Biochemistry
1 questionsA software engineer presents to the OPD with 'complaints of easy fatigability. He reports sitting in front of a computer for 12-14 hours a day consuming junk food, and eating few fruits and vegetables. CBC results show hemoglobin (Hb) concentration of $7 \mathrm{gm} \%$ and MCV of 120 fL . What is the most likely cause of anemia?
NEET-PG 2021 - Biochemistry NEET-PG Practice Questions and MCQs
Question 91: A software engineer presents to the OPD with 'complaints of easy fatigability. He reports sitting in front of a computer for 12-14 hours a day consuming junk food, and eating few fruits and vegetables. CBC results show hemoglobin (Hb) concentration of $7 \mathrm{gm} \%$ and MCV of 120 fL . What is the most likely cause of anemia?
- A. Cyanocobalamin deficiency
- B. Acute blood loss
- C. Sideroblastic anemia
- D. Folate deficiency (Correct Answer)
- E. Iron deficiency anemia
Explanation: ***Folate deficiency*** - A **macrocytic anemia** with an **MCV of 120 fL** is characteristic of folate deficiency, as folate is vital for **DNA synthesis** in red blood cell production. - The patient's diet of **junk food** and few fruits/vegetables suggests poor nutritional intake, as folate is abundant in leafy greens and fresh produce. *Cyanocobalamin deficiency* - While also causing **macrocytic anemia** with high MCV, cyanocobalamin (Vitamin B12) deficiency often presents with **neurological symptoms** (e.g., neuropathy, cognitive changes) which are not mentioned. - Dietary sources of B12 are primarily **animal products**, and while junk food is poor, a strict vegetarian/vegan diet is a stronger indicator of B12 deficiency. *Acute blood loss* - Acute blood loss typically causes **normocytic, normochromic anemia**, characterized by a normal MCV in the initial stages. - While severe blood loss can lead to fatigue, the **elevated MCV** of 120 fL makes this diagnosis unlikely unless there's a pre-existing macrocytic condition. *Sideroblastic anemia* - Sideroblastic anemia can be **microcytic, normocytic, or macrocytic**, but it is primarily characterized by the presence of **ring sideroblasts** in the bone marrow and iron overload. - It's often associated with **alcoholism, lead poisoning, or myelodysplastic syndromes**, and the typical features of the patient's diet and MCV do not point towards this condition. *Iron deficiency anemia* - Iron deficiency anemia presents with **microcytic, hypochromic anemia** with a **low MCV** (typically <80 fL), not macrocytic anemia. - While iron deficiency is the most common cause of anemia worldwide and can result from poor diet, the **elevated MCV of 120 fL** clearly excludes this diagnosis.
Internal Medicine
4 questionsA 56-year-old patient developed excruciating chest discomfort in the past 72 hours, relieved by GTN spray. Troponin I is normal, and the ECG shows features of left ventricular hypertrophy (LVH) with T wave flattening. The patient is already on statins, aspirin, and metoprolol 50 mg . What is the next best step in management?
A patient presents with a mediastinal mass and is diagnosed with pure red cell aplasia. What is the most probable underlying cause?
A 68-year-old male presents with cough, sputum production, bronchial breath sounds, respiratory rate of 20/min, urea of 44 mg/dl, and BP of 110/70 mmHg. What is the next step in management?
A patient presents with numb fingertips and tight facial skin. ANA is positive with an immunofluorescence nucleolar pattern. What is the most likely diagnosis?
NEET-PG 2021 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 91: A 56-year-old patient developed excruciating chest discomfort in the past 72 hours, relieved by GTN spray. Troponin I is normal, and the ECG shows features of left ventricular hypertrophy (LVH) with T wave flattening. The patient is already on statins, aspirin, and metoprolol 50 mg . What is the next best step in management?
- A. LMWH (Low Molecular Weight Heparin)
- B. Increase beta blocker dose
- C. IV NTG Drip
- D. Add Clopidogrel (Correct Answer)
- E. Arrange urgent coronary angiography
Explanation: ***Add Clopidogrel*** - The patient presents with **unstable angina** (chest discomfort relieved by GTN, normal troponin, and ECG changes indicative of ischemia) and is already on aspirin, statins, and a beta-blocker. - Adding **clopidogrel** (or another P2Y12 inhibitor) is crucial for **dual antiplatelet therapy (DAPT)**, which is a cornerstone in the management of unstable angina/NSTEMI to prevent further thrombotic events. - This is the **immediate next step** to optimize medical therapy before considering invasive strategies. *LMWH (Low Molecular Weight Heparin)* - While **anticoagulation** is important in acute coronary syndromes and would be appropriate to add, the question asks for the **next best step** given the patient's existing management. - LMWH would typically be added alongside DAPT, but establishing dual antiplatelet therapy takes priority. *Increase beta blocker dose* - The patient is already on metoprolol 50 mg, and while **titrating beta-blockers** is important for symptom control and reducing myocardial oxygen demand, the immediate priority in unstable angina is to address the underlying thrombotic process with DAPT. - Beta-blocker optimization can be done after ensuring adequate antiplatelet therapy. *IV NTG Drip* - **Intravenous nitroglycerin (IV NTG)** is used to relieve ongoing chest pain and reduce preload/afterload, especially in severe or refractory symptoms. - However, the patient's chest discomfort was already **relieved by GTN spray**, indicating that immediate pain control with IV NTG is not the most urgent next step compared to preventing further thrombotic events with DAPT. *Arrange urgent coronary angiography* - While **coronary angiography** is indicated in high-risk unstable angina, the immediate next step is to **optimize medical management** with dual antiplatelet therapy. - Angiography timing depends on risk stratification; in a stable patient already on aspirin, beta-blockers, and statins, adding clopidogrel first ensures optimal antiplatelet coverage before any invasive procedure. - Early invasive strategy (angiography within 24-72 hours) would be appropriate after medical stabilization.
Question 92: A patient presents with a mediastinal mass and is diagnosed with pure red cell aplasia. What is the most probable underlying cause?
- A. Bronchogenic carcinoma
- B. T-cell Acute Lymphoblastic Leukemia
- C. Non-Hodgkin Lymphoma
- D. Thymic neoplasia (Correct Answer)
Explanation: ***Thymic neoplasia*** - **Thymoma** is strongly associated with **pure red cell aplasia (PRCA)**, where the body's immune system, influenced by the abnormal thymus, attacks and destroys red blood cell precursors in the bone marrow. - A mediastinal mass, particularly in an adult presenting with PRCA, should raise strong suspicion for a **thymic tumor**. *Bronchogenic carcinoma* - While bronchogenic carcinoma can present as a **mediastinal mass**, it is not typically associated with **pure red cell aplasia**. - Its paraneoplastic syndromes usually involve endocrine or neurological manifestations rather than direct hematopoietic suppression of red cell precursors. *T-cell Acute Lymphoblastic Leukemia* - **T-cell ALL** can present with a **mediastinal mass** due to thymic involvement, but it causes **pancytopenia** or **anemia** due to bone marrow infiltration by leukemic cells, not a selective aplasia of red cell precursors. - In T-cell ALL, there would be a proliferation of immature lymphoid cells, differentiating it from PRCA. *Non-Hodgkin Lymphoma* - Certain types of **non-Hodgkin lymphoma** (e.g., lymphoblastic lymphoma) can present with a **mediastinal mass**. - However, lymphoma would typically cause **bone marrow infiltration** leading to cytopenias, not specifically **pure red cell aplasia**, where only erythroid precursors are targeted.
Question 93: A 68-year-old male presents with cough, sputum production, bronchial breath sounds, respiratory rate of 20/min, urea of 44 mg/dl, and BP of 110/70 mmHg. What is the next step in management?
- A. Admit in ICU without mechanical ventilation (MV)
- B. Home treatment (Rx)
- C. Admit in ICU with mechanical ventilation (MV)
- D. Room admission (Correct Answer)
- E. Observation in emergency department
Explanation: ***Room admission*** - The patient's **CURB-65 score** is **2** (one point for urea >7 mmol/L [44 mg/dL = 15.7 mmol/L] and one point for age ≥65 years), indicating **moderate mortality risk** and clear need for **hospital admission**. - **CURB-65 score of 2** mandates inpatient admission for monitoring, IV antibiotics if needed, and supportive care in a general medical ward. - While showing signs of respiratory infection, the vital signs are stable and do not meet criteria for ICU admission. *Admit in ICU without mechanical ventilation (MV)* - **ICU criteria** for pneumonia typically include severe respiratory failure, hemodynamic instability (shock requiring vasopressors), or impending organ dysfunction, which are not met. - The patient's respiratory rate (20/min) and blood pressure (110/70 mmHg) are within acceptable limits for a non-ICU setting. - CURB-65 score of 3-5 or presence of major severity criteria would warrant ICU consideration. *Home treatment (Rx)* - **CURB-65 score of 2** precludes outpatient management and requires hospital admission. - Outpatient treatment is only appropriate for CURB-65 scores of 0-1 in patients without other comorbidities. - Given the patient's age (68 years), elevated urea, and presence of **bronchial breath sounds** consistent with consolidative pneumonia, **hospital admission** is mandatory. *Admit in ICU with mechanical ventilation (MV)* - There is no indication of **severe respiratory distress** (e.g., severe hypoxemia with SpO2 <90% on high-flow oxygen, hypercapnia, or respiratory acidosis) that would necessitate immediate mechanical ventilation. - The respiratory rate of 20/min is normal, and there is no mention of altered mental status, severe tachypnea, or increased work of breathing. *Observation in emergency department* - While brief observation may be appropriate for borderline cases, a **CURB-65 score of 2** indicates the patient requires formal hospital admission rather than just ED observation. - The presence of consolidation (bronchial breath sounds) and elevated urea support the need for inpatient ward admission with monitoring and treatment.
Question 94: A patient presents with numb fingertips and tight facial skin. ANA is positive with an immunofluorescence nucleolar pattern. What is the most likely diagnosis?
- A. Systemic lupus erythematosus
- B. Mixed connective tissue disease
- C. Systemic sclerosis (Correct Answer)
- D. Rheumatoid arthritis
Explanation: ***Systemic sclerosis*** - The combination of **numb fingertips** (suggesting Raynaud's phenomenon) and **tight facial skin** (cutaneous fibrosis) is highly characteristic of systemic sclerosis [1]. - A **positive ANA with a nucleolar pattern** is strongly associated with systemic sclerosis, particularly the diffuse cutaneous form, and often indicates the presence of anti-RNA polymerase III, anti-Th/To or anti-U3-RNP (fibrillarin) antibodies. *Systemic lupus erythematosus* - While ANA is positive in SLE, a **nucleolar pattern is uncommon**; common patterns include homogeneous or speckled [1]. - SLE typically presents with **malar rash**, photosensitivity, and arthritis, with tight skin being less common. *Mixed connective tissue disease* - MCTD is characterized by overlapping features of SLE, systemic sclerosis, and polymyositis, with a very high titer of **anti-U1-RNP antibodies** [1]. - While Raynaud's phenomenon can occur, profound skin tightening is less typical than in systemic sclerosis, and the ANA pattern is often speckled. *Rheumatoid arthritis* - RA primarily affects the **synovial joints**, causing pain, swelling, and stiffness (especially in small joints of hands and feet). - A positive ANA is less specific for RA, and neither tight skin nor a nucleolar ANA pattern are characteristic features [1].
Pharmacology
4 questionsA patient has been diagnosed with Primary Open Angle Glaucoma (POAG). On eliciting history, it is observed that the patient is a known case of bronchial asthma. What is the drug of choice for POAG in this patient?
A patient has a history of vomiting and was given an antiemetic. The patient subsequently developed abnormal movements (likely extrapyramidal symptoms or dystonia). What medication should be given to manage these abnormal movements?
Which of the following is false about pheochromocytoma?
A 50-year-old patient with renal insufficiency was recently operated on for pyelolithotomy. Which drug is the most appropriate choice for post-operative analgesia?
NEET-PG 2021 - Pharmacology NEET-PG Practice Questions and MCQs
Question 91: A patient has been diagnosed with Primary Open Angle Glaucoma (POAG). On eliciting history, it is observed that the patient is a known case of bronchial asthma. What is the drug of choice for POAG in this patient?
- A. Gemeprost
- B. Alprostadil
- C. Latanoprost (Correct Answer)
- D. Carboprost
Explanation: ***Latanoprost*** - **Latanoprost** is a **prostaglandin analog** and is considered a **first-line drug of choice** for POAG due to its excellent efficacy and tolerability profile, especially in patients with **bronchial asthma**. - It works by increasing the **uveoscleral outflow** of aqueous humor, thus lowering **intraocular pressure** without causing systemic effects like bronchoconstriction. *Gemeprost* - **Gemeprost** is a **prostaglandin E1 analog** primarily used for **cervical ripening** and **abortion**, not for glaucoma treatment. - It has no role in managing **intraocular pressure** and would be an inappropriate choice for POAG. *Alprostadil* - **Alprostadil** is another **prostaglandin E1 analog** used for **erectile dysfunction** and maintaining **patency of the ductus arteriosus** in neonates. - It does not lower **intraocular pressure** and is not indicated for the treatment of glaucoma. *Carboprost* - **Carboprost** is a **prostaglandin F2α analog** mainly used to **manage postpartum hemorrhage** due to its potent uterotonic effects. - While it is a prostaglandin, it is not used in the treatment of glaucoma and has significant systemic side effects.
Question 92: A patient has a history of vomiting and was given an antiemetic. The patient subsequently developed abnormal movements (likely extrapyramidal symptoms or dystonia). What medication should be given to manage these abnormal movements?
- A. Hyoscine
- B. Methyl dopa
- C. Benzhexol (Correct Answer)
- D. Cyproheptadine
- E. Diphenhydramine
Explanation: ***Benzhexol*** - **Extrapyramidal symptoms (EPS)** and **dystonia** are often caused by dopamine receptor blockade, and **anticholinergic medications** like benzhexol help restore the **dopamine-acetylcholine balance**. - Benzhexol is a **muscarinic antagonist** that effectively reduces drug-induced Parkinsonism, dystonia, and akathisia by acting centrally. - It is the **preferred oral agent** for ongoing management of drug-induced movement disorders. *Diphenhydramine* - Diphenhydramine is an **antihistamine** with **anticholinergic properties** that can be used for **acute dystonic reactions**, particularly when given parenterally (IV/IM). - While effective for acute management, benzhexol is generally preferred for **ongoing oral therapy** and has more potent central anticholinergic effects. *Hyoscine* - While hyoscine is also an **anticholinergic agent**, it is primarily used for preventing **motion sickness** and managing **postoperative nausea and vomiting**. - Its efficacy in reversing acute extrapyramidal symptoms induced by neuroleptics or antiemetics is generally **less pronounced** compared to agents like benzhexol. *Methyl dopa* - Methyl dopa is an **alpha-2 adrenergic agonist** primarily used in the treatment of **hypertension**, especially in pregnancy. - It works by reducing sympathetic outflow and is **not indicated** for managing extrapyramidal symptoms or dystonia. *Cyproheptadine* - Cyproheptadine is an **antihistamine** with **serotonin antagonist** properties, used to treat allergic reactions, appetite stimulation, and occasionally **serotonin syndrome**. - It does not have significant anticholinergic effects that would alleviate medication-induced extrapyramidal symptoms or dystonia.
Question 93: Which of the following is false about pheochromocytoma?
- A. Surgery is the treatment of choice
- B. VMA (vanillylmandelic acid) is a diagnostic test
- C. Propranolol is the preferred drug for hypertension control (Correct Answer)
- D. Catecholamines are a diagnostic test
- E. Most pheochromocytomas are benign
Explanation: ***Propranolol is the preferred drug for hypertension control*** - Propranolol, a **beta-blocker**, is generally contraindicated as monotherapy in pheochromocytoma because blocking beta-receptors unopposed can lead to a **hypertensive crisis** due to unopposed alpha-adrenergic vasoconstriction. - **Alpha-blockers** (e.g., phenoxybenzamine) are the first-line agents for hypertension control, followed by beta-blockers once adequate alpha-blockade is established. *Surgery is the treatment of choice* - **Surgical resection** of the tumor is indeed the definitive treatment for pheochromocytoma once the patient has been appropriately prepared with alpha-blockade. - This approach aims to remove the source of excessive catecholamine production and resolve the associated symptoms. *VMA (vanillylmandelic acid) is a diagnostic test* - **VMA** is a metabolic breakdown product of catecholamines, and its measurement in a **24-hour urine collection** is a long-standing method for diagnosing pheochromocytoma. - Elevated VMA levels indicate overproduction of catecholamines, which is characteristic of the tumor. *Catecholamines are a diagnostic test* - Measuring **plasma free metanephrines** and **24-hour urinary fractionated metanephrines** (which are methylated metabolites of catecholamines) are highly sensitive and specific diagnostic tests for pheochromocytoma. - Elevated levels confirm the excessive secretion of these hormones by the tumor. *Most pheochromocytomas are benign* - Approximately **90% of pheochromocytomas are benign**, with only about 10% being malignant. - The **"rule of 10s"** is a helpful mnemonic: 10% bilateral, 10% extra-adrenal, 10% malignant, 10% familial, and 10% occur in children.
Question 94: A 50-year-old patient with renal insufficiency was recently operated on for pyelolithotomy. Which drug is the most appropriate choice for post-operative analgesia?
- A. Diclofenac sodium
- B. Naproxen
- C. Indomethacin
- D. Acetaminophen (Correct Answer)
- E. Ketorolac
Explanation: ***Acetaminophen*** - **Acetaminophen** is primarily metabolized in the liver, with minimal renal excretion, making it a safer option for patients with **renal insufficiency**. - It provides effective **analgesia** without the adverse renal effects associated with NSAIDs. *Diclofenac sodium* - **Diclofenac** is a non-steroidal anti-inflammatory drug (**NSAID**) that can impair renal function, especially in patients with pre-existing **renal insufficiency**, by inhibiting prostaglandin synthesis. - Its use can lead to further **kidney damage** or exacerbate existing renal impairment. *Naproxen* - **Naproxen** is an **NSAID** that carries a significant risk of causing acute kidney injury in patients with **compromised renal function**. - It reduces renal blood flow and glomerular filtration rate, making it unsuitable for this patient. *Indomethacin* - **Indomethacin** is a potent **NSAID** known for its adverse renal effects, including acute renal failure. - It should be avoided in patients with **renal insufficiency** due to its potential to further decline kidney function. *Ketorolac* - **Ketorolac** is a potent **NSAID** commonly used for post-operative pain but is **contraindicated** in patients with renal insufficiency. - It has significant nephrotoxic potential and can cause acute renal failure, especially in patients with pre-existing kidney disease.
Physiology
1 questionsA hyperventilating patient has the following ABG values: pH=7.53, pCO2=20 mmHg, HCO3= 26 mEq/L. What is the most likely diagnosis?
NEET-PG 2021 - Physiology NEET-PG Practice Questions and MCQs
Question 91: A hyperventilating patient has the following ABG values: pH=7.53, pCO2=20 mmHg, HCO3= 26 mEq/L. What is the most likely diagnosis?
- A. Metabolic alkalosis
- B. Metabolic acidosis
- C. Respiratory alkalosis (Correct Answer)
- D. Respiratory acidosis
Explanation: ***Respiratory alkalosis*** - The pH of 7.53 indicates **alkalemia**, and the low pCO2 (20 mmHg) is the primary driver, signifying **respiratory alkalosis** - A hyperventilating patient exhales more CO2, leading to a decrease in its partial pressure in the blood and a subsequent rise in pH - The HCO3 is within normal range (26 mEq/L), indicating **uncompensated respiratory alkalosis** *Metabolic alkalosis* - This would be characterized by a high pH and an elevated **HCO3**, but the HCO3 is within the normal range (26 mEq/L) - While it causes alkalemia, the primary disturbance here is respiratory, not metabolic *Metabolic acidosis* - This would present with a **low pH** and a low **HCO3**, which is contrary to the given ABG values - The patient's pH is elevated, indicating an alkalotic state, not acidotic *Respiratory acidosis* - This would be defined by a **low pH** and an elevated **pCO2**, which is the exact opposite of the provided ABG results - The patient's high pH and low pCO2 rule out respiratory acidosis