NEET-PG 2018 Practice Questions

Q: Which of the following will best describe this patient?

Fever, weight loss, night sweats and elevated ESR. ***Fever, weight loss, night sweats and elevated ESR*** - The CT scan shows numerous **small, diffuse nodules** throughout both lung fields, consistent with **miliary tuberculosis (TB)**. - The systemic symptoms of **fever, weight loss, night sweats**, and an **elevated ESR** are classic constitutional symptoms of disseminated TB. *Rusty sputum with gram positive diplococci* - This description is characteristic of **Streptococcus pneumoniae (pneumococcal pneumonia)**. - Pneumococcal pneumonia typically presents with lobar consolidation on imaging, not diffuse miliary nodules. *Acute dyspnea, elevated JVP and long history of air travel* - This constellation of symptoms (acute dyspnea, elevated JVP) and risk factor (long history of air travel) strongly suggests **pulmonary embolism (PE)**. - Imaging findings for PE would typically include a filling defect in the pulmonary arteries, rather than diffuse nodularity. *Acute dyspnea, pink frothy sputum and mid-diastolic rumble* - These symptoms point towards **left-sided heart failure (acute pulmonary edema)**, often associated with **mitral stenosis** (suggested by the mid-diastolic rumble). - Pulmonary edema on CT would show ground-glass opacities, septal thickening, and pleural effusions, not diffuse nodular infiltrates.

Q: Which of the following is responsible for the abnormality shown below?

Zika virus. ***Zika virus*** - The image depicts a newborn with **microcephaly**, characterized by a significantly smaller head circumference than expected, which is a hallmark congenital abnormality associated with **Zika virus infection** during pregnancy. - Zika virus is a **teratogen** that primarily targets neural progenitor cells, leading to severe brain malformations and microcephaly in developing fetuses. *Human parvovirus B19* - This virus is known to cause **erythema infectiosum** (fifth disease) in children and can lead to **hydrops fetalis**, severe anemia, and cardiac failure in fetuses if transmitted during pregnancy. - It does not typically cause microcephaly as its primary congenital manifestation. *HHV6* - Human Herpesvirus 6 (HHV6) is the causative agent of **roseola infantum** (exanthem subitum) in young children. - While it can cause febrile seizures and encephalitis, it is not primarily associated with congenital microcephaly or other severe birth defects when acquired prenatally. *EBV* - Epstein-Barr virus (EBV) is responsible for **infectious mononucleosis** and is linked to various malignancies. - Congenital EBV infection is rare and has been associated with a range of non-specific outcomes, but it is not a recognized cause of microcephaly.

Q: Patient with eye surgery done 2 days ago presents with pain and dimness of vision. Which of the following is not useful for management?

Topical antibiotics. ***Topical antibiotics*** - This patient presents with symptoms suggestive of **post-surgical endophthalmitis** (pain and dimness of vision after eye surgery), which is a severe infection of the intraocular fluids (vitreous and/or aqueous humor). - Topical antibiotics typically do not achieve sufficient intraocular concentrations to effectively treat a deep-seated infection like endophthalmitis. *Intravenous antibiotics* - **Intravenous antibiotics** can provide systemic coverage and may reach the posterior segment of the eye, although their penetration into the vitreous can be limited. - They are often used as an adjunct to more direct routes of administration in severe endophthalmitis. *Intravitreal antibiotics* - **Intravitreal antibiotics** are injected directly into the vitreous cavity, providing high local concentrations of medication directly at the site of infection. - This is considered a cornerstone of endophthalmitis management due to its immediate and potent antimicrobial effect. *Pars plana vitrectomy* - **Pars plana vitrectomy** involves surgical removal of the infected vitreous, which reduces the bacterial load and inflammatory mediators, and allows for direct sampling for microbiology. - It is particularly indicated in cases of severe endophthalmitis or when there is poor response to antibiotics, often improving visual outcomes.

Q: The following image shows the presence of?

Bladder stone. ***Bladder stone*** - The image displays multiple **radiopaque densities** (stones) clustered within the pelvic cavity, specifically in the region where the urinary bladder is anatomically located. - The aggregation and rounded shapes are characteristic of **vesical calculi** (bladder stones). *Ureter stone* - **Ureteral stones** would typically appear as a single or a few stones following the course of the ureters, which are tubular structures extending from the kidneys to the bladder. - The diffuse, multi-focal collection seen in the image is not consistent with the typical presentation of a ureteric calculus. *Urethral stone* - A **urethral stone** would be located within the urethra, which is inferior to the bladder and would typically present as a single, elongated calculus in the distal urinary tract. - The location and multiple, scattered appearance in the image do not match a urethral stone. *Prostate calcification* - **Prostatic calcifications** are usually smaller, often punctate, and concentrated within the confines of the prostatic gland, typically inferior to the bladder neck. - The calcifications in the image are larger and more widely distributed, not confined to the typical anatomical borders of the prostate.

Q: The following X-ray is used to evaluate \qquad sinus?

Maxillary. ***Maxillary*** - The image provided is a **Waters' view** (occipitomental view) X-ray of the paranasal sinuses, which is primarily used to visualize the **maxillary sinuses**. - In a Waters' view, the **petrous ridges** (dense bone at the base of the skull) are projected below the maxillary sinuses, allowing for a clear view of these sinuses. *Frontal* - While the **frontal sinuses** are visible in a Waters' view, they are generally better visualized in a **Caldwell view** (occipitofrontal view) or lateral view. - In this projection, their visualization can be obscured by other bony structures, and they are not the primary focus. *Ethmoidal* - The **ethmoidal sinuses** are typically comprised of multiple small air cells located between the orbits and are best seen on a **Caldwell view** or specialized oblique views. - In a Waters' view, their evaluation is limited due to superimposition of other facial bones. *Sphenoidal* - The **sphenoidal sinuses** are located deep within the skull, inferior to the sella turcica, and are quite difficult to visualize on standard plain radiographs like the Waters' view. - They are best assessed using a **lateral view of the skull** or advanced imaging like **CT scans**.

Q: A radiographic projection with X-ray beam angled at 30 degrees to the radiographic plate, with the skull positioned laterally (as shown in the image), is used to visualize which of the following structures?

Sinus tympani. ***Sinus tympani*** - The image shows a **radiographic projection** designed to visualize structures of the **temporal bone**. Specifically, an X-ray beam angled at 30 degrees to the radiographic plate, with the skull positioned laterally, is characteristic of specific views for the **middle ear structures**, such as the sinus tympani. - The **sinus tympani** is a small, deep recess in the posterior wall of the middle ear, and its detailed visualization often requires specialized **oblique radiographic projections**. *Recess of fourth ventricle* - The **fourth ventricle** is located within the brain stem, and its recesses are deep brain structures. - Visualization of the fourth ventricle and its recesses typically requires advanced imaging modalities like **CT or MRI**, not standard X-ray projections of the skull. *Round window* - The **round window** is a structure of the inner ear, specifically located at the cochlea. - While it is part of the temporal bone, standard skull X-rays are not optimal for its detailed visualization, and a specialized view for the **hypotympanum** would be needed to see it clearly, which is not depicted by this projection angle. *Lateral ventricle* - The **lateral ventricles** are located within the cerebral hemispheres of the brain. - Similar to the fourth ventricle, these structures are best visualized with **CT or MRI** and are not effectively seen with basic skull X-ray projections, especially not with an angled view designed for the temporal bone.

Q: A patient with obstructive jaundice has the following imaging findings suggestive of pancreatic cancer. Which is the most appropriate method for obtaining tissue diagnosis?

EUS guided trans-gastric biopsy. ***EUS guided trans-gastric biopsy*** - **Endoscopic Ultrasound (EUS)** provides high-resolution imaging of the pancreas and surrounding structures, allowing for precise targeting of lesions for biopsy. - EUS-guided fine-needle aspiration (FNA) can accurately diagnose pancreatic tumors causing **obstructive jaundice** with minimal risk of tumor seeding. *CECT guided biopsy* - While computed tomography (CECT) can identify pancreatic masses, **percutaneous CECT-guided biopsy** carries a higher risk of complications such as bleeding, pancreatitis, and tumor seeding, especially for lesions near vital structures. - This method is less accurate for small lesions and may not always provide sufficient tissue for complete diagnosis compared to EUS-FNA. *MRI guided biopsy* - **MRI-guided biopsy** is not a standard or preferred method for biopsying pancreatic lesions due to technical challenges and the availability of more efficient and less invasive alternatives like EUS-FNA. - While MRI is excellent for imaging tissue characteristics, its real-time guidance capabilities for biopsy are limited compared to ultrasound. *Laparoscopic biopsy* - **Laparoscopic biopsy** is a more invasive surgical procedure compared to EUS-FNA and is typically reserved for cases where less invasive methods have failed or when **surgical staging** is required. - It involves general anesthesia, longer recovery, and higher risks of complications, making it less appropriate for obtaining a primary tissue diagnosis in obstructive jaundice due to a pancreatic mass.

Q: Which retractor is shown in the image?

Deaver retractor. ***Deaver retractor*** - The Deaver retractor is easily identifiable by its distinct **flat, C-shaped, curved blade** at one end and a **long handle with a fenestrated grip**. - It is commonly used in deep abdominal and thoracic procedures to **retract organs and tissues**, providing excellent exposure. *Morris retractor* - The Morris retractor typically features a **curved blade** that is less pronounced than a Deaver and often includes a **fenestrated handle**. - However, its blade is generally **flatter and broader** compared to the distinctive C-shape of the Deaver. *Langenbeck retractor* - A Langenbeck retractor is characterized by a **small, L-shaped blade** and a handle, designed for retracting small incisions and delicate tissues. - Its blade is significantly smaller and has a **sharper, angled bend** compared to the broad, C-shaped blade shown. *Doyen retractor* - The Doyen retractor, also known as a Doyen rib raspatory, is typically used to **retract ribs** and protect lung tissue during thoracic surgeries. - It has a distinctive **hooked end** or a spoon-like blade, which is quite different from the broad, curved blade in the image.

Q: Which is correct about the suture material shown in the image?

Absorbed by phagocytosis and enzymatic degradation. ***Absorbed by phagocytosis and enzymatic degradation*** - This description is characteristic of **natural absorbable sutures**, such as **catgut** (which appears to be depicted by the golden, multi-filament material with a needle). Catgut is absorbed by the body's enzymatic processes and macrophage activity. - This type of absorption is a key feature distinguishing natural absorbable sutures from synthetic ones (which are absorbed by hydrolysis) and non-absorbable sutures. *It is less reactive* - Natural absorbable sutures like catgut are generally associated with a **higher inflammatory reaction** in tissues compared to synthetic absorbable sutures due to their proteinacious nature. - The body's immune system recognizes these natural proteins, leading to a more pronounced foreign body response. *Derived from cat gut mucosa* - **Catgut sutures** are indeed derived from the sub-mucosal layer of the sheep or goat **intestine**, not the mucosa itself. - The term "catgut" is historical and misleading, as it is not derived from cats. *Used for bowel anastomosis* - While absorbable sutures are used for bowel anastomosis, the use of **plain catgut** (which the image suggests due to its color and appearance) is generally not preferred for critical anastomoses due to its variable and rapid absorption time, which can compromise wound strength before healing is complete. - **Chromic catgut** or synthetic absorbable sutures (like Vicryl or PDS) with more predictable absorption profiles are typically favored for bowel anastomoses.

Q: Based on the image shown, a patient has been diagnosed with a gastric ulcer. According to the Modified Johnson classification, what type of gastric ulcer is present?

Type 1. ***Type 1*** - The image shows a gastric ulcer located in the **gastric body along the lesser curvature**, which is characteristic of a **Type 1 ulcer** (most common type, ~55% of gastric ulcers). - Type 1 ulcers are typically associated with **normal or decreased acid secretion** and occur in patients with **chronic gastritis** and decreased mucosal resistance. - These ulcers are **not associated with duodenal ulcers** and have the **highest risk of malignancy** among gastric ulcer types. *Type 2* - A Type 2 ulcer involves **two concurrent ulcers**: one in the gastric body and a **concomitant active duodenal ulcer**. - Associated with **increased acid secretion** (similar to duodenal ulcer pathophysiology). - The image shows only a **single gastric ulcer** without evidence of duodenal involvement. *Type 3* - A Type 3 ulcer is located in the **prepyloric region** (within 3 cm of the pylorus). - Associated with **high acid secretion** and often occurs in younger patients. - The ulcer shown is in the **body/lesser curvature**, not the prepyloric area. *Type 4* - A Type 4 ulcer is a **high lesser curvature ulcer** located near the **gastroesophageal junction** (proximal stomach/cardia). - Associated with **low acid secretion** and has high malignant potential. - The image clearly shows the ulcer in the **mid-body region**, distal to the cardia. *Type 5* - Type 5 ulcers can occur **anywhere in the stomach** and are specifically associated with **chronic NSAID use**. - These are medication-induced ulcers rather than location-specific. - The image shows a typical Type 1 location without clinical information suggesting NSAID etiology.

Question 1

Which of the following will best describe this patient?

Accepted Answer

Fever, weight loss, night sweats and elevated ESR

Answer

Rusty sputum with gram positive diplococci

Answer

Acute dyspnea, elevated JVP and long history of air travel

Answer

Acute dyspnea, pink frothy sputum and mid-diastolic rumble

Question 2

Which of the following is responsible for the abnormality shown below?

Accepted Answer

Zika virus

Answer

Human parvovirus B19

Answer

HHV6

Answer

EBV

Question 3

Patient with eye surgery done 2 days ago presents with pain and dimness of vision. Which of the following is not useful for management?

Accepted Answer

Topical antibiotics

Answer

Intravenous antibiotics

Answer

Intravitreal antibiotics

Answer

Pars plana vitrectomy

Question 4

The following image shows the presence of?

Accepted Answer

Bladder stone

Answer

Ureter stone

Answer

Urethral stone

Answer

Prostate calcification

Question 5

The following X-ray is used to evaluate \qquad sinus?

Accepted Answer

Maxillary

Answer

Frontal

Answer

Ethmoidal

Answer

Sphenoidal

Question 6

A radiographic projection with X-ray beam angled at 30 degrees to the radiographic plate, with the skull positioned laterally (as shown in the image), is used to visualize which of the following structures?

Accepted Answer

Sinus tympani

Answer

Recess of fourth ventricle

Answer

Round window

Answer

Lateral ventricle

Question 7

A patient with obstructive jaundice has the following imaging findings suggestive of pancreatic cancer. Which is the most appropriate method for obtaining tissue diagnosis?

Accepted Answer

EUS guided trans-gastric biopsy

Answer

CECT guided biopsy

Answer

MRI guided biopsy

Answer

Laparoscopic biopsy

Question 8

Which retractor is shown in the image?

Accepted Answer

Deaver retractor

Answer

Morris retractor

Answer

Langenbeck retractor

Answer

Doyen retractor

Question 9

Which is correct about the suture material shown in the image?

Accepted Answer

Absorbed by phagocytosis and enzymatic degradation

Answer

It is less reactive

Answer

Derived from cat gut mucosa

Answer

Used for bowel anastomosis

Question 10

Based on the image shown, a patient has been diagnosed with a gastric ulcer. According to the Modified Johnson classification, what type of gastric ulcer is present?

Accepted Answer

Type 1

Answer

Type 2

Answer

Type 3

Answer

Type 4

Answer

Type 5

NEET-PG 2018

Internal Medicine

Microbiology

Ophthalmology

Radiology

Surgery