True about Ebstein anomaly is ?
Muller's manoeuvre is used to
Which of the following is caused by congenital 17 hydroxylase deficiency:
Tuberculin test is positive in general population (immunocompetent individuals with no specific risk factors) if induration is?
Rash is absent in ?
Kveim test (historical) is used for diagnosis of
Most common cause of facial nerve palsy:
NEET-PG 2013 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 151: True about Ebstein anomaly is ?
- A. Right ventricular dilatation
- B. Right atrial dilatation (Correct Answer)
- C. Left atrial dilatation
- D. Left ventricular dilatation
Explanation: 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.
Question 152: Muller's manoeuvre is used to
- A. To remove foreign body from ear
- B. To find degree of obstruction in sleep disordered breathing (Correct Answer)
- C. To remove laryngeal foreign body
- D. To find out opening of mouth
Explanation: ***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.
Question 153: Which of the following is caused by congenital 17 hydroxylase deficiency:
- A. Hypertension (Correct Answer)
- B. Virilism
- C. Hyperkalemia
- D. Hermaphroditism
Explanation: ***Hypertension*** - **Congenital 17-hydroxylase deficiency** leads to impaired synthesis of **cortisol** and **sex steroids**, resulting in an accumulation of **mineralocorticoid precursors (corticosterone and deoxycorticosterone)** [1]. - Increased levels of these mineralocorticoids cause **sodium and water retention**, leading to **hypertension** and **hypokalemia**. *Virilism* - **17-hydroxylase deficiency** impairs **androgen synthesis**, preventing the development of male secondary sexual characteristics [2]. - Individuals with this deficiency often present with **female external genitalia** regardless of their genetic sex, or **under-virilization** in genetic males, not virilism [2]. *Hyperkalemia* - The excess mineralocorticoids (deoxycorticosterone) in **17-hydroxylase deficiency** promote **sodium reabsorption** and **potassium excretion** in the kidneys [1]. - This leads to **hypokalemia**, which is the opposite of hyperkalemia. *Hermaphroditism* - **17-hydroxylase deficiency** affects the development of gonads and internal reproductive organs depending on genetic sex. - Genetic males (**XY**) with this deficiency typically develop **female external genitalia** (pseudohermaphroditism or 46, XY DSD), while genetic females (**XX**) typically present as normal females but with **primary amenorrhea** [2]. This genetic condition does not result in true hermaphroditism (presence of both ovarian and testicular tissue) [2].
Question 154: Tuberculin test is positive in general population (immunocompetent individuals with no specific risk factors) if induration is?
- A. >7mm
- B. >5mm
- C. >2mm
- D. >10mm (Correct Answer)
Explanation: >10mm - For **immunocompetent** individuals without specific risk factors, a tuberculin skin test (TST) induration of **≥10 mm** is considered positive. - This threshold indicates a likely **exposure to Mycobacterium tuberculosis** and a cellular immune response. *>7mm* - This is not a standard threshold for a positive TST in any risk group. - TST interpretation is based on specific **induration sizes** corresponding to different risk factors. *>5mm* - An induration of **≥5 mm** is considered positive for individuals with compromised immunity, those in close contact with active TB cases, or those with fibrotic changes on chest X-ray. - This lower threshold is used for **high-risk groups** due to their increased susceptibility to developing active tuberculosis. *>2mm* - An induration of **≥2 mm** is not typically used as a positive threshold for the tuberculin test in any established guidelines. - Such a small induration is generally considered **negative** or clinically insignificant.
Question 155: Rash is absent in ?
- A. Endemic typhus
- B. Epidemic typhus
- C. Scrub typhus
- D. Q. fever (Correct Answer)
Explanation: ***Q. fever*** - Q fever, caused by **Coxiella burnetii**, is characterized by **flu-like symptoms**, pneumonia, and hepatitis, but **does not typically present with a rash**. - This differentiates it from other rickettsial infections that commonly involve skin manifestations. *Endemic typhus* - Endemic (murine) typhus, caused by **Rickettsia typhi**, is transmitted by **fleas** and commonly presents with a **maculopapular rash** on the trunk and extremities [2]. - The rash usually appears several days after fever onset [2]. *Epidemic typhus* - Epidemic typhus, caused by **Rickettsia prowazekii** and transmitted by the **human body louse**, classically presents with a **centrifugal rash** that spares the face, palms, and soles [2]. - The rash typically starts on the trunk and spreads outwards [2]. *Scrub typhus* - Scrub typhus, caused by **Orientia tsutsugamushi**, is transmitted by **chiggers** and often features an **eschar** (a necrotic lesion at the bite site) along with a **maculopapular rash** [1]. - The rash may be transient or absent in some cases, but an eschar is a highly characteristic finding [1].
Question 156: Kveim test (historical) is used for diagnosis of
- A. Wegeners granulomatosis
- B. Graves disease
- C. Sarcoidosis
- D. None of the options (Correct Answer)
Explanation: ***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 157: Most common cause of facial nerve palsy:
- A. Mastoid surgery
- B. Herpes zoster oticus
- C. Chronic suppurative Otitis media
- D. Idiopathic Bell's palsy (Correct Answer)
Explanation: ***Idiopathic Bell's palsy*** - **Bell's palsy** is the most common cause of **facial nerve palsy**, accounting for approximately 60-75% of cases. - It is an **idiopathic** condition, meaning its exact cause is unknown, although it is often linked to viral infections (e.g., herpes simplex virus). [1] *Mastoid surgery* - **Iatrogenic facial nerve injury** during mastoidectomy is a known complication, but it is a relatively rare cause of facial nerve palsy. - While it can cause significant palsy, the incidence is low compared to Bell's palsy. *Herpes zoster oticus* - This condition, also known as **Ramsay Hunt syndrome**, is a cause of facial nerve palsy associated with a **vesicular rash** (zoster) in the ear canal or on the face. - While it is a significant cause of viral-induced facial palsy, it is less common than idiopathic Bell's palsy. *Chronic suppurative Otitis media* - **Chronic otitis media** can, in rare cases, lead to facial nerve palsy due to persistent inflammation spreading to the facial nerve. [2] - This is a less common etiology than Bell's palsy and would typically present with a history of recurrent ear discharge and hearing loss.