INI-CET 2014 Practice Questions

Q: A 40-year old man presented with acute onset pain and swelling of the left great toe. On X-ray, a punched-out lytic lesion is seen on the phalanx with sclerotic margins and overhanging bony edges. What is the most likely diagnosis?

Gout. ### Explanation The clinical presentation and radiographic findings are classic for **Gouty Arthritis**. **1. Why Gout is Correct:** The patient presents with **Podagra** (acute involvement of the first metatarsophalangeal joint), which is the most common site for gout. The X-ray description is pathognomonic: * **Punched-out lytic lesions:** These represent intraosseous tophi (monosodium urate crystals). * **Martel’s Sign (Overhanging edges):** The sclerotic, "rat-bite" erosions with overhanging bony margins are highly characteristic of chronic tophaceous gout. Unlike other inflammatory arthritides, the joint space in gout is often preserved until late stages. **2. Why Other Options are Incorrect:** * **Rheumatoid Arthritis (RA):** Typically presents with symmetrical involvement of small joints (MCP, PIP). Radiologically, it shows **periarticular osteopenia** and marginal erosions without sclerotic borders or overhanging edges. * **Psoriatic Arthritis:** While it can affect the distal phalanges, it is characterized by the "pencil-in-cup" deformity and periosteal new bone formation, not isolated punched-out lesions with sclerotic margins. * **Reiter’s Syndrome (Reactive Arthritis):** Usually follows a GI or GU infection and presents as an asymmetric oligoarthritis, often involving the heel (Achilles tendonitis) or sacroiliac joints. **3. High-Yield Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Polarized light microscopy showing **needle-shaped, negatively birefringent** crystals (Yellow when parallel to the axis). * **Martel’s Sign:** The radiographic hallmark of gout (overhanging edges). * **Drug of Choice:** NSAIDs are first-line for acute attacks; **Colchicine** is an alternative. **Allopurinol** (Xanthine oxidase inhibitor) is used for chronic management but should *never* be started during an acute attack. * **Dietary triggers:** High purine foods (red meat, seafood) and alcohol.

Question 1

A 40-year old man presented with acute onset pain and swelling of the left great toe. On X-ray, a punched-out lytic lesion is seen on the phalanx with sclerotic margins and overhanging bony edges. What is the most likely diagnosis?

Accepted Answer

Gout

Answer

Rheumatoid arthritis

Answer

Psoriatic arthritis

Answer

Reiter's syndrome

Question 2

A 6-year-old Afroamerican boy presented with abdominal pain, chronic hemolysis, and abnormal RBC shape on peripheral smear. What is the most likely underlying molecular disorder responsible for this condition?

Accepted Answer

Point mutation

Answer

Trinucleotide repeat

Answer

Antibody against RBC membrane

Answer

Genomic imprinting

Question 3

A 17-year-old female underwent Fine Needle Aspiration cytology (FNAC) for a lump in the breast which was non-tender, firm and mobile. Which of the following features would suggest a benign breast disease?

Accepted Answer

Tightly arranged ductal epithelial cells with dyscohesive bare nuclei

Answer

Dyscohesive ductal epithelial cells without cellular fragments

Answer

Stromal predominance with spindle cells

Answer

Polymorphism with single or arranged ductal epithelial cells

INI-CET 2014

Internal Medicine

Pathology

Surgery