NEET-PG 2022 Practice Questions

Q: Based on the provided wound characteristics, identify the type of firearm used and the estimated range of the shot.

Pistol, close shot. ***Pistol, close shot*** - The wound shows **soot deposition (blackening/fouling)** around the entry point, which is characteristic of a **close shot** fired within the **flame distance** (~8 cm). - **Close shots** produce both **soot blackening** and **powder tattooing (stippling)**, distinguishing them from near shots which show only tattooing. *Shotgun, intermediate range* - Shotgun wounds at intermediate range produce **multiple scattered pellet wounds** with a **dispersed pattern**, not a single entry wound. - There would be **no soot or powder burns** at intermediate range due to the greater distance. *Shotgun, close range* - Close range shotgun wounds create **large, ragged wounds** with **extensive tissue destruction** due to the **shot column** and **wadding impact**. - The wound pattern would be **much larger and more irregular** than the single projectile entry seen here. *Pistol, near shot* - **Near shots** (3-24 inches) show **powder tattooing only** without any **soot deposition** or blackening around the wound. - The presence of **soot blackening** in this image rules out a near shot classification.

Q: A 45-year-old female patient is told about the benefits and complications of a hysterectomy, and she agrees to the procedure. What kind of consent is this?

Informed consent. ***Informed consent*** - This type of consent occurs when a patient is fully educated about the proposed treatment, including its **benefits, risks, and alternatives**, and voluntarily agrees to proceed. - It ensures the patient has adequate information to make an **autonomous decision** about their healthcare. *Implied consent* - This consent is inferred from a patient's **actions or conduct**, rather than being explicitly stated or written. - Examples include extending an arm for a blood draw or arriving at an appointment for a specific test. *Opt-out consent* - This model assumes agreement unless the individual explicitly **refuses or declines** participation. - It is commonly used in organ donation systems, where individuals are presumed donors unless they register otherwise. *Passive consent* - This usually refers to situations where explicit consent is not sought but also explicitly not denied, such as when parents are informed about a school health program and are given the opportunity to decline, but if they don't, consent is assumed. - It is less formal than informed consent and typically used for **low-risk interventions** or data collection.

Q: A patient on anti-depressants presented to you with hypotension. An ECG was done, which showed wide QRS complexes and right axis deviation. How will you manage this patient?

Intravenous sodium bicarbonate for TCA-induced arrhythmias. Intravenous sodium bicarbonate for TCA-induced arrhythmias - The patient's presentation with **hypotension**, **wide QRS complexes**, and **right axis deviation** in the context of antidepressant use is highly suggestive of **Tricyclic Antidepressant (TCA) toxicity**. [1] - **Sodium bicarbonate** improves cardiac function by increasing plasma sodium and alkalizing the blood, which reduces the binding of TCAs to myocardial fast sodium channels and alleviates cardiotoxicity. [1] *Use of antiarrhythmics* - Many antiarrhythmics, particularly **Class IA and IC agents**, block sodium channels and could exacerbate TCA-induced cardiotoxicity. [1] - Furthermore, antiarrhythmics may worsen hypotension and prolong the QRS interval in TCA overdose. *Administration of propranolol* - **Propranolol** is a non-selective beta-blocker that can worsen **hypotension** and **bradycardia**, which are common in TCA overdose. - It would not address the primary issue of **sodium channel blockade** caused by TCAs. *Use of phenytoin* - **Phenytoin** acts by blocking sodium channels and is used for certain arrhythmias, but its efficacy in TCA toxicity is limited and can be proarrhythmic. - **Sodium bicarbonate** is the preferred treatment as it is more effective at reversing the cardiotoxic effects of TCAs. [1]

Q: A hypertensive patient who is non-compliant with medication presents to you with sudden onset breathlessness. A chest x-ray was done, which is shown below. How will you manage this patient?

Intravenous nitroglycerin. ***Intravenous nitroglycerin*** - The chest X-ray shows diffuse bilateral infiltrates and **cardiomegaly**, consistent with **pulmonary edema** due to **acute decompensated heart failure** in a hypertensive patient. - **Intravenous nitroglycerin** is crucial for patients with acute cardiogenic pulmonary edema, as it **reduces preload and afterload**, thereby decreasing pulmonary congestion and improving breathlessness. *Intravenous salbutamol* - **Salbutamol** is a **bronchodilator** used for bronchospasm in conditions like asthma or COPD. - It would not address the underlying pathology of **pulmonary edema** and could potentially worsen the condition by causing **tachycardia** and increasing myocardial oxygen demand. *Nebulization with salbutamol* - Similar to intravenous salbutamol, nebulized salbutamol is used for **bronchospasm** and is ineffective in treating **cardiogenic pulmonary edema**. - There is no indication of airway constriction, and its systemic effects could paradoxically **exacerbate heart failure**. *Oxygen and antibiotics* - While **oxygen** is always indicated for hypoxemia, it alone is insufficient to manage severe **pulmonary edema**. - **Antibiotics** are used to treat bacterial infections, but there are no signs of infection (e.g., fever, purulent sputum) to suggest **pneumonia** as the primary cause of breathlessness; the X-ray findings are more typical of edema.

Q: A 40-year-old man with a known case of hypertension presented with multiple episodes of hematuria and loin pain. His elder brother passed away due to a stroke at the age of 40. What is the probable diagnosis based on the clinical presentation?

Autosomal dominant polycystic kidney disease. ***Autosomal dominant polycystic kidney disease*** - The patient's presentation with **pain**, **hematuria**, and **hypertension** is typical for **ADPKD**. The family history of a brother dying of a **stroke** at a young age suggests a genetic predisposition to vascular abnormalities, common in ADPKD. - **Cerebral aneurysms**, which can lead to stroke, are a known extranal manifestation of ADPKD, and early onset stroke in a sibling strengthens the diagnosis despite it not being the defining feature of ADPKD itself. *Renal cell carcinoma* - While **hematuria**, **loin pain**, and **hypertension** can be symptoms of renal cell carcinoma, the bilateral nature of the cysts seen in the image and the family history of **early stroke** make ADPKD a more probable diagnosis. - Renal cell carcinoma usually presents as a **unilateral** solid mass, not diffuse cystic changes in both kidneys. *Tuberculosis of the kidney* - Renal tuberculosis would present with symptoms like sterile pyuria, dysuria, and flank pain, but less commonly with the dramatic cystic changes and family history of stroke seen here. - The imaging would typically show cavitary lesions or hydronephrosis rather than widespread bilateral cysts. *Autosomal recessive polycystic kidney disease* - **ARPKD** typically presents in **infancy or childhood** with severe renal failure and liver involvement. - The patient's age (40 years) makes ARPKD highly unlikely, as individuals with this condition rarely survive into adulthood without significant medical intervention.

Q: A female patient presents with complaints of thick white vaginal secretions. Which of the following can be used to identify the likely species of the causative agent?

CHROMagar. ***CHROMagar*** - **CHROMagar Candida** is a differential and selective medium used for the isolation and presumptive identification of common yeast species, including *Candida albicans*, *Candida tropicalis*, and *Candida glabrata*, based on chromogenic reactions. - Different *Candida* species produce distinct colonies of varying colors on this medium, aiding in their **presumptive identification** directly from patient samples like vaginal secretions. *Birdseed agar* - This medium (also known as Staib's medium or Niger seed agar) is primarily used for the isolation and identification of **Cryptococcus neoformans**, which produces dark brown to black colonies due to its phenoloxidase activity. - While it's a fungal growth medium, it is not optimized for distinguishing common *Candida* species responsible for vaginal candidiasis. *Brain heart infusion agar* - **Brain heart infusion (BHI) agar** is a general-purpose, enriched non-selective medium used for the cultivation of a wide variety of fastidious bacteria, yeasts, and molds. - It does not contain differential components that would allow for the specific identification or differentiation of *Candida* species based on colony color or morphology. *Sabouraud dextrose agar* - **Sabouraud dextrose agar (SDA)** is a selective medium primarily used for the isolation and cultivation of pathogenic and nonpathogenic fungi, including yeasts and molds. - While *Candida* species will grow well on SDA, it does not provide differential characteristics (like distinct colony colors) to allow for the presumptive identification and differentiation of various *Candida* species.

Q: A diabetic patient presents to you with visual acuity of 6/9 in one eye. Further investigations revealed preretinal hemorrhages with neovascularization at the optic disc. What is the next step in management?

Pan-retinal photocoagulation. ***Pan-retinal photocoagulation*** - The presence of **preretinal hemorrhages** and **neovascularization at the optic disc (NVD)** indicates **high-risk proliferative diabetic retinopathy (PDR)**. - **NVD is a high-risk characteristic** for severe vision loss and requires urgent treatment with **pan-retinal photocoagulation (PRP)**. - PRP aims to ablate ischemic peripheral retina, which reduces the production of **VEGF** and other angiogenic factors that stimulate neovascularization. *Focal laser photocoagulation* - This treatment targets discrete leaking microaneurysms in cases of **clinically significant macular edema (CSME)**, which is not the primary issue here. - It is used for **non-proliferative diabetic retinopathy** with macular involvement, not for neovascularization. *Grid laser photocoagulation* - Grid laser is a type of focal laser used for **diffuse macular edema** where specific leaking microaneurysms cannot be identified. - It is not indicated for **neovascularization** or **preretinal hemorrhages**, which are signs of PDR. *Scleral buckling* - **Scleral buckling** is a surgical procedure primarily used to treat **retinal detachment** by indenting the sclera to relieve vitreoretinal traction. - It is not the initial or primary treatment for **proliferative diabetic retinopathy** or **neovascularization**.

Q: A middle aged male patient presents with painless slow growing neck swelling. On examination, lymph nodes are positive. Surgery is done and biopsy is shown in the image below. Which of the following is false regarding the HPE findings?

FNAC is not diagnostic. ***Fine needle aspiration cytology (FNAC) is not diagnostic*** - FNAC can often provide significant insights, but in cases of **specific malignancies** or certain lesions, it may not yield definitive diagnoses [1]. - Diagnostic challenges arise as **cellular architecture** or certain **nuclear features** may not be appreciated in FNAC samples [1]. *It spreads quickly via lymphatics* - This condition can indeed spread via lymphatics, making it **aggressive** in nature [1]. - **Lymphatic spread** is a common pathway for many head and neck conditions, particularly malignancies [1]. *Excellent prognosis is associated with this condition* - While some conditions may have favorable prognoses, many midline neck lesions can have **serious implications** depending on their nature [1]. - Prognosis often varies widely and may not always be classified as **excellent** based solely on initial presentation [1]. *Nuclear characteristics are used for the identification* - Nuclear morphology is critical for identifying various **neoplastic conditions**, aiding in differentiation from benign lesions [1][2]. - Many pathologies, especially those involving **malignancy**, rely heavily on **nuclear features** for accurate diagnosis [1][2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1101-1102. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1100-1101.

Question 1

Based on the provided wound characteristics, identify the type of firearm used and the estimated range of the shot.

Accepted Answer

Pistol, close shot

Answer

Shotgun, intermediate range

Answer

Shotgun, close range

Answer

Pistol, near shot

Question 2

A 45-year-old female patient is told about the benefits and complications of a hysterectomy, and she agrees to the procedure. What kind of consent is this?

Accepted Answer

Informed consent

Answer

Implied consent

Answer

Opt-out consent

Answer

Passive consent

Question 3

A surgeon is called to perform an emergency operation after attending a party. During the operation, the assisting staff notices the surgeon's hands shaking and instruments falling from his grasp. He eventually nicks an artery, leading to the patient's collapse and significant blood loss. Under which legal term is this incident most likely to be classified in Indian medical jurisprudence?

Accepted Answer

Criminal negligence in medical practice

Answer

Civil negligence

Answer

Medical error

Answer

Informed consent violation

Question 4

A patient on anti-depressants presented to you with hypotension. An ECG was done, which    showed wide QRS complexes and right axis deviation. How will you manage this patient?

Accepted Answer

Intravenous sodium bicarbonate for TCA-induced arrhythmias

Answer

Use of antiarrhythmics

Answer

Administration of propranolol

Answer

Use of phenytoin

Question 5

A hypertensive patient who is non-compliant with medication presents to you with sudden onset breathlessness. A chest x-ray was done, which is shown below. How will you manage this patient?

Accepted Answer

Intravenous nitroglycerin

Answer

Intravenous salbutamol

Answer

Nebulization with salbutamol

Answer

Oxygen and antibiotics

Question 6

A 40-year-old man with a known case of hypertension presented with multiple episodes of hematuria and loin pain. His elder brother passed away due to a stroke at the age of 40. What is the probable diagnosis based on the clinical presentation?

Accepted Answer

Autosomal dominant polycystic kidney disease

Answer

Renal cell carcinoma

Answer

Tuberculosis of the kidney

Answer

Autosomal recessive polycystic kidney disease

Question 7

A female patient presents with complaints of thick white vaginal secretions. Which of the following can be used to identify the likely species of the causative agent?

Accepted Answer

CHROMagar

Answer

Brain heart infusion agar

Answer

Sabouraud dextrose agar

Answer

Birdseed agar

Question 8

A diabetic patient presents to you with visual acuity of 6/9 in one eye. Further investigations revealed preretinal hemorrhages with neovascularization at the optic disc. What is the next step in management?

Accepted Answer

Pan-retinal photocoagulation

Answer

Focal laser photocoagulation

Answer

Grid laser photocoagulation

Answer

Scleral buckling

Question 9

A middle aged male patient presents with painless slow growing neck swelling. On examination, lymph nodes are positive. Surgery is done and biopsy is shown in the image below. Which of the following is false regarding the HPE findings?

Accepted Answer

FNAC is not diagnostic

Answer

Spread is through lymphatics

Answer

Nuclear features are the characteristic of this tumor

Answer

It has excellent prognosis

Question 10

A 7 – year old boy presented with abdominal pain, vomiting, oliguria, and periorbital puffiness    following chemotherapy. Investigations reveal hyperuricemia, raised creatinine levels, and    hyperkalemia. What is the next best step in the management of this condition ?

Accepted Answer

Hydration

Answer

Probenecid

Answer

Allopurinol

Answer

Rasburicase

NEET-PG 2022

Forensic Medicine

Internal Medicine

Microbiology

Ophthalmology

Pathology

Pediatrics