NEET-PG 2021 Practice Questions

Q: A patient presents with ear discharge. The CT image is shown below. Based on the clinical presentation and imaging, what is the most likely diagnosis?

Temporal lobe abscess. ***Temporal lobe abscess*** - The CT scan shows a **ring-enhancing lesion** in the **temporal lobe**, which is characteristic of a brain abscess. - **Ear discharge** (otorrhea), particularly from otitis media, is a common predisposing factor for temporal lobe abscesses due to the proximity of the middle ear and mastoid to the temporal lobe. - Otogenic brain abscesses account for a significant proportion of intracranial complications from ear infections, with the temporal lobe being the most common location. *Extradural abscess* - An **extradural abscess** would typically be located between the dura mater and the skull, often presenting as a **lenticular or biconvex collection** displacing the dura and brain, not within the brain parenchyma as seen here. - While ear infections can lead to extradural abscesses, the imaging clearly shows an intraparenchymal lesion. *Cerebellar abscess* - A **cerebellar abscess** would be located in the cerebellum (posterior fossa), which is a different anatomical location from the lesion seen in the image (which is in the supratentorial compartment, consistent with the temporal lobe). - Although ear infections can also lead to cerebellar abscesses, the lesion's position on the CT scan does not correspond to the cerebellum. *Meningitis* - **Meningitis** is an inflammation of the meninges and typically manifests on CT as **leptomeningeal enhancement**, particularly in the sulci and basal cisterns, rather than a discrete, encapsulated mass lesion like an abscess. - While ear discharge can be associated with meningitis, the imaging findings strongly point to an abscess, not diffuse meningeal inflammation.

Q: A 50-year-old male presents with backache, morning stiffness, red eye, and ankle swelling. Based on the X-ray provided, what is the most likely diagnosis?

Ankylosing Spondylitis. ***Ankylosing Spondylitis*** - The X-ray likely shows features of **sacroiliitis** (joint space narrowing, sclerosis, erosion) and possibly **vertebral fusion**, consistent with ankylosing spondylitis. The clinical presentation of **backache, morning stiffness, red eye (uveitis), and ankle swelling (enthesitis)** are classic extra-articular manifestations and peripheral arthritis of ankylosing spondylitis. - X-ray findings like **bamboo spine** (late stage), syndesmophytes, and erosions of the sacroiliac joints are characteristic of this seronegative spondyloarthropathy. *Paget's Disease* - Paget's disease is characterized by disorganized bone remodeling, leading to bone enlargement, deformity, and increased density or lysis. It typically does not present with **sacroiliitis** or widespread **ankylosis**. - Clinical features usually include **bone pain**, **bone deformities**, and potentially **nerve compression**, which are not the primary symptoms described. *Healed TB spine* - Healed TB spine (Pott's disease) would typically show bone destruction, collapse of vertebral bodies, **kyphosis**, and often calcified abscesses. - While backache can occur, the presence of **red eye** and **ankle swelling** are not characteristic of spinal tuberculosis. *Osteopetrosis* - Osteopetrosis is a rare genetic disorder characterized by **increased bone density** due to defective osteoclast function, leading to abnormally thick and brittle bones. - The X-ray would show **generalized sclerosis** (diffuse increased bone density) throughout the skeleton, which is not the primary finding indicated by the clinical context of sacroiliitis and joint fusion.

Q: A mother brings her daughter with short stature, webbed neck, and other physical features. What is the most likely finding on ultrasound?

Streak ovaries with small uterus. ***Streak ovaries with small uterus*** - The constellation of **short stature** and **webbed neck** is highly suggestive of **Turner syndrome (45,X0)**. - A characteristic feature of Turner syndrome is **gonadal dysgenesis**, which manifests as **streak ovaries** and a **small uterus** due to the absence of normal ovarian development. *Hepatomegaly with altered echotexture* - This finding is more indicative of **liver disease** or metabolic disorders, which are not primary features of Turner syndrome. - While Turner syndrome can be associated with various health issues, **hepatomegaly** is not a common or defining ultrasonographic finding. *Echo showing tricuspid stenosis* - **Cardiac abnormalities** are common in Turner syndrome, but the most frequent ones are **bicuspid aortic valve** and **coarctation of the aorta**, not typically **tricuspid stenosis**. - **Tricuspid stenosis** is a rare congenital heart defect and not specifically associated with Turner syndrome. *Single kidney* - **Renal anomalies**, such as a **horseshoe kidney** or **renal agenesis**, can occur in Turner syndrome. - However, the description of **single kidney** is less specific than **streak ovaries** in identifying the most likely finding given the presented clinical features of short stature and webbed neck.

Q: A patient with infertility has an ultrasound (USG) suggestive of a uterine anomaly. Which of the following is the best method to confirm the diagnosis?

Hysteroscopy + Laparoscopy. ***Hysteroscopy + Laparoscopy*** - This combination allows for a comprehensive evaluation: **hysteroscopy** visualizes the uterine cavity to confirm the type of anomaly (e.g., septum), while **laparoscopy** assesses the external uterine contour and overall pelvic anatomy. - It is considered the **gold standard** for diagnosing complex uterine anomalies as it provides the most detailed information for both diagnosis and surgical planning. *Hysterosalpingography (HSG)* - HSG can delineate the **uterine cavity morphology** and patency of fallopian tubes. - However, it is an **X-ray based test** and does not provide information about the external contour of the uterus, which is crucial for differentiating anomalies like a bicornuate from a septate uterus. *Transvaginal Sonography (TVS)* - While TVS is an excellent initial screening tool and can suggest a uterine anomaly, it often **lacks the definitive resolution** to precisely classify the anomaly, especially differentiating between septate and bicornuate uteri. - Its accuracy can be **operator-dependent** and limited in visualizing the external uterine contour. *Laparoscopy* - Laparoscopy alone provides an excellent view of the **external uterine contour** and pelvic organs. - However, it **does not visualize the internal uterine cavity**, which is essential for identifying and classifying anomalies such as a uterine septum.

Q: The image shows a wrist deformity and an X-ray of a bone lesion near the distal radius. Based on the clinical and radiological features, what is the most likely diagnosis?

Giant Cell Tumor (GCT). ***Giant Cell Tumor (GCT)*** * The image shows a **lytic (lucid) lesion** located in the **epiphysis/metaphysis of the distal radius**, which is a classic presentation site for GCT. * GCTs are typically seen in individuals aged 20-40, often present with **pain, swelling, and reduced range of motion**, and can show a **soap bubble appearance** on X-ray even with cortical erosion as seen in the image. *Ewing's Sarcoma* * Ewing's Sarcoma commonly affects the **diaphysis of long bones** and may present with an **onion skin periosteal reaction**, none of which are clearly depicted. * It primarily affects children and young adults (5-20 years old), which does not align with the assumed adult presentation given the fused epiphysis. *Osteochondroma* * Osteochondromas are **bony prominences covered by cartilage** and grow **outward from the bone surface**, often away from the joint, unlike the intraosseous lytic lesion seen. * They typically appear as **pedunculated or sessile exostoses** and are benign growth plate abnormalities, not lytic lesions of the marrow cavity. *Osteoid Osteoma* * Osteoid osteomas are characterized by a **small lucent nidus** (usually <1.5 cm) surrounded by a significant margin of **sclerotic bone**, which is not seen here. * They classically cause **nocturnal pain** relieved by NSAIDs and are typically smaller than the lesion depicted, which appears expansile.

Q: A 10-year-old child presents with limb pain and recurrent fractures. Bone mineral density is normal, as seen on the X-ray. What is the most likely diagnosis?

Pyknodysostosis. ***Pyknodysostosis*** - The X-ray shows **dense bones** and **persistence of open metaphyses**, which are characteristic features of pyknodysostosis. - While overall bone mineral density is normal, the **abnormal bone modeling** and **sclerotic appearance** are crucial for diagnosis. - This rare skeletal dysplasia presents with **short stature**, **fragile bones despite density**, and **recurrent fractures**. *Rickets* - Rickets typically presents with features of **poor mineralization**, leading to **widened growth plates**, **fraying**, and **cupping of metaphyses**. - The provided X-ray does not show these features of demineralization or abnormal growth plate morphology. - BMD would be **decreased**, not normal. *Metaphyseal Dysplasia* - Metaphyseal dysplasia primarily affects the **metaphyses**, leading to abnormalities like **Erlenmeyer flask deformity** or **splaying**. - It does not typically present with the generalized **bone sclerosis** seen in the image. *Scurvy* - Scurvy (Vitamin C deficiency) in children causes skeletal changes such as **periosteal hemorrhages**, **osteopenia**, and a **"white line of Frankel"** (dense metaphyseal line). - The image does not show signs of **osteopenia** or **hemorrhage-related features**. *Osteopetrosis* - Osteopetrosis also presents with **increased bone density**, but differs from pyknodysostosis. - It typically shows **"bone-within-bone" appearance**, **Erlenmeyer flask deformity**, and **obliteration of medullary cavity**. - The clinical presentation and radiographic pattern in this case are more consistent with pyknodysostosis.

Q: A patient presents with abdominal distension. Based on the X-ray, which of the following bowel loops are dilated?

Jejunum. ***Jejunum*** - The image shows dilated small bowel loops with prominent **valvulae conniventes** (also known as plicae circulares), which are characteristic of the jejunum. - These folds are typically closely spaced and extend across the entire lumen, giving a "coiled spring" or "stack of coins" appearance on plain radiographs when dilated. *Duodenum* - While the duodenum is part of the small bowel, it is the most proximal segment and typically not as diffusely involved in generalized small bowel dilation as the jejunum and ileum unless the obstruction is very high. - The valvulae conniventes in the duodenum are less prominent and more sparsely distributed compared to the jejunum. *Transverse colon* - The transverse colon is part of the large intestine and would show **haustra**, which are sacculations that do not extend across the entire lumen and are typically more widely spaced than valvulae conniventes. - The dilated loops in the image clearly show mucosal folds that span the entire width of the bowel. *Ileum* - The ileum also has valvulae conniventes, but they are less prominent and more sparsely distributed than in the jejunum. - In cases of small bowel obstruction or dilation, the jejunum characteristically shows more distinct and closely packed valvulae conniventes, making it the most identifiable segment in this image.

Q: A 30-year-old female presents with sterile pyuria. The radiograph below is provided. What is the most likely diagnosis?

Putty Kidney. ***Putty Kidney*** - The image visible in the question shows a **caseous calcification** of the renal parenchyma, which is characteristic of a "putty kidney," a late manifestation of **renal tuberculosis**. - **Sterile pyuria** is commonly associated with renal tuberculosis, where Mycobacterium tuberculosis infection leads to chronic inflammation and granuloma formation in the kidney, eventually resulting in caseous necrosis and calcification. *Psoas Calcification* - This typically refers to calcification within the **psoas muscle**, which would appear as a linear or amorphous calcification along the path of the muscle, an appearance not consistent with the image. - While psoas abscesses can calcify, they would not manifest as widespread renal parenchymal calcification and are not specifically linked to sterile pyuria in this manner. *Staghorn Calculus* - A **staghorn calculus** is a large, branched kidney stone that fills all or part of the renal pelvis and calyces, resembling the antlers of a stag. - While these stones are composed of mineral salts and would be radiopaque, their morphology is distinctly different from the diffuse, caseous calcification seen in the image. *Nephrocalcinosis* - **Nephrocalcinosis** is a condition characterized by diffuse microcalcifications throughout the renal parenchyma, usually affecting the tubules. - The calcifications in the provided image appear more nodular and clustered, consistent with late-stage tuberculous caseous necrosis, rather than the fine, diffuse pattern of nephrocalcinosis.

Q: A **hemodynamically stable** patient involved in a Road Traffic Accident (RTA) presents with: - Absent air entry on the left side of the chest. - Tenderness in the left lower chest wall. What is the next step in the Emergency Medicine Room (EMR) management?

Chest X-ray. ***X-ray*** - In a **hemodynamically stable** patient with absent air entry and chest wall tenderness post-RTA, a **chest X-ray** is the most appropriate initial imaging in the EMR. - It quickly diagnoses conditions like **pneumothorax**, **hemothorax**, or **rib fractures** and guides management decisions. - **Important**: Clinical assessment for **tension pneumothorax** (hypotension, tracheal deviation, distended neck veins) must be done first. If tension pneumothorax is suspected, **immediate needle decompression** is required without waiting for imaging. - X-ray is **rapidly available** and provides crucial information for trauma management in stable patients. *FAST* - **Focused Assessment with Sonography for Trauma (FAST)** is primarily used to detect **intra-abdominal free fluid** (hemoperitoneum) or pericardial effusion in trauma. - While valuable in RTA evaluation, it is not the primary diagnostic tool for absent air entry in the chest. - FAST has limited sensitivity for **pneumothorax** and does not visualize **rib fractures** in detail. *DPL* - **Diagnostic Peritoneal Lavage (DPL)** is an invasive procedure used to detect **intra-abdominal injury** and hemorrhage. - It has largely been replaced by FAST and CT scans due to its invasive nature and lower specificity. - DPL provides **no information about chest injuries** and is irrelevant for evaluating absent air entry. *CT* - A **CT scan** (chest CT) provides highly detailed imaging and is excellent for diagnosing specific chest injuries. - However, it is **time-consuming**, requires patient transport, and is typically reserved for **stable patients** after initial X-ray assessment. - In the immediate EMR setting, X-ray is preferred for rapid decision-making, with CT used for further evaluation if needed.

Question 1

A patient presents with ear discharge. The CT image is shown below. Based on the clinical presentation and imaging, what is the most likely diagnosis?

Accepted Answer

Temporal lobe abscess

Answer

Extradural abscess

Answer

Cerebellar abscess

Answer

Meningitis

Question 2

A 50-year-old male presents with backache, morning stiffness, red eye, and ankle swelling. Based on the X-ray provided, what is the most likely diagnosis?

Accepted Answer

Ankylosing Spondylitis

Answer

Paget's Disease

Answer

Healed TB spine

Answer

Osteopetrosis

Question 3

A mother brings her daughter with short stature, webbed neck, and other physical features. What is the most likely finding on ultrasound?

Accepted Answer

Streak ovaries with small uterus

Answer

Hepatomegaly with altered echotexture

Answer

Echo showing tricuspid stenosis

Answer

Single kidney

Question 4

A patient with infertility has an ultrasound (USG) suggestive of a uterine anomaly. Which of the following is the best method to confirm the diagnosis?

Accepted Answer

Hysteroscopy + Laparoscopy

Answer

Hysterosalpingography (HSG)

Answer

Transvaginal Sonography (TVS)

Answer

Laparoscopy

Question 5

The image shows a wrist deformity and an X-ray of a bone lesion near the distal radius. Based on the clinical and radiological features, what is the most likely diagnosis?

Accepted Answer

Giant Cell Tumor (GCT)

Answer

Ewings Sarcoma

Answer

Osteochondroma

Answer

Osteoid Osteoma

Question 6

A child undergoes prophylactic irradiation as preparation for bone marrow transplantation (BMT) for treatment of acute lymphoblastic leukemia (ALL). Which of the following cell types will be least affected by the radiation?

Accepted Answer

Neurons

Answer

Spermatogonia

Answer

Bone marrow

Answer

Intestinal epithelial cells

Question 7

A 10-year-old child presents with limb pain and recurrent fractures. Bone mineral density is normal, as seen on the X-ray. What is the most likely diagnosis?

Accepted Answer

Pyknodysostosis

Answer

Rickets

Answer

Metaphyseal Dysplasia

Answer

Scurvy

Answer

Osteopetrosis

Question 8

A patient presents with abdominal distension. Based on the X-ray, which of the following bowel loops are dilated?

Accepted Answer

Jejunum

Answer

Duodenum

Answer

Transverse colon

Answer

Ileum

Question 9

A 30-year-old female presents with sterile pyuria. The radiograph below is provided. What is the most likely diagnosis?

Accepted Answer

Putty Kidney

Answer

Psoas Calcification

Answer

Staghorn calculus

Answer

Nephrocalcinosis

Question 10

A **hemodynamically stable** patient involved in a Road Traffic Accident (RTA) presents with:

- Absent air entry on the left side of the chest.
- Tenderness in the left lower chest wall.

What is the next step in the Emergency Medicine Room (EMR) management?

Accepted Answer

Chest X-ray

Answer

FAST (Focused Assessment with Sonography for Trauma)

Answer

DPL (Diagnostic Peritoneal Lavage)

Answer

CT scan (Computed Tomography)

NEET-PG 2021

ENT

Internal Medicine

OB/GYN

Obstetrics and Gynecology

Orthopaedics

Pathology

Pediatrics

Radiology

Surgery