Which of the following is NOT a feature of Refsum disease?
Prepyloric or channel ulcer in the stomach is termed as:
In total parenteral nutrition, which of the following parameters is not routinely measured daily?
Which of the following is NOT a characteristic feature of systemic sclerosis?
What are the key characteristics of Evans syndrome?
Which of the following is NOT a feature of Cushing's triad?
Most common hematological malignancy associated with Rheumatoid Arthritis (RA)?
All of the following are features of Obstructive jaundice except:
Impotence is a feature of which of the following:
Which of the following is not a recognized complication of chronic pancreatitis?
NEET-PG 2013 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 71: Which of the following is NOT a feature of Refsum disease?
- A. Retinitis pigmentosa
- B. Ataxia
- C. CCF (Correct Answer)
- D. Ichthyosis
Explanation: ***CCF*** - **Congestive cardiac failure (CCF)** is generally **not a primary feature** or common complication of Refsum disease. While some cardiac abnormalities can occur, severe CCF is rare. - Refsum disease is characterized by the accumulation of **phytanic acid**, which primarily affects the nervous system, skin, and eyes. *Ataxia* - **Cerebellar ataxia** is a very common and prominent neurological symptom in Refsum disease, due to damage to the cerebellum. - Patients often present with **unsteady gait and poor coordination**. *Ichthyosis* - **Ichthyosis** (dry, scaly skin) is a characteristic dermatological manifestation of Refsum disease, occurring in nearly all patients. - It is caused by the disruption of **lipid metabolism** in the skin due to phytanic acid accumulation. *Retinitis pigmentosa* - **Retinitis pigmentosa** is one of the classic ocular features of Refsum disease, leading to **night blindness** and progressive **visual field loss**. - It involves the degeneration of photoreceptor cells in the retina.
Question 72: Prepyloric or channel ulcer in the stomach is termed as:
- A. Type 3 (Correct Answer)
- B. Type 1
- C. Type 4
- D. Type 2
Explanation: ***Type 3*** - **Type 3 ulcers** are located in the **prepyloric region** or within the **pyloric channel** of the stomach. - They are often associated with **duodenal ulcers** and are characterized by **normal to high acid secretion**. *Type 1* - **Type 1 ulcers** are typically found in the **lesser curvature of the stomach body**, not the prepyloric region. - These ulcers are usually associated with **low or normal acid secretion** and are often linked to *H. pylori* infection. *Type 2* - **Type 2 ulcers** involve both a **gastric ulcer** (usually in the body) and an **active or healed duodenal ulcer**. - They are associated with **normal to high acid secretion**, but the location is not exclusively prepyloric. *Type 4* - **Type 4 ulcers** are located high on the **lesser curvature near the gastroesophageal junction**. - They are associated with **low acid secretion** and are sometimes termed **juxta-esophageal ulcers**.
Question 73: In total parenteral nutrition, which of the following parameters is not routinely measured daily?
- A. Electrolyte
- B. Fluid intake and output
- C. Magnesium
- D. Liver function tests (LFTs) (Correct Answer)
Explanation: ***Liver function tests (LFTs)*** - **LFTs** are typically monitored periodically (e.g., weekly or bi-weekly) in patients on TPN, not daily, unless there are specific concerns about liver dysfunction [1]. - Daily monitoring is generally not required because changes in liver function due to TPN are usually insidious and not acutely life-threatening in hours. *Electrolyte* - **Electrolytes** (e.g., sodium, potassium, chloride) are crucial for cellular function and fluid balance [2]. They can fluctuate rapidly with TPN administration and patient's clinical status. - Daily measurement ensures prompt correction of imbalances to prevent serious complications like **cardiac arrhythmias** or neurological disturbances [2]. *Fluid intake and output* - **Fluid intake and output** are essential for assessing **hydration status** and preventing fluid overload or dehydration, which can change rapidly [2]. - Daily monitoring helps guide adjustments to fluid administration in TPN and other intravenous fluids. *Magnesium* - **Magnesium** is an important electrolyte involved in numerous enzymatic reactions and neuromuscular function, and its levels can be significantly affected by TPN [2]. - Daily or frequent monitoring is often necessary, especially in the initial phases of TPN or in patients with pre-existing deficiencies, to prevent complications such as **cardiac arrhythmias** or **weakness** [2].
Question 74: Which of the following is NOT a characteristic feature of systemic sclerosis?
- A. Calcinosis cutis
- B. Digital ulcers
- C. Acroosteolysis
- D. Gottron's papules (Correct Answer)
Explanation: ***Gottron's papules*** - **Gottron's papules** are pathognomonic for **dermatomyositis**, not systemic sclerosis. They are red, scaling papules found over the extensor surfaces of the metacarpophalangeal (MCP) and interphalangeal (IP) joints. - While both systemic sclerosis and dermatomyositis are connective tissue diseases, their distinct cutaneous manifestations aid in differentiation. *Acroosteolysis* - **Acroosteolysis** refers to the resorption of the distal phalanges, a common feature in systemic sclerosis, particularly in severe cases. - This symptom contributes to the characteristic digital abnormalities seen in the disease. *Calcinosis cutis* - **Calcinosis cutis** is the deposition of calcium in the skin and subcutaneous tissues, often seen in subsets of systemic sclerosis, especially the CREST syndrome. - It can manifest as firm, white-yellow nodules or plaques and contribute to skin breakdown. *Digital ulcers* - **Digital ulcers** are a frequent and debilitating complication of systemic sclerosis, resulting from severe **vasculopathy** [1] and **ischemia** [1]. - They are often painful and can lead to significant tissue loss and infection.
Question 75: What are the key characteristics of Evans syndrome?
- A. Autoimmune hemolytic anemia and immune thrombocytopenia (Correct Answer)
- B. Low lymphocyte and red blood cell counts
- C. High platelet and lymphocyte counts
- D. A reduction in all blood cell types
Explanation: ***Autoimmune hemolytic anemia and immune thrombocytopenia*** - **Evans syndrome** is defined by the simultaneous or sequential occurrence of **autoimmune hemolytic anemia (AIHA)** and **immune thrombocytopenia (ITP)** [1], [2]. - Both conditions involve the immune system mistakenly attacking and destroying **red blood cells** and **platelets**, respectively [1], [2]. *Low lymphocyte and red blood cell counts* - While **red blood cell counts** are low in Evans syndrome due to AIHA, **lymphocyte counts** are not a defining characteristic; they can vary. - This option does not fully capture the dual autoimmune destruction of red blood cells and platelets specific to Evans syndrome. *High platelet and lymphocyte counts* - **Platelet counts** are **low** in Evans syndrome due to ITP, not high. - **Lymphocyte counts** are not characteristically high; a high count might suggest other conditions like leukemias or lymphomas. *A reduction in all blood cell types* - A reduction in all (red blood cells, white blood cells, and platelets) is known as **pancytopenia**, which is not the defining feature of Evans syndrome. - Evans syndrome specifically involves the destruction of **red blood cells** and **platelets**, but not necessarily all white blood cell types.
Question 76: Which of the following is NOT a feature of Cushing's triad?
- A. Hypertension
- B. Bradycardia
- C. Irregular breathing
- D. Hypotension (Correct Answer)
Explanation: ***Hypotension*** - Cushing's triad is an indicator of **increased intracranial pressure (ICP)** and classically presents with **hypertension**, not hypotension. - Hypotension would suggest a different problem, such as **spinal shock** or **hypovolemia**, which are not directly associated with Cushing's triad. *Bradycardia* - **Bradycardia** is a key component of Cushing's triad, resulting from vagal stimulation due to increased intracranial pressure. - This reflex reduces heart rate in an attempt to maintain cerebral perfusion. *Hypertension* - **Hypertension**, specifically a widened pulse pressure, is a cardinal feature of Cushing's triad, caused by systemic vasoconstriction to overcome increased ICP and maintain **cerebral perfusion pressure**. - It is a compensatory mechanism to push blood into the brain. *Irregular breathing* - **Irregular breathing patterns**, such as Cheyne-Stokes respiration or ataxic breathing, are characteristic of Cushing's triad, indicating brainstem compression [1]. - This irregular respiratory effort is due to direct pressure on the **respiratory centers** in the medulla [1].
Question 77: Most common hematological malignancy associated with Rheumatoid Arthritis (RA)?
- A. Diffuse large B cell lymphoma
- B. Chronic lymphocytic leukemia
- C. T-cell prolymphocytic leukemia
- D. Large granular lymphocytic leukemia (LGLL) (Correct Answer)
Explanation: ***Large granular lymphocytic leukemia (LGLL)*** - **LGLL** is the most common hematological malignancy strongly associated with **rheumatoid arthritis (RA)**, often presenting with features such as **neutropenia** and splenomegaly. - Approximately 80% of patients with LGLL have a **T-cell phenotype**, and a significant subset experiences **autoimmune diseases**, with RA being the most frequent. *Diffuse large B cell lymphoma* - While patients with **RA** have an increased risk of **lymphoma**, **diffuse large B-cell lymphoma (DLBCL)** is a more aggressive type but not the most common hematologic malignancy directly associated with the disease itself in terms of prevalence [3]. - Inflammatory conditions like **RA** can contribute to chronic immune stimulation, increasing the risk of certain lymphomas, but LGLL holds a more direct and prevalent association [1]. *Chronic lymphocytic leukemia* - **Chronic lymphocytic leukemia (CLL)** is a lymphoproliferative disorder of **B lymphocytes**, but it does not have a particularly strong or common association with **RA** compared to LGLL [2]. - The elevated risk of hematological malignancies in RA patients typically points more towards lymphoproliferative disorders driven by specific immune dysregulations characteristic of RA. *T-cell prolymphocytic leukemia* - **T-cell prolymphocytic leukemia (T-PLL)** is a rare and aggressive **T-cell leukemia** that generally presents with a high white blood cell count and splenomegaly, but it is not commonly linked with **RA**. - Its clinical presentation and biology are distinct from the more indolent leukemias like LGLL that are often seen in conjunction with autoimmune conditions.
Question 78: All of the following are features of Obstructive jaundice except:
- A. Clay colour stools
- B. Pruritis
- C. Normal alkaline phosphatase (Correct Answer)
- D. Elevated serum aminotransferases level
Explanation: ***Normal alkaline phosphatase*** - In obstructive jaundice, alkaline phosphatase is typically **elevated** due to bile duct obstruction [2]. - A **normal level** suggests that the jaundice may not be of obstructive origin. *Pruritis* - Often seen in obstructive jaundice due to **bile salts** accumulating in the bloodstream, leading to itching. - It is a common symptom associated with **cholestasis**. *Mildly elevated serum aminotransferases level* - In obstructive jaundice, serum aminotransferases are usually elevated, though may be mildly in early cases [1]. - This reflects liver involvement, which is consistent with biliary obstruction [2]. *Clay colour stools* - Clay-colored stools arise from the absence of **bile** in the intestines, indicative of obstruction [3]. - This is a direct result of blockage in the bile duct system affecting stool pigmentation [3].
Question 79: Impotence is a feature of which of the following:
- A. Poliomyelitis
- B. Amyotrophic lateral sclerosis
- C. Meningitis
- D. Multiple sclerosis (Correct Answer)
Explanation: ***Multiple sclerosis*** - **Erectile dysfunction** (impotence) is a common symptom in men with multiple sclerosis, often resulting from **demyelination** in nerve pathways controlling sexual function [1], [2]. - MS can affect various neurological functions, leading to problems with **autonomic nervous system** control, sensation, and motor coordination, all of which can impact sexual health. *Poliomyelitis* - Poliomyelitis primarily affects the **anterior horn cells** of the spinal cord, leading to acute **flaccid paralysis** of muscles. - While it can cause muscle weakness and atrophy, it is not typically associated with chronic impotence or sexual dysfunction as a primary feature. *Amyotrophic lateral sclerosis* - ALS is a progressive neurodegenerative disease affecting **motor neurons**, leading to muscle weakness, atrophy, and spasticity. - It primarily impacts voluntary muscle movement and does not directly cause impotence, although the physical limitations and psychological stress can indirectly affect sexual function. *Meningitis* - Meningitis is an inflammation of the **meninges** (membranes surrounding the brain and spinal cord) caused by infection. - Its symptoms include headache, fever, and neck stiffness, and while severe cases can lead to neurological complications, impotence is not a typical direct consequence.
Question 80: Which of the following is not a recognized complication of chronic pancreatitis?
- A. Renal artery thrombosis (Correct Answer)
- B. Pancreatic pseudocyst
- C. Splenic vein thrombosis
- D. Pancreatic fistula
Explanation: ***Renal artery thrombosis*** - **Renal artery thrombosis** is generally associated with conditions like **atherosclerosis**, atrial fibrillation, or vasculitis, not directly with chronic pancreatitis. - While chronic pancreatitis can lead to systemic complications, direct renal arterial clotting is an atypical and **uncommon sequela**. *Pancreatic pseudocyst* - **Pancreatic pseudocysts** are common complications of chronic pancreatitis, occurring when fluid collections around the pancreas become walled off by fibrous tissue [1]. - They can cause pain, obstruction, and even rupture if left untreated [2]. *Splenic vein thrombosis* - **Splenic vein thrombosis** can result from inflammation and compression of the splenic vein by the diseased pancreatic tissue in chronic pancreatitis [1]. - This can lead to **splenomegaly** and **gastric varices** due to increased pressure in the portal system. *Pancreatic fistula* - A **pancreatic fistula** occurs when pancreatic fluid leaks from the gland, often forming a connection to another organ or the skin [2]. - This is a well-recognized complication of both acute and chronic pancreatitis, usually due to ductal disruption.