In a patient with suspected vitamin B12 deficiency, which condition would result in an abnormal Schilling test?
Secretory diarrhea is not typically associated with which of the following conditions?
What is the daily temperature variation in remittent fever?
Investigation of choice in pheochromocytoma is:
Which of the following is a characteristic of Yellow-nail syndrome?
Which of the following medications is not typically used in the treatment of malignant malaria?
What is the most common complication of a large Patent Ductus Arteriosus (PDA)?
In axillary nerve paralysis, which of the following statements is false?
Tuberculosis of the spine; what is the most common site affected?
Oculoorogenital ulcers are associated with which of the following conditions?
NEET-PG 2012 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 61: In a patient with suspected vitamin B12 deficiency, which condition would result in an abnormal Schilling test?
- A. Amylase deficiency
- B. Pancreatic endocrine insufficiency
- C. Lipase deficiency
- D. Intrinsic factor deficiency (Correct Answer)
Explanation: ***Intrinsic factor deficiency*** - The Schilling test assesses the absorption of **vitamin B12**. **Intrinsic factor** is crucial for B12 absorption in the ileum. - Deficiency of intrinsic factor, as seen in **pernicious anemia**, directly impairs B12 absorption, leading to an abnormal Schilling test result [1]. *Amylase deficiency* - **Amylase** is an enzyme involved in the digestion of carbohydrates, not vitamin B12 absorption [2]. - Its deficiency would primarily cause carbohydrate malabsorption symptoms, not an abnormal Schilling test. *Pancreatic endocrine insufficiency* - **Pancreatic endocrine function** relates to hormone production (e.g., insulin, glucagon), while exocrine function involves digestive enzymes. - Impairment of endocrine function does not directly affect vitamin B12 absorption or the Schilling test. *Lipase deficiency* - **Lipase** is an enzyme essential for the digestion of fats [2]. - Its deficiency would lead to fat malabsorption (steatorrhea) but would not affect vitamin B12 absorption or the Schilling test results.
Question 62: Secretory diarrhea is not typically associated with which of the following conditions?
- A. Phenolphthalein
- B. Cholera
- C. Celiac disease (Correct Answer)
- D. VIPoma
Explanation: ***Celiac disease*** [1] - Characterized by **malabsorption** due to immune-mediated damage to the intestinal mucosa, leading to **osmotic diarrhea** rather than secretory diarrhea [1]. - Symptoms include **bloating**, **weight loss**, and **steatorrhea**, which are not consistent with secretory processes. *Cholera* - Caused by **Vibrio cholerae**, leading to **massive secretory diarrhea** due to the action of cholera toxin on intestinal epithelial cells. - Presents with **watery diarrhea**, potentially leading to **dehydration** and electrolyte imbalances. *Addison's Disease* - This condition may cause **diarrhea** but typically results in **non-secretory diarrhea**, often associated with adrenal insufficiency symptoms. - Presenting features include **fatigue**, **weight loss**, and **hyperpigmentation**, not primarily secretory processes. *Phenolphthalein* - A laxative that can induce **secretory diarrhea** through its stimulant effects on the bowel. - Its mechanism leads to increased fluid secretion in the intestines, thus contributing to secretory diarrhea.
Question 63: What is the daily temperature variation in remittent fever?
- A. < 0.5 °C
- B. > 1.0 °C (Correct Answer)
- C. < 1.0 °C
- D. > 2.0 °C
Explanation: ***> 1.0 °C*** - In **remittent fever**, the temperature fluctuates by **more than 1.0 °C** (or 2°F) over a 24-hour period. [1] - Despite the significant variation, the temperature **never returns to normal** during the day. [1] *< 0.5 °C* - A variation of less than 0.5 °C (or 1°F) is more characteristic of a **sustained or continuous fever**, where the temperature remains elevated with minimal fluctuation. [1] - This pattern is seen in conditions like **typhoid fever** or **pneumonia**. *< 1.0 °C* - While reflecting some fluctuation, a variation of less than 1.0 °C is not sufficient to classify a fever as remittent. - Remittent fever specifically requires a **larger daily swing** in temperature. *> 2.0 °C* - While a variation greater than 2.0 °C would certainly fall under the definition of remittent fever (as it's > 1.0 °C), the defining lower limit for remittent fever is typically **> 1.0 °C (or 2°F)**. - A larger fluctuation might occur, but > 1.0 °C is the minimum threshold.
Question 64: Investigation of choice in pheochromocytoma is:
- A. CT scan
- B. Urinary catecholamines (Correct Answer)
- C. MIBG scan
- D. MRI Scan
Explanation: ***Urinary catecholamines*** - Measurement of **24-hour urinary fractionated metanephrines and catecholamines** is the initial **biochemical test of choice**. - These biochemical tests are preferred over plasma levels due to the **episodic release** of hormones from a pheochromocytoma, which can lead to high false-negative rates in single plasma measurements. *CT scan* - While a **CT scan** is a crucial **imaging modality** for localizing a pheochromocytoma once the biochemical diagnosis is established [1], it is not the *initial* diagnostic investigation. - Imaging should be performed only after **biochemical confirmation** to avoid unnecessary investigations of incidental adrenal masses [1]. *MIBG scan* - An **MIBG scan** (metaiodobenzylguanidine scan) is a **functional imaging study** used primarily for **localizing metastatic pheochromocytomas** [1] or for cases where CT/MRI is equivocal. - It is not the initial investigation but rather a **secondary imaging test** [1]. *MRI Scan* - **MRI** is an alternative **imaging modality** to CT for localizing pheochromocytomas [1], especially in pregnant women or when radiation exposure is a concern. - Like CT, it serves as a **localization tool** after biochemical confirmation, not the diagnostic test itself.
Question 65: Which of the following is a characteristic of Yellow-nail syndrome?
- A. Knee joint effusion and lymphedema, associated with discolored nails
- B. Pericardial effusion and lymphedema, associated with discolored nails
- C. Pleural effusion and lymphedema, associated with discolored nails (Correct Answer)
- D. Peritoneal effusion and lymphedema, associated with discolored nails
Explanation: ***Pleural effusion and lymphedema, associated with discolored nails*** - Yellow-nail syndrome is characterized by the triad of **yellow, thickened, slow-growing nails**, **lymphedema**, and **pleural effusions**. - **Pleural effusions** are the most common respiratory manifestation, often chronic and recurrent. *Knee joint effusion and lymphedema, associated with discolored nails* - While **lymphedema** is a feature of Yellow-nail syndrome, **knee joint effusion** is not a primary or defining characteristic of the syndrome. - Joint effusions can occur in various conditions, but Yellow-nail syndrome is specifically associated with serous effusions in cavities like the pleura. *Pericardial effusion and lymphedema, associated with discolored nails* - **Pericardial effusion** is a rare manifestation of Yellow-nail syndrome, not a defining characteristic. - The classic triad includes **pleural effusions**, not pericardial. *Per peritoneal effusion and lymphedema, associated with discolored nails* - **Peritoneal effusion** (ascites) is another rare manifestation of Yellow-nail syndrome, not typically included in its core diagnostic criteria. - The syndrome is predominantly associated with effusions in the **pleural space**.
Question 66: Which of the following medications is not typically used in the treatment of malignant malaria?
- A. Doxycycline
- B. Artesunate
- C. Quinine
- D. Quinolone (Correct Answer)
Explanation: ***Quinolone*** - **Quinolone** antibiotics, while broad-spectrum, are not typically used as primary antimalarial agents due to limited efficacy against *Plasmodium falciparum* and potential for resistance. - Their use in malaria treatment is generally restricted to specific co-infections rather than direct antimalarial efficacy. *Quinine* - **Quinine** has been a cornerstone of severe malaria treatment for many years, especially in regions with limited access to newer artemisinin derivatives. - It works by interfering with the parasite's ability to detoxify heme, thus killing the parasites. *Doxycycline* - **Doxycycline** is an effective antimalarial, particularly as a prophylactic agent and in combination therapy for uncomplicated malaria or as an alternative for severe malaria when other agents are contraindicated. - It inhibits **protein synthesis** in the parasite. *Artesunate* - **Artesunate** is the recommended first-line treatment for severe malaria due to its rapid action and potent parasiticidal effects. - It is an **artemisinin derivative** that produces free radicals toxic to the parasite.
Question 67: What is the most common complication of a large Patent Ductus Arteriosus (PDA)?
- A. Eisenmenger syndrome
- B. Congestive Heart Failure (CHF) (Correct Answer)
- C. Infective endocarditis
- D. None of the options
Explanation: ***Congestive Heart Failure (CHF)*** - A large PDA results in a significant **left-to-right shunt**, increasing pulmonary blood flow and leading to **pulmonary overcirculation**. [1] - This increased workload on the heart, particularly the left atrium and ventricle, can lead to **ventricular dysfunction** and ultimately CHF. [1] *Eisenmenger syndrome* - While a severe complication of an untreated large PDA, it represents a **late stage** where the left-to-right shunt has reversed due to **pulmonary hypertension**. [1] - It is not the *most common* initial complication, as CHF often develops earlier in the disease progression. *Infective endocarditis* - This is a potential long-term complication of a PDA, especially if untreated, due to the **turbulent blood flow** across the ductus. - However, it is less common than CHF, which results directly from the hemodynamic burden imposed by a large shunt. *None of the options* - This option is incorrect because **Congestive Heart Failure** is indeed a very common and significant complication of a large Patent Ductus Arteriosus.
Question 68: In axillary nerve paralysis, which of the following statements is false?
- A. Extension of shoulder with arm abducted to 90 degrees is impossible (Correct Answer)
- B. Deltoid muscle is wasted
- C. Small area of numbness is present over the shoulder region
- D. Patient cannot initiate abduction
Explanation: Extension of shoulder with arm abducted to 90 degrees is impossible - The **axillary nerve** primarily innervates the **deltoid** and **teres minor muscles**. [2] - While axillary nerve paralysis would affect abduction and external rotation, the ability to *extend* the shoulder from an abducted position is mainly a function of muscles like the **posterior deltoid** (also innervated by axillary nerve to varying degrees) and latissimus dorsi, and its impossibility is not a definitive and exclusive sign of axillary nerve paralysis, as other muscles contribute to extension. *Deltoid muscle is wasted* - The **deltoid muscle** is the principal muscle supplied by the **axillary nerve**. [2] - Paralysis leads to **denervation atrophy**, causing visible wasting and weakness of the deltoid. [1] *Small area of numbness is present over the shoulder region* - The **axillary nerve** gives rise to the **upper lateral cutaneous nerve of the arm**. - Damage to the nerve results in sensory loss in a small, circumscribed area over the **deltoid insertion**. [2] *Patient cannot initiate abduction* - The **deltoid muscle**, innervated by the **axillary nerve**, is the primary abductor of the arm after the initial 0-15 degrees (supraspinatus). [2] - Paralysis of the deltoid significantly impairs or prevents the initiation and execution of **shoulder abduction**.
Question 69: Tuberculosis of the spine; what is the most common site affected?
- A. Sacral
- B. Dorsolumbar (Correct Answer)
- C. Lumbosacral
- D. Cervical
Explanation: ***94ed055d-c7da-4d18-a2fd-52720dfe8b6e*** - The **dorsolumbar (thoracolumbar)** region is the most common site of **spinal tuberculosis (Pott's disease)** [1] due to its high vascularity, facilitating hematogenous spread. - **Spinal tuberculosis** typically affects the vertebral bodies, leading to their destruction, kyphosis (angular deformity), and potentially neurological deficits [1]. *aebdfe6c-98dc-4073-892f-bb24d047bab4* - The **sacral** region can be affected by **tuberculosis**, but it is considerably less common than the thoracolumbar region. - Involvement of the sacrum is often associated with **direct extension** from adjacent structures, such as the sacroiliac joint, rather than primary vertebral involvement. *15c1feef-e3ca-496f-a180-127d52b77bfa* - **Cervical spine tuberculosis** is relatively rare, accounting for a small percentage of all spinal tuberculosis cases. - While possible, it presents with specific challenges due to the proximity of vital neurological and vascular structures. *d05d4d13-bb83-4f26-aa2d-c9c0203d299c* - The **lumbosacral region** (L5-S1) can be involved in **tuberculosis**, but it is less frequently affected than the thoracolumbar region. - While the lumbar spine is a common site, the entire lumbosacral region as a single entity is not the most common spot for spinal TB.
Question 70: Oculoorogenital ulcers are associated with which of the following conditions?
- A. Lichen planus
- B. Behcet's disease (Correct Answer)
- C. Systemic lupus erythematosus (SLE)
- D. Psoriasis
Explanation: ***Behcet's disease*** - This condition is characterized by **recurrent oral and genital ulcers**, along with **ocular inflammation** (e.g., uveitis), perfectly matching the "Oculoorogenital ulcers" description. - It is a **chronic, relapsing inflammatory disease** of unknown etiology involving vasculitis affecting various organ systems. *Lichen planus* - This is a chronic inflammatory condition affecting the **skin, hair, nails, and mucous membranes**. - While it can cause oral lesions, it typically presents as **purple, polygonal, pruritic papules** on the skin and does not cause genital ulcers or significant ocular involvement like Behcet's. *Systemic lupus erythematosus (SLE)* - SLE is a **systemic autoimmune disease** with diverse manifestations, including skin rashes, arthritis, and internal organ involvement. - Oral ulcers can occur, but **genital ulcers and severe ocular inflammation** as a prominent triad are not typical diagnostic features of SLE. *Psoriasis* - This is a common **chronic inflammatory skin disease** characterized by well-demarcated erythematous plaques with silvery scales. - Psoriasis primarily affects the skin and joints, and **does not typically present with oral, genital, or ocular ulcers** as described.