Polyuria with low fixed specific gravity urine is seen in ?
Which disease does not recur in the kidney after a renal transplant?
According to standard clinical practice guidelines, significant weight loss requiring medical evaluation is defined as:
Hepatic Encephalopathy is predisposed by all, Except:
Which of the following statements about alcoholic hepatitis is false?
What is the primary clinical application of the Rockall score?
Which of the following statements is true regarding amoebic liver abscess?
Which of the following is not a characteristic of Zieve syndrome?
Which of the following statements about CNS leukemia is false?
Thrombocythemia is characterized by an elevated platelet count.
NEET-PG 2015 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 61: Polyuria with low fixed specific gravity urine is seen in ?
- A. Diabetes mellitus
- B. Diabetes insipidus
- C. Chronic glomerulonephritis (Correct Answer)
- D. Potomania
Explanation: ***Chronic glomerulonephritis*** - Damage to the **renal tubules** in chronic glomerulonephritis impairs their ability to concentrate urine, leading to polyuria with a **low, fixed specific gravity**. [1] - This fixed specific gravity reflects the kidneys' inability to adjust urine concentration in response to hydration status, a hallmark of **chronic kidney disease**. [2] *Diabetes mellitus* - Polyuria in diabetes mellitus is caused by **osmotic diuresis** due to high glucose levels in the urine, leading to increased urinary volume. [2] - While there is polyuria, the specific gravity is not necessarily fixed and can vary, often being high due to the presence of glucose. *Diabetes insipidus* - Diabetes insipidus causes polyuria and dilute urine due to either a deficiency of **ADH (central DI)** or renal unresponsiveness to ADH **(nephrogenic DI)**. - While it causes polyuria with low specific gravity, it's typically *not* fixed; the urine specific gravity can still fluctuate to some extent depending on the patient's hydration, or in response to ADH if it's central DI. *Potomania* - Potomania, or **primary polydipsia**, is excessive water intake that leads to dilutional hyponatremia and polyuria. - The kidneys are otherwise healthy and can still concentrate urine to some extent if water intake is restricted, preventing a truly fixed low specific gravity.
Question 62: Which disease does not recur in the kidney after a renal transplant?
- A. Alport syndrome (Correct Answer)
- B. Amyloidosis
- C. Goodpasture's syndrome
- D. Diabetic nephropathy (due to uncontrolled diabetes)
Explanation: **Alport syndrome** * **Alport syndrome** is a genetic disorder affecting type IV collagen, primarily in the kidney; recurrence is not observed in a renal allograft because the transplanted kidney provides new, healthy type IV collagen [2]. * The disease is due to a genetic defect in the recipient's collagen genes, so the transplanted kidney, which is genetically distinct, is not susceptible to the same primary disease process [2]. *Amyloidosis* * **Amyloidosis** can recur in the transplanted kidney, as it is a systemic disease where abnormal proteins continue to deposit in various organs, including the new kidney. * The underlying cause of amyloid production is typically not cured by a kidney transplant, making the new organ vulnerable to recurrence. *Goodpasture's syndrome* * **Goodpasture's syndrome** is an autoimmune disease where antibodies target type IV collagen in the glomerular basement membrane; these autoantibodies can attack the new kidney if they are still present at the time of transplant or re-emerge [1]. * Recurrence is a significant concern, although it can often be prevented by ensuring the patient is antibody-negative before transplantation and through immunosuppression [1]. *Diabetic nephropathy (due to uncontrolled diabetes)* * **Diabetic nephropathy** almost invariably recurs in the transplanted kidney if the recipient's diabetes remains uncontrolled after transplantation. * The metabolic environment, characterized by hyperglycemia, directly contributes to the damage of the new kidney, leading to the development of diabetic nephropathy over time.
Question 63: According to standard clinical practice guidelines, significant weight loss requiring medical evaluation is defined as:
- A. 5% weight loss in 1-2 months
- B. 10% weight loss in 2-3 months (Correct Answer)
- C. 5% weight loss in 2-3 months
- D. 10% weight loss in 1-2 months
Explanation: ***10% weight loss in 2-3 months*** - **Unexplained weight loss** of **10%** or more of usual body weight over a period of **2-3 months** is generally considered a significant amount requiring medical evaluation. - This degree of weight loss can be indicative of underlying serious medical conditions like cancer, gastrointestinal disorders, endocrine disorders, or chronic infections [1]. *5% weight loss in 1-2 months* - While any unexplained weight loss should be noted, a **5% loss** in this timeframe is usually not considered immediately "significant" enough to warrant an aggressive workup unless other concerning symptoms are present. - It might be due to minor lifestyle changes, temporary illness, or benign factors. *5% weight loss in 2-3 months* - A **5% weight loss** over **2-3 months** is a less critical threshold than 10% for initiating an extensive medical evaluation for serious underlying disease. - This level of weight change could be due to a variety of less severe causes or even normal fluctuations. *10% weight loss in 1-2 months* - While a **10% weight loss** is significant, the **1-2 month** timeframe is generally considered slightly too short to immediately classify it as "requiring medical evaluation" in the strictest sense compared to the 2-3 month period which allows for better observation. - Rapid weight loss over a very short period might sometimes be related to acute illness or dehydration rather than chronic underlying conditions, though still warrants attention.
Question 64: Hepatic Encephalopathy is predisposed by all, Except:
- A. Constipation
- B. GI Bleeding
- C. Dehydration
- D. Hyperkalemia (Correct Answer)
Explanation: ***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].
Question 65: Which of the following statements about alcoholic hepatitis is false?
- A. Gamma glutamyl transferase is raised
- B. Alkaline phosphatase is raised
- C. SGOT is raised > SGPT
- D. SGPT is raised > SGOT (Correct Answer)
Explanation: ***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].
Question 66: What is the primary clinical application of the Rockall score?
- A. Upper GI bleeding (Correct Answer)
- B. Lower GI bleeding
- C. Hepatic encephalopathy
- D. IBD
Explanation: ***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.
Question 67: Which of the following statements is true regarding amoebic liver abscess?
- A. May rupture into the pleural cavity.
- B. Mostly involving the right lobe of the liver. (Correct Answer)
- C. For asymptomatic luminal carriers, metronidazole is the drug of choice.
- D. Multiple abscesses is less common than a single abscess.
Explanation: ***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.
Question 68: Which of the following is not a characteristic of Zieve syndrome?
- A. Alcohol abuse
- B. Chronic pancreatitis (Correct Answer)
- C. Hemolysis
- D. Hypertriglyceridemia
Explanation: ***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.
Question 69: Which of the following statements about CNS leukemia is false?
- A. Intrathecal methotrexate is given
- B. Seen with acute myeloid leukemia
- C. CNS irradiation is given
- D. Single blast in CSF is sufficient for diagnosis (Correct Answer)
Explanation: ***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.
Question 70: Thrombocythemia is characterized by an elevated platelet count.
- A. Low platelets
- B. Neutrophilia
- C. Monocytosis
- D. Elevated platelet count (Correct Answer)
Explanation: 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.