NEET-PG 2025 Practice Questions

Q: Which of the following is used to measure the degree of objective and target achievement, and assess the quality of results obtained in a health program?

Evaluation. ***Evaluation*** - **Evaluation** is the specific process used to measure the degree of **objective and target achievement** and assess the **quality and impact** of results obtained in a health program. - It determines the overall **worth and effectiveness** of the program and typically occurs at the end or specific phases to inform future policy. - Evaluation answers: *"Did we achieve what we set out to do, and what was the quality of those results?"* *Monitoring* - **Monitoring** is the periodic oversight of ongoing activities to check if they are proceeding according to schedule and resource utilization (efficiency). - It tracks the **input, process, and output** (activities completed) rather than assessing the final effectiveness or the quality of results (program impact). - Monitoring answers: *"Are activities happening as planned?"* *Surveillance* - **Surveillance** is the continuous, systematic collection and analysis of data, primarily used for **tracking disease trends** and providing early warning. - Its focus is on monitoring health events (e.g., incidence/prevalence), not assessing overall program performance against predefined final objectives. - Surveillance answers: *"What is happening in terms of disease occurrence?"* *Planning* - **Planning** is the initial stage involving defining goals, establishing strategies, and allocating resources, occurring *before* program implementation. - It sets the foundation but does not involve measuring the achievement of targets after the program has run. - Planning answers: *"What do we want to achieve and how?"*

Q: A 12-year-old male with a history of recurrent epistaxis presents with nasal obstruction for the past 1 year. On examination the presence of nasal mass and investigation shows bowing of the posterior wall of maxillary sinus. What is the probable diagnosis?

Nasopharyngeal angiofibroma. ***Nasopharyngeal angiofibroma*** - This diagnosis is strongly suggested by the classic triad of **adolescent male** (12 years old), **recurrent epistaxis**, and **nasal obstruction** - the typical presentation of this benign but locally aggressive tumor. - The **Holman-Miller sign** (bowing of the posterior wall of maxillary sinus) is pathognomonic for nasopharyngeal angiofibroma, indicating aggressive expansion and bony remodeling. *Rhinosporidiosis* - This condition presents as **friable, strawberry-like polyps** that may bleed, but doesn't cause the severe, recurrent epistaxis seen in this case. - It does not cause aggressive **bony remodeling** or the characteristic Holman-Miller sign seen on imaging. *Antrochoanal polyp* - While it can cause **unilateral nasal obstruction**, it rarely presents with severe, recurrent **epistaxis** as the predominant feature. - This benign polyp does not cause the aggressive **bony expansion** and Holman-Miller sign characteristic of angiofibroma. *Rhinoscleroma* - This chronic granulomatous infection caused by **Klebsiella rhinoscleromatis** typically presents with firm, sclerotic lesions and **crusting**. - It rarely causes the prominent, recurrent **epistaxis** or the destructive bony changes (Holman-Miller sign) seen in this patient.

Q: A 30-year-old male presents to the clinic with a history of recurrent ear infections and a recent "popping" sensation in his left ear. Otoscopic examination of the left ear reveals a central perforation of the tympanic membrane. The pure tone audiometry (PTA) results show the following: Right Ear: Air conduction and bone conduction thresholds are within normal limits. Left Ear: A significant air-bone gap is present, with bone conduction thresholds within the normal range. Based on these findings, what is the most likely diagnosis regarding the type of hearing loss?

Left conductive hearing loss. ***Left conductive hearing loss*** - A conductive hearing loss is defined on PTA by the presence of a significant **air-bone gap** (AC threshold worse than BC threshold) with **normal bone conduction** thresholds. - The otoscopic finding of a **central perforation of the tympanic membrane** indicates a pathology in the middle ear/conducting mechanism, which is the classical cause of a conductive loss. *Left sensorineural hearing loss* - This type of loss occurs when both **air conduction** and **bone conduction** thresholds are equally reduced (no air-bone gap) and are outside the normal limits. - It indicates a problem with the **cochlea** or the **auditory nerve**, which contradicts the normal bone conduction found in the left ear. *Right conductive hearing loss* - The PTA results for the right ear showed **air and bone conduction thresholds** within normal limits, confirming **normal hearing** in the right ear. - Therefore, a hearing loss of any type in the right ear is ruled out by the objective audiometric data. *Right sensorineural hearing loss* - This would require both air and bone conduction thresholds in the right ear to be significantly elevated (impaired), which is inconsistent with the **normal audiometry findings** reported for the right ear.

Q: A patient presents to the emergency department with significant nasal trauma after a fall. Examination reveals a deviated nasal pyramid and palpation confirms crepitus and mobility of the nasal bones. A lateral nasal bone X-ray confirms a displaced nasal bone fracture. Which of the following instruments is specifically designed for the closed reduction of a displaced nasal bone fracture?

Walsham forceps. ***Walsham forceps*** - The **Walsham forceps** is specifically designed for the **closed reduction** of displaced nasal bone fractures, utilizing an internal blade and an external padded blade for controlled lifting and manipulation. - They allow the surgeon to gain purchase on the fractured segments to safely elevate **depressed nasal bones** and restore the nasal pyramid's shape. *Tilley's forceps* - **Tilley's nasal dressing forceps** are primarily used for general purposes, such as removing foreign bodies, packing the nose, or removing **small polyps** from the nasal cavity. - They lack the necessary structure, leverage, and specialized curve required to successfully engage and **reduce** a bony nasal fracture. *Luc's forceps* - **Luc's forceps** are generally used for applying **anterior nasal packing** or removing dressings, serving primarily as a dressing forceps. - Although used in the nose, they do not have the specialized geometry needed to grasp and elevate the bony cartilage for **fracture reduction**. *Bayonet forceps* - **Bayonet forceps** are commonly used in microscopic or endoscopic procedures (e.g., ear or fine nasal surgery) because their offset handle prevents the surgeon's hand from obstructing the line of sight. - They are used for fine grasping, packing, or dissection, but are entirely unsuitable for the heavy task of **reducing** a **displaced nasal bone fracture**.

Q: A patient with HIV develops tuberculosis. When should ART be initiated?

Start ATT, then ART after 2 weeks. ***A. Start ATT, then ART after 2 weeks*** - This strategy is the standard recommendation, particularly for patients with CD4 counts >50 cells/mm³, to reduce the risk of **Tuberculosis-Associated Immune Reconstitution Inflammatory Syndrome (IRIS)** [1]. - Delaying ART by 2 weeks allows patients to establish tolerance to **Anti-Tubercular Treatment (ATT)** and simplifies the management of potential overlapping drug toxicities [2]. *B. Start ART and ATT simultaneously* - Simultaneous initiation significantly increases the risk and severity of developing **IRIS**, which can worsen the patient's clinical status due to paradoxical worsening of TB symptoms [1]. - This approach also makes it challenging to identify the source of **drug-related toxicities** (e.g., hepatotoxicity), as many ATT and ART drugs are metabolized by the liver [2]. *C. Start ART followed by ATT* - Delaying the initiation of **ATT** is dangerous as active tuberculosis is the immediate life-threatening condition that requires urgent treatment [2]. - Treatment priority in HIV-TB co-infection must first focus on effectively treating the active infection to prevent **disseminated disease** and death. *D. ART alone* - Administering **ART alone** will lead to the progression of active tuberculosis, resulting in significant morbidity and high mortality rates. - ART is necessary but must be combined with effective **ATT** as it is not a treatment for Mycobacterium tuberculosis itself.

Q: A patient is on salbutamol and ipratropium but continues to have nocturnal exacerbations of asthma. What is the next step?

Laba plus inhalation steroids. ***Laba plus inhalation steroids*** - In a patient with persistent symptoms (nocturnal exacerbations) despite using a SABA (**salbutamol**) and a SAMA (**ipratropium**), the next step is to initiate or step up therapy by adding a long-term controller medication, which is typically a combination of **Inhaled Corticosteroids (ICS)** and a **Long-Acting Beta-Agonist (LABA)** [1]. - This combination is crucial for controlling airway inflammation and providing prolonged bronchodilation, effectively managing nocturnal symptoms [1], [2]. *Oral corticosteroids* - **Oral corticosteroids** are reserved for acute, severe exacerbations, short courses for bridging, or in cases of very severe asthma refractory to high-dose inhaled therapy [3]. - They are not the standard next step for managing persistent nocturnal symptoms in a patient previously stable on SABA/SAMA. *Montelukast* - **Montelukast** (a leukotriene receptor antagonist) is generally considered a less potent controller than the ICS/LABA combination and is often used as an add-on therapy or for specific phenotypes like aspirin-exacerbated respiratory disease (AERD). - Its efficacy in independently controlling moderate-to-severe persistent asthma, characterized by nocturnal symptoms, is lower than that of ICS/LABA [2]. *Increase the dose of salbutamol* - **Salbutamol** is a **Short-Acting Beta-Agonist (SABA)**, used primarily as a reliever for acute symptoms, not as a long-term controller [2], [4]. - Increasing its dose or frequency significantly suggests reliance on relief medication, which indicates poorly controlled asthma and can increase the risk of adverse cardiac side effects like **tachycardia**.

Q: A 25-year-old sewage worker presents with fever for 1 week and weakness for 1 day. Laboratory evaluation reveals elevated bilirubin and decreased urine output. Conjunctival redness? What is the most likely diagnosis?

Weil's disease. ***Weil's disease*** - The clinical triad of fever, **jaundice (elevated bilirubin)**, and **acute kidney injury (decreased urine output)**, particularly in an individual with exposure to contaminated water (**sewage worker**), is the classical presentation of the severe form of leptospirosis, also known as Weil's disease [1]. - **Conjunctival suffusion/redness** without inflammation or discharge is a pathognomonic physical sign highly suggestive of Weil's disease, caused by the spirochete **Leptospira interrogans** [1], [2]. *Brucellosis* - Usually presents with an undulating fever, night sweats, and localized infection in the bones (**spondylitis**) or reticuloendothelial system; it is often linked to consumption of **unpasteurized dairy**. - While mild hepatic involvement can occur, it rarely causes the severe combination of **acute renal failure** and deep jaundice seen in this patient. *Enteric fever* - Characterized by a gradually rising fever, **relative bradycardia**, and often features a dry cough, abdominal discomfort, and sometimes **rose spots**. [2] - Severe organ damage like acute kidney injury and profound jaundice simultaneously is unusual in typhoid fever, and **conjunctival suffusion** is not a feature. *Acute Viral Hepatitis* - Presents with fever, malaise, and eventually **jaundice (elevated bilirubin)**; the primary pathology is hepatocyte necrosis. [2] - It typically does not cause simultaneous severe **acute renal failure** and the specific finding of **conjunctival suffusion**, which are hallmarks of Weil's disease.

Q: A patient presents with recurrent infections with Neisseria gonorrhoeae. Which of the following investigations is most appropriate to evaluate the underlying immunodeficiency?

Terminal complement (C5-C9) assay. ***Terminal complement (C5-C9) assay*** - Recurrent infections with *Neisseria* species (gonorrhoeae or meningitidis) are the classic presentation of a deficiency in the **Terminal Complement Components (C5-C9)**. - These components assemble the **Membrane Attack Complex (MAC)**, which is crucial for the lysis and killing of the thin cell walls of Neisserial organisms. *C1 esterase inhibitor assay* - This assay is used to diagnose **Hereditary Angioedema (HAE)**, which presents with recurrent episodes of swelling, not recurrent bacterial infections like *N. gonorrhoeae*. - HAE involves uncontrolled activation of the complement and kinin pathways, not failure to eliminate bacteria. *Quantitative immunoglobulin levels* - Measuring **IgG, IgA, and IgM** levels evaluates humoral immunity, typically diagnosing conditions like **Common Variable Immunodeficiency (CVID)**. - Antibody deficiencies usually lead to recurrent sinopulmonary infections with encapsulated bacteria (*Strep pneumoniae*, *H flu*), not specifically *Neisseria*. *Nitroblue tetrazolium test* - This test, or the modern DHR assay, screens for **Chronic Granulomatous Disease (CGD)**, a defect in phagocyte function (NADPH oxidase). - CGD patients suffer from severe, deep-seated infections and abscesses caused by **catalase-positive organisms** (e.g., *Staph aureus*, *Aspergillus*), not complement-dependent issues like recurrent *Neisseria*.

Q: A patient presents with GERD. Which drug helps in contraction of LES and increases gastric emptying?

Metoclopramide. ***Metoclopramide*** - It is a **prokinetic agent** that acts as a D2 dopamine receptor antagonist, which increases esophageal tone, enhances peristalsis, and facilitates **gastric emptying**. - It specifically increases the pressure of the **Lower Esophageal Sphincter (LES)**, reducing reflux associated with GERD. *Pantoprazole* - This is a **Proton Pump Inhibitor (PPI)** that reduces acid production by irreversible inhibition of the H+/K+-ATPase pump in parietal cells [1], [2]. - It does not have any significant effect on **LES contraction** or **gastric motility**. *Vonoprazan* - This is a **Potassium-Competitive Acid Blocker (P-CAB)**, which directly and reversibly inhibits the H+/K+-ATPase pump. - Like other acid suppressants, it decreases acid secretion but does not improve **LES function** or **gastric emptying**. *Ranitidine* - This is an **H2 receptor antagonist** that blocks histamine receptors on parietal cells, leading to decreased acid secretion [3]. - It treats GERD by reducing acidity but has no direct action on **LES tone** or stomach **motility**.

Q: A patient on haloperidol for 2 years presents with orofacial dyskinesia and extrapyramidal symptoms. What is the appropriate treatment?

Tardive dyskinesia - valbenazine. ***Tardive dyskinesia - valbenazine*** - The patient's presentation of **orofacial dyskinesia** following **long-term use** (2 years) of a high-potency antipsychotic like haloperidol is highly characteristic of **Tardive Dyskinesia (TD)**, a chronic EPS. - **Valbenazine** (a VMAT2 inhibitor) is one of the primary, FDA-approved treatments specifically used to reduce the severity of abnormal movements in TD. *Acute dystonia - ropinirole* - **Acute dystonia** is an immediate reaction (hours to days) involving severe muscle spasms, not a delayed presentation of dyskinesia. - The treatment for acute dystonia is typically an **anticholinergic** (e.g., benztropine) or diphenhydramine; **ropinirole** is a dopamine agonist used for Parkinson's disease. *Akathisia - propranolol* - **Akathisia** is defined by a subjective feeling of restlessness and an objective inability to sit still, which is different from the involuntary, choreiform movements of **dyskinesia**. - Although **propranolol** is the appropriate treatment for akathisia, the symptom cluster (orofacial dyskinesia) indicates a diagnosis of **TD**. *Parkinsonism - amantadine* - Drug-induced **Parkinsonism** involves bradykinesia, rigidity, and resting tremor, rather than the prominent abnormal mouth and face movements (dyskinesia) seen here. - While **amantadine** is used for drug-induced parkinsonism, it is generally ineffective or potentially worsens the movements associated with **Tardive Dyskinesia**.

Question 1

Which of the following is used to measure the degree of objective and target achievement, and assess the quality of results obtained in a health program?

Accepted Answer

Evaluation

Answer

Monitoring

Answer

Surveillance

Answer

Planning

Question 2

A 12-year-old male with a history of recurrent epistaxis presents with nasal obstruction for the past 1 year. On examination the presence of nasal mass and investigation shows bowing of the posterior wall of maxillary sinus. What is the probable diagnosis?

Accepted Answer

Nasopharyngeal angiofibroma

Answer

Rhinosporidiosis

Answer

Antrochoanal polyp

Answer

Rhinoscleroma

Question 3

A 30-year-old male presents to the clinic with a history of recurrent ear infections and a recent "popping" sensation in his left ear. Otoscopic examination of the left ear reveals a central perforation of the tympanic membrane. The pure tone audiometry (PTA) results show the following: Right Ear: Air conduction and bone conduction thresholds are within normal limits. Left Ear: A significant air-bone gap is present, with bone conduction thresholds within the normal range. Based on these findings, what is the most likely diagnosis regarding the type of hearing loss?

Accepted Answer

Left conductive hearing loss

Answer

Right sensorineural hearing loss

Answer

Left sensorineural hearing loss

Answer

Right conductive hearing loss

Question 4

A patient presents to the emergency department with significant nasal trauma after a fall. Examination reveals a deviated nasal pyramid and palpation confirms crepitus and mobility of the nasal bones. A lateral nasal bone X-ray confirms a displaced nasal bone fracture. Which of the following instruments is specifically designed for the closed reduction of a displaced nasal bone fracture?

Accepted Answer

Walsham forceps

Answer

Luc's forceps

Answer

Bayonet forceps

Answer

Tilley's forceps

Question 5

A patient with HIV develops tuberculosis. When should ART be initiated?

Accepted Answer

Start ATT, then ART after 2 weeks

Answer

Start ART followed by ATT

Answer

ART alone

Answer

Start ART and ATT simultaneously

Question 6

A patient is on salbutamol and ipratropium but continues to have nocturnal exacerbations of asthma. What is the next step?

Accepted Answer

Laba plus inhalation steroids

Answer

Montelukast

Answer

Increase the dose of salbutamol

Answer

Oral corticosteroids

Question 7

A 25-year-old sewage worker presents with fever for 1 week and weakness for 1 day. Laboratory evaluation reveals elevated bilirubin and decreased urine output. Conjunctival redness? What is the most likely diagnosis?

Accepted Answer

Weil's disease

Answer

Enteric fever

Answer

Acute Viral Hepatitis

Answer

Brucellosis

Question 8

A patient presents with recurrent infections with Neisseria gonorrhoeae. Which of the following investigations is most appropriate to evaluate the underlying immunodeficiency?

Accepted Answer

Terminal complement (C5-C9) assay

Answer

Nitroblue tetrazolium test

Answer

Quantitative immunoglobulin levels

Answer

C1 esterase inhibitor assay

Question 9

A patient presents with GERD. Which drug helps in contraction of LES and increases gastric emptying?

Accepted Answer

Metoclopramide

Answer

Vonoprazan

Answer

Ranitidine

Answer

Pantoprazole

Question 10

A patient on haloperidol for 2 years presents with orofacial dyskinesia and extrapyramidal symptoms. What is the appropriate treatment?

Accepted Answer

Tardive dyskinesia - valbenazine

Answer

Akathisia - propranolol

Answer

Parkinsonism - amantadine

Answer

Acute dystonia - ropinirole

NEET-PG 2025

Community Medicine

ENT

Internal Medicine

Microbiology

Pharmacology

Psychiatry