NEET-PG 2012 - Internal Medicine Practice Questions

Q: Renal vein thrombosis is associated with all of the following conditions except:

Trauma. **Trauma** - While trauma to the abdomen can cause **renal injury** and other vascular issues, isolated **renal vein thrombosis** is not a common direct association or complication [1]. - Renal vein thrombosis typically results from conditions that lead to a **hypercoagulable state** or local vascular stasis. *Sickle cell anemia* - Individuals with **sickle cell anemia** are prone to **vaso-occlusive crises** from sickled red blood cells obstructing blood flow [2]. - This can lead to **renal medullary ischemia** and infarction, making them highly susceptible to **renal vein thrombosis**. *Nephrotic syndrome* - **Nephrotic syndrome** is a significant risk factor for **renal vein thrombosis** due to the urinary loss of **antithrombin III**, a natural anticoagulant. - This loss creates a **hypercoagulable state**, increasing the likelihood of thrombus formation in renal veins. *Dehydration* - Severe **dehydration** leads to **hemoconcentration** (increased blood viscosity) and reduced blood flow. - These factors promote a **hypercoagulable state**, increasing the risk of thrombotic events, including **renal vein thrombosis**, especially in vulnerable populations like infants or the elderly.

Q: All of the following statements about the third heart sound (S3) are true, except:

Seen in Constrictive Pericarditis. ***Seen in Constrictive Pericarditis*** - While constrictive pericarditis can lead to a diastolic sound, it's typically a **pericardial knock**, which is sharper and occurs earlier than an S3, due to abrupt halting of ventricular filling. - A true S3 is a low-pitched sound caused by turbulent blood flow into an overly compliant or volume-overloaded ventricle, which is not the primary mechanism in constrictive pericarditis. *Occurs due to rapid filling of the ventricles during early diastole.* - The S3 heart sound is precisely caused by the **rapid inflow of blood** into a dilated or poorly compliant ventricle during the early, rapid filling phase of diastole [1]. - This rapid distension causes vibrations in the ventricular wall, audible as S3, and is often associated with conditions causing **volume overload** or **ventricular dysfunction**. *Seen in Atrial Septal Defect (ASD)* - Patients with a large ASD have increased blood flow through the tricuspid valve, leading to **right ventricular volume overload** [2]. - This increased volume can cause an **S3** sound, particularly a **right ventricular S3**, due to rapid filling of the overloaded right ventricle [2]. *Seen in Ventricular Septal Defect (VSD)* - A significant VSD leads to a **left-to-right shunt**, increasing blood flow to the pulmonary circulation and subsequently returning to the left atrium and left ventricle. - This **left ventricular volume overload** can result in an audible **left ventricular S3**, reflecting rapid filling of the dilated left ventricle.

Q: Among the following, most reliable test for screening of diabetes mellitus?

Fasting sugar. ***Fasting sugar*** - A **fasting plasma glucose** (FPG) test is the most common and reliable initial test for screening for **diabetes mellitus** because it measures blood glucose after an overnight fast (typically 8-12 hours), providing a baseline level unaffected by recent food intake [1]. - A fasting glucose level of **≥ 126 mg/dL** (7.0 mmol/L) on two separate occasions is diagnostic of diabetes, making it an excellent screening tool for identifying individuals with impaired glucose metabolism [1]. *Random sugar* - A random plasma glucose test can be used to diagnose diabetes if the level is **≥ 200 mg/dL** (11.1 mmol/L) in a symptomatic individual, but it is less reliable for screening asymptomatic individuals due to its variability depending on recent food intake [1]. - Because it can be measured at any time of day without regard to the last meal, it has a **lower sensitivity** for detecting early stages of diabetes compared to fasting glucose. *Glucose tolerance test* - An **oral glucose tolerance test** (OGTT) is highly sensitive and specific for diagnosing diabetes and impaired glucose tolerance, but it is more cumbersome and time-consuming, involving multiple blood draws over two hours after consuming a sugary drink. - While it is a definitive diagnostic test, its complexity makes it **less practical for routine screening** in large populations compared to simpler tests like fasting plasma glucose. *Urine sugar* - The presence of glucose in urine (glycosuria) indicates that blood glucose levels have exceeded the **renal threshold** (typically around 180 mg/dL), meaning the kidneys are unable to reabsorb all the glucose. - This is a **less sensitive and specific** method for screening, as it only becomes positive once blood glucose is significantly elevated, and it does not detect milder forms of impaired glucose metabolism or early diabetes.

Q: A 45-year-old patient presents with progressive dyspnea, orthopnea, and bilateral pedal edema. On examination, there is elevated JVP, S3 gallop, and hepatomegaly. What is the most likely underlying pathophysiology?

HALE. ***HALE*** - This acronym stands for **Heart-failure Associated Lung Edema**. The symptoms of **progressive dyspnea**, **orthopnea**, **bilateral pedal edema**, **elevated JVP**, **S3 gallop**, and **hepatomegaly** are classic signs of **congestive heart failure** leading to fluid overload and pulmonary congestion [1]. - The pathophysiology involves the heart's inability to pump blood effectively, causing a buildup of pressure in the pulmonary and systemic circulations, leading to the observed symptoms [1]. *DALEY* - This is not a recognized acronym in medical pathophysiology. The symptoms presented are strongly indicative of a specific cardiovascular condition. - There is no clinical scenario where "DALEY" would accurately describe the underlying pathophysiology of dyspnea, edema, and heart failure signs. *OALY* - This is not a recognized acronym in medical pathophysiology. The presented clinical picture requires a well-established and specific pathophysiological explanation. - Using an unrecognized term would not provide an accurate or helpful description of the patient's condition. *None of the options* - The acronym HALE (Heart-failure Associated Lung Edema) accurately captures the core pathophysiology evident from the patient's symptoms and signs. - Given the strong clinical presentation of congestive heart failure with pulmonary and systemic congestion, one of the provided options *does* accurately describe the situation.

Q: Ataxia, nystagmus, and ophthalmoplegia are seen in which of the following conditions?

Wernicke encephalopathy. ***Wernicke encephalopathy*** - This condition is characterized by the classic triad of **ataxia**, **nystagmus**, and **ophthalmoplegia** (often presenting as external ophthalmoplegia), alongside confusion [2]. - It results from a **thiamine (vitamin B1) deficiency** [2], [3], commonly seen in chronic alcoholics or individuals with severe malnutrition. *Myasthenia gravis* - This is an **autoimmune disorder** affecting the neuromuscular junction, leading to fluctuating muscle weakness that worsens with activity [1]. - While it can cause **ophthalmoplegia** (especially ptosis and diplopia), it does not typically present with ataxia or nystagmus. *3rd nerve palsy* - A **third nerve palsy** specifically affects the oculomotor nerve, causing a constellation of symptoms including ptosis, pupillary dilation, and inability to move the eye up, down, or medially. - While it causes **ophthalmoplegia** affecting one eye, it does not typically cause nystagmus or ataxia. *Chronic progressive external ophthalmoplegia* - This is a mitochondrial disorder characterized by **slowly progressive weakness** of the extraocular muscles, leading to bilateral ptosis and limitation of eye movements. - It causes a specific type of **ophthalmoplegia** but is not typically associated with nystagmus or prominent ataxia.

Q: HIV post exposure prophylaxis should be started within?

72 hrs. ***72 hrs*** - **Post-exposure prophylaxis (PEP)** aims to prevent HIV infection after potential exposure and should ideally be initiated as soon as possible, but no later than **72 hours** after exposure [1]. - Starting PEP within this window significantly increases its effectiveness in preventing HIV seroconversion. *1-2 hrs* - While initiating PEP as soon as possible is crucial, stating it must be within **1-2 hours** can be misleading as the window of effectiveness extends beyond this. - This timeframe might be an ideal, but not the absolute crucial limit for efficacy. *14 hrs* - This timeframe is **too restrictive** for the recommended window for PEP initiation. - Missing the opportunity within **14 hours** does not negate the effectiveness of PEP if started within the broader 72-hour window. *18 hrs* - Similar to **14 hours**, **18 hours** is an unnecessarily strict limit for PEP initiation. - Guidelines universally support starting PEP up to **72 hours** post-exposure for optimal benefit [1].

Q: What is the most common cause of ophthalmoplegia in adults?

Cranial nerve palsy. ***Cranial nerve palsy*** - **Cranial nerve palsies**, particularly those affecting cranial nerves III, IV, or VI, are the most frequent causes of isolated ophthalmoplegia in adults [1]. - They can result from various etiologies like **ischemia**, **compression**, or **inflammation**, directly impairing the nerves responsible for eye movement [1]. *Myasthenia gravis* - While it frequently causes **ocular symptoms** (ptosis and diplopia), it typically presents with **fluctuating weakness** that worsens with sustained effort [1]. - It's a neuromuscular junction disorder, not a primary cranial nerve issue, and often affects other muscle groups beyond the eyes. *Diabetes mellitus* - **Diabetic ophthalmoplegia** is a specific type of cranial nerve palsy (often CN III or VI) caused by microvascular ischemia. - While common in diabetics, it is a *cause* of cranial nerve palsy, not the overarching most common cause of ophthalmoplegia itself. *Trauma* - **Trauma** can certainly cause ophthalmoplegia, often due to direct damage to **extraocular muscles**, **orbital fractures**, or **cranial nerve injury**. - However, in the general adult population, non-traumatic cranial nerve palsies are more frequently encountered as the cause of ophthalmoplegia.

Q: Which visual disturbance is commonly associated with Vitamin B12 deficiency?

Centrocaecal scotoma. No relevant citations could be added to the original explanation because the provided references did not specifically address the association between Vitamin B12 deficiency and centrocaecal scotoma. ***Centrocaecal scotoma*** - **Vitamin B12 deficiency** can lead to optic neuropathy, which often manifests as a **centrocaecal scotoma**, affecting central and paracentral vision. - This visual impairment is due to **demyelination of the optic nerve fibers** caused by the deficiency. *Binasal hemianopia* - This type of visual field defect is rare and typically caused by lesions that compress the uncrossed retinal nerve fibers, such as **bilateral internal carotid artery aneurysms** or **bilateral optic nerve disease**. - It does not directly correlate with **Vitamin B12 deficiency**. *Constriction of peripheral vision* - **Peripheral vision loss** is associated with conditions like **glaucoma** or advanced **retinitis pigmentosa**. - It is not a characteristic visual disturbance of **Vitamin B12 deficiency**. *Bitemporal hemianopia* - This visual field defect is commonly caused by compression of the **optic chiasm**, most often due to a **pituitary adenoma**. - It results in loss of vision in the outer half of both visual fields and is not linked to **Vitamin B12 deficiency**.

Q: What is the most likely diagnosis for a young patient presenting with iritis and joint pain?

AS. ***AS (Ankylosing Spondylitis)*** - **Iritis** (anterior uveitis) is a common extra-articular manifestation of **ankylosing spondylitis**, affecting up to 40% of patients [1]. - **Joint pain**, particularly in the axial skeleton (spine and sacroiliac joints), is a hallmark feature in young patients with AS [1]. *Gout* - Characterized by **recurrent attacks of acute inflammatory arthritis** due to **monosodium urate crystal deposition**. - While it causes severe joint pain, **iritis is not a typical manifestation** of gout. *RA (Rheumatoid Arthritis)* - RA is a **chronic autoimmune inflammatory disease** primarily affecting the **synovial joints** symmetrically, mostly in older adults. - While ocular manifestations like **scleritis** or **episcleritis** can occur, **iritis is less common** compared to AS. *Toxoplasma* - **Toxoplasmosis** primarily causes **chorioretinitis** (inflammation of the choroid and retina), not typically isolated iritis. - Although it can cause **arthralgia** (joint pain), it does not cause inflammatory arthritis like the spondyloarthropathies.

Q: Madarosis is seen in ?

Hypothyroidism. ***Hypothyroidism*** - **Madarosis**, specifically the loss of the **outer third of the eyebrows**, is a classic sign of **hypothyroidism** due to decreased thyroid hormone levels affecting hair follicle growth [1]. - Other common symptoms include **fatigue**, **weight gain**, **cold intolerance**, and **dry skin**. *Addison's disease* - This condition involves **adrenal insufficiency**, primarily causing symptoms like **hyperpigmentation**, low blood pressure, and fatigue. - **Hair loss** is generally not a prominent feature, and madarosis is not typically seen. *Acromegaly* - Characterized by excessive **growth hormone** production, leading to enlargement of hands, feet, and facial features. - While it can cause some changes in hair texture, **madarosis** is not a common clinical manifestation. *None of the options* - This option is incorrect because **Hypothyroidism** is a direct cause of madarosis due to its impact on **hair follicle metabolism** [1]. - The other conditions listed do not typically present with this specific type of eyebrow hair loss.

Question 1

Renal vein thrombosis is associated with all of the following conditions except:

Accepted Answer

Trauma

Answer

Nephrotic syndrome

Answer

Dehydration

Answer

Sickle cell anemia

Question 2

All of the following statements about the third heart sound (S3) are true, except:

Accepted Answer

Seen in Constrictive Pericarditis

Answer

Seen in Atrial Septal Defect (ASD)

Answer

Seen in Ventricular Septal Defect (VSD)

Answer

Occurs due to rapid filling of the ventricles during early diastole.

Question 3

Among the following, most reliable test for screening of diabetes mellitus?

Accepted Answer

Fasting sugar

Answer

Urine sugar

Answer

Random sugar

Answer

Glucose tolerance test

Question 4

A 45-year-old patient presents with progressive dyspnea, orthopnea, and bilateral pedal edema. On examination, there is elevated JVP, S3 gallop, and hepatomegaly. What is the most likely underlying pathophysiology?

Accepted Answer

HALE

Answer

DALEY

Answer

OALY

Answer

None of the options

Question 5

Ataxia, nystagmus, and ophthalmoplegia are seen in which of the following conditions?

Accepted Answer

Wernicke encephalopathy

Answer

3rd nerve palsy

Answer

Myasthenia gravis

Answer

Chronic progressive external ophthalmoplegia

Question 6

HIV post exposure prophylaxis should be started within?

Accepted Answer

72 hrs

Answer

1-2 hrs

Answer

14 hrs

Answer

18 hrs

Question 7

What is the most common cause of ophthalmoplegia in adults?

Accepted Answer

Cranial nerve palsy

Answer

Myasthenia gravis

Answer

Diabetes mellitus

Answer

Trauma

Question 8

Which visual disturbance is commonly associated with Vitamin B12 deficiency?

Accepted Answer

Centrocaecal scotoma

Answer

Binasal hemianopia

Answer

Constriction of peripheral vision

Answer

Bitemporal hemianopia

Question 9

What is the most likely diagnosis for a young patient presenting with iritis and joint pain?

Accepted Answer

AS

Answer

Gout

Answer

RA

Answer

Toxoplasma

Question 10

Madarosis is seen in ?

Accepted Answer

Hypothyroidism

Answer

None of the options

Answer

Addison's disease

Answer

Acromegaly

NEET-PG 2012 — Internal Medicine