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
What is the main contraindication for performing a liver biopsy?
A patient presents with difficulty with swallowing liquids but not solids. The best investigation to make a diagnosis is
Which of the following is true about menetrier's disease
A 55 years old male with a known history of gallstones presents with chief complaints of severe abdominal pain and elevated levels of serum lipase with periumbilical ecchymosis. All of the following are prognostic criteria to predict the severity of acute pancreatitis except:
A 45 year old lawyer presents with pain in the abdomen more so in the epigastric region that worsens with eating spicy food and is relieved by bending forward. Complications of the above mentioned condition could be all except:
All of the following statements about Gastrointestinal carcinoid tumors are true, Except:
NEET-PG 2015 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 151: 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 152: 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 153: 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 154: 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.
Question 155: What is the main contraindication for performing a liver biopsy?
- A. Severe thrombocytopenia
- B. Liver hemangioma
- C. Presence of ascites
- D. Severe coagulopathy (Correct Answer)
Explanation: ***Severe coagulopathy*** - **Severe coagulopathy** is the main contraindication for liver biopsy due to a significantly increased risk of **hemorrhage** [1]. - A **prothrombin time (PT)** or **activated partial thromboplastin time (aPTT)** significantly prolonged beyond the normal range, or an **INR > 1.5**, should be corrected before the procedure [1]. *Severe thrombocytopenia* - While **thrombocytopenia** (platelet count <50,000/µL) does increase bleeding risk, it is often correctable with a **platelet transfusion** prior to biopsy, making it a relative rather than an absolute contraindication [1]. - The risk of major bleeding is typically lower with isolated thrombocytopenia compared to severe coagulopathy. *Liver hemangioma* - The presence of a **liver hemangioma** at the biopsy site is a contraindication as biopsying it can lead to massive hemorrhage. - However, if the biopsy can be performed safely away from the hemangioma, it is not an absolute contraindication to the procedure itself. *Presence of ascites* - **Ascites** can complicate a liver biopsy by increasing the risk of **peritoneal bleeding** and difficulty in targeting the liver [1]. - However, it is often manageable by draining the ascites or using imaging guidance, making it a relative contraindication rather than an absolute one [1].
Question 156: A patient presents with difficulty with swallowing liquids but not solids. The best investigation to make a diagnosis is
- A. Endoscopy
- B. Endoscopic ultrasound
- C. Manometry (Correct Answer)
- D. PET CT
Explanation: ***Manometry*** - **Esophageal manometry** measures the pressure and coordination of muscle contractions in the esophagus, which is crucial for diagnosing motility disorders like **achalasia** [1] or **esophageal spasm** [2] that can cause difficulty swallowing liquids. - The symptom of difficulty swallowing liquids but not solids (**paradoxical dysphagia**) is characteristic of a primary esophageal motility disorder rather than a structural obstruction [1]. *Endoscopy* - **Endoscopy** is primarily used to visualize the esophagus and stomach for structural abnormalities such as **strictures**, **tumors**, or **inflammation** [1]. - While it can rule out structural causes, it is less effective for diagnosing purely functional or motility disorders [1]. *Endoscopic ultrasound* - **Endoscopic ultrasound (EUS)** provides detailed imaging of the esophageal wall and surrounding structures, helping to stage cancers or identify extrinsic compression. - It is not the primary investigation for assessing **esophageal motility**. *PET CT* - **PET CT** is primarily used in oncology for **cancer staging**, recurrence detection, and assessing metabolic activity of lesions. - It has limited utility in the initial diagnosis of a **swallowing disorder**, especially one indicating a motility issue.
Question 157: Which of the following is true about menetrier's disease
- A. Atrophied mucosal folds are seen
- B. It is premalignant condition
- C. There is decreased gastric acid secretion (Correct Answer)
- D. It causes increased gastric acid secretion
Explanation: ***It is a premalignant condition*** - Menetrier's disease is characterized by **hyperplastic gastric mucosa** and is considered a **premalignant condition** due to its association with gastric cancers. - Regular surveillance and monitoring are recommended because of this increased risk for malignancy. *Affects the stomach and small intestines* - Menetrier's disease primarily **affects the stomach**, specifically leading to excessive growth of the gastric mucosa. - It does not typically involve the **small intestines**, which differentiates it from other gastrointestinal diseases. *There is increased gastric acid secretion* - In Menetrier's disease, there is actually a **decreased gastric acid secretion** due to the alteration of gastric mucosal structure. - This condition leads to **hypochlorhydria**, contrasting with conditions that increase acid secretion like Zollinger-Ellison syndrome. *Atrophied mucosal folds are seen* - Menetrier's disease is marked by **hypertrophy of the gastric folds**, not atrophy, resulting in **enlarged rugae** within the stomach. - Atrophied mucosal folds are more associated with conditions like chronic atrophic gastritis.
Question 158: A 55 years old male with a known history of gallstones presents with chief complaints of severe abdominal pain and elevated levels of serum lipase with periumbilical ecchymosis. All of the following are prognostic criteria to predict the severity of acute pancreatitis except:
- A. Serum GGT (Correct Answer)
- B. Serum LDH
- C. Base deficit
- D. Age
Explanation: ***Serum GGT*** - **Serum GGT (gamma-glutamyl transpeptidase)** is primarily used to evaluate liver and bile duct function and cholestasis, not as a direct prognostic indicator for acute pancreatitis severity. - While gallstones are mentioned, GGT elevation in this context would suggest the cause of pancreatitis rather than its severity. *Age* - **Age older than 55 years** is a significant prognostic factor in various scoring systems like Ranson's criteria and the APACHE II score, indicating a higher risk of severe disease and complications [1]. - Older patients generally have less physiologic reserve and are more prone to organ failure during severe pancreatitis [1]. *Serum LDH* - **Elevated serum LDH (lactate dehydrogenase)**, specifically above 350 IU/L, is one of Ranson's criteria for assessing the severity of acute pancreatitis within the first 48 hours. - It suggests significant tissue damage and necrosis, which correlates with worse outcomes. *Base deficit* - A **base deficit greater than 4 mEq/L** is an indicator of metabolic acidosis and is included in prognostic scoring systems for acute pancreatitis, such as the modified Glasgow criteria. - It reflects poor tissue perfusion, hypovolemia, and potentially severe systemic inflammation.
Question 159: A 45 year old lawyer presents with pain in the abdomen more so in the epigastric region that worsens with eating spicy food and is relieved by bending forward. Complications of the above mentioned condition could be all except:
- A. Splenic Vein Thrombosis (Correct Answer)
- B. Bleeding
- C. Gastric Outlet Obstruction
- D. Perforation
Explanation: ***Splenic Vein Thrombosis*** - The patient's symptoms (epigastric pain worsening with spicy food, relieved by bending forward) are highly suggestive of **pancreatitis**, not peptic ulcer disease [1]. **Splenic vein thrombosis** is a known complication of chronic pancreatitis due to inflammation and compression of the splenic vein [2]. - While pancreatitis can cause significant morbidity, **splenic vein thrombosis** is a specific vascular complication associated with prolonged inflammation of the pancreas, leading to localized portal hypertension and potentially isolated gastric varices. *Perforation* - **Perforation** (specifically of a peptic ulcer or potentially surrounding bowel in severe pancreatitis) is a severe complication that can occur in conditions causing abdominal pain, but it is not the *exception* among the given options for the likely underlying condition indicated by the patient's symptoms (pancreatitis) [3]. - This complication typically leads to **peritonitis**, a medical emergency requiring immediate surgical intervention [3]. *Bleeding* - **Bleeding** (e.g., from a pancreatic pseudocyst rupturing into the gastrointestinal tract or from localized varices secondary to portal hypertension in pancreatitis) is a recognized complication of the patient's likely underlying condition [1]. - Gastrointestinal bleeding can also result from **gastric erosions** or ulcers exacerbated by ongoing inflammation. *Gastric Outlet Obstruction* - **Gastric outlet obstruction** can occur as a complication of severe or chronic pancreatitis, often due to **inflammation**, **fibrosis**, or **pseudocyst formation** compressing the duodenum [1]. - This typically presents with **postprandial vomiting** and early satiety, which can arise in the context of chronic pancreatic inflammation.
Question 160: All of the following statements about Gastrointestinal carcinoid tumors are true, Except:
- A. Small intestine and appendix account for almost 60% of all gastrointestinal carcinoid
- B. Rectum is spared (Correct Answer)
- C. Appendicial carcinoids are more common in females than males
- D. 5 year survival for carcinoid tumors is >60%
Explanation: ***Rectum is spared*** - This statement is **incorrect**; carcinoid tumors can occur in the rectum, which is often **affected** by such tumors. - It is more accurate to say that carcinoid tumors arise in various gastrointestinal locations, including the **rectum** itself. *Small intestine and appendix account for almost 60% of all gastrointestinal carcinoid* - This statement is **true**; small intestine and appendix are indeed significant sites for carcinoid tumors, together accounting for nearly **60% of cases**. - These locations are particularly prominent due to the number of neuroendocrine cells found in these areas of the **gastrointestinal tract** [1][2]. *5 year survival for carcinoid tumors is >60%* - This statement is **true**, as many patients with localized carcinoid tumors exhibit a **5-year survival rate** greater than 60%. - Survival rates vary depending on the tumor's stage and location, but overall, they tend to have a favorable prognosis when diagnosed early. *Appendicial carcinoids are more common in females than males* - This statement is **true**; studies indicate that appendiceal carcinoids are indeed more frequently diagnosed in **females** compared to males [2]. - This differentiation is one of the notable epidemiological trends observed with carcinoid tumors.