NEET-PG 2013 - Internal Medicine Practice Questions

Q: True about Ebstein anomaly is ?

Right atrial dilatation. 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.

Q: Muller's manoeuvre is used to

To find degree of obstruction in sleep disordered breathing. ***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.

Q: Which of the following is caused by congenital 17 hydroxylase deficiency:

Hypertension. ***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].

Q: Tuberculin test is positive in general population (immunocompetent individuals with no specific risk factors) if induration is?

>10mm. >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.

Q: Rash is absent in ?

Q. fever. ***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].

Q: Kveim test (historical) is used for diagnosis of

None of the options. ***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].

Q: Most common cause of facial nerve palsy:

Idiopathic Bell's palsy. ***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.

Question 1

True about Ebstein anomaly is ?

Accepted Answer

Right atrial dilatation

Answer

Right ventricular dilatation

Answer

Left atrial dilatation

Answer

Left ventricular dilatation

Question 2

Muller's manoeuvre is used to

Accepted Answer

To find degree of obstruction in sleep disordered breathing

Answer

To remove foreign body from ear

Answer

To remove laryngeal foreign body

Answer

To find out opening of mouth

Question 3

Which of the following is caused by congenital 17 hydroxylase deficiency:

Accepted Answer

Hypertension

Answer

Virilism

Answer

Hyperkalemia

Answer

Hermaphroditism

Question 4

Tuberculin test is positive in general population (immunocompetent individuals with no specific risk factors) if induration is?

Accepted Answer

>10mm

Answer

>7mm

Answer

>5mm

Answer

>2mm

Question 5

Rash is absent in ?

Accepted Answer

Q. fever

Answer

Endemic typhus

Answer

Epidemic typhus

Answer

Scrub typhus

Question 6

Kveim test (historical) is used for diagnosis of

Accepted Answer

None of the options

Answer

Wegeners granulomatosis

Answer

Graves disease

Answer

Sarcoidosis

Question 7

Most common cause of facial nerve palsy:

Accepted Answer

Idiopathic Bell's palsy

Answer

Mastoid surgery

Answer

Herpes zoster oticus

Answer

Chronic suppurative Otitis media

NEET-PG 2013 — Internal Medicine