NEET-PG 2013 - Internal Medicine Practice Questions

Q: In Wilson's disease, copper deposition primarily occurs in which part of the brain?

Basal ganglia. ***Basal ganglia*** - The **basal ganglia**, particularly the **putamen** and **globus pallidus**, are the most common sites for copper deposition in the brain in Wilson's disease [1]. - This deposition leads to **neurological symptoms** such as dystonia [2], tremor, and dysarthria. *Pons* - While copper can accumulate in various brain regions, the **pons** is not a primary or characteristic site of significant copper deposition. - Neurological symptoms associated with pontine damage are not typical presenting features of Wilson's disease. *Cerebellum* - The **cerebellum** can show some copper accumulation in advanced stages, but it is not the primary site. - Cerebellar signs like **ataxia** can occur in Wilson's disease, but usually secondary to more widespread pathology rather than primary cerebellar copper deposition. *Medulla* - The **medulla oblongata** is generally spared from significant copper deposition in Wilson's disease. - Involvement of the medulla would typically manifest with severe autonomic or brainstem dysfunction, which is not a hallmark of early Wilson's disease.

Q: Which of the following is NOT a characteristic feature of systemic sclerosis?

Gottron's papules. ***Gottron's papules*** - **Gottron's papules** are pathognomonic for **dermatomyositis**, not systemic sclerosis. They are red, scaling papules found over the extensor surfaces of the metacarpophalangeal (MCP) and interphalangeal (IP) joints. - While both systemic sclerosis and dermatomyositis are connective tissue diseases, their distinct cutaneous manifestations aid in differentiation. *Acroosteolysis* - **Acroosteolysis** refers to the resorption of the distal phalanges, a common feature in systemic sclerosis, particularly in severe cases. - This symptom contributes to the characteristic digital abnormalities seen in the disease. *Calcinosis cutis* - **Calcinosis cutis** is the deposition of calcium in the skin and subcutaneous tissues, often seen in subsets of systemic sclerosis, especially the CREST syndrome. - It can manifest as firm, white-yellow nodules or plaques and contribute to skin breakdown. *Digital ulcers* - **Digital ulcers** are a frequent and debilitating complication of systemic sclerosis, resulting from severe **vasculopathy** [1] and **ischemia** [1]. - They are often painful and can lead to significant tissue loss and infection.

Q: The common cause of subarachnoid hemorrhage is:

Aneurysm. ***Aneurysm*** - Aneurysms, particularly **saccular** or **berry aneurysms**, are the most frequent cause of **spontaneous subarachnoid hemorrhage (SAH)**, accounting for about 80-85% of cases [2]. - The sudden rupture of an intracranial aneurysm leads to blood spilling into the **subarachnoid space**, causing characteristic symptoms like a "thunderclap headache" [1]. *Arterio-venous malformation* - While AV malformations (AVMs) can cause SAH, they are a less common cause than aneurysms, accounting for approximately 5-10% of cases. - AVMs are abnormal direct connections between arteries and veins that bypass the capillary system and can rupture, leading to SAH or intraparenchymal hemorrhage. *Cavernous angioma* - Cavernous angiomas are abnormal clusters of dilated, thin-walled capillaries that can lead to hemorrhage, but they primarily cause **intraparenchymal hemorrhage** rather than SAH. - They are much less likely to result in diffuse bleeding into the subarachnoid space compared to ruptured aneurysms. *Hypertension* - Hypertension is a significant risk factor for the formation and rupture of aneurysms [1], but it is not a direct cause of SAH itself in the same way an aneurysm rupture is. - While uncontrolled hypertension is often associated with **intracerebral hemorrhage** (bleeding within the brain tissue), its direct role in causing SAH is usually secondary to an underlying vascular abnormality like an aneurysm.

Q: Which of the following is commonly seen in Polycythemia Vera?

Thrombosis. ***Spontaneous severe infection*** - In Polycythemia Vera, there is usually an **increased red blood cell mass** leading to complications like thrombosis, rather than a predisposition to severe infections. - Severe infections are not a typical feature, as the condition usually maintains **functional immunity** despite hyperviscosity. *Thrombosis* - Individuals with Polycythemia Vera have increased blood viscosity that results in a higher risk of **thrombosis**, which is a common complication [1]. - Events like **deep vein thrombosis (DVT)** or **cerebral venous sinus thrombosis** are often observed due to altered hemodynamics. *Hyperuricemia* - Hyperuricemia occurs due to increased cell turnover and breakdown of red cells in Polycythemia Vera, leading to elevated **uric acid levels** [1]. - Patients may experience **gout attacks** as a consequence of this elevated uric acid [1]. *Prone for acute leukemia* - While there is an increased risk of transformation to myeloid neoplasms, the risk for **acute leukemia** is not directly attributed to Polycythemia Vera in most cases. - It is more related to myelofibrosis or secondary conditions developing over time rather than a direct association.

Q: Which of the following is not a clinical feature of Bronchiectasis?

Night sweats. ***Night sweats*** - While **night sweats** can be present in chronic infections, they are not considered a primary or defining clinical feature directly associated with the pathology of bronchiectasis itself. - They are more commonly linked with systemic conditions like **tuberculosis** or malignancy, which would require alternative diagnostic pathways. *Hemoptysis* - **Hemoptysis** (coughing up blood) is a common and often alarming symptom of bronchiectasis due to the inflammation and damage to the bronchial walls and underlying vasculature [1]. - Blood vessels in damaged airways are prone to rupture, leading to bleeding, which can range from blood-streaked sputum to massive hemorrhage [1]. *Chest pain* - **Chest pain** can occur in bronchiectasis, often related to the chronic cough, pleural inflammation, or musculoskeletal strain from persistent coughing. - It can also be a symptom if there's an associated infection or inflammation extending to the pleura. *Productive cough* - A **chronic productive cough** with significant amounts of purulent sputum is the hallmark symptom of bronchiectasis [1]. - This is due to the impaired mucociliary clearance and chronic infection within the dilated, damaged airways .

Q: Subclavian steal syndrome is

Reversal of blood flow in the ipsilateral vertebral artery. ***Reversal of blood flow in the ipsilateral vertebral artery*** - Subclavian steal syndrome occurs due to a **proximal stenosis** or **occlusion of the subclavian artery**. - This causes blood to be "stolen" from the **ipsilateral vertebral artery**, flowing retrograde to supply the arm and thereby reducing blood flow to the brainstem. *Reversal of blood flow in the contralateral carotid artery* - The carotid arteries supply blood to the brain directly and are typically not directly involved in thesteal phenomenon in this specific syndrome. - Reversal of flow in the carotid artery would indicate a much more severe and different pathology, not characteristic of subclavian steal. *Reversal of blood flow in the contralateral vertebral artery* - The steal phenomenon specifically involves the vertebral artery on the **same side (ipsilateral)** as the subclavian artery obstruction. - The contralateral vertebral artery would typically continue to supply blood to the brain without a reversed flow in this syndrome. *B/L reversal of blood flow in vertebral arteries* - Subclavian steal syndrome is generally a **unilateral phenomenon**, affecting the vertebral artery ipsilateral to the subclavian artery stenosis. - Bilateral reversal would imply bilateral subclavian artery obstruction or other severe cerebrovascular disease, which is not the definition of subclavian steal syndrome itself.

Q: Acute orchitis is characterized by all of the following except:

Decreased blood flow. ***Decreased blood flow*** - **Acute orchitis** is an inflammatory process that typically leads to increased blood flow (hyperemia) to the affected testis due to the inflammatory response. - Decreased blood flow would be more characteristic of conditions like **testicular torsion**, which is an emergent condition causing ischemia. *Increased local temperature* - **Inflammation** is characterized by the classic signs of rubor (redness) and calor (heat), leading to an **increased local temperature** in the affected area. - This is a common finding in acute orchitis due to the inflammatory response. *Erythematous scrotum* - The inflammatory process in orchitis causes **vasodilation** and increased vascular permeability, leading to redness and swelling of the overlying scrotal skin. - An **erythematous scrotum** is a typical clinical sign of acute orchitis. *Raised TLC* - **TLC (Total Leukocyte Count)** is often elevated in cases of acute infection or inflammation, such as orchitis. - A **raised TLC** indicates a systemic inflammatory response to the infection.

Q: Down beat nystagmus is seen in?

Arnold Chiari malformation and other conditions. ***Arnold Chiari malformation and other conditions*** - Downbeat nystagmus is a characteristic finding in Arnold-Chiari malformations, especially **Chiari type 1**, due to compression of cerebellar structures. - Other conditions associated with downbeat nystagmus include **medullary lesions**, **magnesium deficiency**, and **lithium toxicity** [1]. *Brain stem lesions* - While brainstem lesions can cause various nystagmus types, **pure downbeat nystagmus** is less commonly the primary or most specific finding compared to cerebellar involvement [1]. - **Upbeat nystagmus** and other complex nystagmus patterns are more often associated with brainstem lesions like those in the tegmentum. *Pontine hemorrhage and other conditions* - Pontine hemorrhages are more commonly associated with **ocular bobbing**, **blink reflex abnormalities**, or **horizontal gaze palsies**, rather than downbeat nystagmus. - A pontine hemorrhage would typically present with more severe neurological deficits such as **coma** or **quadriparesis**, which are not directly associated with isolated nystagmus. *Labyrinthine damage and other conditions* - **Peripheral vestibular abnormalities** from labyrinthine damage typically cause **horizontal or torsional nystagmus**, often suppressed by visual fixation. - Downbeat nystagmus is a **central vestibular sign**, indicating a problem with central vestibular processing rather than the peripheral labyrinth [1].

Q: In the context of hemorrhagic pancreatitis, which sign is indicated by bluish discoloration of the flank?

Grey Turner's sign. ***Grey Turner's sign*** - This sign refers to **bluish discoloration of the flank** due to **hemorrhage** into the retroperitoneal space, commonly seen in severe hemorrhagic pancreatitis. [1] - The discoloration is caused by **peripancreatic inflammation** and fat necrosis, leading to localized bleeding. *Cullen's sign* - Cullen's sign is characterized by **bluish discoloration around the umbilicus**. - It is also indicative of **retroperitoneal hemorrhage**, but specifically in the periumbilical region. *Trousseau's sign* - This sign refers to **carpal spasm** induced by inflating a blood pressure cuff above systolic pressure for several minutes. - It is indicative of **hypocalcemia**, not hemorrhage, and is seen in conditions like pancreatitis that cause low calcium levels. *None of the options* - This option is incorrect because **Grey Turner's sign** specifically describes the bluish discoloration of the flank associated with hemorrhagic pancreatitis.

Q: Where is Schatzki's Ring present?

Lower end of esophagus. ***Lower end of esophagus*** - **Schatzki's Ring** is a localized narrowing that can occur at the **gastroesophageal junction**, specifically at the squamocolumnar junction. - This ring is a common cause of intermittent **dysphagia** for solid foods. [2] *Upper end of trachea* - The upper end of the trachea is the **larynx** or a region just below it, which is anatomically distinct from the esophagus. - Constrictions in this area are generally unrelated to Schatzki's Ring and typically involve conditions like **subglottic stenosis**. *Upper end of esophagus* - The upper end of the esophagus contains the **upper esophageal sphincter** (UES), which is a muscular structure. [3] - While strictures can occur here, they are not referred to as Schatzki's Ring. *Lower end of trachea* - The lower end of the trachea **bifurcates into the bronchi** and is part of the respiratory system. [1] - Anatomically, it is separate from the esophagus, and issues here would be related to respiratory conditions, not Schatzki's Ring.

Question 1

In Wilson's disease, copper deposition primarily occurs in which part of the brain?

Accepted Answer

Basal ganglia

Answer

Cerebellum

Answer

Pons

Answer

Medulla

Question 2

Which of the following is NOT a characteristic feature of systemic sclerosis?

Accepted Answer

Gottron's papules

Answer

Calcinosis cutis

Answer

Digital ulcers

Answer

Acroosteolysis

Question 3

The common cause of subarachnoid hemorrhage is:

Accepted Answer

Aneurysm

Answer

Arterio-venous malformation

Answer

Cavernous angioma

Answer

Hypertension

Question 4

Which of the following is commonly seen in Polycythemia Vera?

Accepted Answer

Thrombosis

Answer

Hyperuricemia

Answer

Prone for acute leukemia

Answer

Spontaneous severe infection

Question 5

Which of the following is not a clinical feature of Bronchiectasis?

Accepted Answer

Night sweats

Answer

Hemoptysis

Answer

Chest pain

Answer

Productive cough

Question 6

Subclavian steal syndrome is

Accepted Answer

Reversal of blood flow in the ipsilateral vertebral artery

Answer

Reversal of blood flow in the contralateral carotid artery

Answer

Reversal of blood flow in the contralateral vertebral artery

Answer

B/L reversal of blood flow in vertebral arteries

Question 7

Acute orchitis is characterized by all of the following except:

Accepted Answer

Decreased blood flow

Answer

Increased local temperature

Answer

Erythematous scrotum

Answer

Raised TLC

Question 8

Down beat nystagmus is seen in?

Accepted Answer

Arnold Chiari malformation and other conditions

Answer

Brain stem lesions

Answer

Pontine hemorrhage and other conditions

Answer

Labyrinthine damage and other conditions

Question 9

In the context of hemorrhagic pancreatitis, which sign is indicated by bluish discoloration of the flank?

Accepted Answer

Grey Turner's sign

Answer

Cullen's sign

Answer

Trousseau's sign

Answer

None of the options

Question 10

Where is Schatzki's Ring present?

Accepted Answer

Lower end of esophagus

Answer

Upper end of trachea

Answer

Upper end of esophagus

Answer

Lower end of trachea

NEET-PG 2013 — Internal Medicine