NEET-PG 2025 Practice Questions

Q: Patient in hospital was given IVF and patient develops hyperchloremic metabolic acidosis. Which fluid will cause this?

NS. ***NS*** - **Normal Saline (0.9% NaCl)** contains a **chloride concentration of 154 mEq/L**, which is unphysiologically high (supranormal) compared to plasma (approx. 100 mEq/L). - Rapid infusion leads to the retention of excess chloride and dilution of serum bicarbonate, resulting in a **non-anion gap (hyperchloremic) metabolic acidosis**. *RL* - Ringer's Lactate (RL) is a **buffered solution** because it contains **lactate (28 mEq/L)**, which is metabolized by the liver into bicarbonate. - Because of the bicarbonate precursor (lactate) and a near-physiologic chloride concentration (109 mEq/L), RL tends to **prevent or correct** acidosis, rather than causing it. *DNS* - Dextrose Normal Saline (DNS) still contains the **supranormal chloride concentration** (154 mEq/L) from the normal saline component, posing a similar theoretical risk. - However, it is typically less associated with severe acidosis than pure NS in large volumes, and often the primary differentiating fluid in this context is the **buffered RL**. *5 % dextrose* - **5% Dextrose in Water (D5W)** contains no electrolytes (salt) and is only used to provide free water and small amounts of calories. - Rapid infusion of D5W results in dilution and can cause **hyponatremia** and free water excess, but it cannot precipitate hyperchloremic acidosis.

Q: A 35-year-old male undergoing abdominal surgery under general anesthesia develops sudden generalized muscle rigidity, rapid increase in body temperature, and tachycardia shortly after administration of sevoflurane and succinylcholine. His end-tidal CO2 is rising despite controlled ventilation. What is the most appropriate immediate treatment?

Dantrolene. ***Dantrolene*** - This clinical scenario is a classic presentation of **Malignant Hyperthermia (MH)**, a life-threatening pharmacogenetic disorder triggered by volatile anesthetics (like sevoflurane) and succinylcholine. - **Dantrolene sodium** is the only specific treatment for MH; it acts by directly interfering with excitation-contraction coupling in skeletal muscle, reducing the intracellular calcium release from the sarcoplasmic reticulum. *Diazepam* - Diazepam is an anxiolytic/sedative and an anticonvulsant; it might be used to control generalized seizures or anxiety, but it is **not effective** against the massive muscle contracture seen in Malignant Hyperthermia. - Administering diazepam would only treat minor symptoms or anxiety and delay the necessary specific treatment, leading to potentially fatal outcomes from **rhabdomyolysis and hyperkalemia**. *Pancuronium* - Pancuronium is a **non-depolarizing neuromuscular blocking agent** (muscle relaxant) and will not halt the underlying pathological process of Malignant Hyperthermia, which involves uncontrolled calcium release from the sarcoplasmic reticulum. - Although it causes paralysis, it would not address the **hypermetabolic state** (characterized by rising ETCO2 and temperature) that is the hallmark of MH. *Vecuronium* - Vecuronium is also a **non-depolarizing neuromuscular blocking agent** used for muscle relaxation during anesthesia, similar to pancuronium. - While it causes muscle paralysis, it does not correct the massive, uncontrolled increase in intracellular calcium that drives the **malignant hyperthermic crisis**.

Q: A patient presents with sudden onset aphasia and right sided arm weakness for past 4 hours. Which of the following investigations will be done to determine etiology of this case presentation?

Transesophageal echocardiography. ***Transesophageal echocardiography*** - The patient presents with **sudden onset focal neurological deficits** (aphasia and hemiparesis), highly suggestive of an acute stroke, likely ischemic [2]. - TEE is superior to TTE for visualizing potential **cardiac sources of embolism**, such as intracardiac thrombi (especially in the left atrial appendage), patent foramen ovale (PFO), or aortic arch plaques, which are common etiologies in cryptogenic stroke [1], [4]. *Transthoracic echocardiography* - TTE is the initial, non-invasive cardiac evaluation but may miss smaller defects or clots, particularly in the **left atrial appendage** or smaller PFOs, due to poor resolution. - While useful for overall cardiac function, it has **lower sensitivity** than TEE for detecting specific high-risk embolic sources. *Carotid doppler* - This test assesses **carotid artery stenosis**, which is a common cause of ipsilateral stroke [1]. - It primarily determines large vessel disease in the neck, but the clinical presentation (sudden onset) and age may also suggest a **cardioembolic source** warranting cardiac investigation. *MRI brain* - MRI brain is the standard imaging modality used to **confirm the stroke** (especially DWI in the acute stage) and localize the lesion [1], [3]. - However, it determines the **consequence of the stroke** (location and extent of damage) rather than the underlying **etiology** (the source of the embolus or infarct), which is the focus of this question [1], [4].

Q: A patient presents with salt wasting, craving, hyperkalemia, metabolic acidosis, and skin pigmentation. What is the most likely diagnosis?

Addison's disease. ***Addison's disease*** - The features (salt wasting, hyperkalemia, metabolic acidosis, and skin pigmentation) are hallmarks of **primary adrenal insufficiency** (Addison's disease) [1], [2]. - **Skin pigmentation** (due to increased ACTH/MSH) and **salt wasting** (due to cortisol and aldosterone deficiency) are key differentiating points [2]. *Cushing's syndrome* - This condition is caused by **excess glucocorticoids** and typically presents with central obesity, moon facies, hypertension, and hypokalemia [3]. - It is characterized by **fluid retention** and suppressed ACTH (in secondary/tertiary causes), entirely opposite to the salt wasting seen here [3]. *Conn's syndrome* - Conn's syndrome is **primary hyperaldosteronism**, leading to sodium retention, **hypertension**, **hypokalemia**, and metabolic alkalosis [1]. - The presentation includes **hypokalemia** and **alkalosis**, which directly contradict the hyperkalemia and acidosis noted in the patient. *Pheochromocytoma* - This is a catecholamine-secreting tumor leading to episodic or sustained **hypertension**, palpitations, headaches, and sweating. - It primarily affects the cardiovascular system and does not cause the **salt wasting** or **hyperkalemia** profile seen in this patient.

Q: A known type 1 diabetic presents with glucose 799 mg/dL, Na+ 128 mEq/L, Cl- 88 mEq/L, and signs of dehydration. Which of the following is NOT used in the initial management?

3 % Saline. Hypotonic conditions in Diabetic Ketoacidosis (DKA) are typically addressed with isotonic fluids. 3% saline is not used in initial management because it is reserved for severe cerebral edema or profound hypovolemia [3]. The immediate priority for fluid resuscitation in DKA is often 0.9% Normal Saline to correct volume depletion and hypotonicity [2], [4]. *0.9 % Normal saline* - This is essential for volume resuscitation to correct the severe dehydration (due to osmotic diuresis) and is the standard initial fluid administered in DKA [1], [2]. - It helps restore effective circulating volume and is initiated before insulin therapy to prevent vascular collapse [4]. *IV infusion insulin* - After initial fluid therapy is initiated, IV regular insulin infusion is crucial to transition the patient from a catabolic to an anabolic state, stopping ketone production and lowering blood glucose levels [2]. - Insulin therapy must be delayed until fluid resuscitation begins to prevent vascular collapse [4]. *Potassium monitoring* - Continuous and careful potassium monitoring is vital because acidosis and cellular shifts lead to rapid changes in serum potassium levels [2], [3]. - Potassium supplementation is often required if the serum potassium is < 5.5 mmol/L (or 5.2 mEq/L) to prevent life-threatening cardiac arrhythmias [2].

Q: Patient came with fever headache and nuchal rigidity. LP shows gram-negative diplococci in gram stain. Which of the following will be used for chemoprophylaxis in close contacts of a patient with meningococcal meningitis?

Rifampicin. ***Rifampicin*** - **Rifampicin** is one of the preferred agents for chemoprophylaxis against meningococcal meningitis in close contacts because it effectively eliminates **Neisseria meningitidis** colonization from the nasopharynx. - The other common options for prophylaxis include **Ceftriaxone** (single IM dose, safe in pregnancy) or **Ciprofloxacin** (single oral dose). *Amoxicillin* - Amoxicillin is commonly used for **otitis media** and **sinusitis** but is ineffective for reliable elimination of nasopharyngeal colonization by **Neisseria meningitidis**. - It is not a recommended prophylactic agent for **meningococcal disease** in close contacts. *Doxycycline* - While a broad-spectrum antibiotic, **Doxycycline** is not the standard or preferred drug for routine **meningococcal prophylaxis**. - It is often used for atypical pneumonias or tick-borne diseases like **Rocky Mountain spotted fever**. *Ethambutol* - **Ethambutol** is a primary anti-mycobacterial drug, used exclusively in the treatment regimen for **Tuberculosis (TB)**. - It has no role or efficacy in the prophylaxis or treatment of **bacterial meningitis** caused by **Neisseria meningitidis**.

Q: A 56-year-old female presents with chronic lower back pain. A lateral lumbar spine X-ray is provided. Based on the radiological findings, which of the following is the most likely diagnosis?

Spondylolisthesis. ***Spondylolisthesis*** - The lateral X-ray view demonstrates classic evidence of **anterior displacement** (slippage) of the superior vertebral body relative to the inferior body (shown by the red measurement line). - This condition is often due to a defect in the **pars interarticularis** (spondylolysis), indicated by the yellow arrows, causing mechanical instability and chronic pain. *Spondylitis* - Refers specifically to **inflammation** of the spinal vertebrae, seen in conditions like **Ankylosing Spondylitis** or infectious processes (e.g., spinal tuberculosis). - Radiological findings would include bone erosions, endplate destruction, or squaring of vertebrae, not clear mechanical vertebral slippage. *Osteosarcoma* - This is a primary malignant bone tumor, usually presenting radiographically as a solitary, aggressively lytic, or **sclerotic mass** with poorly defined margins. - It does not cause the characteristic pattern of forward vertebral body slip and pars defect visible in this chronic mechanical pathology. *Vertebral fracture* - An acute **compression fracture** results in a loss of vertebral height, often a wedge-shaped deformity, which is not the predominant finding here. - While traumatic fracture-dislocation can cause displacement, the image shows a chronic slip pattern, often secondary to a **spondylolysis** (pars defect), rather than an acute traumatic bone break.

Q: After a building collapse, a patient presents with airway obstruction and mouth filled with concrete debris. BP is 90/60 mmHg, HR 105/min. A cricothyrotomy is performed. Which of the following statements regarding this procedure is true?

It must be followed by a formal tracheostomy. ***It must be followed by a formal tracheostomy*** - The procedure performed is an emergency surgical airway, likely a **cricothyrotomy**, which is a life-saving but temporary measure used when **endotracheal intubation** is impossible. - Due to the high risk of long-term complications, especially **subglottic stenosis** and cricoid cartilage damage, it requires prompt conversion (typically within 48-72 hours) to a more permanent airway using a **formal tracheostomy**. *It provides adequate ventilation for up to 6 hours* - While it provides adequate immediate ventilation, 6 hours is not a safety cut-off; the decision to convert is driven by the risk of **laryngeal damage** and scarring with delayed action. - The primary goal of cricothyrotomy is **immediate stability**, not providing a specific period of ventilation. *It allows for removal of large foreign bodies from the airway* - The procedure bypasses the upper airway obstruction by inserting a tube through the **cricothyroid membrane** (below the vocal cords). - It does **not** facilitate the removal of large foreign bodies or concrete debris, which would require specialized tools like **bronchoscopy** or direct laryngoscopy. *It can be safely used for prolonged airway management without further intervention* - This statement is false, as prolonged use (>72 hours) of a cricothyrotomy is highly associated with localized complications, including vocal cord dysfunction and life-threatening **subglottic stenosis**. - A cricothyrotomy is only intended as a **bridge** until a definitive airway (tracheostomy) can be established in a controlled environment.

Q: Identify the knot?

Surgeon's knot. ***Surgeon's knot*** - The image displays the characteristic first throw of a **Surgeon's knot**, which involves looping the suture end twice (a **double throw** or double twist) instead of once. - This double throw is designed to increase friction, preventing slippage when securing vascular pedicles or tissues under **high tension** before completing the knot with a second single throw. *Granny's knot* - A **Granny's knot** is formed by two consecutive throws made in the same direction, meaning the second throw does not reverse the first. - This design causes the knot to lie obliquely, making it inherently weak and prone to **slipping** or untying, especially under tension. *Reef knot* - Also known as a **Square knot**, a Reef knot consists of two consecutive throws made in **opposite directions** (e.g., right-over-left followed by left-over-right). - It is a secure knot when used correctly, but it uses only a single twist for the first throw, unlike the double twist shown in the image. *Double Knot* - "Double knot" is a generalized or imprecise term; while a Surgeon's knot involves a double twist, this term does not precisely describe the unique **structure and function** of the knot shown. - The image specifically illustrates the deliberate **two consecutive wraps** in the first throw, which precisely defines the specialized technique of the Surgeon's knot.

Q: A 43-year-old female presents to OPD due to changes in breast and a lump in breast as given below. What is the diagnosis?

T4d. ### ***T4d*** - The image displays characteristic findings of **Inflammatory Breast Cancer** (IBC), including **erythema** (redness), **edema**, and **peau d'orange** (orange peel appearance) involving more than one-third of the skin of the breast. - According to the **AJCC TNM Staging** system (8th edition), T4d specifically denotes a tumor size equivalent to Inflammatory Breast Cancer, regardless of the actual tumor dimension or nodal status. ### *T4a* - T4a describes a tumor of any size with direct extension to the **chest wall** (ribs, intercostal muscles, or serratus anterior muscle) but **not** including the pectoralis muscle. - The primary feature in the image is **skin involvement** (**edema** and **erythema**), **not** direct extension to the underlying chest wall structures, which is why this is not T4a. ### *T1c* - T1c describes an invasive carcinoma where the maximum tumor dimension is **greater than 10 mm but less than or equal to 20 mm**. - This staging category is based on the size of the primary tumor mass and does not account for the extensive skin changes (**inflammatory signs**) visible in the image, which immediately mandate a T4 classification. ### *T3* - T3 describes an invasive carcinoma where the maximum tumor dimension is **greater than 50 mm**. - While the tumor size might be large, the presence of **Inflammatory breast symptoms** (**erythema**, **edema**, **peau d'orange**) overrides tumor size for T staging, escalating the stage to **T4d**.

Question 1

Patient in hospital was given IVF and patient develops hyperchloremic metabolic acidosis. Which fluid will cause this?

Accepted Answer

NS

Answer

RL

Answer

5 % dextrose

Answer

DNS

Question 2

A 35-year-old male undergoing abdominal surgery under general anesthesia develops sudden generalized muscle rigidity, rapid increase in body temperature, and tachycardia shortly after administration of sevoflurane and succinylcholine. His end-tidal CO2 is rising despite controlled ventilation. What is the most appropriate immediate treatment?

Accepted Answer

Dantrolene

Answer

Vecuronium

Answer

Diazepam

Answer

Pancuronium

Question 3

A patient presents with sudden onset aphasia and right sided arm weakness for past 4 hours. Which of the following investigations will be done to determine etiology of this case presentation?

Accepted Answer

Transesophageal echocardiography

Answer

Transthoracic echocardiography

Answer

MRI brain

Answer

Carotid doppler

Question 4

A patient presents with salt wasting, craving, hyperkalemia, metabolic acidosis, and skin pigmentation. What is the most likely diagnosis?

Accepted Answer

Addison's disease

Answer

Pheochromocytoma

Answer

Cushing's syndrome

Answer

Conn's syndrome

Question 5

A known type 1 diabetic presents with glucose 799 mg/dL, Na+ 128 mEq/L, Cl- 88 mEq/L, and signs of dehydration. Which of the following is NOT used in the initial management?

Accepted Answer

3 % Saline

Answer

0.9 % Normal saline

Answer

Potassium monitoring

Answer

IV infusion insulin

Question 6

Patient came with fever headache and nuchal rigidity. LP shows gram-negative diplococci in gram stain. Which of the following will be used for chemoprophylaxis in close contacts of a patient with meningococcal meningitis?

Accepted Answer

Rifampicin

Answer

Amoxicillin

Answer

Doxycycline

Answer

Ethambutol

Question 7

A 56-year-old female presents with chronic lower back pain. A lateral lumbar spine X-ray is provided. Based on the radiological findings, which of the following is the most likely diagnosis?

Accepted Answer

Spondylolisthesis

Answer

Spondylitis

Answer

Vertebral fracture

Answer

Osteosarcoma

Question 8

After a building collapse, a patient presents with airway obstruction and mouth filled with concrete debris. BP is 90/60 mmHg, HR 105/min. A cricothyrotomy is performed. Which of the following statements regarding this procedure is true?

Accepted Answer

It must be followed by a formal tracheostomy

Answer

It provides adequate ventilation for up to 6 hours

Answer

It can be safely used for prolonged airway management without further intervention

Answer

It allows for removal of large foreign bodies from the airway

Question 9

Identify the knot?

Accepted Answer

Surgeon's knot

Answer

Double Knot

Answer

Reef knot

Answer

Granny's knot

Question 10

A 43-year-old female presents to OPD due to changes in breast and a lump in breast as given below. What is the diagnosis?

Accepted Answer

T4d

Answer

T3

Answer

T1c

Answer

T4a

NEET-PG 2025

Anesthesiology

Internal Medicine

Pharmacology

Radiology

Surgery