NEET-PG 2024 Practice Questions

Q: A young patient presents to the OPD with recurrent colicky abdominal pain. Urine examination shows the presence of red blood cells (RBCs) and the following crystal shape in the figure. What is the most likely diagnosis?

Cystine stone. ***Cystine stone*** - The image displays classic **hexagonal** crystals, which are pathognomonic for **cystine stones**. - Recurrent colicky abdominal pain in a young patient with hematuria (RBCs in urine) is highly suggestive of **nephrolithiasis** (kidney stones), and the crystal morphology confirms cystine as the cause. - Cystine stones are associated with **cystinuria**, an autosomal recessive disorder causing defective renal tubular reabsorption of cystine. *Glomerulonephritis* - While glomerulonephritis can cause hematuria, the presence of **hexagonal crystals** in the urine is not a feature of this condition. - Glomerulonephritis typically involves **dysmorphic RBCs** and **RBC casts** in the urine, not hexagonal crystals. *Oxalate stone* - **Calcium oxalate crystals** typically appear as **envelope-shaped (dihydrate)** or **dumbbell-shaped (monohydrate)**. - While oxalate stones are the most common cause of kidney stones and colicky pain, their crystal morphology is distinct from the hexagonal shape seen here. *Polycystic kidney disease* - Polycystic kidney disease is a genetic disorder characterized by **multiple cysts** in the kidneys, which can cause pain and hematuria. - However, it does **not** typically present with specific crystal shapes like those shown in the image, as the primary pathology is structural, not related to crystal formation. *Uric acid stone* - **Uric acid crystals** typically appear as **rhomboid or diamond-shaped** crystals, often with a yellow-brown color. - While uric acid stones can cause similar symptoms (colicky pain, hematuria), the crystal morphology is distinctly different from the hexagonal cystine crystals shown in the image. - Uric acid stones are associated with **hyperuricemia**, **low urine pH**, and conditions like gout.

Q: What is the most common cause of death in idiopathic pulmonary fibrosis (IPF)?

Respiratory failure. ***Respiratory failure*** - **Progressive fibrosis** of the lung tissue in idiopathic pulmonary fibrosis (IPF) directly impairs gas exchange, leading to **hypoxemia** and hypercapnia. - This deterioration ultimately culminates in **respiratory failure**, which is the primary cause of mortality in most IPF patients. *Pulmonary edema* - While pulmonary edema can occur in systemic conditions, it is not the **primary or most common cause of death** specifically in IPF. - IPF is characterized by **fibrotic remodeling**, not primarily fluid overload in the alveoli. *Cancer* - Patients with IPF have an **increased risk of lung cancer**, but it is not the most common cause of death compared to respiratory failure. - The development of cancer is a **complication**, not the direct mechanism by which most IPF patients succumb to the disease. *Pulmonary arterial hypertension (PAH)* - PAH can be a significant complication of IPF, contributing to increased morbidity and mortality, but it is typically a **secondary contributor to death**, often by worsening respiratory mechanics. - Its presence usually **compounds respiratory failure**, rather than being the standalone, most common cause of death. *Acute exacerbation of IPF* - Acute exacerbations represent episodes of **rapid clinical deterioration** with worsening dyspnea and hypoxemia, often idiopathic or triggered by infections. - While they are a **significant cause of mortality** (accounting for a substantial proportion of IPF deaths), the underlying mechanism still relates to respiratory failure, making chronic progressive respiratory failure the most common overall cause of death.

Q: A patient presents with large sweaty hands, macroglossia, and frontal bossing. What is the best test for confirmation of the diagnosis?

IGF-1. ***IGF-1*** - Elevated **IGF-1 (Insulin-like Growth Factor 1)** is the most reliable screening test for acromegaly, reflecting integrated GH secretion over time. - The clinical signs of **large sweaty hands**, **macroglossia**, and **frontal bossing** are classic symptoms of acromegaly, caused by excessive growth hormone (GH) production, which then stimulates IGF-1. *GHRH levels* - **Growth hormone-releasing hormone (GHRH)** levels are typically only measured when investigating ectopic GHRH production as a rare cause of acromegaly, which is not the primary diagnostic step. - While GHRH stimulates GH, its direct measurement is not the standard initial diagnostic test for suspected pituitary-driven acromegaly. *IGF-2* - **IGF-2 (Insulin-like Growth Factor 2)** plays a role in fetal growth and certain tumor-related syndromes, but it is not the primary mediator or diagnostic marker for acromegaly in adults. - IGF-1, not IGF-2, is the main growth factor responsible for the anabolic effects of growth hormone. *GH levels after glucose suppression* - Measuring **GH levels after glucose suppression** (oral glucose tolerance test with 75g glucose) is a confirmatory test for acromegaly, used when IGF-1 levels are equivocal or borderline. - In healthy individuals, glucose suppresses GH secretion to <1 ng/mL, but in acromegaly, GH levels remain elevated (failure to suppress), confirming autonomous GH hypersecretion. *Random GH level* - **Random GH levels** are unreliable for diagnosing acromegaly due to the pulsatile nature of GH secretion, with significant variation throughout the day. - A single normal GH level does not exclude acromegaly, and a single elevated level can occur in healthy individuals during normal secretory peaks, making it inadequate as a diagnostic test.

Q: A patient presents with recurrent lung infections, and the chest X-ray provided shows a characteristic finding. What is the most likely diagnosis?

Kartagener syndrome. ***Kartagener syndrome*** - This syndrome is a subgroup of **primary ciliary dyskinesia** and is characterized by the triad of **situs inversus** (dextrocardia as seen on the chest X-ray), **chronic sinusitis**, and **bronchiectasis**. - Recurrent lung infections are a common presentation due to impaired mucociliary clearance leading to bronchiectasis. *Cystic fibrosis* - While cystic fibrosis does present with **recurrent lung infections** and **bronchiectasis**, it is not typically associated with **situs inversus** or other malformations of organ placement. - Diagnosis is usually supported by a **positive sweat chloride test** and genetic testing for CFTR mutations. *DiGeorge syndrome* - This syndrome is characterized by **T-cell immunodeficiency**, **hypocalcemia**, and **congenital heart defects**. - Recurrent infections in DiGeorge syndrome are due to immunodeficiency, not primarily due to impaired ciliary function or situs inversus. *Down syndrome* - Down syndrome is a chromosomal disorder associated with intellectual disability, distinctive facial features, and an increased risk of several health problems, including **congenital heart disease** and **immune dysfunction**. - Recurrent lung infections can occur due to weakened immune function or structural airway abnormalities, but it does not cause situs inversus or primary ciliary dyskinesia.

Q: A patient presents with headache, confusion, and a diagnosis of a brain tumor. The family history reveals brain and kidney tumors. What is the most likely diagnosis?

VHL syndrome. ***VHL syndrome*** - **Von Hippel-Lindau (VHL) syndrome** is an inherited disorder characterized by the growth of tumors and cysts in various parts of the body, including the **brain (hemangioblastomas)** and **kidneys (renal cell carcinoma)**. - The presentation of a brain tumor, kidney tumors, and a positive family history for both organs strongly points to VHL syndrome. *Neurofibromatosis* - **Neurofibromatosis (NF)** typically presents with **cafe-au-lait spots**, neurofibromas, optic gliomas, and Lisch nodules. - While it involves brain tumors, kidney tumors are not a primary feature of NF. *Li-Fraumeni syndrome* - **Li-Fraumeni syndrome** is associated with an increased risk of various cancers, including **sarcomas**, **breast cancer**, **adrenocortical carcinomas**, and **leukemia**. - While brain tumors can occur, the specific combination of brain and kidney tumors with a clear family history is less characteristic of Li-Fraumeni than VHL syndrome. *Churg-Strauss syndrome* - **Churg-Strauss syndrome (Eosinophilic Granulomatosis with Polyangiitis)** is a systemic vasculitis characterized by **asthma**, **eosinophilia**, and **granulomatous inflammation**. - It does not involve the development of brain or kidney tumors.

Q: A 26-year-old woman presents to the OPD with distended neck veins and difficulty in breathing. On further evaluation, the patient is diagnosed with myasthenia gravis. Radiological imaging reveals an anterior mediastinal mass on CT. What is the most likely diagnosis?

Thymoma. ***Thymoma*** - **Thymomas** are frequently associated with myasthenia gravis, occurring in roughly 10-15% of patients with the condition. - An **anterior mediastinal mass** in a patient with myasthenia gravis is highly suggestive of a thymoma, which can compress surrounding structures leading to symptoms like distended neck veins and dyspnea [1]. *Aortic aneurysm* - While an aortic aneurysm can cause a mediastinal mass and potentially lead to pressure symptoms, it is not directly associated with the pathogenesis of **myasthenia gravis**. - **Distended neck veins** and **dyspnea** could be symptoms of a large aneurysm, but the link to myasthenia gravis makes a thymoma more likely. *CA lung* - Lung cancer can present as a mediastinal mass, but it is not typically associated with **myasthenia gravis** as a paraneoplastic syndrome, especially in a 26-year-old. - While lung cancer could cause **distended neck veins** (due to SVC syndrome) and **dyspnea**, the co-occurrence with myasthenia gravis points away from this diagnosis. *Cardiomegaly* - **Cardiomegaly** refers to an enlarged heart and is not typically described as an "anterior mediastinal mass." - Although it can cause **dyspnea**, it does not explain the **distended neck veins** in this context or the specific association with **myasthenia gravis**.

Q: A Myasthenia Gravis patient on mycophenolate and pyridostigmine presents with hypercalcemia. Apart from the obvious drug-related cause, what other condition could be associated with hypercalcemia in this patient?

Non-Small Cell Lung Cancer (NSCLC). ***Non-Small Cell Lung Cancer (NSCLC)*** - **Hypercalcemia of malignancy** is a common paraneoplastic syndrome in NSCLC, particularly squamous cell carcinoma, due to the production of **parathyroid hormone-related protein (PTHrP)**. - Patients with myasthenia gravis, especially those with thymoma, have an increased risk of developing other malignancies, including lung cancer, making this an important consideration. *Drug induced* - While certain medications can cause hypercalcemia, the question specifically asks for a condition **apart from the obvious drug-related cause**. - Medications like **thiazide diuretics**, **lithium**, or excessive **vitamin D** supplementation are known causes of hypercalcemia. *Parathyroid adenoma* - A parathyroid adenoma causes **primary hyperparathyroidism**, characterized by elevated PTH and hypercalcemia. - While possible, the association with myasthenia gravis and the increased risk of malignancy make **paraneoplastic syndrome** a more contextual answer here given the prompt. *Small Cell Lung Cancer (SCLC)* - SCLC is more commonly associated with other paraneoplastic syndromes like **SIADH (syndrome of inappropriate antidiuretic hormone secretion)** due to ectopic ADH production, or **Cushing's syndrome** due to ectopic ACTH production. - While hypercalcemia can rarely occur, it is **less common** and typically not due to PTHrP in SCLC compared to NSCLC. *Sarcoidosis* - Sarcoidosis can cause hypercalcemia through increased production of **1,25-dihydroxyvitamin D** by activated macrophages in granulomas, leading to enhanced intestinal calcium absorption. - However, in the context of a myasthenia gravis patient with the clinical scenario described, **malignancy-associated hypercalcemia** (particularly NSCLC) is a more likely and clinically relevant consideration.

Q: A 45-year-old farmer presents with right upper quadrant pain and a history of exposure to livestock. An abdominal ultrasound shows a cystic lesion in the liver with internal floating membranes, described as the "Water lily sign." Based on this finding, what is the most likely Gharbi classification stage of the hydatid cyst?

Gharbi Stage III. ***Gharbi Stage III*** - This stage is characterized by a **cystic lesion with internal floating membranes** (daughter cysts or detached endocyst), which is consistent with the "Water lily sign" described. - The membranes are indicative of a **degenerating or ruptured endocyst** within the main cyst, signifying a more advanced stage than simple cysts. *Gharbi Stage I* - This stage represents a **simple, unilocular cyst** with an anechoic (fluid-filled) lumen, without any internal structures or membranes. - It would appear as a clearly defined, fluid-filled mass with a smooth wall, lacking the internal complexity shown in the image. *Gharbi Stage II* - Gharbi Stage II is characterized by a **cyst with internal septations**, indicating the presence of multiple daughter cysts within the main cyst. - While it involves internal structures, these are typically well-defined septa rather than freely moving, detached membranes. *Gharbi Stage IV* - This stage describes a **heterogeneous, degenerating cyst** with a solid-like appearance, often without a clear cystic lumen. - It reflects a more advanced, often calcified or completely inactivated cyst, which does not match the clear cystic structure with floating membranes seen in the image.

Q: A 78-year-old immobile patient presents with a pressure ulcer on the sacral area, as shown in the image below. How would you grade this bedsore?

Stage 4. *Stage 1* - A Stage 1 pressure ulcer is characterized by **non-blanchable erythema** of intact skin, typically over a bony prominence. - There is no break in the skin, which is not what is visible in the image. *Stage 2* - A Stage 2 pressure ulcer involves **partial-thickness skin loss** presenting as a shallow open ulcer with a red-pink wound bed, without slough or bruising. - The depth and tissue involvement shown in the image are far more extensive than a Stage 2 ulcer. *Stage 3* - A Stage 3 pressure ulcer involves **full-thickness tissue loss** where subcutaneous fat may be visible, but bone, tendon, or muscle are not exposed. - The visible structures in the image suggest involvement beyond the subcutaneous fat layer, distinguishing it from a Stage 3 ulcer. ***Stage 4*** - The image shows **full-thickness tissue loss** with visible **bone, tendon, or muscle**, indicating a Stage 4 pressure ulcer. - There is also evidence of **slough and eschar** in the wound bed, which is consistent with severe tissue damage extending beyond the subcutaneous fat. - This is the **correct answer** as the exposed deeper structures are pathognomonic for Stage 4.

Question 1

A young patient presents to the OPD with recurrent colicky abdominal pain. Urine examination shows the presence of red blood cells (RBCs) and the following crystal shape in the figure. What is the most likely diagnosis?

Accepted Answer

Cystine stone

Answer

Glomerulonephritis

Answer

Oxalate stone

Answer

Polycystic kidney disease

Answer

Uric acid stone

Question 2

What is the most common cause of death in idiopathic pulmonary fibrosis (IPF)?

Accepted Answer

Respiratory failure

Answer

Pulmonary edema

Answer

Cancer

Answer

Pulmonary arterial hypertension (PAH)

Answer

Acute exacerbation of IPF

Question 3

A patient presents with large sweaty hands, macroglossia, and frontal bossing. What is the best test for confirmation of the diagnosis?

Accepted Answer

IGF-1

Answer

GHRH levels

Answer

IGF-2

Answer

GH levels after glucose suppression

Answer

Random GH level

Question 4

A patient presents with recurrent lung infections, and the chest X-ray provided shows a characteristic finding. What is the most likely diagnosis?

Accepted Answer

Kartagener syndrome

Answer

Cystic fibrosis

Answer

DiGeorge syndrome

Answer

Down syndrome

Question 5

A patient presents with headache, confusion, and a diagnosis of a brain tumor. The family history reveals brain and kidney tumors. What is the most likely diagnosis?

Accepted Answer

VHL syndrome

Answer

Neurofibromatosis

Answer

Li-Fraumeni syndrome

Answer

Churg-Strauss syndrome

Question 6

A 26-year-old woman presents to the OPD with distended neck veins and difficulty in breathing. On further evaluation, the patient is diagnosed with myasthenia gravis. Radiological imaging reveals an anterior mediastinal mass on CT. What is the most likely diagnosis?

Accepted Answer

Thymoma

Answer

Aortic aneurysm

Answer

CA lung

Answer

Cardiomegaly

Question 7

Which of the following statements regarding von Willebrand disease is incorrect?

Accepted Answer

Type 1 von Willebrand disease presents with severe bleeding since childhood.

Answer

Type 2 von Willebrand disease is associated with a moderate bleeding tendency.

Answer

Type 3 von Willebrand disease is associated with severe deficiency of factor VIII.

Answer

Type 2 von Willebrand disease includes subtypes with varying defects in von Willebrand factor.

Question 8

A Myasthenia Gravis patient on mycophenolate and pyridostigmine presents with hypercalcemia. Apart from the obvious drug-related cause, what other condition could be associated with hypercalcemia in this patient?

Accepted Answer

Non-Small Cell Lung Cancer (NSCLC)

Answer

Drug induced

Answer

Parathyroid adenoma

Answer

Small Cell Lung Cancer (SCLC)

Answer

Sarcoidosis

Question 9

A 45-year-old farmer presents with right upper quadrant pain and a history of exposure to livestock. An abdominal ultrasound shows a cystic lesion in the liver with internal floating membranes, described as the "Water lily sign." Based on this finding, what is the most likely Gharbi classification stage of the hydatid cyst?

Accepted Answer

Gharbi Stage III

Answer

Gharbi Stage I

Answer

Gharbi Stage II

Answer

Gharbi Stage IV

Question 10

A 78-year-old immobile patient presents with a pressure ulcer on the sacral area, as shown in the image below. How would you grade this bedsore?

Accepted Answer

Stage 4

Answer

Stage 1

Answer

Stage 2

Answer

Stage 3

NEET-PG 2024

Diagnosis

Internal Medicine

Pathology

Pharmacology

Radiology

Surgery