Which species of malaria is associated with nephrotic syndrome?
Hereditary angioneurotic edema is due to?
In which condition is paradoxical splitting of the second heart sound observed?
Which of the following is a characteristic feature of Crohn's disease?
Migraine is due to
Antibodies most commonly seen in drug induced lupus are:
A person experiences asthma attacks more than twice during the day and at least once during the night. What is the most likely classification of their asthma?
What is the first symptom of leprosy?
Which of the following is a characteristic feature of primary Sjogren's syndrome?
Which of the following is not a feature of Systemic Lupus Erythematosus (SLE)?
NEET-PG 2012 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 41: 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**.
Question 42: Hereditary angioneurotic edema is due to?
- A. Deficiency of C1 inhibitor (Correct Answer)
- B. Deficiency of NADPH oxidase
- C. Deficiency of MPO
- D. Deficiency of properdin
Explanation: ***Deficiency of C1 inhibitor*** - **Hereditary angioedema (HAE)** is caused by a genetic deficiency or dysfunction of the **C1 esterase inhibitor (C1-INH)** protein. - C1-INH normally regulates the **complement system**, kinin system (mediating **bradykinin** release), and coagulation pathways, and its deficiency leads to uncontrolled activation and excessive bradykinin production, causing angioedema. *Deficiency of NADPH oxidase* - A deficiency in **NADPH oxidase** is associated with **Chronic Granulomatous Disease (CGD)**, a primary immunodeficiency characterized by recurrent bacterial and fungal infections due to impaired phagocytic oxidative burst. - It does not cause angioedema, which involves fluid extravasation rather than impaired microbial killing. *Deficiency of MPO* - **Myeloperoxidase (MPO) deficiency** typically leads to mild to moderate impairment in the killing of certain microorganisms by phagocytes but is often asymptomatic or causes only recurrent candidal infections. - It is not linked to the pathogenesis of angioedema, which involves dysregulation of vasoactive peptides. *Deficiency of properdin* - A deficiency in **properdin** affects the **alternative pathway of the complement system**, increasing susceptibility to **Neisseria infections**. - While properdin is part of the complement system, its deficiency does not directly lead to the uncontrolled production of bradykinin, which is the primary mediator in angioedema due to C1-INH deficiency.
Question 43: In which condition is paradoxical splitting of the second heart sound observed?
- A. Right Bundle Branch Block (RBBB)
- B. Left Bundle Branch Block (LBBB) (Correct Answer)
- C. Ventricular Septal Defect (VSD)
- D. Atrial Septal Defect (ASD)
Explanation: ***Left Bundle Branch Block (LBBB)*** - In LBBB, the **left ventricle** depolarizes and contracts *after* the right ventricle, causing the **aortic valve (A2)** to close *after* the **pulmonic valve (P2)** [1]. - During inspiration, right ventricular ejection time is prolonged, which further delays P2. However, in LBBB, A2 is already delayed, and the inspiratory delay of P2 can bring P2 closer to A2, or even cause them to merge, making the splitting *less wide* or *disappear* on inspiration, which is paradoxical. *Right Bundle Branch Block (RBBB)* - RBBB causes a **delay in right ventricular depolarization**, leading to a **delayed P2** (pulmonic valve closure). - This typically results in **wide and fixed splitting of S2**, where the splitting persists during expiration and widens further with inspiration, which is not paradoxical. *Ventricular Septal Defect (VSD)* - A VSD can cause a **loud holosystolic murmur** and may lead to increased pulmonary blood flow. - While it can affect the timing of heart sounds, it does not typically cause paradoxical splitting of S2. *Atrial Septal Defect (ASD)* - An ASD causes a **left-to-right shunt**, leading to chronic volume overload of the right ventricle and increased pulmonary blood flow. - This often results in a **widely fixed splitting of S2**, where the split between A2 and P2 is constant regardless of respiration, which is different from paradoxical splitting.
Question 44: Which of the following is a characteristic feature of Crohn's disease?
- A. Sinus & fistula (Correct Answer)
- B. Mesenteric lymphadenitis
- C. Continuous involvement
- D. Crypt abscesses
Explanation: ***Sinus & fistula*** - **Transmural inflammation**, a hallmark of Crohn's disease, can extend through the bowel wall, leading to the formation of **sinus tracts** and **fistulae** (abnormal connections between organs or to the skin). [1] - These complications include enteroenteric, enterovesical, and perianal fistulae, which are highly characteristic of Crohn's. [1] *Continuous involvement* - Crohn's disease is characterized by **skip lesions**, meaning there are healthy segments of bowel interspersed with diseased segments, not continuous involvement. [1] - **Ulcerative colitis** typically presents with continuous inflammation, starting from the rectum and extending proximally. [1] *Mesenteric lymphadenitis* - While mesenteric lymph nodes can be involved in Crohn's disease due to inflammation, **mesenteric lymphadenitis** is more commonly associated with infectious etiologies or other inflammatory conditions, and not a primary defining characteristic. - It refers to inflammation of lymph nodes in the mesentery, which can cause abdominal pain but does not specifically differentiate Crohn's from other conditions. *Crypt abscesses* - **Crypt abscesses** are a characteristic histological feature of **ulcerative colitis**, where neutrophils infiltrate the glandular crypts. [1] - While they can occasionally be seen in Crohn's, they are much more common and prominent in ulcerative colitis and are not a defining feature of Crohn's.
Question 45: Migraine is due to
- A. Cortical spreading depression (Correct Answer)
- B. Dilatation of cranial blood vessels
- C. Constriction of cranial blood vessels
- D. Inflammation of the meninges
Explanation: ***Cortical spreading depression*** - The current understanding is that **cortical spreading depression (CSD)** is the initiating event in migraine with aura, characterized by a wave of neuronal and glial depolarization that spreads across the cerebral cortex, leading to a temporary shutdown of neuronal activity [1]. - CSD is thought to activate the **trigeminal nerve**, subsequently causing the release of inflammatory neuropeptides and contributing to the pain phase [1]. *Dilatation of cranial blood vessels* - While **vasodilation of intracranial and extracranial blood vessels** does occur during the headache phase of migraine, it is now considered a *consequence* of the initial neurological events rather than the primary cause [1]. - This vasodilation contributes to the throbbing sensation of migraine pain but does not explain the aura or the initiation of the attack. *Constriction of cranial blood vessels* - **Vasoconstriction** was previously thought to be the cause of the migraine aura, but this theory has largely been disproven. - While some temporary constriction may precede CSD, it is not the primary mechanism behind the migraine attack. *Inflammation of the meninges* - While **neurogenic inflammation** of the meninges, involving the release of inflammatory mediators like **calcitonin gene-related peptide (CGRP)**, does play a role in sensitizing the trigeminal system and contributing to migraine pain, it is a downstream effect. - It is not the initial trigger for a migraine attack but rather part of the pain pathway activated by events like CSD.
Question 46: Antibodies most commonly seen in drug induced lupus are:
- A. Anti ds DNA Antibodies
- B. Anti Sm Antibodies
- C. Anti-Ro Antibodies
- D. Antihistone Antibodies (Correct Answer)
Explanation: ***Antihistone Antibodies*** - **Antihistone antibodies** are the most common laboratory finding, present in 95% of patients with **drug-induced lupus erythematosus (DIL)**. - This type of lupus is often triggered by medications such as **procainamide**, **hydralazine**, and **isoniazid**. *Anti ds DNA Antibodies* - **Anti-double-stranded DNA (dsDNA) antibodies** are highly specific for **systemic lupus erythematosus (SLE)**, particularly severe cases, but are rarely seen in DIL. - High titers of anti-dsDNA often correlate with **lupus nephritis** and disease activity. *Anti Sm Antibodies* - **Anti-Sm antibodies** are highly specific for **SLE**, sometimes associated with neuropsychiatric manifestations, but are rarely identified in drug-induced lupus. - Their presence helps to confirm the diagnosis of SLE but not DIL. *Anti-Ro Antibodies* - **Anti-Ro (SSA) antibodies** are most commonly associated with **Sjögren's syndrome** and **neonatal lupus**, and can be seen in a subset of SLE patients, especially those with photosensitivity. - While they can be present in some forms of SLE, they are not the hallmark autoantibody for drug-induced lupus.
Question 47: A person experiences asthma attacks more than twice during the day and at least once during the night. What is the most likely classification of their asthma?
- A. Intermittent asthma
- B. Mild persistent asthma
- C. Moderate persistent asthma
- D. Severe persistent asthma (Correct Answer)
Explanation: ***Severe persistent asthma*** - This classification is characterized by **frequent symptoms**, specifically asthma attacks occurring more than twice daily and at least once nightly. - Individuals with severe persistent asthma often experience significant limitations in their daily activities and may have a **FEV1 (forced expiratory volume in 1 second)** less than 60% of predicted. *Intermittent asthma* - This classification is characterized by symptoms occurring less than two days per week and **nighttime awakenings less than two times per month**. - Symptoms are generally well-controlled with a short-acting beta-agonist (SABA) as needed. *Mild persistent asthma* - Patients with mild persistent asthma typically experience symptoms more than twice a week but **less than once a day**, and **nighttime awakenings 3-4 times per month**. - Their lung function (FEV1) is usually 80% or more of predicted. *Moderate persistent asthma* - This category involves daily symptoms and **nighttime awakenings more than once per week but not nightly**. - Lung function (FEV1) in moderate persistent asthma typically falls between 60% and 80% of predicted.
Question 48: What is the first symptom of leprosy?
- A. Decreased vibration & position sense
- B. Decreased pain (Correct Answer)
- C. Decreased temperature
- D. Decreased light touch
Explanation: Decreased pain - Leprosy primarily targets Schwann cells in peripheral nerves, leading to sensory loss [1]. - The sensation of pain is typically affected earliest, often presenting as areas of numbness [1]. Decreased vibration & position sense - These sensations are typically carried by larger myelinated fibers, which tend to be affected later in the disease progression of leprosy. - While eventually involved, they are not usually the first symptom of sensory loss. Decreased temperature - Temperature sensation is also an early modality affected in leprosy, as it's carried by small, unmyelinated or thinly myelinated fibers [1]. - However, pain is often cited as the very first sensory loss, even preceding temperature changes in some cases. Decreased light touch - Light touch sensation is generally an early loss, similar to pain and temperature, due to damage to nerve fibers in the skin. - But, when distinguishing the absolute first symptom, pain perception often shows impairment even before light touch in affected areas.
Question 49: Which of the following is a characteristic feature of primary Sjogren's syndrome?
- A. Can occur in children
- B. Increased complement C4 is associated with thymoma
- C. Can be associated with rheumatoid arthritis
- D. Enlargement of salivary glands (Correct Answer)
Explanation: ***Enlargement of salivary glands*** - **Sjögren's syndrome** is characterized by chronic inflammation of **exocrine glands**, leading to swelling and dysfunction, most notably in the **parotid** and **submandibular glands**. - This glandular enlargement often presents as recurrent or persistent **bilateral swelling** of the major salivary glands. *Can occur in children* - While possible, Sjögren's syndrome is predominantly a disease of **adults**, with incidence peaking in individuals between **40 and 60 years old**. - **Juvenile Sjögren's syndrome** is rare and typically presents with more variable symptoms, making it less of a characteristic feature of the primary disease in the general population. *Increased complement C4 is associated with thymoma* - **Increased complement C4** levels are generally not associated with Sjögren's syndrome; instead, **hypocomplementemia** (low C4) can be seen in some patients, indicating immune complex activity. - **Thymoma** is primarily linked to **myasthenia gravis** and other paraneoplastic syndromes, not a direct or characteristic association with Sjögren's syndrome or C4 levels in this context. *Can be associated with rheumatoid arthritis* - Sjögren's syndrome can be classified as **primary** (occurring alone) or **secondary** (occurring in conjunction with another autoimmune disease). - Its association with **rheumatoid arthritis** defines **secondary Sjögren's syndrome**, meaning it's not a characteristic feature of the *primary* form of the disease itself.
Question 50: Which of the following is not a feature of Systemic Lupus Erythematosus (SLE)?
- A. Recurrent abortion
- B. Sterility (Correct Answer)
- C. Psychosis
- D. Coomb's positive hemolytic anemia
Explanation: ***Sterility*** - While SLE can affect fertility due to **gonadal dysfunction** or **treatment-related factors**, it is not a *direct* or *defining feature* of the disease itself. - Sterility is a less common manifestation compared to the widespread organ system involvement that characterizes SLE [2]. *Recurrent abortion* - **Recurrent abortions** are a well-recognized complication in SLE, particularly when associated with **antiphospholipid syndrome**, which frequently co-occurs with SLE [1]. - **Antiphospholipid antibodies** can lead to thrombosis in placental vessels, causing fetal loss. *Psychosis* - **Psychosis** is a significant neuropsychiatric manifestation of SLE, classified under **neuropsychiatric lupus (NPSLE)**. - It can result from **inflammation**, **autoantibody effects**, or **ischemia** within the central nervous system. *Coomb's positive hemolytic anemia* - **Coomb's positive hemolytic anemia** is a common hematological complication in SLE, indicating the presence of **autoantibodies** against red blood cells [3]. - This **autoimmune destruction** of red blood cells leads to anemia, and a positive direct Coombs test confirms antibody sensitization [3].