INI-CET 2022 - Internal Medicine Practice Questions

Q: What is the most common site of abdominal tuberculosis?

Ileocecal junction. ***Ileocecal junction*** - The **ileocecal junction** is the most common site for abdominal tuberculosis due to its rich lymphoid tissue (Peyer's patches) and physiological stasis. - Tuberculous infection at this site can lead to **mucosal ulceration**, stricture formation, and mass lesions. *Colon* - While the colon can be affected by abdominal tuberculosis, it is **less common** than the ileocecal region. - Colonic involvement often presents with symptoms such as abdominal pain, diarrhea, and weight loss. *Small intestine* - Though other parts of the small intestine can be involved, the **distal ileum** and its junction with the cecum are disproportionately affected. - Involvement of the jejunum and duodenum is less frequent. *Rectum* - **Rectal involvement** in abdominal tuberculosis is rare and typically occurs in conjunction with more extensive colonic or disseminated disease. - Symptoms may include tenesmus, rectal bleeding, or fistula formation.

Q: A woman presents with altered sensorium, breathlessness, hypotension and bradycardia. Examination revealed non-pitting edema of the extremities. She has a long -standing history of weight gain, constipation, cold intolerance, and menorrhagia. What is the most likely diagnosis?

Myxedema coma. ***Myxedema coma*** - The constellation of **altered sensorium**, **hypotension**, **bradycardia**, and **non-pitting edema** in a patient with a history of **weight gain**, **constipation**, **cold intolerance**, and **menorrhagia** (symptoms of hypothyroidism) is highly suggestive of myxedema coma [2]. - This is an **extreme manifestation of severe, untreated hypothyroidism**, characterized by decompensation of multiple organ systems. *Hyperthyroidism* - Hyperthyroidism usually presents with symptoms like **tachycardia**, **tremors**, **weight loss**, and **heat intolerance** [1], [3], which are contrary to the patient's presentation. - It would not explain the **bradycardia**, **non-pitting edema**, or chronic symptoms like **constipation** and **cold intolerance**. *Cardiogenic shock* - While cardiogenic shock can cause **hypotension** and **altered sensorium**, it is typically characterized by signs of **cardiac dysfunction** such as elevated JVP, crackles, and often **tachycardia** (reflexive or primary), not bradycardia [4]. - It does not account for the **long-standing hypothyroid symptoms** like weight gain, constipation, and cold intolerance. *Septic shock* - Septic shock is primarily due to a severe infection, leading to **fever** (though hypothermia can occur in severe cases), **leukocytosis**, and signs of systemic inflammatory response (SIRS), which are not mentioned. - The patient's chronic symptoms are inconsistent with an acute infectious process as the primary cause of shock.

Q: A patient presented with ipsilateral Horner's syndrome, ipsilateral loss of pain and temperature sensations in the face, vertigo with numbness and loss of sweating and dysarthria on the contralateral side. All these symptoms are caused due to a lesion in:

B and D. ***B and D*** - This complex of symptoms, including ipsilateral **Horner's syndrome**, ipsilateral facial **pain and temperature loss**, **vertigo**, and contralateral **pain and temperature loss** on the body, is characteristic of **Wallenberg syndrome**, also known as **lateral medullary syndrome**. - Wallenberg syndrome is caused by an infarction in the **vertebral artery** (dorsal portion) or its branch, the **posterior inferior cerebellar artery (PICA)**, which supplies the lateral medulla. *A and B* - This option refers to lesions in the **medial medulla**, which would present with completely different symptoms such as contralateral **hemiplegia**, contralateral **loss of proprioception**, and ipsilateral **tongue deviation**. - While both medulla, the distinct clinical presentations differentiate **medial from lateral medullary lesions**. *B, C, D* - This combination attempts to incorporate a lesion in the **medial medulla** (C) with the other relevant areas. - However, the symptom complex clearly points to **lateral medullary involvement**, and including the medial medulla would suggest a different or more extensive stroke. *A, B, C* - This option includes the **anterior spinal artery**, which primarily supplies the **medial medulla** and spinal cord, leading to distinct symptoms. - Involvement of the **anterior spinal artery** would result in motor deficits and loss of pain/temperature on the contralateral side, but would not typically cause **Horner's syndrome** or the intense **vertigo** seen in lateral medullary syndrome.

Q: Seminal vesicles and vas deferens would be bilaterally absent congenitally in which of the following conditions?

Cystic fibrosis. ***Cystic fibrosis*** - **Congenital bilateral absence of the vas deferens (CBAVD)** is found in over 95% of males with cystic fibrosis, often leading to infertility. - This condition results from mutations in the **CFTR gene**, which is responsible for chloride transport, causing thick, viscous secretions that block or prevent the development of these structures. *Kartagener syndrome* - This syndrome is a subgroup of **primary ciliary dyskinesia**, characterized by a triad of *situs inversus*, chronic sinusitis, and bronchiectasis. - While it causes **infertility due to immotile sperm**, the male reproductive tract organs like the vas deferens and seminal vesicles are typically present. *Klinefelter syndrome* - Individuals with Klinefelter syndrome have a **47,XXY karyotype** and typically present with small testes, azoospermia, and hypogonadism [1]. - However, the **vas deferens and seminal vesicles are usually present**, though they may be underdeveloped or dysfunctional. *Kallmann syndrome* - This is a form of **hypogonadotropic hypogonadism** associated with anosmia or hyposmia (impaired sense of smell). - It results from a failure of GnRH-producing neurons to migrate to the hypothalamus, affecting hormone production, but the **anatomical structures of the vas deferens and seminal vesicles are usually intact**.

Q: All the following are criteria for SIRS, except

Systolic blood pressure 90/min* - An elevated **heart rate** (tachycardia) is a common physiological response to systemic stress and inflammation. - This criterion fulfills one of the four clinical parameters to diagnose **SIRS**. *Respiratory rate >20 bpm* - An increased **respiratory rate** (tachypnea) reflects the body's attempt to compensate for metabolic acidosis or increased oxygen demand during a systemic inflammatory response. - This criterion is one of the four clinical parameters used to diagnose **SIRS**. *Temperature >38 degree Celsius or 38°C) and **hypothermia** (<36°C) are indicators of a systemic inflammatory response, as the body's thermoregulation is affected [1]. - This criterion is one of the four principal parameters used to diagnose **SIRS** [1].

Q: Abdominal TB can occur through all of the following EXCEPT

Direct contact with infected animal. ***Direct contact with infected animal*** - While animal products like **unpasteurized milk** can transmit *Mycobacterium bovis* to humans, direct contact with an infected animal is not a primary mode of transmission for **abdominal TB**. - **Abdominal TB** is usually caused by *Mycobacterium tuberculosis* which is primarily a human pathogen, not typically transmitted through direct contact with animals. *Direct spread from mesenteric lymph nodes* - **Mesenteric lymph nodes** are often involved in abdominal TB, and the infection can directly spread from these nodes to adjacent abdominal organs. - This is a common mechanism for localized propagation within the abdominal cavity. *Feco - oral route* - The **ingestion of contaminated food or milk** (from infected cattle) containing *Mycobacterium bovis* or swallowing of **infected sputum** (from pulmonary TB) containing *Mycobacterium tuberculosis* are common ways the bacteria can reach the gastrointestinal tract. - This leads to primary intestinal infection or reactivation of previously ingested bacteria. *Hematogenous spread* - **Hematogenous dissemination** from a primary pulmonary or other mycobacterial focus is a significant mode of transmission for abdominal TB. - Bacteria can travel through the bloodstream and seed distant abdominal organs, including the **peritoneum**, **intestines**, or **mesenteric lymph nodes**.

Question 1

What is the most common site of abdominal tuberculosis?

Accepted Answer

Ileocecal junction

Answer

Colon

Answer

Small intestine

Answer

Rectum

Question 2

A woman presents with altered sensorium, breathlessness, hypotension and bradycardia.
Examination revealed non-pitting edema of the extremities. She has a long -standing history of weight gain, constipation, cold intolerance, and menorrhagia. What is the most likely diagnosis?

Accepted Answer

Myxedema coma

Answer

Hyperthyroidism

Answer

Cardiogenic shock

Answer

Septic shock

Question 3

A patient presented with ipsilateral Horner's syndrome, ipsilateral loss of pain and temperature sensations in the face, vertigo with numbness and loss of sweating and dysarthria on the contralateral side. All these symptoms are caused due to a lesion in:

Accepted Answer

B and D

Answer

A and B

Answer

B, C, D

Answer

A, B, C

Question 4

Seminal vesicles and vas deferens would be bilaterally absent congenitally in which of the following conditions?

Accepted Answer

Cystic fibrosis

Answer

Kartagener syndrome

Answer

Klinefelter syndrome

Answer

Kallmann syndrome

Question 5

All the following are criteria for SIRS, except

Accepted Answer

Systolic blood pressure <90 mmHg

Answer

Heart rate >90/min

Answer

Respiratory rate >20 bpm

Answer

Temperature >38 degree Celsius or <36 degree Celsius

Question 6

Abdominal TB can occur through all of the following EXCEPT

Accepted Answer

Direct contact with infected animal

Answer

Direct spread from mesenteric lymph nodes

Answer

Feco - oral route

Answer

Hematogenous spread

INI-CET 2022 — Internal Medicine