NEET-PG 2021 Practice Questions

Q: A 30-year-old woman presents with flaccid bullae on her skin that are easy to rupture. A biopsy of the lesion reveals a suprabasal split. What is the most likely diagnosis?

Pemphigus vulgaris. ***Pemphigus vulgaris*** - Characterized by **flaccid bullae** that are easily ruptured, and a classic histological finding of a **suprabasal split** in the epidermis, indicating acantholysis just above the basal layer. - Mucosal involvement is common, and the positive **Nikolsky sign** (epidermal detachment with lateral pressure) is often present, which is typical for pemphigus vulgaris due to the superficial nature of the blistering. - The combination of **flaccid bullae + suprabasal split** is pathognomonic for pemphigus vulgaris. *Erythema multiforme* - Typically presents with **targetoid lesions** (concentric rings of erythema) and is often associated with infections, particularly herpes simplex virus (HSV). - Histologically, it shows **interface dermatitis** with vacuolar degeneration of basal cells and scattered necrotic keratinocytes, not a suprabasal split or acantholysis. *Pemphigus vegetans* - A rare variant of pemphigus vulgaris, it presents with **vegetating plaques** in intertriginous areas (axillae, groin), which are eroded but not primarily flaccid bullae covering wide areas. - While it also involves a suprabasal split at the same level as pemphigus vulgaris, the clinical presentation of vegetating plaques rather than widespread flaccid bullae helps differentiate it. *Pemphigus foliaceous* - This autoimmune blistering disease features very **superficial bullae** that rupture so easily they typically present as erosions, crusts, and scaling rather than intact blisters. - Histologically, it shows a **subcorneal or granular layer split** (more superficial than pemphigus vulgaris), not the deeper suprabasal split seen in this patient's biopsy. - Mucosal involvement is **rare** in pemphigus foliaceous, unlike pemphigus vulgaris.

Q: A male patient presents with white discharge from the urethra, as shown in the image. What is the most probable causative organism?

Neisseria gonorrhoeae. ***Neisseria gonorrhoeae*** - Among the given options, *Neisseria gonorrhoeae* is the **most probable causative organism** for **urethral discharge** in males. - Gonorrhea is a common sexually transmitted infection (STI) presenting with **purulent urethritis**, typically with thick, yellow-green discharge, though appearance can vary. - **Clinical note:** While classic gonococcal discharge is purulent and yellow-green, the clinical presentation can vary. None of the other organisms listed cause urethritis with discharge. *Haemophilus ducreyi* - This bacterium causes **chancroid**, a sexually transmitted infection characterized by **painful genital ulcers (chancres)** and **inguinal lymphadenopathy**, not urethral discharge. - Presents with ulcerative lesions, not discharge. *Klebsiella granulomatis* - This organism is responsible for **donovanosis** (granuloma inguinale), which manifests as **painless, progressive ulcerative lesions** on the genitals. - It does not cause urethral discharge; presents with beefy red granulomatous lesions. *Treponema pallidum* - This spirochete causes **syphilis**, which presents with **painless chancres** in the primary stage, **maculopapular rash** in the secondary stage, and gummas or neurological symptoms in later stages. - Urethral discharge is not a typical symptom of syphilis; primary lesions are ulcerative.

Q: A 36-week pregnant woman with mitral stenosis has been on warfarin for anticoagulation. What is the most appropriate next step in her management?

Shift to Low Molecular Weight (LMW) Heparin. ***Shift to Low Molecular Weight (LMW) Heparin*** - At 36 weeks gestation, **warfarin is contraindicated** due to its teratogenic effects and increased risk of **fetal bleeding**, especially during labor and delivery. - **LMW heparin** does not cross the placenta, making it a safer option for both mother and fetus in late pregnancy, and it can be discontinued prior to delivery to reduce bleeding risk. *Continue Warfarin* - Continuing warfarin at 36 weeks could lead to **fetal warfarin syndrome** if exposure occurred earlier, and significantly increases the risk of **fetal intracranial hemorrhage** during labor. - Warfarin has a narrow therapeutic window and requires close monitoring, making it less practical for ensuring fetal safety during an unpredictable labor and delivery. *Aspirin + Heparin* - While heparin is appropriate, the addition of **aspirin** to anticoagulation in a patient already on warfarin for mitral stenosis does not provide significant additional benefit and could **increase bleeding risk**. - **Unfractionated heparin (UFH)** is generally preferred over LMWH for patients requiring rapid reversal or close monitoring around delivery. *Switch to Aspirin* - **Aspirin alone is insufficient** for anticoagulation in a pregnant woman with mitral stenosis who has been on warfarin, as it does not adequately prevent thromboembolic events. - Mitral stenosis carries a high risk of **thrombus formation** and systemic embolization, necessitating more potent anticoagulation than aspirin provides.

Q: A patient with second-degree cervical prolapse complains of dribbling of urine when coughing. What is the most likely diagnosis?

Stress incontinence. ***Stress incontinence*** - **Stress incontinence** is characterized by involuntary urine leakage due to increased **intra-abdominal pressure** (e.g., coughing, sneezing), often associated with **cervical prolapse**. - Pelvic organ prolapse causes a loss of the **urethrovesical angle** and weakens **pelvic floor support**, leading to urethral hypermobility and failure to maintain closure. *Cystitis* - **Cystitis** typically presents with localized symptoms of bladder irritation such as **dysuria**, **frequency**, and **suprapubic pain**. - While it may cause **urgency**, it is not primarily triggered by mechanical factors like coughing or physical exertion. *Overflow incontinence* - **Overflow incontinence** is characterized by a constant dribbling of urine due to a **distended bladder** and incomplete emptying. - It is usually caused by **detrusor underactivity** or **urethral obstruction**, rather than a sudden rise in abdominal pressure. *Functional incontinence* - **Functional incontinence** occurs when patients have normal urinary function but cannot reach the toilet due to **mobility issues** or **cognitive impairment**. - This condition is unrelated to the mechanical integrity of the pelvic floor or **second-degree cervical prolapse**.

Q: A woman presents with a history of recurrent abortions at 8,11 , and 22 weeks, with normal fetal cardiac activity in all three pregnancies. She also has a history of preeclampsia in her last pregnancy. What is the most probable cause?

Antiphospholipid Antibody Syndrome (APLA). ***Antiphospholipid Antibody Syndrome (APLA)*** - The presentation of **recurrent abortions** (especially with normal fetal cardiac activity) and a history of **preeclampsia** is highly characteristic of Antiphospholipid Antibody Syndrome (APLA). - In APLA, antibodies cause **thrombosis** in the placental vasculature, leading to placental insufficiency, fetal loss, and complications like preeclampsia. *Syphilis* - While syphilis can cause fetal loss, it typically presents with **hydrops fetalis**, hepatosplenomegaly, and bone abnormalities, rather than recurrent losses with normal cardiac activity in the early stages. - Untreated syphilis usually leads to congenital syphilis or stillbirths later in pregnancy, not necessarily early recurrent abortions with good fetal heart tones. *Gestational Diabetes Mellitus (GDM)* - GDM is associated with complications like **macrosomia**, polyhydramnios, and an increased risk of shoulder dystocia, but it is not a direct cause of recurrent early and mid-trimester abortions with normal fetal cardiac activity. - While poorly controlled diabetes can affect fetal development and pregnancy outcomes, it does not typically manifest as recurrent unexplained fetal demise with this specific presentation. *TORCH infections* - TORCH infections (Toxoplasmosis, Other [syphilis, varicella-zoster, parvovirus B19], Rubella, Cytomegalovirus, and Herpes simplex virus) can cause congenital anomalies and fetal death. - However, they would usually present with specific fetal abnormalities, signs of infection, or hydrops, and not typically with recurrent, apparently healthy fetal losses followed by preeclampsia, as often seen in APLA.

Q: What is a potential consequence of administering indomethacin beyond 36 weeks of gestation?

Premature closure of the patent ductus arteriosus (PDA). ***Premature closure of the patent ductus arteriosus (PDA)*** - **Indomethacin**, a non-steroidal anti-inflammatory drug (NSAID), inhibits **prostaglandin synthesis**, which is crucial for maintaining PDA patency in utero. - **Premature closure of the PDA** beyond 36 weeks of gestation can lead to **pulmonary hypertension** and **fetal heart failure**, as blood flow through the fetal circulation would be significantly altered. - This is the **most serious cardiovascular complication** of indomethacin use in late pregnancy. *Teratogenic* - While some medications can be teratogenic (cause birth defects), **indomethacin** is not generally considered to have a significant teratogenic risk when used in the third trimester. - The primary concern with NSAID use in late pregnancy is related to their effects on fetal circulation and renal function, not structural anomalies. *No effect* - This statement is incorrect because **indomethacin** has well-documented and significant effects on fetal circulation, particularly on the **ductus arteriosus**, especially in the third trimester. - Its mechanism of action profoundly impacts the maintenance of the fetal circulatory shunts. *Still birth* - While **indomethacin** use in late pregnancy can lead to serious fetal complications such as **pulmonary hypertension** and **renal dysfunction**, leading to **fetal compromise**, it does not directly or exclusively cause stillbirth. - The specific and most direct consequence on the cardiovascular system is the premature closure of the PDA. *Oligohydramnios* - While **oligohydramnios** (decreased amniotic fluid) can occur with prolonged NSAID use due to **decreased fetal urine output** from renal effects, this is not the primary concern beyond 36 weeks. - The more immediate and serious risk is **premature PDA closure** with its cardiovascular consequences.

Q: What is the most suitable antibiotic to treat the condition shown in the image ?

Amoxicillin & Clavulanic Acid. ***Amoxicillin & Clavulanic Acid*** - The image shows a **paronychia** (an infection around the fingernail), likely bacterial, which typically involves **Gram-positive cocci** like *Staphylococcus aureus* or *Streptococcus spp.* - **Amoxicillin & Clavulanic Acid** is a broad-spectrum antibiotic effective against these common skin pathogens, including **beta-lactamase producing strains** of *Staphylococcus aureus* - This is the **first-line empiric treatment** for uncomplicated paronychia *Norfloxacin* - **Norfloxacin** is a **fluoroquinolone** primarily used for **urinary tract infections** and some gastrointestinal infections - It has limited efficacy against the common skin flora responsible for paronychia and is not a first-line choice for skin and soft tissue infections *Metronidazole* - **Metronidazole** is an antibiotic primarily effective against **anaerobic bacteria** and certain parasites - Paronychia is typically caused by aerobic bacteria, making metronidazole an inappropriate choice for empiric treatment *Amikacin* - **Amikacin** is an **aminoglycoside** antibiotic, usually reserved for serious Gram-negative bacterial infections due to its potential **ototoxicity** and **nephrotoxicity** - It is administered intravenously and is not suitable for a localized skin infection like paronychia unless there are severe systemic complications *Ciprofloxacin* - **Ciprofloxacin** is a **fluoroquinolone** with broader coverage than norfloxacin, including some Gram-positive organisms - However, it has **suboptimal activity against Streptococcus species** and methicillin-susceptible *S. aureus* compared to beta-lactam antibiotics - FDA guidelines recommend **avoiding fluoroquinolones for uncomplicated infections** due to serious side effects (tendon rupture, peripheral neuropathy) when safer alternatives exist

Q: What is the function of the umbilical artery in fetal circulation?

Carry deoxygenated blood from the fetus to the placenta. ***Carry deoxygenated blood from the fetus to the placenta*** - The **umbilical arteries** are responsible for transporting **deoxygenated blood** and waste products away from the fetal circulation to the placenta. - There are typically **two umbilical arteries** that branch off the internal iliac arteries of the fetus. *Provide nutrients* - **Nutrient delivery** to the fetus is primarily a function of the **umbilical vein**, which carries oxygenated and nutrient-rich blood from the placenta. - The umbilical arteries carry metabolic waste products away from the fetus, not nutrients to it. *None of the options* - This option is incorrect because one of the provided options accurately describes the function of the umbilical artery. - The specific role of the umbilical artery is distinct from other fetal circulatory components. *Carry oxygenated blood from the placenta to the fetus* - This function is performed by the **umbilical vein**, which brings **oxygen-rich blood** and nutrients from the placenta to the fetus. - The umbilical arteries carry blood in the opposite direction and with a different oxygenation status.

Question 1

A 30-year-old woman presents with flaccid bullae on her skin that are easy to rupture. A biopsy of the lesion reveals a suprabasal split. What is the most likely diagnosis?

Accepted Answer

Pemphigus vulgaris

Answer

Erythema multiforme

Answer

Pemphigus vegetans

Answer

Pemphigus foliaceous

Question 2

A male patient presents with white discharge from the urethra, as shown in the image. What is the most probable causative organism?

Accepted Answer

Neisseria gonorrhoeae

Answer

Haemophilus ducreyi

Answer

Klebsiella granulomatis

Answer

Treponema pallidum

Question 3

A female patient missed her oral contraceptive pill (OCP) on four different days during the first two weeks of her menstrual cycle. What is the most appropriate advice for her?

Accepted Answer

Continue current pack, consider additional contraceptive method for remaining days

Answer

Adopt another method of contraception

Answer

Continue taking the pill

Answer

Take all 4 pills at once and continue taking pills

Question 4

A 36-week pregnant woman with mitral stenosis has been on warfarin for anticoagulation. What is the most appropriate next step in her management?

Accepted Answer

Shift to Low Molecular Weight (LMW) Heparin

Answer

Continue Warfarin

Answer

Aspirin + Heparin

Answer

Switch to Aspirin

Question 5

A patient with second-degree cervical prolapse complains of dribbling of urine when coughing. What is the most likely diagnosis?

Accepted Answer

Stress incontinence

Answer

Cystitis

Answer

Overflow incontinence

Answer

Functional incontinence

Question 6

A woman presents with a history of recurrent abortions at 8,11 , and 22 weeks, with normal fetal cardiac activity in all three pregnancies. She also has a history of preeclampsia in her last pregnancy. What is the most probable cause?

Accepted Answer

Antiphospholipid Antibody Syndrome (APLA)

Answer

Syphilis

Answer

Gestational Diabetes Mellitus (GDM)

Answer

TORCH infections

Question 7

What is a potential consequence of administering indomethacin beyond 36 weeks of gestation?

Accepted Answer

Premature closure of the patent ductus arteriosus (PDA)

Answer

Teratogenic

Answer

No effect

Answer

Still birth

Answer

Oligohydramnios

Question 8

What is the most suitable antibiotic to treat the condition shown in the image ?

Accepted Answer

Amoxicillin & Clavulanic Acid

Answer

Norfloxacin

Answer

Metronidazole

Answer

Amikacin

Answer

Ciprofloxacin

Question 9

A patient on multidrug therapy (MBMDT) for leprosy presents with inflammation over preexisting lesions and nerve involvement. What is the best approach for treatment?

Accepted Answer

Continue anti-leprosy treatment (ALT) and start steroids

Answer

Continue anti-leprosy treatment (ALT) and start thalidomide

Answer

Stop anti-leprosy treatment (ALT) and start thalidomide

Answer

Stop anti-leprosy treatment (ALT) and start steroids

Answer

Stop anti-leprosy treatment (ALT) temporarily and reassess

Question 10

What is the function of the umbilical artery in fetal circulation?

Accepted Answer

Carry deoxygenated blood from the fetus to the placenta

Answer

Provide nutrients

Answer

None of the options

Answer

Carry oxygenated blood from the placenta to the fetus

NEET-PG 2021

Dermatology

Microbiology

OB/GYN

Obstetrics and Gynecology

Pharmacology

Physiology