NEET-PG 2019 — General Medicine

Q: A 25-year-old female presents with history of fever and oral ulcers and has developed erythematous lesions on her face. Comment on the diagnosis?

Systemic Lupus Erythematosus (SLE). ***Systemic Lupus Erythematosus (SLE)*** - The combination of **fever**, **oral ulcers**, and **malar rash** (butterfly-shaped erythematous lesions across the cheeks and nose) represents classic triad of **SLE** according to **ACR/EULAR diagnostic criteria**. - SLE is a **multisystem autoimmune disease** affecting young women (female:male ratio 9:1) with systemic manifestations including constitutional symptoms and mucocutaneous involvement. *Discoid Lupus Erythematosus (DLE)* - DLE presents with **chronic scarring plaques** with **follicular plugging** and **atrophy**, typically without systemic features like fever. - Lacks **systemic manifestations** such as fever and oral ulcers that are characteristic of systemic lupus. *Dermatomyositis* - Characterized by **heliotrope rash** (violaceous discoloration around eyelids) and **Gottron's papules** over knuckles, not malar distribution. - Associated with **proximal muscle weakness** and elevated **creatine kinase levels**, which are absent in this presentation. *Rosacea* - A **chronic inflammatory skin condition** affecting central face with **persistent erythema** and **papulopustular lesions**. - Does **not** present with systemic symptoms like **fever** or **oral ulcers**, and typically occurs in middle-aged adults. [Practice more General Medicine PYQs on OnCourse]

Q: Drug of choice for following infection (as shown in image) in a HIV patient: (NEET Pattern 2019)

Cotrimoxazole. ***Cotrimoxazole*** - The image shows numerous **dark-stained cysts** and **trophozoites** within lung tissue, characteristic of **Pneumocystis jirovecii pneumonia (PCP)**, a common opportunistic infection in HIV patients. - **Cotrimoxazole (trimethoprim-sulfamethoxazole)** is the drug of choice for the treatment and prophylaxis of PCP. *INH + Rifampicin* - This combination is used for the treatment of **tuberculosis**, characterized by **acid-fast bacilli** and granulomas, which are not seen in this image. - While TB is common in HIV patients, the morphology in the image is not consistent with Mycobacterium tuberculosis. *Doxycycline* - Doxycycline is a broad-spectrum antibiotic used for various bacterial infections, including atypical pneumonia, but it is not effective against **Pneumocystis jirovecii.** - It is also used for malaria prophylaxis and Rickettsial infections. *Azithromycin* - Azithromycin is an antibiotic primarily effective against atypical bacteria like **Mycoplasma** and **Chlamydia**, and it is used for **MAC (Mycobacterium avium complex)** prophylaxis in advanced HIV. - It has no role in the treatment of Pneumocystis jirovecii pneumonia. [Practice more General Medicine PYQs on OnCourse]

2 Previous Year Questions with Answers & Explanations

Questions

A 25-year-old female presents with history of fever and oral ulcers and has developed erythematous lesions on her face. Comment on the diagnosis?

Drug of choice for following infection (as shown in image) in a HIV patient: (NEET Pattern 2019)

NEET-PG 2019 - General Medicine NEET-PG Practice Questions and MCQs

Question 1: A 25-year-old female presents with history of fever and oral ulcers and has developed erythematous lesions on her face. Comment on the diagnosis?

A. Systemic Lupus Erythematosus (SLE) (Correct Answer)
B. Discoid Lupus Erythematosus (DLE)
C. Dermatomyositis
D. Rosacea

Explanation: ***Systemic Lupus Erythematosus (SLE)*** - The combination of **fever**, **oral ulcers**, and **malar rash** (butterfly-shaped erythematous lesions across the cheeks and nose) represents classic triad of **SLE** according to **ACR/EULAR diagnostic criteria**. - SLE is a **multisystem autoimmune disease** affecting young women (female:male ratio 9:1) with systemic manifestations including constitutional symptoms and mucocutaneous involvement. *Discoid Lupus Erythematosus (DLE)* - DLE presents with **chronic scarring plaques** with **follicular plugging** and **atrophy**, typically without systemic features like fever. - Lacks **systemic manifestations** such as fever and oral ulcers that are characteristic of systemic lupus. *Dermatomyositis* - Characterized by **heliotrope rash** (violaceous discoloration around eyelids) and **Gottron's papules** over knuckles, not malar distribution. - Associated with **proximal muscle weakness** and elevated **creatine kinase levels**, which are absent in this presentation. *Rosacea* - A **chronic inflammatory skin condition** affecting central face with **persistent erythema** and **papulopustular lesions**. - Does **not** present with systemic symptoms like **fever** or **oral ulcers**, and typically occurs in middle-aged adults.

Question 2: Drug of choice for following infection (as shown in image) in a HIV patient: (NEET Pattern 2019)

A. INH+ Rifampicin
B. Cotrimoxazole (Correct Answer)
C. Doxycycline
D. Azithromycin

Explanation: ***Cotrimoxazole*** - The image shows numerous **dark-stained cysts** and **trophozoites** within lung tissue, characteristic of **Pneumocystis jirovecii pneumonia (PCP)**, a common opportunistic infection in HIV patients. - **Cotrimoxazole (trimethoprim-sulfamethoxazole)** is the drug of choice for the treatment and prophylaxis of PCP. *INH + Rifampicin* - This combination is used for the treatment of **tuberculosis**, characterized by **acid-fast bacilli** and granulomas, which are not seen in this image. - While TB is common in HIV patients, the morphology in the image is not consistent with Mycobacterium tuberculosis. *Doxycycline* - Doxycycline is a broad-spectrum antibiotic used for various bacterial infections, including atypical pneumonia, but it is not effective against **Pneumocystis jirovecii.** - It is also used for malaria prophylaxis and Rickettsial infections. *Azithromycin* - Azithromycin is an antibiotic primarily effective against atypical bacteria like **Mycoplasma** and **Chlamydia**, and it is used for **MAC (Mycobacterium avium complex)** prophylaxis in advanced HIV. - It has no role in the treatment of Pneumocystis jirovecii pneumonia.