Which of the following is not typically associated with cystic fibrosis?
Creola bodies are seen in:
Which type of fatty acids should be included in the diet to manage chyluria?
What is the most common cause of dissecting hematoma?
Among the following, most reliable test for screening of diabetes mellitus?
What is the primary electrolyte found in Oral Rehydration Salts (ORS) at a concentration of 75 mEq/L?
Tabes dorsalis is seen in -
Meningitis with rash is seen in -
What condition is caused by the intake of exogenous steroids?
Which species of malaria is associated with nephrotic syndrome?
NEET-PG 2012 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 21: Which of the following is not typically associated with cystic fibrosis?
- A. Infertility
- B. Azoospermia
- C. Nasal polyps
- D. Renal failure (Correct Answer)
Explanation: ***Renal failure*** - **Renal failure** is not a typical manifestation or complication of **cystic fibrosis (CF)**. The CFTR protein primarily affects epithelial cells in organs like the lungs, pancreas, liver, and intestines, not the kidneys. - While CF patients may experience **electrolyte imbalances** due to excessive salt loss, this rarely progresses to **kidney failure** as a direct result of the disease itself. *Infertility* - **Infertility** is commonly associated with CF, particularly in males due to **congenital bilateral absence of the vas deferens (CBAVD)**, which is found in over 95% of male CF patients [1]. - In females, CF can cause **viscous cervical mucus** and nutritional deficiencies, leading to challenges with conception [1]. *Azoospermia* - **Azoospermia**, specifically **obstructive azoospermia**, is a direct consequence of **congenital bilateral absence of the vas deferens (CBAVD)**, which is highly prevalent in male CF patients [1]. - This condition prevents sperm from reaching the ejaculate, despite normal sperm production in the testes. *Nasal polyps* - **Nasal polyps** are a common feature in patients with **cystic fibrosis**, often leading to **chronic rhinosinusitis** and nasal obstruction. - This is due to the dysfunctional CFTR protein leading to abnormal mucus production and inflammation in the nasal passages [1].
Question 22: Creola bodies are seen in:
- A. Emphysema
- B. Chronic bronchitis
- C. Bronchiectasis
- D. Bronchial asthma (Correct Answer)
Explanation: ***Bronchial asthma*** - **Creola bodies** are clusters of **desquamated columnar epithelial cells** found in the sputum of patients with asthma. [1] - Their presence indicates ongoing **bronchial inflammation** and epithelial damage, characteristic of asthma exacerbations. *Chronic bronchitis* - Characterized by **mucus hypersecretion** and **chronic productive cough**, without the specific finding of Creola bodies. - Histologically, it involves **goblet cell hyperplasia** and **mucous gland enlargement**. *Emphysema* - Defined by irreversible enlargement of airspaces distal to the terminal bronchioles with **destruction of alveolar walls**, not specific cell aggregates. [1] - The primary defect is loss of **elastic recoil** and **airflow limitation**. *Bronchiectasis* - Involves **permanent abnormal dilation** of the bronchi due to destruction of the muscular and elastic components of the bronchial wall. [1] - Sputum typically contains inflammatory cells and bacteria, but Creola bodies are not a defining feature.
Question 23: Which type of fatty acids should be included in the diet to manage chyluria?
- A. Short-chain fatty acids
- B. Medium-chain fatty acids (Correct Answer)
- C. Long-chain fatty acids
- D. Omega-3 fatty acids
Explanation: ***Medium-chain fatty acids*** - **Medium-chain fatty acids (MCFAs)** are absorbed directly into the **portal circulation** without being re-esterified to triglycerides or incorporated into chylomicrons [1]. This helps bypass the compromised lymphatic system. - In **chyluria**, the lymphatic system's integrity is disrupted, leading to leakage of **chyle** (lymphatic fluid rich in chylomicrons) into the urinary tract. MCFAs provide a source of fat that does not rely on the lymphatic pathway for transport [1]. *Short-chain fatty acids* - **Short-chain fatty acids (SCFAs)** are primarily produced by bacterial fermentation in the colon and are absorbed directly into the portal circulation. - While they do not rely on the lymphatic system, their dietary contribution as a significant energy source is limited, and they are not the primary fat source for patients with chyluria. *Long-chain fatty acids* - **Long-chain fatty acids (LCFAs)** are absorbed with the help of bile salts, re-esterified into triglycerides, and packaged into **chylomicrons** within the intestinal cells [2]. - These chylomicrons then enter the **lymphatic system** and eventually the bloodstream, which is precisely the pathway that is compromised in chyluria, making them unsuitable [2]. *Omega-3 fatty acids* - **Omega-3 fatty acids** are a type of **long-chain polyunsaturated fatty acid** that also follow the chylomicron-lymphatic pathway for absorption [3]. - While beneficial for other health aspects, they are not suitable for managing chyluria due to their reliance on the **lymphatic system** for transport, which is dysfunctional in this condition.
Question 24: What is the most common cause of dissecting hematoma?
- A. Hypertension (Correct Answer)
- B. Marfan syndrome
- C. Iatrogenic causes
- D. Kawasaki disease
Explanation: ***Hypertension*** - **Chronic hypertension** is the most frequent cause of dissecting hematoma (aortic dissection) due to the constant high pressure stressing the arterial wall [1]. - It leads to **medial degeneration** and predisposition to intimal tear, allowing blood to enter the arterial wall [1]. *Marfan syndrome* - While Marfan syndrome is a significant risk factor for aortic dissection due to **connective tissue weakness** (cystic medial necrosis), it is much less common than hypertension [1]. - It primarily affects younger individuals with a genetic predisposition to **fibrillin-1 mutations**. *Iatrogenic causes* - These include complications from medical procedures like **cardiac catheterization** or surgery [1]. - Though a possible cause, iatrogenic dissection is relatively rare compared to spontaneous dissection due to hypertension [1]. *Kawasaki disease* - Kawasaki disease primarily causes **coronary artery aneurysms** in children. - It is not a common cause of aortic dissecting hematoma in adults.
Question 25: Among the following, most reliable test for screening of diabetes mellitus?
- A. Urine sugar
- B. Random sugar
- C. Fasting sugar (Correct Answer)
- D. Glucose tolerance test
Explanation: ***Fasting sugar*** - A **fasting plasma glucose** (FPG) test is the most common and reliable initial test for screening for **diabetes mellitus** because it measures blood glucose after an overnight fast (typically 8-12 hours), providing a baseline level unaffected by recent food intake [1]. - A fasting glucose level of **≥ 126 mg/dL** (7.0 mmol/L) on two separate occasions is diagnostic of diabetes, making it an excellent screening tool for identifying individuals with impaired glucose metabolism [1]. *Random sugar* - A random plasma glucose test can be used to diagnose diabetes if the level is **≥ 200 mg/dL** (11.1 mmol/L) in a symptomatic individual, but it is less reliable for screening asymptomatic individuals due to its variability depending on recent food intake [1]. - Because it can be measured at any time of day without regard to the last meal, it has a **lower sensitivity** for detecting early stages of diabetes compared to fasting glucose. *Glucose tolerance test* - An **oral glucose tolerance test** (OGTT) is highly sensitive and specific for diagnosing diabetes and impaired glucose tolerance, but it is more cumbersome and time-consuming, involving multiple blood draws over two hours after consuming a sugary drink. - While it is a definitive diagnostic test, its complexity makes it **less practical for routine screening** in large populations compared to simpler tests like fasting plasma glucose. *Urine sugar* - The presence of glucose in urine (glycosuria) indicates that blood glucose levels have exceeded the **renal threshold** (typically around 180 mg/dL), meaning the kidneys are unable to reabsorb all the glucose. - This is a **less sensitive and specific** method for screening, as it only becomes positive once blood glucose is significantly elevated, and it does not detect milder forms of impaired glucose metabolism or early diabetes.
Question 26: What is the primary electrolyte found in Oral Rehydration Salts (ORS) at a concentration of 75 mEq/L?
- A. Sodium (Correct Answer)
- B. Potassium
- C. Glucose
- D. Chloride
Explanation: ***Sodium*** - The primary electrolyte in **Oral Rehydration Salts (ORS)** is **sodium**, which is crucial for replacing losses due to diarrhea and facilitating water absorption in the intestines [1]. - The standard ORS formulation, recommended by the WHO, contains **75 mEq/L of sodium** to effectively rehydrate individuals with acute watery diarrhea [1]. *Potassium* - While **potassium** is an essential electrolyte found in ORS, its concentration is typically lower than sodium, usually around **20 mEq/L**. - Potassium helps replenish intracellular losses and supports normal cellular function, but it is not the primary electrolyte at the 75 mEq/L concentration. *Glucose* - **Glucose** is a crucial component of ORS, but it is a sugar, not an electrolyte. - Its role is to facilitate the co-transport of **sodium and water** across the intestinal wall, enhancing fluid absorption, but it does not contribute to the electrolyte concentration in mEq/L [1]. *Chloride* - **Chloride** is an electrolyte present in ORS, primarily to balance the charge of **sodium** and prevent hyynatremia. - Its concentration is typically around **65 mEq/L**, making it slightly less concentrated than sodium but still vital for maintaining electrolyte balance.
Question 27: Tabes dorsalis is seen in -
- A. Tertiary syphilis (Correct Answer)
- B. Primary syphilis
- C. Latent syphilis
- D. Secondary syphilis
Explanation: ***Tertiary syphilis*** - **Tabes dorsalis** is a neurological manifestation of **tertiary syphilis**, characterized by demyelination and degeneration of the posterior columns of the spinal cord [1]. - This leads to symptoms such as **ataxia**, **loss of proprioception**, **lightning pains**, and **Argyll-Robertson pupils**. *Primary syphilis* - Characterized by the presence of a **chancre**, a painless ulcer, at the site of infection [1]. - This stage typically occurs 3-90 days after exposure and is not associated with neurological complications of tabes dorsalis. *Latent syphilis* - This is a period during which there are **no clinical signs or symptoms** of syphilis, although the infection persists. - It can be early or late, but it is not the stage where overt neurological complications like tabes dorsalis arise [1]. *Secondary syphilis* - This stage typically presents with a **generalized mucocutaneous rash**, **lymphadenopathy**, and **condylomata lata** [1]. - While it can involve various organ systems, it does not typically include the severe neurological degeneration seen in tabes dorsalis.
Question 28: Meningitis with rash is seen in -
- A. Neisseria meningitidis (Correct Answer)
- B. H. influenzae
- C. Strepto. agalactae
- D. Pneumococcus
Explanation: **Neisseria meningitidis** - **Meningococcal meningitis** is classically associated with an acute onset of fever, headache, stiff neck, and a characteristic **petechial or purpuric rash** [1]. - The rash is due to widespread **vasculitis** and disseminated intravascular coagulation (DIC) caused by the bacteria. *H. influenzae* - While *H. influenzae* type b (Hib) was a major cause of bacterial meningitis before vaccination, it typically does not cause a *rash*. - Meningitis caused by *H. influenzae* presents with fever, headache, stiff neck, and altered mental status without dermatological manifestations. *Strepto. agalactiae* - *Streptococcus agalactiae* (Group B Strep) is a common cause of meningitis in **neonates** and infants. - It usually presents with non-specific symptoms like fever, lethargy, and poor feeding, and a rash is not a typical feature of GBS meningitis. *Pneumococcus* - *Streptococcus pneumoniae* (Pneumococcus) is another leading cause of bacterial meningitis in adults and children [1]. - Symptoms include fever, headache, stiff neck, and altered mental status, but a cutaneous rash is not characteristic of pneumococcal meningitis [1].
Question 29: What condition is caused by the intake of exogenous steroids?
- A. Addison's disease
- B. Cushing's syndrome (Correct Answer)
- C. Pheochromocytoma
- D. Conn's syndrome
Explanation: ***Cushing's syndrome*** - **Exogenous steroid intake** is the most common cause of Cushing's syndrome, leading to symptoms associated with **excess cortisol** [1]. - This occurs because the steroids mimic the effects of **cortisol**, suppressing the body's natural production and leading to its characteristic signs and symptoms [2]. *Addison's disease* - This condition is characterized by **adrenal insufficiency**, meaning the adrenal glands produce too little **cortisol** and often **aldosterone**. - It is typically caused by autoimmune destruction of the adrenal glands, not by exogenous steroid intake. *Pheochromocytoma* - This is a rare tumor of the **adrenal medulla** that causes the overproduction of **catecholamines** (epinephrine and norepinephrine). - Symptoms include sudden, severe episodes of hypertension, palpitations, and sweating, unrelated to steroid intake. *Conn's syndrome* - Also known as **primary hyperaldosteronism**, this condition involves the overproduction of **aldosterone** by the adrenal glands. - It typically results in hypertension and hypokalemia and is not directly caused by exogenous steroid administration.
Question 30: Which species of malaria is associated with nephrotic syndrome?
- A. P. vivax
- B. P. falciparum
- C. P. malariae (Correct Answer)
- D. P. ovale
Explanation: ***P. malariae*** - *P. malariae* infection is classically associated with **quartan fever** and can lead to **nephrotic syndrome**, particularly in children [1]. - The mechanism involves the deposition of immune complexes in the glomeruli, causing **membranoproliferative glomerulonephritis**. *P. vivax* - *P. vivax* is known for causing **benign tertian malaria** and frequently leads to **relapses** due to hypnozoites in the liver [1]. - While it can cause renal dysfunction, **nephrotic syndrome** is not a characteristic complication. *P. falciparum* - *P. falciparum* is responsible for the most severe form of malaria, often complicated by **cerebral malaria**, **acute renal failure**, and **blackwater fever** [1]. - Renal complications typically present as **acute tubular necrosis** rather than nephrotic syndrome. *P. ovale* - *P. ovale* causes **mild tertian malaria** similar to *P. vivax* and is also known for **relapses** due to hypnozoites [1]. - It is the least common form of malaria and is not typically associated with **nephrotic syndrome**.