NEET-PG 2023 Practice Questions

Q: An infant is brought by his parents with complaints that his urine turns black on standing. Which of the following metabolic disorders is likely?

Alkaptonuria. ***Alkaptonuria*** - **Alkaptonuria** is an autosomal recessive disorder characterized by a deficiency of **homogentisate 1,2-dioxygenase**, an enzyme involved in the metabolism of tyrosine. - The accumulation of **homogentisic acid** in tissues and urine causes the urine to turn black on standing due to oxidation. *Phenylketonuria* - **Phenylketonuria (PKU)** is caused by a deficiency of **phenylalanine hydroxylase**, leading to the accumulation of phenylalanine. - While it can manifest with intellectual disability and neurological symptoms, it does not typically cause the urine to turn black. *Homocystinuria* - **Homocystinuria** is a disorder of methionine metabolism, typically due to a deficiency of **cystathionine beta-synthase**. - It is characterized by intellectual disability, skeletal abnormalities, and lens dislocation, but not black urine. *Maple syrup urine disease* - **Maple syrup urine disease (MSUD)** results from a deficiency of **branched-chain alpha-keto acid dehydrogenase complex**, leading to the accumulation of branched-chain amino acids. - The distinguishing feature is urine that smells like maple syrup, not turning black.

Q: In a village, it is observed that several farmers have crossed gait and use a stick for support to stand up and walk. Due to poor yield from farms, they consume meals containing rice and pulses only. Supplementing their diet with which of the following vitamins could have prevented neurological symptoms associated with their condition?

Vitamin B1 (Thiamine). ***Vitamin B1 (Thiamine)*** - The symptoms described, such as **crossed gait** (ataxia) and difficulty standing and walking, are classic signs of **neurological dysfunction**. A diet primarily of **rice and pulses** is often deficient in thiamine, especially in regions where polished rice is a staple. - Deficiency in thiamine leads to **beriberi**, which can manifest as **dry beriberi** (neurological symptoms) or **wet beriberi** (cardiovascular symptoms). *Vitamin A* - Deficiency primarily affects **vision** (e.g., **night blindness**, xerophthalmia) and **immune function**, not gait or neurological coordination in this manner. - While essential for health, its deficiency does not typically present with the described neurological signs. *Vitamin D* - Deficiency primarily affects **bone health**, leading to conditions like **rickets in children** and **osteomalacia in adults**, causing bone pain and muscle weakness, but not typically a crossed gait. - It plays a role in calcium and phosphate metabolism, essential for bone mineralization. *Vitamin C* - Deficiency causes **scurvy**, characterized by **gingival bleeding**, **poor wound healing**, and **petechiae**, due to impaired collagen synthesis. - It does not directly cause the neurological symptoms or gait abnormalities described in the scenario.

Q: A child presents with intermittent jaundice and splenomegaly. There is a history of similar complaints in the elder brother. Peripheral smear shows the following finding. What is the most appropriate investigation for this condition?

Osmotic fragility test. ***Osmotic fragility test*** - The image shows **spherocytes** (dense, small red cells lacking central pallor), a hallmark of **hereditary spherocytosis**. The clinical picture of intermittent jaundice, splenomegaly, and a family history further supports this diagnosis. - The **osmotic fragility test** measures the red blood cell's susceptibility to hemolysis in hypotonic solutions and is the most appropriate test to confirm hereditary spherocytosis. *Coombs test* - The Coombs test (direct antiglobulin test) detects **antibodies on the surface of red blood cells** or in the serum. It is primarily used to diagnose **autoimmune hemolytic anemia**. - Hereditary spherocytosis is a membrane defect, not an immune-mediated condition, so the Coombs test would typically be negative. *G6PD deficiency testing* - **Glucose-6-phosphate dehydrogenase (G6PD) deficiency** leads to episodic hemolytic anemia triggered by oxidative stress (e.g., fava beans, certain drugs, infections). - While it causes episodic hemolysis and jaundice, the peripheral smear typically shows **Heinz bodies** and **bite cells** during hemolytic episodes, not spherocytes, and without specific triggers, it doesn't fit the clinical picture as well as hereditary spherocytosis. *Flow cytometry for PNH* - **Flow cytometry** is used to diagnose **paroxysmal nocturnal hemoglobinuria (PNH)** by detecting the absence of GPI-anchored proteins (e.g., CD55, CD59) on blood cells. - PNH is characterized by dark urine (hemoglobinuria), thrombosis, and bone marrow failure, and its peripheral smear does not typically show spherocytes.

Q: A man presents with a history of dysuria and urethral discharge after having unprotected sexual intercourse. What is the treatment of choice for this infection?

Ceftriaxone. ***Ceftriaxone*** - The combination of **dysuria** and **urethral discharge** following unprotected sexual intercourse is highly suggestive of **gonorrhea**. - **Ceftriaxone** is the recommended first-line treatment for uncomplicated gonococcal infections due to increasing antibiotic resistance. *Erythromycin* - Erythromycin is primarily used for atypical bacterial infections, such as those caused by *Mycoplasma pneumoniae* or *Chlamydia trachomatis*. - While it can be used for chlamydia, it is not the preferred treatment for suspected gonorrhea. *Azithromycin* - Azithromycin is often used in combination with ceftriaxone for gonorrhea to cover potential co-infection with **Chlamydia trachomatis**. - However, **monotherapy with azithromycin is not recommended for gonorrhea** due to concerns about emerging resistance and suboptimal efficacy. *Penicillin G* - Penicillin G was historically used to treat gonorrhea, but this is no longer the case due to widespread **resistance** of *Neisseria gonorrhoeae* strains. - Its primary use now is for susceptible bacterial infections, such as syphilis and certain streptococcal infections.

Q: An infant presents with hepatosplenomegaly and thrombocytopenia. Neuroimaging with CT shows periventricular calcifications. What is the most likely diagnosis?

Congenital cytomegalovirus infection. ***Congenital cytomegalovirus infection*** - **Periventricular calcifications** on neuroimaging are a classic and highly suggestive finding for congenital CMV infection. - **Hepatosplenomegaly** and **thrombocytopenia** are common systemic manifestations of congenital CMV, which can be severe. *Congenital rubella syndrome* - Rubella typically causes **sensorineural hearing loss**, ocular abnormalities (e.g., cataracts), and congenital heart defects (e.g., patent ductus arteriosus), rather than periventricular calcifications. - While hepatosplenomegaly and thrombocytopenia can occur, the specific brain calcification pattern points away from rubella. *Congenital herpes simplex virus infection* - HSV infection in neonates presents with a variety of symptoms, including skin vesicles, keratoconjunctivitis, and seizures. - Brain imaging often shows **focal necrosis** or **encephalitis**, not typically periventricular calcifications unless it's a very widespread and destructive process. *Congenital toxoplasmosis* - Congenital toxoplasmosis classic triad includes **chorioretinitis**, **hydrocephalus**, and **intracranial calcifications**, but these calcifications are typically scattered or diffuse rather than strictly periventricular. - While hepatosplenomegaly and thrombocytopenia can be present, the specific location of calcifications is a key differentiating factor.

Q: Which of the following is the best sign to indicate adequate growth in an infant with a birth weight of 2.8 kg?

Increase in length of 25 centimetres in the first year. ***Increase in length of 25 centimetres in the first year*** - A **25 cm increase in length during the first year** is a normal and expected growth rate for infants, indicating adequate overall growth and development since overall length growth is a sensitive indicator of good health. - This corresponds to roughly a **50% increase in birth length** (which is typically around 50 cm), demonstrating appropriate linear growth. *Weight gain of 300 grams per month till 1 year* - While weight gain is crucial, an infant typically **gains more than 300 grams per month** in the early months (e.g., 500-1000g/month for the first 3-4 months) and then the rate slows. - This value represents an **average over the entire year** and may not reflect adequate growth during periods of rapid weight gain. *Anterior fontanelle closure by 6 months of age* - The **anterior fontanelle typically closes between 10 to 18 months of age**, with closure as early as 6 months being within the normal range but not the *best* indicator of overall growth. - While fontanelle closure is an important developmental milestone, it is **not a direct measure of growth in length or weight**, which are more indicative of nutritional status. *Weight under the 75th percentile and height under the 25th percentile* - Having weight under the 75th percentile and height under the 25th percentile means the **child is growing disproportionately**, which could suggest a growth problem or underlying health issue. - **Optimal growth** is typically indicated when weight and height measurements fall within a similar percentile range, generally between the 25th and 75th percentiles.

Q: A patient with a malignancy is undergoing chemotherapy. The platelet counts were reduced after the previous cycle of chemotherapy. Which of the following drugs can be used to treat this patient?

Oprelvekin (IL-11) - stimulates platelet production. ***Oprelvekin (IL-11) - stimulates platelet production*** - **Oprelvekin** is a recombinant interleukin-11 (IL-11) that directly stimulates the proliferation and maturation of **megakaryocytes**, leading to increased platelet production. - It is specifically indicated for the prevention of **severe thrombocytopenia** and the reduction of the need for platelet transfusions following myelosuppressive chemotherapy. *Filgrastim - stimulates white blood cell production* - **Filgrastim** is a **granulocyte colony-stimulating factor (G-CSF)** that primarily acts on neutrophil precursors, promoting their proliferation and maturation. - It is used to prevent and treat **neutropenia** and reduce the incidence of febrile neutropenia, but it does not significantly affect platelet counts. *Amifostine - protects against chemotherapy toxicity* - **Amifostine** is a **cytoprotective agent** that reduces toxicities associated with chemotherapy and radiation by preferentially protecting non-malignant cells. - It does not directly stimulate blood cell production but rather acts as a **free radical scavenger** to mitigate damage from cytotoxic treatments. *Erythropoietin - stimulates red blood cell production* - **Erythropoietin** is a **hematopoietic growth factor** that specifically stimulates the production of **red blood cells** by promoting the proliferation and differentiation of erythroid progenitor cells. - It is used to treat **anemia**, particularly in patients with chronic kidney disease or those undergoing chemotherapy, but it has no role in managing thrombocytopenia.

Q: A patient was brought to the ER following a road traffic accident. On examination, the patient opens his eyes to a painful stimulus, speaks inappropriately, and withdraws his limbs to a painful stimulus. What is his GCS score?

E2V3M4. ***E2V3M4*** - Eye opening to **painful stimulus** scores 2 (E2). - Inappropriate speech scores 3 (V3). - Withdrawal from pain scores 4 (M4). *E2V2M3* - This option incorrectly assesses the **verbal response** and **motor response**. - Speaking incomprehensibly scores V2, while here the patient speaks inappropriately (V3). - Flexion to pain scores M3, but the patient exhibits withdrawal from pain (M4). *E3V3M3* - This option incorrectly assesses the **eye opening response**. - Eye opening to verbal command scores E3, but here the patient opens eyes to painful stimulus (E2). - The motor response is also incorrect, as M3 is flexion to pain, not withdrawal from pain (M4). *E3V2M2* - This option incorrectly assesses all three components of the **GCS score**. - A patient who opens eyes to a painful stimulus would score E2, not E3 (eyes opening to verbal command). - Both verbal (V3 for inappropriate speech, not V2 for incomprehensible sounds) and motor responses (M4 for withdrawal from pain, not M2 for extension to pain) are incorrectly scored.

Q: A diabetic patient presents with sudden-onset perineal pain. On examination, foul-smelling discharge and necrotic tissue are noted. Which of the following is the most characteristic feature of this condition?

Mixed aerobic and anaerobic infection. **Mixed aerobic and anaerobic infection** - Fournier's gangrene is a polymicrobial infection typically involving a **synergistic mixture of aerobic and anaerobic bacteria**. - This mixed infection contributes to the rapid progression and tissue destruction seen in this condition, leading to the **foul-smelling discharge** due to anaerobic metabolism. *Anti-gas gangrene serum is indicated only in specific cases.* - Anti-gas gangrene serum is specifically for **Clostridium perfringens** infections, which can cause gas gangrene but is usually a distinct clinical entity from Fournier's. - While Clostridium species can be present in Fournier's gangrene, it is not the sole causative agent, and **broader antimicrobial therapy** is the mainstay of treatment, not antitoxin serum. *Urinary diversion may be considered in severe cases.* - Urinary diversion, such as a **suprapubic catheter**, may be necessary when the urethra or perineum is extensively involved or to prevent ongoing contamination of the surgical site. - However, it's not a primary treatment for the infection itself but rather an **adjunctive measure** to manage complicated cases of Fournier's gangrene. *Bilateral orchidectomy is not routinely required.* - **Testicular involvement** in Fournier's gangrene is rare due to the separate blood supply of the testes. - **Orchidectomy** is only performed if the testes themselves are affected by necrosis, which is uncommon and occurs in critically severe cases; routine removal is not indicated.

Question 1

An infant is brought by his parents with complaints that his urine turns black on standing.    Which of the following metabolic disorders is likely?

Accepted Answer

Alkaptonuria

Answer

Phenylketonuria

Answer

Homocystinuria

Answer

Maple syrup urine disease

Question 2

What is the correct method for collecting water for bacteriological examination during a disease outbreak?

Accepted Answer

Collect water from a tap after letting it flow for at least 1 minute to ensure freshness

Answer

Collect water from already leaking taps

Answer

Collect from a gentle stream of water to avoid splashing

Answer

Before collecting, let water flow for at least 1 minute

Question 3

In a village, it is observed that several farmers have crossed gait and use a stick for support to stand up and walk. Due to poor yield from farms, they consume meals containing rice and pulses only. Supplementing their diet with which of the following vitamins could have prevented neurological symptoms associated with their condition?

Accepted Answer

Vitamin B1 (Thiamine)

Answer

Vitamin A

Answer

Vitamin D

Answer

Vitamin C

Question 4

A child presents with intermittent jaundice and splenomegaly. There is a history of similar complaints in the elder brother. Peripheral smear shows the following finding. What is the most appropriate investigation for this condition?

Accepted Answer

Osmotic fragility test

Answer

Coombs test

Answer

G6PD deficiency testing

Answer

Flow cytometry for PNH

Question 5

A man presents with a history of dysuria and urethral discharge after having unprotected sexual intercourse. What is the treatment of choice for this infection?

Accepted Answer

Ceftriaxone

Answer

Erythromycin

Answer

Azithromycin

Answer

Penicillin G

Question 6

An infant presents with hepatosplenomegaly and thrombocytopenia. Neuroimaging with CT    shows periventricular calcifications. What is the most likely diagnosis?

Accepted Answer

Congenital cytomegalovirus infection

Answer

Congenital rubella syndrome

Answer

Congenital herpes simplex virus infection

Answer

Congenital toxoplasmosis

Question 7

Which of the following is the best sign to indicate adequate growth in an infant with a birth weight of 2.8 kg?

Accepted Answer

Increase in length of 25 centimetres in the first year

Answer

Weight gain of 300 grams per month till 1 year

Answer

Anterior fontanelle closure by 6 months of age

Answer

Weight under the 75th percentile and height under the 25th percentile

Question 8

A patient with a malignancy is undergoing chemotherapy. The platelet counts were reduced after the previous cycle of chemotherapy. Which of the following drugs can be used to treat this patient?

Accepted Answer

Oprelvekin (IL-11) - stimulates platelet production

Answer

Filgrastim - stimulates white blood cell production

Answer

Amifostine - protects against chemotherapy toxicity

Answer

Erythropoietin - stimulates red blood cell production

Question 9

A patient was brought to the ER following a road traffic accident. On examination, the patient opens his eyes to a painful stimulus, speaks inappropriately, and withdraws his limbs to a painful stimulus. What is his GCS score?

Accepted Answer

E2V3M4

Answer

E2V2M3

Answer

E3V3M3

Answer

E3V2M2

Question 10

A diabetic patient presents with sudden-onset perineal pain. On examination, foul-smelling discharge and necrotic tissue are noted. Which of the following is the most characteristic feature of this condition?

Accepted Answer

Mixed aerobic and anaerobic infection

Answer

Urinary diversion may be considered in severe cases

Answer

Bilateral orchidectomy is not routinely required

Answer

Anti-gas gangrene serum is indicated only in specific cases

NEET-PG 2023

Biochemistry

Community Medicine

Internal Medicine

Pediatrics

Pharmacology

Surgery