NEET-PG 2017 Practice Questions

Q: A 40-year-old woman with history of progressive shortness of breath has lesions on her legs as shown. HbA1C of the patient is 5.8%. Lipid profile shows serum cholesterol 175 mg%. What is the diagnosis? (Recent NEET Pattem 2016-17)

Erythema nodosum. ***Erythema Nodosum*** - The image shows **tender, red nodules** primarily on the shins, consistent with the characteristic presentation of erythema nodosum. - While exact values for **HbA1c** and **cholesterol** don't directly diagnose this, erythema nodosum is often associated with systemic conditions, and the patient's progressive shortness of breath prompts further investigation into potential underlying causes. *Necrobiosis lipoidica diabeticorum* - This condition presents as **well-demarcated, yellow-brown patches** with a waxy or atrophic center, often with telangiectasias, not the acute tender nodules seen here. - Although it is associated with **diabetes**, the patient's HbA1c (5.8%) is within the prediabetic range, not typically indicative of established diabetes that commonly precedes significant necrobiosis lipoidica. *Xanthoma* - Xanthomas are **yellowish plaques or nodules** caused by lipid deposits in the skin, which can vary in appearance depending on the type (e.g., eruptive, tendinous, planar). - While hyperlipidemia can cause xanthomas, the patient's **normal cholesterol level** (175 mg%) makes this diagnosis less likely, and the lesions in the image are more erythematous and nodular than typical xanthomas. *Carotenemia* - **Carotenemia** is characterized by a harmless **yellow-orange discoloration of the skin**, particularly on the palms and soles, caused by excessive intake of carotene-rich foods. - This condition does not present with discrete, erythematous nodules as depicted in the image.

Q: The EEG of the patient shows which of the following? (Recent NEET Pattern 2016-17)

Burst suppression pattern. ***Burst suppression pattern*** - The EEG shows periods of high amplitude, mixed-frequency **bursts of activity** alternating with periods of **relative electrical silence** (suppression). - This pattern is often seen in conditions like severe **hypoxic-ischemic encephalopathy**, deep **anesthesia**, or severe brain injury. *Rademecker complex* - This refers to periodic trifasic complexes, often associated with subacute sclerosing panencephalitis (SSPE), which is a **slow viral infection** of the brain. - The complexes are typically **bilateral, synchronous, and repetitive**, not characterized by alternating bursts and suppression. *3/sec spike and slow wave pattern* - This pattern is characteristic of **absence seizures (petit mal epilepsy)**, where there are generalized, synchronous 3 Hz spike-and-wave discharges. - The image does not show continuous, rhythmic 3 Hz activity but rather alternating periods of activity and flat-lining. *4-6 Hz Polyspike* - Polyspikes are a series of two or more spikes or sharp waves clustered together, often associated with **myoclonic seizures** or other generalized epilepsies. - While there are some sharp waves in the burst phases, the overall pattern is dominated by the distinct periods of suppression, not continuous polyspike activity.

Q: The EEG of a 16-year-old boy with early morning involuntary movements of hands in his sleep noticed by parents, was performed. Immunization is complete. What does EEG show? (Recent NEET Pattern 2016-17)

Juvenile myoclonic epilepsy. ***Juvenile myoclonic epilepsy*** - The EEG shows generalized **polyspike-and-slow-wave discharges**, which are characteristic of juvenile myoclonic epilepsy (JME), especially when associated with early morning myoclonus. - The clinical presentation of a **16-year-old boy** with **involuntary movements of hands in his sleep** (suggesting myoclonic jerks), particularly in the morning, is highly consistent with JME. *SSPE* - Subacute sclerosing panencephalitis (SSPE) typically presents with characteristic EEG patterns like **Radermacker complexes** or **periodic complexes**, which are not seen here. - Clinical features of SSPE include progressive cognitive decline, myoclonus, and other neurological deficits, usually following a measles infection, which are not described. *Benign rolandic epilepsy* - Benign rolandic epilepsy (BRE) is characterized by **centrotemporal spikes** on EEG, often exacerbated by sleep, and presents with focal seizures affecting the face and mouth. - The generalized polyspike-and-slow-wave pattern and the clinical description of hand myoclonus do not fit the profile of BRE. *Huntington chorea* - Huntington's chorea is a **neurodegenerative genetic disorder** characterized by involuntary movements (chorea), cognitive decline, and psychiatric problems. - EEG findings in Huntington's chorea are often non-specific or show generalized slowing, and it is not an epilepsy syndrome with specific high-amplitude epileptiform discharges like those seen.

Q: Which of the following is correct about the image shown? (Recent NEET Pattern 2016-17)

A = Kayser Fleischer ring, B = Arcus senilis. ***A = Kayser Fleischer ring, B = Arcus senilis*** - Image A displays a **Kayser-Fleischer ring**, a greenish-brown ring in the periphery of the cornea, characteristic of **Wilson's disease** due to copper deposition. - Image B shows **arcus senilis**, a milky-white or grayish ring around the cornea, which is a **common age-related change** due to lipid deposits, and can appear at any age. *A = Arcus senilis, B = Kayser-Fleischer ring* - This option incorrectly identifies the lesions; the ring in image A is associated with copper deposition, not lipid deposition. - The ring in image B is clearly a common lipid ring often seen in older individuals, contrasting with the distinct appearance of a Kayser-Fleischer ring. *A = Arcus senilis, B = Hudson-Stahli line* - Image A does not show arcus senilis; its color and location are consistent with copper deposition. - Image B does not depict a Hudson-Stahli line, which is a thin, brownish-linear deposit of iron in the corneal epithelium, typically horizontal and not circumferential. *A = Hudson-Stahli line, B = Arcus senilis* - Image A's appearance, as a circumferential greenish-brown deposit, is not consistent with a linear Hudson-Stahli line. - While image B correctly identifies arcus senilis, the identification of A as a Hudson-Stahli line is incorrect.

Q: Comment on the diagnosis of this child, presenting with eye swelling. (Recent NEET Pattern 2016-17)

Neuroblastoma. ***Neuroblastoma*** - The image shows **periorbital ecchymosis** and **proptosis** in a child, which are classic signs of orbital metastatic neuroblastoma, often referred to as "raccoon eyes." - The abdominal scar suggests a prior surgery, possibly for removal of the primary tumor, which is typically found in the **adrenal gland** or **sympathetic ganglia**. *Chloroma* - **Chloromas** (also known as granulocytic sarcomas) are extramedullary manifestations of myeloid leukemia, presenting as solid tumors composed of myeloid blast cells. - While they can appear in the orbit and mimic proptosis, the presence of bilateral periorbital ecchymosis ("raccoon eyes") is more characteristic of neuroblastoma metastasis. *Wilms tumor* - **Wilms tumor** is a kidney cancer, typically presenting as an **abdominal mass** and occasionally with hypertension or hematuria. - Ocular manifestations, such as proptosis, are extremely **rare** and do not typically involve periorbital ecchymosis. *Ameloblastoma* - An **ameloblastoma** is a benign but locally aggressive tumor of odontogenic (tooth-forming) origin, primarily affecting the **jawbones**. - It does not metastasize to the orbit and would not present with periorbital swelling or ecchymosis.

Q: Neonate born at 34 weeks with premature rupture of membranes develops respiratory distress. CXR was performed. All are considered in differential diagnosis except:

Tetralogy of Fallot. ***Tetralogy of Fallot*** - **Tetralogy of Fallot** is a **cyanotic congenital heart defect** characterized by VSD, pulmonary stenosis, right ventricular hypertrophy, and overriding aorta. - It presents primarily with **cyanosis** (not respiratory distress) and would show **normal or oligemic lung fields** on CXR, not the diffuse parenchymal lung disease patterns seen in RDS, pneumonia, or alveolar proteinosis. - **Not part of the differential diagnosis** for a preterm neonate with PROM presenting with respiratory distress and lung infiltrates on imaging. *Congenital pneumonia* - This is a significant concern in a neonate born prematurely with **premature rupture of membranes (PROM)**, as ascending infection is a known risk factor. - Chest X-ray findings can include **diffuse hazy infiltrates** or **patchy consolidation**, consistent with infections. - Would be considered in the differential diagnosis. *Hyaline membrane disease* - Also known as **respiratory distress syndrome (RDS)**, this is common in **premature infants at 34 weeks** due to **surfactant deficiency**. - The chest X-ray typically shows **diffuse reticulogranular ground-glass opacities** and **air bronchograms**. - Most common cause of respiratory distress in preterm neonates and a key differential. *Congenital alveolar proteinosis* - This is a rare genetic disorder where **surfactant proteins accumulate in the alveoli**, leading to impaired gas exchange and respiratory distress. - Chest X-ray findings often include **diffuse alveolar infiltrates** or consolidation, which can resemble other neonatal lung diseases. - Though rare, must be considered in the differential for neonatal respiratory distress.

Q: Preterm child on cow milk due to death of mother is having blood in stools. X-ray abdomen was done. Diagnosis is:

Rigler sign. ***Rigler sign*** - Rigler sign (also called **double wall sign**) refers to **visualization of both sides of the bowel wall** on X-ray due to **free intraperitoneal air (pneumoperitoneum)**, indicating bowel perforation. - In the clinical context of a **preterm infant on cow milk with bloody stools**, this presentation is highly suggestive of **Necrotizing Enterocolitis (NEC) with perforation**. - The X-ray shows Rigler sign as evidence of pneumoperitoneum, a serious complication of NEC requiring urgent surgical intervention. - **Key NEC radiological findings** include: pneumatosis intestinalis (intramural gas), portal venous gas, and pneumoperitoneum (Rigler sign) in cases with perforation. *Double bubble appearance* - This sign shows **two distinct air-filled structures** (distended stomach and duodenum) on abdominal X-ray, indicating **duodenal obstruction** from duodenal atresia or annular pancreas. - Not associated with bloody stools or NEC in preterm infants. *Claw sign* - The claw sign is seen in **intussusception**, where the bowel telescopes into itself, creating a soft tissue mass with a crescent-shaped gas pattern. - Typically occurs in older infants (6-18 months), not preterm neonates, and presents differently from NEC. *Bird of prey sign* - This sign is associated with **sigmoid or cecal volvulus**, showing a distended bowel loop with a beak-like configuration. - Represents large bowel obstruction, not the typical presentation of a preterm infant with feeding intolerance and bloody stools from NEC.

Q: Which of the following is the best diagnosis of this neonate who is excessively hungry, warm with flushed skin?

Neonatal thyrotoxicosis. ***Neonatal thyrotoxicosis*** - The image shows a neonate with **exophthalmos** and signs of being **hypermetabolic** (excessively hungry, warm, flushed skin), all consistent with hyperthyroidism. - This condition occurs when **maternal thyroid-stimulating immunoglobulins** cross the placenta, causing transient hyperthyroidism in the newborn. *Neonatal lupus* - Neonatal lupus is primarily characterized by **congenital heart block** and **dermatological manifestations** (e.g., erythematous annular lesions) but does not typically present with severe metabolic hyperactivity or exophthalmos as seen here. - It is caused by the transplacental passage of maternal autoantibodies (anti-Ro/SSA and anti-La/SSB). *Congenital hypothyroidism* - Congenital hypothyroidism would present with symptoms opposite to those described, such as **lethargy**, **poor feeding**, **cold and mottled skin**, and **constipation**. - Physical features often include a **puffy face**, **macroglossia**, and an **umbilical hernia**. *Progeria* - Progeria is a rare genetic disorder characterized by **accelerated aging** that typically manifests later in infancy or early childhood with features like **alopecia**, **thin skin**, and **skeletal abnormalities**, which are not depicted or described as primary symptoms here. - It does not cause the acute signs of hypermetabolism seen in neonatal thyrotoxicosis.

Q: CT abdomen shows: (Recent NEET Pattern 2016-17)

Diverticulosis. ***Diverticulosis*** - The image shows an out-pouching of the colonic wall (indicated by the white arrow), characteristic of a **diverticulum**. - **Diverticulosis** refers to the presence of multiple such diverticula, often seen in the colon on CT scans. *Hiatus hernia* - A hiatus hernia involves the protrusion of the **stomach** through the **esophageal hiatus** of the diaphragm into the chest cavity. - This image does not show any gastric organ extending above the diaphragm. *Gallstones* - Gallstones are calcified deposits found within the **gallbladder**, appearing as bright, high-density structures. - The structure indicated by the arrow is clearly an out-pouching of the bowel wall, not a calcified stone within the gallbladder. *Acute pancreatitis* - Acute pancreatitis is characterized by **inflammation of the pancreas**, often visible as pancreatic enlargement, peripancreatic fat stranding, and fluid collections. - The image does not show any signs suggestive of pancreatic inflammation or changes in the pancreas itself.

Q: X-ray skull shows: (Recent NEET Pattern 2016-17)

Silver-beaten appearance. ***Silver-beaten appearance*** - The image shows a skull with multiple **gyral impressions** on the inner table, giving it a **bumpy**, 'silver-beaten' or 'copper-beaten' appearance. - This pattern is classically associated with **chronically increased intracranial pressure**, which causes the brain's convolutions to press against the skull. *Multiple myeloma* - Multiple myeloma typically presents with multiple, sharply demarcated **"punched-out" lytic lesions** in the skull, not diffuse gyral impressions. - These lesions often lack a sclerotic rim and are more discrete than the pattern seen here. *Histiocytosis-X* - Histiocytosis-X (now called Langerhans cell histiocytosis) can cause lytic skull lesions, often described as **"beveled edge"** or geographically distributed lesions. - While it can cause osteolytic bone destruction, it does not typically produce the widespread, uniform gyral impressions of a silver-beaten skull. *Letterer-Siwe disease* - Letterer-Siwe disease is an aggressive, disseminated form of **Langerhans cell histiocytosis** affecting infants. - While it can cause bone lesions, including in the skull, it typically manifests as generalized lytic lesions rather than the "silver-beaten" pattern indicative of chronic elevated intracranial pressure.

Question 1

A 40-year-old woman with history of progressive shortness of breath has lesions on her legs as shown. HbA1C of the patient is 5.8%. Lipid profile shows serum cholesterol 175 mg%. What is the diagnosis? (Recent NEET Pattem 2016-17)

Accepted Answer

Erythema nodosum

Answer

Necrobiosis lipidoica diabeticorum

Answer

Xanthoma

Answer

Carotenemia

Question 2

The EEG of the patient shows which of the following? (Recent NEET Pattern 2016-17)

Accepted Answer

Burst suppression pattern

Answer

Rademecker complex

Answer

3/sec spike and slow wave pattern

Answer

4-6 Hz Polyspike

Question 3

The EEG of a 16-year-old boy with early morning involuntary movements of hands in his sleep noticed by parents, was performed. Immunization is complete. What does EEG show? (Recent NEET Pattern 2016-17)

Accepted Answer

Juvenile myoclonic epilepsy

Answer

SSPE

Answer

Benign rolandic epilepsy

Answer

Huntington chorea

Question 4

Which of the following is correct about the image shown? (Recent NEET Pattern 2016-17)

Accepted Answer

A = Kayser Fleischer ring, B = Arcus senilis

Answer

A = Arcus senilis, B = Kayser-Fleischer ring

Answer

A = Arcus senilis, B = Hudson-Stahli line

Answer

A = Hudson-Stahli line, B = Arcus senilis

Question 5

Comment on the diagnosis of this child, presenting with eye swelling. (Recent NEET Pattern 2016-17)

Accepted Answer

Neuroblastoma

Answer

Chloroma

Answer

Wilms tumor

Answer

Ameloblastoma

Question 6

Neonate born at 34 weeks with premature rupture of membranes develops respiratory distress. CXR was performed. All are considered in differential diagnosis except:

Accepted Answer

Tetralogy of Fallot

Answer

Congenital pneumonia

Answer

Hyaline membrane disease

Answer

Congenital alveolar proteinosis

Question 7

Preterm child on cow milk due to death of mother is having blood in stools. X-ray abdomen was done. Diagnosis is:

Accepted Answer

Rigler sign

Answer

Double bubble appearance

Answer

Claw sign

Answer

Bird of prey sign

Question 8

Which of the following is the best diagnosis of this neonate who is excessively hungry, warm with flushed skin?

Accepted Answer

Neonatal thyrotoxicosis

Answer

Neonatal lupus

Answer

Congenital hypothyroidism

Answer

Progeria

Question 9

CT abdomen shows: (Recent NEET Pattern 2016-17)

Accepted Answer

Diverticulosis

Answer

Hiatus hernia

Answer

Gallstones

Answer

Acute pancreatitis

Question 10

X-ray skull shows: (Recent NEET Pattern 2016-17)

Accepted Answer

Silver-beaten appearance

Answer

Multiple myeloma

Answer

Histiocytosis-X

Answer

Letterer-Siwe disease

NEET-PG 2017

Internal Medicine

Pediatrics

Radiology