NEET-PG 2019 Practice Questions

Q: The following lesion was noticed in a patient with history of involuntary weight loss. What is the diagnosis?

Leser-Trelat sign. ***Leser-Trelat sign*** - The image illustrates numerous rapidly appearing or increasing **seborrheic keratoses**, which, when accompanied by symptoms like **involuntary weight loss**, are highly suggestive of the Leser-Trelat sign. - The Leser-Trelat sign is a **paraneoplastic syndrome** commonly associated with **gastrointestinal adenocarcinomas** or **lymphoid malignancies**. *Acanthosis nigricans* - This condition presents as **dark, velvety patches** on the skin, typically in body folds like the neck, armpits, and groin. - While it can be associated with malignancy (especially gastric adenocarcinoma), the image shows multiple, distinct seborrheic keratoses rather than diffuse hyperpigmentation. *Actinic keratosis* - Actinic keratoses are **premalignant lesions** caused by chronic sun exposure, appearing as rough, scaly patches on sun-exposed areas. - They are typically single or a few scattered lesions and do not usually erupt rapidly or widely as shown, nor are they directly associated with systemic malignancy in the same way as Leser-Trelat. *Intertriginous candida* - Intertriginous candidiasis is a **fungal infection** that occurs in skin folds, characterized by **redness, itching, and satellite lesions**. - The lesions in the image are distinct, raised, and brownish, not consistent with the erythematous and often moist presentation of intertriginous candidiasis.

Q: Which is not correct about the lesion shown below?

Bilaterally symmetrical dermatomal vesicular eruption. ***Bilaterally symmetrical dermatomal vesicular eruption*** - The image shows a **unilateral, dermatomal vesicular eruption**, characteristic of herpes zoster (shingles). - Herpes zoster lesions are typically restricted to **one side of the body** and follow a single dermatome, making bilateral symmetry incorrect. *The lesions are infectious to seronegative individuals* - The vesicles of herpes zoster contain **live varicella-zoster virus (VZV)**, which can be transmitted through direct contact. - Individuals who have not previously had chickenpox (seronegative for VZV) can contract **chickenpox** (not shingles) from exposure to these lesions. *Can be associated with meningoencephalitis* - Although rare, disseminated herpes zoster can lead to severe complications, including **meningoencephalitis** if the virus spreads to the central nervous system. - This complication is more likely in **immunocompromised individuals**. *Geniculate ganglion is involved in Ramsay hunt syndrome* - **Ramsay Hunt syndrome (Herpes zoster oticus)** is a specific complication of VZV reactivation involving the **geniculate ganglion** of the facial nerve. - This involvement leads to facial nerve palsy, ear pain, and typical vesicular rash in the ear canal or on the auricle.

Q: A one-year-old child presents with the following lesion on the face. His mother has a history of bronchial asthma. What is the diagnosis?

Atopic dermatitis. ***Atopic dermatitis*** - The rash on the face of a one-year-old, coupled with a maternal history of **bronchial asthma**, strongly suggests **atopic dermatitis (eczema)** due to its association with the **atopic triad** (eczema, asthma, allergic rhinitis). - In infants, atopic dermatitis commonly presents as erythematous, scaly, and sometimes **weeping patches** on the face and extensor surfaces. *Eczematous dermatitis* - While atopic dermatitis is a form of eczematous dermatitis, this term is **too broad** and does not specify the underlying cause evident from the patient's history. - Eczematous dermatitis describes a **pattern of inflammation** rather than a specific diagnosis. *Seborrheic dermatitis* - Typically characterized by **greasy, yellowish scales** on an erythematous base, often affecting the scalp (**cradle cap**), eyebrows, and nasolabial folds. - It usually **lacks the strong association with atopy** seen in this case. *Contact dermatitis* - Caused by exposure to an **irritant or allergen**, leading to a localized rash. - The diffuse nature of the rash in the image and the family history of asthma make a specific contact allergen less likely as the primary cause.

Q: A patient presents with the skin finding shown in the image. Identify the most likely diagnosis for this lesion.

Piebaldism. ***Piebaldism*** - The image shows a **localized patch of depigmentation** on the forehead, characteristic of **piebaldism**. - **Piebaldism** is a rare, congenital autosomal dominant disorder caused by a defect in melanocyte development and migration, resulting in stable, well-demarcated depigmented areas, often with a **white forelock**. *Vitiligo* - **Vitiligo** typically presents as **progressive, acquired macules and patches of depigmentation** that often enlarge over time. - While it can appear on the face, the sharply demarcated, congenital appearance seen here is more consistent with piebaldism. *Contact leukoderma* - **Contact leukoderma** is an **acquired depigmentation** resulting from exposure to chemicals (e.g., rubber, phenols). - It would usually present in areas of direct contact, and the congenital nature of the lesion in the image rules this out. *Albinism* - **Albinism** is a **generalized hypopigmentation** affecting the skin, hair, and eyes due to a defect in melanin production. - The image shows a localized patch of depigmentation, not a widespread lack of pigment characteristic of albinism.

Q: A 65-year-old alcoholic is admitted to the ICU with diagnosis of acute pancreatitis. After 48 hours he is unconscious and has the following findings: $\mathrm{sPO}_{2}=$ $60 \%, \mathrm{pO}_{2}=60 \mathrm{~mm} \mathrm{Hg}, \mathrm{pCO}_{2}=30 \mathrm{~mm} \mathrm{Hg}$ and $\mathrm{HR}=$ 120 bpm . CXR was performed. Diagnosis is?

Shock lung. ***Shock lung*** - The rapid progression to severe hypoxemia (sPO2 60%, pO2 60 mmHg), tachycardia, and the CXR findings of **bilateral diffuse infiltrates** in a patient with severe pancreatitis is highly suggestive of **Acute Respiratory Distress Syndrome (ARDS)**, which is colloquially known as "shock lung". - **Acute pancreatitis** is a common cause of ARDS due to the systemic inflammatory response leading to increased pulmonary vascular permeability and non-cardiogenic pulmonary edema. *Mendelson syndrome* - This syndrome refers to **chemical pneumonitis** caused by aspiration of gastric contents, typically during anesthesia or in patients with impaired consciousness. - While aspiration is a concern in an unconscious patient, the diffuse, widespread infiltrates seen on CXR and the context of severe pancreatitis point more strongly to ARDS. *Nosocomial pneumonia* - Nosocomial pneumonia is an infection acquired in a hospital setting, often characterized by **new onset fever, purulent sputum, and new infiltrate on chest X-ray**. - While possible in an ICU patient, the rapid deterioration, severe hypoxemia, and acute onset after 48 hours of admission with acute pancreatitis are more classic for ARDS than typical nosocomial pneumonia. *Sympathetic pleural effusion* - **Sympathetic pleural effusions** can occur in acute pancreatitis, particularly on the left side, due to localized inflammation. - However, the chest X-ray shows **diffuse bilateral parenchymal infiltrates** rather than predominant pleural fluid, and the severe hypoxemia is indicative of significant lung tissue involvement, not just an effusion.

Q: Comment on the diagnosis of the patient?

Ventricular flutter. ***Ventricular flutter*** - This ECG shows a very rapid, regular ventricular rhythm with **sine-wave-like morphology** and no discernible P waves or T waves, characteristic of ventricular flutter. - The rate is typically between **250-350 bpm**, and the QRS complexes are wide and uniform but merge with the T waves to create a continuous undulating pattern. *Ventricular tachycardia* - While ventricular tachycardia (VT) is a fast ventricular rhythm, it usually presents with **discrete QRS complexes** and identifiable (although wide) QRS and ST-T segments. - The rate in VT is typically **100-250 bpm**, and the complexes often show some degree of variability in morphology or R-R interval. *Ventricular fibrillation* - Ventricular fibrillation (VF) is characterized by **chaotic, irregular electrical activity** with no identifiable QRS complexes, P waves, or T waves. - The waveforms are highly variable in shape and amplitude, representing uncoordinated ventricular muscle activity, unlike the regular, undulating pattern seen here. *Electromechanical dissociation* - **Electromechanical dissociation (EMD)**, also known as pulseless electrical activity (PEA), occurs when there is organized electrical activity on the ECG but no palpable pulse. - The ECG in EMD can show a variety of rhythms, including normal sinus rhythm or bradycardia, but it will always show **discernible electrical complexes**, unlike the continuous sinusoidal pattern of ventricular flutter.

Q: A 25-year-old female presents with history of fever and oral ulcers and has developed erythematous lesions on her face. Comment on the diagnosis?

Systemic Lupus Erythematosus (SLE). ***Systemic Lupus Erythematosus (SLE)*** - The combination of **fever**, **oral ulcers**, and **malar rash** (butterfly-shaped erythematous lesions across the cheeks and nose) represents classic triad of **SLE** according to **ACR/EULAR diagnostic criteria**. - SLE is a **multisystem autoimmune disease** affecting young women (female:male ratio 9:1) with systemic manifestations including constitutional symptoms and mucocutaneous involvement. *Discoid Lupus Erythematosus (DLE)* - DLE presents with **chronic scarring plaques** with **follicular plugging** and **atrophy**, typically without systemic features like fever. - Lacks **systemic manifestations** such as fever and oral ulcers that are characteristic of systemic lupus. *Dermatomyositis* - Characterized by **heliotrope rash** (violaceous discoloration around eyelids) and **Gottron's papules** over knuckles, not malar distribution. - Associated with **proximal muscle weakness** and elevated **creatine kinase levels**, which are absent in this presentation. *Rosacea* - A **chronic inflammatory skin condition** affecting central face with **persistent erythema** and **papulopustular lesions**. - Does **not** present with systemic symptoms like **fever** or **oral ulcers**, and typically occurs in middle-aged adults.

Q: Identify the parasite shown in the image.

Sarcoptes scabiei. ***Sarcoptes scabiei*** - The image displayed is a characteristic microscopic view of **_Sarcoptes scabiei_**, the mite responsible for scabies. Key features include its **round to oval body** shape and the presence of **spines and setae** on its dorsal surface, which are visible. - The short, stubby legs with prominent suckers are consistent with the morphology used for burrowing into the skin. *Pediculus humanus capitis* - This parasite, the **head louse**, has a more **elongated body** shape and distinct legs with claws adapted for gripping hair shafts, which is not what is seen in the image. - Head lice are typically found on the scalp and attach nits (eggs) to hair, unlike the burrowing nature of the organism shown. *Pthirus Pubis* - **_Pthirus pubis_**, or the **pubic louse** (crab louse), has a distinctly **crab-like appearance** with broad bodies and large, clawed legs, especially the second and third pairs, which is not consistent with the image. - These lice typically infest coarse body hair, such as pubic hair, eyelashes, and eyebrows. *Dermatobia hominis* - **_Dermatobia hominis_** is the **human botfly**, and its larval stage (maggot) causes **cutaneous myiasis**. The image does not show a maggot-like larva but rather a microscopic mite. - The morphology of a botfly larva is worm-like and segmented, featuring prominent spines for anchoring within the host's skin.

Q: An image of a newborn infant is shown. What is the most likely diagnosis?

Infant of diabetic mother. ***Infant of diabetic mother*** - The image depicts a **large for gestational age (LGA)** or **macrosomic** infant with a **plethoric appearance** and significant subcutaneous fat, which are classic signs of an infant of a diabetic mother. - Maternal hyperglycemia leads to fetal hyperinsulinemia, causing increased fetal growth and fat deposition. *Beckwith Wiedemann syndrome* - While infants with Beckwith-Wiedemann syndrome can be LGA, they typically present with characteristic features such as **macroglossia**, **omphalocele**, **ear creases/pits**, and **hemihyperplasia**, which are not clearly evident in this image. - The overall appearance of diffuse adiposity is more consistent with uncontrolled maternal diabetes. *Congenital hypothyroidism* - Infants with congenital hypothyroidism are often **hypotonic**, have a **hoarse cry**, prolonged jaundice, and a characteristic **coarse facial appearance** with a large tongue and umbilical hernia, and are typically *not* macrosomic. - The appearance in the image does not align with the typical features of congenital hypothyroidism. *IUGR baby* - An **intrauterine growth restriction (IUGR)** baby is small for gestational age (SGA) due to various factors impeding fetal growth. - The infant in the image is clearly **macrosomic**, and not small, directly contradicting the definition of IUGR.

Q: A 6-year-old child with abdominal pain and a rash is shown. Comment on the diagnosis?

Henoch-Schonlein purpura. ***Henoch Schonlein purpura*** - This diagnosis is strongly suggested by the child's age (6 years old), presentation of abdominal pain, and the characteristic **palpable purpuric rash**, particularly on the lower extremities, as seen in the image. - **Henoch-Schönlein purpura (HSP)**, now known as IgA vasculitis, is a systemic small-vessel vasculitis predominantly affecting children, characterized by the classic triad of palpable purpura, arthritis/arthralgia, and abdominal pain. *Kawasaki* - **Kawasaki disease** primarily affects children under 5 years of age and presents with persistent fever, conjunctivitis, oral mucosal changes (strawberry tongue), cervical lymphadenopathy, and a polymorphous rash. Abdominal pain is less common as a primary feature. - The rash in Kawasaki disease is typically not purpuric but can be maculopapular or scarlatiniform, and does not show the characteristic distribution seen in the image. *Varicella* - **Varicella (chickenpox)** is characterized by a pruritic vesicular rash that progresses from macules to papules to vesicles and then crusts, usually starting on the trunk and spreading centrifugally. This is distinctly different from the purpuric rash shown. - While it can cause abdominal pain, the skin lesions are the key differentiator, and the image does not depict vesicular lesions. *Meningococcemia* - **Meningococcemia** is a severe bacterial infection often presenting with petechial or purpuric rash, fever, and signs of sepsis. However, the rash in meningococcemia rapidly progresses to large ecchymoses and is often associated with signs of critical illness (e.g., hypotension, altered mental status). - While purpura is present, the widespread, relatively uniform appearance of the rash, combined with abdominal pain in a 6-year-old, points away from the fulminant course typical of meningococcemia towards a vasculitis like HSP.

Question 1

The following lesion was noticed in a patient with history of involuntary weight loss. What is the diagnosis?

Accepted Answer

Leser-Trelat sign

Answer

Acanthosis nigricans

Answer

Actinic keratosis

Answer

Intertriginous candida

Question 2

Which is not correct about the lesion shown below?

Accepted Answer

Bilaterally symmetrical dermatomal vesicular eruption

Answer

The lesions are infectious to seronegative individuals

Answer

Can be associated with meningoencephalitis

Answer

Geniculate ganglion is involved in Ramsay hunt syndrome

Question 3

A one-year-old child presents with the following lesion on the face. His mother has a history of bronchial asthma. What is the diagnosis?

Accepted Answer

Atopic dermatitis

Answer

Eczematous dermatitis

Answer

Seborrheic dermatitis

Answer

Contact dermatitis

Question 4

A patient presents with the skin finding shown in the image. Identify the most likely diagnosis for this lesion.

Accepted Answer

Piebaldism

Answer

Vitiligo

Answer

Contact leukoderma

Answer

Albinism

Question 5

A 65-year-old alcoholic is admitted to the ICU with diagnosis of acute pancreatitis. After 48 hours he is unconscious and has the following findings: $\mathrm{sPO}_{2}=$ $60 \%, \mathrm{pO}_{2}=60 \mathrm{~mm} \mathrm{Hg}, \mathrm{pCO}_{2}=30 \mathrm{~mm} \mathrm{Hg}$ and $\mathrm{HR}=$ 120 bpm . CXR was performed. Diagnosis is?

Accepted Answer

Shock lung

Answer

Mendelson syndrome

Answer

Nosocomial pneumonia

Answer

Sympathetic pleural effusion

Question 6

Comment on the diagnosis of the patient?

Accepted Answer

Ventricular flutter

Answer

Ventricular tachycardia

Answer

Ventricular fibrillation

Answer

Electromechanical dissociation

Question 7

A 25-year-old female presents with history of fever and oral ulcers and has developed erythematous lesions on her face. Comment on the diagnosis?

Accepted Answer

Systemic Lupus Erythematosus (SLE)

Answer

Discoid Lupus Erythematosus (DLE)

Answer

Dermatomyositis

Answer

Rosacea

Question 8

Identify the parasite shown in the image.

Accepted Answer

Sarcoptes scabiei

Answer

Pediculus humanus capitis

Answer

Pthirus pubis

Answer

Dermatobia hominis

Question 9

An image of a newborn infant is shown. What is the most likely diagnosis?

Accepted Answer

Infant of diabetic mother

Answer

Beckwith Wiedemann syndrome

Answer

Congenital hypothyroidism

Answer

IUGR baby

Question 10

A 6-year-old child with abdominal pain and a rash is shown. Comment on the diagnosis?

Accepted Answer

Henoch-Schonlein purpura

Answer

Kawasaki

Answer

Varicella

Answer

Meningococcemia

NEET-PG 2019

Dermatology

Internal Medicine

Microbiology

Pediatrics