NEET-PG 2024

354 Questions — Page 32 of 36

Dermatology

3 questions

Q311

An adolescent male presents with severe acne lesions and sinus tracts. Which is the most effective drug for this condition?

Q312

A patient presents with skin lesions and erosions on the buccal mucosa. The immunofluorescence image is shown. What is the most likely diagnosis?

Q313

A child presents with multiple patchy areas of hair loss, scales, and itching. The sister also had similar lesions. What is the most likely diagnosis?

NEET-PG 2024 - Dermatology NEET-PG Practice Questions and MCQs

Question 311: An adolescent male presents with severe acne lesions and sinus tracts. Which is the most effective drug for this condition?

A. Minocycline
B. Doxycycline
C. Isotretinoin (Correct Answer)
D. Topical dapsone

Explanation: ***Isotretinoin*** - This patient presents with **severe acne**, likely cystic or nodular, given the mention of "sinus tracts," which often correlates with **acne conglobata**. - **Isotretinoin** is the most effective treatment for severe acne as it targets all four pathogenic factors of acne: **sebaceous gland activity**, **follicular hyperkeratinization**, *C. acnes* proliferation, and inflammation. *Minocycline* - Minocycline is an **oral antibiotic** used for moderate to severe inflammatory acne, primarily due to its anti-inflammatory properties and ability to reduce *C. acnes*. - While effective for some inflammatory acne, it is **less effective than isotretinoin** for severe, nodulocystic acne or acne with sinus tracts and is not a definitive cure. *Doxycycline* - Doxycycline is another **oral tetracycline antibiotic** commonly used for moderate to severe inflammatory acne due to its anti-inflammatory effects and reduction of *C. acnes*. - Similar to minocycline, it is a good option for inflammatory acne but **insufficient for very severe, recalcitrant acne** with sinus tracts, where isotretinoin is superior. *Topical dapsone* - Topical dapsone is an **anti-inflammatory agent** primarily used for mild to moderate inflammatory acne, particularly papules and pustules. - It is **not effective for severe nodulocystic acne** or acne associated with sinus tracts and would not be appropriate as monotherapy for this presentation.

Question 312: A patient presents with skin lesions and erosions on the buccal mucosa. The immunofluorescence image is shown. What is the most likely diagnosis?

A. Bullous pemphigoid
B. Pemphigus vulgaris (Correct Answer)
C. Linear IgA disease
D. Dermatitis herpetiformis

Explanation: ***Pemphigus vulgaris*** - The combination of **flaccid blisters/erosions** on the skin and **buccal mucosal lesions** is characteristic of pemphigus vulgaris. The image showing **intercellular IgG deposits** (a "chicken wire" pattern) in the epidermis confirms the diagnosis on immunofluorescence. - Pemphigus vulgaris is an **autoimmune blistering disease** caused by autoantibodies against **desmoglein 1 and 3**, leading to acantholysis (loss of cell adhesion) within the epidermis. *Bullous pemphigoid* - This condition typically presents with **tense bullae** that are less prone to rupture, and **mucosal involvement is rare**. - Immunofluorescence in bullous pemphigoid shows **linear IgG and C3 deposits at the dermoepidermal junction**, not an intercellular epidermal pattern. *Linear IgA disease* - Characterized by **linear IgA deposition along the basement membrane zone** on direct immunofluorescence. - Clinically, it presents with **blisters** that can be variable in appearance, but the pathognomonic immunofluorescence pattern is distinct. *Dermatitis herpetiformis* - Presents with very **pruritic vesicles and papules**, primarily on extensor surfaces, and is strongly associated with **celiac disease**. - Direct immunofluorescence reveals **granular IgA deposits in the dermal papillae**, which is distinct from the intercellular IgG pattern seen here.

Question 313: A child presents with multiple patchy areas of hair loss, scales, and itching. The sister also had similar lesions. What is the most likely diagnosis?

A. Alopecia areata
B. Tinea capitis (Correct Answer)
C. Pediculosis capitis
D. Pyoderma

Explanation: ***Tinea capitis*** - **Tinea capitis** presents with **patchy hair loss**, **scaling**, and **itching** on the scalp, which are classic signs of a fungal infection. - The fact that the sister also had similar lesions indicates a **contagious** condition, consistent with a **dermatophyte infection**. *Alopecia areata* - Characterized by **sudden, non-scarring hair loss** in circular or oval patches, often with no scaling or inflammation. - It is an **autoimmune condition** and typically not associated with itching or contagiousness amongst siblings. *Pediculosis capitis* - This condition involves an **infestation of head lice**, primarily causing **intense itching** of the scalp. - While it is contagious, it typically presents with **nits** (lice eggs) firmly attached to hair shafts and excoriations from scratching, rather than significant hair loss and scaling. *Pyoderma* - **Pyoderma** is a bacterial skin infection, often presenting as **pustules**, **crusts**, or **blisters** on the scalp. - While it can be contagious and cause discomfort, it is primarily characterized by purulent lesions and not the diffuse patchy hair loss and scaling seen in this case.

Internal Medicine

2 questions

Q311

A 60-year-old person who completed treatment for leprosy many years ago now presents with a punched-out, painless ulcer on the sole of his foot. What is the most appropriate management?

Q312

A person with a history of chronic alcohol consumption who indulged in binge drinking 10 days ago is brought to the emergency department in an unconscious state. A non-contrast CT scan was normal, and his blood glucose level is 45 mg/dL. What is the most appropriate treatment?

NEET-PG 2024 - Internal Medicine NEET-PG Practice Questions and MCQs

Question 311: A 60-year-old person who completed treatment for leprosy many years ago now presents with a punched-out, painless ulcer on the sole of his foot. What is the most appropriate management?

A. Restart MDT
B. Amputation
C. Intense debridement and intravenous antibiotics (Correct Answer)
D. Offloading and comprehensive wound care

Explanation: ***Intense debridement and intravenous antibiotics*** - The presence of a **punched-out, painless ulcer** in a patient with a history of leprosy suggests a **neuropathic ulcer** that has likely become infected due to compromised sensation and foot care [3]. - **Intense debridement** is crucial to remove necrotic tissue and reduce bacterial load, while **intravenous antibiotics** are necessary to treat the deep-seated infection often associated with such ulcers, especially given the poor vascularity and compromised healing in leprosy [2]. *Restart MDT* - The patient completed **leprosy treatment many years ago**, indicating that the current ulcer is not an active leprosy lesion requiring multidrug therapy (MDT). - Restarting MDT would be inappropriate as there is no evidence of **active Mycobacterium leprae infection**. *Amputation* - Amputation is a **last resort** for severe, uncontrolled infections or extensive tissue damage that cannot be salvaged. - While neuropathic ulcers can lead to amputation, it is not the initial or most appropriate management unless there are signs of **irreversible ischemia or overwhelming sepsis** that are not mentioned here. *Offloading and comprehensive wound care* - While **offloading** and comprehensive wound care are essential components of long-term management and prevention for neuropathic ulcers, they are insufficient as the primary treatment for an already **infected, deep ulcer** [2]. - **Debridement** and **antibiotics** are critical initial steps to control the infection before offloading and routine wound care can effectively promote healing [1].

Question 312: A person with a history of chronic alcohol consumption who indulged in binge drinking 10 days ago is brought to the emergency department in an unconscious state. A non-contrast CT scan was normal, and his blood glucose level is 45 mg/dL. What is the most appropriate treatment?

A. Normal saline
B. IM thiamine followed by dextrose (Correct Answer)
C. 5% dextrose/vitamin K
D. 25% dextrose
E. IV dextrose followed by thiamine

Explanation: **IM thiamine followed by dextrose** - Administering **thiamine** prior to **dextrose** is crucial in patients with chronic alcohol use to prevent **Wernicke-Korsakoff syndrome**, as glucose administration can precipitate or worsen Wernicke encephalopathy in thiamine-deficient individuals. - The patient's **hypoglycemia** (45 mg/dL) requires immediate correction with **dextrose**, but **thiamine** must be given first due to the patient's history of chronic alcohol consumption. *Normal saline* - While **normal saline** is used for rehydration and volume expansion, it does not address the patient's immediate and life-threatening **hypoglycemia** or **thiamine deficiency**. - Without addressing **hypoglycemia**, the patient's unconscious state will persist and lead to further neurological damage. *5% dextrose/vitamin K* - **5% dextrose** alone might correct **hypoglycemia**, but administering it without prior **thiamine** in a chronic alcoholic can precipitate **Wernicke encephalopathy**. - **Vitamin K** is typically given for coagulopathies or bleeding disorders, not as a primary treatment for **hypoglycemia** or **alcohol-related neurological emergencies** unless specific indications are present. *25% dextrose* - **25% dextrose** would rapidly correct **hypoglycemia**, but as with 5% dextrose, administering it without prior **thiamine** in a chronic alcoholic can precipitate or worsen **Wernicke encephalopathy**. - The primary concern in this context for an alcoholic patient with hypoglycemia is the potential for **thiamine deficiency**. *IV dextrose followed by thiamine* - While this option includes both necessary treatments, the **incorrect sequence** is critical—administering **dextrose before thiamine** in a chronic alcoholic can precipitate **Wernicke encephalopathy**. - The correct protocol requires **thiamine first** to replenish stores before glucose metabolism is accelerated by dextrose administration.

Microbiology

1 questions

Q311

A patient presents with sinus tracts on the foot, and a smear reveals filamentous organisms.

Pharmacology

2 questions

Q311

A patient with multiple sexual exposures is diagnosed with gonorrhea. What is the appropriate treatment?

Q312

Which of the following drugs is used in opioid maintenance therapy?

NEET-PG 2024 - Pharmacology NEET-PG Practice Questions and MCQs

Question 311: A patient with multiple sexual exposures is diagnosed with gonorrhea. What is the appropriate treatment?

A. Acyclovir
B. Cefixime
C. Doxycycline
D. Ceftriaxone (Correct Answer)

Explanation: ***Ceftriaxone*** - **Ceftriaxone** is the **first-line recommended treatment** for uncomplicated gonorrhea according to **CDC and WHO guidelines**. - Administered as a **single intramuscular injection (500 mg IM)**, it provides highly effective coverage against *Neisseria gonorrhoeae* with minimal resistance. - It works by inhibiting bacterial cell wall synthesis, and is the **gold standard therapy** for gonorrhea treatment. - For patients with multiple sexual exposures, empiric treatment for co-infection with *Chlamydia trachomatis* (doxycycline) should also be considered. *Cefixime* - **Cefixime** was previously used as an oral alternative but is **no longer recommended** as first-line therapy due to **increasing resistance** of *N. gonorrhoeae*. - The CDC removed cefixime from recommended regimens due to **inferior efficacy** compared to ceftriaxone and concerns about treatment failures. - While it is an oral cephalosporin, it is **not appropriate first-line therapy** for gonorrhea. *Doxycycline* - **Doxycycline** is commonly used to treat **co-infection with *Chlamydia trachomatis***, which frequently occurs alongside gonorrhea. - The typical regimen is **100 mg twice daily for 7 days** as adjunctive therapy. - However, doxycycline is **not effective as monotherapy for gonorrhea** and should not be used alone to treat *N. gonorrhoeae* infection. *Acyclovir* - **Acyclovir** is an **antiviral medication** used to treat **herpes simplex virus (HSV)** infections. - It works by inhibiting viral DNA replication and has **no activity against bacterial infections** like gonorrhea. - It would be completely ineffective against *Neisseria gonorrhoeae*.

Question 312: Which of the following drugs is used in opioid maintenance therapy?

A. Naltrexone
B. Clonidine
C. Buprenorphine (Correct Answer)
D. Disulfiram
E. Naloxone

Explanation: ***Buprenorphine*** - **Buprenorphine** is a **partial opioid agonist** used in opioid maintenance therapy to reduce cravings and withdrawal symptoms without producing the full euphoric effects of other opioids. - It is often combined with **naloxone** (as Suboxone) to prevent misuse by injection, as naloxone is only active if injected. - Buprenorphine has a **ceiling effect** for respiratory depression, making it safer than full agonists like methadone. *Naltrexone* - **Naltrexone** is an **opioid antagonist** that blocks opioid receptors, preventing the euphoric effects of opioids and reducing cravings. - While used in opioid use disorder treatment, it is primarily for relapse prevention and not typically for the active maintenance phase where agonist effects are desired. *Clonidine* - **Clonidine** is an **alpha-2 adrenergic agonist** primarily used to manage the **autonomic symptoms of opioid withdrawal**, such as anxiety, sweating, and rapid heart rate. - It does not directly act on opioid receptors and is not a primary agent for long-term opioid maintenance therapy. *Disulfiram* - **Disulfiram** is a drug used in the treatment of **alcohol use disorder**, not opioid use disorder. - It works by inhibiting acetaldehyde dehydrogenase, leading to an unpleasant reaction when alcohol is consumed. *Naloxone* - **Naloxone** is an **opioid antagonist** used for **emergency reversal of opioid overdose**, not for maintenance therapy. - It rapidly displaces opioids from receptors and reverses respiratory depression. - While combined with buprenorphine in Suboxone to prevent misuse, naloxone itself is not used for maintenance therapy.

Psychiatry

2 questions

Q311

A 45-year-old female presents to the OPD with complaints of "feeling tense" and experiencing stomach upset with heartburn and diarrhea. She reports having these symptoms for many years and mentions that her family members also usually feel tense and nervous. Which of the following symptoms is most likely to be seen in this patient?

Q312

A 30-year-old male needs to be dressed in female lingerie and high heels to feel aroused and have intercourse with a female. He denies any attraction towards males. What is the most likely diagnosis?

NEET-PG 2024 - Psychiatry NEET-PG Practice Questions and MCQs

Question 311: A 45-year-old female presents to the OPD with complaints of "feeling tense" and experiencing stomach upset with heartburn and diarrhea. She reports having these symptoms for many years and mentions that her family members also usually feel tense and nervous. Which of the following symptoms is most likely to be seen in this patient?

A. Ideas of reference
B. Tingling of extremities (Correct Answer)
C. Hallucination
D. Neologism

Explanation: ***Tingling of extremities*** - The patient's presentation of "feeling tense," **stomach upset, heartburn, and diarrhea** for many years, alongside a family history of similar issues, suggests significant **anxiety**. - **Peripheral neurological symptoms** such as **tingling of extremities (paresthesia)** are common manifestations of anxiety and panic attacks due to **hyperventilation** (causing respiratory alkalosis and decreased ionized calcium) and **physiological arousal**. *Ideas of reference* - **Ideas of reference** are typically seen in **psychotic disorders** (e.g., schizophrenia) where a person believes that unrelated, external events have a special, personal meaning. - While anxiety can sometimes lead to misinterpretations, **ideas of reference** at a delusional level are not characteristic of generalized anxiety. *Hallucination* - **Hallucinations** are perceptual disturbances where an individual experiences sensory perceptions (e.g., hearing voices, seeing things) in the absence of an external stimulus. - These are core symptoms of **psychotic disorders** and are not typical findings in anxiety disorders without comorbid conditions. *Neologism* - A **neologism** is the coining of new words or phrases, often without clear meaning, which is a hallmark feature of disorganized thought in **psychotic disorders** (e.g., schizophrenia). - This symptom is related to severe thought disorganization and is not associated with anxiety disorders.

Question 312: A 30-year-old male needs to be dressed in female lingerie and high heels to feel aroused and have intercourse with a female. He denies any attraction towards males. What is the most likely diagnosis?

A. Gender dysphoria
B. Transvestic Disorder (Correct Answer)
C. Homosexuality
D. Testicular feminization

Explanation: ***Transvestic Disorder*** - This condition involves **recurrent, intense sexual arousal from cross-dressing** in clothes typically associated with the opposite sex. The man experiences this specifically for sexual arousal and activity with a female partner, rather than for gender identity reasons. - The patient's denial of attraction to males and the context of heterosexual intercourse confirm that this is a paraphilic disorder related to specific sexual arousal patterns. - This diagnosis (formerly called "Transvestic fetishism" in DSM-IV) is the appropriate term in DSM-5-TR. *Gender dysphoria* - This involves a **marked incongruence between one's experienced/expressed gender and one's assigned gender**, often accompanied by distress or impairment. The patient's desire to dress in female clothing is for sexual arousal, not because he identifies as female. - Individuals with gender dysphoria typically experience a persistent and profound discomfort with their birth-assigned gender and a strong desire to be of the other gender, which is not described in this case. *Homosexuality* - This refers to **sexual attraction to individuals of the same sex**. The patient explicitly denies any attraction towards males, indicating that his sexual orientation is not homosexual. - His arousal is tied to a specific activity, cross-dressing, in the context of heterosexual intercourse, not the gender of his partner. *Testicular feminization* - This is an older term for **Androgen Insensitivity Syndrome (AIS)**, a genetic condition where an individual who is genetically male (XY) is resistant to male hormones (androgens). This results in female external sexual characteristics or ambiguous genitalia. - This is a biological developmental disorder, not a psychological or sexual preference, and is unrelated to the behavioral description of sexual arousal from cross-dressing.