NEET-PG 2013 - Internal Medicine Practice Questions

Q: In a patient with heart disease, which condition is most commonly associated with left atrial enlargement?

Mitral stenosis. ***Mitral stenosis*** - **Mitral stenosis** leads to an obstruction of blood flow from the **left atrium to the left ventricle**, causing pressure buildup in the left atrium [1]. - This increased pressure over time results in **left atrial enlargement** as the chamber struggles to push blood through the narrowed valve [1]. *Tricuspid regurgitation* - **Tricuspid regurgitation** involves the backflow of blood from the **right ventricle to the right atrium**. - This condition primarily affects the **right side of the heart**, leading to **right atrial enlargement**, not left. *AR* - **Aortic regurgitation (AR)** is the backflow of blood from the **aorta into the left ventricle**. - While AR can cause **left ventricular enlargement** and eventually lead to left atrial dilation, it is not the most common direct cause of *primary* left atrial enlargement compared to mitral stenosis [2]. *None of the options* - **Mitral stenosis** is a well-established cause of significant left atrial enlargement due to the direct pressure overload it imposes on the left atrium [1].

Q: What condition is characterized by a short fourth metacarpal?

Pseudohypoparathyroidism. Pseudohypoparathyroidism - **Pseudohypoparathyroidism** is characterized by end-organ resistance to parathyroid hormone (PTH), leading to hypocalcemia and hyperphosphatemia [2, 4]. - Patients often present with **Albright's hereditary osteodystrophy**, which includes characteristic features like a **shortened fourth metacarpal**, short stature, rounded face, and obesity [2, 4]. *Primary Hyperparathyroidism* - **Primary hyperparathyroidism** involves excessive PTH production from an adenoma or hyperplasia of the parathyroid glands [1, 3, 5]. - This typically leads to **hypercalcemia** and **hypophosphatemia**, and does not involve a short fourth metacarpal as a characteristic feature [1, 3, 5]. *Secondary Hyperparathyroidism* - **Secondary hyperparathyroidism** occurs as a compensatory response to hypocalcemia, often due to chronic kidney disease or vitamin D deficiency [1]. - It’s characterized by elevated PTH levels alongside the underlying cause of hypocalcemia, without the classic skeletal deformities seen in pseudohypoparathyroidism [1, 4]. *Scleroderma* - **Scleroderma** is a chronic autoimmune disease characterized by thickening and hardening of the skin and connective tissues. - It can lead to various complications like Raynaud phenomenon and internal organ fibrosis, but a **short fourth metacarpal is not a feature** of this condition.

Q: All are seen in Behçet's syndrome except:

Pyoderma gangrenosum. ***Pyoderma gangrenosum*** - While Behçet's syndrome can involve skin lesions, **pyoderma gangrenosum** is not typically part of its diagnostic criteria or common manifestations. - Pyoderma gangrenosum is a distinct neutrophilic dermatosis characterized by rapidly enlarging, painful ulcers. *Erythema nodosum* - **Erythema nodosum** is a common dermatological manifestation in Behçet's syndrome, characterized by tender subcutaneous nodules, usually on the shins. - These lesions reflect the systemic inflammatory nature of the disease in various organs. *Genital ulcers* - **Genital ulcers** are one of the major diagnostic criteria for Behçet's syndrome, often painful and recurrent. - They tend to be deep and can form scars, appearing on the scrotum, penis, labia, or perianal area. *Oral ulcers* - **Recurrent oral aphthous ulcers** are the most common and often the initial symptom of Behçet's syndrome. - These ulcers are typically painful, varying in size, and can occur on any mucosal surface in the mouth.

Q: What will the aspirated synovial fluid in a case of septic arthritis typically show?

Markedly increased polymorphonuclear leukocytes. ***Markedly increased polymorphonuclear leukocytes*** - **Septic arthritis** is characterized by an acute infection within the joint, leading to a profound inflammatory response with a significant influx of **neutrophils** (polymorphonuclear leukocytes) into the synovial fluid. - A synovial leukocyte count greater than **50,000 cells/mm³** with over **75% neutrophils** is highly suggestive of septic arthritis. *Clear and straw-colored fluid* - This description typically corresponds to **normal synovial fluid** or fluid from a mild **non-inflammatory condition**, which is not consistent with bacterial infection. - Normal synovial fluid is usually **transparent**, indicating the absence of significant cellular debris or inflammatory cells. *Low viscosity fluid* - While septic synovial fluid can have reduced viscosity due to the breakdown of **hyaluronic acid** by bacterial enzymes and inflammatory mediators, this characteristic alone is not the most definitive diagnostic feature. - Reduced viscosity is also observed in other inflammatory conditions, making it less specific than direct cellular analysis for diagnosing infection. *Cloudy or purulent fluid* - The presence of **cloudy** or **purulent (pus-like)** fluid *is* often seen in septic arthritis, reflecting the high cell count and protein content. - However, this is a **gross visual observation**, and a more precise and diagnostic indicator is the microscopic finding of markedly increased **polymorphonuclear leukocytes**.

Q: Lovibond profile sign is seen in ?

Nail clubbing. Nail clubbing - The Lovibond profile sign (Lovibond's angle or profile sign) is a clinical finding where the angle between the nail plate and the proximal nail fold straightens or becomes greater than 180 degrees. - This sign is a key indicator of nail clubbing, which is often associated with underlying systemic conditions such as respiratory or cardiac diseases [1]. Koilonychia (spoon nails) - Koilonychia presents as concave or spoon-shaped nails, where the nail plate is depressed centrally with everted edges [1]. - This condition is typically associated with iron deficiency anemia and does not involve an alteration of the Lovibond angle. Platynochia (flat nails) - Platynochia refers to nails that are unusually flat without the normal convex curvature. - This is a descriptive term for nail shape and is not specifically evaluated by the Lovibond profile sign. Onycholysis (separation of the nail from the nail bed) - Onycholysis is the detachment of the nail plate from the nail bed, usually starting at the distal free edge. - This condition is unrelated to the angle of the nail and the nail fold, which are assessed by the Lovibond profile sign.

Q: What disease is associated with ascitic fluid SAAG < 1.1?

Peritoneal carcinomatosis. Peritoneal carcinomatosis - A serum-ascites albumin gradient (SAAG) less than 1.1 g/dL indicates that the ascites is not due to portal hypertension [1]. - In peritoneal carcinomatosis, the malignant cells in the peritoneum disrupt the normal fluid exchange, leading to fluid accumulation that is low in albumin relative to serum [1]. Liver failure - Liver failure, especially when leading to cirrhosis, is typically associated with portal hypertension and a SAAG ≥ 1.1 g/dL [1]. - The high SAAG reflects the increased hydrostatic pressure in the hepatic sinusoids, forcing fluid low in protein into the peritoneal cavity [1]. Portal vein thrombosis - Portal vein thrombosis causes portal hypertension and would therefore be associated with a high SAAG (≥ 1.1 g/dL) [1]. - The obstruction of the portal vein leads to increased sinusoidal hydrostatic pressure, similar to other causes of portal hypertension [1]. Tuberculosis peritonitis - Tuberculosis peritonitis is an inflammatory condition that can cause ascites, but it is typically associated with a SAAG < 1.1 g/dL [1]. - This is because the inflammatory process in the peritoneum allows for the leakage of albumin into the ascitic fluid, diminishing the gradient [1].

Q: Common deformity in Chiari II malformation is -

Syringomyelia. ***Syringomyelia*** - **Syringomyelia** is a common deformity associated with Chiari II malformation, characterized by a **fluid-filled cyst (syrinx)** within the spinal cord. - This cyst can expand and damage the spinal cord, leading to symptoms such as **pain**, **weakness**, and **sensory deficits**. *Hydrocephalus* - While **hydrocephalus** (excess CSF in the brain) is frequently seen with Chiari II malformation, it is a **complication** or associated condition rather than a specific deformity caused by the malformation itself [1]. - It often results from the **obstruction of CSF flow** due to the displacement of hindbrain structures [1]. *Meningo myelocele* - **Meningomyelocele** is a severe form of **spina bifida** where the spinal cord and its coverings protrude through an opening in the spine. - It is often associated with Chiari II malformation, as they share a common developmental origin, but it is a primary **neural tube defect**, not a deformity specifically *caused by* Chiari II. *All of the options* - While all three conditions (syringomyelia, hydrocephalus, and meningomyelocele) are often seen in conjunction with Chiari II malformation, only **syringomyelia** is directly considered a "deformity" or direct consequence resulting from the herniation of brain tissue characteristic of Chiari II. - Hydrocephalus and meningomyelocele are either associated conditions or complications, rather than a direct structural deformity of the brainstem and cerebellum.

Q: True about Ebstein anomaly is ?

Right atrial dilatation. Right atrial dilatation - Ebstein anomaly is characterized by the **apical displacement** of the tricuspid valve leaflets, which incorporates a portion of the right ventricle into the right atrium, functionally increasing its size. - This **atrialization of the right ventricle** leads to significant **right atrial dilatation** as it has to handle a larger volume [1]. *Right ventricular dilatation* - While there is a functional impairment of the right ventricle due to the displaced tricuspid valve, the **working part of the right ventricle** is often small and hypoplastic, not dilated. - The "atrialized" part of the right ventricle contributes to **right atrial dilatation**, not ventricular dilatation [1]. *Left atrial dilatation* - Ebstein anomaly primarily affects the **right side of the heart**, specifically the **tricuspid valve** and right ventricle. - There is no direct anatomical or physiological mechanism in Ebstein anomaly that would typically cause **left atrial dilatation**. *Left ventricular dilatation* - Similar to left atrial dilatation, Ebstein anomaly is a **right-sided heart defect**. - **Left ventricular morphology and function** are generally preserved in Ebstein anomaly, and dilatation is not a characteristic feature.

Q: Muller's manoeuvre is used to

To find degree of obstruction in sleep disordered breathing. ***To find degree of obstruction in sleep disordered breathing*** - **Muller's manoeuvre** is a diagnostic technique where the patient attempts to inspire forcefully against a **closed mouth and nostrils** while an endoscope observes the upper airway. - This maneuver helps to simulate the negative intraluminal pressure that occurs during sleep, making it useful in identifying the **site and severity of airway obstruction** in patients with sleep-disordered breathing. *To remove foreign body from ear* - Removing foreign bodies from the ear typically involves **irrigation**, specialized instruments (e.g., alligator forceps), or suction, not a breathing maneuver. - This option is unrelated to the physiological assessment of airway obstruction. *To remove laryngeal foreign body* - The primary methods for removing laryngeal foreign bodies are the **Heimlich maneuver** (abdominal thrusts) or direct laryngoscopy and removal. - Muller's manoeuvre is a diagnostic procedure, not a therapeutic one for foreign body extraction. *To find out opening of mouth* - Measuring the **opening of the mouth** is typically done with a ruler or specific instruments to assess jaw mobility (e.g., for temporomandibular joint disorders or trismus). - This is a simple measurement and does not involve the complex physiological assessment of the upper airway that Muller's manoeuvre provides.

Q: Kveim test (historical) is used for diagnosis of

None of the options. ***None of the options.*** - While the Kveim test was historically used to diagnose **sarcoidosis**, it is now obsolete. - The Kveim test involved injecting a sarcoid tissue extract and observing for a reaction, but it is no longer used due to concerns about **specificity**, **standardization**, and **transmission of infectious agents**. *Wegeners granulomatosis* - This condition is now known as **Granulomatosis with Polyangiitis (GPA)**. - Diagnosis relies on clinical features, imaging, **biopsy showing granulomatous inflammation and vasculitis**, and **antineutrophil cytoplasmic antibodies (ANCAs)**, particularly **c-ANCA**. *Graves disease* - This is an **autoimmune hyperthyroid condition** diagnosed by specific thyroid hormone levels (low TSH, high free T3/T4) [2]. - The presence of **TSH receptor antibodies (TRAb)** or thyroid-stimulating immunoglobulins (TSI) are key diagnostic markers. *Sarcoidosis* - The Kveim test was indeed historically associated with sarcoidosis, but it is **no longer a current diagnostic tool**. - Current diagnosis involves clinical presentation, **imaging (chest X-ray/CT)** showing bilateral hilar lymphadenopathy, and **biopsy** demonstrating non-caseating granulomas [1].

Question 1

In a patient with heart disease, which condition is most commonly associated with left atrial enlargement?

Accepted Answer

Mitral stenosis

Answer

Tricuspid regurgitation

Answer

AR

Answer

None of the options

Question 2

What condition is characterized by a short fourth metacarpal?

Accepted Answer

Pseudohypoparathyroidism

Answer

Primary Hyperparathyroidism

Answer

Secondary Hyperparathyroidism

Answer

Scleroderma

Question 3

All are seen in Behçet's syndrome except:

Accepted Answer

Pyoderma gangrenosum

Answer

Erythema nodosum

Answer

Genital ulcers

Answer

Oral ulcers

Question 4

What will the aspirated synovial fluid in a case of septic arthritis typically show?

Accepted Answer

Markedly increased polymorphonuclear leukocytes

Answer

Clear and straw-colored fluid

Answer

Low viscosity fluid

Answer

Cloudy or purulent fluid

Question 5

Lovibond profile sign is seen in ?

Accepted Answer

Nail clubbing

Answer

Koilonychia (spoon nails)

Answer

Platynochia (flat nails)

Answer

Onycholysis (separation of the nail from the nail bed)

Question 6

What disease is associated with ascitic fluid SAAG < 1.1?

Accepted Answer

Peritoneal carcinomatosis

Answer

Liver failure

Answer

Portal vein thrombosis

Answer

Tuberculosis peritonitis

Question 7

Common deformity in Chiari II malformation is -

Accepted Answer

Syringomyelia

Answer

Hydrocephalus

Answer

Meningo myelocele

Answer

All of the options

Question 8

True about Ebstein anomaly is ?

Accepted Answer

Right atrial dilatation

Answer

Right ventricular dilatation

Answer

Left atrial dilatation

Answer

Left ventricular dilatation

Question 9

Muller's manoeuvre is used to

Accepted Answer

To find degree of obstruction in sleep disordered breathing

Answer

To remove foreign body from ear

Answer

To remove laryngeal foreign body

Answer

To find out opening of mouth

Question 10

Kveim test (historical) is used for diagnosis of

Accepted Answer

None of the options

Answer

Wegeners granulomatosis

Answer

Graves disease

Answer

Sarcoidosis

NEET-PG 2013 — Internal Medicine