Internal Medicine
8 questionsWhat is the best indicator for assessing short-term control of blood glucose levels over a period of 2-3 weeks?
What is the recommended postprandial capillary glucose level (in mg/dl) for adequate diabetes control?
Hyperpigmentation is seen with which hormone?
Which of the following is NOT a criterion for the diagnosis of Primary Hyperaldosteronism?
Most common cause of Addison's Disease in India is:
Female with blood sugar of 600 mg% and sodium of 110 mEq. Insulin was given, what will happen to serum sodium levels ?
What condition is characterized by hypertension and hypokalemia?
Which of the following is the MOST common condition caused by hypernatremia?
NEET-PG 2015 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 681: What is the best indicator for assessing short-term control of blood glucose levels over a period of 2-3 weeks?
- A. Serum fructosamine (Correct Answer)
- B. Blood sugar
- C. Urine sugar
- D. HbA1c
Explanation: ***Serum fructosamine*** - **Fructosamine** reflects the glycation of serum proteins, primarily albumin, which has a shorter half-life (around 17-20 days) compared to hemoglobin. - This allows it to assess average blood glucose control over the preceding **2-3 weeks**, making it suitable for short-term monitoring. *HbA1c* - **HbA1c** (glycated hemoglobin) reflects average blood glucose levels over the lifespan of red blood cells, typically **2-3 months** [1]. - While an excellent long-term indicator, its longer time frame makes it less suitable for assessing short-term changes over just 2-3 weeks [1]. *Blood sugar* - A single **blood sugar** measurement (fasting or random) provides an instantaneous snapshot of glucose levels at that specific moment [2]. - It does not reflect average glucose control over a period of 2-3 weeks and is highly influenced by recent food intake and activity [2]. *Urine sugar* - **Urine sugar** levels indicate that the kidney's reabsorption capacity for glucose has been exceeded, resulting in glucose spilling into the urine [3]. - This is a qualitative or semi-quantitative measure that primarily reflects very high blood glucose levels and is not a reliable indicator of averaged glucose control over any specific time frame [3].
Question 682: What is the recommended postprandial capillary glucose level (in mg/dl) for adequate diabetes control?
- A. < 180 mg/dl (Correct Answer)
- B. < 200 mg/dl
- C. < 100 mg/dl
- D. < 140 mg/dl
Explanation: ***< 180 mg/dl*** - This is the **recommended target** for postprandial (1-2 hours after a meal) capillary glucose levels in most non-pregnant adults with diabetes to achieve **adequate glycemic control** [1], [2]. - Maintaining levels below 180 mg/dl helps to minimize the risk of **long-term microvascular and macrovascular complications**. *< 100 mg/dl* - While this is an ideal fasting glucose level, it is generally **too low for postprandial glucose**, and attempting to maintain such levels might increase the risk of **hypoglycemia** in many patients with diabetes [1]. - This target is more appropriate for **fasting or pre-meal glucose** goals. *< 140 mg/dl* - This is a **more stringent target** that may be appropriate for some individuals with diabetes, particularly those who are carefully managed and at low risk of hypoglycemia. - However, for the general population with diabetes, **< 180 mg/dl is the more commonly accepted and achievable goal** for postprandial readings [2]. *< 200 mg/dl* - A postprandial glucose level of < 200 mg/dl is considered **good control** in some contexts, but it's often a **less strict target** than < 180 mg/dl for optimal long-term management. - While better than uncontrolled high levels, consistently approaching 200 mg/dl may still contribute to **increased risk of complications** over time compared to tighter control.
Question 683: Hyperpigmentation is seen with which hormone?
- A. TSH
- B. ACTH (Correct Answer)
- C. FSH
- D. LH
Explanation: ***ACTH*** - In conditions like **Addison's disease**, the adrenal glands' inability to produce cortisol leads to increased **ACTH** (adrenocorticotropic hormone) secretion due to a lack of negative feedback [3], [4]. - ACTH is derived from proopiomelanocortin (POMC), which also gives rise to alpha-melanocyte-stimulating hormone (α-MSH). Elevated ACTH levels can thus stimulate melanocytes, causing **hyperpigmentation** in skin folds, buccal mucosa, and pressure points [4]. *FSH* - **FSH** (follicle-stimulating hormone) primarily regulates the development of **follicles in the ovaries** and sperm production in the testes [1]. - There is no known direct association between excessive FSH levels and **hyperpigmentation**. *TSH* - **TSH** (thyroid-stimulating hormone) stimulates the **thyroid gland** to produce thyroid hormones (T3 and T4) [1]. - While thyroid disorders can affect skin texture and moisture, there is no direct link between elevated TSH and **hyperpigmentation**. *LH* - **LH** (luteinizing hormone) plays a key role in **ovulation** in females and testosterone production in males [2]. - High LH levels are not associated with **hyperpigmentation**.
Question 684: Which of the following is NOT a criterion for the diagnosis of Primary Hyperaldosteronism?
- A. Diastolic Hypertension without edema
- B. Low Plasma Renin Activity
- C. Hyperkalemia (Correct Answer)
- D. Hyperaldosteronism which is not suppressed by volume expansion
Explanation: Primary hyperaldosteronism is typically characterized by **hypokalemia** due to excessive aldosterone-mediated potassium excretion in the urine, not hyperkalemia [1]. Hyperkalemia would suggest other conditions, such as **adrenal insufficiency** or kidney disease, rather than primary hyperaldosteronism [2]. *Diastolic Hypertension without edema* - **Diastolic hypertension** is a common presentation of primary hyperaldosteronism due to increased **sodium and water retention**, leading to expanded extracellular volume. - The absence of significant edema is also common, as the body often develops an **"escape phenomenon"** where natriuresis occurs despite high aldosterone, preventing overt fluid overload [3]. *Low Plasma Renin Activity* - In primary hyperaldosteronism, the high aldosterone levels **suppress renin secretion** through negative feedback mechanisms. - Therefore, a **low plasma renin activity** (PRA) or plasma renin concentration (PRC) is a key diagnostic feature [4]. *Hyperaldosteronism which is not suppressed by volume expansion* - Normally, volume expansion would suppress aldosterone secretion. However, in primary hyperaldosteronism, aldosterone production is **autonomous** and remains elevated even after volume expansion. - This lack of suppression is a critical diagnostic criterion, often assessed through various **confirmatory tests** like saline infusion or oral sodium loading.
Question 685: Most common cause of Addison's Disease in India is:
- A. Autoimmune
- B. HIV
- C. Tuberculosis (Correct Answer)
- D. Malignancy
Explanation: ***Tuberculosis*** - In India, **tuberculosis** is the most common cause of **Addison's disease** due to the high prevalence of TB infections. - Adrenal involvement in TB can lead to gradual destruction of the adrenal cortex, resulting in **adrenal insufficiency**. *Autoimmune* - **Autoimmune adrenalitis** is the leading cause of Addison's disease in developed Western countries. - It involves the destruction of adrenal cortical cells by the body's own immune system, often associated with other autoimmune conditions. *Malignancy* - **Malignancy**, particularly metastatic cancer to the adrenals, can cause adrenal insufficiency but is a less common primary cause of Addison's disease overall. - While possible, it is not the most prevalent cause in India compared to infectious etiologies. *HIV* - **HIV infection** can lead to adrenal dysfunction, but it's typically through opportunistic infections like CMV, cryptococcosis, or direct HIV effects, rather than being the direct cause of widespread adrenal destruction. - It increases the risk of adrenal insufficiency but is not the most common etiology in India for Addison's disease.
Question 686: Female with blood sugar of 600 mg% and sodium of 110 mEq. Insulin was given, what will happen to serum sodium levels ?
- A. Sodium levels may appear to increase (Correct Answer)
- B. Sodium levels decrease
- C. Sodium levels remain unchanged
- D. Relative sodium deficiency may occur
Explanation: ***Sodium levels may appear to increase*** - The patient's initial presentation with severe hyperglycemia (600 mg%) and hyponatremia (110 mEq/L) suggests **hyperglycemia-induced pseudohyponatremia**. - **Insulin administration** will lower blood glucose, causing water to shift back into the cells from the extracellular space, thereby correcting the dilutional effect and leading to an **apparent increase in serum sodium levels**. *Sodium levels decrease* - This is incorrect because the hyponatremia in this scenario is largely **dilutional** due to hyperglycemia. - As glucose levels decrease with insulin, the osmotic drive for water movement out of cells diminishes, leading to **normalization**, not further decrease, of sodium concentration. *Sodium levels remain unchanged* - This is incorrect because the underlying cause of the initial low sodium is dilution from high glucose. - Once **hyperglycemia is treated**, the osmotic gradient changes, and water shifts, directly impacting and changing the serum sodium concentration. *Relative sodium deficiency may occur* - This option is incorrect because the initial hyponatremia is not primarily due to an absolute lack of sodium in the body but rather a **dilutional effect** caused by the osmotic pull of glucose. - As hyperglycemia resolves, the extracellular fluid becomes less diluted, and the measured sodium concentration will **rise**, not indicate a deficiency.
Question 687: What condition is characterized by hypertension and hypokalemia?
- A. Gitelman's Syndrome
- B. Liddle's Syndrome (Correct Answer)
- C. Bartter Syndrome
- D. All of the options
Explanation: ***Liddle's Syndrome*** - This syndrome is characterized by **overactivity of the epithelial sodium channel (ENaC)** in the collecting ducts, leading to increased sodium reabsorption and potassium excretion. [1] - The resulting **sodium retention causes hypertension**, while the **potassium excretion leads to hypokalemia**. *Gitelman's Syndrome* - This is an **autosomal recessive kidney disorder** causing a defect in the **thiazide-sensitive NaCl cotransporter** in the distal convoluted tubule. - It presents with **hypokalemia and hypomagnesemia**, but typically with **normal or low blood pressure**, not hypertension. *Bartter Syndrome* - This is a group of **autosomal recessive salt-wasting tubulopathies** affecting the **Na-K-2Cl cotransporter** in the thick ascending limb of the loop of Henle. - It leads to **hypokalemia, metabolic alkalosis, and normal or low blood pressure**, similar to chronic loop diuretic use. *All of the options* - While all mentioned conditions involve **hypokalemia**, only **Liddle's Syndrome** is consistently associated with **hypertension**. - **Gitelman's and Bartter syndromes** typically present with **normal or low blood pressure**.
Question 688: Which of the following is the MOST common condition caused by hypernatremia?
- A. Altered mental status
- B. Brain hemorrhage
- C. Seizure (Correct Answer)
- D. Central pontine myelinosis
Explanation: ***Seizure*** - While not the *most* common initial symptom, **seizure** can be a severe manifestation of hypernatremia, particularly when the serum sodium levels rise rapidly or to very high concentrations leading to significant neuronal dehydration. - **Rapid correction of severe hypernatremia** can also induce seizures if the brain cells swell too quickly. *Altered mental status* - **Altered mental status** such as lethargy, confusion, or irritability, is a very common and often an earlier symptom of hypernatremia due to neuronal dehydration and intracellular water shifts, but it generally precedes more severe neurological complications like seizures.[1] - It is a broad term that encompasses a range of neurological dysfunctions, and while frequent, it is not as specific a severe endpoint as a seizure. *Brain hemorrhage* - **Brain hemorrhage** is a rare and severe complication of hypernatremia, primarily seen when extreme osmotic shifts cause significant brain shrinkage, leading to tension on bridging veins and potential rupture. - This is not a common presentation and typically occurs only in very severe cases of hypernatremia or during overly rapid correction. *Central pontine myelinosis* - **Central pontine myelinolysis (CPM)** is a neurological disorder caused by too rapid correction of *chronic hyponatremia*, not hypernatremia.[1] - It results from osmotic damage to myelin sheaths in the pons, leading to severe neurological deficits such as dysphagia, dysarthria, and even locked-in syndrome.[1]
Ophthalmology
1 questionsA patient sustained an eye injury leading to corneal opacification and complete vision loss in the affected eye. Following successful corneal grafting, the patient regained clear vision. According to injury severity classification, this injury would be categorized as:
NEET-PG 2015 - Ophthalmology NEET-PG Practice Questions and MCQs
Question 681: A patient sustained an eye injury leading to corneal opacification and complete vision loss in the affected eye. Following successful corneal grafting, the patient regained clear vision. According to injury severity classification, this injury would be categorized as:
- A. Non-serious
- B. Serious (Correct Answer)
- C. Critical
- D. Life-threatening
Explanation: ***Serious (Grievous Hurt)*** - According to **IPC Section 320**, an injury causing **permanent privation of sight of either eye** is classified as **grievous hurt** - At the time of injury, the patient had **complete vision loss** due to corneal opacification, which constitutes grievous hurt - In medico-legal classification, **injury severity is determined at the time of examination**, not after treatment outcomes - The fact that vision was later restored through corneal grafting does **not change the initial classification** of the injury - This principle is crucial in forensic medicine: **treatment success does not downgrade injury severity** *Non-serious (Simple Injury)* - Simple injuries are those that do **not fall under the definition of grievous hurt** - Complete vision loss clearly meets the criteria for **grievous hurt** (permanent privation of sight) - Even though vision was eventually restored, the initial injury severity was grievous, not simple *Critical* - Critical injuries typically refer to conditions requiring **immediate intensive care** with uncertain outcomes or multiple organ involvement - While the eye injury was severe, this term is not part of the standard **IPC Section 320 classification** - The correct legal classification for this injury is grievous hurt (serious), not critical *Life-threatening* - Life-threatening injuries pose **imminent danger to life** if untreated - Corneal injury with vision loss, while serious for visual function, does **not endanger life** - This injury falls under **grievous hurt** due to vision loss, not life-threatening category
Psychiatry
1 questionsIrresistible sexual desire is known as:
NEET-PG 2015 - Psychiatry NEET-PG Practice Questions and MCQs
Question 681: Irresistible sexual desire is known as:
- A. Nymphomania
- B. Tribadism
- C. Sadism
- D. Hypersexuality (Correct Answer)
Explanation: ***Hypersexuality*** - This term describes an **unusually high or frequent sexual drive** or activity in either males or females that causes significant distress or impairment. - While "satyriasis" was historically used for males, **hypersexuality** is the current, more inclusive and clinically recognized term for excessive sexual desire. *Nymphomania* - This term specifically refers to **excessive sexual desire in a female**. - It is an older, often pathologizing term and is generally replaced by terms like **hypersexuality** or **compulsive sexual behavior**. *Tribadism* - This refers to a specific sexual practice between **women involving friction** of the vulva or clitoris. - It describes a *sexual act*, not an overwhelming sexual desire. *Sadism* - This is a paraphilia characterized by deriving **sexual pleasure from inflicting pain or humiliation on others**. - It describes a *preference for a certain type of sexual activity* rather than an irresistible or excessive general sexual desire.