NEET-PG 2024 Practice Questions

Q: An 18-year-old boy presents with tenderness, warmth over the bone, and fever, ESR and CRP levels. The radiograph is shown below. What is the most likely diagnosis?

Osteomyelitis. ***Osteomyelitis*** - The presentation of **tenderness**, **warmth over the bone**, **fever**, and elevated **ESR** and **CRP** are classic signs of a bone infection, or osteomyelitis. - While not explicitly shown in the provided text, a radiograph in acute osteomyelitis might show **soft tissue swelling** or subtle **periosteal elevation**, progressing to **bone destruction** and **sclerosis** in later stages. *Ewing's sarcoma* - This is a highly malignant bone tumor that presents with **pain** and **swelling**, but is typically not associated with a pronounced **fever** and signs of systemic infection. - Radiographically, it often shows an "onion-skin" **periosteal reaction** and lytic lesions, without the strong inflammatory markers seen here. *Osteosarcoma* - This is another malignant bone tumor, primarily presenting with bone **pain** and **swelling**, but systemic inflammatory signs like **fever** are rare unless there is a pathologic fracture or infection secondary to tumor necrosis. - Radiographs typically show a "sunburst" appearance, **Codman's triangle**, or mixed lytic and blastic lesions, not indicative of acute infection. *Giant cell tumor* - This is a usually **benign aggressive bone tumor** that causes **pain** and **swelling** around joints. - It does not typically present with systemic signs of infection such as **fever** and significantly elevated **ESR** and **CRP** unless there is a secondary infection, and it usually affects the **epiphyses** of long bones in young adults.

Q: A mother reports that her daughter ingested a substance in an unknown dose. The girl presents with hypertension, tachycardia, mydriasis, and hyperthermia. What is the most likely substance?

Cocaine. ***Cocaine*** - The presented symptoms of **hypertension, tachycardia, mydriasis, and hyperthermia** are characteristic of a **sympathomimetic toxidrome**, frequently caused by cocaine overdose. - Cocaine acts as a **norepinephrine-dopamine-serotonin reuptake inhibitor**, leading to excessive stimulation of the central and peripheral nervous systems. *Heroin* - Heroin is an **opioid**, and overdose generally presents with **respiratory depression, bradycardia, miosis (pinpoint pupils)**, and hypotension, which are contrary to the patient's symptoms. - Patients typically exhibit central nervous system **depression**, rather than the hyperactive state seen here. *Morphine* - Similar to heroin, morphine is an **opioid** and causes symptoms like **respiratory depression, bradycardia, miosis**, and hypotension. - These effects are the opposite of the **sympathomimetic** signs observed in the patient. *Chlorpheniramine* - Chlorpheniramine is an **antihistamine** with significant **anticholinergic effects**. An overdose might cause **mydriasis and tachycardia**, but not typically severe hypertension or hyperthermia as the primary features. - Other anticholinergic signs such as **dry mucous membranes, urinary retention, and altered mental status (delirium)** would also be expected. *Organophosphate* - Organophosphate poisoning causes a **cholinergic toxidrome** due to **acetylcholinesterase inhibition**, resulting in excessive cholinergic stimulation. - Classic presentation includes **SLUDGE syndrome** (Salivation, Lacrimation, Urination, Defecation, GI upset, Emesis) along with **miosis (pinpoint pupils), bradycardia, bronchospasm**, and muscle fasciculations. - These findings are the **opposite** of the sympathomimetic signs seen in this patient.

Q: A 40-year-old female has visited multiple plastic surgeons requesting correction of a perceived facial deformity. She was referred to a psychiatrist because she repeatedly checks her face, insists that it is deformed and needs surgery despite no evidence on examination. She persists with her demand despite reassurances by family members and doctors. What is the most appropriate management?

Behavior therapy. ***Behavior therapy*** - The patient presents with **Body Dysmorphic Disorder (BDD)**, where **Cognitive Behavioral Therapy (CBT)** using **exposure and response prevention** is considered the first-line psychological treatment. - Behavior therapy aims to reduce **compulsive behaviors** like mirror checking and correct the distorted cognitive processing associated with perceived defects. *SSRI* - While **SSRIs** are the first-line **pharmacotherapy** for BDD, behavioral interventions are often prioritized or used in conjunction for better long-term outcomes. - High doses of **SSRIs** are typically required to see clinical improvement in BDD symptoms compared to depression. *Atypical antipsychotics* - These agents are not first-line and are generally reserved as **augmentation therapy** for patients who are non-responsive to SSRIs and therapy. - Even when BDD presents with **delusional intensity** (poor insight), SSRIs and CBT remain the preferred initial treatments over antipsychotics. *Allow her to have surgery* - Cosmetic surgery is **contraindicated** because it does not address the underlying psychiatric pathology and typically leads to **dissatisfaction** or shifts in preoccupation to another body part. - Research indicates that surgical or dermatological procedures often **exacerbate symptoms** and can lead to legal or physical threats against the providing surgeon.

Q: Untreated ADHD persisting from childhood increases the risk of developing which of the following in adolescence?

Conduct disorder. ***Conduct disorder*** - **Untreated ADHD**, marked by impulsivity and difficulty with emotional regulation, significantly increases the risk of developing **conduct disorder** in adolescence. - Adolescents with untreated ADHD may struggle with following rules, exhibiting aggressive behaviors, and engaging in antisocial acts, which are hallmarks of conduct disorder. *Selective mutism* - This is an **anxiety disorder** characterized by a child's consistent failure to speak in specific social situations where there is an expectation for speaking despite speaking in other situations. - While it can co-occur with ADHD, it is not a direct consequence of untreated ADHD and involves distinct psychological mechanisms. *Binge eating disorder* - This disorder is characterized by recurrent episodes of **eating unusually large amounts of food** in a short period, often accompanied by a sense of loss of control. - While there is a higher prevalence of eating disorders in individuals with ADHD, it is not a primary or direct developmental risk from untreated ADHD in adolescence. *Separation anxiety disorder* - This disorder involves **excessive fear or anxiety** concerning separation from home or from attachment figures, beyond what is expected for the individual's developmental level. - While it can co-occur with ADHD, it is not a direct developmental risk that emerges from untreated ADHD in adolescence.

Q: A young girl presents with a history of multiple episodes of loss of consciousness lasting for 20 minutes. These episodes occur only in front of family members and only during the daytime. There is no history of tongue biting or incontinence, and EEG and MRI studies are normal. What is the most appropriate management?

Insight-oriented psychotherapy. ***Insight-oriented psychotherapy*** - The presentation strongly suggests **non-epileptic seizures (NES)**, also known as **psychogenic non-epileptic seizures (PNES)**, which are usually of psychological origin. - **Insight-oriented psychotherapy** is the most appropriate management, aiming to address underlying psychological conflicts or stress that manifest as these episodes. *Treat with aversive therapy* - **Aversive therapy** is typically used for behavioral modification in conditions like substance abuse or paraphilias, where a negative stimulus is paired with an undesirable behavior. - It is not indicated for **psychogenic non-epileptic seizures**, where the underlying cause is psychological distress rather than a learned undesirable behavior. *Valproate* - **Valproate** is an **antiepileptic drug** used to treat various types of seizures, including generalized tonic-clonic and absence seizures. - Since EEG and MRI are normal, and the clinical features (no tongue biting/incontinence, specific timing/audience) rule out epilepsy, antiepileptic medication like Valproate is **inappropriate**. *Ketogenic diet* - The **ketogenic diet** is a high-fat, low-carbohydrate diet used as a medical treatment for **drug-resistant epilepsy**, particularly in children. - Given that the episodes are **non-epileptic** and investigations are normal, a ketogenic diet would be ineffective and unnecessary.

Q: A 40-year-old patient complains of a headache. A CT head was taken, as shown below. What is the most accurate diagnosis?

Subarachnoid hemorrhage (SAH) - aneurysm. ***Subarachnoid hemorrhage (SAH) - aneurysm*** - The CT scan likely showed diffuse high attenuation (white areas) within the **subarachnoid spaces**, particularly in the basal cisterns and sulci, which is characteristic of SAH. - A common cause of non-traumatic SAH, especially in a 40-year-old presenting with a headache (often described as **"thunderclap" headache**), is a ruptured **cerebral aneurysm**. *Epidural hemorrhage* - An epidural hemorrhage typically appears as a **lenticular** or **biconvex** (lens-shaped) collection of blood, usually associated with an overlying skull fracture and often crossing the midline. - It occurs between the dura mater and the inner table of the skull, rarely extending into the subarachnoid space. *Subdural hemorrhage* - Subdural hemorrhages appear as **crescent-shaped** collections of blood, typically bridging the cerebral sulci and conforming to the brain's curvature. - They occur between the dura mater and arachnoid mater and are usually due to tearing of **bridging veins**, often following a head injury. *Intraparenchymal hemorrhage* - This involves bleeding directly into the **brain parenchyma** and appears as a focal area of high attenuation within the brain tissue itself. - While it can cause headache, its appearance on CT is distinct from bleeding in the subarachnoid spaces.

Q: A 38-year-old patient presents with chest pain and hoarseness of voice for the past month. Based on the radiographic image below, what is the most likely diagnosis?

Aortic dissection of the arch. ***Aortic dissection of the arch*** - The image suggests a dissection flap within the **aortic arch**, creating a true and false lumen, which is characteristic of an aortic dissection. - Chest pain and **hoarseness of voice** (due to recurrent laryngeal nerve compression by the expanding aorta) are classic symptoms of aortic dissection affecting the aortic arch. - Aortic dissection involves an **intimal tear** with blood entering the media, creating separate lumens, which differentiates it from a simple aneurysm. *Saccular aneurysm of distal arch* - A **saccular aneurysm** would appear as a focal, out-pouching dilatation of the aorta, without evidence of an intimal flap or separate lumens seen in the image. - While an aneurysm can cause symptoms like chest pain or hoarseness, the imaging features specifically point to dissection rather than a simple saccular aneurysm. *Coarctation of the aorta* - **Coarctation of the aorta** is a congenital narrowing of the aorta, typically distal to the left subclavian artery, which would appear as a localized constriction, not a dissection. - While it can manifest with chest pain, hoarseness is not a typical symptom, and classic imaging would show a "shelf-like" indentation or rib notching on X-ray. *Stenosis of the aorta* - **Aortic stenosis** usually refers to narrowing of the aortic valve or a focal narrowing of the aorta. The image displays a complex abnormality of the aortic wall and lumen, not simple stenosis. - While severe aortic stenosis can cause chest pain (angina), hoarseness is not a common associated symptom.

Q: Identify the condition shown in the plain abdominal radiograph.

Pancreatic calcification. ***Pancreatic calcification*** - The radiograph displays **multiple, punctate, and amorphous calcifications** clustered in the upper abdomen, characteristic of **chronic pancreatitis**. - These calcifications represent **calcium deposits within the pancreatic ducts and parenchyma**, a hallmark sign of chronic inflammation and damage to the pancreas. *Mesenteric calcification* - **Mesenteric calcifications** are typically more scattered and linear, often following the distribution of blood vessels or lymph nodes within the mesentery, which is not seen here. - They are generally less dense and less granular than the calcifications observed in the image. *Horseshoe kidney* - A **horseshoe kidney** is a congenital anomaly where the kidneys are fused at their lower poles, forming a U-shape, and is typically located lower in the abdomen, often overlying the spine. - This condition presents with the characteristic **renal outlines** and not diffuse calcifications as shown. *Jejunal fecolith* - A **jejunal fecolith** would appear as a singular or a few discrete, dense, and typically rounded or oval radio-opacities within the lumen of the jejunum. - The diffuse, scattered pattern of calcifications displayed in the image is inconsistent with a fecolith, which is usually composed of inspissated fecal material.

Q: Identify the diagnosis using the MRI provided.

Chiari type 1 malformation. ***Chiari type 1 malformation*** - The sagittal MRI image clearly shows the **cerebellar tonsils prolapsing below the foramen magnum** into the cervical spinal canal, which is the hallmark of a Chiari type 1 malformation. - This condition can lead to symptoms like headaches, neck pain, and neurological deficits due to compression of the brainstem and spinal cord. *Dandy-Walker malformation* - This malformation involves the **agenesis or hypoplasia of the cerebellar vermis** and persistent cystic dilation of the fourth ventricle, creating a large posterior fossa cyst. - The image does not show an enlarged posterior fossa with a cystic fourth ventricle or a severely hypoplastic vermis. *Vein of Galen malformation* - This is a **rare congenital vascular malformation** involving a direct arteriovenous shunt without an intervening capillary bed, typically presenting as an enlarged vein of Galen. - The provided image is a sagittal view demonstrating cerebellar tonsillar herniation, not a prominent or malformed vein of Galen. *Agenesis of the corpus callosum* - This condition is characterized by the **partial or complete absence of the corpus callosum**, the band of white matter connecting the two cerebral hemispheres. - On sagittal MRI, this would show absence of the corpus callosum and typically radial gyral patterns, which are not seen in this image.

Question 1

An 18-year-old boy presents with tenderness, warmth over the bone, and fever, ESR and CRP levels. The radiograph is shown below. What is the most likely diagnosis?

Accepted Answer

Osteomyelitis

Answer

Ewing's sarcoma

Answer

Osteosarcoma

Answer

Giant cell tumor

Question 2

A 3-year-old child presents with respiratory distress and a history of recurrent respiratory infections. Based on the provided imaging, what is the most likely diagnosis?

Accepted Answer

CPAM (Congenital Pulmonary Airway Malformation)

Answer

Lung abscess

Answer

Pyopneumothorax

Answer

CDH (Congenital Diaphragmatic Hernia)

Answer

Pulmonary sequestration

Question 3

A mother reports that her daughter ingested a substance in an unknown dose. The girl presents with hypertension, tachycardia, mydriasis, and hyperthermia. What is the most likely substance?

Accepted Answer

Cocaine

Answer

Heroin

Answer

Morphine

Answer

Chlorpheniramine

Answer

Organophosphate

Question 4

A 40-year-old female has visited multiple plastic surgeons requesting correction of a perceived facial deformity. She was referred to a psychiatrist because she repeatedly checks her face, insists that it is deformed and needs surgery despite no evidence on examination. She persists with her demand despite reassurances by family members and doctors. What is the most appropriate management?

Accepted Answer

Behavior therapy

Answer

SSRI

Answer

Atypical antipsychotics

Answer

Allow her to have surgery

Question 5

Untreated ADHD persisting from childhood increases the risk of developing which of the following in adolescence?

Accepted Answer

Conduct disorder

Answer

Selective mutism

Answer

Binge eating disorder

Answer

Separation anxiety disorder

Question 6

A young girl presents with a history of multiple episodes of loss of consciousness lasting for 20 minutes. These episodes occur only in front of family members and only during the daytime. There is no history of tongue biting or incontinence, and EEG and MRI studies are normal. What is the most appropriate management?

Accepted Answer

Insight-oriented psychotherapy

Answer

Treat with aversive therapy

Answer

Valproate

Answer

Ketogenic diet

Question 7

A 40-year-old patient complains of a headache. A CT head was taken, as shown below. What is the most accurate diagnosis?

Accepted Answer

Subarachnoid hemorrhage (SAH) - aneurysm

Answer

Epidural hemorrhage

Answer

Subdural hemorrhage

Answer

Intraparenchymal hemorrhage

Question 8

A 38-year-old patient presents with chest pain and hoarseness of voice for the past month. Based on the radiographic image below, what is the most likely diagnosis?

Accepted Answer

Aortic dissection of the arch

Answer

Saccular aneurysm of distal arch

Answer

Coarctation of the aorta

Answer

Stenosis of the aorta

Question 9

Identify the condition shown in the plain abdominal radiograph.

Accepted Answer

Pancreatic calcification

Answer

Mesenteric calcification

Answer

Horseshoe kidney

Answer

Jejunal fecolith

Question 10

Identify the diagnosis using the MRI provided.

Accepted Answer

Chiari type 1 malformation

Answer

Dandy-Walker malformation

Answer

Vein of Galen malformation

Answer

Agenesis of the corpus callosum

NEET-PG 2024

Orthopaedics

Pediatrics

Pharmacology

Psychiatry

Radiology