NEET-PG 2020 Practice Questions

Q: Which of the following is true about polyaeritis nodosa?

HBsAg is positive in 30% patients. ### HBsAg is positive in 30% patients - **Polyarteritis nodosa (PAN)** is strongly associated with **hepatitis B virus (HBV)** infection; about 30% of patients with PAN have evidence of current or past HBV infection, particularly **HBsAg positivity**. - This association suggests that HBV infection can trigger the immune complex vasculitis characteristic of PAN. ### It shows fibrinoid necrosis in large blood vessels - PAN primarily affects **medium-sized muscular arteries**, not typically large blood vessels [1]. - The inflammation causes **fibrinoid necrosis** and aneurysmal dilations in these medium-sized arteries [1]. ### It has ANCA positivity - **Polyarteritis nodosa (PAN)** is generally considered an **ANCA-negative vasculitis**. - **ANCA positivity** (especially c-ANCA/PR3-ANCA or p-ANCA/MPO-ANCA) is characteristic of other small-vessel vasculitides like **Granulomatosis with polyangiitis** or **Microscopic polyangiitis**. ### Affected individuals have involvement of pulmonary circulation. - A defining characteristic of **Polyarteritis nodosa (PAN)** is that it generally **spares the pulmonary circulation** [1]. - Pulmonary involvement is more commonly seen in other vasculitides, such as **Granulomatosis with polyangiitis (Wegener's)** or **Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)**.

Q: A 25-year-old man presents for a routine physical examination. The patient is tall (6 ft. 5 in) and on examination he was found to have an early diastolic murmur. His family pedigree is as given below. Which of the following is the mode of inheritance by which the disease is likely to be transmitted?

Autosomal dominant. ***Autosomal dominant*** - The pedigree shows **affected individuals in every generation**, and transmission from an affected parent to approximately half of their children, which is characteristic of **autosomal dominant inheritance**. - The disease affects both males and females, and **affected fathers transmit the disease to both sons and daughters** (e.g., I-1 to II-1 and II-5), ruling out X-linked inheritance. *X linked dominant disorder* - This pattern would show affected fathers transmitting the trait to **all their daughters but no sons**, which is not seen here (e.g., father I-1 has an affected son II-1). - Also, affected mothers would transmit to half their sons and daughters, but the key discriminatory factor is the father-to-son transmission. *X-linked recessive* - X-linked recessive traits usually show **more males affected than females**, and affected sons are typically born to carrier mothers. - An affected father would **not transmit the disease to his sons**, but the pedigree clearly shows affected father I-1 transmitting to son II-1. *Autosomal recessive* - Autosomal recessive disorders typically **skip generations**, with affected individuals often born to unaffected carriers. - The pedigree shows **direct transmission** from affected parents to offspring in every generation, which is inconsistent with recessive inheritance.

Q: A patient undergoes bilateral adrenalectomy in view of bilateral pheochromocytoma. A day after surgery patient develops lethargy, fatigue and loss of appetite. On examination BP is 90/ 60 mmHg, pulse rate of 74 beats/min. No evidence of loss of volume. The likely cause is?

Cortisol deficiency. ***Cortisol deficiency*** - Following **bilateral adrenalectomy**, the body loses its primary source of **cortisol**, a critical hormone for maintaining blood pressure and energy levels. [1] - The symptoms of **lethargy, fatigue, loss of appetite, and hypotension** are classic signs of **acute adrenal insufficiency** or **adrenal crisis** due to cortisol deficiency. [1] *Cardiogenic shock* - This condition involves severe pump failure of the heart, leading to **reduced cardiac output**. - While hypotension is present, the symptom complex of fatigue and loss of appetite shortly after adrenal surgery points away from primary cardiac dysfunction in the absence of preceding cardiac events. *Septic shock* - Characterized by hypotension, signs of infection, and organ dysfunction due to a systemic inflammatory response. - There is no mention of fever, leukocytosis, or other signs of infection in the patient's presentation. *Hypovolemic shock* - Caused by a significant reduction in circulating blood volume, often due to hemorrhage or severe dehydration. - The question explicitly states "No evidence of loss of volume," ruling out hypovolemic shock.

Q: Urethritis in males is not caused by:

H. ducreyi. ***H. ducreyi*** - *Haemophilus ducreyi* is the causative agent of **chancroid**, a sexually transmitted infection characterized by **genital ulcers** [1] with painful regional lymphadenopathy. - It does not typically cause urethritis as its primary site of infection is the **skin and mucous membranes** of the external genitalia, forming ulcers rather than urethral inflammation. *Chlamydia* - **Chlamydia trachomatis** is a common cause of **non-gonococcal urethritis** in males [1]. - It often presents with **dysuria**, **urethral discharge**, and sometimes can be asymptomatic [1]. *Gonococcus* - **Neisseria gonorrhoeae** (gonococcus) is a well-known cause of urethritis, often referred to as **gonococcal urethritis** [1]. - It typically causes a **purulent urethral discharge** and **dysuria** [1]. *Trichomonas* - **Trichomonas vaginalis** can cause **urethritis** in males [1], although it is less common than in females. - Males may experience **dysuria**, **urethral discharge**, or can be asymptomatic carriers.

Q: 35 yr old lady attends gynaec OPD with excessive bleeding since 6 months, not controlled with non hormonal drugs. USG and clinical examination reveals no abnormality. Next step is?

Endometrial sampling. ***Endometrial sampling*** - In a 35-year-old with **excessive uterine bleeding** not controlled by non-hormonal drugs and with normal imaging/clinical exam, endometrial sampling is crucial to **rule out endometrial hyperplasia or malignancy**. - This diagnostic step is essential before considering definitive treatments, as it provides a **histological diagnosis** of the endometrial lining. *Hysterectomy* - Hysterectomy is a **definitive surgical treatment** for excessive bleeding, but it is typically reserved for cases where conservative or less invasive treatments have failed, or if there's a serious underlying pathology like malignancy. - It involves removing the uterus and is a **major surgery** with potential complications, thus not usually the first step given an otherwise normal examination and imaging. *Endometrial ablation* - Endometrial ablation is a procedure to destroy the lining of the uterus, aiming to **reduce or stop menstrual bleeding**. - It is a treatment option for **abnormal uterine bleeding (AUB)**, but it's typically performed after other diagnostic steps (like endometrial sampling) have ruled out malignancy or high-risk hyperplasia, and when conservative medical management has failed. *Hormonal therapy* - Hormonal therapy (e.g., combined oral contraceptives, progestin-only pills, levonorgestrel-releasing intrauterine device) is often a **first-line medical treatment** for excessive uterine bleeding. - However, the question states that non-hormonal drugs have already failed, and without a clear diagnosis, initiating new hormonal therapy without **evaluating the endometrium** is not the next best step for persistent bleeding.

Q: What is the diagnosis for a patient with unilateral proptosis with bilateral 6th nerve palsy with chemosis and euthyroid status?

Cavernous sinus thrombosis. ***Cavernous sinus thrombosis*** - The combination of **unilateral proptosis**, **bilateral 6th nerve palsy**, and **chemosis** strongly suggests cavernous sinus thrombosis. - The cavernous sinus contains cranial nerves III, IV, V1, V2, and VI; thrombosis can lead to dysfunction of these nerves, particularly the **abducens nerve (VI)**, and venous congestion causing proptosis and chemosis. *Retinoblastoma* - Typically presents in **children** with **leukocoria**, strabismus, and sometimes proptosis. - It is a primary intraocular tumor and does not usually cause acute bilateral cranial nerve palsies and chemosis. *Thyroid ophthalmopathy* - Characterized by proptosis, lid retraction, and ophthalmoplegia, often with chemosis and conjunctival injection, but usually in the context of thyroid dysfunction (hyperthyroidism). - While it can cause proptosis, the presence of **bilateral 6th nerve palsy** and a **euthyroid** status makes cavernous sinus thrombosis more likely, as thyroid ophthalmopathy typically presents with restrictive ophthalmoplegia rather than isolated cranial nerve palsies. *Orbital pseudotumour* - Presents with painful proptosis, chemosis, and ophthalmoplegia, which can be unilateral or bilateral. - Differentiating features include a good response to **steroids** and usually **no associated cranial nerve palsies** in the pattern described.

Q: A term neonate, with a birth weight of 2700 g, who is otherwise well, and is exclusively breastfed, presents for routine evaluation. His total serum bilirubin is found to be 14mg/dl on day 5. What is the management?

No active treatment required. ***No active treatment required*** - A total serum bilirubin of **14 mg/dL** on day 5 in an otherwise well, exclusively breastfed term neonate (birth weight 2700g, which is >2500g) falls within the **physiologic jaundice range** and below thresholds for intervention. - This level is considered **normal for breastfed infants** at this age and does not warrant medical intervention as per current guidelines. *Stop breastfeeding for 2 days* - This intervention, known as **breast milk jaundice interruption**, is usually reserved for higher bilirubin levels or if there is concern for significant breast milk jaundice, which is not indicated here. - Temporarily stopping breastfeeding can disrupt the establishment of breastfeeding and is generally discouraged unless strictly necessary. *Phototherapy* - **Phototherapy** is indicated for bilirubin levels typically >15-18 mg/dL in a healthy term neonate on day 5, depending on risk factors, which this infant does not meet. - It works by converting unconjugated bilirubin into water-soluble isomers that can be excreted more easily. *Exchange transfusion* - **Exchange transfusion** is reserved for severe hyperbilirubinemia, usually with bilirubin levels approaching or exceeding 20-25 mg/dL, especially if there are signs of **acute bilirubin encephalopathy**. - This level is far below the threshold for such an invasive procedure.

Q: A patient of biliary colic presented to hospital. Intern gave an injection and the pain worsened. Which is the most likely injection given?

Morphine. *Morphine*- **Morphine** and other opioids can cause **spasm of the sphincter of Oddi**, leading to increased pressure in the **biliary tree** and worsening of biliary colic.- This effect is mediated through **mu-opioid receptors** on the smooth muscle of the sphincter.*Diclofenac*- **Diclofenac** is a non-steroidal anti-inflammatory drug (NSAID) which is an excellent choice for **biliary colic** because it reduces inflammation and relaxes smooth muscle.- It works by inhibiting **prostaglandin synthesis**, thus reducing pain and spasm of the gallbladder.*Etoricoxib*- **Etoricoxib** is a selective COX-2 inhibitor [1], another type of NSAID, which would typically alleviate pain in biliary colic.- It reduces inflammation and pain [1] without the **sphincter of Oddi spasm** concerns associated with opioids.*Nefopam*- **Nefopam** is a non-opioid analgesic that acts as a centrally acting **serotonin-norepinephrine-dopamine reuptake inhibitor (SNDRI)**. It would typically help with pain relief.- It is not known to cause **sphincter of Oddi spasm** and would therefore not usually worsen biliary colic.

Q: What is the most probable cause of this condition?

Chronic lymphedema. ***Chronic lymphedema*** - This condition is characterized by chronic accumulation of **interstitial fluid** and **proteins** due to impaired lymphatic drainage. - Causes persistent, non-pitting edema that often starts distally and progresses proximally, leading to characteristic limb enlargement. *Chronic aerial blockage* - This term is not a recognized medical condition and does not describe a mechanism for chronic edema. - The human body does not have a system of "aerial" structures that could cause chronic blockage leading to edema. *Chronic venous insufficiency* - While chronic venous insufficiency causes edema, it is typically characterized by **pitting edema**, skin discoloration (hyperpigmentation), and sometimes ulceration due to impaired venous return. - Unlike lymphedema, it does not primarily involve the lymphatic system and the edema is usually less firm and often improves with elevation. *Chronic venous blockage* - This term is less precise than chronic venous insufficiency and generally refers to conditions like **deep vein thrombosis (DVT)**, which can cause acute or subacute edema. - Chronic venous blockage (e.g., post-thrombotic syndrome) can lead to chronic edema, but it is typically associated with prominent venous signs and symptoms, and the edema can still be different from the specific characteristics of lymphedema.

Question 1

Which of the following is true about polyaeritis nodosa?

Accepted Answer

HBsAg is positive in 30% patients

Answer

It shows fibrinoid necrosis in large blood vessels

Answer

It has ANCA positivity

Answer

Affected individuals have involvement of pulmonary circulation.

Question 2

A 25-year-old man presents for a routine physical examination. The patient is tall (6 ft. 5 in) and on examination he was found to have an early diastolic murmur. His family pedigree is as given below. Which of the following is the mode of inheritance by which the disease is likely to be transmitted?

Accepted Answer

Autosomal dominant

Answer

X linked dominant disorder

Answer

X-linked recessive

Answer

Autosomal recessive

Question 3

A patient undergoes bilateral adrenalectomy in view of bilateral pheochromocytoma. A day after surgery patient develops lethargy, fatigue and loss of appetite. On examination BP is 90/ 60 mmHg, pulse rate of 74 beats/min. No evidence of loss of volume. The likely cause is?

Accepted Answer

Cortisol deficiency

Answer

Cardiogenic shock

Answer

Septic shock

Answer

Hypovolemic shock

Question 4

Urethritis in males is not caused by:

Accepted Answer

H. ducreyi

Answer

Chlamydia

Answer

Gonococcus

Answer

Trichomonas

Question 5

35 yr old lady attends gynaec OPD with excessive bleeding since 6 months, not controlled with non hormonal drugs. USG and clinical examination reveals no abnormality. Next step is?

Accepted Answer

Endometrial sampling

Answer

Hysterectomy

Answer

Endometrial ablation

Answer

Hormonal therapy

Question 6

What is the diagnosis for a patient with unilateral proptosis with bilateral 6th nerve palsy with chemosis and euthyroid status?

Accepted Answer

Cavernous sinus thrombosis

Answer

Retinoblastoma

Answer

Thyroid ophthalmopathy

Answer

Orbital pseudotumour

Question 7

A 2 years old child presents to PHC with fever and cough. He has chest in-drawing and respiratory rate of 38 per minute, weight 11 kg. The next step in management according to IMNCI is:

Accepted Answer

Give antibiotics and refer to tertiary centre

Answer

Give antibiotics and re-assess in 3 days

Answer

Refer to tertiary care

Answer

Only antipyretics are given

Question 8

A term neonate, with a birth weight of 2700 g, who is otherwise well, and is exclusively breastfed, presents for routine evaluation. His total serum bilirubin is found to be 14mg/dl on day 5. What is the management?

Accepted Answer

No active treatment required

Answer

Stop breastfeeding for 2 days

Answer

Phototherapy

Answer

Exchange transfusion

Question 9

A patient of biliary colic presented to hospital. Intern gave an injection and the pain worsened. Which is the most likely injection given?

Accepted Answer

Morphine

Answer

Diclofenac

Answer

Etoricoxib

Answer

Nefopam

Question 10

What is the most probable cause of this condition?

Accepted Answer

Chronic lymphedema

Answer

Chronic aerial blockage

Answer

Chronic venous insufficiency

Answer

Chronic venous blockage

NEET-PG 2020

Internal Medicine

Microbiology

Obstetrics and Gynecology

Ophthalmology

Pediatrics

Pharmacology

Surgery