NEET-PG 2020 - Internal Medicine PYQs Practice Questions

Q: In renal transplant recipients, which is the likely organism causing reactivation disease within 1 to 4 months after surgery?

CMV. ***CMV*** - **Cytomegalovirus (CMV)** is the most common viral infection causing significant morbidity and mortality in solid organ transplant recipients, often leading to **reactivation disease** within 1 to 4 months post-transplant due to immunosuppression [1]. - CMV disease can manifest in various forms, including **fever**, **leukopenia**, **gastroenteritis**, and potentially organ-specific involvement, mimicking transplant rejection [3]. *EBV* - **Epstein-Barr Virus (EBV)** reactivation is a concern in transplant recipients but is more strongly associated with the development of **post-transplant lymphoproliferative disorder (PTLD)**, which tends to occur later than the 1-4 month window for typical CMV reactivation [1]. - While EBV can cause a mononucleosis-like syndrome, its timeline and common severe complications differ from the typical CMV reactivation pattern [2]. *HSV* - **Herpes Simplex Virus (HSV)** reactivation is typically seen much earlier in transplant recipients, often within the first few weeks (usually 1-2 weeks) post-transplant [1]. - HSV reactivation typically presents as **mucocutaneous lesions** (e.g., cold sores, genital ulcers) rather than systemic disease in the 1-4 month window [3]. *VZV* - **Varicella-Zoster Virus (VZV)** reactivation (shingles) occurs in transplant recipients, but it generally has a slightly later onset than CMV, often beyond 4 months post-transplant or less commonly within the 1-4 month window [1]. - VZV reactivation typically presents as **dermatomal rash** and pain, which is distinct from the systemic symptoms of CMV disease. [Practice more Internal Medicine PYQs on OnCourse]

Q: In multiple sclerosis, where does the defect occur?

Myelin sheath. ***Myelin sheath*** - Multiple sclerosis (MS) is an autoimmune disorder characterized by the destruction of the **myelin sheath** in the central nervous system [3]. - The demyelination of nerve fibers impairs the **conduction of electrical signals**, leading to a wide range of neurological symptoms [3]. *Oligodendrocytes* - **Oligodendrocytes** are the cells responsible for **producing and maintaining the myelin sheath** in the central nervous system [1]. - While oligodendrocytes are directly involved in myelination, the primary defect in MS is the **destruction of the myelin itself**, not primarily a defect in the oligodendrocytes' ability to produce it initially [3]. *Node of Ranvier* - The **nodes of Ranvier** are gaps in the myelin sheath that allow for **saltatory conduction** of nerve impulses [1]. - While damage to the myelin sheath around the nodes can affect their function, the primary defect in MS is the **loss of the insulating myelin material**, not a structural defect in the nodes themselves [2]. *Neuroglial cells* - **Neuroglial cells** (or glial cells) encompass various cell types, including oligodendrocytes, astrocytes, microglia, and ependymal cells, which support neurons [4]. - While glial cells (specifically oligodendrocytes) are involved in myelin production, and other glial cells like microglia can contribute to the inflammatory response in MS, the **direct defect leading to neurological impairment is the destruction of the myelin sheath**, not a general defect in all neuroglial cells [4]. [Practice more Internal Medicine PYQs on OnCourse]

Q: A middle-aged male presented with a history of fatigue and tiredness. On investigation, he had a hemoglobin level of 8 g/dL and a mean corpuscular volume (MCV) of 110 fl, with the peripheral smear showing macrocytes and hypersegmented neutrophils. Which of the following is the most likely cause of these findings in this patient?

Chronic alcohol use. ***Chronic alcoholism*** - **Macrocytic anemia** with a **hemoglobin level of 8 g/dL** is commonly seen in chronic alcoholism due to impaired erythropoiesis and folate deficiency. [1] - The **peripheral smear** showing **hypersegmented neutrophils** is indicative of megaloblastic anemia, often linked to **alcoholism**. [1] *Chronic renal failure* - Typically causes **normocytic anemia** due to inadequate erythropoietin production, not macrocytic anemia. [2] - While uremic effects can impact erythropoiesis, they usually do not produce **hypersegmented neutrophils** found in megaloblastic anemia. *Colon cancer* - More commonly causes **microcytic anemia** due to **iron deficiency** from chronic blood loss rather than macrocytic anemia. [2] - **Macrocytic anemia** with hypersegmented neutrophils would not be expected in most cases of colon cancer. *Ancylostoma duodenale infestation* - This hookworm infection typically leads to **microcytic anemia** due to **iron deficiency**, not macrocytic. [2] - The presence of **macrocytes** and **hypersegmented neutrophils** does not correlate with this type of anemia. [Practice more Internal Medicine PYQs on OnCourse]

Q: A 13-year-old child visits the OPD with complaints of not attaining menarche, and has a karyotype of 46,XX. On examination, there is clitoromegaly. Which enzyme is likely deficient?

21-alpha hydroxylase. ***21-alpha hydroxylase*** - A deficiency in **21-alpha hydroxylase** leads to **Congenital Adrenal Hyperplasia (CAH)**, shunting precursors towards **androgen production**. - In a 46,XX individual, this results in **virilization** such as **clitoromegaly** and **primary amenorrhea** due to excess androgens suppressing gonadotropin release and ovarian function. *17-alpha hydroxylase* - Deficiency in **17-alpha hydroxylase** in a 46,XX individual would lead to impaired sex steroid synthesis but **excess mineralocorticoids**, causing **hypertension** and **hypokalemia**. - While it causes **primary amenorrhea** due to lack of estrogen, it typically presents with **female external genitalia** that are underdeveloped, not virilized with clitoromegaly. *11-alpha hydroxylase* - There is no known functional enzyme called **11-alpha hydroxylase** in the steroid synthesis pathway. The relevant enzyme is **11-beta hydroxylase**, which, when deficient, leads to **CAH** with virilization and hypertension. - Assuming it refers to 11-beta hydroxylase, deficiency would cause **virilization** in 46,XX females but also lead to **hypertension** due to accumulation of 11-deoxycorticosterone, which is not mentioned in the presentation. *3-beta hydroxysteroid dehydrogenase* - Deficiency of **3-beta hydroxysteroid dehydrogenase** impairs the synthesis of **all classes of adrenal steroids** (glucocorticoids, mineralocorticoids, and sex steroids). - In 46,XX individuals, it leads to **females with ambiguous genitalia** (due to accumulation of DHEA) and **salt wasting**, but typically does not cause overt clitoromegaly and amenorrhea in the manner seen with 21-hydroxylase deficiency. [Practice more Internal Medicine PYQs on OnCourse]

Q: Esophageal manometry was performed - it revealed panesophageal pressurization with distal contractile integrity as >450mm Hg pressure in the body. What will be the diagnosis?

Type 3 achalasia. The diagnosis is Type 3 achalasia. This condition is characterized by panesophageal pressurization, indicating diffuse, simultaneous contractions throughout the esophagus. The high distal contractile integrity (>450 mmHg pressure) further supports Type 3 achalasia, which involves significant spastic contractions. In contrast, while high-resolution manometry allows for the accurate classification of these motility abnormalities [1], other types present differently. Type 1 achalasia (classic achalasia) is marked by failed esophageal peristalsis and absent or minimal esophageal pressurization [1]. The primary characteristic is incomplete or absent lower esophageal sphincter (LES) relaxation, not hypercontractility [1]. Type 2 achalasia is identified by esophageal panesophageal pressurization (simultaneous contractions), but with normal to high contractile pressures, not the extremely high values seen here. Jackhammer esophagus involves hypercontractility (distal contractile integral >8000 mmHg·cm·s) and is characterized by rapid, repetitive, and fragmented contractions, rather than the diffuse panesophageal pressurization and spasticity typical of Type 3 achalasia [2]. [Practice more Internal Medicine PYQs on OnCourse]

Question 1

In renal transplant recipients, which is the likely organism causing reactivation disease within 1 to 4 months after surgery?

Accepted Answer

CMV

Answer

EBV

Answer

HSV

Answer

VZV

Question 2

In multiple sclerosis, where does the defect occur?

Accepted Answer

Myelin sheath

Answer

Oligodendrocytes

Answer

Node of Ranvier

Answer

Neuroglial cells

Question 3

A middle-aged male presented with a history of fatigue and tiredness. On investigation, he had a hemoglobin level of 8 g/dL and a mean corpuscular volume (MCV) of 110 fl, with the peripheral smear showing macrocytes and hypersegmented neutrophils. Which of the following is the most likely cause of these findings in this patient?

Accepted Answer

Chronic alcohol use

Answer

Ancylostoma duodenale infection

Answer

Chronic kidney disease

Answer

Colorectal cancer

Question 4

A 13-year-old child visits the OPD with complaints of not attaining menarche, and has a karyotype of 46,XX. On examination, there is clitoromegaly. Which enzyme is likely deficient?

Accepted Answer

21-alpha hydroxylase

Answer

17-alpha hydroxylase

Answer

11-alpha hydroxylase

Answer

3-beta hydroxysteroid dehydrogenase

Question 5

Esophageal manometry was performed - it revealed panesophageal pressurization with distal contractile integrity as >450mm Hg pressure in the body. What will be the diagnosis?

Accepted Answer

Type 3 achalasia

Answer

Type 2 achalasia

Answer

Jackhammer esophagus

Answer

Type 1 achalasia (classic achalasia)

Question 6

MC location of gastrinoma in MEN-1 syndrome?

Accepted Answer

Duodenum

Answer

Jejunum

Answer

Ileum

Answer

Pancreas

Question 7

A 42-year-old patient with obstructive jaundice. Alp, Ggt, haptoglobin all increased. The most likely cause is:

Accepted Answer

Biliary obstruction

Answer

Alcohol

Answer

Lead

Answer

None of the options

Question 8

A Patient falls down often with behavioral change and enuresis. What is the condition associated with him?

Accepted Answer

Normal pressure hydrocephalus (NPH)

Answer

Parkinson's disease (PD)

Answer

Alzheimer's disease (AD)

Answer

Frontotemporal dementia (FTD)

Question 9

Which of the following is commonly seen in Pituitary apoplexy?

Accepted Answer

Headache

Answer

Hypertension

Answer

Hypotension

Answer

Vomiting

Question 10

Which is the most common pancreatic endocrine neoplasm?

Accepted Answer

Insulinoma

Answer

Gastrinoma

Answer

VIPoma

Answer

Glucagonoma

NEET-PG 2020 — Internal Medicine