Decreased CVP is seen in
What condition is associated with Lemierre's syndrome?
Absent P Wave is seen on an ECG in:
Torsades de pointes is seen in all except
Which of the following statements is true regarding the diagnostic criteria for Chronic Obstructive Pulmonary Disease (COPD)?
In which condition is Cepacia syndrome most commonly associated?
What is the most common cause of lobar consolidation?
Which of the following is not a clinical feature of Bronchiectasis?
The physiological marker of the last stage of acute asthma is
Which of the following is a characteristic finding in distal RTA?
NEET-PG 2013 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 71: Decreased CVP is seen in
- A. PEEP
- B. Bacterial sepsis (Correct Answer)
- C. Heart failure
- D. Pneumothorax
Explanation: ***Bacterial sepsis*** - In **sepsis**, widespread **vasodilation** and increased capillary permeability lead to significant fluid redistribution out of the intravascular space [3]. - This results in a decrease in **venous return** and thus a lower **central venous pressure (CVP)** due to relative hypovolemia [2]. *Pneumothorax* - A **pneumothorax** causes increased intrathoracic pressure, compressing the great veins and heart. - This leads to **reduced venous return** and typically an *increase* in CVP, or at least a minimal change, due to obstructed outflow from the right atrium, not a decrease [2]. *PEEP* - **Positive end-expiratory pressure (PEEP)** increases intrathoracic pressure, which impedes venous return to the right atrium [2]. - This elevated pressure can artificially *increase* the measured CVP reading, and it does not typically cause a decrease in intrinsic CVP [2]. *Heart failure* - In **heart failure**, particularly right-sided heart failure or biventricular failure, the heart's pumping efficiency is reduced [1]. - This leads to **venous congestion** and an *increase* in CVP due to fluid overload and the inability of the right ventricle to effectively pump blood forward [2].
Question 72: What condition is associated with Lemierre's syndrome?
- A. Carotid sinus aneurysm
- B. Traumatic occlusion of IJV
- C. Any of the above
- D. Thrombophlebitis of IJV (Correct Answer)
Explanation: ***Thrombophlebitis of IJV*** - **Lemierre's syndrome** is classically defined as **septic thrombophlebitis of the internal jugular vein (IJV)** following an oropharyngeal infection [1]. - The infection, most commonly caused by *Fusobacterium necrophorum*, spreads from the pharynx to the parapharyngeal space, leading to IJV inflammation and thrombosis [1]. *Carotid sinus aneurysm* - A **carotid sinus aneurysm** is an abnormal focal dilation of the carotid sinus, often associated with atherosclerosis or connective tissue disorders. - It is not directly linked to the pathogenesis or complications of **Lemierre's syndrome**. *Traumatic occlusion of IJV* - **Traumatic occlusion of the IJV** results from direct injury to the neck, leading to vessel compression or damage. - While it affects the IJV, it does not involve the septic thrombophlebitis or preceding oropharyngeal infection characteristic of **Lemierre's syndrome**. *Any of the above* - This option is incorrect because **Lemierre's syndrome** is specifically associated with **septic thrombophlebitis of the IJV**, not with other unrelated vascular conditions affecting the neck.
Question 73: Absent P Wave is seen on an ECG in:
- A. Cor Pulmonale
- B. Mitral Stenosis
- C. Chronic Obstructive Pulmonary Disease (COPD)
- D. Atrial Fibrillation (AF) (Correct Answer)
Explanation: ***Atrial Fibrillation (AF)*** - In **atrial fibrillation**, the atria beat chaotically and irregularly, leading to the absence of coordinated **atrial depolarization**, thus no distinct P wave is seen [1]. - The ECG characteristically shows an **irregularly irregular rhythm** with narrow QRS complexes and no discernible P waves. *Cor Pulmonale* - Cor pulmonale involves right ventricular hypertrophy and dilation due to lung disease, which can cause peaked **P waves (P pulmonale)** in leads II, III, aVF, indicating right atrial enlargement. - It does not typically lead to the absence of P waves but rather changes in their morphology. *Mitral Stenosis* - **Mitral stenosis** can cause left atrial enlargement, which typically manifests as a broad, notched **P wave (P mitrale)**, especially in lead II, and a prominent negative phase in V1. - P waves are present but altered in appearance due to the increased atrial pressure and volume. *Chronic Obstructive Pulmonary Disease (COPD)* - Patients with **COPD** often show signs of right atrial enlargement, similar to cor pulmonale, resulting in **P pulmonale** on the ECG due to increased pulmonary pressures. - While other ECG changes like low voltage and right axis deviation may be present, the P wave is generally present, though often peaked.
Question 74: Torsades de pointes is seen in all except
- A. Hyponatremia (Correct Answer)
- B. Hypomagnesemia
- C. Hypokalemia
- D. Hypocalcemia
Explanation: ***Hyponatremia*** - **Hyponatremia** (low sodium levels) primarily affects neuronal function and can lead to neurological symptoms like seizures and altered mental status [1]. - It does not directly cause **QT prolongation** or **Torsades de Pointes (TdP)**, which are typically associated with electrolyte imbalances affecting cardiac repolarization. *Hypocalcemia* - **Hypocalcemia** (low calcium levels) can prolong the **QT interval** on an electrocardiogram. - Prolongation of the QT interval increases the risk of developing **Torsades de Pointes**, a life-threatening polymorphic ventricular tachycardia [2]. *Hypomagnesemia* - **Hypomagnesemia** (low magnesium levels) is a common cause and aggravator of **Torsades de Pointes**. - Magnesium plays a crucial role in cardiac ion channel function, and its deficiency can lead to significant **QT prolongation** and ventricular arrhythmias. *Hypokalemia* - **Hypokalemia** (low potassium levels) can prolong the **QT interval** and increase the risk of developing ventricular arrhythmias, including **Torsades de Pointes** [1]. - Potassium channels are essential for cardiac repolarization, and their dysfunction due to low potassium can destabilize myocardial electrical activity [1].
Question 75: Which of the following statements is true regarding the diagnostic criteria for Chronic Obstructive Pulmonary Disease (COPD)?
- A. A post-bronchodilator FEV1/FVC ratio above the threshold indicates normal lung function.
- B. A post-bronchodilator FEV1/FVC ratio below the threshold indicates airflow limitation. (Correct Answer)
- C. Residual Volume (RV) is normal.
- D. Total Lung Capacity (TLC) is decreased.
Explanation: ***A post-bronchodilator FEV1/FVC ratio below the threshold indicates airflow limitation.*** [1] - This is the **hallmark diagnostic criterion** for COPD, confirming persistent **airflow obstruction** that is not fully reversible. [1] - The threshold typically used is **< 0.70** or below the **fifth percentile** of the lower limit of normal (LLN). *A post-bronchodilator FEV1/FVC ratio above the threshold indicates normal lung function.* - An FEV1/FVC ratio **above the threshold** indicates the absence of significant **airflow obstruction**, but does not automatically guarantee normal lung function as other parameters like **FEV1** could be affected. - This measurement would suggest a **restrictive lung disease** or **normal lung function**, depending on other spirometry values. *Residual Volume (RV) is normal.* - In COPD, **air trapping** due to airflow obstruction leads to an **increased Residual Volume (RV)**, not a normal RV. - An elevated RV reflects **hyperinflation** of the lungs, a characteristic feature of emphysema and chronic bronchitis. *Total Lung Capacity (TLC) is decreased.* - COPD is characterized by **hyperinflation**, which typically results in an **increased Total Lung Capacity (TLC)** as the lungs become more distended. - A **decreased TLC** would be indicative of a **restrictive lung disease**, which is different from obstructive patterns seen in COPD.
Question 76: In which condition is Cepacia syndrome most commonly associated?
- A. Immotile cilia syndrome
- B. Sarcoidosis
- C. Cystic fibrosis (Correct Answer)
- D. Tuberculosis
Explanation: ***Cystic fibrosis*** - **Cepacia syndrome** is a severe and often fatal complication in patients with **cystic fibrosis** caused by infection with bacteria of the *Burkholderia cepacia complex*. - Patients with cystic fibrosis have impaired mucociliary clearance, making them highly susceptible to chronic bacterial infections, including those leading to Cepacia syndrome. *Sarcoidosis* - **Sarcoidosis** is a multisystem inflammatory disease characterized by the formation of **non-caseating granulomas**, primarily affecting the lungs and lymph nodes. - It is not associated with bacterial infections causing Cepacia syndrome. *Tuberculosis* - **Tuberculosis** is caused by *Mycobacterium tuberculosis* and primarily affects the lungs, leading to granuloma formation and tissue destruction. - While it is a chronic bacterial infection, it does not typically lead to or interact with the *Burkholderia cepacia complex* in the way seen in Cepacia syndrome. *Immotile cilia syndrome* - Also known as **primary ciliary dyskinesia**, this condition involves defective ciliary function leading to recurrent respiratory infections and other issues like situs inversus. - Although patients have recurrent respiratory infections, **Cepacia syndrome** is not a characteristic or commonly associated complication.
Question 77: What is the most common cause of lobar consolidation?
- A. Mycoplasma
- B. Chlamydia
- C. Streptococcus (Correct Answer)
- D. Legionella
Explanation: ***Streptococcus*** - **_Streptococcus pneumoniae_** is the **most common bacterial cause** of community-acquired pneumonia, frequently leading to lobar consolidation. [1] - It often presents with classic symptoms such as **sudden onset of fever**, productive cough with **rusty sputum**, and pleuritic chest pain. [1] *Mycoplasma* - **_Mycoplasma pneumoniae_** typically causes **"walking pneumonia"**, characterized by a more indolent course and often presents with **interstitial infiltrates** rather than dense lobar consolidation. - Though common, it is a less frequent cause of true lobar consolidation compared to _Streptococcus pneumoniae_. *Chlamydia* - **_Chlamydia pneumoniae_** causes atypical pneumonia, similar to _Mycoplasma_, presenting with less severe symptoms and **patchy infiltrates** or **interstitial patterns** rather than lobar consolidation. - It is a common cause of **atypical pneumonia** but not the leading cause of lobar consolidation. *Legionella* - **_Legionella pneumophila_** can cause severe pneumonia with consolidation, but it is **less common overall** than pneumococcal pneumonia. [1] - **Legionnaires' disease** is often associated with exposure to contaminated water sources and may present with **gastrointestinal and neurological symptoms** in addition to respiratory manifestations.
Question 78: Which of the following is not a clinical feature of Bronchiectasis?
- A. Hemoptysis
- B. Chest pain
- C. Night sweats (Correct Answer)
- D. Productive cough
Explanation: ***Night sweats*** - While **night sweats** can be present in chronic infections, they are not considered a primary or defining clinical feature directly associated with the pathology of bronchiectasis itself. - They are more commonly linked with systemic conditions like **tuberculosis** or malignancy, which would require alternative diagnostic pathways. *Hemoptysis* - **Hemoptysis** (coughing up blood) is a common and often alarming symptom of bronchiectasis due to the inflammation and damage to the bronchial walls and underlying vasculature [1]. - Blood vessels in damaged airways are prone to rupture, leading to bleeding, which can range from blood-streaked sputum to massive hemorrhage [1]. *Chest pain* - **Chest pain** can occur in bronchiectasis, often related to the chronic cough, pleural inflammation, or musculoskeletal strain from persistent coughing. - It can also be a symptom if there's an associated infection or inflammation extending to the pleura. *Productive cough* - A **chronic productive cough** with significant amounts of purulent sputum is the hallmark symptom of bronchiectasis [1]. - This is due to the impaired mucociliary clearance and chronic infection within the dilated, damaged airways .
Question 79: The physiological marker of the last stage of acute asthma is
- A. Hypocapnia
- B. Hyperoxia
- C. Alkalosis
- D. Increased carbon dioxide levels (Hypercapnia) (Correct Answer)
Explanation: ***Increased carbon dioxide levels (Hypercapnia)*** - In severe, acute asthma, **air trapping** and **muscle fatigue** lead to inadequate ventilation and impaired gas exchange [1]. - This results in a buildup of carbon dioxide in the blood, indicating impending **respiratory failure** and a critical stage of the asthma exacerbation [3]. *Hypocapnia* - **Hypocapnia**, or low blood CO2, is common in the **early stages** of an asthma attack due to **tachypnea** (rapid breathing) in an effort to compensate [1]. - As the condition worsens, the ability to ventilate adequately diminishes, leading to CO2 retention [3]. *Hyperoxia* - **Hyperoxia** means abnormally high levels of oxygen in the blood, which is generally not a physiological marker of acute asthma. - Patients with acute asthma typically experience **hypoxemia** (low oxygen levels) due to ventilation-perfusion mismatch [1]. *Alkalosis* - **Respiratory alkalosis** (high pH due to low CO2) can occur in the early stages as patients **hyperventilate**. - However, in the late stages, as CO2 builds up (**hypercapnia**), the patient shifts towards **respiratory acidosis** (low pH), which is a sign of severe compromise [2], [3].
Question 80: Which of the following is a characteristic finding in distal RTA?
- A. Urine pH < 5.5
- B. Hypokalemia
- C. Hypercalciuria (Correct Answer)
- D. Nephrolithiasis
Explanation: ***Hypercalciuria*** - **Hypercalciuria** is a characteristic finding in distal RTA (Type 1), leading to increased calcium in the urine. - This occurs due to reduced **distal tubular reabsorption of calcium** and increased bone resorption from chronic acidosis. *Urine pH < 5.5* - In distal RTA, the kidneys are unable to acidify the urine properly, leading to a **urine pH > 5.5** [1]. - A urine pH < 5.5 would suggest a normal kidney response to systemic acidosis, ruling out distal RTA. *Hypokalemia* - While hypokalemia can occur in distal RTA, it is not always present and is not the most definitive characteristic finding. - **Hypokalemia** is more characteristic of Type 1 RTA due to increased potassium excretion in an attempt to excrete H+ ions. *Nephrolithiasis* - **Nephrolithiasis** (kidney stones) is a common complication of distal RTA due to hypercalciuria and alkaline urine [2]. - However, hypercalciuria is the *reason* for the increased risk of nephrolithiasis, making it a more fundamental characteristic finding.