NEET-PG 2024 - Internal Medicine Practice Questions

Q: A patient presents to the OPD with recurrent diarrhea, abdominal pain, and foul-smelling stools. The colonoscopy reveals the following findings. What is the most likely diagnosis?

Pseudomembranous colitis. ***Pseudomembranous colitis*** - The image clearly shows **yellowish-white plaques or pseudomembranes** scattered over the inflamed colonic mucosa, which are characteristic endoscopic findings of **pseudomembranous colitis**. - The clinical symptoms of **recurrent diarrhea**, **abdominal pain**, and **foul-smelling stools** are consistent with this diagnosis, often caused by *Clostridioides difficile* infection. *FAP (Familial Adenomatous Polyposis)* - FAP is characterized by hundreds to thousands of **adenomatous polyps** throughout the colon, usually **smaller and more uniform** in appearance than the pseudomembranes seen here. - While it can cause diarrhea and abdominal pain, the endoscopic appearance of discrete polyps rather than diffuse pseudomembranes differentiates it from the image shown. *Ulcerative colitis* - Ulcerative colitis typically presents with **continuous inflammation** of the colon, often involving **ulcerations, friability, and loss of haustra**, without the distinct pseudomembranes. - Symptoms usually include **bloody diarrhea** and tenesmus, which differ from the foul-smelling stools mentioned. *Acute gastritis* - Acute gastritis is an inflammation of the **stomach lining**, not the colon, and would not be diagnosed via colonoscopy. - Symptoms are usually upper GI-related, such as **epigastric pain, nausea, and vomiting**, not recurrent diarrhea and foul-smelling stools.

Q: An alcoholic patient presents with a wide-based gait and nystagmus after a road traffic accident (RTA). Which lobe of the cerebellum is most likely affected?

Flocculonodular. ***Flocculonodular Lobe*** - The **flocculonodular lobe** (or vestibulocerebellum) is responsible for **balance and oculomotor control**. Its damage leads to **truncal ataxia** (wide-based gait) and **nystagmus**. [1] - This lobe is particularly vulnerable in **alcoholic patients**, as chronic alcohol exposure can cause atrophy and dysfunction. [3] *Dentate Nucleus* - The **dentate nucleus** is a deep cerebellar nucleus primarily involved in the **planning and initiation of voluntary movements**, not directly with balance or nystagmus. - Damage typically results in **intention tremor**, **dysmetria**, and **dysdiadochokinesia**, which are not the primary symptoms described. [2] *Anterior Lobe* - The **anterior lobe** (spinocerebellum) largely controls **limb coordination**. - Lesions here typically cause **ataxia of the limbs** (e.g., dysmetria, intention tremor), but are less directly associated with truncal ataxia or nystagmus as initial prominent signs compared to flocculonodular lobe damage. *Vermis* - The **vermis** is part of the spinocerebellum and plays a critical role in **truncal coordination**. - While damage here can cause **truncal ataxia**, the combination with **nystagmus** points more specifically to the flocculonodular lobe (vestibulocerebellum), which has strong connections to vestibular nuclei. [1], [3]

Q: A patient living with HIV presents with foulsmelling stools. Microscopic examination of the stool reveals no cysts or ova, but a 200-micrometer larva is observed. What is the most likely pathogen?

Strongyloides stercoralis. ***Strongyloides stercoralis*** - The presence of **larvae** in the stool [2], particularly **rhabditiform larvae**, is characteristic of *Strongyloides stercoralis* infection, as this parasite has an **autoinfective cycle** involving larval stages in the human host [2]. - In HIV-positive patients, *Strongyloides* can cause **hyperinfection syndrome**, leading to severe gastrointestinal symptoms like foul-smelling stools, and increased larval shedding [2]. *Ascaris lumbricoides* - *Ascaris lumbricoides* is a large intestinal nematode, but it typically presents with **ova** (eggs) in the stool, not larvae, as the eggs hatch in the small intestine. - While it can cause gastrointestinal symptoms, the hallmark microscopic finding in stool samples is the presence of **mammillated or decorticated eggs**. *Ancylostoma duodenale* - *Ancylostoma duodenale* (hookworm) infections are identified by the presence of **eggs** in the stool [1], which are typically oval with a thin shell and contain a developing larva. - Hookworm larvae usually develop in **soil** and infect humans through skin penetration, rather than being commonly found in stool samples from intestinal infection [1]. *Schistosoma mansoni* - *Schistosoma mansoni* is a **blood fluke** that causes intestinal schistosomiasis, characterized by the presence of **spined eggs** in the stool. - The parasite's life cycle involves **freshwater snails** as intermediate hosts, and a **larval stage (cercariae)** that penetrates human skin, but larvae are not typically found in human stool.

Q: Which of the following statements is correct about Paroxysmal Nocturnal Hemoglobinuria (PNH)?

Flow cytometry is the best investigation. ***Flow cytometry is the best investigation*** - **Flow cytometry** is the gold standard for diagnosing PNH as it directly detects the absence of **GPI-anchored proteins (CD55 and CD59)** on the surface of red blood cells, granulocytes, and monocytes. - This method is highly sensitive and specific, allowing for the precise quantification of PNH clones even when present in small numbers. *Sucrose lysis test is used for the confirmation* - The **sucrose lysis test** (or sugar-water test) was an older screening test for PNH, but it is **not specific or sensitive enough** for confirmation. - It works by inducing complement activation on PNH cells in low ionic strength sucrose solution [1], but it has a high rate of false positives and negatives. *The most common cause of death is heart failure* - The most common cause of death in patients with PNH is **thrombosis**, particularly in unusual sites such as hepatic, cerebral, or abdominal veins, due to the prothrombotic state caused by the disease. - While heart complications can occur, they are not the leading cause of mortality. *It is an inherited disorder* - PNH is an **acquired clonal disorder** of hematopoietic stem cells, not an inherited genetic disorder [1]. - It results from a somatic mutation in the **PIG-A gene** in a hematopoietic stem cell, leading to the deficiency of GPI-anchored proteins.

Q: A patient presents with pulmonary hemorrhage and is P-ANCA positive. What is the most likely diagnosis?

Microscopic polyangiitis. ***Microscopic polyangiitis*** - This condition is characterized by **pulmonary hemorrhage** (often manifesting as diffuse alveolar hemorrhage) and **P-ANCA positivity**, which is typically associated with antibodies against **myeloperoxidase (MPO)**. [1] - It is a **small-vessel vasculitis** that frequently affects the kidneys (glomerulonephritis) and lungs without granuloma formation. *Churg-Strauss syndrome* - While Churg-Strauss syndrome (now known as **Eosinophilic Granulomatosis with Polyangiitis**, EGPA) can be P-ANCA positive, it is typically associated with a history of **asthma**, **allergic rhinitis**, and **eosinophilia**. [1] - Pulmonary involvement often includes **infiltrates** and nodules, but diffuse alveolar hemorrhage with severe pulmonary hemorrhage is less common as the primary presentation compared to MPA. *Wegener granulomatosis* - Wegener granulomatosis (now known as **Granulomatosis with Polyangiitis**, GPA) primarily presents with **upper and lower respiratory tract granulomatous inflammation** and **glomerulonephritis**. - It is typically associated with **C-ANCA positivity** (antibodies against proteinase 3, PR3), not P-ANCA. *Polyarteritis nodosa (PAN)* - Polyarteritis nodosa is a **medium-vessel vasculitis** that typically affects the **kidneys, gastrointestinal tract, skin, and nervous system**. [1] - It is classically **ANCA-negative** and does not typically cause pulmonary hemorrhage or diffuse alveolar hemorrhage.

Q: Which of the following options shows the correct order?

I cannot provide a meaningful explanation for this question. The question "Which of the following options shows the correct order?" is an abstract question, and the answer choices are simply sequences of numbers. Without any context or information about what these numbers represent or what "correct order" refers to, it is impossible to evaluate the options or provide a medical explanation.

Q: A 25-year-old patient presents with acute epigastric pain and elevated serum lipase. The patient was stabilized after 3 days, and a chest X-ray was obtained. What is the most common pulmonary complication associated with this condition?

ARDS. ***ARDS (Acute Respiratory Distress Syndrome)*** - **Acute pancreatitis** can lead to significant systemic inflammation, causing widespread lung injury and subsequent **ARDS** [1, 2]. - This complication presents with bilateral infiltrates on chest X-ray [3] and severe **hypoxemia** refractory to oxygen therapy [1]. *Acute pulmonary edema* - While pulmonary edema can occur in critical illness, **cardiogenic pulmonary edema** is less common as the primary pulmonary complication of pancreatitis in young, otherwise healthy patients [3]. - Pancreatitis-related pulmonary issues are more often inflammatory, leading to lung injury rather than direct fluid overload from cardiac dysfunction. *Pulmonary thromboembolism* - Although critically ill patients, including those with acute pancreatitis, are at increased risk for **thrombotic events**, it's not the most common immediate pulmonary complication. - A pulmonary embolism would typically present with pleuritic chest pain, dyspnea, and potentially hemodynamic instability, and often without diffuse infiltrates on chest X-ray unless severe. *Miliary TB* - **Miliary tuberculosis** is a chronic infectious process characterized by widespread dissemination of Mycobacterium tuberculosis. - It would not manifest as an acute complication of acute pancreatitis and typically presents with constitutional symptoms and a different pattern on chest X-ray.

Q: An adult man presents with the clinical condition shown in the image, and a Gram stain reveals Gram-negative diplococci. What is the most appropriate treatment?

Ceftriaxone. ***Ceftriaxone*** - The image shows **urethritis** (discharge from the urethra), and the Gram stain revealing **Gram-negative diplococci** is characteristic of **Neisseria gonorrhoeae**. - **Ceftriaxone** is the recommended first-line treatment for **gonorrhea**, often administered as a single intramuscular dose. *Azithromycin* - While often co-administered with ceftriaxone to cover potential **Chlamydia coinfection**, it is not the primary treatment for gonorrhea alone. - Azithromycin is the main treatment for uncomplicated **Chlamydia trachomatis** infections. *Doxycycline* - **Doxycycline** is a highly effective antibiotic for treating **Chlamydia trachomatis** infections and certain other bacterial STIs. - It is not the primary treatment for **gonorrhea** due to resistance concerns and preferred efficacy of cephalosporins. *Acyclovir* - **Acyclovir** is an antiviral medication used to treat infections caused by the **herpes simplex virus (HSV)**. - It has no activity against **bacterial infections** like gonorrhea, making it inappropriate for this presentation.

Q: A 45-year-old male presents to the emergency department following a motor vehicle accident. He complains of severe chest pain and difficulty breathing. On examination, he appears distressed, with a respiratory rate of 28 breaths per minute. His oxygen saturation is 88% on room air. There is visible bruising on the chest, X-ray is done which is shown below. Which of the following is seen in this patient?

Bronchial breathing. ***Bronchial breathing*** - The provided image is a chest X-ray. The question describes a patient with severe chest pain, difficulty breathing, hypoxemia, and visible chest bruising after a motor vehicle accident, which suggests **pulmonary contusion** or **pneumonia**. - In such conditions, **bronchial breathing** might be heard on auscultation due to consolidation or compression of lung tissue. The X-ray shows diffuse infiltrates or opacities indicative of lung injury, making bronchial breathing a plausible physical exam finding. *Kussmaul breathing* - This is a pattern of **deep and labored breathing** associated with severe **metabolic acidosis**, particularly diabetic ketoacidosis. - While the patient is in distress, the chest X-ray and accident history point to acute respiratory injury rather than metabolic acidosis as the primary cause. *Paradisical breathing* - This term is **not a recognized medical breathing pattern**. It appears to be a distracter. - Medical terminology for breathing patterns includes terms like Kussmaul, Cheyne-Stokes, Biot's, etc. *Apneustic breathing* - Characterized by **prolonged inspiratory pauses** followed by short exhalations, indicating severe damage to the **pons (brainstem)**. - This breathing pattern is typically seen with neurological insults like stroke or severe head injury, which is not directly indicated by the information given, although a head injury could theoretically occur in a MVC, it's not the primary finding for the presented complaints and X-ray.

Question 1

A patient presents to the OPD with recurrent diarrhea, abdominal pain, and foul-smelling stools. The colonoscopy reveals the following findings. What is the most likely diagnosis?

Accepted Answer

Pseudomembranous colitis

Answer

FAP (Familial Adenomatous Polyposis)

Answer

Ulcerative colitis

Answer

Acute gastritis

Question 2

An alcoholic patient presents with a wide-based gait and nystagmus after a road traffic accident (RTA). Which lobe of the cerebellum is most likely affected?

Accepted Answer

Flocculonodular

Answer

Dentate

Answer

Anterior lobe

Answer

Vermis

Question 3

A patient living with HIV presents with foulsmelling stools. Microscopic examination of the stool reveals no cysts or ova, but a 200-micrometer larva is observed. What is the most likely pathogen?

Accepted Answer

Strongyloides stercoralis

Answer

Ascaris lumbricoides

Answer

Ancylostoma duodenale

Answer

Schistosoma mansoni

Question 4

Which of the following statements is correct about Paroxysmal Nocturnal Hemoglobinuria (PNH)?

Accepted Answer

Flow cytometry is the best investigation

Answer

Sucrose lysis test is used for the confirmation

Answer

The most common cause of death is heart failure

Answer

It is an inherited disorder

Question 5

A patient presents with pulmonary hemorrhage and is P-ANCA positive. What is the most likely diagnosis?

Accepted Answer

Microscopic polyangiitis

Answer

Churg-Strauss syndrome

Answer

Wegener granulomatosis

Answer

Polyarteritis nodosa (PAN)

Question 6

Which of the following options shows the correct order?

Answer

2 -> 5 -> 4 -> 3 -> 1

Answer

5 -> 2 -> 4 -> 1 -> 3

Answer

2 -> 4 -> 3 -> 1 -> 5

Answer

1 -> 2 -> 3 -> 5 -> 4

Question 7

A 25-year-old patient presents with acute epigastric pain and elevated serum lipase. The patient was stabilized after 3 days, and a chest X-ray was obtained. What is the most common pulmonary complication associated with this condition?

Accepted Answer

ARDS

Answer

Acute pulmonary edema

Answer

Pulmonary thromboembolism

Answer

Miliary TB

Question 8

An adult man presents with the clinical condition shown in the image, and a Gram stain reveals Gram-negative diplococci. What is the most appropriate treatment?

Accepted Answer

Ceftriaxone

Answer

Azithromycin

Answer

Doxycycline

Answer

Acyclovir

Question 9

A 45-year-old male presents to the emergency department following a motor vehicle accident. He complains of severe chest pain and difficulty breathing. On examination, he appears distressed, with a respiratory rate of 28 breaths per minute. His oxygen saturation is 88% on room air. There is visible bruising on the chest, X-ray is done which is shown below. Which of the following is seen in this patient?

Accepted Answer

Bronchial breathing

Answer

Kussmaul breathing

Answer

Paradisical breathing

Answer

Apneustic breathing

NEET-PG 2024 — Internal Medicine