NEET-PG 2023 Practice Questions

Q: In a 10-year-old school child, which of the following vaccines is given as a part of the school immunization program?

TT/Td vaccine. ***TT/Td vaccine*** - The **tetanus toxoid (TT)** or **tetanus and diphtheria (Td) vaccine** is commonly administered to school-aged children as a booster to maintain immunity against these diseases. - This is part of many national immunization programs, including those in schools, to ensure continued protection beyond early childhood vaccinations. *Measles vaccine* - The **measles vaccine (MMR)** is typically given at 9-12 months and a second dose around 4-6 years of age, much earlier than 10 years. - While essential, it's usually completed before a child reaches the age of 10 for primary vaccination. *Rotavirus vaccine* - The **rotavirus vaccine** is administered to infants, usually before 6 months of age, to protect against severe rotavirus gastroenteritis. - It is not part of school immunization programs for 10-year-olds. *Hepatitis B vaccine* - The **Hepatitis B vaccine** is typically given at birth and completed during infancy, with a series of doses before 1 year of age. - While crucial for early protection, it is not a routine vaccination for 10-year-olds within a school immunization program unless for catch-up reasons.

Q: A construction worker came to the OPD complaining of white fingers. He has been working in the cement and concrete industry and has been working on heavy machinery drills, wood, and furniture polishing for 20 years. What is the most likely etiology for this condition?

Continuous exposure to drills and machines. ***Continuous exposure to drills and machines*** - The use of **heavy machinery drills** subjects the hands to **vibration**, which is a well-known cause of **Raynaud's phenomenon**, presenting as "white fingers" due to **vasospasm**. - This condition, often referred to as **vibration white finger**, is a common occupational hazard for workers using vibratory tools over long periods. *Candidal infection of the fingers due to continuous exposure to water* - While prolonged exposure to moisture can cause **Candidal infections** (e.g., paronychia), this typically presents as **redness, swelling, and pain** around the nails or skin, not the characteristic "white fingers" of Raynaud's. - White fingers due to candidiasis are not a primary manifestation and lack the **vasospastic component** seen with vibration exposure. *Exposure to thinners and paints* - Exposure to chemicals like **thinners and paints** can cause **irritant or allergic contact dermatitis**, leading to redness, itching, and skin lesions. - However, direct exposure to these substances is not typically associated with the sudden, episodic **blanching of fingers** characteristic of Raynaud's phenomenon. *Continuous exposure to cement and concrete* - **Cement and concrete** exposure often leads to **irritant or allergic contact dermatitis** due to the alkaline nature of cement, causing dryness, cracking, and eczema. - This type of exposure does not directly cause the **vasospastic episodes** that result in "white fingers."

Q: Which of the following is the sensitive indicator to assess the availability, utilization, and effectiveness of healthcare in a community?

Infant mortality rate. ***Infant mortality rate*** - The **infant mortality rate (IMR)** is widely considered a sensitive indicator of a community's health status, including access to and quality of healthcare, nutrition, and environmental conditions. - A high IMR often reflects inadequate maternal and child health services, poor sanitation, and socioeconomic disparities within a population. *Maternal mortality rate* - While a critical indicator of the health system's ability to provide safe pregnancy and childbirth services, the **maternal mortality rate (MMR)** specifically reflects women's health during gestation and postpartum. - It does not encompass the broader spectrum of health determinants that affect infants, such as postnatal care, nutrition, and infectious disease control, as comprehensively as IMR. *Immunization coverage* - **Immunization coverage** is an excellent indicator of the reach and effectiveness of preventive health services for infectious diseases. - However, it is a specific measure of program implementation, not a comprehensive indicator of overall healthcare availability, utilization, or effectiveness across all health domains. *Disability-adjusted life years* - **Disability-adjusted life years (DALYs)** measure the total healthy life years lost due to premature mortality and disability from specific diseases and injuries. - While a valuable concept for burden of disease analysis, DALYs are a complex measure of population health outcome, rather than a direct and sensitive indicator of the operational aspects of healthcare like availability and utilization.

Q: A chronic alcoholic is brought to the emergency department with confusion, ataxia, and painful eye movements, including nystagmus. The 6th cranial nerve is also involved. What is the likely diagnosis?

Wernicke's encephalopathy. ***Wernicke's encephalopathy*** - This diagnosis aligns perfectly with the classic triad of **confusion, ataxia, and ophthalmoplegia** (manifested as painful eye movements, nystagmus, and 6th cranial nerve involvement) in the setting of chronic alcoholism [1], [2]. - It is caused by **thiamine (vitamin B1) deficiency**, common in chronic alcoholics due to malnutrition and impaired absorption [1]. *Korsakoff psychosis* - This condition is typically a **later complication** of Wernicke's encephalopathy, characterized by profound **anterograde and retrograde amnesia**, confabulation, and apathy [2]. - While an alcoholic patient might develop this, the immediate presentation with acute confusion, ataxia, and cranial nerve signs points to Wernicke's encephalopathy being the more acute and primary diagnosis in this scenario. *Delirium tremens* - This is a severe form of **alcohol withdrawal**, typically occurring 48-96 hours after the last drink, and is characterized by **global confusion, hallucinations (often visual), severe autonomic instability** (tachycardia, hypertension, fever, sweating), and seizures [3]. - While confusion is present, the specific neurological signs like ataxia and ophthalmoplegia are not typical of delirium tremens. *De Clerambault syndrome* - Also known as **erotomania**, this is a rare delusional disorder where an individual has a fixed, false belief that another person, usually of higher social status, is in love with them. - This is a **psychiatric disorder** with no relation to the neurological symptoms or alcohol-related complications described in the patient.

Q: A patient with a history of alcohol dependence syndrome presents with sudden and unintentional weight loss. What is the most likely diagnosis?

Hepatocellular carcinoma. ***Hepatocellular carcinoma*** - The **alpha-fetoprotein (AFP)** level of **600 ng/mL** is significantly elevated, suggesting a diagnosis of hepatocellular carcinoma, especially in a patient with a history of **alcohol dependence syndrome** [1]. - The **AST/ALT ratio of 0.5** indicates significant liver damage, commonly seen in chronic liver disease leading to **hepatocellular cancer**. *Alcoholic hepatitis* - Typically presents with **elevated AST and ALT**, usually with a ratio >2:1, which is not the case here [2]. - May cause weight loss, as alcoholic patients often lose weight due to self-neglect and poor dietary intake, but the **elevated AFP** is not characteristic of merely alcoholic hepatitis [3]. *Cholangiocarcinoma* - This type of cancer primarily presents with **biliary obstruction** symptoms, such as jaundice, which is not indicated here given **normal bilirubin levels**. - Does not typically lead to such high levels of **AFP**, making it less likely with the provided lab results. *Hepatic adenoma* - More commonly associated with **oral contraceptive use** or anabolic steroid use, not primarily alcohol dependence. - AFP levels are usually normal or only mildly elevated in hepatic adenoma, making this option less viable with an **AFP level of 600 ng/mL**.

Q: A bronchial asthma patient on inhalational steroids presented with white patchy lesions on the tongue and buccal mucosa. What condition is likely to be present in this patient?

Oral candidiasis. **Oral candidiasis** - **Inhaled corticosteroids** can suppress the local immune response in the oral cavity, creating an environment conducive to the overgrowth of *Candida albicans*. - The classic presentation includes **white patchy lesions** on the tongue and buccal mucosa, which can often be scraped off. *Oral lichen planus* - Characterized by **reticular (Wickham's striae)**, papular, or erosive lesions, which are often bilateral and symmetric [1]. - While it can present with white lesions, they are typically not easily scraped off and are not primarily associated with inhaled corticosteroid use [1]. *Aphthous ulcers* - These are typically **painful, solitary, or multiple ulcers** with a red halo and a yellowish-gray center [2]. - They are distinct from widespread white patchy lesions and are not directly caused by inhaled corticosteroid use [2]. *Oral leukoplakia* - Defined as a **white patch or plaque** on the oral mucosa that cannot be characterized clinically or pathologically as any other disease, and which is not removable by scraping. - It is often associated with tobacco use and alcohol consumption, and carries a risk of malignancy; it does not typically appear as a direct side effect of inhaled corticosteroids.

Q: A female presents with 6 weeks of amenorrhea, experiencing vaginal bleeding and slight abdominal pain. A urine pregnancy test is positive, and her hCG level is 2800 IU/L. A mass measuring 3 x 2.5 cm is observed on the left adnexa. She is hemodynamically stable. What is the most appropriate management for this patient?

Single-dose methotrexate injection. ***Single-dose methotrexate injection*** - The patient presents with a **hemodynamically stable ectopic pregnancy**, as suggested by the positive pregnancy test, amenorrhea, vaginal bleeding, abdominal pain, an hCG level of 2800 IU/L, and an adnexal mass. - A single-dose methotrexate injection is the **first-line medical management** for ectopic pregnancies in stable patients, particularly when hCG levels are typically below 5000 IU/L and the mass size is less than 4 cm (or 3.5 cm in some guidelines). *Oral methotrexate* - **Oral methotrexate** is not typically used for the treatment of ectopic pregnancy due to unpredictable absorption and less reliable therapeutic efficacy compared to intramuscular administration. - The **intramuscular route** is preferred to ensure consistent systemic exposure and effectiveness in dissolving the ectopic gestation. *Serial methotrexate + leucovorin rescue* - **Leucovorin rescue** is used to mitigate the adverse effects of high-dose methotrexate, typically in cancer chemotherapy, and is not indicated for the standard treatment of ectopic pregnancy. - Serial doses of methotrexate without leucovorin may be given if the initial single dose fails, but **leucovorin is not part of the standard initial treatment protocol** for ectopic pregnancy. *Salpingectomy* - **Salpingectomy (surgical removal of the fallopian tube)** is indicated for ectopic pregnancies that are **hemodynamically unstable**, ruptured, too large for medical management (e.g., >4 cm), or in cases where medical management with methotrexate fails or is contraindicated. - Since this patient is **hemodynamically stable** and meets the criteria for medical management, surgery is not the most appropriate initial management.

Q: A patient given digoxin started having side effects like nausea and vomiting. The serum concentration of digoxin was 4 ng/mL. The plasma therapeutic range is 1-2 ng/mL. If the half-life of digoxin is 40 hours, how long should one wait before resuming the treatment?

80 hours. ***80 hours (2 half-lives)***- Current digoxin level is **4 ng/mL**, which is **twice the upper therapeutic limit** (2 ng/mL), causing toxicity with nausea and vomiting [1]- After **1 half-life (40 hours)**: concentration reduces to 2 ng/mL (upper therapeutic limit) [2]- After **2 half-lives (80 hours)**: concentration reduces to 1 ng/mL (mid-therapeutic range) [2]- **Clinical rationale**: While 2 ng/mL is technically within range, waiting for 2 half-lives ensures the level is comfortably in the **middle of the therapeutic window** (1 ng/mL), providing a **safer margin** before resuming treatment in a patient who just experienced toxicity- This conservative approach minimizes risk of recurrent toxicity, especially important given the patient's recent symptoms at 4 ng/mL*1 half-life (40 hours)*- After 1 half-life, digoxin level would be 2 ng/mL, which is at the **upper limit** of the therapeutic range- While technically within the therapeutic range, this leaves **minimal safety margin** in a patient who just experienced toxicity- Starting treatment immediately at this level carries higher risk of recurrent side effects*120 hours (3 half-lives)*- After 3 half-lives, the concentration would be **0.5 ng/mL**, which is **below the therapeutic range** (1-2 ng/mL)- This is overly conservative and would **unnecessarily delay** resumption of essential cardiac medication- Could lead to inadequate control of the underlying condition (heart failure or atrial fibrillation)*140-180 hours (3.5-4.5 half-lives)*- This would reduce digoxin to **0.25-0.35 ng/mL**, well below therapeutic levels- This **excessive delay** is not clinically justified and could worsen the patient's cardiac condition- No standard protocol recommends waiting this long before resuming digoxin therapy

Q: A woman, who is 4 days postpartum, presented with tearfulness, mood swings, and occasional insomnia. What is the likely diagnosis?

Postpartum blues. ***Postpartum blues*** - This condition presents with mild, transient symptoms like **tearfulness**, **mood swings**, and **insomnia** typically peaking around **4-5 days postpartum** and resolving within two weeks. - It is a very common, self-limiting condition impacting up to 80% of new mothers, attributed to drastic **hormonal shifts** post-delivery. *Postpartum depression* - Symptoms are similar to postpartum blues but are more **severe**, last longer (typically **beyond two weeks**), and significantly impair functioning. - It often includes feelings of **hopelessness**, pervasive sadness, loss of pleasure, and sometimes thoughts of harming oneself or the baby. *Postpartum psychosis* - This is a severe psychiatric emergency characterized by **hallucinations**, delusions, disorganized thinking, and bizarre behavior, usually within the first 2-3 weeks postpartum. - It is a rare condition requiring **urgent medical intervention** due to the high risk of harm to mother and baby. *Postpartum anxiety* - While anxiety can co-occur with postpartum blues or depression, primary postpartum anxiety specifically involves excessive and **uncontrollable worry** or fear, often about the baby's health or safety. - It does not typically present with the prominent **tearfulness** and **mood swings** characteristic of blues or depression.

Q: A 78-year-old woman presents with a progressive decline in daily activity. She gives a history of convulsions and visual hallucinations. She does not talk to anyone and keeps looking at the sky. Pathological examination shows the presence of Lewy bodies within the neurons. What is the most probable diagnosis?

Lewy body dementia. ***Lewy body dementia*** - The presence of **progressive cognitive decline**, **visual hallucinations**, and **convulsions** in an elderly patient is highly indicative of Lewy body dementia. - The definitive pathological finding of **Lewy bodies** within neurons confirms the diagnosis. *Prion disease* - Characterized by rapidly progressive dementia, **myoclonus**, and cerebellar ataxia, without typical visual hallucinations or convulsions. - Pathological examination typically shows **spongiform changes** and accumulation of abnormal prion protein, not Lewy bodies. *Huntington's disease* - Presents with a classic triad of **motor dysfunction** (chorea), psychiatric symptoms, and cognitive decline, typically with an earlier onset (30-50 years). - It is an inherited neurodegenerative disorder, and its pathology involves neuronal loss in the striatum, without Lewy bodies. *Alzheimer's disease* - The most common cause of dementia, characterized by **memory impairment** as an early and prominent feature. - Pathological findings include **amyloid plaques** and **neurofibrillary tangles**, not Lewy bodies, and visual hallucinations are less common or occur later in the disease.

Question 1

In a 10-year-old school child, which of the following vaccines is given as a part of the school immunization program?

Accepted Answer

TT/Td vaccine

Answer

Measles vaccine

Answer

Rotavirus vaccine

Answer

Hepatitis B vaccine

Question 2

A construction worker came to the OPD complaining of white fingers. He has been working in the cement and concrete industry and has been working on heavy machinery drills, wood, and furniture polishing for 20 years. What is the most likely etiology for this condition?

Accepted Answer

Continuous exposure to drills and machines

Answer

Candidal infection of the fingers due to continuous exposure to water

Answer

Exposure to thinners and paints

Answer

Continuous exposure to cement and concrete

Question 3

Which of the following is the sensitive indicator to assess the availability, utilization, and effectiveness of healthcare in a community?

Accepted Answer

Infant mortality rate

Answer

Maternal mortality rate

Answer

Immunization coverage

Answer

Disability-adjusted life years

Question 4

A chronic alcoholic is brought to the emergency department with confusion, ataxia, and painful eye movements, including nystagmus. The 6th cranial nerve is also involved. What is the likely diagnosis?

Accepted Answer

Wernicke's encephalopathy

Answer

Korsakoff psychosis

Answer

Delirium tremens

Answer

De Clerambault syndrome

Question 5

A patient with a history of alcohol dependence syndrome presents with sudden and unintentional weight loss. What is the most likely diagnosis?

Accepted Answer

Hepatocellular carcinoma

Answer

Hepatic adenoma

Answer

Cholangiocarcinoma

Answer

Alcoholic hepatitis

Question 6

A bronchial asthma patient on inhalational steroids presented with white patchy lesions on the tongue and buccal mucosa. What condition is likely to be present in this patient?

Accepted Answer

Oral candidiasis

Answer

Oral lichen planus

Answer

Aphthous ulcers

Answer

Oral leukoplakia

Question 7

A female presents with 6 weeks of amenorrhea, experiencing vaginal bleeding and slight abdominal pain. A urine pregnancy test is positive, and her hCG level is 2800 IU/L. A mass measuring 3 x 2.5 cm is observed on the left adnexa. She is hemodynamically stable. What is the most appropriate management for this patient?

Accepted Answer

Single-dose methotrexate injection

Answer

Oral methotrexate

Answer

Serial methotrexate + leucovorin rescue

Answer

Salpingectomy

Question 8

A patient given digoxin started having side effects like nausea and vomiting. The serum concentration of digoxin was 4 ng/mL. The plasma therapeutic range is 1-2 ng/mL. If the half-life of digoxin is 40 hours, how long should one wait before resuming the treatment?

Accepted Answer

80 hours

Answer

120 hours

Answer

140-180 hours

Answer

1 half-life (40 hours)

Question 9

A woman, who is 4 days postpartum, presented with tearfulness, mood swings, and occasional insomnia. What is the likely diagnosis?

Accepted Answer

Postpartum blues

Answer

Postpartum depression

Answer

Postpartum psychosis

Answer

Postpartum anxiety

Question 10

A 78-year-old woman presents with a progressive decline in daily activity. She gives a history of convulsions and visual hallucinations. She does not talk to anyone and keeps looking at the sky. Pathological examination shows the presence of Lewy bodies within the neurons. What is the most probable diagnosis?

Accepted Answer

Lewy body dementia

Answer

Prion disease

Answer

Huntington's disease

Answer

Alzheimer's disease

NEET-PG 2023

Community Medicine

Internal Medicine

Obstetrics and Gynecology

Pharmacology

Psychiatry