NEET-PG 2019 Practice Questions

Q: Which of the following nail findings is seen in the condition shown below?

Pitting. ***Pitting*** - The image displays multiple small, **punctate depressions** on the nail plate, which are characteristic features of nail pitting. - Nail pitting is a common finding in conditions affecting the **nail matrix**, such as psoriasis. *Pterygium* - **Pterygium** refers to the forward growth of the proximal nail fold onto the nail plate, or the lateral nail folds onto the nail plate, often leading to nail loss. - This is not observed in the image, which primarily shows depressions rather than overgrowth of skin onto the nail. *Pigmentation* - **Nail pigmentation** involves discoloration of the nail plate, appearing as streaks, spots, or diffuse changes in color (e.g., brown, black, blue). - The nail in the image does not show abnormal discoloration but rather surface irregularities. *Ridges* - **Ridges** in nails (longitudinal or transverse) are linear elevations or grooves on the nail surface. - While some linear texture is present, the predominant feature in the image is distinct, small, and scattered depressions, which are consistent with pitting rather than continuous ridges.

Q: A patient presented with the following picture of Tympanic Membrane. Most Probable diagnosis (marked with arrow):

Tubercular Otitis Media. ***Tubercular Otitis Media*** - The image exhibits **multiple perforations** in the tympanic membrane, along with **pale granulation tissue**, which are classic clinical features of **tubercular otitis media**. - Tubercular ear infections often present insidiously with **painless otorrhea** and **progressive hearing loss**, eventually leading to multiple perforations as the disease advances. *Syphilitic Otitis Media* - Syphilitic otitis media typically presents as **sensorineural hearing loss**, often sudden, and can be associated with **vestibular symptoms**. - It usually does **not cause multiple perforations** or extensive granulation tissue in the tympanic membrane. *Pseudomonas infection* - **Pseudomonas otitis externa** commonly causes severe pain, swelling, and purulent discharge, often seen in _elderly diabetic_ or _immunocompromised_ patients with potentially **malignant otitis externa**. - While *Pseudomonas* can cause chronic suppurative otitis media (CSOM) with a perforation, it doesn't typically lead to **multiple perforations** in the manner depicted. *Fungal Otitis Media* - Fungal otitis media (otomycosis) is characterized by the presence of **black, white, or yellow fungal debris** and hyphae within the external ear canal and on the tympanic membrane. - While it can cause inflammation and sometimes perforation, the image does not show characteristic **fungal elements** or the extensive **granulation tissue** typical of tubercular disease.

Q: A patient presents with hoarseness and laryngoscopy reveals a warty, cauliflower-like growth on the vocal cord. Identify the most likely lesion.

Laryngeal papilloma. ***Laryngeal papilloma*** - **Hoarseness** and a **warty, cauliflower-like growth** on the vocal cord are classic descriptions of a laryngeal papilloma, often caused by **HPV infection**. - These lesions can be solitary or multiple, and while benign, they can recur and cause voice changes and respiratory obstruction. *Laryngeal malignancy* - While hoarseness is a common symptom of laryngeal malignancy, the description of a **"warty, cauliflower-like growth"** is more characteristic of a papilloma than most typical carcinomas, which might appear more ulcerative or infiltrative. - Malignancies are more commonly associated with risk factors like **smoking and alcohol use**, and often present with other symptoms like dysphagia or weight loss. *Tracheomalacia* - **Tracheomalacia** refers to softening of the tracheal cartilage, leading to airway collapse, typically causing stridor or respiratory distress. - It does not present as a **discrete growth** on the vocal cords but rather as a diffuse structural weakness of the trachea. *Reinke’s edema* - **Reinke's edema** (polypoid corditis) is characterized by a **gelatinous or fluid-filled swelling** of the vocal cords, usually associated with chronic irritation like smoking. - It presents as a swollen, boggy appearance of the vocal cords, not a warty or cauliflower-like growth.

Q: Which murmur increases on standing?

HOCM. ***HOCM*** - Standing decreases **venous return** and **left ventricular volume**, which reduces the size of the LV outflow tract and thus exacerbates the obstruction in **hypertrophic obstructive cardiomyopathy (HOCM)**, making the murmur louder [1]. - This maneuver is a key diagnostic feature as reduced preload intensifies the dynamic obstruction. *MR* - **Mitral regurgitation (MR)** is typically a volume overload lesion, and standing (which reduces preload) generally causes the murmur to **decrease** in intensity due to less blood volume ejected back into the atrium [3]. - The murmur of MR is usually a holosystolic murmur radiating to the axilla [3]. *MS* - **Mitral stenosis (MS)** is a fixed obstruction to left ventricular filling. Changes in preload (like standing) do not significantly alter the gradient across the mitral valve or the intensity of the murmur [2]. - Its characteristic murmur is a **mid-diastolic rumble** with an opening snap [1]. *VSD* - A **ventricular septal defect (VSD)** murmur is caused by blood flowing from the high-pressure left ventricle to the low-pressure right ventricle. Standing, by reducing systemic vascular resistance, would typically cause the murmur to **decrease** in intensity as less blood shunts left-to-right. - The murmur is usually a **holosystolic murmur** best heard at the lower left sternal border.

Q: A 25-year-old male presents with localized pain in the tibia and swelling. Imaging reveals a bone abscess. Identify the condition.

Brodie abscess. ***Brodie abscess*** - A Brodie abscess is a **subacute or chronic osteomyelitis** characterized by a well-circumscribed, **radiolucent lesion** (an abscess cavity) often surrounded by a zone of **sclerosis**, representing the body's attempt to wall off the infection. - The presentation of localized pain and swelling in the tibia, with imaging revealing a bone abscess, is consistent with this condition, which is a common form of localized osteomyelitis. *Osteoid osteoma* - This is a **benign bone tumor** characterized by a small, radiolucent nidus surrounded by a large area of **sclerotic bone**. The pain from an osteoid osteoma is typically **worse at night** and dramatically relieved by NSAIDs. - While it can cause localized pain and swelling, the imaging features of a distinct abscess cavity are not characteristic of an osteoid osteoma. *Intracortical hemangioma* - An intracortical hemangioma is a **rare benign vascular lesion** within the cortex of a bone. - Imaging typically shows a **lytic lesion** with a characteristic **"honeycomb" or "sunburst" appearance**, not a well-defined abscess. *Chondromyxoid fibroma* - This is a rare, **benign cartilaginous tumor** that usually presents as an **eccentric lytic lesion** in the metaphysis of long bones, often with a scalloped border and sclerotic rim. - While it can cause localized pain and swelling, the imaging appearance of an abscess with sclerotic margins is not typical of a chondromyxoid fibroma.

Q: 30 year old woman with complaint of dysmenorrhoea, dyspareunia with chronic pelvic pain undergoes hysterectomy. From the cut section of hysterectomy specimen below identify the condition.

Adenomyosis. ***Adenomyosis*** - The image shows a **thickened uterine wall** with poorly demarcated, **cystic or hemorrhagic areas** within the myometrium, which are characteristic macroscopic findings of adenomyosis. - The clinical symptoms of **dysmenorrhea, dyspareunia, and chronic pelvic pain** are classic presentations for adenomyosis, caused by the presence of endometrial glands and stroma within the myometrium. - The **globular uterine enlargement** with diffuse involvement distinguishes this from discrete lesions. *Fibroids (Leiomyoma)* - Fibroids are **well-circumscribed, discrete, rubbery masses** within the myometrium, often bulging from the surface or cut section with a characteristic **whorled appearance**. - While fibroids can cause menorrhagia and bulk symptoms, the diffuse thickening and **ill-defined hemorrhagic foci** in the image are inconsistent with the **sharply defined borders** of leiomyomas. *Endometrial hyperplasia* - Endometrial hyperplasia involves **thickening of the endometrial lining** due to excess estrogen stimulation, typically presenting with abnormal uterine bleeding. - This condition affects the **endometrium (lining) rather than the myometrium (muscle wall)**, and would not show the deep myometrial involvement with cystic spaces seen in the image. - The clinical picture of dysmenorrhea and dyspareunia is more consistent with adenomyosis than hyperplasia. *Endometriosis* - Endometriosis involves the presence of **endometrial tissue outside the uterus**, such as on the ovaries, peritoneum, or pelvic organs. - While it shares similar symptoms like dysmenorrhea and dyspareunia, endometriosis is a **separate condition from adenomyosis** (which is endometrial tissue within the uterine wall). - The image shows the **uterine cut section with myometrial involvement**, not external implants characteristic of endometriosis.

Q: What is the PRIMARY mechanism by which Interleukin-1 (IL-1) induces fever?

Endogenous pyrogen. ***Endogenous pyrogen*** - **IL-1** is a potent **endogenous pyrogen** that acts directly on the **hypothalamus**, the body's thermoregulatory center. - It stimulates the production of **prostaglandin E2 (PGE2)** in the hypothalamus, which then resets the body's thermoregulatory set point to a higher temperature, leading to fever. *Stimulates antibody production* - While IL-1 can have broader immune functions and can influence B cell activity, its **primary role in fever** production is not through antibody stimulation. - Antibody production is a function of **B lymphocytes** and is primarily driven by antigen presentation and T cell help. *Inhibits inflammation* - **IL-1** is a key **pro-inflammatory cytokine** that promotes inflammation, rather than inhibiting it. - It induces the expression of various adhesion molecules and inflammatory mediators, contributing to the inflammatory response. *Activates complement cascade* - The **complement cascade** is a part of the innate immune system, typically activated by **antigen-antibody complexes** (classical pathway) or **microbial surfaces** (alternative and lectin pathways). - While IL-1 plays a role in overall immune responses, its direct mechanism for inducing fever does not primarily involve activating the complement system.

Q: A female patient presented with recurrent urinary tract infections. What is the most probable diagnosis based on the imaging findings?

Ureterocele. ***Ureterocele*** - The imaging shows a rounded, radiolucent filling defect within the **contrast-filled bladder**, which is characteristic of a **ureterocele**. This is often associated with recurrent UTIs due to obstruction and stasis. - A ureterocele is a **congenital dilation** of the terminal part of the ureter as it enters the bladder, causing a cystic protrusion into the bladder lumen. *Congenital megaureter* - A congenital megaureter would appear as a **diffusely dilated ureter** throughout its course, often extending from the renal pelvis, rather than a localized cystic structure within the bladder. - While it can cause recurrent UTIs, the specific bladder filling defect seen here is not typical for an isolated megaureter. *Urinary stones* - Urinary stones would typically appear as **radiopaque foci** of varying size, depending on their composition, within the collecting system or bladder. - They do not typically present as a smooth, rounded filling defect within a contrast-filled bladder. *Ureteral duplication* - Ureteral duplication involves two separate ureters draining a single kidney, which often have their own separate openings into the bladder or meet before entering. - While it can be associated with UTIs (especially with reflux or ectopia), the primary finding on imaging would be the presence of **two distinct ureters**, not an intravesical cystic structure.

Q: Identify the most likely diagnosis based on the chest X-ray findings in a patient with low-grade fever.

Miliary TB. ***Miliary TB*** - The chest X-ray shows diffuse, small, uniformly distributed nodular opacities (2-3 mm in diameter) bilaterally, characteristic of "**millet seed**" pattern seen in **miliary tuberculosis**. - This pattern results from the hematogenous spread of *Mycobacterium tuberculosis* throughout the lungs, often presenting with **low-grade fever** and constitutional symptoms. *ILD* - **Interstitial lung disease (ILD)** typically shows reticular, nodular, or ground-glass opacities, sometimes with honeycombing, but the pattern is usually more heterogeneous and often basal or peripheral, unlike the uniform fine nodularity seen here. - While some ILDs can present with diffuse nodular patterns, the clinical context of **fever** and the classic "millet seed" appearance are more indicative of miliary TB. *Bronchopneumonia* - **Bronchopneumonia** presents as patchy, often ill-defined, multifocal areas of opacification or consolidation, usually distributed around the bronchi. - It does not typically cause the fine, diffuse, and uniform nodular pattern seen in this image, which represents widespread interstitial or alveolar involvement rather than primarily bronchial inflammation. *Consolidation* - **Consolidation** appears as a homogeneous opacification that obliterates vessels and airway walls, often with air bronchograms, typically confined to a lobe or segment. - The image shows diffuse nodular infiltrates rather than large, confluent areas of homogeneous opacification, making isolated consolidation an unlikely primary description.

Q: Identify the triangle in the image below.

Gastrinoma triangle. ***Gastrinoma triangle*** - The image displays the **gastrinoma triangle** (also known as the **Passaro triangle**), which is the most common location for **gastrinomas** within the abdomen. - This triangle is formed by the superior border of the **duodenum** (first part), the inferior border of the **duodenum** (third part), and the junction of the **cystic duct** and **common bile duct**. *Koch’s triangle* - **Koch's triangle** is an anatomical region within the **right atrium of the heart**, defined by the septal leaflet of the tricuspid valve, the coronary sinus ostium, and the tendon of Todaro. - It is significant as it contains the **atrioventricular (AV) node**, crucial for cardiac conduction. *Hesselbach’s triangle* - **Hesselbach's triangle** is located in the **inguinal region** on the anterior abdominal wall, bounded by the inferior epigastric artery, the lateral border of the rectus abdominis muscle, and the inguinal ligament. - It is a clinically important landmark for differentiating between **direct and indirect inguinal hernias**. *Sherren’s triangle* - **Sherren's triangle** refers to a zone of **hyperesthesia** (increased tactile sensitivity) in the right iliac fossa that can be indicative of **acute appendicitis**. - It is bounded by the umbilicus, the anterior superior iliac spine, and the pubic symphysis, and differs from the anatomical triangles shown in the image.

Question 1

Which of the following nail findings is seen in the condition shown below?

Accepted Answer

Pitting

Answer

Pterygium

Answer

Pigmentation

Answer

Ridges

Question 2

A patient presented with the following picture of Tympanic Membrane. Most Probable diagnosis (marked with arrow):

Accepted Answer

Tubercular Otitis Media

Answer

Syphilitic Otitis Media

Answer

Pseudomonas infection

Answer

Fungal Otitis Media

Question 3

A patient presents with hoarseness and laryngoscopy reveals a warty, cauliflower-like growth on the vocal cord. Identify the most likely lesion.

Accepted Answer

Laryngeal papilloma

Answer

Laryngeal malignancy

Answer

Tracheomalacia

Answer

Reinke’s edema

Question 4

Which murmur increases on standing?

Accepted Answer

HOCM

Answer

MR

Answer

MS

Answer

VSD

Question 5

A 25-year-old male presents with localized pain in the tibia and swelling. Imaging reveals a bone abscess. Identify the condition.

Accepted Answer

Brodie abscess

Answer

Osteoid osteoma

Answer

Intracortical hemangioma

Answer

Chondromyxoid fibroma

Question 6

30 year old woman with complaint of dysmenorrhoea, dyspareunia with chronic pelvic pain undergoes hysterectomy. From the cut section of hysterectomy specimen below identify the condition.

Accepted Answer

Adenomyosis

Answer

Fibroids

Answer

Endometrial hyperplasia

Answer

Endometriosis

Question 7

What is the PRIMARY mechanism by which Interleukin-1 (IL-1) induces fever?

Accepted Answer

Endogenous pyrogen

Answer

Stimulates antibody production

Answer

Inhibits inflammation

Answer

Activates complement cascade

Question 8

A female patient presented with recurrent urinary tract infections. What is the most probable diagnosis based on the imaging findings?

Accepted Answer

Ureterocele

Answer

Congenital megaureter

Answer

Urinary stones

Answer

Ureteral duplication

Question 9

Identify the most likely diagnosis based on the chest X-ray findings in a patient with low-grade fever.

Accepted Answer

Miliary TB

Answer

ILD

Answer

Bronchopneumonia

Answer

Consolidation

Question 10

Identify the triangle in the image below.

Accepted Answer

Gastrinoma triangle

Answer

Hesselbach’s triangle

Answer

Koch’s triangle

Answer

Sherren’s triangle

NEET-PG 2019

Dermatology

ENT

Internal Medicine

Orthopaedics

Pathology

Radiology

Surgery