NEET-PG 2012 - Internal Medicine Practice Questions

Q: What is true about HER2/neu overexpression in cancer?

Responds well to monoclonal antibodies. ***Responds well to monoclonal antibodies*** - HER2/neu overexpression is targeted by **monoclonal antibodies** like trastuzumab (Herceptin), improving treatment outcomes [1]. - These therapies are specifically designed to **inhibit HER2-positive** tumors, leading to better overall prognosis compared to those without such therapies [1]. *Good prognosis* - HER2/neu overexpression is generally associated with a **poor prognosis** due to increased aggressiveness of the cancer. - It correlates with **higher rates of recurrence** and metastasis compared to HER2-negative breast cancers. *Responds well to taxanes* - While taxanes are commonly used in breast cancer treatment, HER2/neu positivity does not specifically imply a good response. - Response rates may not significantly differ based on HER2 status for taxane-based therapies alone. *Seen only in breast cancer* - HER2/neu overexpression can also occur in other cancers, such as **gastric and gastroesophageal junction cancers**. - It is not exclusive to breast cancer, though it is most commonly studied in this context [1].

Q: Jaw tightness is typically seen in:

Giant cell arteritis (GCA). ***Giant cell arteritis (GCA)*** - **Jaw claudication** or tightness, difficulty chewing, and pain in the jaw are classic symptoms of GCA, resulting from **ischemia of the masticatory muscles**. [1] - This condition is a **large vessel vasculitis** that frequently affects the **temporal arteries** and can lead to blindness if untreated. [1] *Polyarteritis nodosa (PAN)* - PAN is a **necrotizing vasculitis** that typically affects **medium-sized arteries**, often sparing the pulmonary circulation. [1] - Common symptoms include **neuropathy**, abdominal pain, and skin lesions (e.g., livedo reticularis), but **jaw tightness is not a typical feature**. *Coarctation of aorta* - This is a **congenital narrowing of the aorta**, leading to symptoms like **upper extremity hypertension**, headache, and claudication in the lower extremities. - **Jaw tightness is not a symptom** associated with coarctation of the aorta. *Granulomatosis with Polyangiitis (GPA)* - GPA is a **small-vessel vasculitis** characterized by **granulomatous inflammation** involving the upper and lower respiratory tracts, and glomerulonephritis. - Symptoms often include **sinusitis**, lung nodules, and kidney disease, but **jaw claudication is not a characteristic presentation**.

Q: Most common symptom of genitourinary TB

Hematuria. ***Hematuria*** - **Gross or microscopic hematuria** is the most common symptom of genitourinary tuberculosis, often occurring early in the disease course. - It results from the **inflammatory and destructive changes** caused by Mycobacterium tuberculosis in the urinary tract. *Renal colic* - Renal colic is typically associated with **acute obstruction of the ureter**, often by a renal stone. - While TB can cause strictures leading to obstruction, **colic** itself is not the most common initial symptom. *Increased frequency* - Increased urinary frequency is a common symptom in genitourinary TB, especially with **bladder involvement**. - However, it ranks below hematuria in terms of overall prevalence as the *most common* symptom. *Painful micturition* - **Dysuria** or painful micturition is frequently observed in genitourinary TB, particularly with **bladder or urethral inflammation**. - While common, it is generally less prevalent than hematuria as the presenting complaint.

Q: Secretory diarrhea is not typically associated with which of the following conditions?

Celiac disease. ***Celiac disease*** [1] - Characterized by **malabsorption** due to immune-mediated damage to the intestinal mucosa, leading to **osmotic diarrhea** rather than secretory diarrhea [1]. - Symptoms include **bloating**, **weight loss**, and **steatorrhea**, which are not consistent with secretory processes. *Cholera* - Caused by **Vibrio cholerae**, leading to **massive secretory diarrhea** due to the action of cholera toxin on intestinal epithelial cells. - Presents with **watery diarrhea**, potentially leading to **dehydration** and electrolyte imbalances. *Addison's Disease* - This condition may cause **diarrhea** but typically results in **non-secretory diarrhea**, often associated with adrenal insufficiency symptoms. - Presenting features include **fatigue**, **weight loss**, and **hyperpigmentation**, not primarily secretory processes. *Phenolphthalein* - A laxative that can induce **secretory diarrhea** through its stimulant effects on the bowel. - Its mechanism leads to increased fluid secretion in the intestines, thus contributing to secretory diarrhea.

Q: Investigation of choice in pheochromocytoma is:

Urinary catecholamines. ***Urinary catecholamines*** - Measurement of **24-hour urinary fractionated metanephrines and catecholamines** is the initial **biochemical test of choice**. - These biochemical tests are preferred over plasma levels due to the **episodic release** of hormones from a pheochromocytoma, which can lead to high false-negative rates in single plasma measurements. *CT scan* - While a **CT scan** is a crucial **imaging modality** for localizing a pheochromocytoma once the biochemical diagnosis is established [1], it is not the *initial* diagnostic investigation. - Imaging should be performed only after **biochemical confirmation** to avoid unnecessary investigations of incidental adrenal masses [1]. *MIBG scan* - An **MIBG scan** (metaiodobenzylguanidine scan) is a **functional imaging study** used primarily for **localizing metastatic pheochromocytomas** [1] or for cases where CT/MRI is equivocal. - It is not the initial investigation but rather a **secondary imaging test** [1]. *MRI Scan* - **MRI** is an alternative **imaging modality** to CT for localizing pheochromocytomas [1], especially in pregnant women or when radiation exposure is a concern. - Like CT, it serves as a **localization tool** after biochemical confirmation, not the diagnostic test itself.

Q: Tuberculosis of the spine; what is the most common site affected?

Dorsolumbar. ***94ed055d-c7da-4d18-a2fd-52720dfe8b6e*** - The **dorsolumbar (thoracolumbar)** region is the most common site of **spinal tuberculosis (Pott's disease)** [1] due to its high vascularity, facilitating hematogenous spread. - **Spinal tuberculosis** typically affects the vertebral bodies, leading to their destruction, kyphosis (angular deformity), and potentially neurological deficits [1]. *aebdfe6c-98dc-4073-892f-bb24d047bab4* - The **sacral** region can be affected by **tuberculosis**, but it is considerably less common than the thoracolumbar region. - Involvement of the sacrum is often associated with **direct extension** from adjacent structures, such as the sacroiliac joint, rather than primary vertebral involvement. *15c1feef-e3ca-496f-a180-127d52b77bfa* - **Cervical spine tuberculosis** is relatively rare, accounting for a small percentage of all spinal tuberculosis cases. - While possible, it presents with specific challenges due to the proximity of vital neurological and vascular structures. *d05d4d13-bb83-4f26-aa2d-c9c0203d299c* - The **lumbosacral region** (L5-S1) can be involved in **tuberculosis**, but it is less frequently affected than the thoracolumbar region. - While the lumbar spine is a common site, the entire lumbosacral region as a single entity is not the most common spot for spinal TB.

Q: Oculoorogenital ulcers are associated with which of the following conditions?

Behcet's disease. ***Behcet's disease*** - This condition is characterized by **recurrent oral and genital ulcers**, along with **ocular inflammation** (e.g., uveitis), perfectly matching the "Oculoorogenital ulcers" description. - It is a **chronic, relapsing inflammatory disease** of unknown etiology involving vasculitis affecting various organ systems. *Lichen planus* - This is a chronic inflammatory condition affecting the **skin, hair, nails, and mucous membranes**. - While it can cause oral lesions, it typically presents as **purple, polygonal, pruritic papules** on the skin and does not cause genital ulcers or significant ocular involvement like Behcet's. *Systemic lupus erythematosus (SLE)* - SLE is a **systemic autoimmune disease** with diverse manifestations, including skin rashes, arthritis, and internal organ involvement. - Oral ulcers can occur, but **genital ulcers and severe ocular inflammation** as a prominent triad are not typical diagnostic features of SLE. *Psoriasis* - This is a common **chronic inflammatory skin disease** characterized by well-demarcated erythematous plaques with silvery scales. - Psoriasis primarily affects the skin and joints, and **does not typically present with oral, genital, or ocular ulcers** as described.

Q: Which of the following conditions is most commonly associated with resorption of the distal phalanx?

Scleroderma. ***Scleroderma*** - **Scleroderma** (systemic sclerosis) can cause characteristic changes in the distal phalanges, specifically **acro-osteolysis**, leading to resorption of the **distal tufts** [1]. - This is often associated with **Raynaud's phenomenon**, **digital ischemia**, and **calcinosis**, leading to severe circulatory compromise in the digits [1]. *Hyperparathyroidism* - **Primary hyperparathyroidism** causes bone resorption due to increased parathyroid hormone, primarily affecting the **subperiosteal bone** (especially in the radial aspect of the middle phalanges), leading to a "lace-like" appearance on X-ray. - While it causes bone resorption, **distal phalanx tuft resorption** is not its most common or prominent skeletal feature compared to scleroderma. *Reiter's syndrome* - **Reiter's syndrome** (now known as reactive arthritis) is an inflammatory arthropathy usually involving large joints of the lower extremities in an **asymmetric** pattern. - It does not typically cause **resorption of the distal phalanx**; instead, it's associated with enthesitis, dactylitis, and periostitis. *Osteitis deformans (Paget's disease)* - **Paget's disease** is characterized by abnormal bone remodeling, leading to enlarged, deformed bones that are prone to fracture, predominantly affecting the **pelvis, spine, skull, and long bones**. - It causes areas of localized bone destruction and excessive bone formation, but **distal phalanx resorption** is not a feature of this condition.

Q: In an EMG/NCV study, which radiculopathy is most closely associated with the H. reflex?

S1 radiculopathy. ***S1 radiculopathy*** - The **H-reflex (Hoffmann reflex)** primarily assesses the integrity of the **S1 nerve root** and the **tibial nerve** pathway. - A diminished or absent H-reflex is a sensitive indicator of **S1 radiculopathy**, often correlating with **Achilles reflex loss** [1]. *L3 radiculopathy* - **L3 radiculopathy** typically affects the **quadriceps muscle** and the **patellar reflex** [1]. - The H-reflex is not a primary diagnostic tool for isolated L3 nerve root involvement. *L4 radiculopathy* - **L4 radiculopathy** usually presents with weakness in **tibialis anterior** and altered sensation over the medial leg/foot [1]. - While it can sometimes impact the patellar reflex, the H-reflex is not the most direct or specific measure for L4 involvement. *L5 radiculopathy* - **L5 radiculopathy** often leads to weakness in **foot dorsiflexion** and **toe extension**, with sensory loss over the dorsum of the foot [1]. - It does not directly involve the reflex arc assessed by the H-reflex.

Question 1

What is true about HER2/neu overexpression in cancer?

Accepted Answer

Responds well to monoclonal antibodies

Answer

Good prognosis

Answer

Responds well to taxanes

Answer

Seen in various cancers, including breast cancer

Question 2

Jaw tightness is typically seen in:

Accepted Answer

Giant cell arteritis (GCA)

Answer

Coarctation of aorta

Answer

Polyarteritis nodosa (PAN)

Answer

Granulomatosis with Polyangiitis (GPA)

Question 3

Most common symptom of genitourinary TB

Accepted Answer

Hematuria

Answer

Increased frequency

Answer

Renal colic

Answer

Painful micturition

Question 4

Secretory diarrhea is not typically associated with which of the following conditions?

Accepted Answer

Celiac disease

Answer

Phenolphthalein

Answer

Cholera

Answer

VIPoma

Question 5

Investigation of choice in pheochromocytoma is:

Accepted Answer

Urinary catecholamines

Answer

CT scan

Answer

MIBG scan

Answer

MRI Scan

Question 6

Which of the following is a characteristic of Yellow-nail syndrome?

Accepted Answer

Pleural effusion and lymphedema, associated with discolored nails

Answer

Knee joint effusion and lymphedema, associated with discolored nails

Answer

Pericardial effusion and lymphedema, associated with discolored nails

Answer

Peritoneal effusion and lymphedema, associated with discolored nails

Question 7

Tuberculosis of the spine; what is the most common site affected?

Accepted Answer

Dorsolumbar

Answer

Sacral

Answer

Lumbosacral

Answer

Cervical

Question 8

Oculoorogenital ulcers are associated with which of the following conditions?

Accepted Answer

Behcet's disease

Answer

Lichen planus

Answer

Systemic lupus erythematosus (SLE)

Answer

Psoriasis

Question 9

Which of the following conditions is most commonly associated with resorption of the distal phalanx?

Accepted Answer

Scleroderma

Answer

Hyperparathyroidism

Answer

Reiter's syndrome

Answer

Osteitis deformans (Paget's disease)

Question 10

In an EMG/NCV study, which radiculopathy is most closely associated with the H. reflex?

Accepted Answer

S1 radiculopathy

Answer

L3 radiculopathy

Answer

L4 radiculopathy

Answer

L5 radiculopathy

NEET-PG 2012 — Internal Medicine