Madarosis is seen in ?
Chemotherapeutic Agent of Choice for the treatment of CML?
A pregnant woman is diagnosed with Graves' disease. The most appropriate therapy for her would be:
Hypophosphatemia is seen in:
Which of the following diseases is NOT associated with Anti-Neutrophil Cytoplasmic Antibodies (ANCA)?
Which of the following statements about Sickle Cell Anemia is FALSE?
What is the initial treatment of choice for managing secondary hyperparathyroidism in patients with renal osteodystrophy?
In which of the following conditions is hypomagnesemia not typically observed?
What is true about HER2/neu overexpression in cancer?
Jaw tightness is typically seen in:
NEET-PG 2012 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 41: Madarosis is seen in ?
- A. None of the options
- B. Addison's disease
- C. Acromegaly
- D. Hypothyroidism (Correct Answer)
Explanation: ***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 42: Chemotherapeutic Agent of Choice for the treatment of CML?
- A. Imatinib (Correct Answer)
- B. Vincristine
- C. Cyclophosphamide
- D. Methotrexate
Explanation: ***Imatinib*** - **Imatinib** is a **tyrosine kinase inhibitor** specifically targeting the **BCR-ABL fusion protein**, which is the hallmark of CML [1][2]. - It dramatically improved the prognosis of CML patients, making it the **first-line therapy** and agent of choice due to its high efficacy and relatively low toxicity compared to conventional chemotherapy [2]. *Vincristine* - **Vincristine** is a **vinca alkaloid** that inhibits microtubule formation, primarily used in acute leukemias and lymphomas. - It is not the agent of choice for CML due to its different mechanism of action and the availability of more targeted therapies for CML. *Cyclophosphamide* - **Cyclophosphamide** is an **alkylating agent** that causes DNA damage, used in various cancers and autoimmune diseases. - While it can be used in some hematologic malignancies, it is not the preferred or most effective treatment for CML, especially given the success of targeted therapies. *Methotrexate* - **Methotrexate** is an **antimetabolite** that interferes with DNA synthesis, commonly used in acute leukemias, lymphomas, and autoimmune conditions. - It is not considered the chemotherapeutic agent of choice for CML, as its mechanism of action is not specific to the BCR-ABL anomaly characteristic of CML.
Question 43: A pregnant woman is diagnosed with Graves' disease. The most appropriate therapy for her would be:
- A. Radioiodine therapy
- B. Total thyroidectomy
- C. Carbimazole parenteral
- D. Propylthiouracil oral (Correct Answer)
Explanation: ***Propylthiouracil oral*** - **Propylthiouracil (PTU)** is the preferred antithyroid drug during the **first trimester** of pregnancy due to a lower risk of teratogenicity compared to methimazole/carbimazole [1]. - It works by inhibiting both the synthesis of thyroid hormones and the peripheral conversion of **T4 to T3**. *Radioiodine therapy* - **Radioactive iodine** is absolutely contraindicated in pregnancy as it can cross the placenta and cause **fetal hypothyroidism or athyreosis**. - It leads to permanent destruction of the thyroid gland and is not suitable for a temporary condition in a pregnant woman. *Total thyroidectomy* - While thyroidectomy can be considered for Graves' disease in pregnancy, it is generally reserved for cases where antithyroid drugs are not tolerated or ineffective, or for very large goiters causing compressive symptoms. - It carries risks associated with **surgery and anesthesia** during pregnancy, and requires **lifelong thyroid hormone replacement**. *Carbimazole parenteral* - **Carbimazole** (which is metabolized to methimazole) is generally avoided in the **first trimester** due to an increased risk of teratogenicity, particularly **aplasia cutis**, omphalocele, and choanal atresia [1]. - While it can be used in the second and third trimesters, **PTU is preferred in the first trimester**, and carbimazole is not typically administered parenterally.
Question 44: Hypophosphatemia is seen in:
- A. Hyperthyroidism
- B. Hypoparathyroidism
- C. Hyperparathyroidism (Correct Answer)
- D. Pseudohypoparathyroidism
Explanation: ***Hyperparathyroidism*** - In **primary hyperparathyroidism**, the excess **parathyroid hormone (PTH)** leads to increased phosphate excretion by the kidneys [1], [4]. - This results in **hypophosphatemia** as the body attempts to maintain **calcium-phosphate balance**, often at the expense of phosphate levels [1]. *Hyperthyroidism* - While hyperthyroidism can affect **bone metabolism**, it is typically associated with **normal or slightly elevated phosphate levels**, not hypophosphatemia [3]. - The main electrolyte disturbances are usually related to **calcium** (e.g., hypercalcemia) due to increased bone turnover [3]. *Hypoparathyroidism* - **Hypoparathyroidism** is characterized by **low or absent PTH**, leading to decreased renal phosphate excretion. - This results in **hyperphosphatemia**, along with **hypocalcemia** [2]. *Pseudohypoparathyroidism* - In **pseudohypoparathyroidism**, there is **PTH resistance** at target tissues, even with high or normal PTH levels [2]. - This leads to symptoms resembling hypoparathyroidism, including **hyperphosphatemia** and **hypocalcemia** [2].
Question 45: Which of the following diseases is NOT associated with Anti-Neutrophil Cytoplasmic Antibodies (ANCA)?
- A. Wegener's granulomatosis
- B. Henoch schonlein purpura (Correct Answer)
- C. Microscopic PAN
- D. Churg Strauss syndrome
Explanation: ***Henoch schonlein purpura*** - **Henoch-Schönlein purpura (HSP)** is not associated with **ANCA**; it primarily involves IgA deposition [1]. - Commonly presents with **purpura**, **abdominal pain**, and **glomerulonephritis**, differentiating it from ANCA-associated vasculitides [1]. *Wegener's granulomatosis* - **Wegener's granulomatosis**, now known as **Granulomatosis with polyangiitis**, is strongly associated with **c-ANCA** and anti-PR3 antibodies. - It typically presents with **respiratory** and **renal symptoms** due to vasculitis [2]. *Microscopic PAN* - **Microscopic polyangiitis (PAN)** is associated with **p-ANCA** and myeloperoxidase (MPO) antibodies. - It leads to **glomerulonephritis** and **pulmonary hemorrhage**, indicating its vasculitic nature. *Churg Strauss syndrome* - **Churg-Strauss syndrome**, or **Eosinophilic Granulomatosis with Polyangiitis**, is associated with **p-ANCA** and perinuclear staining [1]. - Often presents with **asthma**, **eosinophilia**, and systemic vasculitis affecting multiple organs [1].
Question 46: Which of the following statements about Sickle Cell Anemia is FALSE?
- A. There is a positive correlation between HBS and polymerization of HBS (Correct Answer)
- B. Recurrent infections is the most common cause of death
- C. Patients require frequent blood transfusions
- D. Patients usually present before the age of 6 months
Explanation: ***There is a positive correlation between HBS and polymerization of HBS*** - This statement is false because the polymerization of **hemoglobin S (HbS)** is reduced as HbS levels decrease and is increased as HbS levels increase. Therefore, there is a **direct correlation**, not a positive one, where higher levels of HbS lead to more polymerization and sickling. - The disease is caused by the **polymerization of deoxyhemoglobin S**, which distorts red blood cells into a sickle shape, leading to vaso-occlusion and hemolysis [1]. *Recurrent infections is the most common cause of death* - **Recurrent infections** are indeed a leading cause of morbidity and mortality in sickle cell anemia patients, particularly in children due to **functional asplenia**. [1] - **Splenic dysfunction** impairs the ability to clear encapsulated bacteria, increasing the risk of severe infections like **pneumonia** and **meningitis**. *Patients require frequent blood transfusions* - **Frequent blood transfusions** are a common treatment strategy for sickle cell anemia to manage complications such as severe anemia, acute chest syndrome, and stroke prevention [1]. - **Chronic transfusion therapy** helps to suppress abnormal sickle cell production and dilute existing sickle cells, thereby reducing vaso-occlusive crises. *Patients usually present before the age of 6 months* - Patients with sickle cell anemia typically become symptomatic after 6 months of age, when **fetal hemoglobin (HbF)** levels decline. - **HbF protects** against sickling, so symptoms like **dactylitis** and **splenic sequestration** usually manifest once HbF is replaced by HbS [1].
Question 47: What is the initial treatment of choice for managing secondary hyperparathyroidism in patients with renal osteodystrophy?
- A. Cinacalcet
- B. Bisphosphonates
- C. Calcium restriction
- D. Phosphate binders (Correct Answer)
Explanation: ***Phosphate binders*** - **Phosphate binders** are the initial treatment because **hyperphosphatemia** is the primary driver of secondary hyperparathyroidism in renal disease, triggering parathyroid hormone (PTH) release [1]. - They work by binding dietary phosphate in the gastrointestinal tract, preventing its absorption and thus lowering serum phosphate levels [1]. *Cinacalcet* - **Cinacalcet** is a calcimimetic that increases the sensitivity of calcium-sensing receptors on the parathyroid gland, reducing **PTH secretion** [1]. - It is often used if **phosphate binders** and **vitamin D analogs** are insufficient in controlling PTH, making it a second-line treatment [1]. *Bisphosphonates* - **Bisphosphonates** are used to treat osteoporosis by inhibiting osteoclast activity and reducing bone resorption. - They are generally contraindicated in advanced renal osteodystrophy due to concerns about adynamic bone disease and are not an initial treatment for **secondary hyperparathyroidism**. *Calcium restriction* - While restricting dietary calcium might seem intuitive, **hypocalcemia** is often a problem in renal disease due to impaired vitamin D activation [1]. - Overly restricting calcium can worsen hypocalcemia, which would further stimulate PTH release, thus it is not an initial treatment for **secondary hyperparathyroidism**.
Question 48: In which of the following conditions is hypomagnesemia not typically observed?
- A. Diarrhea
- B. Gitelman syndrome
- C. Diabetes mellitus (Correct Answer)
- D. Bartter syndrome
Explanation: Diabetes mellitus - While hypomagnesemia can occur in poorly controlled diabetes due to osmotic diuresis, it is not a typical or defining feature of the condition itself in the same way as other options. - Many individuals with controlled diabetes may have normal magnesium levels, and it's often associated with complications rather than the primary disease process. Diarrhea - Chronic or severe diarrhea leads to significant gastrointestinal losses of electrolytes, including magnesium. - This is a common cause of hypomagnesemia, as the body loses fluids and minerals before they can be absorbed. Gitelman syndrome - This is a renal tubular disorder characterized by a defect in the thiazide-sensitive Na-Cl cotransporter in the distal convoluted tubule. - It leads to hypomagnesemia (due to increased renal excretion) and hypokalemia, along with metabolic alkalosis. Bartter syndrome - This syndrome involves a defect in the Na-K-2Cl cotransporter in the thick ascending limb of the loop of Henle. - It results in significant renal wasting of magnesium [1], leading to hypomagnesemia, along with hypokalemia and metabolic alkalosis.
Question 49: What is true about HER2/neu overexpression in cancer?
- A. Good prognosis
- B. Responds well to taxanes
- C. Responds well to monoclonal antibodies (Correct Answer)
- D. Seen in various cancers, including breast cancer
Explanation: ***Responds well to monoclonal antibodies*** - HER2/neu overexpression is targeted by **monoclonal antibodies** like trastuzumab (Herceptin), improving treatment outcomes [1]. - These therapies are specifically designed to **inhibit HER2-positive** tumors, leading to better overall prognosis compared to those without such therapies [1]. *Good prognosis* - HER2/neu overexpression is generally associated with a **poor prognosis** due to increased aggressiveness of the cancer. - It correlates with **higher rates of recurrence** and metastasis compared to HER2-negative breast cancers. *Responds well to taxanes* - While taxanes are commonly used in breast cancer treatment, HER2/neu positivity does not specifically imply a good response. - Response rates may not significantly differ based on HER2 status for taxane-based therapies alone. *Seen only in breast cancer* - HER2/neu overexpression can also occur in other cancers, such as **gastric and gastroesophageal junction cancers**. - It is not exclusive to breast cancer, though it is most commonly studied in this context [1].
Question 50: Jaw tightness is typically seen in:
- A. Coarctation of aorta
- B. Giant cell arteritis (GCA) (Correct Answer)
- C. Polyarteritis nodosa (PAN)
- D. Granulomatosis with Polyangiitis (GPA)
Explanation: ***Giant cell arteritis (GCA)*** - **Jaw claudication** or tightness, difficulty chewing, and pain in the jaw are classic symptoms of GCA, resulting from **ischemia of the masticatory muscles**. [1] - This condition is a **large vessel vasculitis** that frequently affects the **temporal arteries** and can lead to blindness if untreated. [1] *Polyarteritis nodosa (PAN)* - PAN is a **necrotizing vasculitis** that typically affects **medium-sized arteries**, often sparing the pulmonary circulation. [1] - Common symptoms include **neuropathy**, abdominal pain, and skin lesions (e.g., livedo reticularis), but **jaw tightness is not a typical feature**. *Coarctation of aorta* - This is a **congenital narrowing of the aorta**, leading to symptoms like **upper extremity hypertension**, headache, and claudication in the lower extremities. - **Jaw tightness is not a symptom** associated with coarctation of the aorta. *Granulomatosis with Polyangiitis (GPA)* - GPA is a **small-vessel vasculitis** characterized by **granulomatous inflammation** involving the upper and lower respiratory tracts, and glomerulonephritis. - Symptoms often include **sinusitis**, lung nodules, and kidney disease, but **jaw claudication is not a characteristic presentation**.