Biochemistry
1 questionsWhich of the following statements about Maple Syrup Urine Disease (MSUD) is true?
NEET-PG 2013 - Biochemistry NEET-PG Practice Questions and MCQs
Question 1021: Which of the following statements about Maple Syrup Urine Disease (MSUD) is true?
- A. FeCl3 turns navy blue
- B. Asymptomatic
- C. Deficiency of branched chain amino acid enzymes (Correct Answer)
- D. Hyperaminoaciduria of aromatic amino acids
Explanation: ***Deficiency of branched chain amino acid enzymes*** - MSUD is caused by a deficiency in the **branched-chain alpha-keto acid dehydrogenase complex (BCKDC)**, an enzyme responsible for metabolizing **leucine, isoleucine, and valine**. - This enzyme deficiency leads to the accumulation of these **branched-chain amino acids (BCAAs)** and their corresponding branched-chain alpha-keto acids in the body. *Asymptomatic* - MSUD is a severe metabolic disorder that is **not asymptomatic**; it typically presents with distinct neurological and metabolic symptoms shortly after birth. - Clinical manifestations can include **poor feeding, lethargy, seizures**, and a characteristic **maple syrup odor** in urine and earwax. *FeCl3 turns navy blue* - The **ferric chloride test (FeCl3 test)** in MSUD typically yields a **green-gray or dark-green color** when testing for the accumulation of alpha-keto acids (specifically alpha-ketoisocaproic acid). - A **navy blue color** with FeCl3 is more characteristic of **alkaptonuria** due to the presence of homogentisic acid. *Hyperaminoaciduria of aromatic amino acids* - MSUD is characterized by the accumulation and excretion of **branched-chain amino acids (leucine, isoleucine, valine)** and their corresponding keto acids. - **Hyperaminoaciduria of aromatic amino acids** (e.g., phenylalanine, tyrosine, tryptophan) is seen in other conditions like **phenylketonuria (PKU)**, not MSUD.
Internal Medicine
8 questionsWhich of the following is NOT an indication for a liver biopsy?
Which of the following is a common finding in patients with Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)?
Which of the following conditions is associated with megaloblastic anemia?
In inflammatory myopathy, which group of muscles is not affected
Which of the following is a feature of tumor lysis syndrome?
In which condition is the Albumin to Globulin (A:G) ratio maintained?
A 68-year-old patient presents with sudden onset of right-sided weakness and slurred speech. The symptoms completely resolve within 30 minutes with no residual neurological deficits. This clinical presentation is most consistent with:
Pea soup diarrhea is seen in -
NEET-PG 2013 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 1021: Which of the following is NOT an indication for a liver biopsy?
- A. Amoebic hepatitis (Correct Answer)
- B. Chronic hepatitis B and C
- C. Autoimmune hepatitis
- D. Wilson's disease
Explanation: ***Amoebic hepatitis*** - Liver biopsy is **not routinely indicated** for amoebic hepatitis as diagnosis is typically made through clinical history and serological tests. - The condition is usually managed with **medications** rather than requiring invasive procedures like a biopsy. *Wilson's disease* - Liver biopsy is important for assessing **copper accumulation** in Wilson's disease, establishing a diagnosis. - It may also provide information regarding the extent of **hepatocellular damage**. *Chronic hepatitis B and C* - In chronic hepatitis B and C, liver biopsy is crucial to evaluate the **degree of fibrosis** and hepatic inflammation. - It assists in determining the need for **antiviral therapy** and prognostication. *Autoimmune hepatitis* - Liver biopsy helps confirm the diagnosis of autoimmune hepatitis and assess the **severity of liver damage**. [1] - It also aids in monitoring the response to **immunosuppressive therapy**. [1] **Note on technique:** Percutaneous liver biopsy requires specific conditions for safety, such as cooperative patients and adequate coagulation profiles. [2]
Question 1022: Which of the following is a common finding in patients with Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)?
- A. Ascites
- B. Normal BP (Correct Answer)
- C. Generalized edema
- D. Dry mucous membrane
Explanation: ***Normal BP*** - In SIADH, patients are typically **euvolemic** due to the primary issue being water retention rather than salt retention or frank dehydration [2]. - While hyponatremia occurs, the body's compensatory mechanisms usually prevent significant changes in blood pressure, maintaining it within the **normal range**. *Generalized edema* - Generalized edema is uncommon in SIADH because the excessive water retention is initially within the **intravascular compartment**, and the body attempts to excrete the additional volume of water [1]. - Although the patient is effectively retaining water, the osmolality is low, leading to fluid shifts rather than overt edema unless severe, protracted fluid overload occurs. *Ascites* - **Ascites**, which is the accumulation of fluid in the peritoneal cavity, is not a characteristic feature of SIADH [2]. - Ascites is more commonly associated with conditions like **liver cirrhosis**, heart failure, or malignancy. *Dry mucous membrane* - **Dry mucous membranes** are a sign of dehydration and fluid volume deficit. - In contrast, SIADH involves **fluid overload** (though euvolemic), making dry mucous membranes an unlikely finding [2].
Question 1023: Which of the following conditions is associated with megaloblastic anemia?
- A. Pernicious anemia (Correct Answer)
- B. Iron deficiency anemia
- C. Intestinal lymphatic ectasia
- D. Chronic kidney disease
Explanation: a and b - Megaloblastic anemia is commonly associated with **vitamin B12** [1] and **folate deficiencies** [2], which can occur due to various causes. - Conditions leading to malabsorption (such as those related to the gastrointestinal tract) contribute significantly to megaloblastic anemia [1, 2]. *ileal resection* - Ileal resection can indeed lead to **malabsorption** of vitamin B12 [1], particularly if the distal ileum is removed. - However, it is important to note that megaloblastic anemia specifically reflects a broader range of potential deficiencies, thus it is not an exclusive answer. *Crohn's disease* - Crohn's disease can cause **malabsorption** and result in vitamin B12 deficiency but is not a direct cause of megaloblastic anemia on its own. - The anemia may occur due to complications like **ileo-pouch anastomosis** rather than the disease itself. *Intestinal lymphatic ectasia* - This condition leads to **protein-losing enteropathy**, potentially causing deficiencies but not specifically leading to megaloblastic anemia. - The anemia associated with this condition is typically due to **hypoalbuminemia** and not a result of any vitamin deficiency directly.
Question 1024: In inflammatory myopathy, which group of muscles is not affected
- A. Facial
- B. Proximal muscles of limb
- C. Ocular (Correct Answer)
- D. Distal muscles of limb
Explanation: ***Ocular*** - The **extraocular muscles** responsible for eye movement are generally spared in typical inflammatory myopathies, distinguishing them from other neuromuscular disorders. - Inflammatory myopathies primarily affect **skeletal muscles**, but **ocular muscles** have unique immunological and physiological properties that often protect them. *Facial* - While less commonly affected early in the disease, some inflammatory myopathies, particularly **dermatomyositis**, can eventually involve **facial muscles**, leading to weakness. - Involvement of **facial muscles** can manifest as difficulty with smiling, whistling, or closing the eyelids. *Proximal muscles of limb* - Inflammatory myopathies characteristically cause **proximal muscle weakness**, affecting muscles of the **shoulders, hips, and thighs** [1]. - This weakness often presents as difficulty climbing stairs, getting up from a chair, or lifting objects overhead [1]. *Distal muscles of limb* - While less common than proximal involvement, **distal muscle weakness** (affecting hands and feet) can occur in some subsets of inflammatory myopathies, such as **inclusion body myositis**. - This can lead to difficulties with fine motor tasks or foot drop.
Question 1025: Which of the following is a feature of tumor lysis syndrome?
- A. Metabolic alkalosis (a rise in blood pH)
- B. Hypokalemia (a decrease in blood potassium levels)
- C. Hypocalcemia (a decrease in blood calcium levels) (Correct Answer)
- D. Hypophosphatemia (a decrease in blood phosphate levels)
Explanation: ***Hypocalcemia (a decrease in blood calcium levels)*** - **Hypocalcemia** in tumor lysis syndrome results from the precipitation of calcium with excessive phosphate released from lysed tumor cells. - The elevated phosphate levels bind to calcium, forming **calcium phosphate crystals** that can deposit in tissues, further lowering serum calcium. *Metabolic alkalosis (a rise in blood pH)* - Tumor lysis syndrome typically leads to **metabolic acidosis**, not alkalosis, due to the release of acidic intracellular metabolites like uric acid and phosphate. - The accumulation of these acidic compounds overwhelms the body's buffering systems, decreasing blood pH. *Hypokalemia (a decrease in blood potassium levels)* - Tumor lysis syndrome is characterized by **hyperkalemia**, an increase in blood potassium, as potassium is a major intracellular cation released during cell lysis. - The rapid breakdown of numerous tumor cells dumps vast amounts of intracellular potassium into the bloodstream. *Hypophosphatemia (a decrease in blood phosphate levels)* - Tumor lysis syndrome causes **hyperphosphatemia**, an elevation in blood phosphate levels, because phosphate is abundantly present within tumor cells and is released upon their destruction. - This excessive release of intracellular phosphate is a hallmark biochemical feature of the syndrome.
Question 1026: In which condition is the Albumin to Globulin (A:G) ratio maintained?
- A. Nephritic syndrome (Correct Answer)
- B. Cirrhosis
- C. Protein losing enteropathy
- D. Multiple myeloma
Explanation: ***Nephritic syndrome*** - In nephritic syndrome, the **glomerular filtration is often preserved**, allowing for the maintenance of A:G ratio despite the presence of hematuria and proteinuria [1]. - The condition typically leads to a **moderate degree of proteinuria**, retaining a relatively normal serum albumin level [1]. *Multiple myeloma* - In multiple myeloma, there is often a **high level of paraproteins** leading to a significant drop in albumin, affecting the A:G ratio. - Patients frequently exhibit **renal impairment**, resulting in a disrupted A:G ratio due to increased urinary protein loss. *Protein losing enteropathy* - This condition causes **loss of proteins** like albumin through the gastrointestinal tract, leading to **hypoalbuminemia** and altered A:G ratio. - It is characterized by **diarrhea** and fluid accumulation, further impacting the protein status in circulation. *Cirrhosis* - Cirrhosis leads to **decreased albumin synthesis**, resulting in a low serum albumin and an altered A:G ratio. - The condition is associated with **portal hypertension** and ascites, complicating the biochemical status.
Question 1027: A 68-year-old patient presents with sudden onset of right-sided weakness and slurred speech. The symptoms completely resolve within 30 minutes with no residual neurological deficits. This clinical presentation is most consistent with:
- A. Transient Ischemic Attack (TIA) (Correct Answer)
- B. Subarachnoid hemorrhage
- C. Intracerebral hemorrhage
- D. Ischemic stroke
Explanation: ***Transient Ischemic Attack (TIA)*** - A TIA is characterized by **transient neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia**, without acute infarction [1]. - The key diagnostic feature here is the **complete resolution of symptoms within a short period** (30 minutes) with no residual deficits, fitting the definition of TIA [1]. *Subarachnoid hemorrhage* - This typically presents with a **sudden, severe headache** (often described as "thunderclap"), stiff neck, and altered mental status. - While it can cause sudden neurological deficits, these symptoms usually **do not resolve completely within minutes**, and often lead to persistent deficits or life-threatening complications. *Intracerebral hemorrhage* - An intracerebral hemorrhage involves **bleeding directly into the brain tissue**, leading to sudden onset of neurological deficits that **progress over time** [2]. - The symptoms are generally **severe and persistent**, and would not resolve completely within 30 minutes. *Ischemic stroke* - An ischemic stroke is caused by a **blockage of blood flow to the brain**, resulting in brain tissue damage (infarction) and persistent neurological deficits [2]. - While initial symptoms can be similar to a TIA [3], an ischemic stroke by definition involves **permanent damage and lasting deficits**, unlike what is described in the patient's presentation.
Question 1028: Pea soup diarrhea is seen in -
- A. Cholera
- B. Typhoid (Correct Answer)
- C. Yersinosis
- D. Hepatitis
Explanation: ***Typhoid*** - **Pea soup diarrhea** is a classic symptom of **typhoid fever**, caused by *Salmonella Typhi* [1]. - This characteristic stool is a greenish-yellow watery diarrhea due to inflammation and ulceration of the Peyer's patches in the small intestine [1]. *Cholera* - Characterized by **rice-water stools**, which are profuse, watery, and often contain flecks of mucus, resembling water in which rice has been rinsed [2]. - This type of diarrhea is due to the potent **cholera toxin** causing massive fluid and electrolyte secretion [2]. *Yersinosis* - Causes diarrhea that can range from watery to bloody, often associated with severe **abdominal pain** mimicking appendicitis. - While it can cause enterocolitis, the stool consistency is not typically described as "pea soup" like in typhoid. *Hepatitis* - Hepatitis primarily affects the **liver** and typically does **not cause diarrhea** as a prominent symptom. - Common symptoms include jaundice, dark urine, and pale stools due to impaired bilirubin metabolism.
Pharmacology
1 questionsA patient has Cushing syndrome due to an adrenal tumor. Which drug should be given?
NEET-PG 2013 - Pharmacology NEET-PG Practice Questions and MCQs
Question 1021: A patient has Cushing syndrome due to an adrenal tumor. Which drug should be given?
- A. Ketoconazole (Correct Answer)
- B. Spironolactone
- C. Hydrocortisone
- D. Dexamethasone
Explanation: ***Ketoconazole*** - **Ketoconazole** is an antifungal agent that also inhibits several enzymes involved in **steroidogenesis**, including 17α-hydroxylase and 11β-hydroxylase. - This action helps to reduce the overproduction of **cortisol** in Cushing syndrome caused by an adrenal tumor. *Hydrocortisone* - **Hydrocortisone** is a glucocorticoid itself and would exacerbate the symptoms of **Cushing syndrome** by adding to the already elevated cortisol levels. - It is used for **cortisol replacement therapy** in conditions like Addison's disease, where cortisol levels are low. *Dexamethasone* - **Dexamethasone** is a potent synthetic glucocorticoid used to suppress **ACTH production** in cases of ACTH-dependent Cushing's syndrome (e.g., Cushing's disease) or to diagnose Cushing's syndrome. - In an adrenal tumor, which is **ACTH-independent**, dexamethasone would not reduce cortisol production but could instead worsen the hypercortisolism. *Spironolactone* - **Spironolactone** is an **aldosterone antagonist** and a weak antiandrogen, primarily used for conditions like hyperaldosteronism, heart failure, and hirsutism. - It has no direct effect on the overproduction of **cortisol** from an adrenal tumor in Cushing syndrome.