Internal Medicine
9 questionsWhich of the following is NOT a common cause of acute renal failure?
All are true about GFR except:
Which of the following conditions is a direct indication for initiating dialysis?
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?
NEET-PG 2015 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 841: Which of the following is NOT a common cause of acute renal failure?
- A. Chronic kidney disease due to analgesic nephropathy (Correct Answer)
- B. Acute pyelonephritis
- C. Acute kidney injury from snakebite
- D. Acute kidney injury due to rhabdomyolysis
Explanation: Chronic kidney disease due to analgesic nephropathy - This is a cause of chronic kidney disease, characterized by gradual, irreversible kidney damage over a long period due to prolonged use of certain analgesics. [1] - It does not present as an acute, sudden decline in kidney function, which is the hallmark of acute renal failure. [1] Acute pyelonephritis - Severe cases of acute pyelonephritis (kidney infection) can lead to acute kidney injury due to sepsis, inflammation, and potential obstruction. [1] - The systemic inflammatory response and direct tissue damage can impair kidney function rapidly. [1] Acute kidney injury from snakebite - Snake envenomation can cause acute kidney injury through various mechanisms, including hemolysis, rhabdomyolysis, direct nephrotoxicity, and systemic hypotension. - These effects can lead to rapid and severe kidney damage. Acute kidney injury due to rhabdomyolysis - Rhabdomyolysis involves the breakdown of skeletal muscle tissue, releasing large amounts of myoglobin into the bloodstream. [1] - Myoglobin is toxic to the renal tubules, leading to acute tubular necrosis and rapid onset of acute kidney injury. [1]
Question 842: All are true about GFR except:
- A. 30-40% decrease after 70 years of age
- B. GFR is dependent on height in children
- C. Chronic Kidney Disease (CKD) is defined as GFR < 60 ml/min/1.73 m² for 3 months or more.
- D. Best estimated by creatinine clearance (Correct Answer)
Explanation: ***Best estimated by creatinine clearance*** - While **creatinine clearance** can be used as a measure of GFR, it is not the *best* estimate; it tends to slightly **overestimate** GFR due to tubular secretion of creatinine. [1] - The gold standard for measuring GFR involves methods like **inulin clearance**, but in clinical practice, GFR is often *estimated* using equations based on **serum creatinine** (e.g., CKD-EPI, MDRD). [2] *30-40% decrease after 70 years of age* - **Aging** is associated with a physiological decline in GFR, with a general decrease often cited as 30-40% after the age of 70 years. - This decline is part of the normal **age-related changes in renal function**. *GFR is dependent on height in children* - In children, GFR is often adjusted for **body surface area (BSA)**, which is calculated based on both **height and weight**, making height an important factor. [1] - This adjustment is crucial for accurate assessment of renal function in a growing pediatric population. *Chronic Kidney Disease (CKD) is defined as GFR < 60 ml/min/1.73 m² for 3 months or more.* - This statement accurately reflects the widely accepted definition of **Chronic Kidney Disease (CKD)** according to clinical guidelines. [3] - A GFR below this threshold sustained for more than three months indicates persistent kidney damage or dysfunction.
Question 843: Which of the following conditions is a direct indication for initiating dialysis?
- A. Severe metabolic acidosis
- B. Fluid overload
- C. Severe hyperkalemia (Correct Answer)
- D. Acute kidney injury
Explanation: ### Severe hyperkalemia - **Severe hyperkalemia** (potassium levels typically >6.5 mEq/L or rapidly rising, especially with ECG changes) is an immediate life-threatening indication for dialysis when conservative measures fail or are insufficient [1]. - Dialysis effectively removes **excess potassium** from the blood, preventing fatal cardiac arrhythmias. *Severe metabolic acidosis* - While **severe metabolic acidosis** (pH <7.1-7.2) can be an indication, it is often managed first with bicarbonate administration and is typically not a stand-alone **direct** *emergency* indication for dialysis unless accompanied by other severe features or resistance to medical therapy. - The decision to dialyze for acidosis often depends on the underlying cause, degree of renal failure, and response to initial management [2]. *Fluid overload* - **Fluid overload** is a common complication of kidney failure, but it becomes a *direct* indication for dialysis when it is **refractory to diuretic therapy** and causes life-threatening symptoms such as **pulmonary edema** [2]. - Without such refractory state and immediate danger, fluid overload itself is not always an *immediate* trigger for dialysis compared to severe hyperkalemia. *Acute kidney injury* - **Acute kidney injury** (AKI) is the underlying *condition* that can lead to indications for dialysis, but AKI itself is not a *direct indication* for dialysis. - Dialysis is initiated for the *complications* of AKI, such as refractory hyperkalemia, severe metabolic acidosis, or fluid overload, rather than the diagnosis of AKI alone [2].
Question 844: 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 845: 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 846: 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 847: 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 848: 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 849: 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.
Pathology
1 questionsBasket weave appearance of glomerular basement membrane on electron microscopy is seen in
NEET-PG 2015 - Pathology NEET-PG Practice Questions and MCQs
Question 841: Basket weave appearance of glomerular basement membrane on electron microscopy is seen in
- A. Alport syndrome (Correct Answer)
- B. Polyarteritis nodosa
- C. Giant cell arteritis
- D. Acute post-streptococcal glomerulonephritis
Explanation: ***Alport syndrome*** - **Alport syndrome** is characterized by a "basket weave" appearance of the **glomerular basement membrane (GBM)** on electron microscopy due to irregular thickening, thinning, and splitting of the lamina densa. - This structural abnormality results from mutations in genes encoding **Type IV collagen**, particularly **COL4A5**, leading to progressive kidney disease, hearing loss, and ocular abnormalities. *Polyarteritis nodosa* - This is a **necrotizing vasculitis** primarily affecting medium-sized arteries, and its renal involvement typically manifests as a focal or diffuse necrotizing glomerulonephritis, often without specific GBM changes. - The electron microscopic findings would generally show inflammatory cell infiltration and fibrinoid necrosis of vessel walls, not a characteristic GBM pattern. *Giant cell arteritis* - **Giant cell arteritis** is a vasculitis affecting large- and medium-sized arteries, typically in the elderly, and often involves the temporal arteries. - Renal involvement is rare, and the characteristic pathological finding is **granulomatous inflammation** within the arterial wall with giant cells, not GBM changes. *Acute post-streptococcal glomerulonephritis* - This condition is characterized by **subepithelial immune deposits ("humps")** on electron microscopy, not a "basket weave" pattern of the GBM. - The GBM itself may show minor changes but does not exhibit the lamellated and split appearance seen in Alport syndrome.