FMGE 2018 - Internal Medicine Practice Questions

Q: All of the following are manifestations of congenital syphilis except:-

Gumma. ***Gumma*** - **Gumma** is a manifestation of **tertiary syphilis** in adults, typically appearing years after the initial infection [1]. - While syphilis can be transmitted congenitally, **gummatous lesions** are not a characteristic finding in congenital syphilis [1]. *Olympian brow* - **Olympian brow** (also known as frontal bossing) is a feature of **congenital syphilis**, characterized by prominent frontal bones [2]. - It results from **periostitis** and abnormal bone development due to chronic infection in utero. *Interstitial keratitis* - **Interstitial keratitis** is a classic manifestation of **late congenital syphilis**, affecting the cornea [2]. - It presents as **bilateral corneal inflammation** leading to vision impairment, often appearing in childhood or adolescence. *Hutchinson's teeth* - **Hutchinson's teeth** are a pathognomonic sign of **congenital syphilis**, characterized by notched, peg-shaped, and widely spaced incisors. - This dental abnormality results from the treponemal infection disrupting the **enamel formation** during tooth development.

Q: Irreversible obstructive lung function is seen in which of the following conditions?

COPD. ***COPD*** - **Chronic Obstructive Pulmonary Disease** (COPD) is characterized by **persistent airflow limitation** that is not fully reversible [3]. - This irreversibility is due to structural changes in the airways and parenchyma, including **emphysema** and **chronic bronchitis** [2]. *Asthma* - Asthma is characterized by **reversible airway obstruction** and hyperresponsiveness, often triggered by allergens or irritants [4]. - While it can be severe, the key distinguishing feature is that the airway limitation can be significantly reversed with bronchodilator treatment [1]. *Pleural effusion* - A pleural effusion involves the **accumulation of fluid in the pleural space**, which is outside the lung tissue. - This condition causes **restrictive lung disease** by compressing the lung, rather than obstructing the airways from within, and is usually treatable by drainage. *Kyphoscoliosis* - **Kyphoscoliosis** is a skeletal deformity of the spine that restricts lung expansion, leading to **restrictive lung disease**. - It does not directly cause an obstructive pattern within the airways, but rather impairs the mechanical ability of the lungs to inflate.

Q: Syndrome of inappropriate ADH secretion is characterized by all of the following EXCEPT:-

Hypo-osmolar urine. ***Hypo-osmolar urine*** - Syndrome of Inappropriate Antidiuretic Hormone (SIADH) is characterized by the secretion of ADH in excess of what is appropriate for the plasma osmolality. This excess ADH causes the kidneys to retain water, leading to **concentrated (hyper-osmolar) urine** [1]. - Therefore, **hypo-osmolar urine** is not a characteristic of SIADH; rather, **hyper-osmolar urine** is expected as the body tries to excrete concentrated urine to compensate for water retention. *Expanded fluid volume* - The excess ADH in SIADH leads to increased **water reabsorption** by the kidneys [1]. - This increased water retention can result in an **expanded extracellular fluid volume**, although usually without significant peripheral edema due to natriuretic peptide release [2]. *Hyponatremia* - The retained water dilutes the plasma sodium concentration, causing **dilutional hyponatremia** [2]. - This is a hallmark feature of SIADH, as the body holds onto too much free water [2]. *Water intoxication* - The characteristic features of SIADH, including **hyponatremia** and **increased total body water**, directly lead to a state of **water intoxication** [1]. - Symptoms can range from mild (nausea, malaise) to severe (seizures, coma) depending on the severity and rapidity of hyponatremia.

Q: In Goodpasture syndrome, which organ is involved apart from the lung?

Kidney. ***Kidney*** - Goodpasture syndrome is an **autoimmune disease** that primarily targets the a3 chain of **type IV collagen**, which is found in the **basement membranes** of both the glomeruli in the kidneys and the alveoli in the lungs. [1] - This leads to rapidly progressive **glomerulonephritis** and **pulmonary hemorrhage**, making the kidney a key organ involved alongside the lungs. [1] *Heart* - The heart is generally **not directly involved** in Goodpasture syndrome. - Cardiac symptoms are typically **secondary** to severe anemia from pulmonary hemorrhage or fluid overload from kidney failure. *Spleen* - The spleen is **not a target organ** for the autoantibodies in Goodpasture syndrome. - While it plays a role in immune responses, it is not directly damaged by the disease process itself. *Liver* - The liver is **not affected** by the autoantibodies in Goodpasture syndrome. - **Type IV collagen**, the autoantigen, is not a significant component of the liver basement membranes.

Q: Pheochromocytoma produces all except?

Secretin. Secretin - **Secretin** is a hormone primarily produced by **S cells in the duodenum and jejunum** [3] in response to acidic chyme, stimulating pancreatic bicarbonate secretion. - Pheochromocytomas originate from **chromaffin cells** of the adrenal medulla and are known for producing catecholamines [2], not secretin. *Vasoactive intestinal polypeptide* - **Vasoactive intestinal polypeptide (VIP)** can be produced by some **neuroendocrine tumors** [1], including pheochromocytomas, though it's more commonly associated with VIPomas. - VIP acts as a **vasodilator** and can contribute to symptoms like flushing and diarrhea in rare cases of VIP-producing pheochromocytomas. *Calcitonin* - While calcitonin is primarily associated with **medullary thyroid carcinoma**, it can rarely be produced ectopically by **neuroendocrine tumors**, including some pheochromocytomas. - This ectopic production is part of the broader concept of **paraneoplastic syndromes** seen in various malignancies. *Norepinephrine* - **Norepinephrine** is a major catecholamine produced by pheochromocytomas, leading to classic symptoms such as **hypertension, palpitations, and sweating** [2]. - The tumor cells (chromaffin cells) are specialized to synthesize and release **catecholamines**, including norepinephrine and epinephrine [2].

Q: Which pattern of inheritance of disease is associated with consanguinity?

Autosomal recessive. ***Autosomal recessive*** - Consanguineous relationships increase the likelihood of offspring inheriting **two copies of a rare deleterious recessive allele**, one from each parent [1]. - This occurs because relatives share a greater proportion of their genes, making it more probable that both parents are **heterozygous carriers** for the same recessive disorder. *Autosomal dominant* - In autosomal dominant disorders, only **one copy of the altered gene** is needed to cause the disease, so expression is not typically influenced by consanguinity. - These conditions often manifest in every generation and are not more prevalent with increased shared genetic material. *X-linked recessive* - X-linked recessive disorders primarily affect males, as they only have one X chromosome, and are transmitted by carrier females. - While consanguinity can theoretically increase the carrier rate within a population, its direct impact on the inheritance pattern of an X-linked trait in a single family is less pronounced compared to autosomal recessive conditions. *X-linked dominant* - X-linked dominant disorders are expressed in heterozygous females and hemizygous males, with affected males often having more severe disease. - The inheritance pattern is not significantly influenced by consanguinity, as only one copy of the affected gene on the X chromosome is sufficient for disease manifestation.

Q: Commonest neurological tumour associated with NF-2:-

Acoustic neuroma. ***Acoustic neuroma*** - **Bilateral acoustic neuromas** (vestibular schwannomas) are the hallmark of **Neurofibromatosis type 2 (NF2)**, virtually diagnostic for the condition [1]. - These tumors arise from the **vestibulocochlear nerve (cranial nerve VIII)** and commonly cause hearing loss and balance problems [1]. *Optic glioma* - **Optic gliomas** are more characteristic of **Neurofibromatosis type 1 (NF1)**, not NF2. - While they can occur in NF2, they are not the most common or diagnostic feature. *Spinal schwannoma* - Spinal schwannomas can occur in NF2, but they are not the *most common* or *defining* neurological tumor associated with the condition. - The presence of multiple schwannomas, especially spinal, is a feature, but **bilateral acoustic neuromas** take precedence for diagnosis. *Meningioma* - Multiple **meningiomas** occur in a significant proportion of NF2 patients, making them common, but they are still secondary to **bilateral acoustic neuromas** in terms of diagnostic significance and prevalence as the *primary* neurological tumor. - These are tumors of the **meninges**, the protective layers surrounding the brain and spinal cord.

Q: Continuous murmur is heard in?

Patent ductus arteriosus. ***Patent ductus arteriosus*** - A **continuous murmur** in PDA is often described as a **"machinery-like" murmur**, audible throughout systole and diastole [1]. - This murmur is caused by the continuous flow of blood from the higher-pressure aorta into the lower-pressure pulmonary artery [1]. *Tetralogy of Fallot* - The murmur associated with Tetralogy of Fallot is typically a **systolic ejection murmur** heard at the upper left sternal border [1]. - This murmur is due to pulmonary stenosis and is not continuous, as it is related to ventricular ejection [1]. *Ventricular septal defect* - A VSD typically presents with a **holosystolic murmur**, meaning it is heard throughout systole [1]. - The murmur in VSD is confined to systole and does not extend into diastole, distinguishing it from a continuous murmur [1]. *Atrial septal defect* - An ASD is typically associated with a **systolic ejection murmur** over the pulmonic area due to increased flow across the pulmonary valve [1]. - There may also be a **diastolic rumble** across the tricuspid valve, but neither of these is a continuous murmur [1].

Q: Gold standard method of diagnosing celiac disease is

Small bowel biopsy. ***Small bowel biopsy*** - A **small bowel biopsy** is considered the **gold standard** for diagnosing celiac disease as it directly visualizes the characteristic damage to the intestinal lining. - The biopsy reveals histologic changes like **villous atrophy**, crypt hyperplasia, and increased intraepithelial lymphocytes, which are pathognomonic for celiac disease [1]. *Blood picture* - A blood picture (complete blood count) might show **anemia** (often iron-deficiency anemia) due to malabsorption, but this is a non-specific finding and not diagnostic for celiac disease [1]. - It does not provide direct evidence of intestinal damage caused by gluten. *Anti-endomysial antibodies* - **Anti-endomysial antibodies (EMA)** are highly specific for celiac disease, but they are still a serological test, not the definitive diagnostic method. - Serological tests like EMA and **tissue transglutaminase (tTG) antibodies** are used for screening and monitoring but require biopsy confirmation. *Biochemical test* - Biochemical tests might show abnormalities related to **malabsorption**, such as low iron, calcium, or vitamin D levels, but these are secondary effects and not diagnostic of celiac disease itself [1]. - These tests indicate nutritional deficiencies but do not identify the underlying cause.

Q: Oliguria is defined as:-

Less than 400 ml of urine excreted in a day. ***Less than 400 ml of urine excreted in a day*** - Oliguria is clinically defined as **urine production** of less than **400-500 mL per 24 hours** in adults. - This reduction in urine output is often a critical sign of acute kidney injury or other underlying medical conditions impacting **renal function**. *More than 900 ml of urine excreted in a day* - This volume is within the normal range of **daily urine output** for an adult, which is typically between **800 mL and 2000 mL**. - It does not represent oliguria, which indicates a significantly **decreased urine production**. *Absence of urine production* - The complete absence of urine production is known as **anuria**, which is a more severe condition than oliguria. - Anuria is typically defined as less than **50 mL of urine per 24 hours**. *600 ml to 700 ml of urine excreted in a day* - While this volume is below the typical average, it does not meet the strict clinical definition of oliguria, which is typically set at **less than 400-500 mL/day**. - This range might be considered **borderline decreased** but is not severe enough to be classified as oliguric by most standards.

Question 1

All of the following are manifestations of congenital syphilis except:-

Accepted Answer

Gumma

Answer

Olympian brow

Answer

Interstitial keratitis

Answer

Hutchinson's teeth

Question 2

Irreversible obstructive lung function is seen in which of the following conditions?

Accepted Answer

COPD

Answer

Asthma

Answer

Pleural effusion

Answer

Kyphoscoliosis

Question 3

Syndrome of inappropriate ADH secretion is characterized by all of the following EXCEPT:-

Accepted Answer

Hypo-osmolar urine

Answer

Expanded fluid volume

Answer

Hyponatremia

Answer

Water intoxication

Question 4

In Goodpasture syndrome, which organ is involved apart from the lung?

Accepted Answer

Kidney

Answer

Heart

Answer

Spleen

Answer

Liver

Question 5

Pheochromocytoma produces all except?

Accepted Answer

Secretin

Answer

Vasoactive intestinal polypeptide

Answer

Norepinephrine

Answer

Calcitonin

Question 6

Which pattern of inheritance of disease is associated with consanguinity?

Accepted Answer

Autosomal recessive

Answer

Autosomal dominant

Answer

X linked recessive

Answer

X linked dominant

Question 7

Commonest neurological tumour associated with NF-2:-

Accepted Answer

Acoustic neuroma

Answer

Optic glioma

Answer

Meningioma

Answer

Spinal schwannoma

Question 8

Continuous murmur is heard in?

Accepted Answer

Patent ductus arteriosus

Answer

Tetralogy of fallot

Answer

Ventricular septal defect

Answer

Atrial septal defect

Question 9

Gold standard method of diagnosing celiac disease is

Accepted Answer

Small bowel biopsy

Answer

Blood picture

Answer

Anti-endomysial antibodies

Answer

Biochemical test

Question 10

Oliguria is defined as:-

Accepted Answer

Less than 400 ml of urine excreted in a day

Answer

More than 900 ml of urine excreted in a day

Answer

Absence of urine production

Answer

600 ml to 700 ml of urine excreted in a day

FMGE 2018 — Internal Medicine