NEET-PG 2015 - Internal Medicine Practice Questions

Q: In evaluation of a case of immotile nasal cilia, which of the following investigations should prove useful?

Nitric oxide test. Nitric oxide test - A low nasal nitric oxide (nNO) concentration is a key diagnostic criterion for Primary Ciliary Dyskinesia (PCD), a genetic disorder characterized by immotile or dyskinetic cilia [1]. - Nasal NO is significantly reduced in PCD patients due to impaired ciliary function, making this test highly useful for screening. *Rhinogram* - A rhinogram is a radiographic imaging technique primarily used to visualize the nasal cavity and paranasal sinuses, often to detect structural abnormalities or foreign bodies. - It does not directly assess ciliary function or provide information about ciliary motility. *Sweat sodium levels* - Elevated sweat chloride or sodium levels are the diagnostic hallmark of cystic fibrosis, a genetic condition primarily affecting mucus production. - While cystic fibrosis can cause respiratory symptoms, it does not directly lead to immotile nasal cilia in the same manner as PCD. *Xray nasal and paranasal sinuses* - An X-ray of the nasal and paranasal sinuses can reveal structural issues, such as sinus opacification or polyps, which may accompany ciliary dysfunction. - However, it does not provide direct information about the motility or structural integrity of the cilia themselves.

Q: Saddle nose deformity is seen in?

Tertiary Syphilis. ***Tertiary Syphilis*** - **Saddle nose deformity** is a characteristic late manifestation of **tertiary syphilis** due to destructive lesions (gummas) affecting the nasal cartilage and bone [1], [2]. - It results from the **collapse of the nasal bridge**, leading to a flattened appearance [2]. *Primary Syphilis* - Characterized by a **chancre**, a painless ulcer, usually at the site of infection [1]. - This stage does not involve destructive lesions of the nose. *Secondary Syphilis* - Presents with a **widespread rash**, lymphadenopathy, and mucous patches [1]. - While systemic, it typically does not cause structural damage like saddle nose deformity. *Lupus Vulgaris* - This is a **cutaneous form of tuberculosis**, characterized by chronic, destructive skin lesions. - While it can cause facial disfigurement, saddle nose deformity is not a typical feature of lupus vulgaris.

Q: Which of the following statements regarding Pertussis is INCORRECT?

Cerebellar ataxia is a known complication.. ***Cerebellar ataxia is a known complication.*** - **Cerebellar ataxia** is not a typical or known complication of pertussis. Complications usually involve the respiratory, neurological (e.g., seizures, encephalopathy due to hypoxia), and nutritional systems due to severe coughing. - While neurological complications can occur, **ataxia** specifically is not frequently sighted in the context of pertussis. *Some infections may be subclinical.* - Some individuals, especially those partially immunized or older, can experience **subclinical or atypical infections** with pertussis, often presenting as a mild cough. - This characteristic makes it difficult to control the spread of the disease as infected individuals may not be recognized. *The most infective stage is the catarrhal stage.* - The **catarrhal stage**, characterized by non-specific cold-like symptoms, is the most contagious phase because bacterial shedding is highest. - During this stage, symptoms are mild and often indistinguishable from a common cold, leading to widespread transmission before diagnosis. *The drug of choice is Erythromycin.* - **Erythromycin**, or other macrolides like azithromycin or clarithromycin, are the drugs of choice for treating pertussis. - These antibiotics are most effective when administered early in the **catarrhal stage** to reduce disease severity and prevent transmission.

Q: Clicking noise in Pneumomediastinum is known as

Hamman's sign. Hamman's sign - Hamman's sign is a crunching, bubbling, or clicking sound synchronous with the heartbeat, audible on auscultation over the precordium. - It is pathognomonic for pneumomediastinum, caused by the heart beating against air-filled tissues. Traube's sign - Traube's sign refers to a pistol-shot sound heard over the femoral artery in severe aortic regurgitation [1]. - It is a vascular sign and not related to pneumomediastinum. Kussmaul's sign - Kussmaul's sign is a paradoxical rise in jugular venous pressure (JVP) during inspiration. - It is typically seen in conditions like constrictive pericarditis or right ventricular infarction, not pneumomediastinum. None of the options - This option is incorrect because Hamman's sign accurately describes the clicking noise associated with pneumomediastinum. - The other options refer to different clinical phenomena unrelated to pneumomediastinum.

Q: What is the most common form of leptospirosis?

Anicteric form. ***Anicteric form*** - The **anicteric form** accounts for about 90% of all leptospirosis cases, presenting with milder, flu-like symptoms without jaundice. - Patients typically experience **fever, headache, myalgia**, and conjunctival suffusion during the initial septicemic phase [1], followed by an immune phase that can involve meningitis or uveitis [1]. *Icteric form* - The **icteric form** (Weil's disease) is a severe manifestation, characterized by jaundice, renal failure, and hemorrhage, occurring in a minority of cases (5-10%). - Although more severe and often life-threatening, it is **less common** than the anicteric presentation [1]. *Hepatorenal form* - This term describes the severe complications of leptospirosis, including **liver and kidney dysfunction**, specifically associated with Weil's disease. - While a critical aspect of severe leptospirosis, it is a description of the organ involvement rather than a distinct common form of the disease. *Weil's disease* - **Weil's disease** is the most severe and potentially fatal form of leptospirosis, characterized by **jaundice, renal failure, hemorrhage, and myocarditis**. - It is a severe subset of the icteric form, making it a very serious but **uncommon variant** of the overall disease.

Q: What is the primary cause of Common Variable Immunodeficiency (CVID)?

Defective B cell differentiation. ***Defective B cell differentiation*** - CVID is characterized primarily by a failure of **B cells** to differentiate into **plasma cells**, which are responsible for producing antibodies [1]. - This defective differentiation leads to **hypogammaglobulinemia**, or low levels of immunoglobulins [1]. *Absent B cells* - Complete absence of B cells is characteristic of severe combined immunodeficiency (SCID) or X-linked agammaglobulinemia (XLA), not CVID [1]. - In CVID, B cells are typically present, but they are dysfunctional. *Reduced number of B cells* - While some patients with CVID may have reduced B cell numbers, this is not the primary or defining defect. - The key issue is the inability of existing B cells to mature and produce antibodies effectively. *Defective B cell function* - While B cell function is indeed defective in CVID, the root cause of this malfunction is specifically the **failure of differentiation** into mature plasma cells. - The B cells are unable to perform their primary function of antibody production due to this arrest in their development.

Q: ABO non- secretors are more prone to ?

Increased risk of infections. Increased risk of infections - Non-secretors of ABO antigens exhibit an increased susceptibility to a variety of infections, particularly bacterial and viral pathogens. - This is thought to be due to the absence of ABO antigens in secretions, which typically act as decoy receptors to prevent pathogen adhesion to host cells. Autoimmune diseases - While some associations between ABO blood groups and autoimmune diseases exist, non-secretor status is not consistently linked to a higher overall risk of autoimmune conditions. Cardiovascular diseases - ABO blood groups have been associated with cardiovascular risk, with non-O blood types generally having a slightly higher risk of certain cardiovascular events. - However, secretor status (the ability to secrete ABO antigens into bodily fluids) itself is not a prominent independent risk factor for cardiovascular diseases. Cancer - There are some documented associations between specific ABO blood types and certain types of cancer (e.g., non-O blood types with pancreatic cancer), but this is distinct from secretor status. - Being an ABO non-secretor is not a primary, broadly recognized risk factor for developing cancer.

Q: What is the most common arrhythmia in ICU patients?

Atrial fibrillation. ***Atrial fibrillation*** - **Atrial fibrillation (AF)** is the most prevalent arrhythmia in the general population [1], and its incidence is significantly higher in critically ill patients due to various stressors. - Factors like **sepsis**, **hypoxemia**, **electrolyte imbalances**, **myocardial ischemia**, and **inflammatory states** common in the ICU are known triggers for new-onset AF. *Atrial flutter* - While atrial flutter is a common arrhythmia, its overall incidence in the ICU setting is **less frequent than atrial fibrillation**. - It often involves a **re-entrant circuit** in the right atrium [2], leading to characteristic "sawtooth" waves on ECG. *Atrial Tachycardia* - Atrial tachycardia is a form of **supraventricular tachycardia (SVT)** that originates in the atria but is **less common** than AF in the ICU [2]. - It often presents as a **regular, narrow-complex tachycardia** with discrete P waves. *Supraventricular Tachycardia* - This is a broad term encompassing arrhythmias that originate **above the ventricles** [3], including AF, atrial flutter, and atrial tachycardia. - While SVT as a category is common, **atrial fibrillation is the single most frequent specific arrhythmia** within this group in the ICU.

Q: Buboes form is which stage of LGV?

Secondary. ***Secondary*** - Buboes, which are swollen, painful lymph nodes, are a hallmark of the **secondary stage** of **Lymphogranuloma Venereum (LGV)** [1]. - This stage typically develops weeks after the initial infection, following the unnoticed or transient primary lesion. *Primary* - The primary stage of LGV is characterized by a **small, painless papule or ulcer** at the site of inoculation, which often goes unnoticed. - **Buboes are not formed** during this initial, often asymptomatic, phase. *Tertiary* - The tertiary stage of LGV involves **chronic inflammation** and **tissue destruction**, leading to complications like **genital elephantiasis**, rectal strictures, and fistulas. - While there is chronic lymphedema, the acute, painful buboes are characteristic of the secondary stage, not this late, destructive phase. *Latent* - The concept of a latent stage is not typically used to describe the progression of LGV in the same way as other infections like syphilis. - LGV progresses through distinct symptomatic primary, secondary, and potentially tertiary stages without a prolonged asymptomatic latency period between symptom presentations.

Q: What is the PRIMARY evidence-based intervention for preventing catheter-associated urinary tract infections (CAUTIs)?

Closed drainage technique to minimize bacterial entry. ***Closed drainage technique to minimize bacterial entry*** - Maintaining a **closed drainage system** prevents the entry of bacteria into the urinary tract, which is a primary cause of CAUTIs. - This technique involves ensuring the connection between the catheter and the drainage bag remains sealed at all times, minimizing **environmental contamination**. *Prophylactic antibiotics are effective* - **Prophylactic antibiotics** are generally not recommended for routine CAUTI prevention due to concerns about **antibiotic resistance** and limited evidence of effectiveness [1]. - Their use is typically reserved for specific high-risk procedures or patient populations. *Use of face mask during catheter insertion* - While maintaining **asepsis** during catheter insertion is crucial, the use of a face mask specifically addresses **respiratory droplet transmission**, which is not the primary route of bacterial entry into the urinary system during catheterization. - **Sterile gloves** and a **sterile field** are more directly relevant for preventing contamination during insertion [1]. *Early catheter removal when clinically appropriate* - While **early catheter removal** is a critical strategy for CAUTI prevention by reducing dwell time, the question asks for the *primary* evidence-based intervention [1]. A **closed drainage system** directly addresses the mechanism of bacterial entry while the catheter is in place. - Reducing catheter duration minimizes risk, but the closed system ensures safety during the necessary period of catheterization.

Question 1

In evaluation of a case of immotile nasal cilia, which of the following investigations should prove useful?

Accepted Answer

Nitric oxide test

Answer

Rhinogram

Answer

Sweat sodium levels

Answer

Xray nasal and paranasal sinuses

Question 2

Saddle nose deformity is seen in?

Accepted Answer

Tertiary Syphilis

Answer

Primary Syphilis

Answer

Secondary Syphilis

Answer

Lupus Vulgaris

Question 3

Which of the following statements regarding Pertussis is INCORRECT?

Accepted Answer

Cerebellar ataxia is a known complication.

Answer

The drug of choice is Erythromycin.

Answer

Some infections may be subclinical.

Answer

The most infective stage is the catarrhal stage.

Question 4

Clicking noise in Pneumomediastinum is known as

Accepted Answer

Hamman's sign

Answer

Traube's sign

Answer

Kussmaul's sign

Answer

None of the options

Question 5

What is the most common form of leptospirosis?

Accepted Answer

Anicteric form

Answer

Icteric form

Answer

Hepatorenal form

Answer

Weil's disease

Question 6

What is the primary cause of Common Variable Immunodeficiency (CVID)?

Accepted Answer

Defective B cell differentiation

Answer

Defective B cell function

Answer

Absent B cells

Answer

Reduced number of B cells

Question 7

ABO non- secretors are more prone to ?

Accepted Answer

Increased risk of infections

Answer

Autoimmune diseases

Answer

Cardiovascular diseases

Answer

Cancer

Question 8

What is the most common arrhythmia in ICU patients?

Accepted Answer

Atrial fibrillation

Answer

Atrial flutter

Answer

Atrial Tachycardia

Answer

Supraventricular Tachycardia

Question 9

Buboes form is which stage of LGV?

Accepted Answer

Secondary

Answer

Tertiary

Answer

Latent

Answer

Primary

Question 10

What is the PRIMARY evidence-based intervention for preventing catheter-associated urinary tract infections (CAUTIs)?

Accepted Answer

Closed drainage technique to minimize bacterial entry

Answer

Use of face mask during catheter insertion

Answer

Prophylactic antibiotics are effective

Answer

Early catheter removal when clinically appropriate

NEET-PG 2015 — Internal Medicine