NEET-PG 2024 Practice Questions

Q: What is the pressure required to open the shown in the image?

Pulse present, breath absent. ***Pulse present, breath absent*** - The image shown is depicting a scenario where a person has a **detectable pulse** but is not breathing, indicating respiratory arrest while the heart is still functioning. - This scenario specifically calls for **rescue breaths** (artificial ventilation) without chest compressions, as the heart is still circulating blood. *Pulse absent, breath present* - This situation is highly unlikely as **breathing requires cardiac output** to supply oxygen to respiratory muscles. - If a patient is breathing, they generally have a pulse, even if it is weak. *Pulse & breath present* - This indicates a conscious and stable individual, or someone who is unconscious but still breathing and has a pulse. **CPR or rescue breaths are not needed** in this case. - The patient would likely need monitoring and assessment for other medical issues. *Pulse and breath both not found* - This scenario describes **cardiac arrest**, requiring immediate **cardiopulmonary resuscitation (CPR)** which includes both chest compressions and rescue breaths. - This is a more critical situation than just respiratory arrest.

Q: Match the following ECG findings (1-4) with their corresponding arrhythmias (A-D): 1. Sawtooth pattern in leads II, III, aVF with regular ventricular response 2. Irregularly irregular rhythm with absent P waves 3. Narrow QRS tachycardia with abrupt onset/termination 4. Wide QRS tachycardia with AV dissociation A. Atrial fibrillation B. PSVT (Paroxysmal Supraventricular Tachycardia) C. Atrial flutter D. Ventricular tachycardia What is the correct matching?

A-2, B-3, C-1, D-4. The correct matching is **A-2, B-3, C-1, D-4**: ***C-1: Atrial flutter - Sawtooth pattern*** - Atrial flutter is characterized by a **sawtooth pattern** of flutter waves, particularly prominent in leads II, III, and aVF - Represents rapid, organized atrial depolarization at 250-350 bpm - Regular ventricular response due to **AV block** (commonly 2:1 or 4:1) - The sawtooth pattern is the pathognomonic feature ***A-2: Atrial fibrillation - Irregularly irregular rhythm*** - Identified by an **irregularly irregular rhythm** with absent distinct P waves - Replaced by chaotic fibrillatory waves showing disorganized atrial activity - Ventricular rate is rapid and unpredictable - No organized atrial pattern unlike the regular flutter waves ***B-3: PSVT - Narrow QRS with abrupt onset/termination*** - Presents with **narrow QRS complex tachycardia** (QRS 0.12 seconds) - **AV dissociation** is a key diagnostic feature showing independent atrial and ventricular activity - Originates from ventricular tissue, not supraventricular structures - Lacks the organized P wave patterns seen in atrial arrhythmias

Q: A patient presents with shortness of breath. Vitals are HR = 120/min with BP = 90/60 mm Hg. Echocardiography shows diastolic collapse of the ventricles. What is the best management for this patient?

Pericardiocentesis. **Pericardiocentesis** * The constellation of **tachycardia**, **hypotension**, and **diastolic collapse of the ventricles** on echocardiography is highly suggestive of **cardiac tamponade**, a life-threatening condition [1]. * **Pericardiocentesis** is the definitive treatment for cardiac tamponade, as it relieves the pressure on the heart by draining the pericardial fluid, thereby restoring cardiac output and improving hemodynamics [1]. * *Start diuretic with BP monitoring* * Administering **diuretics** would further decrease intravascular volume and worsen already compromised cardiac output in the setting of hypotension due to cardiac tamponade. * While **blood pressure monitoring** is essential, diuretics are contraindicated and would exacerbate the patient's hemodynamic instability. * *Intra-aortic balloon pump* * An **intra-aortic balloon pump (IABP)** primarily assists in improving **coronary perfusion** and reducing **afterload** in conditions like cardiogenic shock or severe heart failure. * An IABP does not address the fundamental problem of external compression of the heart in cardiac tamponade and would not relieve the diagnostic finding of diastolic collapse of the ventricles. * *Ventricular assist device* * A **ventricular assist device (VAD)** is used to support failing ventricles by pumping blood from the heart to the rest of the body, typically in cases of advanced heart failure. * A VAD does not resolve the external compression on the heart caused by pericardial fluid in cardiac tamponade and is an invasive measure not indicated as a primary treatment in this scenario.

Q: A patient is pulseless with the following rhythm shown in the ECG. What is the next best step in management?

Defibrillate and continue chest compression. ***Defibrillate and continue chest compression*** - This scenario describes a **pulseless ventricular tachycardia (pVT)**, which is a **shockable rhythm**. - Immediate defibrillation is crucial, followed by resuming **chest compressions** without delay, as per advanced cardiac life support (ACLS) guidelines. - The correct sequence is: shock → immediate CPR for 2 minutes → rhythm/pulse check. *Defibrillate and check pulse* - While defibrillation is the correct initial intervention for a shockable rhythm, checking the pulse immediately after is incorrect. - Chest compressions should be resumed immediately after a shock for 2 minutes before stopping to check a pulse. - Minimizing interruptions in chest compressions is critical for survival. *Check pulse and give synchronized DC* - Checking a pulse before any intervention wastes critical time in a pulseless patient with a shockable rhythm; immediate defibrillation is indicated. - Synchronized direct current (DC) cardioversion is used for unstable patients **with a pulse** (e.g., unstable ventricular tachycardia with a pulse), not for pulseless rhythms. *Give synchronized DC and continue chest compressions* - Synchronized DC cardioversion is inappropriate for a **pulseless rhythm**; unsynchronized defibrillation is required. - Synchronization requires an R wave to time the shock, which is not feasible in pulseless VT management. *Start chest compressions and give epinephrine* - While chest compressions are essential, the **immediate priority** for a shockable rhythm (pVT/VF) is **defibrillation**. - Epinephrine is given during CPR cycles (after the first shock), but defibrillation must come first for shockable rhythms. - This would be the approach for **non-shockable rhythms** (PEA/asystole), not pulseless VT.

Q: A patient with chronic kidney disease (CKD) presents with tachycardia, and the ECG is recorded as shown above. What is the most likely diagnosis?

Hyperkalemia. ***Hyperkalemia*** - The ECG shows characteristic signs of **hyperkalemia**, including **peaked, tall T waves**, which are prominently visible. This is a common finding in CKD patients due to impaired potassium excretion. - The patient's history of **chronic kidney disease (CKD)** predisposes them to hyperkalemia, as the kidneys are responsible for potassium balance. *Hypokalemia* - **Hypokalemia** typically presents with flattened T waves, prominent U waves, and ST-segment depression on an ECG. These features are not seen in the provided ECG. - While CKD can sometimes be associated with hypokalemia (e.g., due to diuretic use), the ECG morphology is inconsistent with this diagnosis. *Hypercalcemia* - **Hypercalcemia** on ECG usually manifests as a **shortened QT interval**. - The ECG does not show a shortened QT interval, making hypercalcemia an unlikely diagnosis based on the cardiac findings. *Hypocalcemia* - **Hypocalcemia** is typically associated with a **prolonged QT interval** on an ECG. - The ECG does not exhibit a prolonged QT interval, ruling out hypocalcemia as the likely cause of the findings. *Hypomagnesemia* - **Hypomagnesemia** can occur in CKD patients, particularly those on diuretics or with poor nutritional intake. ECG findings typically include **prolonged QT interval**, **flattened or inverted T waves**, and **prominent U waves**. - The peaked T waves seen in this ECG are not consistent with hypomagnesemia, making this diagnosis unlikely.

Q: A patient presents with wheezing that improves with as-needed use of albuterol. Spirometry shows FEV1 ranging from 70 % to 83 %, and the patient experiences nighttime chest tightening twice a week. What is the most appropriate treatment?

Add an inhaled corticosteroid. ***Add an inhaled corticosteroid*** * The patient has persistent asthma as evidenced by symptoms occurring twice a week (nighttime chest tightening), and **FEV1 variability** despite current albuterol use. * Adding a **low-dose inhaled corticosteroid** is the recommended *first-line controller treatment* for persistent asthma to reduce inflammation and prevent exacerbations per **GINA guidelines**. *Continue with albuterol* * Continuing albuterol alone is insufficient for persistent asthma, as it only provides **symptomatic relief** and does not address the underlying inflammation. * This approach would lead to continued symptoms and potential **asthma exacerbations**. *Replace with salmeterol twice daily* * Salmeterol is a **long-acting beta-agonist (LABA)**, and while it provides prolonged bronchodilation, it should never be used as monotherapy in asthma due to the risk of severe exacerbations. * LABAs should always be prescribed in combination with an **inhaled corticosteroid**. *Start Tab prednisolone* * **Oral prednisolone** is a systemic corticosteroid typically reserved for **severe asthma exacerbations** or for patients whose symptoms are not controlled by high-dose inhaled corticosteroids and other controller medications. * It carries more significant **side effects** with long-term use compared to inhaled corticosteroids. *Add a leukotriene modifier* * While **leukotriene receptor antagonists** (e.g., montelukast) can be used as alternative controller therapy for mild persistent asthma, they are considered **less effective** than inhaled corticosteroids. * They are typically reserved as an alternative for patients who cannot use or tolerate inhaled corticosteroids, or as **add-on therapy** in more severe cases.

Q: A 15-year-old patient presents with joint swelling, a pan-systolic murmur, negative rheumatoid factor (RF), and elevated ESR. The patient also reports a recent history of sore throat and exhibits subcutaneous nodules and erythema marginatum on physical examination. What is the most likely diagnosis?

Acute rheumatic fever. **Acute rheumatic fever** - The combination of **joint swelling**, a recent **sore throat**, **pan-systolic murmur** (indicating carditis), **subcutaneous nodules**, and **erythema marginatum** meets the **Jones criteria** for acute rheumatic fever [1]. - An **elevated ESR** is a common inflammatory marker, and a **negative rheumatoid factor** helps differentiate it from other rheumatic conditions. - Carditis often presents with new or changed murmurs, such as a soft systolic murmur due to mitral regurgitation [1]. Acute rheumatic carditis is also a principal cause of valve regurgitation [2]. *Seronegative rheumatoid arthritis* - This typically presents with chronic inflammatory arthritis, but lacks specific features like **carditis** or characteristic skin rashes like **erythema marginatum** and **subcutaneous nodules**. - While it has a negative RF, the acute presentation with a preceding sore throat points away from chronic arthropathy. *Juvenile idiopathic arthritis* - This is a diagnosis of exclusion for chronic arthritis in children under 16, lacking acute rheumatic fever's hallmark cardiac involvement, **subcutaneous nodules**, or **erythema marginatum**. - While it can cause joint swelling and elevated ESR, the constellation of symptoms strongly points to an acute systemic illness. *Ankylosing spondylitis* - This primarily affects the **axial skeleton** (spine and sacroiliac joints) and is characterized by back pain and stiffness, predominantly in young adults. - It does not typically present with a **pan-systolic murmur**, **subcutaneous nodules**, or **erythema marginatum**, and is rarely seen in 15-year-old patients with this acute presentation.

Q: A hypertensive patient presents with excruciating chest pain and unequal radial pulses. Which of the following is the correct management for this patient?

Emergency surgical repair. ***Emergency surgical repair*** - The combination of **excruciating chest pain**, a history of **hypertension**, and **unequal radial pulses** is highly suggestive of an **acute aortic dissection**. - **Unequal radial pulses** indicate involvement of the **ascending aorta** (Type A dissection), affecting the brachiocephalic or subclavian arteries that branch proximally from the aortic arch. - **Type A aortic dissections**, involving the ascending aorta, are life-threatening emergencies requiring immediate **surgical repair** to prevent rupture, cardiac tamponade, aortic regurgitation, and organ malperfusion. *BP control and monitoring* - While **blood pressure control** is a crucial initial step in managing aortic dissection to reduce shear stress on the aorta and prevent propagation, it is insufficient as the primary treatment for an **ascending (Type A) aortic dissection**. - Continuous monitoring is necessary but cannot resolve a progressing dissection that poses an immediate threat to life. - Medical management alone is reserved for **uncomplicated Type B dissections**. *Stenting* - **Endovascular stenting** (thoracic endovascular aortic repair, TEVAR) is primarily used for **Type B aortic dissections** (involving the descending aorta) in stable patients or those with complicated features. - It is generally not the first-line treatment for **Type A dissections** due to the anatomical challenges and urgent need for surgical repair in this location. *Balloon dilatation* - **Balloon dilatation** or angioplasty is a procedure used to open narrowed arteries, typically in the context of atherosclerotic disease (e.g., coronary artery disease or peripheral artery disease). - It has no role in the management of an **aortic dissection**, which involves a tear in the aortic wall rather than a simple narrowing.

Question 1

What is the pressure required to open the shown in the image?

Accepted Answer

Pulse present, breath absent

Answer

Pulse absent, breath present

Answer

Pulse & breath present

Answer

Pulse and breath both not found

Question 2

Match the following ECG findings (1-4) with their corresponding arrhythmias (A-D):

1. Sawtooth pattern in leads II, III, aVF with regular ventricular response
2. Irregularly irregular rhythm with absent P waves
3. Narrow QRS tachycardia with abrupt onset/termination
4. Wide QRS tachycardia with AV dissociation

A. Atrial fibrillation
B. PSVT (Paroxysmal Supraventricular Tachycardia)
C. Atrial flutter
D. Ventricular tachycardia

What is the correct matching?

Accepted Answer

A-2, B-3, C-1, D-4

Answer

A-2, B-1, C-3, D-4

Answer

A-1, B-2, C-4, D-3

Answer

A-4, B-3, C-2, D-1

Answer

A-1, B-2, C-3, D-4

Question 3

A patient presents with shortness of breath. Vitals are HR = 120/min with BP = 90/60 mm Hg. Echocardiography shows diastolic collapse of the ventricles. What is the best management for this patient?

Accepted Answer

Pericardiocentesis

Answer

Start diuretic with BP monitoring

Answer

Intra-aortic balloon pump

Answer

Ventricular assist device

Question 4

A patient is pulseless with the following rhythm shown in the ECG. What is the next best step in management?

Accepted Answer

Defibrillate and continue chest compression

Answer

Defibrillate and check pulse

Answer

Check pulse and give synchronized DC

Answer

Give synchronized DC and continue chest compressions

Answer

Start chest compressions and give epinephrine

Question 5

A hypertensive patient presents with an irregularly irregular pulse and a loud P2 on auscultation. Which JVP finding is likely to be seen in this patient?

Accepted Answer

Absent a wave

Answer

Cannon a wave

Answer

Rapid $x$ descent

Answer

Rapid $y$ descent

Answer

Prominent v wave

Question 6

A patient with chronic kidney disease (CKD) presents with tachycardia, and the ECG is recorded as shown above. What is the most likely diagnosis?

Accepted Answer

Hyperkalemia

Answer

Hypokalemia

Answer

Hypercalcemia

Answer

Hypocalcemia

Answer

Hypomagnesemia

Question 7

A 60-year-old lady presents with shortness of breath (SOB) and episodes of angina pectoris. Work-up reveals aortic stenosis. Which of the following is the most likely reason behind these chest pain episodes?

Accepted Answer

Increased oxygen consumption in the heart

Answer

Increased pressure in aorta

Answer

Decreased pressure in aorta

Answer

Increase in volume overload of the heart

Answer

Decreased coronary blood flow

Question 8

A patient presents with wheezing that improves with as-needed use of albuterol. Spirometry shows FEV1 ranging from 70 % to 83 %, and the patient experiences nighttime chest tightening twice a week. What is the most appropriate treatment?

Accepted Answer

Add an inhaled corticosteroid

Answer

Continue with albuterol

Answer

Replace with salmeterol twice daily

Answer

Start Tab prednisolone

Answer

Add a leukotriene modifier

Question 9

A 15-year-old patient presents with joint swelling, a pan-systolic murmur, negative rheumatoid factor (RF), and elevated ESR. The patient also reports a recent history of sore throat and exhibits subcutaneous nodules and erythema marginatum on physical examination. What is the most likely diagnosis?

Accepted Answer

Acute rheumatic fever

Answer

Seronegative rheumatoid arthritis

Answer

Juvenile idiopathic arthritis

Answer

Ankylosing spondylitis

Question 10

A hypertensive patient presents with excruciating chest pain and unequal radial pulses. Which of the following is the correct management for this patient?

Accepted Answer

Emergency surgical repair

Answer

BP control and monitoring

Answer

Stenting

Answer

Balloon dilatation

NEET-PG 2024

Anesthesiology

Internal Medicine

Pediatrics

Surgery