NEET-PG 2015 Practice Questions

Q: In which condition is Chvostek's sign typically observed?

Hypoparathyroidism. Hypoparathyroidism - **Chvostek's sign** is a clinical manifestation of **hypocalcemia**, which is a hallmark of hypoparathyroidism [1]. - It involves a twitch of facial muscles elicited by tapping the **facial nerve** anterior to the ear. Hypercalcemia - **Hypercalcemia** is the opposite of hypocalcemia and would not cause increased neuromuscular excitability [2]. - Patients with hypercalcemia might experience symptoms like **fatigue**, **constipation**, and **bone pain** [2]. Insulinoma - An **insulinoma** is a tumor that produces excessive insulin, leading to **hypoglycemia**, not issues with calcium balance. - Symptoms are primarily related to low blood sugar, such as **confusion** and **tachycardia**. Diabetes mellitus - **Diabetes mellitus** is a metabolic disorder characterized by **high blood glucose levels** due to insulin deficiency or resistance. - It is not directly associated with calcium imbalances that would cause Chvostek's sign.

Q: What is the appropriate fluid management in the case of an intracerebral hemorrhage?

Normal saline. **Normal saline** - **Normal saline (0.9% NaCl)** is the preferred fluid for volume maintenance in patients with **intracerebral hemorrhage (ICH)** as it is an isotonic crystalloid. - It helps maintain an adequate **cerebral perfusion pressure (CPP)** and avoids hypotonic effects that could worsen cerebral edema. *Colloids* - **Colloids** are generally avoided in ICH as they can potentially **increase intracranial pressure (ICP)** due to their osmotic effects within the damaged blood-brain barrier. - They are also associated with **increased risk of cerebral edema** and poor neurological outcomes in stroke patients. *Blood transfusion* - **Blood transfusions** are indicated only in cases of significant **anemia** (typically hemoglobin < 7-8 g/dL) or active bleeding where oxygen delivery to the brain is compromised. - Routine blood transfusion without clear indication is not part of standard fluid management for ICH and carries risks. *Hypertonic fluids* - **Hypertonic saline (e.g., 3% NaCl)** or **mannitol** are used specifically for the acute management of **elevated intracranial pressure (ICP)**, not for routine fluid maintenance. - While they improve cerebral perfusion by reducing brain edema, their continuous use as maintenance fluid can lead to severe electrolyte imbalances and dehydration.

Q: Which of the following conditions is least likely to cause multiple painful ulcers on the tongue?

Sarcoidosis. ***Sarcoidosis*** - While sarcoidosis can affect any organ, **oral involvement is rare** and typically presents as **nodules, plaques, or generalized swelling**, not usually multiple painful ulcers on the tongue. - The lesions, when they occur, are often **painless** and appear as submucosal nodules, red patches, or diffuse swelling. *TB* - Oral tuberculosis can present as **multiple painful ulcers** on the tongue, often with a **granulomatous appearance** mimicking squamous cell carcinoma. - These ulcers are typically **irregular, undermined, and persistent**, often associated with pulmonary TB. *Herpes* - **Herpes simplex virus (HSV)** infection, particularly primary herpetic gingivostomatitis, commonly causes **multiple painful ulcers** on the tongue, gums, and other oral mucosa. - These ulcers begin as vesicles that **rupture to form painful erosions** and are a classic presentation of oral herpes. *Behcet disease* - **Oral aphthous ulcers** are a hallmark feature of Behcet disease, commonly presenting as **multiple, recurrent, painful ulcers** on the tongue and other oral mucosal surfaces. - These ulcers are clinically indistinguishable from common aphthous stomatitis but are more frequent and often associated with genital ulcers, skin lesions, and ocular inflammation.

Q: A patient presents with difficulty with swallowing liquids but not solids. The best investigation to make a diagnosis is

Manometry. ***Manometry*** - **Esophageal manometry** measures the pressure and coordination of muscle contractions in the esophagus, which is crucial for diagnosing motility disorders like **achalasia** [1] or **esophageal spasm** [2] that can cause difficulty swallowing liquids. - The symptom of difficulty swallowing liquids but not solids (**paradoxical dysphagia**) is characteristic of a primary esophageal motility disorder rather than a structural obstruction [1]. *Endoscopy* - **Endoscopy** is primarily used to visualize the esophagus and stomach for structural abnormalities such as **strictures**, **tumors**, or **inflammation** [1]. - While it can rule out structural causes, it is less effective for diagnosing purely functional or motility disorders [1]. *Endoscopic ultrasound* - **Endoscopic ultrasound (EUS)** provides detailed imaging of the esophageal wall and surrounding structures, helping to stage cancers or identify extrinsic compression. - It is not the primary investigation for assessing **esophageal motility**. *PET CT* - **PET CT** is primarily used in oncology for **cancer staging**, recurrence detection, and assessing metabolic activity of lesions. - It has limited utility in the initial diagnosis of a **swallowing disorder**, especially one indicating a motility issue.

Q: Tinel's sign is seen in which of the following conditions?

Carpal tunnel syndrome. ***Carpal tunnel syndrome*** - **Tinel's sign** is elicited by lightly tapping over the median nerve at the wrist, which in carpal tunnel syndrome, reproduces tingling or pain in the median nerve distribution [1]. - This sign indicates **nerve compression** or irritation at the carpal tunnel, a hallmark of the condition [1]. *Avascular necrosis of scaphoid* - This condition involves **bone death** due to interrupted blood supply, leading to pain and reduced range of motion, but not nerve irritation. - Diagnosis is typically made with **imaging studies** like MRI, not by neurological signs like Tinel's. *Kienbock's Disease* - This is a form of **avascular necrosis of the lunate bone**, causing wrist pain and stiffness. - It does not involve nerve compression and therefore **Tinel's sign** would not be expected. *1st carpometacarpal joint arthritis* - This condition affects the **joint at the base of the thumb**, causing localized pain and stiffness during gripping or pinching. - Symptoms are related to **joint degeneration**, not nerve impingement, so Tinel's sign is not relevant.

Q: The A1 pulley involved in trigger finger is located at the level of which joint?

Metacarpophalangeal joint. ***Metacarpophalangeal joint*** - The **A1 pulley** is located at the base of the finger, overlying the **metacarpophalangeal (MCP) joint**. - Its pathological thickening or narrowing can impede the smooth gliding of **flexor tendons**, causing **trigger finger**. *Proximal Interphalangeal joint* - The **A2** and **A3 pulleys** are located at the level of the **proximal phalanx** and **proximal interphalangeal (PIP) joint**, respectively. - While essential for tendon function, they are not primarily involved in typical **trigger finger**. *Distal Interphalangeal joint* - The **A4** and **A5 pulleys** are located at the level of the **middle phalanx** and **distal interphalangeal (DIP) joint**, respectively. - Pathologies at these pulleys are less common in trigger finger and typically affect the **distal tendon glide**. *Carpometacarpal joint* - The **carpometacarpal (CMC) joints** are located at the base of the hand, between the carpal bones and metacarpals. - There are no A pulleys associated with the CMC joints, and they are not directly involved in the mechanism of **trigger finger**.

Q: Chronic lung disease in infancy is defined as

Need for supplemental oxygen at 36 weeks postmenstrual age. ***Need for supplemental oxygen at 36 weeks after conception*** - **Chronic lung disease (CLD)**, also known as **bronchopulmonary dysplasia (BPD)**, is defined by the need for **supplemental oxygen** at 36 weeks postmenstrual age (corrected gestational age) or at 56 days postnatal age, whichever comes first, for infants born before 32 weeks gestation. - This definition reflects persistent respiratory morbidity requiring ongoing support, indicative of lung injury and abnormal development. *Tachypnoea > 50 breaths/ min within 1 week of birth* - **Tachypnoea** within the first week of birth can be a symptom of various neonatal respiratory conditions, such as **transient tachypnoea of the newborn (TTN)** or **respiratory distress syndrome (RDS)**, but it is not a defining feature of CLD. - CLD is characterized by a *prolonged* need for respiratory support, not just an acute symptom in the first week. *Presence of bilateral infiltrates on chest Xray for 2 weeks* - **Bilateral infiltrates** on a chest X-ray over two weeks could suggest conditions like **pneumonia** or **ARDS**, but it is not the diagnostic criterion for CLD. - The definition of CLD focuses on the physiological need for oxygen, rather than specific radiographic findings in isolation. *Reticulogranular pattern on chest Xray for 6 weeks* - A **reticulogranular pattern** on chest X-ray is characteristic of **respiratory distress syndrome (RDS)**, typically seen in premature infants due to surfactant deficiency. - While RDS can precede CLD, a **reticulogranular pattern** typically improves with treatment (surfactant therapy, ventilation) and does not persist for 6 weeks as a defining feature of chronic lung disease.

Q: Most common site for bone marrow aspiration in neonates is -

Anteromedial tibia. ***Anteromedial tibia*** - The **anteromedial tibia** is the preferred site in neonates due to its relatively **large marrow cavity**, superficial location, and reduced risk of vital organ injury. - This site is easily accessible and provides a good yield of marrow cells, making it suitable for diagnostic purposes in newborns. *Anterior superior iliac crest* - While a common site for bone marrow aspiration in older children and adults, the **anterior superior iliac crest** can be more challenging and poses a greater risk in neonates due to their smaller bone structures. - The iliac crest offers less bony prominence and a thinner cortex in neonates, increasing the difficulty of the procedure and potential for sampling error. *Posterior superior iliac crest* - The **posterior superior iliac crest** is another common site in older children and adults but is generally avoided in neonates due to the difficulty in positioning and the risk of damaging vital structures in the vicinity. - It requires prone positioning and offers less superficial bone, making it a less practical and safe choice for neonates compared to the tibia. *Sternum* - **Sternal aspiration** is generally contraindicated in neonates and young children due to the thinness of the sternal bone and proximity to vital structures like the heart and great vessels. - There is a high risk of **perforation** of the sternum and injury to underlying organs, making this site unsafe for bone marrow aspiration in this age group.

Q: The size threshold at which the risk of rupture of an abdominal aortic aneurysm significantly increases is:

5.5 cm. ***5.5 cm*** - An abdominal aortic aneurysm (AAA) 5.5 cm or larger is typically the threshold for considering **elective surgical repair** due to significantly increased **rupture risk**. - For aneurysms smaller than this, the risk of surgery often outweighs the risk of rupture, making watchful waiting with surveillance more appropriate. *6 cm* - While a 6 cm AAA certainly has a very high risk of rupture, the generally accepted guideline for intervention begins at **5.5 cm** for most patients. - Delaying intervention until 6 cm could unnecessarily expose the patient to a higher risk of rupture. *6.5 cm* - An AAA of 6.5 cm carries an extremely high risk of rupture, and intervention would be strongly indicated. - This size is well past the standard **5.5 cm threshold** recommended for elective repair. *7 cm* - A 7 cm AAA is associated with a **critical and very high risk of rupture**, making immediate intervention imperative. - This size is significantly beyond the established guideline for considering elective repair, which is 5.5 cm.

Q: A 60-year-old male presented with jaundice, pale stools, dark urine, and a mass in the epigastric region. Which of the following diagnoses is least likely to be the cause of these symptoms?

Chronic Cholecystitis. ***Chronic Cholecystitis*** - While chronic cholecystitis can cause epigastric pain, it rarely presents with **jaundice**, **pale stools**, and **dark urine** because it typically does not obstruct the common bile duct. - The presence of a palpable **epigastric mass** is also not a common feature of chronic cholecystitis. *Biliary Cancer* - **Biliary cancer**, particularly choledochal cancer, can cause **obstructive jaundice**, leading to **pale stools** (lack of bilirubin) and **dark urine** (conjugated bilirubin in urine). - A mass in the **epigastric region** could represent an enlarged gallbladder due to distal obstruction (Courvoisier's sign) or the tumor itself. *Periampullary Cancer* - **Periampullary cancers**, which arise near the ampulla of Vater, characteristically cause **obstructive jaundice**, presenting with **pale stools** and **dark urine**. - A mass in the **epigastric region** might be the tumor or a dilated gallbladder due to bile duct obstruction. *Pancreatic cancer* - **Pancreatic head cancer** frequently obstructs the common bile duct, resulting in **jaundice**, **pale stools**, and **dark urine**. - An **epigastric mass** can be the palpable tumor itself or an enlarged, distended gallbladder.

Question 1

In which condition is Chvostek's sign typically observed?

Accepted Answer

Hypoparathyroidism

Answer

Hypercalcemia

Answer

Insulinoma

Answer

Diabetes mellitus

Question 2

What is the appropriate fluid management in the case of an intracerebral hemorrhage?

Accepted Answer

Normal saline

Answer

Colloids

Answer

Blood transfusion

Answer

Hypertonic fluids

Question 3

Which of the following conditions is least likely to cause multiple painful ulcers on the tongue?

Accepted Answer

Sarcoidosis

Answer

TB

Answer

Herpes

Answer

Behcet disease

Question 4

A patient presents with difficulty with swallowing liquids but not solids. The best investigation to make a diagnosis is

Accepted Answer

Manometry

Answer

Endoscopy

Answer

Endoscopic ultrasound

Answer

PET CT

Question 5

Tinel's sign is seen in which of the following conditions?

Accepted Answer

Carpal tunnel syndrome

Answer

Avascular necrosis of scaphoid

Answer

Kienbock's Disease

Answer

1st carpometacarpal joint arthritis

Question 6

The A1 pulley involved in trigger finger is located at the level of which joint?

Accepted Answer

Metacarpophalangeal joint

Answer

Proximal Interphalngeal joint

Answer

Carpometacarpal joint

Answer

Distal Interphalangeal joint

Question 7

Chronic lung disease in infancy is defined as

Accepted Answer

Need for supplemental oxygen at 36 weeks postmenstrual age

Answer

Tachypnoea > 50 breaths/ min within 1 week of birth

Answer

Presence of bilateral infiltrates on chest Xray for 2 weeks

Answer

Reticulogranular pattern on chest Xray for 6 weeks

Question 8

Most common site for bone marrow aspiration in neonates is -

Accepted Answer

Anteromedial tibia

Answer

Anterior superior iliac crest

Answer

Posterior superior iliac crest

Answer

Sternum

Question 9

The size threshold at which the risk of rupture of an abdominal aortic aneurysm significantly increases is:

Accepted Answer

5.5 cm

Answer

6 cm

Answer

6.5 cm

Answer

7 cm

Question 10

A 60-year-old male presented with jaundice, pale stools, dark urine, and a mass in the epigastric region. Which of the following diagnoses is least likely to be the cause of these symptoms?

Accepted Answer

Chronic Cholecystitis

Answer

Biliary Cancer

Answer

Periampullary Cancer

Answer

Pancreatic Cancer

NEET-PG 2015

Internal Medicine

Orthopaedics

Pediatrics

Surgery