AIIMS/ NEET-PG 2017: Medicine MCQs 121-130

Q-121. A young man develops gross hematuria 3 days after an attack of URTI; likely renal pathology is
a) Acute glomerulonephritis
b) Minimal change disease
c) IgA nephropathy
d) Membranous glomerulo-nephritis

Answer: IgA nephropathy
Explanation:
IgA nephropathy (Berger disease):
IgA nephropathy is a primary renal disease of IgA deposition in the glomerular mesangium.
An episode of gross hematuria is the most common presenting systems.
Frequently this is associated with an upper respiratory tract infection (60 %), GI symptoms, or flue like illness.
The urine becomes red or cola colored 1-2 days after illness onset.
Post-infectious Glomerulonephritis:
Post-infectious Glomerulonephritis is most often due to infection with nephritogenic group A beta-hemolytic streptococci.
It commonly appears after pharyngitis or impetigo with onset average 7-10 days after infection.
Disease presentation: Glomerular hematuria to nephritis syndrome.

Q-122. A patient CSF report reads as follows; sugar of 40, protein of 150, chloride of 550, lymphocytosis present; the picture is suggestive of
a) Fungal meningitis
b) Viral meningitis
c) TB meningitis
d) Leukemia

Answer: TB meningitis
Explanation:
CSF examination in TB meningitis:
Yellowish color
100-500 cells/ mcL (Predominantly lymphocytes though neutrophils may be present early during infection)
Increased protein
Decreased glucose

Q-123. Lacunar infarcts are caused by
a) Lipo-hyalinosis of penetrating arteries
b) Middle carotid artery involvement
c) Emboli to anterior circulation
d) None of the above

Answer: Lipo-hyalinosis of penetrating arteries
Explanation:
Lacunar infarcts are small lesions that occur in the distribution of short penetrating arterioles in basal ganglion, pons, cerebellum, internal capsule, and thalamus and less commonly deep cerebral white matter; caused by intrinsic disease of small vessels called lipo-hyalinosis, resulting from hypertension and diabetes.

Q-124. Dinesh, a 56 yr aged man presents with complaints of slowness of movements, postural instability, tremors, rigidity and memory loss. Most likely diagnosis is
a) Multi infarct dementia
b) Alzheimer’s disease
c) Parkinsonism
d) None of the above

Answer: Parkinsonism
Explanation:
Tremor, rigidity, bradykinesia and postural instability are the cardinal features of Parkinsonism and may be present in any combination.
The tremor is more conspicuous at rest and enhanced by emotional stress.

Q-125. All of the following may be seen in Wilson’s disease except
a) Cerebellar ataxia
b) Peripheral neuropathy
c) Dysphagia
d) Chorea

Answer: Peripheral neuropathy
Explanation:
The neurological manifestations of Wilson Disease:
These are related to basal ganglion dysfunction and include
Akinetic rigid syndrome
Pseudo-sclerosis with tremor, ataxia, and a dystonic syndrome
Dysarthria, dysphasia, incardination and spasticity are common.
Important points:
Rare autosomal recessive disorder
The pathognomic sign Of Wilson Disease is the brownish or gray-green Kayser-Fleischer rings which presents fine pigmented granular deposits in Descemet’s membrane in the cornea.
The ring is usually most marked at the superior and inferior poles of cornea and readily detected by slit lamp examination.

Q-126. An elderly man presents with features of dementia, ataxia, difficulty in downward gaze and a history of frequent falls. Likely diagnosis is
a) Parkinson’s disease
b) Progressive supra-nuclear gaze palsy
c) Alzheimer’s disease
d) None of the above

Answer: Progressive supra-nuclear gaze palsy Explanation:
Progressive supra-nuclear palsy is a neurodegenerative disease whose characteristics include supra-nuclear, initially vertical, gaze dysfunction accompanied by extra-pyramidal symptoms and cognitive dysfunction.
The cardinal manifestations:
Supra-nuclear ophthalmoplegia
Pseudo-bulbar palsy
Prominent neck dystonia
Parkinsonism
Behavioral, cognitive, and gait disturbances that cause imbalance
Frequent falls/impaired postural reflexes

Q-127. A chromosomal anomaly associated with Alzheimer’s dementia is
a) Trisomy 18
b) Patau syndrome
c) Trisomy 21
d) Turners syndrome

Answer: Trisomy 21
Explanation:
Trisomy 21 OR Down syndrome:
Typical cranio-facial features, hypotonia and single palmar crease
Duodenal atresia
Congenital heart disease (AV canal defects)
Hematological malignancies
Atlanto-axial instability
Celiac disease
Hypothyroidism
Alzheimer like dementia

Q-128. A 30- year old male complains of loss of erection; he has low testosterone and high prolactin level in blood; what is the likely diagnosis?
a) Pituitary adenoma
b) Testicular failure
c) Cranio pharyngioma
d) Cushing’s syndrome

Answer: Pituitary adenoma
Explanation:
Pituitary Adenomas: Symptoms
Symptoms related to overproduction of hormones:
Prolactin-secreting pituitary adenoma (prolactinoma):
Overproduction of prolactin, causing loss of menstrual periods and breast milk production in women
In men, high prolactin levels can lower testosterone levels, leading to diminished sexual interest
Growth hormone-secreting pituitary adenoma:
Acromegaly in adults or gigantism in children
ACTH-secreting pituitary adenoma:
Cushing’s disease
TSH-secreting pituitary adenoma (thyrotropinoma):
Hyperthyroidism
Symptoms related to effect of a large pituitary adenoma (macro-adenoma):
Vision loss
Bi-temporal hemianopsia
Loss of visual acuity (blurry vision)
Loss of pituitary function

Q-129. A woman has bilateral headache that worsens with emotional stress; she has two children both doing badly in school; diagnosis is
a) Migraine
b) Cluster headache
c) Tension headache
d) Trigeminal neuralgia

Answer: Tension headache
Explanation:
Tension headache is the most common type of primary headache disorder and non pulsatile.
Headache may be exacerbated by emotional stress, fatigue, noise or glare.

Q-130. A female aged 30 presents with episodic throbbing headache for past 4 yrs with nauseas and vomiting; most likely diagnosis is
a) Migraine
b) Cluster headache
c) Angle closer glaucoma
d) Temporal arteritis

Answer: Migraine
Explanation:
Presentation of Migraine:
The typical migraine headache is throbbing or pulsatile.
The headache is initially unilateral and localized in the fronto-temporal and ocular area, but pain can be felt anywhere around the head or neck.
Nausea and vomiting usually occur later in the attack.
Neurologic symptoms:
Hemiparesis
Aphasia
Confusion
Paresthesias or numbness