NEET-PG 2021 Practice Questions

Q: 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?

Folate deficiency. ***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.

Q: A young male presents with acute redness of the eye. His X-ray of the spine is shown below. What is the most likely condition?

Ankylosing Spondylitis. ***Ankylosing Spondylitis*** - The young male presenting with **acute redness of the eye** (uveitis) and a spinal X-ray showing changes consistent with **bamboo spine** (fusion of vertebrae due to syndesmophyte formation) is highly indicative of ankylosing spondylitis. - This condition is a chronic inflammatory disorder primarily affecting the **axial skeleton** (spine and sacroiliac joints) and is often associated with extra-articular manifestations like **uveitis**. *Psoriatic Arthritis* - While psoriatic arthritis can affect the spine and cause uveitis, the characteristic imaging findings in the provided X-ray, particularly the **bamboo spine**, are more classical for ankylosing spondylitis. - Psoriatic spondylitis often presents with more asymmetric and less diffuse spinal involvement compared to ankylosing spondylitis. *Rheumatoid Arthritis* - Rheumatoid arthritis primarily affects the **peripheral joints** (e.g., small joints of hands and feet) and typically spares the axial skeleton, except for involvement of the **cervical spine**. - **Uveitis** is a rare extra-articular manifestation in rheumatoid arthritis, and the X-ray findings are not typical for this condition. *Sjögren Syndrome* - Sjögren syndrome is a chronic autoimmune disease characterized by **dry eyes** (keratoconjunctivitis sicca) and **dry mouth** (xerostomia) due to lymphocytic infiltration of exocrine glands. - While it can cause some joint pain, it does not typically lead to the characteristic spinal changes seen on the X-ray or acute uveitis.

Q: A patient presents with a mediastinal mass and is diagnosed with pure red cell aplasia. What is the most probable underlying cause?

Thymic neoplasia. ***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.

Q: A patient presents with numb fingertips and tight facial skin. ANA is positive with an immunofluorescence nucleolar pattern. What is the most likely diagnosis?

Systemic sclerosis. ***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].

Q: 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?

Latanoprost. ***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.

Q: 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?

Benzhexol. ***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.

Q: Which of the following is false about pheochromocytoma?

Propranolol is the preferred drug for hypertension control. ***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.

Q: 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?

Acetaminophen. ***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.

Question 1

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?

Accepted Answer

Folate deficiency

Answer

Cyanocobalamin deficiency

Answer

Acute blood loss

Answer

Sideroblastic anemia

Answer

Iron deficiency anemia

Question 2

A young male presents with acute redness of the eye. His X-ray of the spine is shown below. What is the most likely condition?

Accepted Answer

Ankylosing Spondylitis

Answer

Psoriatic Arthritis

Answer

Rheumatoid Arthritis

Answer

Sjögren Syndrome

Question 3

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?

Accepted Answer

Add Clopidogrel

Answer

LMWH (Low Molecular Weight Heparin)

Answer

Increase beta blocker dose

Answer

IV NTG Drip

Answer

Arrange urgent coronary angiography

Question 4

A patient presents with a mediastinal mass and is diagnosed with pure red cell aplasia. What is the most probable underlying cause?

Accepted Answer

Thymic neoplasia

Answer

Bronchogenic carcinoma

Answer

T-cell Acute Lymphoblastic Leukemia

Answer

Non-Hodgkin Lymphoma

Question 5

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?

Accepted Answer

Room admission

Answer

Admit in ICU without mechanical ventilation (MV)

Answer

Home treatment (Rx)

Answer

Admit in ICU with mechanical ventilation (MV)

Answer

Observation in emergency department

Question 6

A patient presents with numb fingertips and tight facial skin. ANA is positive with an immunofluorescence nucleolar pattern. What is the most likely diagnosis?

Accepted Answer

Systemic sclerosis

Answer

Systemic lupus erythematosus

Answer

Mixed connective tissue disease

Answer

Rheumatoid arthritis

Question 7

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?

Accepted Answer

Latanoprost

Answer

Gemeprost

Answer

Alprostadil

Answer

Carboprost

Question 8

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?

Accepted Answer

Benzhexol

Answer

Hyoscine

Answer

Methyl dopa

Answer

Cyproheptadine

Answer

Diphenhydramine

Question 9

Which of the following is false about pheochromocytoma?

Accepted Answer

Propranolol is the preferred drug for hypertension control

Answer

Surgery is the treatment of choice

Answer

VMA (vanillylmandelic acid) is a diagnostic test

Answer

Catecholamines are a diagnostic test

Answer

Most pheochromocytomas are benign

Question 10

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?

Accepted Answer

Acetaminophen

Answer

Diclofenac sodium

Answer

Naproxen

Answer

Indomethacin

Answer

Ketorolac

NEET-PG 2021

Biochemistry

Internal Medicine

Pharmacology