A female patient presents with hirsutism, amenorrhea, and obesity. What is the most likely diagnosis?
What is the treatment for Trichomonas vaginalis?
What is the primary cause of a decubitus ulcer?
Wireless capsule endoscopy is done to visualize which of the following condition?
In a patient with heart disease, which condition is most commonly associated with left atrial enlargement?
What will the aspirated synovial fluid in a case of septic arthritis typically show?
All are common sites of primary cancer for bone metastasis except:
Lovibond profile sign is seen in ?
Which type of arthritis is characterized by the absence of a periosteal reaction?
What condition is characterized by a short fourth metacarpal?
NEET-PG 2013 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 131: A female patient presents with hirsutism, amenorrhea, and obesity. What is the most likely diagnosis?
- A. Androgen-secreting ovarian tumor
- B. Congenital adrenal hyperplasia
- C. Cushing's syndrome
- D. Polycystic Ovary Syndrome (PCOS) (Correct Answer)
Explanation: ***Polycystic Ovary Syndrome (PCOS)*** - **Hirsutism**, **amenorrhea** (or oligomenorrhea), and **obesity** are classic clinical features of PCOS, reflecting hyperandrogenism and insulin resistance [2]. - PCOS is a diagnosis of exclusion and involves chronic anovulation and polycystic ovaries on ultrasound [3], though these are not explicitly mentioned, the constellation of symptoms strongly points to it. *Androgen-secreting ovarian tumor* - While it can cause **hirsutism** and **amenorrhea**, the onset is typically **rapid** and severe, with very high androgen levels, and obesity is not a primary feature. - Ovarian tumors are generally less common than PCOS and may present with a palpable mass or specific imaging findings. *Congenital adrenal hyperplasia* - This genetic condition often presents in childhood or adolescence with varying degrees of **virilization** and menstrual irregularities due to enzyme deficiencies in cortisol synthesis [1]. - While it causes **hirsutism** and potentially **amenorrhea**, obesity is not a direct consequence, and the patient's age of presentation and specific symptom pattern are less typical for adult-onset CAH in this context. *Cushing's syndrome* - Characterized by **central obesity**, **moon facies**, **buffalo hump**, **striae**, and proximal muscle weakness due to chronic glucocorticoid excess. - Although it can cause **menstrual irregularities** and mild **hirsutism** [2], the overall clinical picture including the absence of other specific Cushingoid features makes it less likely than PCOS.
Question 132: 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 133: 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 134: Wireless capsule endoscopy is done to visualize which of the following condition?
- A. Esophageal varices
- B. Gastric carcinoma
- C. Crohn's disease (Correct Answer)
- D. Ulcerative colitis
Explanation: ***Crohn's disease*** - Wireless capsule endoscopy is primarily used to visualize the **small bowel**, which is the main site of involvement in Crohn's disease [3]. - It helps detect **mucosal inflammation**, ulcers, and strictures that may not be accessible by conventional endoscopy [1]. *Esophageal varices* - **Esophageal varices** are best visualized and treated with conventional **esophagogastroduodenoscopy (EGD)**, which allows for direct intervention [2]. - Capsule endoscopy is not the preferred method due to its inability to adequately distend the esophagus or perform therapeutic maneuvers [4]. *Gastric carcinoma* - Diagnosing **gastric carcinoma** requires visualization of the stomach lining, typically achieved through **conventional upper endoscopy** with biopsies [2]. - The capsule may pass too quickly through the stomach or miss subtle lesions, and it cannot obtain tissue samples. *Ulcerative colitis* - **Ulcerative colitis** primarily affects the **colon**, which is visualized using a **colonoscopy** [3]. - While capsule endoscopy can visualize the small bowel, it is not effective for examining the colon due to insufficient imaging of the entire large intestine and lack of biopsy capabilities.
Question 135: In a patient with heart disease, which condition is most commonly associated with left atrial enlargement?
- A. Mitral stenosis (Correct Answer)
- B. Tricuspid regurgitation
- C. AR
- D. None of the options
Explanation: ***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].
Question 136: What will the aspirated synovial fluid in a case of septic arthritis typically show?
- A. Clear and straw-colored fluid
- B. Low viscosity fluid
- C. Cloudy or purulent fluid
- D. Markedly increased polymorphonuclear leukocytes (Correct Answer)
Explanation: ***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**.
Question 137: All are common sites of primary cancer for bone metastasis except:
- A. Prostate
- B. Lung
- C. Brain (Correct Answer)
- D. Thyroid
Explanation: ***Brain*** - The **brain** is not a common site for primary bone metastasis, as bone metastases typically originate from organs like the **breast**, **lung**, and **prostate**. - While brain tumors can metastasize to bone, the reverse (primary bone cancer) occurring here is rare. *Breast* - Breast cancer is one of the **most prevalent sources** of bone metastases, commonly affecting the spine and pelvis. - Symptoms often include **bone pain** and potential fractures due to metastasis. *Brain* - Similar to , while brain tumors can metastasize, **primary cancers** do not commonly originate in the bone. - The **metastatic spread** to the brain from other primary sites is common, but not the other way around. *Breast* - Again, breast cancer commonly leads to **bone metastasis**, accounting for a significant percentage of these cases. - It is important to identify busy metastasis to **manage** symptoms and improve patient outcomes.
Question 138: 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 139: Which type of arthritis is characterized by the absence of a periosteal reaction?
- A. Psoriatic arthritis
- B. Neuropathic arthritis (Correct Answer)
- C. Rheumatoid arthritis
- D. Reactive arthritis
Explanation: ***Neuropathic arthritis*** - **Neuropathic arthritis** (**Charcot joint**) is characterized by progressive joint destruction due to loss of proprioception and pain sensation, leading to severe bone and joint damage without a typical **periosteal reaction**. - The absence of normal protective reflexes results in repetitive microtrauma, often leading to bone resorption and fragmentation rather than new bone formation (periosteal reaction). *Psoriatic arthritis* - **Psoriatic arthritis** often presents with distinctive **periosteal reactions**, particularly at entheses and along the shafts of small bones (e.g., "pencil-in-cup" deformities and fluffy periostitis) [1]. - These periosteal changes are a hallmark of the inflammatory process affecting bone and connective tissues in psoriatic arthritis. *Rheumatoid arthritis* - **Rheumatoid arthritis** primarily involves the synovium, leading to erosions rather than prominent periosteal reactions in early stages [1]. - While periostitis can occur in chronic, destructive rheumatoid arthritis, it is not a primary or characteristic finding compared to other inflammatory arthritides. *Reactive arthritis* - **Reactive arthritis** frequently causes **periosteal reactions**, particularly at entheses (where tendons and ligaments attach to bone) and along the shafts of long bones, often described as "fluffy" periostitis [1]. - These new bone formations are a key radiological feature distinguishing it from other types of inflammatory arthritis.
Question 140: What condition is characterized by a short fourth metacarpal?
- A. Primary Hyperparathyroidism
- B. Secondary Hyperparathyroidism
- C. Pseudohypoparathyroidism (Correct Answer)
- D. Scleroderma
Explanation: 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.