NEET-PG 2017 Practice Questions

Q: Which of the following infections in most commonly seen in this transfusion dependant child shown below?

Yersinia enterocolitica. ***Yersinia enterocolitica*** - Transfusion-dependent patients, especially those with **iron overload** (common in thalassemia), are particularly susceptible to **Yersinia enterocolitica** infections because *Yersinia* thrives in iron-rich environments. - The image shows a child with marked hepatosplenomegaly (outlined on the abdomen), which is characteristic of conditions leading to transfusion dependence and subsequent iron overload, such as **thalassemia major**. *Listeria monocytogenes* - While *Listeria* can cause serious infections, particularly in immunocompromised individuals and neonates, its association with **iron overload** from transfusions is not as prominent as *Yersinia*. - **Listeriosis** typically presents as meningitis, sepsis, or febrile gastroenteritis. *Acinetobacter* - *Acinetobacter* species are often associated with **nosocomial infections**, affecting critically ill or immunocompromised patients in hospital settings, but not specifically linked to iron overload or transfusion dependence as a primary risk factor like *Yersinia*. - Infections commonly include pneumonia, urinary tract infections, and wound infections. *Pneumococcus* - **Pneumococcal infections** are common in children, especially those with asplenia or functional asplenia (which can occur in thalassemia due to splenic sequestration), but a direct link to **transfusion-associated iron overload** as a specific risk factor for severe pneumococcal disease is not the primary association like *Yersinia*. - These infections typically manifest as pneumonia, meningitis, and otitis media.

Q: Comment on the diagnosis in the patient shown below?

Hand and foot syndrome. ***Hand and foot syndrome*** - The image shows **swelling and dactylitis** of the fingers, along with a peripheral blood smear demonstrating **sickle cells** (indicated by arrows). This combination is characteristic of hand-foot syndrome, also known as **dactylitis**, which is often the first manifestation of **sickle cell disease** in infants and young children. - **Dactylitis** results from **vaso-occlusion** in the small bones of the hands and feet, leading to painful swelling. *Squaring of metacarpals* - **Squaring of metacarpals** is not a typical finding in sickle cell disease and does not correlate with the observed hand swelling and erythrocyte morphology. - This term is sometimes used to describe changes seen in conditions like **rheumatoid arthritis**, but not in the context of dactylitis associated with sickle cells. *Sub-periosteal resorption* - **Sub-periosteal resorption** is a hallmark radiological finding in **hyperparathyroidism**, affecting bones, typically in the phalanges. - It is not directly suggested by the hand swelling (which is soft tissue/marrow oedema) or the presence of sickle cells in the blood smear. *Peripheral oedema with iron deficiency anemia* - While the picture shows **peripheral oedema** (swelling), the concomitant finding of **sickle cells** in the blood smear strongly indicates **sickle cell disease**, not iron deficiency anemia. - **Iron deficiency anemia** typically presents with microcytic hypochromic red cells, not sickle-shaped cells, and while it can cause fatigue and pallor, it does not directly lead to the dactylitis seen here.

Q: A newborn presents with macrosomia, plethoric appearance, and generalized edema. The image shows:

Infant of diabetic mother. ***Infant of diabetic mother*** - The image shows a **macrosomic** infant with a **plethoric appearance**, generalized **edema**, and a **"cherubic" facial appearance** with a prominent philtrum and perioral cyanosis, all characteristic features of an infant of a diabetic mother. - Maternal diabetes leads to fetal **hyperinsulinemia**, resulting in increased fat deposition, organomegaly, and altered growth patterns. *Achondroplasia* - Achondroplasia is characterized by **proximal limb shortening** (rhizomelia), a large head with a prominent forehead, and a flattened nasal bridge. - The pictured infant does not show these specific skeletal dysplasias. *Hemi-hypertrophy* - Hemi-hypertrophy involves **asymmetric growth**, where one side or part of the body is significantly larger than the other. - The infant in the image exhibits generalized, symmetrical macrosomia rather than unilateral overgrowth. *Albright hereditary osteodystrophy* - Albright hereditary osteodystrophy is a genetic disorder associated with short stature, **obesity**, brachydactyly (short digits), and typically presents with features related to **pseudohypoparathyroidism** (e.g., hypocalcemia, hyperphosphatemia). - The characteristic findings of this syndrome, such as brachydactyly, are not evident in the image.

Q: A 2-day-old neonate under phototherapy unit. For exchange transfusion serum bilirubin-albumin ratio should be: (Recent NEET Pattern 2016-17)

$>3.5$. ***$>3.5$*** - A **serum bilirubin-albumin ratio greater than 3.5** is a common guideline indicating the need for exchange transfusion in neonates, especially those at high risk or with rapidly rising bilirubin levels. - This ratio helps assess the risk of **bilirubin-induced neurotoxicity (kernicterus)**, as unbound (free) bilirubin can cross the blood-brain barrier [1]. *$ 35$* - A serum bilirubin-albumin ratio of **greater than 35** would represent an extremely high and clinically improbable value. - Clinically, the bilirubin-albumin ratio is typically used with values in the single digits, making a value of 35 or higher incongruent with standard medical guidelines. *$<35$* - While technically true that $<35$ would include the correct threshold, it is not sufficiently specific to denote the critical value for exchange transfusion. - This range is too broad and does not pinpoint the specific bilirubin-albumin ratio that prompts intervention.

Q: All are true about the swelling on scalp of a 2-day old neonate except: (Recent NEET Pattern 2016-17)

Heals from periphery. ***Heals from periphery*** - This is the **INCORRECT statement** about cephalohematoma in a neonate - Cephalohematomas do NOT heal from the periphery like a skin wound - Instead, the blood clot gradually **liquefies and is reabsorbed** over weeks to months (typically 2-3 months) - Resorption occurs uniformly or may even start centrally, not from the edges - This is the **exception** among the given statements *Sub-periosteal bleeding with gradual hardening* - This accurately describes **cephalohematoma**, a common birth injury - It is a **subperiosteal collection of blood** confined by suture lines - The blood undergoes **organization and calcification** over time, leading to gradual hardening - A bony rim may be palpable at the edges after 2-3 weeks *Can lead to prolongation of physiological Jaundice* - Breakdown of red blood cells within the cephalohematoma releases **bilirubin** - This increased bilirubin load can contribute to **prolonged physiological jaundice** - The large blood collection acts as an extravascular source of bilirubin *Painless* - Cephalohematoma is generally **painless** to touch for the neonate - Unlike caput succedaneum or infections, the blood collection does not cause acute pain - The swelling may appear large but is not tender

Q: Which of the following interventions is being done in this neonate?

Nasal CPAP and orogastric tube to decompress stomach. ***Nasal CPAP and orogastric tube to decompress stomach*** - The image shows a neonate with a device inserted into the nostrils for **nasal continuous positive airway pressure (nCPAP)**, used to support breathing. - Additionally, a tube is visible in the neonate's mouth leading to the stomach, which is an **orogastric (OG) tube** used for feeding or stomach decompression, especially important when using CPAP as air can be swallowed. *Positive pressure ventilation and NG tube to decompress stomach* - This option refers to positive pressure ventilation, which typically involves an **endotracheal tube** or mask/bag, neither of which is clearly depicted as the primary respiratory support. - An **NG tube (nasogastric tube)** would be inserted through the nose, but the tube shown for gastric access is in the mouth (orogastric). *Surfactant therapy and NG tube to decompress stomach* - **Surfactant therapy** is administered directly into the lungs, usually via an endotracheal tube, and is not a visible intervention in the image itself. - As noted previously, the tube for gastric decompression appears to be **orogastric**, not nasogastric. *Oxygen hood* - An **oxygen hood** is a clear plastic dome placed over the neonate's head to deliver oxygen, which is not what is shown in the image. - The visible tubes are for respiratory support and gastric access, indicating a more direct and invasive form of intervention than an oxygen hood.

Q: A 3-year-old child presents with sudden onset generalized petechiae and bruise on forehead. Sternal tenderness is absent and liver and spleen are not palpable. Bone marrow aspiration is normal. Probable cause is? (Recent NEET Pattern 2016-17)

Acute ITP. ***Acute ITP*** - A 3-year-old child presenting with **sudden onset petechiae and ecchymoses (bruise on forehead)**, without signs of systemic illness (no sternal tenderness, non-palpable liver/spleen), and a normal bone marrow is highly suggestive of **Idiopathic Thrombocytopenic Purpura (ITP)**. ITP is characterized by isolated thrombocytopenia due to autoimmune destruction of platelets. - The **normal bone marrow**, in particular, rules out conditions like leukemia and aplastic anemia, where bone marrow pathology would be evident. *Aplastic anemia* - **Aplastic anemia** would typically present with **pancytopenia** (affecting all blood cell lines), leading to symptoms like pallor, fatigue, infections, and bleeding. - A **bone marrow aspiration** in aplastic anemia would show a **hypocellular marrow** with a reduction in hematopoietic cells, which contradicts the "normal" finding in this case. *Acute leukemia* - **Acute leukemia** in children often presents with **bone pain (sternal tenderness)**, fever, fatigue, and organomegaly (enlarged liver and spleen) due to infiltration of leukemic cells. - A **bone marrow aspiration** would reveal a **hypercellular marrow** with a large proportion of blasts, which is not consistent with the "normal" bone marrow finding provided. *Dengue hemorrhagic fever* - **Dengue hemorrhagic fever** typically presents with symptoms like high fever, severe headache, muscle and joint pain, and often signs of bleeding (like petechiae and bruising) and can lead to severe thrombocytopenia. - However, it is usually preceded by a **fever** and other systemic symptoms, which are not mentioned in this sudden onset presentation in the given case scenario.

Q: A 6-month-old child brought by parents for diffuse ecchymosis on extremities and trunk. Probable diagnosis is? (Recent NEET Pattern 2016-17)

Protein C deficiency. ***Protein C deficiency*** - A 6-month-old with **diffuse ecchymoses on extremities and trunk** is classic for **homozygous protein C deficiency** presenting as **purpura fulminans**. - Severe congenital protein C deficiency typically manifests in **early infancy** (within first few weeks to months) with widespread purpuric lesions, skin necrosis, and thrombotic complications. - The presentation includes **large ecchymotic patches** that can progress to necrosis, affecting extremities and trunk as described. - This is the **most likely diagnosis** for this age group and clinical presentation in the absence of other systemic features. *Disseminated intravascular coagulation* - DIC causes diffuse bleeding and purpura due to consumption coagulopathy and microthrombi formation. - However, DIC is a **secondary complication** requiring an underlying trigger (sepsis, trauma, malignancy) with acute systemic illness. - The child would typically present with **multiple bleeding sites**, systemic signs, and evidence of the underlying condition—not isolated ecchymosis. *A.P.L.A.S (Antiphospholipid Antibody Syndrome)* - Neonatal antiphospholipid syndrome from maternal antibodies presents in the **neonatal period** (first 28 days of life), not at 6 months. - APLAS primarily causes **thrombotic events** (stroke, renal vein thrombosis) rather than diffuse ecchymosis alone. - This diagnosis is **extremely rare** in infancy and would not be the probable diagnosis for isolated ecchymotic presentation at this age. *Dengue hemorrhagic fever* - Dengue requires **exposure in endemic areas** and presents with fever, headache, myalgia, and characteristic rash followed by hemorrhagic manifestations. - More common in **older children and adults**; the 6-month-old age and absence of fever/systemic symptoms make this unlikely. - The clinical picture describes ecchymosis without mention of fever or other dengue features.

Q: All investigations are useful in work up of this condition except:

Invertogram at 24 hours. ***Urine for meconium particles*** - **Urine for meconium particles** is actually a valuable and standard investigation in **anorectal malformations** to detect **rectourinary fistulas**. - The presence of meconium in urine indicates a **communication between the rectum and urinary tract**, which is crucial information for surgical planning and management. *Invertogram at 24 hours* - An **invertogram** is a plain X-ray taken with the infant inverted for 3-5 minutes, allowing gas in the rectum to rise to the highest point. - This helps determine the **level of rectal pouch termination** relative to the **pubococcygeal line**, which is essential for distinguishing between high and low anorectal malformations. *Ultrasound* - **Perineal ultrasound** can assess the **perineal body thickness**, presence of a **rectal pouch**, and help visualize **fistulous connections**. - It is particularly useful in **real-time assessment** of the anatomy and can identify associated **genitourinary anomalies** commonly seen with anorectal malformations. *Lateral pelvic radiography* - A **lateral pelvic radiograph** provides information about the **sacral anatomy** and helps assess the **level of anorectal malformation**. - It is crucial for identifying associated **sacral anomalies** (sacral dysgenesis, hemisacrum) which occur in up to 60% of patients with anorectal malformations and affect surgical outcomes.

Question 1

Which of the following infections in most commonly seen in this transfusion dependant child shown below?

Accepted Answer

Yersinia enterocolitica

Answer

Listeria monocytogenes

Answer

Acinetobacter

Answer

Pneumococcus

Question 2

Comment on the diagnosis in the patient shown below?

Accepted Answer

Hand and foot syndrome

Answer

Squaring of metacarpals

Answer

Sub-periosteal resorption

Answer

Peripheral oedema with iron deficiency anemia

Question 3

A 3-year-old child has presented with abdominal lump and peculiar appearance of eyes. All genes are responsible for development of this condition except:

Accepted Answer

K-ras gene

Answer

WT1

Answer

P53

Answer

Beta-catenin

Question 4

A newborn presents with macrosomia, plethoric appearance, and generalized edema. The image shows:

Accepted Answer

Infant of diabetic mother

Answer

Achondroplasia

Answer

Hemi-hypertrophy

Answer

Albright hereditary osteodystrophy

Question 5

A 2-day-old neonate under phototherapy unit. For exchange transfusion serum bilirubin-albumin ratio should be: (Recent NEET Pattern 2016-17)

Accepted Answer

$>3.5$

Answer

$<3.5$

Answer

$>35$

Answer

$<35$

Question 6

All are true about the swelling on scalp of a 2-day old neonate except: (Recent NEET Pattern 2016-17)

Accepted Answer

Heals from periphery

Answer

Can lead to prolongation of physiological Jaundice

Answer

Painless

Answer

Sub-periosteal bleeding with gradual hardening

Question 7

Which of the following interventions is being done in this neonate?

Accepted Answer

Nasal CPAP and orogastric tube to decompress stomach

Answer

Positive pressure ventilation and NG tube to decompress stomach

Answer

Surfactant therapy and NG tube to decompress stomach

Answer

Oxygen hood

Question 8

A 3-year-old child presents with sudden onset generalized petechiae and bruise on forehead. Sternal tenderness is absent and liver and spleen are not palpable. Bone marrow aspiration is normal. Probable cause is? (Recent NEET Pattern 2016-17)

Accepted Answer

Acute ITP

Answer

Aplastic anemia

Answer

Acute leukemia

Answer

Dengue hemorrhagic fever

Question 9

A 6-month-old child brought by parents for diffuse ecchymosis on extremities and trunk. Probable diagnosis is? (Recent NEET Pattern 2016-17)

Accepted Answer

Protein C deficiency

Answer

Disseminated intravascular coagulation

Answer

A.P.L.A.S

Answer

Dengue hemorrhagic fever

Question 10

All investigations are useful in work up of this condition except:

Accepted Answer

Invertogram at 24 hours

Answer

Urine for meconium particles

Answer

Ultrasound

Answer

Lateral pelvic radiography

NEET-PG 2017

Internal Medicine

Pathology

Pediatrics

Surgery