NEET-PG 2017 - Internal Medicine Practice Questions

Q: A 12-year-old boy presents with difficulty in reading from the blackboard in school. Initially refraction error was considered but visual acuity was normal. He has started complaining of diplopia on watching TV or after studying for long. He takes very long time to finish his meals and his speech becomes very difficult to understand after speaking continuously for few minutes. Anti-Acetylcholine receptor blocking antibody is detected in high titers. All are done in management except? (Recent NEET Pattern 2016-17)

Atropine. ***Atropine*** - The patient's symptoms (diplopia, dysphagia, dysarthria, and improvement with rest, along with high titers of **anti-acetylcholine receptor blocking antibody**) are classic for **myasthenia gravis (MG)** [1], [2]. - **Atropine** is an anticholinergic agent that may occasionally be used to manage muscarinic side effects of cholinesterase inhibitors (like pyridostigmine), such as bradycardia, hypersalivation, or diarrhea [3]. - However, **atropine is NOT a primary treatment modality for MG** and is not part of routine management protocols [3]. It does not address the underlying pathophysiology or improve muscle strength. - In contrast, the other options represent core components of MG management. *Pyridostigmine* - **Pyridostigmine** is an **acetylcholinesterase inhibitor** and is the **first-line symptomatic treatment** for myasthenia gravis [1]. - It increases the amount of acetylcholine available at the neuromuscular junction, improving muscle strength and function. *Steroids* - **Corticosteroids** (like prednisone) are a mainstay of **immunosuppressive therapy** for myasthenia gravis, used to reduce the autoimmune attack on acetylcholine receptors [1]. - They are typically used when symptoms are not adequately controlled by pyridostigmine alone or in moderate to severe cases. *CT chest* - A **CT scan of the chest** is crucial in the initial workup of myasthenia gravis to screen for a **thymoma**, a tumor of the thymus gland. - Thymomas are associated with MG in 10-15% of patients, and their presence often dictates the need for thymectomy. - Even in the absence of thymoma, thymic hyperplasia is common in MG patients.

Q: The MRI findings shown in the image are consistent with multiple sclerosis. All of the following drugs are useful for management of this patient EXCEPT:

Intravenous immunoglobulin. ***Intravenous immunoglobulin*** - The image shows multiple **periventricular and juxtacortical white matter lesions**, characteristic of **multiple sclerosis (MS)**. IVIG is generally not a first-line treatment or disease-modifying therapy for MS. - While IVIG is used for some autoimmune neurological conditions (e.g., Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy) and acute MS exacerbations in specific cases, it is not a standard long-term management drug for MS. *Methylprednisolone* - **High-dose intravenous methylprednisolone** is the standard treatment for acute exacerbations or relapses in multiple sclerosis to reduce inflammation and shorten the duration of an attack. - It helps to restore the **blood-brain barrier** integrity and reduce edema associated with active demyelinating lesions. *Fingolimod* - Fingolimod is an **oral disease-modifying therapy (DMT)** approved for relapsing forms of MS. - It works by trapping lymphocytes in lymph nodes, preventing them from entering the central nervous system and causing demyelination. *Mitoxantrone* - Mitoxantrone is an **antineoplastic agent** that also has immunosuppressant properties, approved for worsening relapsing-remitting, secondary progressive, and progressive-relapsing MS. - It is used in more **aggressive forms of MS** due to its potential for serious side effects, including cardiotoxicity.

Q: The following test is performed for evaluating the integrity of: (Recent NEET Pattern 2016-17)

Cerebellum. ***Cerebellum*** - The image depicts a person performing a **tandem gait** (walking heel-to-toe along a straight line), which is a common test for **cerebellar function**. - The cerebellum is critical for **coordination**, balance, and **fine motor control**, including the ability to maintain a straight path during walking. *Basal ganglia* - The basal ganglia are primarily involved in the **initiation and modulation of movement**, and their dysfunction leads to characteristic movement disorders such as **Parkinsonism (bradykinesia, rigidity, tremor)** or **Huntington's disease (chorea)**. - While gait can be affected in basal ganglia disorders (e.g., shuffling gait in Parkinson's), tandem gait specifically emphasizes balance and coordination more directly attributed to cerebellar function. *Corticospinal pathway* - The **corticospinal pathway** (pyramidal tract) is responsible for **voluntary, skilled movements**, particularly of the distal limbs. - Damage to this pathway typically results in **weakness (paresis)**, spasticity, and hyperreflexia, which would manifest as difficulty with initiating or executing movements rather than purely balance and coordination issues highlighted by tandem gait. *Spinothalamic pathway* - The spinothalamic pathway transmits **pain** and **temperature** sensations from the body to the brain. - Evaluating this pathway involves sensory testing (e.g., pinprick, hot/cold sensation), which is unrelated to the motor task of tandem walking.

Question 1

A 12-year-old boy presents with difficulty in reading from the blackboard in school. Initially refraction error was considered but visual acuity was normal. He has started complaining of diplopia on watching TV or after studying for long. He takes very long time to finish his meals and his speech becomes very difficult to understand after speaking continuously for few minutes. Anti-Acetylcholine receptor blocking antibody is detected in high titers. All are done in management except? (Recent NEET Pattern 2016-17)

Accepted Answer

Atropine

Answer

Pyridostigmine

Answer

Steroids

Answer

CT chest

Question 2

The MRI findings shown in the image are consistent with multiple sclerosis. All of the following drugs are useful for management of this patient EXCEPT:

Accepted Answer

Intravenous immunoglobulin

Answer

Methylprednisolone

Answer

Fingolimod

Answer

Mitoxantrone

Question 3

The following test is performed for evaluating the integrity of: (Recent NEET Pattern 2016-17)

Accepted Answer

Cerebellum

Answer

Basal ganglia

Answer

Corticospinal pathway

Answer

Spinothalamic pathway

NEET-PG 2017 — Internal Medicine