Dermatology
1 questionsDermatological manifestation of which of the following diseases?
NEET-PG 2020 - Dermatology NEET-PG Practice Questions and MCQs
Question 211: Dermatological manifestation of which of the following diseases?
- A. Photo dermatitis
- B. Pellagra (Correct Answer)
- C. Acrodermatitis enteropathica
- D. Vitamin B deficiency
Explanation: ***Pellagra*** - The image shows a classic "butterfly" rash on the face, specifically a photosensitive dermatitis, which is a hallmark of **pellagra**. - Pellagra is caused by a deficiency of **niacin (vitamin B3)**, characterized by the "3 D's": **dermatitis**, **diarrhea**, and **dementia**. *Photo dermatitis* - While pellagra often presents with photosensitive dermatitis, "photo dermatitis" is a general term for **skin inflammation caused by light exposure** and not a specific disease itself. - It could be caused by various factors, including medication, immune reactions, or other underlying conditions, but the pattern seen here is highly suggestive of pellagra. *Acrodermatitis enteropathica* - This condition is a **hereditary zinc deficiency** that typically presents with a periorificial and acral dermatitis. - The skin lesions are typically **vesicular-pustular or eczematous** and do not usually have the distinct butterfly pattern of photosensitive dermatitis seen in the image. *Vitamin B deficiency* - While pellagra is a vitamin B **(niacin, B3)** deficiency, this option is too broad. - Other vitamin B deficiencies, such as **riboflavin (B2)** or **pyridoxine (B6)** deficiency, have different dermatological manifestations like angular cheilitis, glossitis, or seborrheic dermatitis, but not the characteristic facial rash seen here.
Internal Medicine
3 questionsWhich of the following is true about polyaeritis nodosa?
A patient undergoes bilateral adrenalectomy in view of bilateral pheochromocytoma. A day after surgery patient develops lethargy, fatigue and loss of appetite. On examination BP is 90/ 60 mmHg, pulse rate of 74 beats/min. No evidence of loss of volume. The likely cause is?
Urethritis in males is not caused by:
NEET-PG 2020 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 211: Which of the following is true about polyaeritis nodosa?
- A. It shows fibrinoid necrosis in large blood vessels
- B. HBsAg is positive in 30% patients (Correct Answer)
- C. It has ANCA positivity
- D. Affected individuals have involvement of pulmonary circulation.
Explanation: ### HBsAg is positive in 30% patients - **Polyarteritis nodosa (PAN)** is strongly associated with **hepatitis B virus (HBV)** infection; about 30% of patients with PAN have evidence of current or past HBV infection, particularly **HBsAg positivity**. - This association suggests that HBV infection can trigger the immune complex vasculitis characteristic of PAN. ### It shows fibrinoid necrosis in large blood vessels - PAN primarily affects **medium-sized muscular arteries**, not typically large blood vessels [1]. - The inflammation causes **fibrinoid necrosis** and aneurysmal dilations in these medium-sized arteries [1]. ### It has ANCA positivity - **Polyarteritis nodosa (PAN)** is generally considered an **ANCA-negative vasculitis**. - **ANCA positivity** (especially c-ANCA/PR3-ANCA or p-ANCA/MPO-ANCA) is characteristic of other small-vessel vasculitides like **Granulomatosis with polyangiitis** or **Microscopic polyangiitis**. ### Affected individuals have involvement of pulmonary circulation. - A defining characteristic of **Polyarteritis nodosa (PAN)** is that it generally **spares the pulmonary circulation** [1]. - Pulmonary involvement is more commonly seen in other vasculitides, such as **Granulomatosis with polyangiitis (Wegener's)** or **Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)**.
Question 212: A patient undergoes bilateral adrenalectomy in view of bilateral pheochromocytoma. A day after surgery patient develops lethargy, fatigue and loss of appetite. On examination BP is 90/ 60 mmHg, pulse rate of 74 beats/min. No evidence of loss of volume. The likely cause is?
- A. Cardiogenic shock
- B. Septic shock
- C. Cortisol deficiency (Correct Answer)
- D. Hypovolemic shock
Explanation: ***Cortisol deficiency*** - Following **bilateral adrenalectomy**, the body loses its primary source of **cortisol**, a critical hormone for maintaining blood pressure and energy levels. [1] - The symptoms of **lethargy, fatigue, loss of appetite, and hypotension** are classic signs of **acute adrenal insufficiency** or **adrenal crisis** due to cortisol deficiency. [1] *Cardiogenic shock* - This condition involves severe pump failure of the heart, leading to **reduced cardiac output**. - While hypotension is present, the symptom complex of fatigue and loss of appetite shortly after adrenal surgery points away from primary cardiac dysfunction in the absence of preceding cardiac events. *Septic shock* - Characterized by hypotension, signs of infection, and organ dysfunction due to a systemic inflammatory response. - There is no mention of fever, leukocytosis, or other signs of infection in the patient's presentation. *Hypovolemic shock* - Caused by a significant reduction in circulating blood volume, often due to hemorrhage or severe dehydration. - The question explicitly states "No evidence of loss of volume," ruling out hypovolemic shock.
Question 213: Urethritis in males is not caused by:
- A. Chlamydia
- B. Gonococcus
- C. Trichomonas
- D. H. ducreyi (Correct Answer)
Explanation: ***H. ducreyi*** - *Haemophilus ducreyi* is the causative agent of **chancroid**, a sexually transmitted infection characterized by **genital ulcers** [1] with painful regional lymphadenopathy. - It does not typically cause urethritis as its primary site of infection is the **skin and mucous membranes** of the external genitalia, forming ulcers rather than urethral inflammation. *Chlamydia* - **Chlamydia trachomatis** is a common cause of **non-gonococcal urethritis** in males [1]. - It often presents with **dysuria**, **urethral discharge**, and sometimes can be asymptomatic [1]. *Gonococcus* - **Neisseria gonorrhoeae** (gonococcus) is a well-known cause of urethritis, often referred to as **gonococcal urethritis** [1]. - It typically causes a **purulent urethral discharge** and **dysuria** [1]. *Trichomonas* - **Trichomonas vaginalis** can cause **urethritis** in males [1], although it is less common than in females. - Males may experience **dysuria**, **urethral discharge**, or can be asymptomatic carriers.
Obstetrics and Gynecology
1 questions35 yr old lady attends gynaec OPD with excessive bleeding since 6 months, not controlled with non hormonal drugs. USG and clinical examination reveals no abnormality. Next step is?
NEET-PG 2020 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 211: 35 yr old lady attends gynaec OPD with excessive bleeding since 6 months, not controlled with non hormonal drugs. USG and clinical examination reveals no abnormality. Next step is?
- A. Hysterectomy
- B. Endometrial sampling (Correct Answer)
- C. Endometrial ablation
- D. Hormonal therapy
Explanation: ***Endometrial sampling*** - In a 35-year-old with **excessive uterine bleeding** not controlled by non-hormonal drugs and with normal imaging/clinical exam, endometrial sampling is crucial to **rule out endometrial hyperplasia or malignancy**. - This diagnostic step is essential before considering definitive treatments, as it provides a **histological diagnosis** of the endometrial lining. *Hysterectomy* - Hysterectomy is a **definitive surgical treatment** for excessive bleeding, but it is typically reserved for cases where conservative or less invasive treatments have failed, or if there's a serious underlying pathology like malignancy. - It involves removing the uterus and is a **major surgery** with potential complications, thus not usually the first step given an otherwise normal examination and imaging. *Endometrial ablation* - Endometrial ablation is a procedure to destroy the lining of the uterus, aiming to **reduce or stop menstrual bleeding**. - It is a treatment option for **abnormal uterine bleeding (AUB)**, but it's typically performed after other diagnostic steps (like endometrial sampling) have ruled out malignancy or high-risk hyperplasia, and when conservative medical management has failed. *Hormonal therapy* - Hormonal therapy (e.g., combined oral contraceptives, progestin-only pills, levonorgestrel-releasing intrauterine device) is often a **first-line medical treatment** for excessive uterine bleeding. - However, the question states that non-hormonal drugs have already failed, and without a clear diagnosis, initiating new hormonal therapy without **evaluating the endometrium** is not the next best step for persistent bleeding.
Ophthalmology
1 questionsWhat is the diagnosis for a patient with unilateral proptosis with bilateral 6th nerve palsy with chemosis and euthyroid status?
NEET-PG 2020 - Ophthalmology NEET-PG Practice Questions and MCQs
Question 211: What is the diagnosis for a patient with unilateral proptosis with bilateral 6th nerve palsy with chemosis and euthyroid status?
- A. Retinoblastoma
- B. Thyroid ophthalmopathy
- C. Cavernous sinus thrombosis (Correct Answer)
- D. Orbital pseudotumour
Explanation: ***Cavernous sinus thrombosis*** - The combination of **unilateral proptosis**, **bilateral 6th nerve palsy**, and **chemosis** strongly suggests cavernous sinus thrombosis. - The cavernous sinus contains cranial nerves III, IV, V1, V2, and VI; thrombosis can lead to dysfunction of these nerves, particularly the **abducens nerve (VI)**, and venous congestion causing proptosis and chemosis. *Retinoblastoma* - Typically presents in **children** with **leukocoria**, strabismus, and sometimes proptosis. - It is a primary intraocular tumor and does not usually cause acute bilateral cranial nerve palsies and chemosis. *Thyroid ophthalmopathy* - Characterized by proptosis, lid retraction, and ophthalmoplegia, often with chemosis and conjunctival injection, but usually in the context of thyroid dysfunction (hyperthyroidism). - While it can cause proptosis, the presence of **bilateral 6th nerve palsy** and a **euthyroid** status makes cavernous sinus thrombosis more likely, as thyroid ophthalmopathy typically presents with restrictive ophthalmoplegia rather than isolated cranial nerve palsies. *Orbital pseudotumour* - Presents with painful proptosis, chemosis, and ophthalmoplegia, which can be unilateral or bilateral. - Differentiating features include a good response to **steroids** and usually **no associated cranial nerve palsies** in the pattern described.
Pediatrics
2 questionsA 2 years old child presents to PHC with fever and cough. He has chest in-drawing and respiratory rate of 38 per minute, weight 11 kg. The next step in management according to IMNCI is:
A term neonate, with a birth weight of 2700 g, who is otherwise well, and is exclusively breastfed, presents for routine evaluation. His total serum bilirubin is found to be 14mg/dl on day 5. What is the management?
NEET-PG 2020 - Pediatrics NEET-PG Practice Questions and MCQs
Question 211: A 2 years old child presents to PHC with fever and cough. He has chest in-drawing and respiratory rate of 38 per minute, weight 11 kg. The next step in management according to IMNCI is:
- A. Give antibiotics and re-assess in 3 days
- B. Refer to tertiary care
- C. Give antibiotics and refer to tertiary centre (Correct Answer)
- D. Only antipyretics are given
Explanation: ***Give antibiotics and refer to tertiary centre*** - The child presents with **cough**, **fever**, and **chest in-drawing** with a respiratory rate of **38/minute**. According to **IMNCI guidelines**, the presence of **chest in-drawing** in a child aged 2 months to 5 years classifies the condition as **SEVERE PNEUMONIA**. - For severe pneumonia, IMNCI protocol mandates **urgent referral to a hospital** where the child can receive injectable antibiotics (e.g., IV/IM ampicillin or ceftriaxone) and appropriate monitoring. - The child should be given the **first dose of appropriate antibiotic** at the PHC level before referral to prevent deterioration during transport. - This is the correct management approach combining immediate antibiotic therapy with necessary referral for severe disease. *Give antibiotics and re-assess in 3 days* - This management is appropriate for **simple pneumonia** (fast breathing without chest in-drawing), where oral antibiotics can be given at home with reassessment in 2-3 days. - However, in the presence of **chest in-drawing**, the classification escalates to **severe pneumonia**, which requires hospital-level care with injectable antibiotics and monitoring, not outpatient management. - Managing severe pneumonia at PHC without referral risks complications like respiratory failure, sepsis, or death. *Only antipyretics are given* - This is completely inadequate for a child with **severe pneumonia** (chest in-drawing). - Fever management alone does not address the underlying **bacterial infection** requiring antibiotic therapy. - This approach would lead to disease progression and potentially fatal complications. *Refer to tertiary care* - While referral is correct, giving the **first dose of antibiotic before referral** is a critical component of IMNCI protocol. - Pre-referral antibiotic administration helps prevent deterioration during transport and initiates early treatment. - Therefore, "give antibiotics AND refer" is more complete than referral alone.
Question 212: A term neonate, with a birth weight of 2700 g, who is otherwise well, and is exclusively breastfed, presents for routine evaluation. His total serum bilirubin is found to be 14mg/dl on day 5. What is the management?
- A. No active treatment required (Correct Answer)
- B. Stop breastfeeding for 2 days
- C. Phototherapy
- D. Exchange transfusion
Explanation: ***No active treatment required*** - A total serum bilirubin of **14 mg/dL** on day 5 in an otherwise well, exclusively breastfed term neonate (birth weight 2700g, which is >2500g) falls within the **physiologic jaundice range** and below thresholds for intervention. - This level is considered **normal for breastfed infants** at this age and does not warrant medical intervention as per current guidelines. *Stop breastfeeding for 2 days* - This intervention, known as **breast milk jaundice interruption**, is usually reserved for higher bilirubin levels or if there is concern for significant breast milk jaundice, which is not indicated here. - Temporarily stopping breastfeeding can disrupt the establishment of breastfeeding and is generally discouraged unless strictly necessary. *Phototherapy* - **Phototherapy** is indicated for bilirubin levels typically >15-18 mg/dL in a healthy term neonate on day 5, depending on risk factors, which this infant does not meet. - It works by converting unconjugated bilirubin into water-soluble isomers that can be excreted more easily. *Exchange transfusion* - **Exchange transfusion** is reserved for severe hyperbilirubinemia, usually with bilirubin levels approaching or exceeding 20-25 mg/dL, especially if there are signs of **acute bilirubin encephalopathy**. - This level is far below the threshold for such an invasive procedure.
Pharmacology
1 questionsA patient of biliary colic presented to hospital. Intern gave an injection and the pain worsened. Which is the most likely injection given?
NEET-PG 2020 - Pharmacology NEET-PG Practice Questions and MCQs
Question 211: A patient of biliary colic presented to hospital. Intern gave an injection and the pain worsened. Which is the most likely injection given?
- A. Morphine (Correct Answer)
- B. Diclofenac
- C. Etoricoxib
- D. Nefopam
Explanation: *Morphine*- **Morphine** and other opioids can cause **spasm of the sphincter of Oddi**, leading to increased pressure in the **biliary tree** and worsening of biliary colic.- This effect is mediated through **mu-opioid receptors** on the smooth muscle of the sphincter.*Diclofenac*- **Diclofenac** is a non-steroidal anti-inflammatory drug (NSAID) which is an excellent choice for **biliary colic** because it reduces inflammation and relaxes smooth muscle.- It works by inhibiting **prostaglandin synthesis**, thus reducing pain and spasm of the gallbladder.*Etoricoxib*- **Etoricoxib** is a selective COX-2 inhibitor [1], another type of NSAID, which would typically alleviate pain in biliary colic.- It reduces inflammation and pain [1] without the **sphincter of Oddi spasm** concerns associated with opioids.*Nefopam*- **Nefopam** is a non-opioid analgesic that acts as a centrally acting **serotonin-norepinephrine-dopamine reuptake inhibitor (SNDRI)**. It would typically help with pain relief.- It is not known to cause **sphincter of Oddi spasm** and would therefore not usually worsen biliary colic.
Surgery
1 questionsWhich one of the following is not a component of THORACOSCORE?
NEET-PG 2020 - Surgery NEET-PG Practice Questions and MCQs
Question 211: Which one of the following is not a component of THORACOSCORE?
- A. Performance status
- B. Complication of surgery (Correct Answer)
- C. Priority of surgery
- D. ASA grading
Explanation: ***Complication of surgery*** - THORACOSCORE is a **risk prediction model** for thoracic surgery used to estimate the *probability of mortality and significant morbidity*, but it does not account for the complications of surgery itself as a component. - The score uses **pre-operative patient characteristics** and co-morbidities to predict outcomes, not post-operative events. *Performance status* - **Performance status**, such as the **ECOG scale**, is a crucial component of THORACOSCORE, reflecting the patient's general health and functional capacity prior to surgery. - A lower performance status (indicating poorer functional ability) increases the predicted risk in THORACOSCORE. *Priority of surgery* - The **priority of surgery** (e.g., elective, urgent, emergency) is an important factor in THORACOSCORE, as emergency procedures generally carry a higher risk. - This variable helps to capture the urgency and associated physiological stress on the patient at the time of presentation for surgery. *ASA grading* - The **American Society of Anesthesiologists (ASA) physical status classification system** is a component of THORACOSCORE, assessing the patient's overall health status and anesthetic risk. - A higher ASA grade (indicating more severe systemic disease) contributes to a higher predicted risk in the THORACOSCORE model.