NEET-PG 2017 Practice Questions

Q: The EEG of the patient shows which of the following? (Recent NEET Pattern 2016-17)

Burst suppression pattern. ***Burst suppression pattern*** - The EEG shows periods of high amplitude, mixed-frequency **bursts of activity** alternating with periods of **relative electrical silence** (suppression). - This pattern is often seen in conditions like severe **hypoxic-ischemic encephalopathy**, deep **anesthesia**, or severe brain injury. *Rademecker complex* - This refers to periodic trifasic complexes, often associated with subacute sclerosing panencephalitis (SSPE), which is a **slow viral infection** of the brain. - The complexes are typically **bilateral, synchronous, and repetitive**, not characterized by alternating bursts and suppression. *3/sec spike and slow wave pattern* - This pattern is characteristic of **absence seizures (petit mal epilepsy)**, where there are generalized, synchronous 3 Hz spike-and-wave discharges. - The image does not show continuous, rhythmic 3 Hz activity but rather alternating periods of activity and flat-lining. *4-6 Hz Polyspike* - Polyspikes are a series of two or more spikes or sharp waves clustered together, often associated with **myoclonic seizures** or other generalized epilepsies. - While there are some sharp waves in the burst phases, the overall pattern is dominated by the distinct periods of suppression, not continuous polyspike activity.

Q: The EEG of a 16-year-old boy with early morning involuntary movements of hands in his sleep noticed by parents, was performed. Immunization is complete. What does EEG show? (Recent NEET Pattern 2016-17)

Juvenile myoclonic epilepsy. ***Juvenile myoclonic epilepsy*** - The EEG shows generalized **polyspike-and-slow-wave discharges**, which are characteristic of juvenile myoclonic epilepsy (JME), especially when associated with early morning myoclonus. - The clinical presentation of a **16-year-old boy** with **involuntary movements of hands in his sleep** (suggesting myoclonic jerks), particularly in the morning, is highly consistent with JME. *SSPE* - Subacute sclerosing panencephalitis (SSPE) typically presents with characteristic EEG patterns like **Radermacker complexes** or **periodic complexes**, which are not seen here. - Clinical features of SSPE include progressive cognitive decline, myoclonus, and other neurological deficits, usually following a measles infection, which are not described. *Benign rolandic epilepsy* - Benign rolandic epilepsy (BRE) is characterized by **centrotemporal spikes** on EEG, often exacerbated by sleep, and presents with focal seizures affecting the face and mouth. - The generalized polyspike-and-slow-wave pattern and the clinical description of hand myoclonus do not fit the profile of BRE. *Huntington chorea* - Huntington's chorea is a **neurodegenerative genetic disorder** characterized by involuntary movements (chorea), cognitive decline, and psychiatric problems. - EEG findings in Huntington's chorea are often non-specific or show generalized slowing, and it is not an epilepsy syndrome with specific high-amplitude epileptiform discharges like those seen.

Q: Comment on the diagnosis of this child, presenting with eye swelling. (Recent NEET Pattern 2016-17)

Neuroblastoma. ***Neuroblastoma*** - The image shows **periorbital ecchymosis** and **proptosis** in a child, which are classic signs of orbital metastatic neuroblastoma, often referred to as "raccoon eyes." - The abdominal scar suggests a prior surgery, possibly for removal of the primary tumor, which is typically found in the **adrenal gland** or **sympathetic ganglia**. *Chloroma* - **Chloromas** (also known as granulocytic sarcomas) are extramedullary manifestations of myeloid leukemia, presenting as solid tumors composed of myeloid blast cells. - While they can appear in the orbit and mimic proptosis, the presence of bilateral periorbital ecchymosis ("raccoon eyes") is more characteristic of neuroblastoma metastasis. *Wilms tumor* - **Wilms tumor** is a kidney cancer, typically presenting as an **abdominal mass** and occasionally with hypertension or hematuria. - Ocular manifestations, such as proptosis, are extremely **rare** and do not typically involve periorbital ecchymosis. *Ameloblastoma* - An **ameloblastoma** is a benign but locally aggressive tumor of odontogenic (tooth-forming) origin, primarily affecting the **jawbones**. - It does not metastasize to the orbit and would not present with periorbital swelling or ecchymosis.

Q: Neonate born at 34 weeks with premature rupture of membranes develops respiratory distress. CXR was performed. All are considered in differential diagnosis except:

Tetralogy of Fallot. ***Tetralogy of Fallot*** - **Tetralogy of Fallot** is a **cyanotic congenital heart defect** characterized by VSD, pulmonary stenosis, right ventricular hypertrophy, and overriding aorta. - It presents primarily with **cyanosis** (not respiratory distress) and would show **normal or oligemic lung fields** on CXR, not the diffuse parenchymal lung disease patterns seen in RDS, pneumonia, or alveolar proteinosis. - **Not part of the differential diagnosis** for a preterm neonate with PROM presenting with respiratory distress and lung infiltrates on imaging. *Congenital pneumonia* - This is a significant concern in a neonate born prematurely with **premature rupture of membranes (PROM)**, as ascending infection is a known risk factor. - Chest X-ray findings can include **diffuse hazy infiltrates** or **patchy consolidation**, consistent with infections. - Would be considered in the differential diagnosis. *Hyaline membrane disease* - Also known as **respiratory distress syndrome (RDS)**, this is common in **premature infants at 34 weeks** due to **surfactant deficiency**. - The chest X-ray typically shows **diffuse reticulogranular ground-glass opacities** and **air bronchograms**. - Most common cause of respiratory distress in preterm neonates and a key differential. *Congenital alveolar proteinosis* - This is a rare genetic disorder where **surfactant proteins accumulate in the alveoli**, leading to impaired gas exchange and respiratory distress. - Chest X-ray findings often include **diffuse alveolar infiltrates** or consolidation, which can resemble other neonatal lung diseases. - Though rare, must be considered in the differential for neonatal respiratory distress.

Q: Preterm child on cow milk due to death of mother is having blood in stools. X-ray abdomen was done. Diagnosis is:

Rigler sign. ***Rigler sign*** - Rigler sign (also called **double wall sign**) refers to **visualization of both sides of the bowel wall** on X-ray due to **free intraperitoneal air (pneumoperitoneum)**, indicating bowel perforation. - In the clinical context of a **preterm infant on cow milk with bloody stools**, this presentation is highly suggestive of **Necrotizing Enterocolitis (NEC) with perforation**. - The X-ray shows Rigler sign as evidence of pneumoperitoneum, a serious complication of NEC requiring urgent surgical intervention. - **Key NEC radiological findings** include: pneumatosis intestinalis (intramural gas), portal venous gas, and pneumoperitoneum (Rigler sign) in cases with perforation. *Double bubble appearance* - This sign shows **two distinct air-filled structures** (distended stomach and duodenum) on abdominal X-ray, indicating **duodenal obstruction** from duodenal atresia or annular pancreas. - Not associated with bloody stools or NEC in preterm infants. *Claw sign* - The claw sign is seen in **intussusception**, where the bowel telescopes into itself, creating a soft tissue mass with a crescent-shaped gas pattern. - Typically occurs in older infants (6-18 months), not preterm neonates, and presents differently from NEC. *Bird of prey sign* - This sign is associated with **sigmoid or cecal volvulus**, showing a distended bowel loop with a beak-like configuration. - Represents large bowel obstruction, not the typical presentation of a preterm infant with feeding intolerance and bloody stools from NEC.

Q: Which of the following is the best diagnosis of this neonate who is excessively hungry, warm with flushed skin?

Neonatal thyrotoxicosis. ***Neonatal thyrotoxicosis*** - The image shows a neonate with **exophthalmos** and signs of being **hypermetabolic** (excessively hungry, warm, flushed skin), all consistent with hyperthyroidism. - This condition occurs when **maternal thyroid-stimulating immunoglobulins** cross the placenta, causing transient hyperthyroidism in the newborn. *Neonatal lupus* - Neonatal lupus is primarily characterized by **congenital heart block** and **dermatological manifestations** (e.g., erythematous annular lesions) but does not typically present with severe metabolic hyperactivity or exophthalmos as seen here. - It is caused by the transplacental passage of maternal autoantibodies (anti-Ro/SSA and anti-La/SSB). *Congenital hypothyroidism* - Congenital hypothyroidism would present with symptoms opposite to those described, such as **lethargy**, **poor feeding**, **cold and mottled skin**, and **constipation**. - Physical features often include a **puffy face**, **macroglossia**, and an **umbilical hernia**. *Progeria* - Progeria is a rare genetic disorder characterized by **accelerated aging** that typically manifests later in infancy or early childhood with features like **alopecia**, **thin skin**, and **skeletal abnormalities**, which are not depicted or described as primary symptoms here. - It does not cause the acute signs of hypermetabolism seen in neonatal thyrotoxicosis.

Q: Child has not passed stool by 2nd day of life. X-Ray study done shows:

Duodenal atresia. ***Duodenal atresia*** - The abdominal X-ray images display the classic **"double bubble sign"**, which is highly characteristic of duodenal atresia. This sign consists of two distinct air-filled loops, one representing the distended stomach and the other the dilated proximal duodenum, with no distal gas. - The clinical presentation of a neonate not passing stool by the second day of life, combined with the characteristic radiological findings, points directly to an **upper gastrointestinal obstruction** like duodenal atresia. *Cystic fibrosis* - While cystic fibrosis can cause **meconium ileus** leading to intestinal obstruction in newborns, it typically presents with diffuse intestinal distension rather than the localized "double bubble" pattern. - Meconium ileus on X-ray would show numerous dilated loops of small bowel with a **"ground-glass" appearance** due to trapped meconium, not the distinct two bubbles seen here. *CHPS* - **Congenital hypertrophic pyloric stenosis (CHPS)** typically manifests later, between 3-6 weeks of age, with projectile non-bilious vomiting, not as early as the second day of life with findings of intestinal obstruction on X-ray. - The X-ray findings in CHPS would show a **distended stomach but without the second bubble** representing a dilated duodenum often seen in duodenal atresia. *Anorectal malformation* - **Anorectal malformations** are lower gastrointestinal obstructions, meaning a significant portion of the bowel would be distended with gas, and the X-ray would not show the isolated "double bubble" sign. - Diagnosis is often made by physical examination demonstrating an **imperforate anus** or abnormal anal opening, in conjunction with plain abdominal radiographs that would show distal intestinal obstruction.

Q: A neonate presents with the clinical features shown in the image below. What is the most likely diagnosis?

Congenital hypothyroidism. ***Congenital hypothyroidism*** - The image shows a neonate with **macroglossia** (large tongue), **umbilical hernia**, and possibly **puffy eyelids** and **dull facies**, all characteristic signs of congenital hypothyroidism. - Other features often include **hypotonia**, **feeding difficulties**, **prolonged jaundice**, and **constipation**. *Down syndrome* - While Down syndrome can present with **hypotonia** and some shared features, the characteristic **epicanthal folds**, **simian crease**, **brushfield spots**, and flattened facial profile are not clearly evident. - Macroglossia is common but other features like an umbilical hernia would be less specific. *Ellis-Van Creveld syndrome* - This syndrome is characterized by **chondroectodermal dysplasia**, typically presenting with **polydactyly**, **short-limbed dwarfism**, **nail dysplasia**, and **cardiac defects**. - These distinct skeletal and ectodermal abnormalities are not visible in the presented image. *Turner syndrome* - Turner syndrome (XO karyotype) primarily affects females and is characterized by **short stature**, **webbed neck**, **lymphedema of hands and feet**, and **cardiac anomalies** (e.g., coarctation of the aorta). - The features shown in the image, such as macroglossia and umbilical hernia, are not typical of Turner syndrome.

Q: X-ray skull shows: (Recent NEET Pattern 2016-17)

Silver-beaten appearance. ***Silver-beaten appearance*** - The image shows a skull with multiple **gyral impressions** on the inner table, giving it a **bumpy**, 'silver-beaten' or 'copper-beaten' appearance. - This pattern is classically associated with **chronically increased intracranial pressure**, which causes the brain's convolutions to press against the skull. *Multiple myeloma* - Multiple myeloma typically presents with multiple, sharply demarcated **"punched-out" lytic lesions** in the skull, not diffuse gyral impressions. - These lesions often lack a sclerotic rim and are more discrete than the pattern seen here. *Histiocytosis-X* - Histiocytosis-X (now called Langerhans cell histiocytosis) can cause lytic skull lesions, often described as **"beveled edge"** or geographically distributed lesions. - While it can cause osteolytic bone destruction, it does not typically produce the widespread, uniform gyral impressions of a silver-beaten skull. *Letterer-Siwe disease* - Letterer-Siwe disease is an aggressive, disseminated form of **Langerhans cell histiocytosis** affecting infants. - While it can cause bone lesions, including in the skull, it typically manifests as generalized lytic lesions rather than the "silver-beaten" pattern indicative of chronic elevated intracranial pressure.

Q: Identify the condition on the basis of infantogram shown in the image:

Congenital diaphragmatic hernia. ***Congenital diaphragmatic hernia*** - The infantogram shows loops of **bowel within the thoracic cavity**, displacing the heart and mediastinum. - This classic appearance, with visible **gas-filled loops** in the chest, is characteristic of a congenital diaphragmatic hernia, typically on the left side (Bochdalek hernia). *Cystic adenomatoid malformation* - This condition involves an abnormal growth of lung tissue forming **cysts**; these cysts typically appear as discrete radiolucencies or a solid mass within the lung. - Unlike in the image, it does not typically show distinct **bowel loops in the chest cavity**. *Pneumomediastinum* - This condition is characterized by air in the **mediastinum**, which would appear as lucency outlining the mediastinal structures, such as the heart and great vessels. - It does not involve the presence of **abdominal contents** within the chest cavity. *Congenital lobar emphysema* - This condition presents with **hyperinflation of a single lobe** (usually left upper lobe) causing mass effect and mediastinal shift. - It appears as a hyperlucent, overexpanded lobe, but does not show **bowel gas pattern** or abdominal contents in the thorax.

Question 1

The EEG of the patient shows which of the following? (Recent NEET Pattern 2016-17)

Accepted Answer

Burst suppression pattern

Answer

Rademecker complex

Answer

3/sec spike and slow wave pattern

Answer

4-6 Hz Polyspike

Question 2

The EEG of a 16-year-old boy with early morning involuntary movements of hands in his sleep noticed by parents, was performed. Immunization is complete. What does EEG show? (Recent NEET Pattern 2016-17)

Accepted Answer

Juvenile myoclonic epilepsy

Answer

SSPE

Answer

Benign rolandic epilepsy

Answer

Huntington chorea

Question 3

Comment on the diagnosis of this child, presenting with eye swelling. (Recent NEET Pattern 2016-17)

Accepted Answer

Neuroblastoma

Answer

Chloroma

Answer

Wilms tumor

Answer

Ameloblastoma

Question 4

Neonate born at 34 weeks with premature rupture of membranes develops respiratory distress. CXR was performed. All are considered in differential diagnosis except:

Accepted Answer

Tetralogy of Fallot

Answer

Congenital pneumonia

Answer

Hyaline membrane disease

Answer

Congenital alveolar proteinosis

Question 5

Preterm child on cow milk due to death of mother is having blood in stools. X-ray abdomen was done. Diagnosis is:

Accepted Answer

Rigler sign

Answer

Double bubble appearance

Answer

Claw sign

Answer

Bird of prey sign

Question 6

Which of the following is the best diagnosis of this neonate who is excessively hungry, warm with flushed skin?

Accepted Answer

Neonatal thyrotoxicosis

Answer

Neonatal lupus

Answer

Congenital hypothyroidism

Answer

Progeria

Question 7

Child has not passed stool by 2nd day of life. X-Ray study done shows:

Accepted Answer

Duodenal atresia

Answer

Cystic fibrosis

Answer

CHPS

Answer

Anorectal malformation

Question 8

A neonate presents with the clinical features shown in the image below. What is the most likely diagnosis?

Accepted Answer

Congenital hypothyroidism

Answer

Down syndrome

Answer

Ellis-Van Creveld syndrome

Answer

Turner syndrome

Question 9

X-ray skull shows: (Recent NEET Pattern 2016-17)

Accepted Answer

Silver-beaten appearance

Answer

Multiple myeloma

Answer

Histiocytosis-X

Answer

Letterer-Siwe disease

Question 10

Identify the condition on the basis of infantogram shown in the image:

Accepted Answer

Congenital diaphragmatic hernia

Answer

Cystic adenomatoid malformation

Answer

Pneumomediastinum

Answer

Congenital lobar emphysema

NEET-PG 2017

Internal Medicine

Pediatrics

Radiology