Which type of leprosy does not involve nerve damage?
A man with pain during defecation, no gastrointestinal symptoms, and ulcers extending into the anal canal. Diagnosis?
Which of the following is a characteristic feature of Granulomatosis with polyangiitis?
What is the treatment for Trichomonas vaginalis?
What is the primary cause of a decubitus ulcer?
Match stick test is positive in ?
Lovibond profile sign is seen in ?
What disease is associated with ascitic fluid SAAG < 1.1?
Cafe coronary commonly occurs when a person is:
Common deformity in Chiari II malformation is -
NEET-PG 2013 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 141: Which type of leprosy does not involve nerve damage?
- A. Indeterminate leprosy (Correct Answer)
- B. Borderline tuberculoid leprosy
- C. Tuberculoid leprosy
- D. Lepromatous leprosy
Explanation: ***Indeterminate leprosy*** - This is the earliest form of leprosy and often presents with only a **single skin lesion** and no demonstrable nerve damage. - Due to the minimal immune response, it can be difficult to classify and may progress to other forms if left untreated. *Tuberculoid leprosy* - Characterized by a **strong cell-mediated immune response** to *Mycobacterium leprae*, leading to significant nerve involvement [1]. - Patients typically present with well-demarcated, **hypopigmented patches** with definite **sensory loss** due to nerve damage [1]. *Borderline tuberculoid leprosy* - This form sits between tuberculoid and borderline lepromatous leprosy, showing features of both, including **nerve involvement** [2]. - It presents with a few to several skin lesions that are usually smaller and less clearly defined than tuberculoid lesions, often with **palpable nerves** and mild sensory loss [2]. *Lepromatous leprosy* - Characterized by a **weak or absent cell-mediated immune response**, leading to widespread bacterial proliferation and extensive nerve damage, often symmetrical [1]. - Patients show numerous, poorly defined skin lesions, nodules, and severe nerve involvement, which can result in significant **deformities** [2].
Question 142: A man with pain during defecation, no gastrointestinal symptoms, and ulcers extending into the anal canal. Diagnosis?
- A. Cytomegalovirus (CMV)
- B. Gonococcal infection
- C. Genital herpes (Correct Answer)
- D. HIV infection
Explanation: Herpes simplex virus (HSV) infection of the anal canal is characterized by lesions that present as painful ulcers [1]. Direct extension into the anal canal is common in individuals with receptive anal intercourse or autoinoculation, often causing symptoms such as anal or rectal pain [1]. CMV proctitis typically causes more diffuse inflammation, often with bloody stools, diarrhea, and abdominal pain, which are not described in this case. While CMV can cause ulcers, they are usually shallow and often associated with immunocompromised states. Gonococcal proctitis often presents with purulent anal discharge, rectal pain, itching, and tenesmus, but typically without deep ulcerations. HIV infection can cause various anorectal complications, including aphthous ulcers, but isolated anal ulcers and defecation pain would prompt investigation into sexually transmitted infections like herpes as a more direct cause.
Question 143: Which of the following is a characteristic feature of Granulomatosis with polyangiitis?
- A. Nasal polyp
- B. Perforated nasal septum (Correct Answer)
- C. Persistent sinusitis
- D. Collapse of nasal bridge
Explanation: ***Perforated nasal septum*** - **Granulomatosis with polyangiitis (GPA)**, previously known as **Wegener's granulomatosis**, is characterized by **granulomatous inflammation** and **vasculitis** of small to medium-sized vessels, particularly affecting the upper and lower respiratory tracts, and the kidneys [1]. - Damage to the nasal cartilage and bone due to inflammation and vasculitis can lead to a **perforation of the nasal septum**, which is a classic feature. *Nasal polyp* - While nasal polyps can occur in inflammatory conditions, they are **not a specific or highly characteristic feature** of Granulomatosis with polyangiitis compared to septal perforation. - **Allergic rhinitis** or **chronic rhinosinusitis** are more commonly associated with nasal polyps. *Persistent sinusitis* - **Persistent sinusitis** (rhinosinusitis) is a very common initial manifestation of Granulomatosis with polyangiitis due to upper airway inflammation. - However, it's a **less specific finding** than a perforated septum, as sinusitis can be caused by many other conditions. *Collapse of nasal bridge* - **Collapse of the nasal bridge**, also known as a **saddle nose deformity**, can occur in advanced or destructive cases of Granulomatosis with polyangiitis due to extensive cartilage and bone destruction. - While possible, a **perforated nasal septum often precedes** or is a more direct, earlier indicator of the destructive process in the nose.
Question 144: What is the treatment for Trichomonas vaginalis?
- A. Metronidazole (Correct Answer)
- B. Azithromycin
- C. Ciprofloxacin
- D. None of the options
Explanation: ***Metronidazole*** - **Metronidazole** is the **first-line drug** for treating *Trichomonas vaginalis* infection. - It is effective against this **anaerobic protozoan** and can be administered as a single dose or a 7-day course. *Azithromycin* - **Azithromycin** is a **macrolide antibiotic** primarily used to treat bacterial infections, such as **chlamydia** or certain **respiratory tract infections**. - It is **not effective** against *Trichomonas vaginalis*, which is a parasitic protozoan. *Ciprofloxacin* - **Ciprofloxacin** is a **fluoroquinolone antibiotic** used for bacterial infections, especially **urinary tract infections** and complicated **gastrointestinal infections**. - It has **no activity** against *Trichomonas vaginalis*. *None of the options* - This option is incorrect because **Metronidazole** is a highly effective and widely accepted treatment for *Trichomonas vaginalis* infections.
Question 145: What is the primary cause of a decubitus ulcer?
- A. Prolonged pressure on the skin (Correct Answer)
- B. Due to friction and shear forces
- C. Due to trauma or injury
- D. Due to moisture and immobility
Explanation: ***Prolonged pressure on the skin*** - **Sustained pressure** on a bony prominence restricts blood flow, leading to **ischemia** and tissue death [1]. - This **impeded circulation** forms the direct cause of cell damage and ulcer formation [1]. *Due to trauma or injury* - While trauma can damage skin, a **decubitus ulcer** specifically results from **sustained pressure**, not typically from a single traumatic event. - Trauma usually leads to acute wounds, whereas pressure ulcers develop over time due to chronic tissue compromise. *Due to friction and shear forces* - **Friction** (skin rubbing against a surface) and **shear** (skin gliding over bone) contribute to decubitus ulcer development by damaging superficial vessels and tissues. - However, they are secondary factors that exacerbate the effects of **primary prolonged pressure**, rather than the initiating cause. *Due to moisture and immobility* - **Moisture** (e.g., from incontinence) macerates the skin, making it more susceptible to breakdown, and **immobility** prevents pressure relief. - These are significant **risk factors** that create an environment conducive to pressure ulcer formation, but the direct cause remains **sustained pressure** leading to ischemia.
Question 146: Match stick test is positive in ?
- A. Rhinophyma
- B. P. versicolor
- C. Leprosy (Correct Answer)
- D. Rhinoscleroma
Explanation: ***Leprosy*** - The **matchstick test** is a simple neurological examination used to detect **nerve damage** in leprosy, specifically **sensory loss** [1]. - A positive test indicates the patient cannot perceive the touch or pain from a matchstick, commonly due to damage to superficial nerves caused by *Mycobacterium leprae* [1]. *Rhinophyma* - This condition is characterized by **sebaceous gland hypertrophy** and **fibrosis** of the nose, often associated with rosacea. - It does not involve nerve damage or sensory loss that would be assessed by a matchstick test. *Rhinoscleroma* - Rhinoscleroma is a **chronic granulomatous bacterial infection** of the upper respiratory tract. - While it causes significant tissue destruction and structural changes, it is not primarily associated with the sensory neuropathies that the matchstick test evaluates. *P. vesticolor* - *Pityriasis versicolor* is a **superficial fungal infection** of the skin, causing discolored patches. - This condition is a dermatological issue and does not involve nerve damage or sensory deficits, making the matchstick test irrelevant.
Question 147: Lovibond profile sign is seen in ?
- A. Koilonychia (spoon nails)
- B. Platynochia (flat nails)
- C. Nail clubbing (Correct Answer)
- D. Onycholysis (separation of the nail from the nail bed)
Explanation: 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.
Question 148: What disease is associated with ascitic fluid SAAG < 1.1?
- A. Peritoneal carcinomatosis (Correct Answer)
- B. Liver failure
- C. Portal vein thrombosis
- D. Tuberculosis peritonitis
Explanation: 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].
Question 149: Cafe coronary commonly occurs when a person is:
- A. Eating meat
- B. Intoxicated (Correct Answer)
- C. Eating fish
- D. Eating fatty food
Explanation: ***Intoxicated*** - **Intoxication**, particularly with alcohol, impairs the **gag reflex** and **swallowing coordination**, increasing the risk of aspiration and airway obstruction [1]. - Reduced awareness and slowed reactions due to intoxication make it difficult for an individual to clear their airway effectively if food becomes lodged, leading to a "cafe coronary" [1]. *Eating meat* - While meat can be a common culprit in cafe coronary incidents due to its **fibrous texture** and potential for large boluses, it's not the primary underlying condition [1], [2]. - The act of eating meat itself does not inherently cause the impaired protective reflexes seen in cafe coronary. *Eating fish* - Fish typically presents a relatively **low risk** for airway obstruction compared to other foods, as it is generally softer and breaks down more easily. - Although bones can be an issue, the specific "cafe coronary" scenario refers to significant airway obstruction by a bolus, not usually associated with typical fish consumption [2]. *Eating fatty food* - Eating fatty foods primarily relates to **digestive issues** or cardiovascular risk, not typically to acute airway obstruction. - Fatty foods do not inherently impair swallowing reflexes or significantly increase the risk of aspiration in the same way intoxication does.
Question 150: Common deformity in Chiari II malformation is -
- A. Syringomyelia (Correct Answer)
- B. Hydrocephalus
- C. Meningo myelocele
- D. All of the options
Explanation: ***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.