NEET-PG 2013 - Internal Medicine Practice Questions

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: Match stick test is positive in ?

Leprosy. ***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.

Q: Which type of leprosy does not involve nerve damage?

Indeterminate leprosy. ***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].

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: 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: 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: 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 disease is associated with ascitic fluid SAAG < 1.1?

Peritoneal carcinomatosis. 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].

Q: Cafe coronary commonly occurs when a person is:

Intoxicated. ***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.

Q: Common deformity in Chiari II malformation is -

Syringomyelia. ***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.

Question 1

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 2

Match stick test is positive in ?

Accepted Answer

Leprosy

Answer

Rhinophyma

Answer

P. versicolor

Answer

Rhinoscleroma

Question 3

Which type of leprosy does not involve nerve damage?

Accepted Answer

Indeterminate leprosy

Answer

Borderline tuberculoid leprosy

Answer

Tuberculoid leprosy

Answer

Lepromatous leprosy

Question 4

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 5

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 6

What is the treatment for Trichomonas vaginalis?

Accepted Answer

Metronidazole

Answer

Azithromycin

Answer

Ciprofloxacin

Answer

None of the options

Question 7

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 8

What disease is associated with ascitic fluid SAAG < 1.1?

Accepted Answer

Peritoneal carcinomatosis

Answer

Liver failure

Answer

Portal vein thrombosis

Answer

Tuberculosis peritonitis

Question 9

Cafe coronary commonly occurs when a person is:

Accepted Answer

Intoxicated

Answer

Eating meat

Answer

Eating fish

Answer

Eating fatty food

Question 10

Common deformity in Chiari II malformation is -

Accepted Answer

Syringomyelia

Answer

Hydrocephalus

Answer

Meningo myelocele

Answer

All of the options

NEET-PG 2013 — Internal Medicine