Buboes form is which stage of LGV?
What is the PRIMARY evidence-based intervention for preventing catheter-associated urinary tract infections (CAUTIs)?
All are seen in Nephrotic syndrome except
Wide pulse pressure is seen in all except which of the following?
The severity of mitral stenosis can be judged by-
Which condition is not associated with complement deficiency?
Becks triad is seen in
Duroziez's sign is associated with which of the following conditions?
Which of the following statements about atrial myxomas is correct?
Murmur heard in aortic stenosis
NEET-PG 2015 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 61: Buboes form is which stage of LGV?
- A. Secondary (Correct Answer)
- B. Tertiary
- C. Latent
- D. Primary
Explanation: ***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.
Question 62: What is the PRIMARY evidence-based intervention for preventing catheter-associated urinary tract infections (CAUTIs)?
- A. Use of face mask during catheter insertion
- B. Prophylactic antibiotics are effective
- C. Early catheter removal when clinically appropriate
- D. Closed drainage technique to minimize bacterial entry (Correct Answer)
Explanation: ***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 63: All are seen in Nephrotic syndrome except
- A. Atherosclerosis
- B. Thrombo-embolism
- C. Lipiduria
- D. Increased protein C levels (Correct Answer)
Explanation: ***Increased protein C levels*** - In **nephrotic syndrome**, there is an **increased urinary loss of anticoagulant proteins**, including **Protein C** and **Protein S**, leading to a state of **hypercoagulability**. [1] - Therefore, **Protein C levels are decreased**, not increased, making this the exception. *Atherosclerosis* - **Hyperlipidemia**, a hallmark of nephrotic syndrome, contributes significantly to **accelerated atherosclerosis** due to dysregulation of lipid metabolism. - The increased levels of **LDL cholesterol** and other lipoproteins promote plaque formation and arterial stiffening. *Thrombo-embolism* - Patients with nephrotic syndrome are at a significantly **increased risk of thromboembolic events**, such as deep vein thrombosis and pulmonary embolism, due to a **hypercoagulable state**. - This state results from the **urinary loss of anticoagulant proteins** (e.g., antithrombin III, Protein C, Protein S) and increased levels of procoagulant factors (e.g., fibrinogen, factor V, factor VIII). *Lipiduria* - **Lipiduria**, the presence of lipids in the urine, is a characteristic feature of nephrotic syndrome, often manifested as **oval fat bodies** and **fatty casts**. [1] - This occurs due to the increased glomerular permeability that allows lipoproteins to filter into the urine. [1]
Question 64: Wide pulse pressure is seen in all except which of the following?
- A. Aortic Regurgitation
- B. PDA
- C. A.V. malformation
- D. Aortic stenosis (Correct Answer)
Explanation: **Aortic stenosis** - In **aortic stenosis**, there is a fixed obstruction to left ventricular outflow, leading to a compensatory increase in systolic pressure to overcome the stenotic valve [2]. - The **reduced stroke volume** and impaired flow through the rigid valve cause a lower pulse pressure, often resulting in a **narrow pulse pressure**. *PDA (Patent Ductus Arteriosus)* - In **PDA**, blood flows from the aorta to the pulmonary artery during systole and diastole, causing a decrease in diastolic pressure. - This creates a **run-off phenomenon**, leading to a **wide pulse pressure** due to high systolic and low diastolic pressures. *Aortic Regurgitation* - **Aortic regurgitation** involves blood flowing back into the left ventricle during diastole, causing a rapid fall in diastolic pressure [1]. - The increased stroke volume from the left ventricle leads to a high systolic pressure, resulting in a **wide pulse pressure** [1]. *A.V. malformation (Arteriovenous Malformation)* - An **AV malformation** creates a shunt where arterial blood flows directly into the venous system, bypassing the capillary bed. - This leads to a **decrease in peripheral resistance** and an increased cardiac output, causing a higher systolic pressure and a lower diastolic pressure, thereby producing a **wide pulse pressure**.
Question 65: The severity of mitral stenosis can be judged by-
- A. Duration of murmur
- B. Intensity of murmur
- C. Presence of left ventricular S3
- D. Loud S1 (Correct Answer)
Explanation: ***Loud S1*** - A **loud S1** in mitral stenosis indicates that the **mitral valve leaflets are still mobile** and able to snap shut forcefully, which is characteristic of early to moderate stenosis [2]. - As mitral stenosis becomes more severe and the valve becomes calcified and rigid, the S1 sound may become diminished or even absent due to reduced leaflet mobility [1]. *Intensity of murmur* - The **intensity (loudness)** of the diastolic murmur in mitral stenosis **does not directly correlate with the severity** of the stenosis. - A loud murmur can be heard with mild stenosis, while a soft murmur in severe stenosis may be due to reduced cardiac output or left atrial pressure. *Duration of murmur* - While a **longer duration of the diastolic murmur** can coincide with more severe mitral stenosis, it is not as reliable a single indicator as other findings. - The duration is influenced by the pressure gradient across the valve and the length of diastole [2]. *Presence of left ventricular S3* - A **left ventricular S3** is typically associated with **left ventricular dysfunction** and volume overload, as seen in conditions like mitral regurgitation or dilated cardiomyopathy [3]. - It is **not a feature of mitral stenosis**, where the primary issue is obstruction to left ventricular filling.
Question 66: Which condition is not associated with complement deficiency?
- A. SLE
- B. PNH
- C. Membranous nephritis (Correct Answer)
- D. Hereditary angioedema
Explanation: Membranous nephritis - Membranous nephritis is associated with immune complex deposition rather than complement deficiencies. [1] - The disease is characterized by thickening of the glomerular basement membrane without significant complement involvement. [1] PNH - Paroxysmal nocturnal hemoglobinuria (PNH) is due to a defect in the GPI-anchor leading to complement-mediated hemolysis. - Complement activation plays a critical role in the destruction of red blood cells in this condition. Hereditary angioedema - Hereditary angioedema is caused by deficiencies in C1 inhibitor, leading to uncontrolled activation of complement. - This results in edema episodes, directly linked to complement pathway dysregulation. SLE - Systemic lupus erythematosus (SLE) involves complement consumption due to autoantibody formation against nuclear antigens. - The disease often presents with hypocomplementemia, indicating complement system involvement.
Question 67: Becks triad is seen in
- A. Cardiac tamponade (Correct Answer)
- B. Restrictive cardiomyopathy
- C. Constrictive pericarditis
- D. None of the options
Explanation: ***Cardiac tamponade*** - **Beck's triad** is a set of three clinical signs associated with acute cardiac tamponade: **hypotension**, **jugular venous distension (JVD)**, and **muffled heart sounds**. [1] - These signs result from the accumulation of fluid in the pericardial sac, which compresses the heart and impairs its ability to fill. [1] *Constrictive pericarditis* - While it can manifest with JVD and signs of right heart failure, **muffled heart sounds** and acute **hypotension** as part of Beck's triad are not typical for its chronic nature. [2] - It involves a rigid, fibrotic pericardium that restricts diastolic filling, often with a **pericardial knock** rather than muffled sounds. [2] *Restrictive cardiomyopathy* - This condition involves impaired ventricular relaxation and filling, leading to signs of heart failure, including JVD. [3] - However, it does not typically present with the acute, severe **hypotension** or **muffled heart sounds** characteristic of cardiac tamponade. [3] *None of the options* - This option is incorrect as cardiac tamponade is the condition associated with Beck's triad.
Question 68: Duroziez's sign is associated with which of the following conditions?
- A. Aortic Regurgitation (Correct Answer)
- B. Pericardial effusion
- C. Tricuspid Regurgitation
- D. Mitral Stenosis
Explanation: ***Aortic Regurgitation*** - **Duroziez's sign** is a characteristic **systolic and diastolic bruit** heard over the femoral artery, indicative of significant **aortic regurgitation**. [1], [2] - This sign occurs due to the rapid antegrade and retrograde flow of blood during systole and diastole, respectively, caused by the incompetent aortic valve. [2] *Tricuspid Regurgitation* - **Tricuspid regurgitation** is primarily associated with **holosystolic murmur** best heard at the left lower sternal border, often increasing with inspiration (Carvallo's sign). - It does not produce arterial bruits like Duroziez's sign. *Pericardial effusion* - **Pericardial effusion** is characterized by the accumulation of fluid in the pericardial sac, which can lead to distant heart sounds, **pulsus paradoxus**, and electrical alternans on ECG. - It does not involve vascular bruits in peripheral arteries. *Mitral Stenosis* - **Mitral stenosis** classically presents with a **diastolic rumble** and an **opening snap**, typically heard at the apex. - It is a left-sided heart valve condition that does not cause peripheral arterial bruits.
Question 69: Which of the following statements about atrial myxomas is correct?
- A. More prevalent in males.
- B. Most myxomas are hereditary.
- C. Most commonly found in the Left Atrium. (Correct Answer)
- D. Distant metastasis is commonly observed.
Explanation: ***Most commonly found in the Left Atrium.*** - **Atrial myxomas** are typically found in the **left atrium** (approximately 75-80% of cases), often attached to the **interatrial septum** near the fossa ovalis. - Their presence in the left atrium can lead to **obstruction of the mitral valve**, causing symptoms mimicking mitral stenosis [1]. *More prevalent in males.* - **Atrial myxomas** are more common in **females** than males, with a female-to-male ratio of approximately 2:1. - This higher prevalence in women is a consistent finding in epidemiological studies of cardiac myxomas [2]. *Most myxomas are hereditary.* - The vast majority of **atrial myxomas** are **sporadic** (non-hereditary), accounting for about 90-95% of cases. - A small percentage (5-10%) are part of a familial syndrome known as **Carney complex**, which is an autosomal dominant disorder. *Distant metastasis is commonly observed.* - **Atrial myxomas** are generally **benign tumors** and do not metastasize to distant sites. - While they can embolize fragments, leading to systemic effects, these are not true metastases.
Question 70: Murmur heard in aortic stenosis
- A. Apex, low pitch murmur associated with mitral valve issues
- B. Pan-systolic murmur, high pitch murmur associated with mitral regurgitation
- C. Left Sternal area, murmur indicating mitral regurgitation
- D. Right 2nd intercostal, high pitch systolic ejection murmur (Correct Answer)
Explanation: ***Right 2nd intercostal, high pitch systolic ejection murmur*** - The murmur of **aortic stenosis** is classically heard loudest at the **right second intercostal space** (aortic area) due to turbulent flow through the stenosed aortic valve. - It is a **high-pitched, systolic ejection murmur** with a crescendo-decrescendo pattern, often radiating to the carotid arteries [2]. *Apex, low pitch murmur associated with mitral valve issues* - A murmur heard at the **apex** that is low-pitched typically suggests **mitral stenosis**, which is a diastolic rumble, not an aortic stenosis murmur [1]. - This option refers to characteristics associated with **mitral valve disease**, not aortic stenosis. *Pan-systolic murmur, high pitch murmur associated with mitral regurgitation* - A **pan-systolic murmur** is characteristic of conditions like **mitral regurgitation** or tricuspid regurgitation, where blood flows throughout the entire systole [3]. - While it can be high-pitched, its pan-systolic nature and association with mitral regurgitation make it distinct from aortic stenosis. *Left Sternal area, murmur indicating mitral regurgitation* - Murmurs heard primarily at the **left sternal area** can indicate various conditions, but this option specifically points to **mitral regurgitation**. - **Mitral regurgitation** is better heard at the apex and usually radiates to the axilla, and the description does not fit the typical presentation of aortic stenosis [3].