **decrease in iron absorption** to prevent iron overload. *The reticulocyte count should begin to increase in two weeks and peak in 4 weeks this suggests good response to treatment* - An increase in **reticulocyte count** by approximately **7-10 days** and peaking around **2-4 weeks** after starting iron therapy indicates that the bone marrow is effectively responding to the increased iron availability by producing new red blood cells. - This **reticulocytosis** is an early and reliable sign of a positive treatment response before a significant rise in hemoglobin is observed.