NEET-PG 2017 Practice Questions

Q: A 45-year-old Ulcerative colitis patient presents with multiple painful lesions on both legs. What is the diagnosis?

Pyoderma gangrenosum. ***Pyoderma gangrenosum*** - This patient has **ulcerative colitis**, which is strongly associated with **pyoderma gangrenosum**, a neutrophilic dermatosis affecting 5-12% of IBD patients. - Presents as **painful, rapidly expanding ulcers** with characteristic **violaceous, undermined borders** and **cribriform scarring**. *Necrotizing fasciitis* - This is a rapidly progressive, **life-threatening deep soft tissue infection** with severe systemic toxicity and **crepitus**. - The chronic nature of the lesions and lack of acute systemic illness makes this unlikely. *Granulomatosis with polyangiitis* - This **systemic vasculitis** primarily affects the **respiratory tract and kidneys**, with skin lesions being secondary manifestations. - Skin involvement typically presents as **palpable purpura** or **necrotizing nodules**, not the characteristic ulcerative pattern seen here. *Febrile neutrophilic dermatosis* - Also known as **Sweet syndrome**, characterized by **fever**, **neutrophilia**, and **dense neutrophilic infiltrates** in the skin. - While it can be associated with IBD, it typically presents as **erythematous plaques or nodules**, not painful ulcerative lesions with undermined borders.

Q: All are causes of following tongue appearance except: (Recent NEET Pattem 2016-17)

HIV. ***HIV*** - The image shows a **fissured tongue**, which is characterized by **grooves and furrows** on the dorsal surface of the tongue. - While other conditions can cause a fissured tongue, **HIV** itself is *not* considered a direct cause of this specific tongue morphology. Oral manifestations of HIV typically include **candidiasis**, **hairy leukoplakia**, or Kaposi's sarcoma. *Melkersson-Rosenthal syndrome* - This syndrome is characterized by a triad of **relapsing facial paralysis**, **persistent orofacial swelling**, and a **fissured tongue**. - Therefore, a fissured tongue is a recognized clinical feature of Melkersson-Rosenthal syndrome. *Down syndrome* - Individuals with Down syndrome (Trisomy 21) frequently present with various oral manifestations, including a **fissured tongue** (also known as scrotal tongue or plicated tongue). - This is a common and characteristic finding in this genetic condition. *Genetic basis* - A **fissured tongue** can have a **genetic predisposition** and may occur as an isolated familial trait. - It can be inherited as an **autosomal dominant trait** and is often seen without any associated syndromic conditions.

Q: A 35-year-old woman presents with breathlessness at rest. She also complains of a skin lesion on nose which has increased in size for last 6 months. What is the diagnosis?

Sarcoidosis. ***Sarcoidosis*** - Sarcoidosis is a multisystem **granulomatous disease** that commonly involves the lungs (causing **breathlessness**) and skin (manifesting as **lesions on the nose**, such as lupus pernio). The chest X-ray likely shows lung involvement like **bilateral hilar lymphadenopathy** or interstitial infiltrates. - The combination of **pulmonary symptoms** and characteristic **skin lesions** in a young to middle-aged adult is highly suggestive of sarcoidosis. *Phakomatosis* - Phakomatoses are a group of syndromes characterized by tumors or malformations of the skin, nervous system, and sometimes other organs. - While they can have skin lesions (e.g., neurofibromas, angiomas) and sometimes central nervous system or visceral involvement, **breathlessness is not a primary or typical presenting symptom**, and their CXR findings are usually normal unless there is specific lung involvement not characteristic of sarcoidosis. *Pulmonary lymphangiomatosis* - Pulmonary lymphangiomatosis is a rare, benign disease involving the proliferation of **lymphatic vessels** within the lung parenchyma, mediastinum, and pleura. - While it can cause breathlessness, **skin lesions on the nose are not a feature** of this condition, making it an unlikely diagnosis in this clinical context. *DRESS syndrome* - **DRESS (Drug Rash with Eosinophilia and Systemic Symptoms) syndrome** is a severe adverse drug reaction characterized by a widespread skin rash, fever, eosinophilia, and internal organ involvement (e.g., liver, kidneys). - While it presents with a skin lesion and systemic symptoms, the **onset is usually acute** following drug exposure, and the skin lesion on the nose described as increasing in size over 6 months is not typical for DRESS. Additionally, the pulmonary involvement differs from granulomatous disease.

Q: A patient of swine flu has developed severe respiratory distress. Which of the following findings confirm the diagnosis of ARDS in this patient?

PaO₂/FiO₂ ratio < 300 and PCWP 18 mm Hg - A PaO₂/FiO₂ ratio less than 200 mmHg would indicate severe ARDS, but the elevated PCWP > 18 mm Hg suggests that the primary issue is cardiogenic pulmonary edema, not ARDS. - In ARDS, the problem is non-cardiogenic pulmonary edema secondary to capillary leakage in the lungs, thus a low PCWP is a diagnostic criterion [1]. PaO₂/FiO₂ ratio 18 mm Hg - A PaO₂/FiO₂ ratio less than 400 mmHg is not a specific criterion for ARDS; the cutoff is 300 mmHg. - An elevated PCWP > 18 mm Hg indicates fluid overload due to cardiac dysfunction, which points away from ARDS. PaO₂/FiO₂ ratio < 100 and PCWP < 18 mm Hg - While a PaO₂/FiO₂ ratio less than 100 mmHg indicates profound hypoxemia consistent with severe ARDS, the diagnosis of ARDS is made at a ratio of < 300 mmHg. - This option describes a very severe form of ARDS but the key diagnostic cutoff for ARDS is < 300 mmHg, not specifically less than 100 mmHg for the confirmation of ARDS per the Berlin definition.

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: 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: Which is correct about the intracranial bleeding shown below?

Chronic subdural hematoma, hypodensity. ***Chronic subdural hematoma, hypodensity*** - The image displays a crescent-shaped collection of fluid with **hypodense characteristics** (darker than brain parenchyma) that crosses suture lines, which is typical for a subdural hematoma. - The **hypodensity indicates older, chronic blood** where the hemoglobin has degraded, differentiating it from acute (hyperdense) or subacute (isodense) collections. *Acute subdural hematoma, hypodensity* - An **acute subdural hematoma** would typically appear **hyperdense** (bright) on CT due to fresh blood. - The observed collection is clearly hypodense, ruling out an acute presentation. *Chronic epidural hematoma, hyperdensity* - An **epidural hematoma** is typically **lenticular (lens-shaped)** and does not cross suture lines, unlike the crescent shape seen here. - While chronic blood *can* be hypodense, an epidural hematoma by definition is outside the dura mater and would not present with this morphology. *Acute epidural hematoma, hyperdensity* - An **acute epidural hematoma** is characterized by a **lenticular (lens-shaped) hyperdense** collection of blood, which is distinctly different from the crescent-shaped, hypodense collection in the image. - Epidural hematomas occur between the dura mater and the skull, typically from arterial injury, and are bound by sutures.

Q: The CXR shows markings near the costophrenic angle. Which of the following is the cause of these markings? (Recent NEET Pattern 2016-17)

Lymphangitis carcinomatosis. ***Lymphangitis carcinomatosis*** - The image shows **reticulonodular interstitial markings** with preserved lung volumes, particularly prominent near the costophrenic angle, which are classic for **lymphangitis carcinomatosis**. - This condition is caused by the infiltration of **malignant cells into the lymphatic channels** of the lung, leading to thickening of the interlobular septa and a characteristic radiographic appearance. *Pulmonary alveolar proteinosis* - This condition typically presents with diffuse ground-glass opacities and consolidation, often described as a **"crazy-paving" pattern** on CT, which is not seen here. - It involves the accumulation of lipoproteinaceous material within the **alveoli**, rather than lymphatic infiltration. *Lung abscess* - A lung abscess would appear as a **cavitated lesion** with an air-fluid level, indicating necrosis and fluid accumulation, which is distinctly different from the interstitial markings in the image. - It is typically caused by **bacterial infection** and is a focal process, not diffuse interstitial infiltration. *Pneumatocele* - A pneumatocele is a **thin-walled, air-filled cyst** commonly seen after pneumonia in children or trauma, appearing as a clear, defined space on imaging. - It does not present with the diffuse reticulonodular pattern or interstitial thickening characteristic of the image.

Q: The CT chest of a patient given below shows presence of: (Recent NEET Pattern 2016-17)

Bronchiectasis. ***Bronchiectasis*** - The CT image shows a cluster of **dilated, thick-walled bronchi** in the left lung, which are characteristic findings of bronchiectasis, especially when they are larger than adjacent pulmonary arteries. - The arrow specifically points to these abnormal, saccular dilations of the bronchi, often described as a **"cluster of grapes"** or **cystic appearance**. *Pneumatoceles* - **Pneumatoceles** are typically thin-walled, air-filled cysts that develop as a complication of pneumonia or trauma, and are usually solitary or few in number, not a widespread cluster of dilated airways. - They also often resolve spontaneously, unlike the chronic, irreversible bronchial dilation seen in the image. *Normal scan* - A **normal CT chest scan** would show finely branching airways that progressively narrow as they extend peripherally, without the presence of prominent thick-walled, dilated bronchi or cystic changes. - The image clearly depicts significant structural abnormalities in the left lung making a normal scan highly improbable. *Loculated empyema* - A **loculated empyema** would appear as a collection of pus within the pleural space, characterized by **fluid attenuation**, internal septations, and enhancement of the pleura. - None of these features are the primary findings seen in this image, which shows dilated airways rather than pleural fluid collections.

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.

Question 1

A 45-year-old Ulcerative colitis patient presents with multiple painful lesions on both legs. What is the diagnosis?

Accepted Answer

Pyoderma gangrenosum

Answer

Necrotizing fasciitis

Answer

Granulomatosis with polyangiitis

Answer

Febrile neutrophilic dermatosis

Question 2

All are causes of following tongue appearance except: (Recent NEET Pattem 2016-17)

Accepted Answer

HIV

Answer

Melkersson-Rosenthal syndrome

Answer

Down syndrome

Answer

Genetic basis

Question 3

A 35-year-old woman presents with breathlessness at rest. She also complains of a skin lesion on nose which has increased in size for last 6 months. What is the diagnosis?

Accepted Answer

Sarcoidosis

Answer

Phakomatosis

Answer

Pulmonary lymphagiomatosis

Answer

DRESS syndrome

Question 4

A patient of swine flu has developed severe respiratory distress. Which of the following findings confirm the diagnosis of ARDS in this patient?

Accepted Answer

PaO₂/FiO₂ ratio < 300 and PCWP < 18 mm Hg

Answer

PaO₂/FiO₂ ratio < 200 and PCWP > 18 mm Hg

Answer

PaO₂/FiO₂ ratio < 400 and PCWP > 18 mm Hg

Answer

PaO₂/FiO₂ ratio < 100 and PCWP < 18 mm Hg

Question 5

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 6

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 7

Which is correct about the intracranial bleeding shown below?

Accepted Answer

Chronic subdural hematoma, hypodensity

Answer

Acute subdural hematoma, hypodensity

Answer

Chronic epidural hematoma, hyperdensity

Answer

Acute epidural hematoma, hyperdensity

Question 8

The CXR shows markings near the costophrenic angle. Which of the following is the cause of these markings? (Recent NEET Pattern 2016-17)

Accepted Answer

Lymphangitis carcinomatosis

Answer

Pulmonary alveolar proteinosis

Answer

Lung abscess

Answer

Pneumatocele

Question 9

The CT chest of a patient given below shows presence of: (Recent NEET Pattern 2016-17)

Accepted Answer

Bronchiectasis

Answer

Pneumatoceles

Answer

Normal scan

Answer

Loculated empyema

Question 10

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

Accepted Answer

Diverticulosis

Answer

Hiatus hernia

Answer

Gallstones

Answer

Acute pancreatitis

NEET-PG 2017

Dermatology

Internal Medicine

Ophthalmology

Radiology