NEET-PG 2020 - Internal Medicine Practice Questions

Q: Which is not seen in heart failure?

Oligemia. ***Oligemia*** - **Oligemia** refers to a reduced blood volume or total blood flow to a region, which is typically not observed in **heart failure**. - In **heart failure**, the body often experiences **fluid overload** and **pulmonary congestion**, leading to increased blood volume in the lungs, not reduced [1]. *Cardiomegaly* - **Cardiomegaly**, or an enlarged heart, is a common finding in **heart failure** as the heart muscle remodels and dilates to compensate for impaired pumping function [1], [3]. - This can be seen on a chest X-ray as an **increased cardiothoracic ratio** [1], [2]. *Kerley B lines* - **Kerley B lines** are thin, horizontal lines visible on a chest X-ray, typically found at the lung periphery. - They indicate **interstitial edema** due to increased pulmonary venous pressure, a characteristic sign of **pulmonary congestion** in **heart failure** [1]. *Kerley A Lines* - **Kerley A lines** are longer, less common lines seen radiating from the hila towards the upper lobes. - These lines represent **distended anastomotic channels** between pulmonary and systemic venous systems, also indicative of **pulmonary edema** and **heart failure** [1], [4].

Q: A 35 year old male presenting with recurrent episodes of abdominal pain, jaundice and fatigue underwent MRCP (shown below). What is the most likely diagnosis?

Primary Sclerosing Cholangitis. ***Primary Sclerosing Cholangitis*** - The MRCP image showing **multiple strictures** and dilatations within the intrahepatic and extrahepatic bile ducts (often described as a **"beaded" appearance**), along with the patient's symptoms of recurrent abdominal pain, jaundice, and fatigue, are classic findings for Primary Sclerosing Cholangitis (PSC). - PSC is a chronic cholestatic liver disease, often associated with **inflammatory bowel disease (IBD)**, particularly ulcerative colitis, and more commonly affects young to middle-aged men. *Oriental Cholangitis* - This condition (also known as recurrent pyogenic cholangitis) is characterized by **intrahepatic bile duct stones** and recurrent bacterial cholangitis, particularly prevalent in East Asia. - While it involves strictures and dilations, the primary driver is often stones and infection, and the demographic and typical MRCP findings are different from the diffuse "beading" seen in PSC. *Primary Biliary Cirrhosis* - Primary Biliary Cirrhosis (PBC) primarily affects the **small intrahepatic bile ducts** and is an autoimmune disease mainly seen in middle-aged women. - While it causes chronic cholestasis and can lead to cirrhosis, the characteristic imaging findings on MRCP as seen here (large duct involvement with diffuse stricturing and beading) are not typical for PBC. *Caroli's Disease* - Caroli's disease is a rare congenital disorder characterized by **segmental cystic dilatation of the intrahepatic bile ducts**. - The imaging findings would show sac-like or cystic dilations of the bile ducts, which is distinct from the diffuse, multifocal strictures and beading pattern observed in the provided MRCP.

Q: A 30-year-old female complaints of fatigue and is unable to gain weight. On examination, her body felt warm. Which of the following investigation can be helpful in reaching the diagnosis?

Suppressed TSH with elevated thyroid hormone levels. Suppressed TSH with elevated thyroid hormone levels - The patient's symptoms of **fatigue** (despite being warm) and **difficulty gaining weight**, coupled with her body feeling **warm**, are classic signs of **hyperthyroidism**. [1] - In hyperthyroidism, the thyroid gland produces **excessive thyroid hormones (T3 and T4)**, which in turn **suppresses TSH** production from the pituitary gland through negative feedback. [2] *Elevated TSH with normal thyroid hormone levels* - This pattern is characteristic of **subclinical hypothyroidism**, where the thyroid gland is beginning to fail, leading to increased TSH to maintain normal thyroid hormone levels. [3] - The patient's symptoms of feeling warm and difficulty gaining weight are inconsistent with hypothyroidism. [1] *Elevated TSH with low thyroid hormone levels* - This indicates **primary hypothyroidism**, where the thyroid gland is underactive and produces insufficient thyroid hormones, leading to a compensatory rise in TSH. [2] - Hypothyroidism typically presents with **weight gain**, **cold intolerance**, and fatigue, which contradict the patient's presentation. [1] *Normal TSH with abnormal thyroid hormone levels* - This scenario usually suggests **central hypothyroidism** (pituitary or hypothalamic dysfunction affecting TSH production) or **thyroid hormone resistance**. [3] - While possible in some rare cases, it does not fit the typical clinical picture of hyperthyroidism presented by the patient's symptoms.

Q: Frontal gyrus lesion leads to?

Broca's aphasia. ***Broca's aphasia*** - A lesion in the **frontal gyrus**, specifically **Broca's area** (Brodmann areas 44 and 45), leads to Broca's aphasia [1]. - This condition is characterized by **non-fluent speech**, difficulty with articulation, and telegraphic sentences, while comprehension remains relatively intact [1]. *Nominal aphasia* - This is also known as **anomic aphasia**, characterized primarily by difficulty with **word finding** (naming objects). - It results from lesions in various cortical areas, but typically not isolated to Broca's area in the frontal gyrus. *Akinetic mutism* - This condition involves a state of **unresponsiveness** where the patient is awake but does not move or speak. - It usually results from lesions in the **cingulate gyrus**, basal ganglia, or medial frontal lobes, often bilateral, not typically a solitary frontal gyrus lesion. *Wernicke's aphasia* - Wernicke's aphasia results from damage to **Wernicke's area**, located in the **posterior superior temporal gyrus** [1]. - It is characterized by **fluent but nonsensical speech** with impaired comprehension [1].

Question 1

Which is not seen in heart failure?

Accepted Answer

Oligemia

Answer

Cardiomegaly

Answer

Kerley B lines

Answer

Kerley A Lines

Question 2

A 35 year old male presenting with recurrent episodes of abdominal pain, jaundice and fatigue underwent MRCP (shown below). What is the most likely diagnosis?

Accepted Answer

Primary Sclerosing Cholangitis

Answer

Oriental Cholangitis

Answer

Primary Biliary Cirrhosis

Answer

Carolis Disease

Question 3

A 30-year-old female complaints of fatigue and is unable to gain weight. On examination, her body felt warm. Which of the following investigation can be helpful in reaching the diagnosis?

Accepted Answer

Suppressed TSH with elevated thyroid hormone levels

Answer

Elevated TSH with normal thyroid hormone levels

Answer

Elevated TSH with low thyroid hormone levels

Answer

Normal TSH with abnormal thyroid hormone levels

Question 4

Frontal gyrus lesion leads to?

Accepted Answer

Broca's aphasia

Answer

Nominal aphasia

Answer

Akinetic mutism

Answer

Wernicke's aphasia

NEET-PG 2020 — Internal Medicine