NEET-PG 2015 - Internal Medicine Practice Questions

Q: All of the following are true about Gout, except which of the following?

Occurs more in females. ***Occurs more in females*** - **Gout** is more prevalent in **males** than in females, especially before menopause, due to hormonal differences and lifestyle factors. - After menopause, the incidence in females increases but generally remains lower than in males. *Occurs due to accumulation of urate crystals in joint* - **Gout** is precisely characterized by the **deposition of monosodium urate crystals** in joints and surrounding tissues, leading to inflammation [1], [2]. - This accumulation is a direct consequence of **hyperuricemia**, either from overproduction or underexcretion of uric acid [2], [3]. *Can be precipitated by pyrazinamide* - **Pyrazinamide** is an anti-tuberculosis drug known to **inhibit uric acid excretion** by the kidneys. - This leads to **hyperuricemia**, thereby increasing the risk of acute gout attacks. *Birefringent crystals are present in the joint* - Microscopic examination of **synovial fluid** from a gouty joint reveals **needle-shaped, negatively birefringent crystals** of monosodium urate [1], [4]. - This finding is a definitive diagnostic criterion for **gout**.

Q: Isaac syndrome is characterized by -

Peripheral nerve hyperexcitability. Isaac syndrome is characterized by - ***Peripheral nerve hyperexcitability*** - Isaac syndrome, also known as **neuromyotonia** or **Isaacs' syndrome**, is fundamentally characterized by symptoms arising from **peripheral nerve hyperexcitability**. [1] - This hyperexcitability leads to continuous muscle fiber activity even at rest, manifesting as **muscle stiffness, cramps, myokymia, and fasciculations**. *Opsoclonus syndrome* - This syndrome is characterized by **rapid, irregular, chaotic eye movements** (**opsoclonus**) and often associated with **myoclonus (rapid muscle jerks)** and **ataxia (impaired coordination)**. - While it can be paraneoplastic, it involves the **central nervous system**, specifically the brainstem and cerebellum, not primarily peripheral nerve hyperexcitability. *Encephalitis* - **Encephalitis** is an inflammation of the **brain parenchyma**, typically caused by viral infections. - Its clinical presentation includes fever, headache, altered mental status, and seizures, which are distinct from the primary neuromuscular symptoms of Isaac syndrome. *Limbic encephalitis syndrome* - **Limbic encephalitis** is a form of encephalitis specifically affecting the **limbic system** of the brain, leading to symptoms like **memory loss, seizures, and psychiatric disturbances**. - This condition involves **central nervous system inflammation** and does not directly cause the peripheral nerve hyperexcitability seen in Isaac syndrome.

Q: Blood transfusion associated acute lung injury occurs due to -

HLA-mediated reaction. ***HLA-mediated reaction*** - Transfusion-related acute lung injury (TRALI) is primarily caused by **antibodies** in the donor plasma (usually anti-HLA or anti-HNA antibodies) reacting with the recipient's **neutrophils** [1]. - This interaction leads to neutrophil activation and sequestration in the pulmonary vasculature, causing **endothelial damage** and increased capillary permeability [1]. *Nosocomial infections* - Nosocomial infections are **hospital-acquired infections** and are not a direct cause of TRALI. - While infections can lead to lung injury, the mechanism of TRALI is distinct and immunologically mediated by donor antibodies. *Auto-immune disorder* - An autoimmune disorder involves the body's immune system attacking its own tissues, which is not the primary mechanism of TRALI. - TRALI is an **alloimmune reaction** where donor antibodies react with host antigens, rather than a pre-existing autoimmune condition. *Genetic susceptibility* - While genetic factors might sometimes play a role in an individual's general inflammatory response or susceptibility to certain conditions, they are **not the direct or primary cause** of TRALI. - The acute lung injury in TRALI is triggered by specific **antibody-antigen interactions** during the transfusion.

Q: Thyroid nodule in a 65 year old male who is clinically euthyroid is most likely to be

Follicular adenoma. ***Follicular adenoma*** - Typically presents as a **solitary, well-defined nodule** in euthyroid patients, making it a common finding in this demographic. - It is often **benign** and can be differentiated from malignancies through imaging and cytological evaluation. *Multinodular goiter* - Usually involves multiple nodules rather than a **single nodule**, and patients often present with thyroid dysfunction [1]. - More common in women, and does not fit the profile of a solitary nodule in a euthyroid male. *Follicular Carcinoma* - While it can present as a nodule, it typically involves **elevated risk factors** such as family history and certain genetic mutations. - Euthyroid status alone is insufficient for a diagnosis of malignancy without further alarming features. *Thyroid Cyst* - Cysts are usually **fluid-filled** and may not present as solid nodules, which are common in cases described. - They tend to be **asymptomatic** and are generally **benign**, lacking the solid characteristics of a follicular adenoma.

Q: What does a motor score of 4 on the Glasgow Coma Scale indicate?

Withdrawal or flexion to pain. A motor score of 4 on the **Glasgow Coma Scale (GCS)** signifies that the patient **withdraws or flexes their limb** away from a painful stimulus. - This response indicates a degree of purposeful movement but is not considered localization to the pain. *Decerebrate posturing* - This represents a GCS motor score of **2**, characterized by **extension and internal rotation of the arms** and extension of the legs in response to pain [1]. - It suggests severe damage to the **brainstem**, specifically below the red nucleus [1]. *Decorticate posturing* - This corresponds to a GCS motor score of **3**, where the patient exhibits **flexion and adduction of the arms** with extension of the legs to painful stimuli [1]. - It often indicates damage to the **corticospinal tracts** above the red nucleus [1]. *Localizes to pain* - This is a GCS motor score of **5**, where the patient **moves their hand beyond the chin** attempting to remove the painful stimulus. - It indicates a higher level of conscious response and purposeful movement compared to withdrawal.

Q: Pseudoclaudication is caused by

Lumbar canal stenosis. ***Lumbar canal stenosis*** - **Pseudoclaudication**, also known as **neurogenic claudication**, is a characteristic symptom of **lumbar canal stenosis**. - It is caused by **compression of spinal nerve roots** in the lumbar spine, leading to pain, numbness, or weakness in the legs, often exacerbated by standing or walking and relieved by sitting or stooping forward [1]. *Femoral Artery stenosis* - **Femoral artery stenosis** causes **vascular claudication**, which is pain in the leg muscles due to insufficient blood flow during exercise [2]. - Unlike pseudoclaudication, vascular claudication is typically relieved by rest and is not influenced by spinal position [2]. *Popliteal Artery stenosis* - **Popliteal artery stenosis** also leads to **vascular claudication**, presenting as calf pain during walking due to reduced blood supply to the distal leg [2]. - This condition is related to **peripheral artery disease**, distinct from neurological compression [2]. *Radial Artery stenosis* - **Radial artery stenosis** typically affects blood flow to the **hand and forearm**, potentially causing symptoms of ischemia in those areas. - It is not associated with leg pain or claudication.

Q: What are the expected neurological manifestations in a patient with complete absence of the corpus callosum?

Severe developmental delays. ***Severe developmental delays*** - Complete agenesis of the corpus callosum often results in **significant neurological impairments** due to the disruption of interhemispheric communication essential for coordinated brain function. - This typically manifests as **intellectual disability**, **developmental delays** in motor and speech skills, and difficulties with complex cognitive tasks. *Mild cognitive impairment* - While some individuals with partial agenesis or isolated cases might present with mild cognitive issues, **complete absence** usually leads to more profound deficits. - Mild impairment would not fully capture the extensive neurological challenges associated with a total lack of such a critical brain structure. *Seizures* - Seizures can occur in patients with corpus callosum agenesis, but they are not the **most encompassing** or universally expected neurological manifestation. - Seizures are often part of a broader syndrome of developmental abnormalities rather than the primary expected outcome of the agenesis itself. *No significant neurological deficits* - The corpus callosum is vital for **integrating information** between the cerebral hemispheres, affecting a wide range of sensory, motor, and cognitive functions. - Therefore, its complete absence almost invariably leads to notable neurological deficits, making a lack of significant issues highly unlikely.

Q: In cobalamin deficiency which is not seen

Microcytic anemia. Microcytic anemia - Cobalamin deficiency typically leads to macrocytic anemia due to impaired DNA synthesis, not microcytic anemia [1]. - Microcytic anemia is usually associated with iron deficiency, thalassemia, or anemia of chronic disease [1]. Long tract signs - Long tract signs are common in cobalamin deficiency due to posterior column and corticospinal tract involvement leading to symptoms like spasticity. - They indicate involvement of pathways that are affected by vitamin B12 deficiency. Loss of proprioception - Loss of proprioception can occur in cobalamin deficiency due to damage to the dorsal columns of the spinal cord. - It is a common clinical finding indicating the involvement of sensory pathways. Rhomberg sign - A positive Rhomberg sign indicates impaired proprioception, which can happen in cobalamin deficiency. - It reflects difficulty maintaining balance, emphasizing sensory dysfunction associated with the deficiency.

Q: Which zone of the prostate is primarily involved in Benign Prostatic Hyperplasia (BPH)?

Transitional zone. ***Transitional zone*** - The **transitional zone** surrounds the urethra and is the primary site of origin and enlargement in **Benign Prostatic Hyperplasia (BPH)**. - Its hypertrophy leads to compression of the urethra, causing **lower urinary tract symptoms (LUTS)**. *Central zone* - The **central zone** surrounds the ejaculatory ducts and is less commonly involved in BPH. - It is more frequently associated with the development of **prostate carcinoma**. *Peripheral zone* - The **peripheral zone** is the largest zone of the prostate and is where the majority of prostate cancers originate. - While it can be affected by BPH, it is not the primary zone for hypertrophy. *Prostate capsule* - The **prostate capsule** is the outer fibrous layer that encloses the prostate gland. - It does not undergo hyperplasia in BPH; rather, it encases the enlarging gland.

Question 1

All of the following are true about Gout, except which of the following?

Accepted Answer

Occurs more in females

Answer

Can be precipitated by pyrazinamide

Answer

Birefringent crystals are present in the joint

Answer

Occurs due to accumulation of urate crystals in joint

Question 2

Isaac syndrome is characterized by -

Accepted Answer

Peripheral nerve hyperexcitability

Answer

Opsoclonus syndrome

Answer

Encephalitis

Answer

Limbic encephalitis syndrome

Question 3

Blood transfusion associated acute lung injury occurs due to -

Accepted Answer

HLA-mediated reaction

Answer

Nosocomial infections

Answer

Auto-immune disorder

Answer

Genetic susceptibility

Question 4

Thyroid nodule in a 65 year old male who is clinically euthyroid is most likely to be

Accepted Answer

Follicular adenoma

Answer

Multinodular goiter

Answer

Thyroid cyst

Answer

Follicular carcinoma

Question 5

What does a motor score of 4 on the Glasgow Coma Scale indicate?

Accepted Answer

Withdrawal or flexion to pain

Answer

Decorticate posturing

Answer

Decerebrate posturing

Answer

Localizes to pain

Question 6

Pseudoclaudication is caused by

Accepted Answer

Lumbar canal stenosis

Answer

Femoral Artery stenosis

Answer

Popliteal Artery stenosis

Answer

Radial Artery stenosis

Question 7

What are the expected neurological manifestations in a patient with complete absence of the corpus callosum?

Accepted Answer

Severe developmental delays

Answer

Mild cognitive impairment

Answer

Seizures

Answer

No significant neurological deficits

Question 8

Which of the following is the MOST characteristic feature of Eaton-Lambert syndrome?

Accepted Answer

Repeated electrical stimulation enhances muscle power in it.

Answer

Neostigmine is not effective for this syndrome.

Answer

It is commonly associated with small cell lung cancer.

Answer

It can affect the ocular muscles.

Question 9

In cobalamin deficiency which is not seen

Accepted Answer

Microcytic anemia

Answer

Loss of proprioception

Answer

Rhomberg sign

Answer

Long tract signs

Question 10

Which zone of the prostate is primarily involved in Benign Prostatic Hyperplasia (BPH)?

Accepted Answer

Transitional zone

Answer

Central zone

Answer

Peripheral zone

Answer

Prostate capsule

NEET-PG 2015 — Internal Medicine