NEET-PG 2017 - General Medicine PYQs Practice Questions

Q: A 2-year-old mentally retarded child with the marked skin lesion presents with left side flank pain. CT scan of abdomen shows -50 to -60 HU densities of the lesions in kidney and liver. The most probable diagnosis is?

Tuberous sclerosis. ***Tuberous sclerosis*** - The combination of **mental retardation**, **skin lesions** (ash-leaf spots are shown in the image), and **renal/hepatic lesions** with characteristic negative HU densities (-50 to -60 HU, consistent with fat in angiomyolipomas) is highly suggestive of Tuberous Sclerosis Complex. - Tuberous sclerosis involves benign tumors (hamartomas) in multiple organs, including the **brain**, **skin**, **kidneys** (angiomyolipomas), and **liver** (hepatic angiomyolipomas), which explains the diverse clinical presentation. *Familial Angiolipomatosis* - While it involves **angiomyolipomas**, it typically does not present with the widespread neurological abnormalities like **mental retardation** or characteristic skin lesions seen in Tuberous Sclerosis. - This condition is often limited to the presence of multiple bilateral renal angiomyolipomas. *ADPKD* - **Autosomal dominant polycystic kidney disease (ADPKD)** primarily involves numerous **renal cysts** with positive or near-zero Hounsfield units (HU), and sometimes hepatic cysts, but does not present with **mental retardation** or **fat-containing lesions** (negative HU) in the kidneys or liver. - The cystic lesions in ADPKD typically have HU values similar to water (0-20 HU). *V.H.L* - **Von Hippel-Lindau disease (VHL)** is characterized by **hemangioblastomas** of the CNS and retina, **renal cell carcinoma**, **pheochromocytomas**, and **pancreatic cysts/tumors**. - VHL does not typically cause the **skin lesions** (ash-leaf spots) or **mental retardation** as described, nor are the kidney lesions characterized by negative HU on CT. [Practice more General Medicine PYQs on OnCourse]

Q: All are correct about the condition shown below except:

Calcification of interosseous membrane. ***Calcification of interosseous membrane*** - The image shows features consistent with **fluorosis**, a condition caused by excessive fluoride intake. While fluorosis can lead to widespread calcification of ligaments and tendons, **calcification of the interosseous membrane** is a characteristic but often later finding. - The patient exhibits **genu valgum** (knock-knees) and the radiograph of the forearm shows diffuse increased bone density and osteosclerosis, typical of fluorosis. *Multiple lytic lesions in vertebra* - **Fluorosis** primarily causes **osteosclerosis** (increased bone density) and periosteal bone formation, not lytic lesions. - **Lytic lesions in vertebrae** are more often associated with conditions like multiple myeloma, metastatic cancer, or infections, which involve bone destruction rather than excessive bone formation. *Barrel chest* - **Barrel chest** is typically associated with chronic obstructive pulmonary disease (COPD) or other respiratory conditions that cause hyperinflation of the lungs. - While **skeletal deformities** are common in advanced fluorosis, a "barrel chest" is not a direct or characteristic manifestation of the condition. *Bony exostosis in limb bones* - **Bony exostoses** (osteochondromas) are generally seen in hereditary multiple exostoses or can be isolated benign bone tumors. - While fluorosis causes irregular new bone formation and thickening of long bones, specific, discrete **bony exostoses** are not a typical feature; rather, it's a more generalized osteosclerosis and periostitis. [Practice more General Medicine PYQs on OnCourse]

Question 1

A 2-year-old mentally retarded child with the marked skin lesion presents with left side flank pain. CT scan of abdomen shows -50 to -60 HU densities of the lesions in kidney and liver. The most probable diagnosis is?

Accepted Answer

Tuberous sclerosis

Answer

Familial Angiolipomatosis

Answer

ADPKD

Answer

V.H.L

Question 2

All are correct about the condition shown below except:

Accepted Answer

Calcification of interosseous membrane

Answer

Multiple lytic lesions in vertebra

Answer

Barrel chest

Answer

Bony exostosis in limb bones

NEET-PG 2017 — General Medicine