Internal Medicine
7 questionsWhich is the most common tumor leading to death in adults?
A 23-year old woman has experienced episodes of myalgias, pleural effusion, pericarditis and arthralgias without joint deformity over course of several years. The best laboratory screening test to diagnose her disease would be -
Which of the following antibodies is highly specific for systemic lupus erythematosus?
Gaisbock syndrome is known as:
Which condition is associated with Streptococcus bovis infection?
In which condition is Chvostek's sign typically observed?
Blood transfusion associated acute lung injury occurs due to -
NEET-PG 2015 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 1261: Which is the most common tumor leading to death in adults?
- A. Lung cancer (Correct Answer)
- B. Prostate cancer
- C. Colorectal cancer
- D. Leukemia
Explanation: ***Lung cancer*** - **Lung cancer** is the most common cause of cancer-related death in both men and women worldwide [1], [2]. - Its high mortality is attributed to its aggressive nature, late diagnosis, and limited treatment options for advanced stages [3]. *Prostate cancer* - While **prostate cancer** is very common in men, it typically has a slower progression and a relatively high survival rate compared to lung cancer. - Early detection through screening often leads to successful treatment and a good prognosis. *Colorectal cancer* - **Colorectal cancer** is a significant cause of cancer mortality but ranks behind lung cancer in overall deaths [2]. - Improved screening methods like colonoscopies allow for early detection and removal of precancerous polyps, reducing mortality. *Leukemia* - **Leukemia** refers to cancers of the blood and bone marrow, and while serious, they are less common causes of cancer death than solid tumors like lung, colorectal, or prostate cancer [2]. - Advances in chemotherapy, stem cell transplantation, and targeted therapies have significantly improved survival rates for many types of leukemia.
Question 1262: A 23-year old woman has experienced episodes of myalgias, pleural effusion, pericarditis and arthralgias without joint deformity over course of several years. The best laboratory screening test to diagnose her disease would be -
- A. Erythrocyte sedimentation rate
- B. Antinuclear antibody (Correct Answer)
- C. Assay for thyroid hormones
- D. CD4/CD8 lymphocyte count
Explanation: ***Antinuclear antibody*** - The constellation of **myalgias**, **pleural effusion**, **pericarditis**, and **arthralgias without joint deformity** is highly suggestive of **systemic lupus erythematosus (SLE)**. - **Antinuclear antibodies (ANA)** are present in over 95% of patients with SLE and are the primary screening test for this condition [1]. *CD4/CD8 lymphocyte count* - This count is more relevant for monitoring **immunodeficiency** conditions like **HIV infection**, where it helps assess immune status. - While lymphocytes can be affected in autoimmune diseases, a CD4/CD8 count is not a primary screening test for SLE. *Erythrocyte sedimentation rate* - An **elevated ESR** indicates general inflammation and is a **non-specific marker** [2]. - While it is often elevated in SLE, it doesn't confirm the diagnosis and can be high in numerous other inflammatory conditions [1]. *Assay for thyroid hormones* - An assay for thyroid hormones is used to diagnose **thyroid disorders** like **hypothyroidism** or **hyperthyroidism**. - There is no direct link between thyroid hormone levels and the symptoms described in the patient.
Question 1263: Which of the following antibodies is highly specific for systemic lupus erythematosus?
- A. Anti-Sm (Correct Answer)
- B. Anti-RO-1
- C. Anti-Centromere
- D. Anti-U1RNP
Explanation: ***Anti-Sm*** - The **Anti-Sm antibody** is highly specific for **systemic lupus erythematosus (SLE)**, with a specificity of over 99% [1]. - It is often associated with **renal involvement** and more severe disease manifestations [1]. *Anti-Centromere* - Mostly associated with **limited scleroderma**, not SLE, and indicates **creatodermal** changes. - Often found in patients with **Raynaud's phenomenon** and **pulmonary hypertension**, distinct from SLE features. *Anti-U1RNP* - Typically seen in **mixed connective tissue disease (MCTD)**, indicating a combination of features from various autoimmune diseases [1]. - While it can be present in SLE patients, it is not specific to SLE and can be found in other conditions as well. *Anti-RO-1* - Also known as **Anti-SSA**, these antibodies are associated with Sjögren's syndrome, as well as SLE [1]. - They are not specific for SLE as they can appear in other autoimmune diseases, marking their lack of specificity.
Question 1264: Gaisbock syndrome is known as:
- A. Primary Familial Polycythemia
- B. High Altitude Erythrocytosis
- C. Spurious Polycythemia (Correct Answer)
- D. Polycythemia Vera
Explanation: ***Spurious Polycythemia*** - Gaisbock syndrome is characterized by an increase in **red blood cells** due to **dehydration** and is a form of **spurious or relative polycythemia** [1]. - It typically occurs in individuals with **high hematocrit levels** without true pathological erythrocytosis [1]. *High Altitude Erythrocytosis* - This condition is caused by **hypoxia** at high altitudes leading to increased **erythropoietin**, resulting in genuine **erythrocytosis** [2]. - Unlike Gaisbock syndrome, it reflects a true physiological response to reduced oxygen levels [2]. *Polycythemia Vera* - Polycythemia vera is a **myeloproliferative disorder** characterized by increased red blood cell mass due to intrinsic bone marrow changes. - It entails elevated **erythropoietin** levels and features such as **splenomegaly** and other cytogenetic changes, which are not present in Gaisbock syndrome [1][3]. *Primary Familial Polycythemia* - This hereditary condition results in increased red blood cells due to genetic mutations leading to overproduction of erythrocytes. - It is distinct from Gaisbock syndrome as it typically manifests from genetic predisposition rather than environmental factors such as dehydration.
Question 1265: Which condition is associated with Streptococcus bovis infection?
- A. Colorectal cancer (Correct Answer)
- B. Chronic lymphocytic leukemia (CLL)
- C. Hairy cell leukemia (HCL)
- D. Multiple myeloma (MM)
Explanation: ***Colorectal cancer*** - *Streptococcus gallolyticus* (formerly known as *Streptococcus bovis* biotype I) infection, particularly **bacteremia** or **endocarditis**, has a strong association with underlying **colorectal cancer**. - It is hypothesized that the bacteria may play a role in **tumorigenesis** or that the cancerous lesions provide an entry point for the bacteria into the bloodstream. *Chronic lymphocytic leukemia (CLL)* - While patients with CLL are **immunocompromised** and prone to infections, there is no specific association between *Streptococcus bovis* and CLL. - Infections in CLL patients are typically due to encapsulated bacteria, such as *Streptococcus pneumoniae* or *Haemophilus influenzae*. *Hairy cell leukemia (HCL)* - Patients with HCL often experience **immunosuppression** due to neutropenia and monocytopenia, leading to increased susceptibility to infections. - However, there is no direct or specific link between *Streptococcus bovis* infection and HCL itself. *Multiple myeloma (MM)* - Patients with multiple myeloma have **impaired humoral immunity** and are at risk for infections, especially from encapsulated bacteria. - There is no established specific association between *Streptococcus bovis* infection and multiple myeloma.
Question 1266: In which condition is Chvostek's sign typically observed?
- A. Hypercalcemia
- B. Hypoparathyroidism (Correct Answer)
- C. Insulinoma
- D. Diabetes mellitus
Explanation: Hypoparathyroidism - **Chvostek's sign** is a clinical manifestation of **hypocalcemia**, which is a hallmark of hypoparathyroidism [1]. - It involves a twitch of facial muscles elicited by tapping the **facial nerve** anterior to the ear. Hypercalcemia - **Hypercalcemia** is the opposite of hypocalcemia and would not cause increased neuromuscular excitability [2]. - Patients with hypercalcemia might experience symptoms like **fatigue**, **constipation**, and **bone pain** [2]. Insulinoma - An **insulinoma** is a tumor that produces excessive insulin, leading to **hypoglycemia**, not issues with calcium balance. - Symptoms are primarily related to low blood sugar, such as **confusion** and **tachycardia**. Diabetes mellitus - **Diabetes mellitus** is a metabolic disorder characterized by **high blood glucose levels** due to insulin deficiency or resistance. - It is not directly associated with calcium imbalances that would cause Chvostek's sign.
Question 1267: Blood transfusion associated acute lung injury occurs due to -
- A. Nosocomial infections
- B. Auto-immune disorder
- C. Genetic susceptibility
- D. HLA-mediated reaction (Correct Answer)
Explanation: ***HLA-mediated reaction*** - Transfusion-related acute lung injury (TRALI) is primarily caused by **antibodies** in the donor plasma (usually anti-HLA or anti-HNA antibodies) reacting with the recipient's **neutrophils** [1]. - This interaction leads to neutrophil activation and sequestration in the pulmonary vasculature, causing **endothelial damage** and increased capillary permeability [1]. *Nosocomial infections* - Nosocomial infections are **hospital-acquired infections** and are not a direct cause of TRALI. - While infections can lead to lung injury, the mechanism of TRALI is distinct and immunologically mediated by donor antibodies. *Auto-immune disorder* - An autoimmune disorder involves the body's immune system attacking its own tissues, which is not the primary mechanism of TRALI. - TRALI is an **alloimmune reaction** where donor antibodies react with host antigens, rather than a pre-existing autoimmune condition. *Genetic susceptibility* - While genetic factors might sometimes play a role in an individual's general inflammatory response or susceptibility to certain conditions, they are **not the direct or primary cause** of TRALI. - The acute lung injury in TRALI is triggered by specific **antibody-antigen interactions** during the transfusion.
Pathology
1 questionsAlzheimer type II astrocytes are seen in which condition?
NEET-PG 2015 - Pathology NEET-PG Practice Questions and MCQs
Question 1261: Alzheimer type II astrocytes are seen in which condition?
- A. Hepatic encephalopathy (Correct Answer)
- B. Parkinsonism
- C. Alzheimer's
- D. Binswanger disease
Explanation: ***Hepatic encephalopathy*** - **Alzheimer type II astrocytes** are characteristic histological findings in cases of **hepatic encephalopathy**, reflecting the brain's response to elevated ammonia levels. - These astrocytes show enlarged, pale nuclei with prominent nucleoli and marginal chromatin, indicating cellular stress from metabolic dysfunction in the setting of liver failure. *Alzheimer's* - Alzheimer's disease is characterized by the presence of **neurofibrillary tangles** (tau protein) and **amyloid plaques** (beta-amyloid protein), not Alzheimer type II astrocytes. - Astrocytes in Alzheimer's disease may show reactive changes, but they do not typically manifest as the specific "Alzheimer type II" morphology. *Parkinsonism* - Parkinsonism is primarily characterized by the degeneration of **dopaminergic neurons** in the substantia nigra and the presence of **Lewy bodies** (alpha-synuclein aggregates). - While glial cells (astrocytes and microglia) do play a role in neuroinflammation in Parkinson's, they do not exhibit the specific Alzheimer type II astrocytic change. *Binswanger disease* - Binswanger disease is a form of **vascular dementia** characterized by diffuse white matter lesions due to chronic ischemia and damage to small cerebral blood vessels. - The pathology primarily involves demyelination and axonal loss in the white matter, with reactive gliosis, but not the specific changes seen in Alzheimer type II astrocytes.
Pediatrics
1 questionsPolyarticular onset JRA involves more than how many joints?
NEET-PG 2015 - Pediatrics NEET-PG Practice Questions and MCQs
Question 1261: Polyarticular onset JRA involves more than how many joints?
- A. 5
- B. 3
- C. 4 (Correct Answer)
- D. 6
Explanation: ***4*** - **Polyarticular onset Juvenile Rheumatoid Arthritis (JRA)**, now often referred to as **Juvenile Idiopathic Arthritis (JIA)**, is defined by the involvement of **five or more joints** within the first six months of the disease. Therefore, "more than 4" correctly describes this threshold. - This subtype of JIA accounts for approximately 30% of all JIA cases and can be further classified into rheumatoid factor-positive and rheumatoid factor-negative forms. *3* - Involvement of **fewer than five joints** (i.e., four or fewer) within the first six months would classify the disease as **oligoarticular JIA**, a distinct and often milder subtype. - Oligoarticular JIA is the most common subtype and often affects large joints like the knees. *5* - While **five or more joints** is the diagnostic criterion for polyarticular JIA, stating "more than 5" would be incorrect as exactly five joints already falls within the polyarticular definition. - The threshold is **equal to or greater than five joints**, not strictly exceeding five. *6* - Specifying "more than 6" joints would exclude cases where 5 or 6 joints are involved, which are still considered polyarticular JIA. - The key diagnostic number is **five**, meaning "more than 4" encompasses the correct definition.
Pharmacology
1 questionsWhich of the following medications is primarily used to decrease serum triglycerides?
NEET-PG 2015 - Pharmacology NEET-PG Practice Questions and MCQs
Question 1261: Which of the following medications is primarily used to decrease serum triglycerides?
- A. Fibrates (Correct Answer)
- B. Ezetimibe
- C. Niacin
- D. Statin
Explanation: ***Fibrates*** - Fibrates, such as **gemfibrozil** and **fenofibrate**, are primarily used to activate **PPAR-alpha**, leading to increased lipoprotein lipase activity and reduced hepatic triglyceride synthesis. - This effectively lowers **serum triglyceride levels** by 20-50% and can also increase HDL cholesterol. *Statin* - Statins primarily inhibit **HMG-CoA reductase**, the rate-limiting enzyme in cholesterol synthesis, which makes them highly effective at lowering **LDL cholesterol**. - While they can cause a modest reduction in triglycerides (10-30%), this is not their primary mechanism or indication. *Ezetimibe* - Ezetimibe works by inhibiting the absorption of **cholesterol** at the brush border of the small intestine, thereby lowering **LDL cholesterol**. - It has minimal effect on **triglyceride levels** and is not indicated for primary triglyceride reduction. *Niacin* - Niacin, or **nicotinic acid**, reduces the liver's production of VLDL (which contains triglycerides) and LDL, and also increases HDL cholesterol. - While it can significantly lower triglycerides, its use is often limited by bothersome side effects such as **flushing** and itchiness, making fibrates generally preferred for primary triglyceride lowering due to better tolerability.