Which of the following is not recommended for patients with coronary artery disease?
Which of the following is not typically used for secondary prevention of myocardial infarction?
A patient with first-degree heart block presents with dizziness. What is the most appropriate management for this patient?
What is the most common arrhythmia in ICU patients?
In the context of ventricular tachycardia, what do extra systoles appear as on an electrocardiogram (ECG)?
What is the primary cause of Common Variable Immunodeficiency (CVID)?
ABO non- secretors are more prone to ?
Buboes form is which stage of LGV?
What is the PRIMARY evidence-based intervention for preventing catheter-associated urinary tract infections (CAUTIs)?
Which condition is not associated with complement deficiency?
NEET-PG 2015 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 41: Which of the following is not recommended for patients with coronary artery disease?
- A. Vitamin E (Correct Answer)
- B. Potassium
- C. Statins
- D. Daily exercise
Explanation: ***Vitamin E*** - **Vitamin E supplements** are generally not recommended for patients with coronary artery disease (CAD) based on current evidence. Some studies suggest a potential link between high doses of vitamin E and an increased risk of **heart failure** or even **overall mortality**. - There is no convincing evidence that vitamin E supplements provide cardiovascular benefits in patients with established CAD, and they may interfere with the efficacy of other beneficial medications like **statins**. *Daily exercise* - **Regular physical activity** is a cornerstone of CAD management, improving cardiovascular fitness, reducing blood pressure, and aiding in weight control [1]. - It helps in preventing disease progression and reducing the risk of future cardiovascular events when performed under appropriate medical guidance [1]. *Potassium* - Maintaining adequate **potassium levels** is crucial for patients with CAD, especially those on diuretics, as it helps regulate **blood pressure** and prevents **cardiac arrhythmias**. - Dietary sources of potassium (fruits, vegetables) are preferred, and supplementation may be necessary for those with deficiencies, but always under medical supervision. *Statins* - **Statins** are a class of medications widely recommended for patients with CAD due to their ability to significantly lower **LDL cholesterol** levels and reduce cardiovascular events [1]. - They stabilize **atherosclerotic plaques** and reduce inflammation, playing a critical role in secondary prevention of heart attacks and strokes [1].
Question 42: Which of the following is not typically used for secondary prevention of myocardial infarction?
- A. Aspirin
- B. Statins
- C. Beta blockers
- D. Warfarin (Correct Answer)
Explanation: ***Warfarin*** - While Warfarin is an **anticoagulant**, its primary role is in preventing *thromboembolism* in conditions like **atrial fibrillation** [1] or **mechanical heart valves**, not routinely for general **secondary prevention of MI** unless specific indications exist. - Unlike the other options, it doesn't directly address the underlying plaque rupture or reduce the workload of the heart in the typical post-MI patient. *Aspirin* - **Aspirin** is a cornerstone of secondary prevention after MI due to its **antiplatelet** effects, which help prevent future clot formation [2]. - It reduces the risk of recurrent MI, stroke, and cardiovascular death by inhibiting **platelet aggregation** [2]. *Statins* - **Statins** are crucial for secondary prevention as they aggressively lower **LDL cholesterol** levels, stabilizing existing plaques and preventing further plaque progression. - They have pleiotropic effects beyond lipid lowering, including **anti-inflammatory** and **endothelial function improvement**. *Beta blockers* - **Beta blockers** reduce myocardial oxygen demand by decreasing heart rate and contractility, which helps prevent recurrent ischemic events and improves survival post-MI [3]. - They are particularly beneficial in patients with **left ventricular dysfunction** or **hypertension** following an MI [1].
Question 43: A patient with first-degree heart block presents with dizziness. What is the most appropriate management for this patient?
- A. Observation and investigation of other causes (Correct Answer)
- B. Pacemaker insertion
- C. Isoprenaline
- D. Atropine
Explanation: ***Observation and investigation of other causes*** - **First-degree heart block** is usually **asymptomatic** and benign, rarely causing dizziness or other symptoms. - The dizziness experienced by the patient is likely due to another underlying condition and warrants **further investigation** rather than direct intervention for the heart block [2], [3]. *Pacemaker insertion* - **Pacemaker insertion** is reserved for **symptomatic heart blocks** of higher degrees (e.g., Mobitz II or complete heart block) or those with significant hemodynamic compromise [1]. - Given that first-degree heart block is typically asymptomatic, inserting a pacemaker would be an **overtreatment** and unnecessary for this condition alone. *Isoprenaline* - **Isoprenaline** is a **beta-agonist** that increases heart rate and AV conduction, sometimes used in certain bradyarrhythmias. - However, for first-degree heart block, which is generally benign, pharmacologic intervention with agents like **isoprenaline** is not typically indicated and carries risks of adverse effects [2]. *Atropine* - **Atropine** is an anticholinergic drug used to **increase heart rate** by blocking vagal stimulation of the SA and AV nodes. - While it can improve AV conduction, it is not indicated for **asymptomatic first-degree heart block** or when symptoms like dizziness are unlikely to be directly caused by the block itself.
Question 44: What is the most common arrhythmia in ICU patients?
- A. Atrial flutter
- B. Atrial fibrillation (Correct Answer)
- C. Atrial Tachycardia
- D. Supraventricular Tachycardia
Explanation: ***Atrial fibrillation*** - **Atrial fibrillation (AF)** is the most prevalent arrhythmia in the general population [1], and its incidence is significantly higher in critically ill patients due to various stressors. - Factors like **sepsis**, **hypoxemia**, **electrolyte imbalances**, **myocardial ischemia**, and **inflammatory states** common in the ICU are known triggers for new-onset AF. *Atrial flutter* - While atrial flutter is a common arrhythmia, its overall incidence in the ICU setting is **less frequent than atrial fibrillation**. - It often involves a **re-entrant circuit** in the right atrium [2], leading to characteristic "sawtooth" waves on ECG. *Atrial Tachycardia* - Atrial tachycardia is a form of **supraventricular tachycardia (SVT)** that originates in the atria but is **less common** than AF in the ICU [2]. - It often presents as a **regular, narrow-complex tachycardia** with discrete P waves. *Supraventricular Tachycardia* - This is a broad term encompassing arrhythmias that originate **above the ventricles** [3], including AF, atrial flutter, and atrial tachycardia. - While SVT as a category is common, **atrial fibrillation is the single most frequent specific arrhythmia** within this group in the ICU.
Question 45: In the context of ventricular tachycardia, what do extra systoles appear as on an electrocardiogram (ECG)?
- A. P wave
- B. QRS complex (Correct Answer)
- C. T wave
- D. R wave
Explanation: ***QRS complex*** - Extra systoles, particularly **premature ventricular contractions (PVCs)**, originate in the ventricles and result in a **wide and bizarre QRS complex** on an ECG [2]. - The QRS complex represents **ventricular depolarization**, and in ventricular tachycardia, the *ventricular activity* dominates the ECG tracing [2]. *P wave* - The **P wave** represents **atrial depolarization** and is typically either absent or dissociated from the QRS complex in ventricular tachycardia [1], [2]. - Its presence or absence helps differentiate supraventricular from ventricular arrhythmias. *T wave* - The **T wave** represents **ventricular repolarization**, which typically follows the QRS complex [1]. - While it will be present, it often appears abnormal or discordant in ventricular tachycardia due to the altered ventricular depolarization. *R wave* - The **R wave** is part of the QRS complex, specifically the first positive deflection. - While an R wave is present within the QRS complex of an extrasystole, referring to the entire **QRS complex** is more accurate as it encompasses the complete ventricular depolarization in an abnormal morphology.
Question 46: What is the primary cause of Common Variable Immunodeficiency (CVID)?
- A. Defective B cell function
- B. Absent B cells
- C. Reduced number of B cells
- D. Defective B cell differentiation (Correct Answer)
Explanation: ***Defective B cell differentiation*** - CVID is characterized primarily by a failure of **B cells** to differentiate into **plasma cells**, which are responsible for producing antibodies [1]. - This defective differentiation leads to **hypogammaglobulinemia**, or low levels of immunoglobulins [1]. *Absent B cells* - Complete absence of B cells is characteristic of severe combined immunodeficiency (SCID) or X-linked agammaglobulinemia (XLA), not CVID [1]. - In CVID, B cells are typically present, but they are dysfunctional. *Reduced number of B cells* - While some patients with CVID may have reduced B cell numbers, this is not the primary or defining defect. - The key issue is the inability of existing B cells to mature and produce antibodies effectively. *Defective B cell function* - While B cell function is indeed defective in CVID, the root cause of this malfunction is specifically the **failure of differentiation** into mature plasma cells. - The B cells are unable to perform their primary function of antibody production due to this arrest in their development.
Question 47: ABO non- secretors are more prone to ?
- A. Increased risk of infections (Correct Answer)
- B. Autoimmune diseases
- C. Cardiovascular diseases
- D. Cancer
Explanation: Increased risk of infections - Non-secretors of ABO antigens exhibit an increased susceptibility to a variety of infections, particularly bacterial and viral pathogens. - This is thought to be due to the absence of ABO antigens in secretions, which typically act as decoy receptors to prevent pathogen adhesion to host cells. Autoimmune diseases - While some associations between ABO blood groups and autoimmune diseases exist, non-secretor status is not consistently linked to a higher overall risk of autoimmune conditions. Cardiovascular diseases - ABO blood groups have been associated with cardiovascular risk, with non-O blood types generally having a slightly higher risk of certain cardiovascular events. - However, secretor status (the ability to secrete ABO antigens into bodily fluids) itself is not a prominent independent risk factor for cardiovascular diseases. Cancer - There are some documented associations between specific ABO blood types and certain types of cancer (e.g., non-O blood types with pancreatic cancer), but this is distinct from secretor status. - Being an ABO non-secretor is not a primary, broadly recognized risk factor for developing cancer.
Question 48: Buboes form is which stage of LGV?
- A. Secondary (Correct Answer)
- B. Tertiary
- C. Latent
- D. Primary
Explanation: ***Secondary*** - Buboes, which are swollen, painful lymph nodes, are a hallmark of the **secondary stage** of **Lymphogranuloma Venereum (LGV)** [1]. - This stage typically develops weeks after the initial infection, following the unnoticed or transient primary lesion. *Primary* - The primary stage of LGV is characterized by a **small, painless papule or ulcer** at the site of inoculation, which often goes unnoticed. - **Buboes are not formed** during this initial, often asymptomatic, phase. *Tertiary* - The tertiary stage of LGV involves **chronic inflammation** and **tissue destruction**, leading to complications like **genital elephantiasis**, rectal strictures, and fistulas. - While there is chronic lymphedema, the acute, painful buboes are characteristic of the secondary stage, not this late, destructive phase. *Latent* - The concept of a latent stage is not typically used to describe the progression of LGV in the same way as other infections like syphilis. - LGV progresses through distinct symptomatic primary, secondary, and potentially tertiary stages without a prolonged asymptomatic latency period between symptom presentations.
Question 49: What is the PRIMARY evidence-based intervention for preventing catheter-associated urinary tract infections (CAUTIs)?
- A. Use of face mask during catheter insertion
- B. Prophylactic antibiotics are effective
- C. Early catheter removal when clinically appropriate
- D. Closed drainage technique to minimize bacterial entry (Correct Answer)
Explanation: ***Closed drainage technique to minimize bacterial entry*** - Maintaining a **closed drainage system** prevents the entry of bacteria into the urinary tract, which is a primary cause of CAUTIs. - This technique involves ensuring the connection between the catheter and the drainage bag remains sealed at all times, minimizing **environmental contamination**. *Prophylactic antibiotics are effective* - **Prophylactic antibiotics** are generally not recommended for routine CAUTI prevention due to concerns about **antibiotic resistance** and limited evidence of effectiveness [1]. - Their use is typically reserved for specific high-risk procedures or patient populations. *Use of face mask during catheter insertion* - While maintaining **asepsis** during catheter insertion is crucial, the use of a face mask specifically addresses **respiratory droplet transmission**, which is not the primary route of bacterial entry into the urinary system during catheterization. - **Sterile gloves** and a **sterile field** are more directly relevant for preventing contamination during insertion [1]. *Early catheter removal when clinically appropriate* - While **early catheter removal** is a critical strategy for CAUTI prevention by reducing dwell time, the question asks for the *primary* evidence-based intervention [1]. A **closed drainage system** directly addresses the mechanism of bacterial entry while the catheter is in place. - Reducing catheter duration minimizes risk, but the closed system ensures safety during the necessary period of catheterization.
Question 50: Which condition is not associated with complement deficiency?
- A. SLE
- B. PNH
- C. Membranous nephritis (Correct Answer)
- D. Hereditary angioedema
Explanation: Membranous nephritis - Membranous nephritis is associated with immune complex deposition rather than complement deficiencies. [1] - The disease is characterized by thickening of the glomerular basement membrane without significant complement involvement. [1] PNH - Paroxysmal nocturnal hemoglobinuria (PNH) is due to a defect in the GPI-anchor leading to complement-mediated hemolysis. - Complement activation plays a critical role in the destruction of red blood cells in this condition. Hereditary angioedema - Hereditary angioedema is caused by deficiencies in C1 inhibitor, leading to uncontrolled activation of complement. - This results in edema episodes, directly linked to complement pathway dysregulation. SLE - Systemic lupus erythematosus (SLE) involves complement consumption due to autoantibody formation against nuclear antigens. - The disease often presents with hypocomplementemia, indicating complement system involvement.