NEET-PG 2024 Practice Questions

Q: A female presents with a 1 × 1 cm thyroid swelling. What is the next best step in management?

TSH. ***Correct Option: TSH*** - **Thyroid-stimulating hormone (TSH)** is the most sensitive initial test to assess thyroid function when a thyroid nodule is discovered. - An abnormal TSH level (either high or low) can guide further investigation into whether the nodule is associated with a functional thyroid disorder. - **TSH should be the first test** according to American Thyroid Association guidelines for thyroid nodule evaluation. *Incorrect Option: I-131* - **I-131 (radioactive iodine therapy)** is a treatment modality for hyperthyroidism or thyroid cancer, not a diagnostic step for initial thyroid swelling evaluation. - Administering I-131 before assessing thyroid function would be inappropriate and could lead to unnecessary or harmful intervention. *Incorrect Option: TSH & T4* - While TSH is crucial, adding **T4 (thyroxine)** as an initial step is often not necessary if TSH is normal, as TSH alone effectively screens for primary thyroid dysfunction. - Measuring both TSH and T4 is typically reserved for situations where TSH is abnormal or when central hypothyroidism is suspected. *Incorrect Option: T3 & T4* - Measuring **T3 (triiodothyronine)** along with T4 as an initial screening for a thyroid nodule is generally not recommended. - T3 levels are primarily used to diagnose **hyperthyroidism** or to evaluate the severity of thyrotoxicosis after an abnormal TSH and T4 have been identified. *Incorrect Option: FNAC* - While **Fine Needle Aspiration Cytology (FNAC)** is an essential diagnostic tool for thyroid nodules, it is typically performed after TSH assessment. - FNAC is indicated for nodules >1 cm with suspicious ultrasound features, but **functional assessment with TSH comes first** to rule out hyperfunctioning nodules.

Q: A 6-week-old child with a history of vomiting undergoes an ultrasound, which shows an antral nipple sign or target sign, as shown in the image. What is the diagnosis?

Congenital pyloric stenosis. ***Congenital pyloric stenosis*** - The ultrasound findings of an **antral nipple sign** and **target sign** are classic indicators of **hypertrophic pyloric stenosis**. - This condition presents with **projectile vomiting** in infants, typically between 3-6 weeks of age, due to hypertrophy of the pyloric muscle. *Umbilical hernia* - An **umbilical hernia** is a protrusion of abdominal contents through the umbilical ring. It is usually diagnosed clinically and presents as a bulge, not with vomiting. - Ultrasound for an umbilical hernia would show bowel loops or omentum protruding through the abdominal wall defect, not the specific pyloric signs described. *Small bowel obstruction* - While small bowel obstruction can cause vomiting, the ultrasound findings would typically show **dilated loops of bowel** and a **transition point**, not an antral nipple or target sign specifically at the pylorus. - Other clinical features, such as abdominal distention and absence of stool, would also be more prominent. *Jejunal atresia* - **Jejunal atresia** is a congenital anomaly where part of the jejunum is underdeveloped or absent, leading to a complete obstruction. - Ultrasound would reveal **dilated loops of small bowel**, typically without peristalsis past the obstruction, and polyhydramnios antenatally, but not the specific pyloric ultrasound signs. *Duodenal atresia* - **Duodenal atresia** is a congenital obstruction of the duodenum that typically presents with bilious vomiting soon after birth. - The characteristic ultrasound finding is the **"double bubble" sign**, representing a distended stomach and proximal duodenum, not the target or antral nipple sign seen at the pylorus.

Q: A 3-year-old child presents to the OPD with a history of recurrent urinary tract infections, poor urinary stream, and difficulty voiding. The radiological image is shown below. What is the most appropriate management?

Endoscopic ablation. ***Endoscopic ablation*** - The image shows a distended bladder with a dilated, elongated posterior urethra and a narrow stream of contrast beyond the bladder neck, characteristic findings of **posterior urethral valves (PUV)**. - **Endoscopic ablation (incision or fulguration)** of the valves is the definitive treatment for PUV to relieve obstruction and prevent further kidney damage. - This is the **gold standard primary treatment** for PUV in children who are large enough to undergo the procedure safely. *Dilation of urethra* - **Dilation** is generally ineffective because PUV are folds of tissue that require incision rather than simple stretching. - This approach does not address the underlying anatomical obstruction caused by the valves and could potentially cause damage to the urethra. *Dilation of urethra and bladder* - **Dilation of the urethra** is not an effective treatment for PUV. The bladder is already dilated due to the obstruction, and further dilation would not resolve the issue. - This approach would not remove the obstruction and could worsen bladder function or lead to further complications like reflux. *Conservative* - **Conservative management** with watchful waiting is not appropriate for PUV, as untreated obstruction can lead to progressive and irreversible kidney damage, bladder dysfunction, and recurrent UTIs. - Timely intervention is crucial to preserve renal function and improve long-term outcomes in boys with PUV. *Vesicostomy* - **Vesicostomy** (temporary bladder diversion) is reserved for specific scenarios such as neonates or very young infants too small for safe endoscopic ablation, severe hydronephrosis with renal failure, or failed primary ablation. - In this **3-year-old child**, endoscopic ablation is preferred as the primary definitive treatment rather than temporary diversion, which would require a second procedure later.

Q: An unimmunized 5 -year-old child presents to the OPD with a white membranous layer on the throat upon inspection. The child's brother is immunized. What is the first step in management?

Diphtheria antitoxin. ***Diphtheria antitoxin*** - The presence of a **white membranous layer** on the **throat** in an **unimmunized child**, along with the high contagiousness (brother's immunization is relevant to exposure), strongly suggests **diphtheria**. - **Diphtheria antitoxin (DAT)** is the crucial first-line treatment to neutralize the **exotoxin** produced by *Corynebacterium diphtheriae*, which is responsible for the severe systemic effects. - Antitoxin must be administered **immediately** without waiting for culture confirmation, as it only neutralizes unbound toxin. *Diphtheria toxoid* - **Diphtheria toxoid** is used for **active immunization** (vaccination) to prevent diphtheria, not for emergency treatment of an active infection. - Administering toxoid during an acute infection would not rapidly neutralize the circulating toxin. *Penicillin* - **Penicillin** (or erythromycin) is used to **eradicate the bacteria** (*Corynebacterium diphtheriae*) from the patient's throat and prevent further toxin production and transmission. - While important for source control, it does not neutralize the pre-formed toxin, which is the immediate threat to life. - Antibiotics should be given **after** antitoxin administration. *Isolation and supportive care* - **Isolation** is essential to prevent transmission, but it does not treat the patient's infection. - **Supportive care** is also crucial, but it addresses symptoms rather than the underlying cause or the effects of the toxin. *Tracheostomy* - **Tracheostomy** may be required later for airway obstruction if the membrane extends to the larynx or causes significant respiratory compromise. - However, it is **not the first step** in management; securing airway patency comes after antitoxin administration unless there is immediate life-threatening airway obstruction. - The priority is neutralizing the toxin to prevent further membrane formation and systemic complications.

Q: A 6-week-old baby is brought in by the mother with complaints of vomiting. An X-ray shows a single bubble appearance. What is the most likely diagnosis?

Congenital hypertrophic pyloric stenosis (CHPS). ***Congenital hypertrophic pyloric stenosis (CHPS)*** - The **single bubble appearance** observed in the X-ray, along with vomiting in a 6-week-old, is characteristic of an obstruction at the gastric outlet due to **pyloric stenosis**. The "bubble" represents the dilated stomach. - Infants with CHPS typically present with **non-bilious projectile vomiting** around 3-6 weeks of age, often accompanied by good appetite. *Duodenal atresia* - This condition classically presents with a **"double bubble" sign** on X-ray, representing dilation of the stomach and the proximal duodenum. - Vomiting is usually **bilious** and occurs earlier, often from birth. *Annular pancreas* - Annular pancreas can cause duodenal obstruction, leading to a **"double bubble" sign** similar to duodenal atresia. - The presentation would also be earlier, typically with **bilious vomiting** from birth or shortly thereafter. *Jejunal atresia* - Jejunal atresia would result in **multiple dilated loops of small bowel** proximal to the obstruction with air-fluid levels, rather than a single bubble. - The vomiting would be **bilious** and abdominal distension would be more prominent. *Malrotation with midgut volvulus* - This presents with **bilious vomiting** and can occur at any age, though commonly in the first few weeks of life. - X-ray findings include a **"corkscrew" or "whirl" sign** on contrast studies, or a gasless abdomen if complete obstruction occurs. - Unlike the single bubble of pyloric stenosis, malrotation typically shows abnormal bowel gas patterns or a paucity of gas in the abdomen.

Q: A patient presents with a penile lesion staged as T3, with clinically palpable lymph nodes. What is the most appropriate management?

Penectomy with deep ilioinguinal node dissection. ***Penectomy with deep ilioinguinal node dissection*** - A **T3 penile lesion** indicates invasion of the corpus cavernosum or corpus spongiosum, which is an aggressive stage requiring **radical local excision (penectomy)**. - **Clinically palpable lymph nodes** alongside a T3 tumor suggest nodal involvement (N1-N3), necessitating a **deep ilioinguinal lymph node dissection** to remove affected deeper lymph nodes that are not readily accessible by superficial dissection. *Penectomy* - While penectomy addresses the primary tumor, it does not manage the **clinically palpable lymph nodes**, which are crucial for staging and prognosis in advanced penile cancer. - This option would be insufficient given the documented **nodal involvement**, leading to likely recurrence and progression of the disease. *Penectomy with superficial node dissection* - This approach is inadequate for **palpable lymph nodes**, especially with a T3 lesion, because such nodes often indicate involvement of **deeper lymphatics (deep ilioinguinal)**. - Superficial dissection alone would likely leave residual disease, failing to properly stage and treat the extent of the cancer. *Chemoradiotherapy* - **Chemoradiotherapy** is typically reserved for patients who are not surgical candidates, or as a neoadjuvant/adjuvant therapy, not as primary treatment for a **T3 lesion with palpable nodes** where surgical intervention is the standard of care for optimal local and regional control. - While it may be used in certain settings, surgery (penectomy with lymph node dissection) offers the best chance for cure in this scenario.

Question 1

An infant presents with vomiting after feeding. Benedict's test was positive for a non-glucose reducing substance. What is the most likely diagnosis?

Accepted Answer

Galactosemia due to GAL-1-P Uridyl Transferase enzyme deficiency

Answer

Fructosuria due to Fructokinase deficiency

Answer

Hereditary fructose intolerance due to Aldolase B deficiency

Answer

Primary lactose intolerance

Answer

Glycogen storage disease due to Glucose-6-phosphatase deficiency

Question 2

Which disease will show the mode of inheritance depicted in this pedigree?

Accepted Answer

Achondroplasia

Answer

Prader-Willi syndrome

Answer

Wilson disease

Answer

Wiskott-Aldrich syndrome

Answer

Hemophilia A

Question 3

What is the most appropriate initial investigation for a solitary thyroid nodule (STN)?

Accepted Answer

Ultrasound

Answer

I-123 scan

Answer

Fine-needle aspiration (FNA) biopsy

Answer

Thyroid function tests (TFTs)

Answer

CT scan of the neck

Question 4

A female presents with a 1 × 1 cm thyroid swelling. What is the next best step in management?

Accepted Answer

TSH

Answer

I-131

Answer

TSH & T4

Answer

T3 & T4

Answer

FNAC

Question 5

A 6-week-old child with a history of vomiting undergoes an ultrasound, which shows an antral nipple sign or target sign, as shown in the image. What is the diagnosis?

Accepted Answer

Congenital pyloric stenosis

Answer

Umbilical hernia

Answer

Small bowel obstruction

Answer

Jejunal atresia

Answer

Duodenal atresia

Question 6

A 3-year-old child presents to the OPD with a history of recurrent urinary tract infections, poor urinary stream, and difficulty voiding. The radiological image is shown below. What is the most appropriate management?

Accepted Answer

Endoscopic ablation

Answer

Dilation of urethra

Answer

Dilation of urethra and bladder

Answer

Conservative

Answer

Vesicostomy

Question 7

An unimmunized 5 -year-old child presents to the OPD with a white membranous layer on the throat upon inspection. The child's brother is immunized. What is the first step in management?

Accepted Answer

Diphtheria antitoxin

Answer

Diphtheria toxoid

Answer

Penicillin

Answer

Isolation and supportive care

Answer

Tracheostomy

Question 8

An unimmunized 5 -year-old child presents to the OPD with a white membranous layer on inspection, suggesting diphtheria. What is the appropriate prophylaxis for a 2 -year-old contact who has completed their vaccination?

Accepted Answer

Penicillin

Answer

No prophylaxis needed

Answer

Toxoid

Answer

Immunoglobulins

Answer

Erythromycin

Question 9

A 6-week-old baby is brought in by the mother with complaints of vomiting. An X-ray shows a single bubble appearance. What is the most likely diagnosis?

Accepted Answer

Congenital hypertrophic pyloric stenosis (CHPS)

Answer

Duodenal atresia

Answer

Annular pancreas

Answer

Jejunal atresia

Answer

Malrotation with midgut volvulus

Question 10

A patient presents with a penile lesion staged as T3, with clinically palpable lymph nodes. What is the most appropriate management?

Accepted Answer

Penectomy with deep ilioinguinal node dissection

Answer

Penectomy

Answer

Penectomy with superficial node dissection

Answer

Chemoradiotherapy

NEET-PG 2024

Biochemistry

Diagnosis

Pediatrics

Surgery