NEET-PG 2021 - Internal Medicine Practice Questions

Q: A 12-year-old boy presents with weak pulses in the upper limbs, a blood pressure of 90/60 mmHg , and retinal hemorrhages. What is the most likely diagnosis?

Takayasu arteritis. ***Takayasu arteritis*** - **Weak pulses** in the upper limbs, **lower blood pressure** (90/60 mmHg), and **retinal hemorrhages** are classic signs of Takayasu arteritis, which primarily affects the aortic arch and its major branches. [1] - This condition is also known as "pulseless disease" due to the significant narrowing of peripheral arteries, leading to diminished or absent pulses. [1] *Henoch-Schönlein purpura (HSP)* - HSP is characterized by a **palpable purpuric rash**, **arthralgia**, **abdominal pain**, and **renal involvement** (hematuria/proteinuria), none of which are explicitly mentioned here. - It typically affects **small vessels** and does not cause weak pulses in the upper limbs or systemic hypotension in this manner. *Polyarteritis nodosa (PAN)* - PAN is a **necrotizing vasculitis** of medium-sized arteries, often presenting with **fever**, **weight loss**, **myalgia**, and visceral infarcts. - While it can affect various organs, it does not typically cause the specific pattern of weak upper limb pulses and retinal hemorrhages observed here, which points to large vessel involvement. *Microscopic polyangiitis* - This is a **small-vessel vasculitis** characterized by **glomerulonephritis** and **pulmonary capillaritis**, often presenting with hemoptysis and rapidly progressive renal failure. - It does not cause the large vessel symptoms like weak upper limb pulses or significant systemic hypotension seen in the patient.

Q: A 26-year-old male presents with backache, morning stiffness, reduced chest expansion, and reddening of the eyes. The X-ray provided is shown below. What is the most likely diagnosis?

Ankylosing spondylitis. ***Ankylosing spondylitis*** - The patient's symptoms of **backache, morning stiffness, reduced chest expansion**, and **reddening of the eyes** (uveitis) are classic manifestations of ankylosing spondylitis. The X-ray image (though somewhat obscured) shows signs consistent with **sacroiliitis** and possibly early **syndesmophyte formation**, leading to a "bamboo spine" appearance which is pathognomonic. - This condition is a **chronic inflammatory disease** primarily affecting the spine and sacroiliac joints, more common in young men. *Osteopetrosis* - This is a rare genetic disorder characterized by **increased bone density** due to defective osteoclast function, leading to bone fragility. - Clinical features usually include **fractures**, cranial nerve palsies due to narrowed foramina, and **hematologic abnormalities** due to marrow obliteration, not inflammatory back pain or uveitis. *Paget's disease* - **Paget's disease of bone** involves localized areas of excessive bone turnover, leading to disorganized bone structure. - It typically affects older individuals and presents with **bone pain**, skull enlargement, and hearing loss, rather than inflammatory back pain and uveitis in a young male. *Rheumatoid arthritis* - Rheumatoid arthritis is a **chronic autoimmune disease** primarily affecting the **synovial joints**, mostly small joints, symmetrically. - While it can cause systemic inflammation, it typically spares the axial skeleton, and symptoms like severe morning stiffness and reduced chest expansion with specific X-ray findings described are not characteristic.

Q: A 20-year-old patient presents with chronic low backache and early morning stiffness for the last 2 years. For the past 6 months, they have also experienced bilateral heel pain. What is the most likely diagnosis?

Ankylosing spondylitis. ***Ankylosing spondylitis*** - The combination of **chronic low backache** and **early morning stiffness** is highly characteristic of inflammatory back pain seen in ankylosing spondylitis. [1] - **Bilateral heel pain** (enthesitis) is a common extra-articular manifestation of ankylosing spondylitis, further supporting the diagnosis. [1] *Mechanical pain* - **Mechanical back pain** typically worsens with activity and improves with rest, in contrast to inflammatory back pain which improves with activity. [2] - It does not usually present with systemic features or enthesitis like heel pain. [2] *Disc prolapse* - **Disc prolapse** usually presents with radicular pain (nerve pain) that radiates down the leg, often unilateral, and is exacerbated by specific movements or coughing. - Early morning stiffness and bilateral heel pain are not typical features of a disc prolapse. *TB spine* - **TB spine** (Pott's disease) often presents with constitutional symptoms like fever, weight loss, and night sweats along with back pain, which are not mentioned here. - While it causes chronic back pain and stiffness, it's typically more localized with vertebral collapse and neurological deficits, and generally doesn't cause bilateral heel pain.

Q: A 50-year-old male presents with backache, morning stiffness, red eye, and ankle swelling. Based on the X-ray provided, what is the most likely diagnosis?

Ankylosing Spondylitis. ***Ankylosing Spondylitis*** - The X-ray likely shows features of **sacroiliitis** (joint space narrowing, sclerosis, erosion) and possibly **vertebral fusion**, consistent with ankylosing spondylitis. The clinical presentation of **backache, morning stiffness, red eye (uveitis), and ankle swelling (enthesitis)** are classic extra-articular manifestations and peripheral arthritis of ankylosing spondylitis. - X-ray findings like **bamboo spine** (late stage), syndesmophytes, and erosions of the sacroiliac joints are characteristic of this seronegative spondyloarthropathy. *Paget's Disease* - Paget's disease is characterized by disorganized bone remodeling, leading to bone enlargement, deformity, and increased density or lysis. It typically does not present with **sacroiliitis** or widespread **ankylosis**. - Clinical features usually include **bone pain**, **bone deformities**, and potentially **nerve compression**, which are not the primary symptoms described. *Healed TB spine* - Healed TB spine (Pott's disease) would typically show bone destruction, collapse of vertebral bodies, **kyphosis**, and often calcified abscesses. - While backache can occur, the presence of **red eye** and **ankle swelling** are not characteristic of spinal tuberculosis. *Osteopetrosis* - Osteopetrosis is a rare genetic disorder characterized by **increased bone density** due to defective osteoclast function, leading to abnormally thick and brittle bones. - The X-ray would show **generalized sclerosis** (diffuse increased bone density) throughout the skeleton, which is not the primary finding indicated by the clinical context of sacroiliitis and joint fusion.

Question 1

A 12-year-old boy presents with weak pulses in the upper limbs, a blood pressure of 90/60 mmHg , and retinal hemorrhages. What is the most likely diagnosis?

Accepted Answer

Takayasu arteritis

Answer

Henoch-Schönlein purpura (HSP)

Answer

Polyarteritis nodosa (PAN)

Answer

Microscopic polyangiitis

Question 2

A 26-year-old male presents with backache, morning stiffness, reduced chest expansion, and reddening of the eyes. The X-ray provided is shown below. What is the most likely diagnosis?

Accepted Answer

Ankylosing spondylitis

Answer

Osteopetrosis

Answer

Paget's disease

Answer

Rheumatoid arthritis

Question 3

A 20-year-old patient presents with chronic low backache and early morning stiffness for the last 2 years. For the past 6 months, they have also experienced bilateral heel pain. What is the most likely diagnosis?

Accepted Answer

Ankylosing spondylitis

Answer

Mechanical pain

Answer

Disc prolapse

Answer

TB spine

Question 4

A 50-year-old male presents with backache, morning stiffness, red eye, and ankle swelling. Based on the X-ray provided, what is the most likely diagnosis?

Accepted Answer

Ankylosing Spondylitis

Answer

Paget's Disease

Answer

Healed TB spine

Answer

Osteopetrosis

NEET-PG 2021 — Internal Medicine