NEET-PG 2021 - Internal Medicine PYQs Practice Questions

Q: All are increased in IDA except

Transferrin saturation. ***Transferrin saturation*** - In **iron deficiency anemia (IDA)**, there is insufficient iron to saturate transferrin, leading to a **decreased** transferrin saturation. This is the exception among the given options. - Transferrin saturation is calculated as (serum iron / TIBC) x 100, and both **serum iron** and its percentage saturation are low in IDA. *TIBC* - **Total iron-binding capacity (TIBC)** is typically **increased** in IDA as the liver produces more transferrin in an attempt to capture more iron [1]. - This elevated TIBC reflects the body's compensatory mechanism to maximize available iron uptake. *Soluble transferrin receptor* - **Soluble transferrin receptor (sTfR)** levels are **elevated** in IDA because iron-deficient erythroblasts upregulate the production of transferrin receptors on their surface as they try to scavenge more iron. - The elevated sTfR is a sensitive and specific marker for **iron deficiency**, particularly useful in differentiating IDA from anemia of chronic disease [1]. *Erythropoietin* - **Erythropoietin (EPO)** levels are **increased** in IDA due to the kidney's response to the decreased oxygen-carrying capacity of the blood (anemia) [1]. - EPO stimulates the bone marrow to produce more red blood cells, which exacerbates the demand for iron, often leading to further iron depletion if iron stores are low. [Practice more Internal Medicine PYQs on OnCourse]

Q: Which of the following is considered a poor prognostic marker in multiple myeloma (MM)?

B2 microglobulins. ***B2 microglobulins*** - Elevated levels of **B2 microglobulin** are a significant indicator of increased tumor burden and are used in the **International Staging System (ISS)** for multiple myeloma, correlating with shorter survival [1]. - This protein is present on the surface of most nucleated cells and its accumulation reflects **renal impairment** or increased cell turnover. *Serum Creatinine* - While elevated **serum creatinine** can indicate **renal insufficiency**, a common complication in MM, it is not a direct measure of tumor burden or aggression in the same way as B2 microglobulin [1]. - **Renal failure** can be a poor prognostic factor in MM, but creatinine itself is a marker of organ damage rather than disease progression or malignancy. *Hypercalcemia* - **Hypercalcemia** is a common complication in MM due to increased **bone resorption**, but it is generally manageable and not considered a primary prognostic marker for disease aggressiveness itself. - While severe hypercalcemia can contribute to overall morbidity, its presence doesn't directly stage the disease or predict survival as significantly as B2 microglobulin. *Telomerase* - **Telomerase** is an enzyme involved in maintaining telomere length and is often overexpressed in various cancers, including MM, allowing cells to proliferate indefinitely. - While it plays a role in the **pathogenesis** of MM, its utility as a prognostic marker in routine clinical practice is not as established or as widely used as B2 microglobulin. [Practice more Internal Medicine PYQs on OnCourse]

Q: An 18-year-old male presents to the OPD with gum bleeding, fever, low total leukocyte count (TLC), and low platelet count. General examination is unremarkable. Further investigations reveal a low reticulocyte count, absent megakaryocytes, and no immature cells in the bone marrow. What is the most likely diagnosis?

Aplastic anemia. ***Aplastic anemia*** - This condition is characterized by **pancytopenia** (low TLC and platelet count, implied low red blood cell count by low reticulocyte count) due to **bone marrow failure**. - The absence of **megakaryocytes** and other immature cells in the bone marrow confirms the **hypocellularity** typical of aplastic anemia. *Immune Thrombocytopenic Purpura (ITP)* - While ITP presents with **low platelet count** and potential gum bleeding [1], the bone marrow typically shows **normal or increased megakaryocytes**. - ITP does not explain the **low total leukocyte count** or low reticulocyte count seen in this patient [1]. *Myelodysplastic Syndrome (MDS)* - MDS involves **ineffective hematopoiesis** and can present with cytopenias, but the bone marrow is usually **hypercellular or normocellular** with dysplastic changes. - The absence of immature cells and overall hypoplasia does not fit the typical picture of MDS. *Acute Myeloid Leukemia (AML)* - AML is characterized by an overproduction of **immature myeloid cells (blasts)** [3], which are conspicuously absent in this patient's bone marrow description. - While AML can cause pancytopenia, the presence of **immature cells** in the bone marrow is its hallmark [3]. Gum hypertrophy is also a common clinical sign in AML [2]. [Practice more Internal Medicine PYQs on OnCourse]

Q: A male presents with urethral discharge as shown in the figure. What is the most likely cause?

Gonorrhea. ***Gonorrhea*** - The image depicts **purulent urethral discharge**, a classic symptom frequently seen in **gonococcal urethritis**. - **Neisseria gonorrhoeae** commonly causes urethritis with a thick, yellowish, or greenish discharge. *HIV* - HIV primarily affects the immune system and does not typically present with **gonorrhea-like urethral discharge** as a direct symptom. - While HIV can increase susceptibility to other STIs, the discharge itself is not a direct manifestation of HIV infection. *Haemophilus ducreyi* - This bacterium is the causative agent of **chancroid**, which presents as painful genital ulcers, not urethral discharge. - **Chancroid ulcers** are typically soft, ragged, and associated with tender inguinal lymphadenopathy. *Syphilis* - Syphilis, caused by **Treponema pallidum**, presents with a **painless chancre** in its primary stage, not urethral discharge. - Later stages of syphilis involve rashes, neurological symptoms, or gummas, which are distinct from the penile discharge shown. [Practice more Internal Medicine PYQs on OnCourse]

Q: A 33-year-old female patient presents with an inability to see the right side from both eyes (right homonymous hemianopia). What is the most probable cause?

Injury to Left Optic Tract. ***Injury to Left Optic Tract*** - A lesion in the **left optic tract** interrupts nerve fibers carrying visual information from the temporal half of the left retina and the nasal half of the right retina [1]. - This results in the loss of vision from the **right visual field** in both eyes, known as **right homonymous hemianopia** [1]. *Right occipital lobe lesion* - A lesion in the **right occipital lobe** would cause a **left homonymous hemianopia**, affecting the left visual field from both eyes [1]. - The visual pathways cross before reaching the occipital cortex, meaning the right occipital lobe processes input from the left visual fields. *Optic chiasma lesion* - A lesion at the **optic chiasma** typically affects the **nasal rectine fibers** from both eyes, causing **bitemporal hemianopia** (loss of vision in the temporal fields of both eyes) [1]. - This presentation is distinct from homonymous hemianopia. *Right optic nerve lesion* - A lesion in the **right optic nerve** would cause complete blindness in the **right eye** (right anopsia/monocular blindness), not a homonymous visual field defect [1]. - The optic nerve carries all visual information from a single eye before any crossing occurs. [Practice more Internal Medicine PYQs on OnCourse]

Question 1

All are increased in IDA except

Accepted Answer

Transferrin saturation

Answer

TIBC

Answer

Soluble transferrin receptor

Answer

Erythropoietin

Question 2

Which of the following is considered a poor prognostic marker in multiple myeloma (MM)?

Accepted Answer

B2 microglobulins

Answer

Serum Creatinine

Answer

Hypercalcemia

Answer

Telomerase

Question 3

An 18-year-old male presents to the OPD with gum bleeding, fever, low total leukocyte count (TLC), and low platelet count. General examination is unremarkable. Further investigations reveal a low reticulocyte count, absent megakaryocytes, and no immature cells in the bone marrow. What is the most likely diagnosis?

Accepted Answer

Aplastic anemia

Answer

Immune Thrombocytopenic Purpura (ITP)

Answer

Myelodysplastic Syndrome (MDS)

Answer

Acute Myeloid Leukemia (AML)

Question 4

A male presents with urethral discharge as shown in the figure. What is the most likely cause?

Accepted Answer

Gonorrhea

Answer

HIV

Answer

Haemophilus ducreyi

Answer

Syphilis

Question 5

A 33-year-old female patient presents with an inability to see the right side from both eyes (right homonymous hemianopia). What is the most probable cause?

Accepted Answer

Injury to Left Optic Tract

Answer

Right occipital lobe lesion

Answer

Optic chiasma lesion

Answer

Right optic nerve lesion

Question 6

A patient complained of gradual diminution of vision. On examination, the patient had dry eyes and a rough corneal surface. What deficiency is most likely causing these manifestations?

Accepted Answer

Vitamin A

Answer

Iron

Answer

Protein

Answer

Niacin

Question 7

A young male presents with acute redness of the eye. His X-ray of the spine is shown below. What is the most likely condition?

Accepted Answer

Ankylosing Spondylitis

Answer

Psoriatic Arthritis

Answer

Rheumatoid Arthritis

Answer

Sjögren Syndrome

Question 8

A patient presents with a mediastinal mass and is diagnosed with pure red cell aplasia. What is the most probable underlying cause?

Accepted Answer

Thymic neoplasia

Answer

Bronchogenic carcinoma

Answer

T-cell Acute Lymphoblastic Leukemia

Answer

Non-Hodgkin Lymphoma

Question 9

A patient presents with numb fingertips and tight facial skin. ANA is positive with an immunofluorescence nucleolar pattern. What is the most likely diagnosis?

Accepted Answer

Systemic sclerosis

Answer

Systemic lupus erythematosus

Answer

Mixed connective tissue disease

Answer

Rheumatoid arthritis

Question 10

A 60-year-old male patient has an antral carcinoma spreading to the head of the pancreas with multiple small metastases to the right lobe of the liver. What is the best treatment approach?

Accepted Answer

Palliative chemotherapy

Answer

Surgical resection with adjuvant chemotherapy

Answer

Radiation therapy alone

Answer

Supportive care only

NEET-PG 2021 — Internal Medicine