NEET-PG 2024

354 Questions — Page 25 of 36

Biochemistry

1 questions

Q241

An adult male presented with a protruding abdomen, diarrhea, visual symptoms, and neurological manifestations. His LDL is low. Based on the peripheral smear finding shown in the image, what is the likely diagnosis?

NEET-PG 2024 - Biochemistry NEET-PG Practice Questions and MCQs

Question 241: An adult male presented with a protruding abdomen, diarrhea, visual symptoms, and neurological manifestations. His LDL is low. Based on the peripheral smear finding shown in the image, what is the likely diagnosis?

A. Abetalipoproteinemia (Correct Answer)
B. EDTA changes
C. Uremia
D. Burns
E. Liver disease

Explanation: ***Abetalipoproteinemia*** - The image shows **acanthocytes (spur cells)**, characterized by irregularly spaced, blunt projections, which are a hallmark of **abetalipoproteinemia** due to abnormal lipid metabolism and membrane defects. - The clinical presentation of a **protruding abdomen (steatorrhea/malabsorption)**, **diarrhea**, **visual symptoms (retinopathy)**, **neurological manifestations (ataxia, peripheral neuropathy)**, and **low LDL** all strongly point to abetalipoproteinemia, a disorder affecting the synthesis of B-apolipoprotein and chylomicrons. *EDTA changes* - **EDTA changes** typically manifest as **rouleaux formation**, platelet satellite formation, or cell shrinkage, with red blood cell morphology generally remaining normal in terms of spur cell formation. - These changes are **artifactual** and are not associated with the patient's systemic symptoms like malabsorption, neurological issues, or specific lipid profile findings. *Uremia* - While **uremia** can cause various red blood cell abnormalities, including **burr cells (echinocytes)** with regularly spaced, pointed projections, it generally does not cause the irregularly shaped **acanthocytes** seen in the image. - The systemic symptoms of uremia would primarily involve **renal dysfunction (e.g., elevated BUN, creatinine)**, which are not mentioned, and not specifically the **visual or malabsorption symptoms** seen here. *Burns* - Severe **burns** can lead to red blood cell fragmentation, causing **schistocytes** or **microspherocytes** due to heat-induced damage. - Burns are not typically associated with the formation of **acanthocytes** or the constellation of symptoms (malabsorption, neurological, visual) and lipid profile (low LDL) described in this patient. *Liver disease* - Advanced **liver disease (cirrhosis)** can cause **spur cell anemia** with acanthocytes due to altered cholesterol-to-phospholipid ratio in RBC membranes. - However, the key distinguishing feature is the **low LDL** in this patient, which is characteristic of abetalipoproteinemia, whereas liver disease typically does not present with specifically **low LDL** as a prominent feature. - Additionally, the constellation of **visual symptoms (retinopathy)** and **neurological manifestations** with malabsorption are more consistent with the fat-soluble vitamin deficiency (A, E, K) seen in abetalipoproteinemia rather than isolated liver pathology.

Dermatology

1 questions

Q241

Identify the diagnosis based on the dermatology immunofluorescence (IF) image provided.

Internal Medicine

4 questions

Q241

Which of the following statements is correct about Paroxysmal Nocturnal Hemoglobinuria (PNH)?

Q242

A patient presents with pulmonary hemorrhage and is P-ANCA positive. What is the most likely diagnosis?

Q243

Which of the following is typically observed in the investigation results for a patient with iron deficiency anemia (IDA)?

Q244

An adult female presents with pallor and fatigue. Blood investigations show low hemoglobin ( Hb ), low serum iron, low ferritin, low transferrin saturation, and increased total iron-binding capacity (TIBC). What is the likely diagnosis?

NEET-PG 2024 - Internal Medicine NEET-PG Practice Questions and MCQs

Question 241: Which of the following statements is correct about Paroxysmal Nocturnal Hemoglobinuria (PNH)?

A. Sucrose lysis test is used for the confirmation
B. Flow cytometry is the best investigation (Correct Answer)
C. The most common cause of death is heart failure
D. It is an inherited disorder

Explanation: ***Flow cytometry is the best investigation*** - **Flow cytometry** is the gold standard for diagnosing PNH as it directly detects the absence of **GPI-anchored proteins (CD55 and CD59)** on the surface of red blood cells, granulocytes, and monocytes. - This method is highly sensitive and specific, allowing for the precise quantification of PNH clones even when present in small numbers. *Sucrose lysis test is used for the confirmation* - The **sucrose lysis test** (or sugar-water test) was an older screening test for PNH, but it is **not specific or sensitive enough** for confirmation. - It works by inducing complement activation on PNH cells in low ionic strength sucrose solution [1], but it has a high rate of false positives and negatives. *The most common cause of death is heart failure* - The most common cause of death in patients with PNH is **thrombosis**, particularly in unusual sites such as hepatic, cerebral, or abdominal veins, due to the prothrombotic state caused by the disease. - While heart complications can occur, they are not the leading cause of mortality. *It is an inherited disorder* - PNH is an **acquired clonal disorder** of hematopoietic stem cells, not an inherited genetic disorder [1]. - It results from a somatic mutation in the **PIG-A gene** in a hematopoietic stem cell, leading to the deficiency of GPI-anchored proteins.

Question 242: A patient presents with pulmonary hemorrhage and is P-ANCA positive. What is the most likely diagnosis?

A. Churg-Strauss syndrome
B. Microscopic polyangiitis (Correct Answer)
C. Wegener granulomatosis
D. Polyarteritis nodosa (PAN)

Explanation: ***Microscopic polyangiitis*** - This condition is characterized by **pulmonary hemorrhage** (often manifesting as diffuse alveolar hemorrhage) and **P-ANCA positivity**, which is typically associated with antibodies against **myeloperoxidase (MPO)**. [1] - It is a **small-vessel vasculitis** that frequently affects the kidneys (glomerulonephritis) and lungs without granuloma formation. *Churg-Strauss syndrome* - While Churg-Strauss syndrome (now known as **Eosinophilic Granulomatosis with Polyangiitis**, EGPA) can be P-ANCA positive, it is typically associated with a history of **asthma**, **allergic rhinitis**, and **eosinophilia**. [1] - Pulmonary involvement often includes **infiltrates** and nodules, but diffuse alveolar hemorrhage with severe pulmonary hemorrhage is less common as the primary presentation compared to MPA. *Wegener granulomatosis* - Wegener granulomatosis (now known as **Granulomatosis with Polyangiitis**, GPA) primarily presents with **upper and lower respiratory tract granulomatous inflammation** and **glomerulonephritis**. - It is typically associated with **C-ANCA positivity** (antibodies against proteinase 3, PR3), not P-ANCA. *Polyarteritis nodosa (PAN)* - Polyarteritis nodosa is a **medium-vessel vasculitis** that typically affects the **kidneys, gastrointestinal tract, skin, and nervous system**. [1] - It is classically **ANCA-negative** and does not typically cause pulmonary hemorrhage or diffuse alveolar hemorrhage.

Question 243: Which of the following is typically observed in the investigation results for a patient with iron deficiency anemia (IDA)?

A. Increased serum ferritin
B. Decreased transferrin saturation (Correct Answer)
C. Increased serum iron
D. Normal total iron-binding capacity (TIBC)
E. Increased mean corpuscular volume (MCV)

Explanation: ***Decreased transferrin saturation*** - In **iron deficiency anemia**, there is insufficient iron to bind to **transferrin**, leading to a reduction in the percentage of transferrin that is iron-bound. - This reflects the body's struggle to supply iron for erythropoiesis due to depleted iron stores. *Increased serum ferritin* - **Serum ferritin** is a key indicator of the body's iron stores; in **iron deficiency anemia**, these stores are depleted, leading to a *decreased* rather than increased serum ferritin level. - An increased serum ferritin is typically seen in conditions of **iron overload** or **inflammation**. *Increased serum iron* - **Serum iron** measures the iron circulating in the blood, and in **iron deficiency anemia**, iron levels are *low* due to inadequate intake or excessive loss. - An increased serum iron level would contradict the diagnosis of iron deficiency. *Normal total iron-binding capacity (TIBC)* - **Total iron-binding capacity (TIBC)** typically *increases* in iron deficiency anemia as the liver produces more transferrin in an attempt to capture any available iron. - A normal TIBC would not reflect the compensatory mechanisms seen in iron deficiency. *Increased mean corpuscular volume (MCV)* - **Iron deficiency anemia** is a **microcytic anemia**, characterized by *decreased* MCV due to inadequate hemoglobin synthesis within red blood cells. - An increased MCV is seen in **macrocytic anemias** such as vitamin B12 or folate deficiency, not in iron deficiency.

Question 244: An adult female presents with pallor and fatigue. Blood investigations show low hemoglobin ( Hb ), low serum iron, low ferritin, low transferrin saturation, and increased total iron-binding capacity (TIBC). What is the likely diagnosis?

A. Iron Deficiency Anemia (IDA) (Correct Answer)
B. Anemia of Chronic Disease
C. Hemolytic Anemia
D. Thalassemia
E. Sideroblastic Anemia

Explanation: ***Iron Deficiency Anemia (IDA)*** - The unique constellation of **low hemoglobin**, **low serum iron**, **low ferritin**, **low transferrin saturation**, and **increased total iron-binding capacity (TIBC)** is the hallmark of Iron Deficiency Anemia. - **Ferritin** is a direct measure of iron stores, and its low level confirms depletion, while **increased TIBC** signifies the body's attempt to absorb more iron due to deficiency. *Anemia of Chronic Disease* - While also presenting with **low hemoglobin** and often **low serum iron**, Anemia of Chronic Disease is characterized by **normal or increased ferritin** (as ferritin is an acute phase reactant) and **decreased TIBC**. - There is a functional iron deficiency, but iron stores are typically adequate, and inflammation plays a central role. *Hemolytic Anemia* - Hemolytic anemia is characterized by the premature destruction of red blood cells, leading to **low hemoglobin** but typically **normal or elevated serum iron** and ferritin due to iron release from lysed red cells. - Key indicators, such as **elevated bilirubin**, **lactate dehydrogenase (LDH)**, and **reticulocytosis**, are absent in the given scenario. *Thalassemia* - Thalassemia is a genetic disorder causing defective hemoglobin synthesis, resulting in **microcytic hypochromic anemia** with **low hemoglobin**. - However, thalassemia typically presents with **normal to high serum iron** and ferritin levels, as iron absorption may be increased, and there's no primary iron deficiency. *Sideroblastic Anemia* - Sideroblastic anemia is characterized by defective heme synthesis with iron accumulation in mitochondria, forming characteristic ring sideroblasts on bone marrow examination. - Laboratory findings typically show **normal to increased serum iron**, **increased ferritin**, and **increased transferrin saturation**, distinguishing it from iron deficiency anemia.

Pathology

2 questions

Q241

Identify the diagnosis from the given image

Q242

An elderly male patient presented with clinical symptoms and signs consistent with possible multiple myeloma. Electrophoresis shows an M spike, and immunofixation findings are shown below. Which of the following statements best corresponds to the findings?

NEET-PG 2024 - Pathology NEET-PG Practice Questions and MCQs

Question 241: Identify the diagnosis from the given image

A. TB
B. Malakoplakia (Correct Answer)
C. BCC
D. Drug induced lesion

Explanation: ***Malakoplakia*** - The image displays characteristic **Michaelis-Gutmann bodies**, which are concentrically laminated calcified inclusions found within macrophages (**Von Hansemann cells**). These are pathognomic for malakoplakia. - **Von Hansemann cells** are large, foamy macrophages with abundant cytoplasm, also visible in the image, mixed with lymphocytes and plasma cells. *TB* - Tuberculosis (TB) typically presents with **granulomatous inflammation** characterized by caseating necrosis, epithelioid macrophages, Langhans giant cells, and lymphocytes [2]. These features are not apparent in the image. - While TB can involve macrophages, the distinct Michaelis-Gutmann bodies seen here are not a feature of tuberculous granulomas [1]. *BCC* - Basal cell carcinoma (BCC) is a malignant epithelial tumor characterized by nests of basaloid cells with peripheral palisading, clear clefts, and often stromal retraction. This biopsy shows inflammatory cells and calcified inclusions, not epithelial malignancy. - BCC would show atypical epithelial cells and features of a neoplastic process, which are distinctly different from the inflammatory infiltrate and inclusion bodies in the image. *Drug induced lesion* - Drug-induced lesions are highly variable and context-dependent, but they do not typically present with the specific histopathological features of Michaelis-Gutmann bodies within macrophages. - The image depicts a specific and recognizable inflammatory pattern with unique inclusions, which points to a distinct disease entity rather than a non-specific drug reaction. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 198-200. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, p. 360.

Question 242: An elderly male patient presented with clinical symptoms and signs consistent with possible multiple myeloma. Electrophoresis shows an M spike, and immunofixation findings are shown below. Which of the following statements best corresponds to the findings?

A. Multiple myeloma with increased IgM
B. Multiple myeloma with increased IgG (Correct Answer)
C. Multiple myeloma with increased IgA
D. Waldenström macroglobulinemia

Explanation: ***Multiple myeloma with increased IgG*** - The immunofixation image shows a distinct, *monoclonal band (M spike)* in the **IgG lane (G)**, corresponding to the initial electrophoresis (ELP) M spike [1]. There is also a corresponding band in the **kappa light chain (K)** lane [1]. - The presence of a dominant band in IgG, along with a matching light chain (either kappa or lambda), indicates an **IgG monoclonal gammopathy**, which is characteristic of the most common type of multiple myeloma [1]. *Multiple myeloma with increased IgM* - This option would correspond to a strong, monoclonal band in the **IgM lane (M)**, which is not the case here. The 'M' lane in the image shows a faint/normal band, not an increased M spike. - Increased IgM monoclonal protein (M spike) is characteristic of **Waldenström macroglobulinemia**, not typically multiple myeloma [2]. *Multiple myeloma with increased IgA* - If the patient had IgA multiple myeloma, there would be a prominent monoclonal band in the **IgA lane (A)**, which is not observed in this immunofixation result. The 'A' lane shows a considerably smaller band compared to IgG. - IgA multiple myeloma is a less common subtype than IgG myeloma and would present with an IgA M spike [1]. *Waldenström macroglobulinemia* - Waldenström macroglobulinemia is characterized by a monoclonal gammopathy of the **IgM type**, which would present as a distinct M spike in the IgM lane [2]. - The immunofixation clearly shows an **IgG M spike**, ruling out Waldenström macroglobulinemia based on the type of monoclonal gammopathy [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 608-609. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 606-607.

Pediatrics

1 questions

Q241

A child presents with recurrent infections. Mediastinal imaging reveals an absent thymus gland, and further investigations show low ADA (adenosine deaminase) levels. What is the most likely diagnosis?

Surgery

1 questions

Q241

Which of the following is not seen with ileal resections?