NEET-PG 2018 Practice Questions

Q: Which one of the following is implicated in the etiology of these adhesions around the liver?

Chlamydial infection. ***Chlamydial infection*** - The image shows **Fitz-Hugh-Curtis syndrome**, characterized by **violin-string adhesions** visible between the liver capsule and the parietal peritoneum. - This condition is a perihepatitis that occurs as a complication of **pelvic inflammatory disease (PID)**, most commonly caused by **Chlamydia trachomatis** or Neisseria gonorrhoeae. *Perforation of dermoid cyst* - A perforated dermoid cyst (mature cystic teratoma) typically causes a **chemical peritonitis** due to the leakage of sebaceous material, hair, and other contents. - While it can lead to adhesions, these are usually diffuse and not specifically the **violin-string type perihepatic adhesions** characteristic of Fitz-Hugh-Curtis syndrome. *Pseudomyxoma peritonei* - Pseudomyxoma peritonei is characterized by the accumulation of **gelatinous ascites** and mucin-producing tumor cells in the peritoneal cavity, often originating from a ruptured appendiceal mucinous neoplasm. - It results in widespread mucinous deposits and adhesions, which are distinct from the fibrous, violin-string adhesions around the liver seen in the image. *Liver metastases in ovarian cancer* - Liver metastases from ovarian cancer would appear as **nodular lesions within the liver parenchyma** or on its surface, not as fibrous adhesions between the liver and abdominal wall. - While ovarian cancer can cause ascites and peritoneal carcinomatosis, the presentation of **perihepatic adhesions** in the image is not typical for direct metastatic spread to the liver surface in this manner.

Q: Which of the following will be the most probable diagnostic finding in the patient with X-Ray skull shown below?

CD1A positivity. ***CD1A positivity*** - The skull X-ray shows multiple punched-out lytic lesions without sclerotic borders, characteristic of **Langerhans Cell Histiocytosis (LCH)**. - **Langerhans cells** in LCH express surface markers like **CD1a** and S100 protein, which are diagnostic when detected via **immunohistochemistry on tissue biopsy**. - CD1a positivity is the **gold standard** for confirming LCH diagnosis. *Elevated SAP* - **Serum Alkaline Phosphatase (SAP)** is typically elevated in conditions with increased osteoblastic activity or liver/biliary disease. - LCH lesions are generally **lytic** and not associated with increased osteoblastic activity, thus SAP elevation is not a specific or common finding. *Bence Jones proteins* - **Bence Jones proteins** (monoclonal light chains) are found in the urine of patients with **Multiple Myeloma**, which can also cause lytic bone lesions. - However, the image shows more discrete, "punched-out" lesions typical of LCH, whereas myeloma lesions are often more diffuse or "salt-and-pepper" in appearance, and LCH does not secrete Bence Jones proteins. *Elevated HbA2* - **Elevated HbA2** is a characteristic finding in **beta-thalassemia trait**, a genetic blood disorder. - There is no clinical or radiological indication in the provided image or question to suggest a connection to thalassemia.

Q: Neonate is brought at 3 weeks of age, with projectile vomiting. USG was performed and is shown below. When can the abdominal mass in this condition be best palpated?

During feeding. ***During feeding*** - In **hypertrophic pyloric stenosis**, the characteristic **"olive" mass** formed by the thickened pylorus is most easily palpable **during feeding or immediately after vomiting**. - During this time, the infant’s abdominal muscles are relaxed, making palpation of the mass in the **epigastrium (right upper quadrant)** more successful. *In umbilical area* - The umbilical area is typically where **omphaloceles** or **umbilical hernias** are found, not the pyloric mass. - The pylorus is located much higher in the epigastric region, to the right of the midline. *In epigastric area* - While the pyloric mass is located in the **epigastric area**, palpation is more difficult when the infant is crying or agitated. - The question asks when it can be *best* palpated, emphasizing the conditions under which it is most detectable. *In Right upper quadrant* - The pylorus is indeed located in the **right upper quadrant/epigastrium**. - However, the optimal timing for palpation is during feeding or after vomiting, as the infant's abdomen is relaxed at that point.

Q: A 1-year-old child with severe acute malnutrition develops pneumonia which is not responding to treatment. Chest X-ray picture is given. What is the likely etiology?

Staphylococcus aureus. ***Staphylococcus aureus*** - The chest X-ray shows extensive **bilateral infiltrates** with areas of potential **abscess formation** or **necrotizing pneumonia**, suggested by the poorly defined lucencies within consolidation, which are characteristic of Staphylococcal infection, especially in immunocompromised individuals like a malnourished child. - Staphylococcal pneumonia is often severe, can lead to **necrosis**, **cavitation**, and is known for its **resistance to common antibiotics**, explaining the poor response to initial treatment in a severely malnourished child. *Mycoplasma* - Mycoplasma pneumoniae typically causes **"walking pneumonia"** with milder symptoms and **diffuse interstitial infiltrates** visible on Chest X-ray, which are not as severe or focal as seen in the image. - It's less common to cause rapidly progressing, severe, and necrotizing pneumonia in this age group, even in malnourished children. *Pneumococcus* - **Streptococcus pneumoniae (Pneumococcus)** usually causes **lobar pneumonia** with dense, homogeneous consolidation in one lobe, often with a visible air bronchogram, rather than the more patchy, bilateral, and potentially necrotizing pattern seen here. - While it can be severe, especially in malnourished children, the radiographic pattern is less typical for pneumococcal infection. *Adenovirus* - Adenovirus can cause a range of respiratory infections, from common colds to severe pneumonia, especially in young children. However, the Chest X-ray findings typically include **perihilar infiltrates**, **bronchial wall thickening**, and hyperinflation, which do not fully match the extensive, severe, and potentially cavitating pattern observed. - While it can cause severe pneumonia, the given X-ray features, particularly the suggestion of necrosis, are less characteristic of adenoviral infection.

Q: A 12-month-old child who was previously well presented with low grade fever and respiratory distress and on examination there is bilateral wheeze. There is a history of URI in elder sibling. What is the diagnosis?

Acute bronchiolitis. ***Acute bronchiolitis*** - The clinical presentation of a **12-month-old** with **low-grade fever**, **respiratory distress**, and **bilateral wheeze**, along with the history of a preceding **URI in an elder sibling**, is highly characteristic of acute bronchiolitis, commonly caused by **Respiratory Syncytial Virus (RSV)**. - Bronchiolitis primarily affects infants and toddlers, causing inflammation and obstruction of the small airways, leading to wheezing and increased work of breathing. - The **age (12 months)** and **contact history** are key diagnostic clues. *Congestive cardiac failure* - While congestive cardiac failure can cause respiratory distress, it typically presents with other signs like **tachycardia**, **hepatomegaly**, and potentially a cardiac murmur, which are not mentioned here. - Wheezing can occur in cardiac failure but is usually accompanied by **rales** and signs of fluid overload rather than prominent diffuse wheezing as the primary respiratory finding in an otherwise well child. *Pneumonia* - Pneumonia would more typically present with a **higher fever**, **cough**, and focal lung findings such as **crackles** or **dullness to percussion**, rather than predominantly bilateral wheezing. - Chest X-ray in pneumonia often shows **infiltrates** or **consolidation**, whereas in bronchiolitis, it commonly shows hyperinflation or peribronchial thickening. *Asthma exacerbation* - Asthma is uncommon as a first diagnosis in a child under **2 years of age**, especially in a **previously well** child with no history of recurrent wheezing episodes. - The **contact history with URI in a sibling** and the **acute, first-time presentation** strongly favor an infectious etiology (bronchiolitis) rather than asthma. - Asthma exacerbations typically occur in children with a known history of reactive airway disease and recurrent wheezing episodes.

Q: Identify this condition?

Prune belly syndrome. ***Prune belly syndrome*** - The image shows the characteristic **wrinkled, prune-like appearance** of the abdominal wall due to **absent or deficient abdominal wall musculature**. - This condition is part of a triad including **urinary tract abnormalities** and **undescended testes** in males, with the distinctive loose, redundant abdominal skin. *Omphalocele* - An **omphalocele** presents with **abdominal contents herniating through the umbilical ring**, covered by a peritoneal membrane. - The image does not show any **herniated organs** or a sac-like protrusion at the umbilical area. *Gastroschisis* - **Gastroschisis** involves an **abdominal wall defect** typically to the right of the umbilical cord with **exposed bowel loops**. - No evidence of **herniated intestinal contents** or abdominal wall dehiscence is visible in this image. *Peritonitis* - **Peritonitis** is an **inflammatory condition** of the peritoneum presenting with abdominal rigidity and systemic signs. - This is not a structural abnormality visible externally but rather an **internal inflammatory process** requiring clinical assessment.

Q: A child with history of diarrhea 1 week back presents with sudden onset pallor and oliguria. Peripheral smear findings are shown below. Which of the following is unlikely finding in this disorder?

Elevated PT. ***Elevated PT*** - **Hemolytic-uremic syndrome (HUS)** is a microangiopathic hemolytic anemia with **normal coagulation parameters**. - **PT** or **aPTT** are not typically elevated in HUS, making this an unlikely finding. *Coomb's test negative* - HUS is a **non-immune hemolytic anemia**, meaning the red cell destruction is not antibody-mediated. - A **negative Coombs test** is an expected finding in HUS, differentiating it from autoimmune hemolytic anemia. *Increased urinary sodium excretion* - HUS causes **acute kidney injury (AKI)**, often leading to tubular damage and impaired sodium reabsorption. - This can result in **increased fractional excretion of sodium** and high urinary sodium concentrations. *Thrombocytopenia* - **Thrombocytopenia** is a hallmark feature of HUS, caused by platelet consumption in the microthrombi formed in the damaged microvasculature. - The severity of thrombocytopenia can vary but is almost always present.

Q: The following Skull X-ray is seen in:

Thalassemia. ***Thalassemia*** - The image shows a classic **hair-on-end appearance** of the skull, which is a characteristic radiological finding in severe forms of thalassemia. - This appearance results from **marrow hyperplasia** in response to chronic hemolysis, leading to widening of the diploic space and expansion of bone marrow at the expense of outer cortical bone. *Multiple myeloma* - Multiple myeloma typically presents with multiple well-demarcated, **punched-out lytic lesions** in the skull, without a "hair-on-end" pattern. - The bone lesions are due to plasma cell infiltration and osteoclast activation, leading to discrete areas of bone destruction. *Histiocytosis-X* - Histiocytosis-X, also known as Langerhans cell histiocytosis, can cause **lytic bone lesions** in the skull, often referred to as "geographic" or "punched-out" lesions. - While it can cause diffuse bone involvement, it does not typically produce the organized trabecular pattern characteristic of "hair-on-end." *Paget's disease* - Paget's disease of bone often manifests as areas of **bone enlargement**, cortical thickening, and a mixture of lytic and sclerotic changes, sometimes described as a **cotton-wool appearance** in the skull. - It does not present with the "hair-on-end" pattern, which is primarily associated with conditions causing chronic marrow expansion.

Q: The following barium swallow study shows which of the following?

Esophageal varices. ***Esophageal varices*** - The Barium Swallow image clearly demonstrates a **serpiginous**, worm-like, or **rosary bead-like appearance** along the esophageal wall, which is characteristic of esophageal varices. - Varices are dilated submucosal veins and appear as **filling defects** on barium studies, especially when distended. *Schatzki ring* - A Schatzki ring is a **thin, symmetric mucosal ring** at the esophagogastric junction, causing solid food dysphagia. - It presents as a **smooth, circumferential narrowing** on a barium swallow, which is not seen here. *Candida esophagitis* - Candida esophagitis typically appears as **ulcerations, plaques, or nodularity** with an irregular, cobblestone pattern on barium swallow. - This image does not show the characteristic **"shaggy" or "cobblestone"** appearance associated with candidal plaques. *Reflux esophagitis* - Reflux esophagitis can manifest as **mucosal irregularity, erosions, or strictures**, but not the distinct serpiginous filling defects seen in this image. - Severe reflux can cause peptic strictures, which appear as **smooth, tapered narrowings**, different from the irregular variceal pattern.

Q: Identify the following abnormality?

Schizencephaly. ***Schizencephaly*** - The image shows a **cleft-like defect** extending from the pial surface to the ventricle, lined by **gray matter**, which is characteristic of schizencephaly. - This typically results in communication between the **subarachnoid space** and the **ventricular system**. *Encephalocoele* - An encephalocoele is a **protrusion of brain tissue** and meninges through a defect in the skull, which is not depicted in this image. - It usually presents as a **sac-like bulge** on the head, often in the occipital or frontal regions. *Prosencephaly* - This term usually refers to the malformation spectrum associated with **holoprosencephaly**, characterized by a failure of the prosencephalon (forebrain) to properly divide. - Features include **fusion of the cerebral hemispheres**, a single ventricle, and facial anomalies, not a cortical cleft as seen here. *Lissencephaly* - Lissencephaly is characterized by a **lack of gyri and sulci** (smooth brain surface) or abnormally broad and flattened gyri, leading to a thickened cortex. - The image clearly displays presence of gyri and sulci, although with an additional unusual cleft, ruling out a primary diagnosis of lissencephaly.

Question 1

Which one of the following is implicated in the etiology of these adhesions around the liver?

Accepted Answer

Chlamydial infection

Answer

Perforion of dermoid cyst

Answer

Pseudomyxoma peritonei

Answer

Liver metastases in ovarian cancer

Question 2

Which of the following will be the most probable diagnostic finding in the patient with X-Ray skull shown below?

Accepted Answer

CD1A positivity

Answer

Elevated SAP

Answer

Bence Jones proteins

Answer

Elevated HbA2

Question 3

Neonate is brought at 3 weeks of age, with projectile vomiting. USG was performed and is shown below. When can the abdominal mass in this condition be best palpated?

Accepted Answer

During feeding

Answer

In umbilical area

Answer

In epigastric area

Answer

In Right upper quadrant

Question 4

A 1-year-old child with severe acute malnutrition develops pneumonia which is not responding to treatment. Chest X-ray picture is given. What is the likely etiology?

Accepted Answer

Staphylococcus aureus

Answer

Mycoplasma

Answer

Pneumococcus

Answer

Adenovirus

Question 5

A 12-month-old child who was previously well presented with low grade fever and respiratory distress and on examination there is bilateral wheeze. There is a history of URI in elder sibling. What is the diagnosis?

Accepted Answer

Acute bronchiolitis

Answer

Congestive cardiac failure

Answer

Pneumonia

Answer

Asthma exacerbation

Question 6

Identify this condition?

Accepted Answer

Prune belly syndrome

Answer

Omphalocele

Answer

Gastroschisis

Answer

Peritonitis

Question 7

A child with history of diarrhea 1 week back presents with sudden onset pallor and oliguria. Peripheral smear findings are shown below. Which of the following is unlikely finding in this disorder?

Accepted Answer

Elevated PT

Answer

Coomb's test negative

Answer

Increased urinary sodium excretion

Answer

Thrombocytopenia

Question 8

The following Skull X-ray is seen in:

Accepted Answer

Thalassemia

Answer

Multiple myeloma

Answer

Histiocytosis-X

Answer

Paget's disease

Question 9

The following barium swallow study shows which of the following?

Accepted Answer

Esophageal varices

Answer

Schatzki ring

Answer

Candida esophagitis

Answer

Reflux esophagitis

Question 10

Identify the following abnormality?

Accepted Answer

Schizencephaly

Answer

Encephalocoele

Answer

Prosencephaly

Answer

Lissencephaly

NEET-PG 2018

Obstetrics and Gynecology

Pathology

Pediatrics

Radiology