Which zone of the prostate is primarily involved in Benign Prostatic Hyperplasia (BPH)?
All of the following may lead to gall bladder carcinoma except which of the following?
Which of the following is NOT a common complication of acute pancreatitis?
Bilateral parotid enlargement occurs in all, Except:
Chronic hemolytic anaemia is associated with which of the following -
All of the following are features of Zollinger Ellison syndrome except:
Thyroid nodule in a 65 year old male who is clinically euthyroid is most likely to be
A 65 year old female presents with a swelling in the neck diagnosed as a solitary thyroid nodule. The patient is investigated and a scan shows increased uptake of iodine. Serum T3 and T4 are elevated . Most probabe diagnosis is
All of the following may lead to pneumatocele formation except which of the following?
Most common precipitant of Raynaud's phenomenon is
NEET-PG 2015 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 141: Which zone of the prostate is primarily involved in Benign Prostatic Hyperplasia (BPH)?
- A. Central zone
- B. Peripheral zone
- C. Transitional zone (Correct Answer)
- D. Prostate capsule
Explanation: ***Transitional zone*** - The **transitional zone** surrounds the urethra and is the primary site of origin and enlargement in **Benign Prostatic Hyperplasia (BPH)**. - Its hypertrophy leads to compression of the urethra, causing **lower urinary tract symptoms (LUTS)**. *Central zone* - The **central zone** surrounds the ejaculatory ducts and is less commonly involved in BPH. - It is more frequently associated with the development of **prostate carcinoma**. *Peripheral zone* - The **peripheral zone** is the largest zone of the prostate and is where the majority of prostate cancers originate. - While it can be affected by BPH, it is not the primary zone for hypertrophy. *Prostate capsule* - The **prostate capsule** is the outer fibrous layer that encloses the prostate gland. - It does not undergo hyperplasia in BPH; rather, it encases the enlarging gland.
Question 142: All of the following may lead to gall bladder carcinoma except which of the following?
- A. Gall Bladder Polyps
- B. Typhoid carriers
- C. Echinococcus Granulosus Infection (Correct Answer)
- D. Exposure to carcinogens like nitrosamine
Explanation: ***Echinococcus Granulosus Infection*** - Echinococcus granulosus is primarily associated with **hydatid cyst formation**, not directly linked to gallbladder carcinoma. - This infection typically affects the **liver** rather than inducing malignant transformation in the gallbladder. *Typhoid carriers* - Chronic infection with **Salmonella typhi** in carriers can cause **gallbladder inflammation** and is a risk factor for gallbladder cancer. - Typhoid carriers retain the bacteria in the gallbladder, leading to chronic irritation and potentially malignant changes. *Gall Bladder Polyps* - Certain types of gallbladder polyps, especially those larger than **1 cm**, have a significant risk of undergoing malignant transformation. - They are associated with **chronic inflammation** and may progress to cancer if not monitored. *Exposure to carcinogens like nitrosamine* - Nitrosamines are known **carcinogens** that can induce protein modifications leading to DNA damage, contributing to gallbladder cancer. - Long-term exposure to such chemicals can result in **cellular mutations** in the gallbladder epithelial lining.
Question 143: Which of the following is NOT a common complication of acute pancreatitis?
- A. Subcutaneous fat necrosis
- B. Hyperlipidemia
- C. Hypercalcemia (Correct Answer)
- D. Increased amylase level
Explanation: ***Hypercalcemia*** - Acute pancreatitis is primarily associated with **increased amylase levels** and **hyperlipidemia**, while hypercalcemia is generally a separate condition. - It is not a classical complication or result of acute pancreatitis, but rather might be a cause in cases like **hyperparathyroidism** [1]. *Subcutaneous fat necrosis* - This occurs as a result of **lipolysis** during acute pancreatitis due to the release of **lipases** into circulation [1]. - It is characterized by the presence of **fat necrosis** on the abdomen or buttocks. *Increased amylase level* - A hallmark of acute pancreatitis is **elevated levels of amylase** and sometimes lipase, indicating pancreatic inflammation [1]. - The rise typically occurs within the first 24 hours of the onset of pancreatitis. *Hyperlipidemia* - This is often found in acute pancreatitis due to excess **lipolysis**, leading to elevated triglycerides in the blood [1]. - It can be both a cause and a consequence of pancreatic inflammation, contributing to the disease process [1].
Question 144: Bilateral parotid enlargement occurs in all, Except:
- A. HIV
- B. SLE
- C. Chronic pancreatitis (Correct Answer)
- D. Mumps
Explanation: ***SLE*** - **Systemic Lupus Erythematosus (SLE)** typically does not present with **bilateral parotid enlargement**, which is more characteristic of other conditions. - Salivary gland involvement in SLE is less prevalent and usually not the primary clinical feature associated with the disease. *HIV* - **HIV** infection can lead to **bilateral parotid enlargement** due to associated conditions such as lymphadenopathy and infections like **salivary gland infections**. [1] - **Lymphoid tissue** hyperplasia in response to HIV is another factor contributing to this enlargement. *Sjogren's syndrome* - **Sjogren's syndrome** is a common cause of **bilateral parotid enlargement** due to inflammatory infiltrates affecting the salivary glands. - Patients typically experience **xerostomia** (dry mouth) and **xerophthalmia** (dry eyes) alongside gland enlargement [2]. *Chronic pancreatitis* - Patients with **chronic pancreatitis** may develop **bilateral parotid enlargement** due to associated changes such as **sialadenosis** from malnutrition and electrolyte imbalances. - The enlargement occurs as a **compensatory mechanism** related to the pancreatic pathology affecting nearby structures.
Question 145: Chronic hemolytic anaemia is associated with which of the following -
- A. Brown Pigment stone of the gall bladder
- B. Black Pigment stone of the gall bladder (Correct Answer)
- C. Uric acid Renal Calculus
- D. Intestinal Obstruction
Explanation: ***Black Pigment stone of the gall bladder*** - Chronic hemolytic anemia leads to increased **bilirubin**, particularly unconjugated bilirubin, which can result in the formation of **black pigment stones** [1]. - These stones are associated with conditions causing **excess bilirubin production**, such as sickle cell disease and thalassemia. *Brown Pigment stone of the gall bladder* - Brown pigment stones are primarily associated with **infection** and **biliary tract disorders**, not directly with chronic hemolytic anemia. - They are mainly composed of **calcium bilirubinate**, which arises in cases of **bacterial infections** or parasitic infestations. *Intestinal Obstruction* - While hemolytic anemia can have various complications, it is **not directly linked with intestinal obstruction**. - Obstruction typically arises from **mechanical causes** such as adhesions, tumors, or hernias, rather than from hemolytic processes. *Uric acid Renal Calculus* - Uric acid stones are formed due to conditions leading to **hyperuricemia** and are not a primary consequence of chronic hemolytic anemia. - They are often associated with **gout** and **certain metabolic disorders**, rather than hemolytic processes.
Question 146: All of the following are features of Zollinger Ellison syndrome except:
- A. Severe diarrhoea
- B. Beta cell tumours of the pancreas (Correct Answer)
- C. Very high acid output
- D. Intractable peptic ulcers
Explanation: ***Beta cell tumours of the pancreas*** - Zollinger-Ellison syndrome (ZES) is caused by **gastrinomas**, which are **neuroendocrine tumors** that typically arise from the **gastrin-producing G cells**, not the insulin-producing beta cells, of the pancreas or duodenum. - While pancreatic tumors are common in ZES, they are specifically **gastrinomas**, leading to excessive gastrin secretion. *Severe diarrhoea* - This is a common feature of ZES resulting from the **high acid output** reaching the small intestine. - The excessive acid inactivates pancreatic lipase, leading to **maldigestion** and stimulates fluid and electrolyte secretion, causing secretory diarrhea. *Very high acid output* - ZES is characterized by the **overproduction of gastrin**, which stimulates the parietal cells of the stomach to secrete large amounts of **hydrochloric acid**. - This leads to a significantly **increased basal and maximal acid output** in the stomach. *Intractable peptic ulcers* - The extremely high gastric acid secretion in ZES causes **multiple, recurrent, and often refractory peptic ulcers**, which can be located in atypical sites such as the jejunum. - These ulcers are typically difficult to treat with standard anti-ulcer medications due to the persistent gastric hypersecretion.
Question 147: Thyroid nodule in a 65 year old male who is clinically euthyroid is most likely to be
- A. Follicular adenoma (Correct Answer)
- B. Multinodular goiter
- C. Thyroid cyst
- D. Follicular carcinoma
Explanation: ***Follicular adenoma*** - Typically presents as a **solitary, well-defined nodule** in euthyroid patients, making it a common finding in this demographic. - It is often **benign** and can be differentiated from malignancies through imaging and cytological evaluation. *Multinodular goiter* - Usually involves multiple nodules rather than a **single nodule**, and patients often present with thyroid dysfunction [1]. - More common in women, and does not fit the profile of a solitary nodule in a euthyroid male. *Follicular Carcinoma* - While it can present as a nodule, it typically involves **elevated risk factors** such as family history and certain genetic mutations. - Euthyroid status alone is insufficient for a diagnosis of malignancy without further alarming features. *Thyroid Cyst* - Cysts are usually **fluid-filled** and may not present as solid nodules, which are common in cases described. - They tend to be **asymptomatic** and are generally **benign**, lacking the solid characteristics of a follicular adenoma.
Question 148: A 65 year old female presents with a swelling in the neck diagnosed as a solitary thyroid nodule. The patient is investigated and a scan shows increased uptake of iodine. Serum T3 and T4 are elevated . Most probabe diagnosis is
- A. Benign Thyroid Nodule
- B. Solitary Toxic Adenoma (Correct Answer)
- C. Follicular Carcinoma
- D. Toxic Multinodular Goiter
Explanation: A **solitary toxic adenoma** is a single thyroid nodule that autonomously produces thyroid hormones, leading to **hyperthyroidism**. The increased iodine uptake on scan reflects its hyperfunctional state, and elevated **T3/T4** confirms hyperthyroidism. [2] - The combination of a **solitary nodule**, **increased iodine uptake**, and **elevated thyroid hormone levels** is pathognomonic for a solitary toxic adenoma. [2] *Benign Thyroid Nodule* - A **benign thyroid nodule** without hyperfunction would typically show **normal or decreased iodine uptake** and **normal T3/T4** levels. [2] - While benign, such a nodule alone does not explain the **elevated T3/T4** or **increased iodine uptake**. *Follicular Carcinoma* - **Follicular carcinoma** is a type of thyroid cancer that typically presents as a **cold nodule** (decreased iodine uptake) and is usually **non-functional**, meaning it does not cause hyperthyroidism with elevated T3/T4. [2] - The presence of **increased iodine uptake** and **hyperthyroidism** makes follicular carcinoma highly unlikely. *Toxic Multinodular Goiter* - A **toxic multinodular goiter** involves **multiple nodules**, not a solitary one, that are autonomously functional and cause hyperthyroidism. [1] - While it causes **hyperthyroidism** and **increased iodine uptake**, the key differentiating factor here is the presentation as a **solitary nodule**.
Question 149: All of the following may lead to pneumatocele formation except which of the following?
- A. Staphylococcal pneumonia
- B. Positive pressure ventilation
- C. Hydrocarbon inhalation
- D. ARDS (Correct Answer)
Explanation: ***ARDS*** - **Acute Respiratory Distress Syndrome (ARDS)** is primarily characterized by **inflammatory lung injury**, leading to **alveolar edema**, but does not typically cause pneumatocele formation [1]. - Pneumatoceles are more likely associated with infections or mechanical ventilation, not with ARDS itself. *Staphylococcal pneumonia* - **Staphylococcal pneumonia** can lead to pneumatocele formation due to **necrotizing pneumonia**, where the formation of air-filled cysts occurs from lung tissue damage. - This type of pneumonia is associated with **Staphylococcus aureus** and can cause cavitary lesions. *Positive pressure ventilation* - **Positive pressure ventilation** can increase the risk of barotrauma, leading to the formation of pneumatocele through excess air entering lung tissue. - It is often used in cases of respiratory distress but can inadvertently contribute to pneumatocele development. *Hydrocarbon inhalation* - **Hydrocarbon inhalation** is linked to pneumonitis and can cause lung injury, leading to the formation of **pneumatoceles** as a result of **lung inflammation**. - Such inhalation can create **alveolar damage**, allowing for air-filled spaces to develop.
Question 150: Most common precipitant of Raynaud's phenomenon is
- A. Exposure to cold (Correct Answer)
- B. Exposure to heat
- C. Psychosocial triggers
- D. Exertion
Explanation: ***Exposure to cold*** - **Exposure to cold temperatures**, even mild cold, is the most frequent and characteristic trigger for **vasoconstriction** in Raynaud's phenomenon. - This leads to the classic **triphasic color changes** (white, blue, red) in the digits due to restricted blood flow. *Exposure to heat* - **Exposure to heat** generally causes **vasodilation**, which would alleviate rather than precipitate the symptoms of Raynaud's phenomenon. - While sudden temperature changes can sometimes be a factor, direct heat exposure is not a primary recognized trigger. *Psychosocial triggers* - **Emotional stress** and anxiety can indeed precipitate Raynaud's episodes in some individuals, as the **sympathetic nervous system** plays a role in vasoconstriction. - However, **cold exposure** remains the most common and potent precipitating factor across the majority of cases. *Exertion* - **Physical exertion** typically leads to **vasodilation** in working muscles and increased blood flow to the skin for heat dissipation. - It is not a common or direct precipitant of the localized vasoconstrictive attacks seen in Raynaud's phenomenon.