NEET-PG 2017 Practice Questions

Q: The patient with the following hematological abnormality presents with severe chest pain and difficulty in breathing. All are useful for managing this emergency except:

Packed RBC. ***Packed RBC*** - Transfusing **packed red blood cells** will increase the overall hemoglobin concentration, which can paradoxically increase blood viscosity and worsen vaso-occlusion in sickle cell crisis, especially in the setting of acute chest syndrome where fluid overload is a concern. - This is generally avoided as a first-line treatment for acute chest syndrome in sickle cell anemia unless the patient has severe anemia with a hemoglobin level significantly below their baseline. *Partial exchange transfusion* - **Partial exchange transfusion** is a critical intervention during sickle cell crises with severe complications like acute chest syndrome. - It rapidly reduces the percentage of **sickle hemoglobin (HbS)** and concurrently provides normal red blood cells, improving oxygen-carrying capacity and reducing blood viscosity without significantly increasing total red blood cell mass. *Morphine* - **Morphine** is essential for effective pain management in sickle cell crisis, including the severe chest pain associated with acute chest syndrome. - Adequate pain control helps reduce patient distress and can indirectly prevent worsening of the crisis by reducing stress-induced sympathetic activation. *Hydroxyurea* - **Hydroxyurea** is a long-term disease-modifying therapy for sickle cell anemia, increasing the production of **fetal hemoglobin (HbF)**, which reduces sickling. - While crucial for preventing future crises and complications, it is not an acute treatment for an emergency like acute chest syndrome, as its effects take weeks to months to manifest.

Q: A 60-year-old hypertension patient presents with breathlessness. ECG was performed. What is the diagnosis? (Recent NEET Pattern 2016-17)

Left ventricular hypertrophy. ***Left ventricular hypertrophy*** - The ECG shows significantly **increased QRS voltage in leads V1-V6**, particularly prominent R waves in V5/V6 and deep S waves in V1/V2, indicating left ventricular hypertrophy as per criteria like **Sokolow-Lyon index** (S in V1 + R in V5/V6 > 35mm). - The presence of **T-wave inversion and ST depression** (strain pattern) in lateral leads (V5, V6), especially in a patient with **hypertension**, further supports the diagnosis of left ventricular hypertrophy. *LBBB* - **LBBB** (Left Bundle Branch Block) is characterized by a **wide QRS complex** (>120 ms) with a **notched or slurred R wave** in lateral leads (I, aVL, V5, V6) and a deep S wave in V1, none of which are definitively seen here. - The QRS duration is not significantly widened, and the morphology is not typical for LBBB. *Normal tracing* - This ECG is not normal due to the **grossly elevated QRS voltages** in precordial leads and the presence of **ST-T wave abnormalities** (strain pattern). - A normal ECG would not exhibit such pronounced voltage criteria for chamber enlargement. *Complete heart block* - Complete heart block is characterized by **dissociation between atrial (P waves) and ventricular (QRS complexes) activity**, where P waves and QRS complexes occur independently. - This ECG shows a regular rhythm with P waves followed by QRS complexes, indicating normal AV conduction and **absence of AV dissociation**. *Right ventricular hypertrophy* - **Right ventricular hypertrophy** (RVH) is characterized by **tall R waves in V1-V2** with **right axis deviation** and **deep S waves in V5-V6**. - This ECG shows the opposite pattern (tall R waves in V5-V6 and deep S waves in V1-V2), which is consistent with **left ventricular** rather than right ventricular hypertrophy.

Q: A 50-year-old smoker comes with complaints of ankle edema for last 3 months. The ECG shows all except: (Recent NEET Pattern 2016-17)

Right bundle branch block. ***Right bundle branch block*** - This ECG does **NOT** show features of right bundle branch block, which would require a **wide QRS (≥120 ms)** with an **RSR' (M-shaped) pattern in V1-V3** and wide, slurred S waves in lateral leads (I, V5-V6). - In cor pulmonale, the QRS is typically **narrow** without the RBBB morphology, making RBBB the finding that is **absent** — the correct "EXCEPT" answer. *P pulmonale* - The P waves in leads II, III, and aVF are **tall and peaked** (amplitude ≥2.5 mm in lead II), characteristic of **P pulmonale**, indicating right atrial enlargement/increased right atrial pressure. - This is consistent with **cor pulmonale** from chronic obstructive pulmonary disease (COPD) in a long-term smoker presenting with ankle edema. *Right axis deviation* - The QRS complex is **predominantly negative in lead I** and **positive in aVF**, indicating a **right axis deviation** (axis > +90°). - This reflects **right ventricular hypertrophy or strain**, classic in cor pulmonale due to COPD-induced pulmonary hypertension. *Left axis deviation* - The ECG shows **right axis deviation**, not left axis deviation. - Left axis deviation (axis −30° to −90°) would show a **predominantly positive QRS in lead I and negative in aVF** — the opposite of what is seen here. - Left axis deviation is therefore **NOT present** on this ECG; it is a distracter option. *T wave inversion in II, III, V1-V2* - The ECG shows **T wave inversions** in leads II, III, and V1-V2. - These inversions over the inferior and right precordial leads reflect **right ventricular strain/hypertrophy**, a well-recognised pattern in cor pulmonale.

Q: A 70-year-old man presents with painless cervical lymphadenopathy with progressive pallor and petechiae on ankles. Peripheral smear shows presence of:

CLL. ***CLL*** - The presentation of **painless cervical lymphadenopathy**, progressive **pallor** (due to anemia), and **petechiae** (due to thrombocytopenia) in an elderly patient is highly suggestive of **Chronic Lymphocytic Leukemia (CLL)** [2]. - Peripheral smear in CLL typically shows a proliferation of mature-appearing **small lymphocytes** and characteristic **smudge cells** [1]. *Acute ITP* - Acute ITP is characterized by sudden onset of **thrombocytopenia** and bleeding, often following a viral infection, and is more common in children. - It does not typically present with **lymphadenopathy** or progressive pallor as a primary feature. *Chronic ITP* - Chronic ITP is characterized by isolated **thrombocytopenia** and bleeding symptoms, usually without lymphadenopathy or significant anemia unless bleeding is severe. - The presence of **lymphadenopathy** points away from isolated ITP and towards a systemic hematological malignancy. *Richter syndrome* - Richter syndrome is the transformation of CLL into a more aggressive lymphoma, most commonly **diffuse large B-cell lymphoma (DLBCL)**. - While it can present with rapidly enlarging lymph nodes and systemic symptoms, the initial presentation described (painless lymphadenopathy, progressive pallor, petechiae) is more typical of **untreated CLL** before transformation [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, p. 602. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 612-613.

Q: Identify the cell.

Monocyte. ***Monocyte*** - Monocytes are characterized by their **large size** (12-20 µm), **kidney-shaped or horseshoe-shaped nucleus**, and **abundant, often grayish-blue cytoplasm** with fine azurophilic granules [1]. - They are precursors to **macrophages** and play a crucial role in phagocytosis and antigen presentation [1]. *Eosinophil* - Eosinophils have a **bilobed nucleus** and prominent **red-orange granules** in their cytoplasm, which stain with eosin [1]. - They are primarily involved in allergic reactions and defense against **parasitic infections** [1]. *Basophil* - Basophils are characterized by a **lobed nucleus** often obscured by large, coarse, **dark purple-blue granules** that contain histamine and heparin [1]. - They are the least common granulocyte and are involved in **allergic and inflammatory responses** [1]. *Lymphocyte* - Lymphocytes are typically **smaller** than monocytes, with a **large, round, or slightly indented nucleus** that occupies most of the cell [1]. - Their cytoplasm is usually **scanty and pale blue**, often appearing as a thin rim around the nucleus [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 578-580.

Q: Name the test given.

ESR measurement. ***ESR measurement*** - The image displays a **Westergren tube** with a column of blood, showing distinct layers of plasma on top and red blood cells settled below against a calibrated scale. - This setup is characteristic of an **Erythrocyte Sedimentation Rate (ESR)** test, which measures the rate at which red blood cells fall in a standardized tube over a specific time, indicating inflammation. *Osmotic fragility* - This test involves exposing red blood cells to varying concentrations of **hypotonic saline solutions** to assess their resistance to lysis. - The results are typically reported as a curve showing the percentage of hemolysis at different saline concentrations, not a simple sedimentation in a tube. *NESTROFT* - The **Naked Eye Single Tube Red Cell Osmotic Fragility Test (NESTROFT)** is a quick screening test for **beta-thalassemia trait**. - It involves mixing blood with a hypotonic saline solution and observing for complete hemolysis or partial hemolysis with a button of red cells, which is different from the image shown. *Sickling test* - A sickling test is used to detect the presence of **sickle hemoglobin**, which causes red blood cells to deform into a sickle shape under low oxygen conditions. - This test is usually performed by adding a reducing agent like **sodium metabisulfite** to a blood sample and observing cell morphology under a microscope or by turbidity, not by sedimentation in a calibrated tube. *Packed cell volume (PCV)* - PCV or **hematocrit** measures the proportion of blood volume occupied by red blood cells after centrifugation in a **microhematocrit tube**. - While it does involve blood in a tube, the tube is much smaller (capillary tube) and requires **centrifugation** to separate components, unlike ESR which relies on natural sedimentation under gravity in a larger calibrated Westergren tube.

Q: Name the anticoagulant used in the following method.

Trisodium citrate. ***Trisodium citrate*** - The image displays a method for measuring **Erythrocyte Sedimentation Rate (ESR)**, typically performed using the **Westergren method**. - In the Westergren method, **trisodium citrate** is the standard anticoagulant used to prevent blood coagulation, allowing red blood cells to settle over time. *EDTA* - **EDTA (ethylenediaminetetraacetic acid)** is a common anticoagulant, primarily used for **hematology tests** such as complete blood counts (CBC), as it preserves cell morphology. - While it prevents clotting, it is not the standard anticoagulant for the Westergren ESR method, as it can cause red blood cell shrinkage affecting sedimentation. *Heparin* - **Heparin** acts as an anticoagulant by enhancing the activity of **antithrombin III**, and is commonly used for chemistry and general coagulation studies. - It interferes with the sedimentation rate in ESR measurements, making it unsuitable for this specific test. *Dalteparin* - **Dalteparin** is a type of **low molecular weight heparin (LMWH)** used therapeutically as an anticoagulant to prevent and treat blood clots. - It is not used as an in-vitro anticoagulant for blood collection tubes or lab diagnostic tests like ESR. *Sodium fluoride* - **Sodium fluoride** is an anticoagulant and enzymatic inhibitor primarily used for **glucose measurement**, as it inhibits glycolysis and preserves glucose levels. - It is not appropriate for ESR testing, as it does not provide the optimal conditions for red blood cell sedimentation measurement.

Q: A 32-year-old male with a history of klebsiella infection presents with right upper quadrant pain and on performing cholecystectomy the following stones were seen. All the following statements are true regarding this condition except: (Recent NEET Pattern 2016-17)

It is composed of calcium palmitate. ***It is composed of calcium palmitate*** - The gallstones formed in the context of **Klebsiella infection** and **beta-glucuronidase** activity are typically **pigment stones**, specifically **brown pigment stones** [1]. - Brown pigment stones are primarily composed of **calcium bilirubinate** and not calcium palmitate . *This condition is a resultant of secretion of beta glucuronidase* - **Bacterial infection**, particularly with *Klebsiella*, can lead to the production of **beta-glucuronidase** [1]. - This enzyme deconjugates **bilirubin glucuronide** in bile, making it insoluble and promoting the formation of **calcium bilirubinate stones** [1]. *Initiating factor could be ascaris worm* - **Parasitic infections**, such as those by **Ascaris lumbricoides**, can act as a nidus for stone formation in the biliary tree. - The presence of the worm or its eggs can lead to **biliary stasis** and recurrent infections, contributing to pigment stone formation. *This is radiolucent in nature* - **Pigment gallstones**, including brown pigment stones, are generally **radiolucent** on plain X-rays. - This is because they contain little to no calcium carbonate, which is required for radiopacity. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, pp. 882-883. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, p. 882.

Q: A 3-year-old child presents with the clinical features shown in the image. What is the most likely diagnosis?

Kawasaki disease. ***Kawasaki disease*** * The image displays classic signs of **Kawasaki disease**, including **bilateral conjunctivitis without exudates** (top left), **erythema of the palms and soles with desquamation** (top right), **cervical lymphadenopathy** (bottom left, indicated by swelling in the neck region), and a **strawberry tongue** (bottom right). * These clinical features, especially in a young child, are diagnostic for **Kawasaki disease**, which is a vasculitis affecting medium-sized arteries, most notably the coronary arteries. *Scarlet fever* * While **scarlet fever** can cause a **strawberry tongue** and a rash, the rash is typically a **fine, sandpaper-like rash** that blanches with pressure, not usually characterized by the distinct palm/sole erythema and desquamation seen in the image. * **Conjunctivitis** is not a prominent feature of scarlet fever, and the lymphadenopathy is typically less pronounced and may be tender. *Kikuchi disease* * **Kikuchi disease** (histiocytic necrotizing lymphadenitis) primarily presents with **cervical lymphadenopathy, fever**, and often rash, but it does **not typically involve conjunctivitis or changes in the hands, feet, or tongue** as dramatically depicted. * It is a self-limiting condition of unknown etiology, distinct from the systemic vasculitis of Kawasaki disease. *Rosai-Dorfman disease* * **Rosai-Dorfman disease** (sinus histiocytosis with massive lymphadenopathy) is characterized by **massive, painless lymphadenopathy**, particularly cervical, with fever and other systemic symptoms. * However, it does **not present with the specific mucocutaneous findings** of conjunctivitis, strawberry tongue, or characteristic hand/foot changes seen in the images indicative of Kawasaki disease.

Question 1

The patient with the following hematological abnormality presents with severe chest pain and difficulty in breathing. All are useful for managing this emergency except:

Accepted Answer

Packed RBC

Answer

Partial exchange transfusion

Answer

Morphine

Answer

Hydroxyurea

Question 2

A 60-year-old hypertension patient presents with breathlessness. ECG was performed. What is the diagnosis? (Recent NEET Pattern 2016-17)

Accepted Answer

Left ventricular hypertrophy

Answer

LBBB

Answer

Normal tracing

Answer

Complete heart block

Answer

Right ventricular hypertrophy

Question 3

A 50-year-old smoker comes with complaints of ankle edema for last 3 months. The ECG shows all except: (Recent NEET Pattern 2016-17)

Accepted Answer

Right bundle branch block

Answer

P pulmonale

Answer

Right axis deviation

Answer

T wave inversion in II,III, V1-V2

Answer

Left axis deviation

Question 4

A 70-year-old man presents with painless cervical lymphadenopathy with progressive pallor and petechiae on ankles. Peripheral smear shows presence of:

Accepted Answer

CLL

Answer

Acute ITP

Answer

Chronic ITP

Answer

Richter syndrome

Answer

Hairy cell leukemia

Question 5

The following bone marrow specimen is suggestive of diagnosis of:

Accepted Answer

Aplastic anemia

Answer

Pure red cell aplasia

Answer

Myelodysplasia

Answer

Normal marrow

Answer

Hairy cell leukemia

Question 6

Identify the cell.

Accepted Answer

Monocyte

Answer

Eosinophil

Answer

Basophil

Answer

Lymphocyte

Answer

Neutrophil

Question 7

Name the test given.

Accepted Answer

ESR measurement

Answer

Osmotic fragility

Answer

NESTROFT

Answer

Sickling test

Answer

Packed cell volume (PCV)

Question 8

Name the anticoagulant used in the following method.

Accepted Answer

Trisodium citrate

Answer

EDTA

Answer

Heparin

Answer

Dalteparin

Answer

Sodium fluoride

Question 9

A 32-year-old male with a history of klebsiella infection presents with right upper quadrant pain and on performing cholecystectomy the following stones were seen. All the following statements are true regarding this condition except: (Recent NEET Pattern 2016-17)

Accepted Answer

It is composed of calcium palmitate

Answer

This condition is a resultant of secretion of beta glucuronidase

Answer

Initiating factor could be ascaris worm

Answer

This is radiolucent in nature

Question 10

A 3-year-old child presents with the clinical features shown in the image. What is the most likely diagnosis?

Accepted Answer

Kawasaki disease

Answer

Scarlet fever

Answer

Kikuchi disease

Answer

Rosai-Dorfman disease

NEET-PG 2017

General Medicine

Internal Medicine

Pathology

Pediatrics