Which of the following complications is commonly associated with mitral valve prolapse?
Progressive distal-to-proximal motor recovery following nerve regeneration is most characteristic of which type of nerve injury?
Which of the following is the most characteristic symptom of obstruction of the inferior vena cava?
In which condition is venous blood most commonly observed to have a high hematocrit in routine clinical practice?
PNH patients have deficient surface proteins that normally protect red blood cells from activated complements. Which two surface proteins are deficient in these patients?
Most common cause of nephrotic syndrome in adults?
Which of the following conditions is the classic example of acute intravascular hemolysis triggered by oxidative stress?
What is the most common site of gastrointestinal stromal tumors (GISTs)?
Which condition is most commonly associated with systemic amyloidosis?
What is the term for the collapse of a lung?
NEET-PG 2012 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 11: Which of the following complications is commonly associated with mitral valve prolapse?
- A. Ventricular arrhythmia
- B. Stroke
- C. Infective endocarditis (Correct Answer)
- D. Mitral stenosis
Explanation: Mitral valve prolapse (MVP) involves myxomatous degeneration of the mitral valve leaflets, which can create a rough surface predisposing to bacterial adhesion and subsequent infective endocarditis [1]. While the overall risk is low, patients with MVP and accompanying mitral regurgitation or thickened leaflets are at higher risk [1]. Patients with valvular heart disease are generally susceptible to bacterial endocarditis, often associated with procedures or dental hygiene [2]. Stroke - Although MVP can sometimes be associated with embolic events (e.g., from thrombi forming on the prolapsing valve), stroke is not considered a commonly associated complication. - The risk of stroke is generally higher in MVP patients with concomitant atrial fibrillation or other cardiovascular risk factors. Mitral stenosis - Mitral valve prolapse is characterized by the displacement of mitral valve leaflets into the left atrium during systole, which can lead to mitral regurgitation [3], not stenosis. - Mitral stenosis involves narrowing of the mitral valve orifice, usually due to rheumatic fever, which is a different pathophysiology [4]. Ventricular arrhythmia - While palpitations (often benign supraventricular ectopy) are common in MVP, clinically significant ventricular arrhythmias are less common. - Severe ventricular arrhythmias are more typically seen with significant underlying myocardial disease or severe mitral regurgitation causing left ventricular dysfunction.
Question 12: Progressive distal-to-proximal motor recovery following nerve regeneration is most characteristic of which type of nerve injury?
- A. Axonotmesis (Correct Answer)
- B. Neurotmesis
- C. Neuropraxia
- D. Nerve injury
Explanation: ***Axonotmesis*** - Involves damage to the **axon** and myelin sheath, while the surrounding **epineurium** remains intact. - This preservation of the connective tissue allows for guided **regeneration** of axons from distal to proximal, leading to a good prognosis for recovery [1]. *Neurotmesis* - Refers to the **complete transection** of the nerve, including the axon, myelin, and all connective tissue sheaths. - Recovery is often **incomplete** or requires surgical repair, as significant misdirection of regenerating axons is common. *Neuropraxia* - Characterized by a **temporary block** in nerve conduction, typically due to **demyelination**, with the axon remaining intact. - Recovery is usually **rapid** and complete, occurring within days to weeks, as no axonal regeneration is needed. *Nerve injury* - This is a **general term** that encompasses all types of nerve damage, from mild to severe. - It does not specify a particular mechanism or pattern of recovery, making it less precise than the more specific classifications.
Question 13: Which of the following is the most characteristic symptom of obstruction of the inferior vena cava?
- A. Paraumblical dilatation (Correct Answer)
- B. Thoraco-epigastric dilatation
- C. Haemorrhoides
- D. Oesophageal varices
Explanation: ***Paraumbilical dilatation*** - Obstruction of the **inferior vena cava (IVC)** leads to collateral circulation through superficial veins, especially around the umbilicus, causing **paraumbilical dilatation** (caput medusae). - This collateral flow bypasses the obstructed IVC to return blood to the superior vena cava system. *Thoraco-epigastric dilatation* - This pattern of collateral circulation is more characteristic of **superior vena cava (SVC) obstruction**, where blood from the upper body needs to bypass the SVC. - The dilated veins would typically be seen on the chest and upper abdomen, draining towards the femoral veins. *Oesophageal varices* - **Oesophageal varices** are typically caused by **portal hypertension** [1], often secondary to liver cirrhosis, not directly by IVC obstruction. - They represent portosystemic collateral veins, diverging from the portal system to the systemic circulation [1]. *Haemorrhoids* - **Haemorrhoids** are dilated veins in the anal canal, most commonly caused by **straining** during defecation or conditions that increase intra-abdominal pressure [2]. - While they can be a sign of portal hypertension [1], **IVC obstruction** is not their primary or most characteristic cause.
Question 14: In which condition is venous blood most commonly observed to have a high hematocrit in routine clinical practice?
- A. Dehydration (Correct Answer)
- B. Anemia
- C. Hypervolemia
- D. Acute blood loss
Explanation: Dehydration - In **dehydration**, the total body water is reduced, leading to a decrease in plasma volume [1, 5]. This concentrates the red blood cells, resulting in a relatively **high hematocrit**. [3] - This is a common finding as the body attempts to conserve fluid, making it a primary cause of **elevated hematocrit** in clinical practice. *Anemia* - **Anemia** is characterized by a decrease in the number of red blood cells or a reduced hemoglobin concentration, which would lead to a **low hematocrit**, not a high one [2]. - This condition involves insufficient oxygen-carrying capacity due to a deficiency in red blood cells or hemoglobin [2]. *Hypervolemia* - **Hypervolemia** describes an excess of fluid in the blood, which would dilute the blood components, leading to a relatively **low hematocrit** [1]. - This condition is often associated with conditions like heart failure or kidney disease, where fluid retention is common. *Acute blood loss* - In **acute blood loss**, the loss of whole blood immediately after the event would initially reduce both red blood cells and plasma proportionally, not immediately raising hematocrit [2]. - As the body attempts to compensate by shifting extravascular fluid into the circulation, this would further dilute the blood, eventually leading to a **decreased hematocrit** [2].
Question 15: PNH patients have deficient surface proteins that normally protect red blood cells from activated complements. Which two surface proteins are deficient in these patients?
- A. CD 55 and CD 58
- B. CD 45 and CD 55 (Correct Answer)
- C. CD 55 and CD 59
- D. CD 51 and CD 55
Explanation: ***CD 55 and CD 59*** - **CD 55 (decay accelerating factor)** and **CD 59 (protectin)** are crucial for inhibiting the complement system, protecting red blood cells from lysis in PNH. - Deficiencies in these proteins lead to increased **susceptibility** of red cells to **complement-mediated hemolysis**. *CD58 and CD 59* - **CD 58** is involved in T-cell interaction but does not solely protect red cells from complement. - While **CD 59** is a correct answer, the absence of **CD 55** makes this option incorrect for PNH. *CD 45 and CD 59* - **CD 45** is primarily a **leukocyte common antigen**, not involved in protecting red cells from complement activation. - This orrectly mentions **CD 59**, but lacks **CD 55**, making it unsuitable as an answer. *CD 51 and CD 59* - **CD 51** is associated with integrin functions and does not play a role in protecting red blood cells from complements. - Although **CD 59** is relevant, the deficiency in **CD 55** highlights the incompleteness of this option.
Question 16: Most common cause of nephrotic syndrome in adults?
- A. Minimal change disease
- B. Acute GN
- C. Membranous glomerulonephritis
- D. Focal Segmental Glomerulosclerosis (FSGS) (Correct Answer)
Explanation: ***Membranous glomerulonephritis*** - Membranous glomerulonephritis is the **most common cause of nephrotic syndrome** in adults, often associated with **autoimmune diseases** or certain medications. [1] - Patients typically present with **heavy proteinuria**, edema, and a normal renal function in early stages. *Focal GN* - Focal glomerulosclerosis typically affects young individuals and may not usually present as nephrotic syndrome. - It is associated with **obesity** and **HIV**, often leading to more significant renal impairment compared to membranous glomerulonephritis. [1] *Acute GN* - Acute glomerulonephritis generally presents with **hematuria**, **hypertension**, and **renal failure**, rather than nephrotic syndrome. [1] - It can have different causes, such as infections or systemic diseases, but is not the primary condition leading to nephrotic syndrome in adults. *Minimal change disease* - Minimal change disease is more prevalent in **children** [1], and while it can occur in adults, it is less common as a cause of nephrotic syndrome in this demographic. - It is characterized by **responsive edema** to steroids, but its incidence is not as high as membranous glomerulonephritis in adults.
Question 17: Which of the following conditions is the classic example of acute intravascular hemolysis triggered by oxidative stress?
- A. Hereditary spherocytosis
- B. Sickle cell disease
- C. Acute G6PD deficiency (Correct Answer)
- D. None of the options
Explanation: ***b and c*** - Intravascular hemolysis is commonly associated with both **Acute G6PD deficiency** and **Hereditary spherocytosis**, leading to destruction of red blood cells in the bloodstream [1]. - These conditions are characterized by **high levels of hemoglobinuria** and **low haptoglobin**, indicative of intravascular hemolysis. *Sickle cell ds* - Sickle cell disease primarily causes **extravascular hemolysis** due to splenic sequestration rather than **intravascular** destruction [3]. - The clinical features include **vaso-occlusive crises** and splenic infarction rather than hemolysis within the blood vessels. *Acute G6PD* - While acute G6PD deficiency can lead to hemolysis, it is typically **triggered by oxidative stress** rather than occurring continuously [2]. - The hemolysis in G6PD deficiency occurs more in an **extravascular** manner unless acute stress occurs, which can result in **acute intravascular hemolysis, marked by anemia, hemoglobinemia, and hemoglobinuria** [4]. *Hereditary spherocytosis* - This condition primarily causes **extravascular hemolysis** through the spleen, where abnormal spherocytes are destroyed [1]. - Although it leads to anemia, the hallmark of hereditary spherocytosis is the **spleen's role** in hemocyte destruction rather than intravascular hemolysis.
Question 18: What is the most common site of gastrointestinal stromal tumors (GISTs)?
- A. Ileum
- B. Esophagus
- C. Colon
- D. Stomach (Correct Answer)
Explanation: Stomach - The stomach is the most common site for gastrointestinal stromal tumors (GISTs), accounting for approximately 60-70% of cases. - GISTs in the stomach often present with symptoms like abdominal pain or bleeding and are associated with mutations in the KIT gene. Ileum - Although GISTs can occur in the ileum, they are far less common than those found in the stomach, representing about 10-15% of cases [1]. - GISTs in the ileum tend to present differently, often with intestinal obstruction or pain [1]. Esophagus - Esophageal GISTs are rare and account for only about 5% of GIST cases, making them an uncommon location. - Symptoms are usually related to dysphagia or chest pain, not typical for GISTs arising from more common sites. Colon - Although GISTs can occur in the colon, their frequency is much lower compared to the stomach and represents a small percentage of cases. - Clinical features in colonic GISTs can mimic other colorectal tumors, often causing obstruction or bleeding rather than classic GIST symptoms.
Question 19: Which condition is most commonly associated with systemic amyloidosis?
- A. Chronic Kidney Disease (Correct Answer)
- B. Multiple Myeloma
- C. Rheumatoid Arthritis
- D. Familial Mediterranean Fever
Explanation: Type II DM - Amyloidosis is commonly associated with **chronic diseases** like type II diabetes mellitus due to insulin resistance leading to amyloid deposition [4]. - The presence of **amiloid in the pancreas** often correlates with the complications of this type of diabetes [3]. *Maturity onset DM* - While maturity-onset diabetes can lead to complications, it is often synonymous with **type II DM**, making this distinction inaccurate regarding amyloidosis. - This term is less commonly used and does not emphasize the direct link to amyloidosis seen in type II diabetes. *HTN* - Hypertension itself is not a direct cause of amyloidosis; it typically results from other underlying conditions. - The association of amyloidosis with hypertension is usually **secondary**, not a primary condition leading to amyloid deposits [2]. *Type I DM* - Type I diabetes is primarily **autoimmune**, resulting in insulin-deficient states and does not strongly associate with amyloidosis like type II [1]. - The amyloid deposits seen in type I are much less common compared to type II or associated chronic conditions.
Question 20: What is the term for the collapse of a lung?
- A. Emphysema
- B. Atelectasis (Correct Answer)
- C. Bronchitis
- D. Bronchiectasis
Explanation: ***Atelectasis*** - **Atelectasis** is the technical term for the **collapse of a lung** or a part of a lung, leading to reduced or absent gas exchange. - It can be caused by **obstruction of the airway** (e.g., mucus plug, foreign body) or external compression on the lung [1]. *Emphysema* - **Emphysema** is a chronic lung disease characterized by the **destruction of the alveoli**, leading to permanent enlargement of airspaces [2]. - It results in reduced elastic recoil of the lungs and is a type of **COPD (chronic obstructive pulmonary disease)** [2]. *Bronchiectasis* - **Bronchiectasis** is a chronic condition where the airways (bronchi) become **abnormally widened** and scarred. - This widening leads to a buildup of mucus, making the lungs vulnerable to **recurrent infections**. *Bronchitis* - **Bronchitis** is an inflammation of the lining of the bronchial tubes, which carry air to and from your lungs. - It typically causes a **cough** with mucus production and can be acute or chronic.