NEET-PG 2015 - Internal Medicine Practice Questions

Q: Hepatic Encephalopathy is predisposed by all, Except:

Hyperkalemia. ***Hyperkalemia*** - **Hyperkalemia** is not a known trigger for hepatic encephalopathy; in fact, **hypokalemia** is a more common electrolyte disturbance that can precipitate it due to its effect on renal ammonia excretion. - Electrolyte imbalances that contribute to hepatic encephalopathy usually involve **hypokalemia**, **hyponatremia**, or **alkalosis**, which affect **ammonia metabolism** and neuronal excitability [1]. *Dehydration* - **Dehydration** can lead to **reduced renal perfusion**, impairing the kidneys' ability to clear **ammonia** and other toxins, thus increasing their concentration in the blood. - It also contributes to **hemoconcentration**, elevating blood **ammonia levels** and increasing the risk of hepatic encephalopathy [1]. *Constipation* - **Constipation** allows for a longer transit time of stool in the colon, providing more opportunity for **intestinal bacteria** to produce **ammonia** from protein breakdown [1]. - The increased production and absorption of ammonia from the gut contribute significantly to the **nitrogenous load** in the bloodstream, predisposing to hepatic encephalopathy [1]. *GI Bleeding* - **Gastrointestinal bleeding** (GI bleeding) introduces a large protein load (blood) into the GI tract, which is then broken down by bacterial action. - This breakdown generates a significant amount of **ammonia** and other nitrogenous compounds, which are then absorbed into the bloodstream, overwhelming the impaired liver's ability to detoxify them and precipitating hepatic encephalopathy [1].

Q: Which of the following statements about alcoholic hepatitis is false?

SGPT is raised > SGOT. ***SGPT is raised > SGOT*** - In **alcoholic hepatitis**, the ratio of **AST (SGOT)** to **ALT (SGPT)** is typically **2:1 or higher**, meaning SGOT is usually significantly higher than SGPT. - This is because alcohol depletes **pyridoxal phosphate**, a cofactor for ALT, leading to relatively lower ALT levels. *Gamma glutamyl transferase is raised* - **Gamma-glutamyl transferase (GGT)** is frequently elevated in **alcoholic liver disease**, including alcoholic hepatitis [1]. - It serves as a sensitive marker for **biliary tract injury** and **alcohol consumption** [1]. *SGOT is raised > SGPT* - This statement is **true** for alcoholic hepatitis, as the **AST (SGOT)** to **ALT (SGPT)** ratio is typically **2:1 or greater**. - The disproportionately high AST is a characteristic feature reflecting the **mitochondrial damage** caused by alcohol within hepatocytes [2]. *Alkaline phosphatase is raised* - **Alkaline phosphatase (ALP)** can be elevated in alcoholic hepatitis, although usually to a lesser extent than in obstructive jaundice [1]. - Its elevation often reflects superimposed **cholestasis** or **biliary inflammation** [1].

Q: What is the primary clinical application of the Rockall score?

Upper GI bleeding. ***Upper GI bleeding*** - The **Rockall score** is a clinical risk assessment tool specifically designed to predict **re-bleeding** and **mortality** in patients admitted with **acute upper gastrointestinal bleeding** [1]. - It uses clinical parameters (age, shock, comorbidities) and endoscopic findings (diagnosis, stigmata of recent hemorrhage) to stratify risk [1]. *Lower GI bleeding* - The Rockall score is **not validated** for assessing risk in **lower gastrointestinal bleeding**, which has different etiologies and clinical courses. - Other scoring systems, like the **Blatchford score** or **Glasgow-Blatchford score**, might be used for initial risk assessment in GI bleeding, but Rockall is specific to upper GI [1]. *Hepatic encephalopathy* - **Hepatic encephalopathy** is a neuropsychiatric complication of liver cirrhosis, for which the Rockall score has **no diagnostic or prognostic utility**. - Its assessment involves grading the severity of neurological symptoms and identifying precipitating factors. *IBD* - Inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, is a chronic inflammatory condition of the GI tract. - The Rockall score is **irrelevant** in the assessment or management of **IBD**, which uses specific disease activity indices.

Q: Which of the following statements is true regarding amoebic liver abscess?

Mostly involving the right lobe of the liver.. ***Mostly involving the right lobe of the liver*** - The **right lobe** of the liver is the most common site for an amoebic liver abscess due to its larger size and preferential blood flow from the portal venous system, which drains the intestines where *Entamoeba histolytica* resides. - The **superior mesenteric vein**, draining the cecum and ascending colon (common sites for amebiasis), primarily feeds the right hepatic lobe. *May rupture into the pleural cavity* - While rupture can occur, the **peritoneal cavity** is a more common site of rupture for amoebic liver abscesses. - Rupture into the pleural cavity or lung is less frequent but can lead to **empyema** or **bronchopleural fistula** [1]. *For asymptomatic luminal carriers, metronidazole is the drug of choice* - **Metronidazole** is effective against invasive amoebiasis (like liver abscess or dysentery) but is not the drug of choice for asymptomatic luminal carriers. - For **asymptomatic luminal carriers**, **luminal amebicides** such as **paromomycin** or **diloxanide furoate** are used to eradicate cysts from the intestine [1]. *Multiple abscesses is less common than a single abscess* - **A single amoebic liver abscess** is more common than multiple abscesses [1]. - Multiple abscesses are typically seen in disseminated disease or immunocompromised individuals, though even then a solitary lesion is more frequent.

Q: Which of the following is not a characteristic of Zieve syndrome?

Chronic pancreatitis. ***Chronic pancreatitis*** - **Zieve syndrome** is an acute, not chronic, condition, and its primary feature is not chronic pancreatic inflammation, though severe alcohol use can cause both. - While **alcohol abuse** is a risk factor for both Zieve syndrome and chronic pancreatitis, **chronic pancreatitis** itself is not considered a characteristic component of Zieve syndrome [1]. *Alcohol abuse* - **Alcohol abuse** is the underlying cause for the development of Zieve syndrome, leading to the characteristic triad of hemolytic anemia, hyperlipidemia, and jaundice. - It triggers the **liver damage** and metabolic disturbances that define the syndrome. *Hemolysis* - **Hemolysis** (destruction of red blood cells) is a key feature of Zieve syndrome, leading to **hemolytic anemia** and jaundice. - It results from increased red blood cell fragility and splenic sequestration exacerbated by altered lipid metabolism. *Hypertriglyceridemia* - **Hypertriglyceridemia** is a hallmark of Zieve syndrome, arising from impaired lipid metabolism secondary to alcohol-induced liver damage. - Elevated **triglyceride levels** contribute to red blood cell membrane abnormalities, thereby promoting hemolysis.

Q: Which of the following statements about CNS leukemia is false?

Single blast in CSF is sufficient for diagnosis. ***Seen with acute myeloid leukemia*** - CNS involvement is typically not a common feature of **acute myeloid leukemia (AML)**; it's more associated with acute lymphoblastic leukemia (ALL) [1]. - While leukemia can affect the CNS, **AML is not predominantly known** for this complication compared to ALL . *Single blast in CSF is sufficient for diagnosis* - A **single blast** in the cerebrospinal fluid (CSF) does **not establish a definitive diagnosis** of CNS leukemia; multiple blasts are typically required. - Diagnosis involves considering clinical symptoms, laboratory findings, and often requires **a combination of findings** to confirm CNS involvement. *Intrathecal methotrexate is given* - **Intrathecal methotrexate** is used for treatment of CNS leukemia; however, this statement is true and does not meet the 'except' criteria. - It is a common practice to deliver chemotherapy directly to the CNS to combat leukemia effectively. *CNS irradiation is given* - CNS irradiation can be used as a treatment modality in certain instances of leukemia; thus, this statement is also true. - It is part of the therapeutic strategies for managing CNS involvement but is not universally applied for all cases.

Q: Thrombocythemia is characterized by an elevated platelet count.

Elevated platelet count. Elevated platelet count - Thrombocythemia is a condition specifically defined by an abnormally high number of platelets (thrombocytes) in the blood [2]. - This elevated count can lead to issues with both bleeding and clotting [2]. Low platelets - Low platelets, also known as thrombocytopenia, is the opposite of thrombocythemia [1]. - This condition is associated with an increased risk of bleeding [1]. Neutrophilia - Neutrophilia refers to an elevated count of neutrophils, a type of white blood cell, which is typically seen in bacterial infections. - It does not directly describe the platelet count. Monocytosis - Monocytosis indicates an increase in monocytes, another type of white blood cell, often seen in chronic infections or inflammatory conditions. - This term is unrelated to platelet levels.

Q: In a patient with hypoglycemia, what is the appropriate dose adjustment of insulin?

Decrease insulin dosage. ***Decrease insulin dosage*** - Hypoglycemia indicates that the current insulin dose is too high, causing blood glucose levels to drop excessively [1]. - Reducing the insulin dosage helps prevent future episodes of low blood sugar by allowing blood glucose to remain within a healthier range [1]. *Increase insulin dosage* - Increasing insulin would further lower blood glucose, exacerbating the **hypoglycemia** and potentially leading to a more severe and dangerous state. - This action is appropriate for **hyperglycemia**, not hypoglycemia. *Maintain current insulin dosage* - Maintaining the current dose would not address the problem, as it has already proven to be too much for the patient, causing the **hypoglycemic episodes** [1]. - This approach would leave the patient at continued risk for recurrent hypoglycemia. *Add a different medication* - While other medications might be used in diabetes management, adding a new one without adjusting the existing insulin dose could further complicate blood glucose control. - The immediate and most direct action for **hypoglycemia** caused by insulin is to adjust the insulin itself [1].

Q: What is the best indicator for assessing short-term control of blood glucose levels over a period of 2-3 weeks?

Serum fructosamine. ***Serum fructosamine*** - **Fructosamine** reflects the glycation of serum proteins, primarily albumin, which has a shorter half-life (around 17-20 days) compared to hemoglobin. - This allows it to assess average blood glucose control over the preceding **2-3 weeks**, making it suitable for short-term monitoring. *HbA1c* - **HbA1c** (glycated hemoglobin) reflects average blood glucose levels over the lifespan of red blood cells, typically **2-3 months** [1]. - While an excellent long-term indicator, its longer time frame makes it less suitable for assessing short-term changes over just 2-3 weeks [1]. *Blood sugar* - A single **blood sugar** measurement (fasting or random) provides an instantaneous snapshot of glucose levels at that specific moment [2]. - It does not reflect average glucose control over a period of 2-3 weeks and is highly influenced by recent food intake and activity [2]. *Urine sugar* - **Urine sugar** levels indicate that the kidney's reabsorption capacity for glucose has been exceeded, resulting in glucose spilling into the urine [3]. - This is a qualitative or semi-quantitative measure that primarily reflects very high blood glucose levels and is not a reliable indicator of averaged glucose control over any specific time frame [3].

Question 1

Hepatic Encephalopathy is predisposed by all, Except:

Accepted Answer

Hyperkalemia

Answer

Constipation

Answer

GI Bleeding

Answer

Dehydration

Question 2

Which of the following statements about alcoholic hepatitis is false?

Accepted Answer

SGPT is raised > SGOT

Answer

Gamma glutamyl transferase is raised

Answer

Alkaline phosphatase is raised

Answer

SGOT is raised > SGPT

Question 3

What is the primary clinical application of the Rockall score?

Accepted Answer

Upper GI bleeding

Answer

Lower GI bleeding

Answer

Hepatic encephalopathy

Answer

IBD

Question 4

Which of the following statements is true regarding amoebic liver abscess?

Accepted Answer

Mostly involving the right lobe of the liver.

Answer

May rupture into the pleural cavity.

Answer

For asymptomatic luminal carriers, metronidazole is the drug of choice.

Answer

Multiple abscesses is less common than a single abscess.

Question 5

All of the following are characteristic features of treatment of iron deficiency anemia with oral iron supplements, except which of the following?

Accepted Answer

The treatment should be discontinued immediately once hemoglobin normalizes to prevent side effects of iron

Answer

Bioavailability is enhanced with vitamin C

Answer

The proportion of iron absorbed reduces as hemoglobin improves

Answer

The reticulocyte count should begin to increase within 7-10 days and peak at 2-4 weeks; this suggests good response to treatment

Question 6

Which of the following is not a characteristic of Zieve syndrome?

Accepted Answer

Chronic pancreatitis

Answer

Alcohol abuse

Answer

Hemolysis

Answer

Hypertriglyceridemia

Question 7

Which of the following statements about CNS leukemia is false?

Accepted Answer

Single blast in CSF is sufficient for diagnosis

Answer

Intrathecal methotrexate is given

Answer

Seen with acute myeloid leukemia

Answer

CNS irradiation is given

Question 8

Thrombocythemia is characterized by an elevated platelet count.

Accepted Answer

Elevated platelet count

Answer

Low platelets

Answer

Neutrophilia

Answer

Monocytosis

Question 9

In a patient with hypoglycemia, what is the appropriate dose adjustment of insulin?

Accepted Answer

Decrease insulin dosage

Answer

Increase insulin dosage

Answer

Maintain current insulin dosage

Answer

Add a different medication

Question 10

What is the best indicator for assessing short-term control of blood glucose levels over a period of 2-3 weeks?

Accepted Answer

Serum fructosamine

Answer

Blood sugar

Answer

Urine sugar

Answer

HbA1c

NEET-PG 2015 — Internal Medicine