Which of the following findings is diagnostic of iron deficiency anemia?
In which condition is Serum Amyloid Associated (SAA) protein most commonly found?
Most common complication of diphtheria is -
Eschar is seen in all the Rickettsial diseases except:
What is the causative agent of trench fever?
Which of the following statements regarding Pertussis is INCORRECT?
What is the primary cause of Common Variable Immunodeficiency (CVID)?
ABO non- secretors are more prone to ?
Buboes form is which stage of LGV?
What is the PRIMARY evidence-based intervention for preventing catheter-associated urinary tract infections (CAUTIs)?
NEET-PG 2015 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 31: Which of the following findings is diagnostic of iron deficiency anemia?
- A. Increased TIBC, decreased serum ferritin (Correct Answer)
- B. Decreased TIBC, decreased serum ferritin
- C. Increased TIBC, increased serum ferritin
- D. Decreased TIBC, increased serum ferritin
Explanation: ***Increased TIBC, decreased serum ferritin*** - **Iron deficiency anemia** is characterized by depleted iron stores, leading to a **decreased serum ferritin** level, which is the most sensitive and specific marker for iron deficiency [4]. - In response to low iron stores, the body upregulates iron absorption and transport mechanisms, resulting in an **increased Total Iron Binding Capacity (TIBC)**, as there are more transferrin molecules available to bind iron [1]. *Decreased TIBC, decreased serum ferritin* - While a **decreased serum ferritin** is consistent with iron deficiency, a **decreased TIBC** is more indicative of **anemia of chronic disease** [1], where the body sequesters iron, leading to reduced iron availability for binding. - In **anemia of chronic disease**, both ferritin (an acute phase reactant) and TIBC can be reduced due to the inflammatory state [1], [2]. *Increased TIBC, increased serum ferritin* - An **increased TIBC** is seen in iron deficiency, but an **increased serum ferritin** indicates adequate or even **overloaded iron stores**, which contradicts the diagnosis of iron deficiency anemia. - High ferritin levels can be seen in conditions like **hemochromatosis** (iron overload) or **inflammation**, where ferritin acts as an acute phase reactant [5]. *Decreased TIBC, increased serum ferritin* - This combination is typical of **anemia of chronic disease**, where inflammation causes **increased serum ferritin** (as an acute phase reactant) and a **decreased TIBC** due to reduced production of transferrin [1]. - In this type of anemia, iron is often trapped within macrophages, making it unavailable for erythropoiesis despite seemingly normal or elevated stores [3].
Question 32: In which condition is Serum Amyloid Associated (SAA) protein most commonly found?
- A. Alzheimer's disease
- B. Malignant hypertension
- C. Chronic inflammatory states (Correct Answer)
- D. Chronic renal failure
- E. Acute myocardial infarction
Explanation: ***Chronic inflammatory states*** [1][2] - Serum amyloid-associated protein is elevated in response to **chronic inflammation**, such as in rheumatic diseases and infections [1][2]. - It serves as a **biomarker** indicating systemic inflammation and is part of the **acute-phase response** [1]. *Chronic renal failure* - While renal failure can lead to amyloidosis, it is not a direct cause of serum amyloid-associated protein elevation. - **Renal impairment** is more associated with a decrease in clearance rather than production of amyloid proteins. *Alzheimer's disease* - Although amyloid plaques are a hallmark of Alzheimer's, they are related to **A-beta peptide**, not serum amyloid-associated protein. - Alzheimer's pathology primarily involves **neurodegeneration** rather than inflammatory response. *Malignant hypertension* - Malignant hypertension primarily affects the **vascular system** and does not directly involve the production of serum amyloid-associated protein. - It is characterized by end-organ damage, rather than a state of chronic inflammation. *Chronic inflammatory conditions like RA, TB & leprosy, osteomyelitis, ankylosing spondylitis, IBD, bronchiectasis, some tumors* [1][2] - While these conditions can be associated with systemic inflammation, they are too specific and do not comprehensively encompass the broader concept of **chronic inflammatory states**. - This option fails to highlight that serum amyloid-associated protein is a marker for **various chronic inflammatory states** beyond just those listed [1].
Question 33: Most common complication of diphtheria is -
- A. Myocarditis (Correct Answer)
- B. Pneumonia
- C. Meningitis
- D. Endocarditis
Explanation: ***Myocarditis*** - Diphtheria toxin can directly damage myocardial cells, leading to inflammation and dysfunction of the heart muscle, making **myocarditis** the most common and serious complication. - This can result in **heart failure**, arrhythmias, and even death, highlighting its significance in diphtheria. *Pneumonia* - While respiratory complications can occur in diphtheria, **pneumonia** is not the most common or life-threatening complication associated with the diphtheria toxin itself. - Secondary bacterial infections might lead to pneumonia, but it is not a direct toxic effect like myocarditis. *Meningitis* - **Meningitis**, an inflammation of the membranes surrounding the brain and spinal cord, is an extremely rare complication of diphtheria. - Diphtheria primarily affects the upper respiratory tract and heart [1], with neurological complications typically manifesting as neuropathies rather than meningitis. *Endocarditis* - Although diphtheria can cause cardiac complications, **endocarditis** (inflammation of the heart's inner lining, including the valves) is not a common complication. - Myocarditis, due to the direct toxic effect on heart muscle, is far more prevalent than endocarditis in diphtheria.
Question 34: Eschar is seen in all the Rickettsial diseases except:
- A. Scrub typhus
- B. Rickettsial pox
- C. Indian tick typhus
- D. Endemic typhus (Correct Answer)
Explanation: ***Endemic typhus*** - **Endemic typhus**, caused by *Rickettsia typhi*, is transmitted by **fleas** and typically presents without an eschar. - The disease is characterized by fever, headache, and a maculopapular rash, but the **inoculation site lesion (eschar) is rare or absent**. *Scrub typhus* - **Scrub typhus**, caused by *Orientia tsutsugamushi*, is known for causing a prominent **eschar** [1] at the site of the **chigger mite bite**. - This **painless black scab** is a classic diagnostic feature of the disease [1]. *Rickettsial pox* - **Rickettsial pox**, caused by *Rickettsia akari*, almost invariably presents with an **eschar**, often referred to as an **inoculation lesion**. - This lesion appears as a papule that vesiculates and then forms a scab, indicating the site of the **mite bite**. *Indian tick typhus* - **Indian tick typhus** (part of the **spotted fever group rickettsioses**), caused by *Rickettsia conorii*, frequently presents with a characteristic **eschar** at the site of the **tick bite**. - This eschar, known as a **tache noire**, is a valuable diagnostic clue in affected patients.
Question 35: What is the causative agent of trench fever?
- A. Q-fever
- B. Boutonneuse fever
- C. Indian tick typhus
- D. Bartonella quintana (Correct Answer)
Explanation: ***Bartonella quintana*** - **Trench fever** is a **rickettsial-like illness** primarily transmitted by the human body louse. - The causative agent is the bacterium **Bartonella quintana**, which causes recurrent fever, headache, and body pains. *Q-fever* - Q-fever is caused by the bacterium **Coxiella burnetii** and is typically transmitted through airborne exposure to contaminated aerosols from infected animals. - It presents with fever, headache, and atypical pneumonia, and is not associated with human body lice. *Boutonneuse fever* - This fever is caused by **Rickettsia conorii**, transmitted by the **brown dog tick**. - Characterized by a **maculopapular rash** and an **eschar (tache noire)** at the site of the tick bite. *Indian tick typhus* - This is a form of spotted fever group rickettsiosis caused by **Rickettsia conorii subspecies indica**, transmitted by ticks [1]. - It presents with fever, rash, and an eschar, similar to boutonneuse fever, but is specified for the Indian subcontinent [1].
Question 36: Which of the following statements regarding Pertussis is INCORRECT?
- A. The drug of choice is Erythromycin.
- B. Cerebellar ataxia is a known complication. (Correct Answer)
- C. Some infections may be subclinical.
- D. The most infective stage is the catarrhal stage.
Explanation: ***Cerebellar ataxia is a known complication.*** - **Cerebellar ataxia** is not a typical or known complication of pertussis. Complications usually involve the respiratory, neurological (e.g., seizures, encephalopathy due to hypoxia), and nutritional systems due to severe coughing. - While neurological complications can occur, **ataxia** specifically is not frequently sighted in the context of pertussis. *Some infections may be subclinical.* - Some individuals, especially those partially immunized or older, can experience **subclinical or atypical infections** with pertussis, often presenting as a mild cough. - This characteristic makes it difficult to control the spread of the disease as infected individuals may not be recognized. *The most infective stage is the catarrhal stage.* - The **catarrhal stage**, characterized by non-specific cold-like symptoms, is the most contagious phase because bacterial shedding is highest. - During this stage, symptoms are mild and often indistinguishable from a common cold, leading to widespread transmission before diagnosis. *The drug of choice is Erythromycin.* - **Erythromycin**, or other macrolides like azithromycin or clarithromycin, are the drugs of choice for treating pertussis. - These antibiotics are most effective when administered early in the **catarrhal stage** to reduce disease severity and prevent transmission.
Question 37: What is the primary cause of Common Variable Immunodeficiency (CVID)?
- A. Defective B cell function
- B. Absent B cells
- C. Reduced number of B cells
- D. Defective B cell differentiation (Correct Answer)
Explanation: ***Defective B cell differentiation*** - CVID is characterized primarily by a failure of **B cells** to differentiate into **plasma cells**, which are responsible for producing antibodies [1]. - This defective differentiation leads to **hypogammaglobulinemia**, or low levels of immunoglobulins [1]. *Absent B cells* - Complete absence of B cells is characteristic of severe combined immunodeficiency (SCID) or X-linked agammaglobulinemia (XLA), not CVID [1]. - In CVID, B cells are typically present, but they are dysfunctional. *Reduced number of B cells* - While some patients with CVID may have reduced B cell numbers, this is not the primary or defining defect. - The key issue is the inability of existing B cells to mature and produce antibodies effectively. *Defective B cell function* - While B cell function is indeed defective in CVID, the root cause of this malfunction is specifically the **failure of differentiation** into mature plasma cells. - The B cells are unable to perform their primary function of antibody production due to this arrest in their development.
Question 38: ABO non- secretors are more prone to ?
- A. Increased risk of infections (Correct Answer)
- B. Autoimmune diseases
- C. Cardiovascular diseases
- D. Cancer
Explanation: Increased risk of infections - Non-secretors of ABO antigens exhibit an increased susceptibility to a variety of infections, particularly bacterial and viral pathogens. - This is thought to be due to the absence of ABO antigens in secretions, which typically act as decoy receptors to prevent pathogen adhesion to host cells. Autoimmune diseases - While some associations between ABO blood groups and autoimmune diseases exist, non-secretor status is not consistently linked to a higher overall risk of autoimmune conditions. Cardiovascular diseases - ABO blood groups have been associated with cardiovascular risk, with non-O blood types generally having a slightly higher risk of certain cardiovascular events. - However, secretor status (the ability to secrete ABO antigens into bodily fluids) itself is not a prominent independent risk factor for cardiovascular diseases. Cancer - There are some documented associations between specific ABO blood types and certain types of cancer (e.g., non-O blood types with pancreatic cancer), but this is distinct from secretor status. - Being an ABO non-secretor is not a primary, broadly recognized risk factor for developing cancer.
Question 39: Buboes form is which stage of LGV?
- A. Secondary (Correct Answer)
- B. Tertiary
- C. Latent
- D. Primary
Explanation: ***Secondary*** - Buboes, which are swollen, painful lymph nodes, are a hallmark of the **secondary stage** of **Lymphogranuloma Venereum (LGV)** [1]. - This stage typically develops weeks after the initial infection, following the unnoticed or transient primary lesion. *Primary* - The primary stage of LGV is characterized by a **small, painless papule or ulcer** at the site of inoculation, which often goes unnoticed. - **Buboes are not formed** during this initial, often asymptomatic, phase. *Tertiary* - The tertiary stage of LGV involves **chronic inflammation** and **tissue destruction**, leading to complications like **genital elephantiasis**, rectal strictures, and fistulas. - While there is chronic lymphedema, the acute, painful buboes are characteristic of the secondary stage, not this late, destructive phase. *Latent* - The concept of a latent stage is not typically used to describe the progression of LGV in the same way as other infections like syphilis. - LGV progresses through distinct symptomatic primary, secondary, and potentially tertiary stages without a prolonged asymptomatic latency period between symptom presentations.
Question 40: What is the PRIMARY evidence-based intervention for preventing catheter-associated urinary tract infections (CAUTIs)?
- A. Use of face mask during catheter insertion
- B. Prophylactic antibiotics are effective
- C. Early catheter removal when clinically appropriate
- D. Closed drainage technique to minimize bacterial entry (Correct Answer)
Explanation: ***Closed drainage technique to minimize bacterial entry*** - Maintaining a **closed drainage system** prevents the entry of bacteria into the urinary tract, which is a primary cause of CAUTIs. - This technique involves ensuring the connection between the catheter and the drainage bag remains sealed at all times, minimizing **environmental contamination**. *Prophylactic antibiotics are effective* - **Prophylactic antibiotics** are generally not recommended for routine CAUTI prevention due to concerns about **antibiotic resistance** and limited evidence of effectiveness [1]. - Their use is typically reserved for specific high-risk procedures or patient populations. *Use of face mask during catheter insertion* - While maintaining **asepsis** during catheter insertion is crucial, the use of a face mask specifically addresses **respiratory droplet transmission**, which is not the primary route of bacterial entry into the urinary system during catheterization. - **Sterile gloves** and a **sterile field** are more directly relevant for preventing contamination during insertion [1]. *Early catheter removal when clinically appropriate* - While **early catheter removal** is a critical strategy for CAUTI prevention by reducing dwell time, the question asks for the *primary* evidence-based intervention [1]. A **closed drainage system** directly addresses the mechanism of bacterial entry while the catheter is in place. - Reducing catheter duration minimizes risk, but the closed system ensures safety during the necessary period of catheterization.