NEET-PG 2013 - Internal Medicine Practice Questions

Q: Lovibond profile sign is seen in ?

Nail clubbing. 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.

Q: What is the treatment for Trichomonas vaginalis?

Metronidazole. ***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.

Q: In a patient with heart disease, which condition is most commonly associated with left atrial enlargement?

Mitral stenosis. ***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].

Q: All are seen in Behçet's syndrome except:

Pyoderma gangrenosum. ***Pyoderma gangrenosum*** - While Behçet's syndrome can involve skin lesions, **pyoderma gangrenosum** is not typically part of its diagnostic criteria or common manifestations. - Pyoderma gangrenosum is a distinct neutrophilic dermatosis characterized by rapidly enlarging, painful ulcers. *Erythema nodosum* - **Erythema nodosum** is a common dermatological manifestation in Behçet's syndrome, characterized by tender subcutaneous nodules, usually on the shins. - These lesions reflect the systemic inflammatory nature of the disease in various organs. *Genital ulcers* - **Genital ulcers** are one of the major diagnostic criteria for Behçet's syndrome, often painful and recurrent. - They tend to be deep and can form scars, appearing on the scrotum, penis, labia, or perianal area. *Oral ulcers* - **Recurrent oral aphthous ulcers** are the most common and often the initial symptom of Behçet's syndrome. - These ulcers are typically painful, varying in size, and can occur on any mucosal surface in the mouth.

Q: Which of the following is not classified as a cutaneous porphyria?

Sideroblastic anemia. ***Hereditary coproporphyria*** - This condition is primarily associated with **acute episodes** and **neuropathy**, rather than cutaneous manifestations. [2] - Unlike cutaneous porphyrias, symptoms are more systemic and do not commonly present with **skin lesions**. Although skin features can occur in some instances, they mimic porphyria cutanea tarda. [2] *Congenital erythropoeitic porphyria* - Characterized by severe **cutaneous symptoms** such as blistering and photosensitivity due to **skin exposure**. - Patients exhibit notable **facial disfigurement** and can have **hemolytic anemia**, aligning it clearly with the cutaneous forms of porphyria. *Sideroblastic anemia* - This condition involves issues with **hemoglobin synthesis** and does not fit the porphyria classification. [1] - It primarily presents with **microcytic anemia**, and the symptoms are primarily hematological, not cutaneous. [1] *Erythropoeitic porphyria* - Characterized by **severe photosensitivity** and skin manifestations, similar to congenital erythropoeitic porphyria. [1] - Patients may develop **blisters** and **hyperpigmentation** upon sun exposure, categorizing it among cutaneous porphyrias. [2]

Q: Wireless capsule endoscopy is done to visualize which of the following condition?

Crohn's disease. ***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.

Q: Which of the following is a characteristic feature of Granulomatosis with polyangiitis?

Perforated nasal septum. ***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.

Q: A man with pain during defecation, no gastrointestinal symptoms, and ulcers extending into the anal canal. Diagnosis?

Genital herpes. 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.

Q: A female patient presents with hirsutism, amenorrhea, and obesity. What is the most likely diagnosis?

Polycystic Ovary Syndrome (PCOS). ***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.

Q: What is the primary cause of a decubitus ulcer?

Prolonged pressure on the skin. ***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 1

Lovibond profile sign is seen in ?

Accepted Answer

Nail clubbing

Answer

Koilonychia (spoon nails)

Answer

Platynochia (flat nails)

Answer

Onycholysis (separation of the nail from the nail bed)

Question 2

What is the treatment for Trichomonas vaginalis?

Accepted Answer

Metronidazole

Answer

Azithromycin

Answer

Ciprofloxacin

Answer

None of the options

Question 3

In a patient with heart disease, which condition is most commonly associated with left atrial enlargement?

Accepted Answer

Mitral stenosis

Answer

Tricuspid regurgitation

Answer

AR

Answer

None of the options

Question 4

All are seen in Behçet's syndrome except:

Accepted Answer

Pyoderma gangrenosum

Answer

Erythema nodosum

Answer

Genital ulcers

Answer

Oral ulcers

Question 5

Which of the following is not classified as a cutaneous porphyria?

Accepted Answer

Sideroblastic anemia

Answer

Congenital erythropoietic porphyria

Answer

Erythropoietic protoporphyria

Answer

Hereditary coproporphyria

Question 6

Wireless capsule endoscopy is done to visualize which of the following condition?

Accepted Answer

Crohn's disease

Answer

Esophageal varices

Answer

Gastric carcinoma

Answer

Ulcerative colitis

Question 7

Which of the following is a characteristic feature of Granulomatosis with polyangiitis?

Accepted Answer

Perforated nasal septum

Answer

Nasal polyp

Answer

Persistent sinusitis

Answer

Collapse of nasal bridge

Question 8

A man with pain during defecation, no gastrointestinal symptoms, and ulcers extending into the anal canal. Diagnosis?

Accepted Answer

Genital herpes

Answer

Cytomegalovirus (CMV)

Answer

Gonococcal infection

Answer

HIV infection

Question 9

A female patient presents with hirsutism, amenorrhea, and obesity. What is the most likely diagnosis?

Accepted Answer

Polycystic Ovary Syndrome (PCOS)

Answer

Androgen-secreting ovarian tumor

Answer

Congenital adrenal hyperplasia

Answer

Cushing's syndrome

Question 10

What is the primary cause of a decubitus ulcer?

Accepted Answer

Prolonged pressure on the skin

Answer

Due to friction and shear forces

Answer

Due to trauma or injury

Answer

Due to moisture and immobility

NEET-PG 2013 — Internal Medicine