NEET-PG 2018 Practice Questions

Q: What constitutes the Malpighian layer of skin?

Spinosum and basale. The Malpighian layer is a historical term used to collectively refer to the stratum spinosum and stratum basale of the epidermis [1]. These two layers are responsible for keratinocyte proliferation (basale) and establishing strong intercellular connections via desmosomes (spinosum) [1].

Q: Identify the skin lesion shown in the image.

Becker nevus. ***Becker nevus*** - This image clearly shows a large, **hyperpigmented patch with overlying coarse terminal hairs**, characteristic of a Becker nevus. - Becker nevi typically develop in adolescence and are often found on the shoulder or upper trunk, as seen here. *Hypopigmented macule* - A **hypopigmented macule** would appear as an area of skin with **reduced pigmentation** (lighter than the surrounding skin), which is contrary to the darker lesion shown. - There would also be no indication of **increased hair growth** within a typical hypopigmented macule. *Spitz nevus* - A Spitz nevus is a benign melanocytic nevus often appearing as a **dome-shaped, pink or red papule or nodule**, commonly on the face or limbs. - It does not present as a large, hairy, **hyperpigmented patch** as depicted in the image. *Epidermal nevus* - An epidermal nevus is a **congenital lesion** formed by an overgrowth of epidermal cells, but its appearance is typically a **verrucous (wart-like) plaque** or linearly arranged papules. - While it can be hyperpigmented, it generally **lacks the prominent hypertrichosis** (excessive hair growth) seen in the image.

Q: What is the most common indication for performing a tracheostomy?

Prolonged mechanical ventilation. ***Prolonged mechanical ventilation*** - Maintaining an **endotracheal tube** for an extended period carries risks like **tracheal injury**, **vocal cord damage**, and difficulty with oral intake. - A tracheostomy provides a more comfortable and stable airway for **long-term respiratory support**, facilitates weaning from the ventilator, and reduces the risk of **ventilator-associated pneumonia**. *Severe obstructive sleep apnea* - While tracheostomy can effectively treat severe OSA by bypassing the upper airway obstruction, it is generally considered a **last resort** after less invasive treatments have failed. - The most common initial treatments for OSA include **CPAP**, weight loss, and oral appliances. *Tracheal stenosis* - Tracheal stenosis itself is a **structural narrowing** of the trachea that may or may not require tracheostomy, depending on its severity and location. - While a tracheostomy can bypass a severe stenosis, surgical repair of the trachea is often the definitive treatment for **severe tracheal stenosis**. *Vocal cord paralysis* - Unilateral vocal cord paralysis typically causes **hoarseness** and may not always necessitate a tracheostomy. - Bilateral vocal cord paralysis can lead to **airway obstruction**, but intervention usually involves vocal cord lateralization procedures or, in severe cases, a tracheostomy for airway patency.

Q: Which condition is associated with the ECG pattern known as pseudo P pulmonale?

Hypercalcemia. ***Hypercalcemia*** - **Hypercalcemia** can cause a characteristic ECG pattern known as pseudo P pulmonale due to its effects on **myocardial repolarization**. - This condition leads to a **shortened QT interval** which causes the T wave to merge with the P wave, giving the appearance of a tall, peaked P wave. *Hypokalemia* - **Hypokalemia** typically presents with **flattened T waves**, prominent U waves, and ST-segment depression on an ECG [1]. - It can prolong repolarization, which is the opposite effect observed with pseudo P pulmonale [1]. *Hyponatremia* - **Hyponatremia** has a less defined direct effect on ECG patterns compared to other electrolyte imbalances. - Severe hyponatremia may lead to **QRS widening** or **bradycardia**, but not pseudo P pulmonale [1]. *Hypocalcemia* - **Hypocalcemia** characteristically causes **prolongation of the QT interval** on an ECG due to delayed ventricular repolarization [2]. - This is distinct from the shortened QT seen in hypercalcemia that contributes to pseudo P pulmonale.

Q: Which of the following is the carrying agent for Lyme disease?

Ixodes scapularis ticks. ***Ixodes scapularis ticks*** - *Ixodes scapularis* ticks (deer ticks) are the primary **vectors for Lyme disease** (caused by *Borrelia burgdorferi*) in North America [1]. - In Europe, *Ixodes ricinus* is the main vector for Lyme disease. - Lyme disease presents with characteristic **erythema migrans** rash, followed by potential neurological, cardiac, and arthritic complications [1]. - Lyme arthritis commonly affects large joints, particularly the **knee**, causing inflammatory arthritis [1]. *Anopheles* - **Anopheles mosquitoes** are the primary vectors for **malaria**, not Lyme disease [2]. - Malaria is caused by *Plasmodium* parasites and presents with fever, chills, and hemolytic anemia [2]. *Louse* - **Lice** are vectors for diseases such as **epidemic typhus** (caused by *Rickettsia prowazekii*) and **relapsing fever** (caused by *Borrelia recurrentis*) [3]. - They are not associated with the transmission of Lyme disease. *Rat flea* - **Rat fleas** (e.g., *Xenopsylla cheopis*) are the primary vectors for **bubonic plague** (caused by *Yersinia pestis*) and **murine typhus**. - These insects do not transmit Lyme disease. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 389-390. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, p. 400. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 392-393.

Q: Which drug regimen is given to a pregnant woman with HIV infection?

All of the options. ***All of the options*** - All listed regimens—**Tenofovir disoproxil fumarate (TDF) with emtricitabine (FTC)**, **TDF with lamivudine (3TC)**, and **Abacavir (ABC) with lamivudine (3TC)**—are commonly used and generally safe combinations of **nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs)** in pregnant women with HIV. - The choice of regimen depends on factors such as individual patient characteristics, viral resistance patterns, and potential side effects, but all mentioned regimens are considered **first-line options** in various guidelines for preventing mother-to-child transmission (PMTCT). *Tenofovir disoproxil fumarate with emtricitabine* - This combination is a common and effective **NRTI backbone** for HIV treatment, including in pregnancy, offering good efficacy and a generally favorable safety profile. - It is frequently paired with a third agent (e.g., a **non-nucleoside reverse transcriptase inhibitor (NNRTI)** or an **integrase strand transfer inhibitor (INSTI)**) as part of a highly active antiretroviral therapy (HAART) regimen. *Tenofovir disoproxil fumarate with lamivudine* - This is another widely used and effective **NRTI combination** and is also a recommended backbone for pregnant women with HIV. - While similar to TDF/FTC, some guidelines might prefer one over the other based on specific regional recommendations or drug availability. *Abacavir with lamivudine* - **Abacavir/lamivudine** is a well-established NRTI combination that is safe and effective in pregnancy, provided the mother is **HLA-B*5701 negative** to avoid hypersensitivity reactions. - It is considered a suitable alternative to TDF-containing regimens, especially when there are contraindications or intolerances to TDF.

Q: Based on the provided image, which of the following is the correct diagnosis?

Unicornuate Uterus. ***Unicornuate Uterus*** - The image distinctly shows **only one fallopian tube and one rudimentary uterine horn** on the right side, indicating a unicornuate uterus. - This malformation results from the **incomplete development of one Müllerian duct**, leading to a single, banana-shaped uterine cavity. *Uterus didelphys* - This condition involves **two completely separate uteri**, each with its own cervix and vagina. - The image does not show evidence of two distinct uterine bodies or cervices. *Bicornuate Uterus* - A bicornuate uterus is characterized by **two uterine horns that fuse caudally**, creating a heart-shaped appearance with a shared cervix. - The image clearly lacks the characteristic heart shape and shows only one functional horn. *Septate uterus* - A septate uterus has a **fibrous or muscular septum** dividing the uterine cavity, while the external uterine contour remains normal. - The image does not show a septum or a normal external uterine contour with an internal division; instead, it presents with a single underdeveloped horn.

Q: Identify the condition represented in the image of a testicular tumor.

Seminoma. ***Seminoma*** - Seminoma is a type of **germ cell tumor** that typically presents with a **painless testicular mass**, making it one of the common types of testicular cancer [1]. - This condition is characterized by the presence of **large, uniform cells** and is highly sensitive to **radiation therapy**, which aids in management [1]. *Non-seminoma* - Non-seminomas encompass a group of tumors including **embryonal carcinoma**, **choriocarcinoma**, and **yolk sac tumor**, which often present with more variable histological features [1]. - Generally considered more aggressive than seminomas, they may yield **higher levels of tumor markers** such as **AFP** or **hCG** [1]. *Teratoma* - Teratomas typically contain **multiple germ layers (ectoderm, mesoderm, and endoderm)**, often presenting with more complex histopathology compared to seminomas [1]. - They can occur in both children and adults, but in adults, they are often a component of a **non-seminomatous germ cell tumor** instead of a pure form [1,2]. *Germ cell differentiate tumor* - This term broadly refers to any tumor originating from **germ cells**, including both seminomas and non-seminomas, lacking specificity [1]. - It does not reflect the defined characteristics of seminoma and can encompass a range of histological types with diverse behaviors [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 979-982. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 512-513.

Q: Identify the condition represented in the chest radiograph.

Miliary tuberculosis. ***Miliary tuberculosis*** - The chest radiograph displays numerous small, well-demarcated **nodules (1-3 mm)** scattered diffusely and uniformly throughout both lung fields. - This widespread, uniform distribution of **miliary nodules** resembling millet seeds is pathognomonic for **miliary tuberculosis**, indicating hematogenous dissemination of *Mycobacterium tuberculosis*. - The **bilateral, symmetrical involvement** with countless tiny nodules of uniform size is characteristic. *Bronchiectasis* - Bronchiectasis on chest radiograph shows **dilated, thickened bronchi** appearing as parallel linear opacities ("tram-track sign") or ring-like structures. - **Increased bronchovascular markings** and areas of cystic lucencies may be visible, not the diffuse miliary nodular pattern seen here. *COPD* - COPD shows **hyperinflation** with flattened diaphragms, increased retrosternal airspace, and bullae. - **Emphysema** produces areas of hyperlucency and vascular attenuation, while **chronic bronchitis** shows increased bronchovascular markings and peribronchial thickening. - Neither produces the uniform miliary nodular pattern characteristic of this image. *Lung cancer* - Primary lung cancer typically presents as a **solitary pulmonary nodule or mass**, often with irregular margins and associated findings like lymphadenopathy or pleural effusion. - While **pulmonary metastases** can present as multiple nodules, they are typically **larger (>5 mm), variable in size**, and less uniformly distributed than the miliary pattern seen here.

Q: What type of lesions in the skull calvarium can be identified on this X-ray?

Brain metastases. ***Brain metastases (Skull metastases)*** - The image shows multiple **lytic lesions** in the skull calvarium, which are characteristic of metastatic disease that has spread to bone - Metastases from primary cancers (lung, breast, kidney, thyroid, prostate) commonly involve the skull and appear as **punched-out or moth-eaten lytic lesions** - While plain X-rays cannot visualize brain parenchyma, they can detect **bony destruction** caused by metastatic deposits in the skull - These appear as well-defined osteolytic lesions without sclerotic margins *Multiple myeloma* - Multiple myeloma typically presents with **multiple punched-out lytic lesions** in the skull that can appear very similar to metastases - However, multiple myeloma is a **primary bone marrow malignancy** rather than metastatic disease - Key differentiator: myeloma lesions are usually more uniform in size and distribution - Clinical context (monoclonal protein, anemia, renal dysfunction) helps distinguish from metastases *Osteosarcoma* - Osteosarcoma is a **primary bone tumor** that usually causes a mixture of lytic and blastic (bone-forming) lesions - Typically presents with **sunburst or spiculated periosteal reaction** and soft tissue mass - Usually occurs as a **solitary aggressive lesion** in younger patients, not multiple scattered lesions - Rarely occurs in the skull compared to long bones *Osteomyelitis* - Osteomyelitis is an **infection of the bone** that causes bone destruction and reactive new bone formation - Shows features of **bone destruction, periosteal reaction**, and possibly sequestra (dead bone fragments) - Typically presents as a **focal process** with surrounding inflammatory changes - Does not produce the multiple discrete lytic lesions pattern seen in metastatic disease

Question 1

What constitutes the Malpighian layer of skin?

Accepted Answer

Spinosum and basale

Answer

Corneum and lucidum

Answer

Spinosum only

Answer

Granulosum only

Question 2

Identify the skin lesion shown in the image.

Accepted Answer

Becker nevus

Answer

Hypopigmented macule

Answer

Spitz nevus

Answer

Epidermal nevus

Question 3

What is the most common indication for performing a tracheostomy?

Accepted Answer

Prolonged mechanical ventilation

Answer

Severe obstructive sleep apnea

Answer

Tracheal stenosis

Answer

Vocal cord paralysis

Question 4

Which condition is associated with the ECG pattern known as pseudo P pulmonale?

Accepted Answer

Hypercalcemia

Answer

Hyponatremia

Answer

Hypocalcemia

Answer

Hypokalemia

Question 5

Which of the following is the carrying agent for Lyme disease?

Accepted Answer

Ixodes scapularis ticks

Answer

Anopheles

Answer

Louse

Answer

Rat flea

Question 6

Which drug regimen is given to a pregnant woman with HIV infection?

Accepted Answer

All of the options

Answer

Tenofovir disoproxil fumarate with emtricitabine

Answer

Tenofovir disoproxil fumarate with lamivudine

Answer

Abacavir with lamivudine

Question 7

Based on the provided image, which of the following is the correct diagnosis?

Accepted Answer

Unicornuate Uterus

Answer

Uterus didelphys

Answer

Bicornuate Uterus

Answer

Septate uterus

Question 8

Identify the condition represented in the image of a testicular tumor.

Accepted Answer

Seminoma

Answer

Non-seminomatous germ cell tumor

Answer

Teratoma (testicular tumor)

Answer

Leydig cell tumor

Question 9

Identify the condition represented in the chest radiograph.

Accepted Answer

Miliary tuberculosis

Answer

Bronchiectasis

Answer

COPD

Answer

Lung cancer

Question 10

What type of lesions in the skull calvarium can be identified on this X-ray?

Accepted Answer

Brain metastases

Answer

Multiple myeloma

Answer

Osteosarcoma

Answer

Osteomyelitis

NEET-PG 2018

Anatomy

Dermatology

ENT

Internal Medicine

Microbiology

Obstetrics and Gynecology

Pathology

Radiology