Orthopaedics
1 questionsAn 18-year-old boy presents with tenderness, warmth over the bone, and fever, ESR and CRP levels. The radiograph is shown below. What is the most likely diagnosis?
NEET-PG 2024 - Orthopaedics NEET-PG Practice Questions and MCQs
Question 321: An 18-year-old boy presents with tenderness, warmth over the bone, and fever, ESR and CRP levels. The radiograph is shown below. What is the most likely diagnosis?
- A. Ewing's sarcoma
- B. Osteosarcoma
- C. Osteomyelitis (Correct Answer)
- D. Giant cell tumor
Explanation: ***Osteomyelitis*** - The presentation of **tenderness**, **warmth over the bone**, **fever**, and elevated **ESR** and **CRP** are classic signs of a bone infection, or osteomyelitis. - While not explicitly shown in the provided text, a radiograph in acute osteomyelitis might show **soft tissue swelling** or subtle **periosteal elevation**, progressing to **bone destruction** and **sclerosis** in later stages. *Ewing's sarcoma* - This is a highly malignant bone tumor that presents with **pain** and **swelling**, but is typically not associated with a pronounced **fever** and signs of systemic infection. - Radiographically, it often shows an "onion-skin" **periosteal reaction** and lytic lesions, without the strong inflammatory markers seen here. *Osteosarcoma* - This is another malignant bone tumor, primarily presenting with bone **pain** and **swelling**, but systemic inflammatory signs like **fever** are rare unless there is a pathologic fracture or infection secondary to tumor necrosis. - Radiographs typically show a "sunburst" appearance, **Codman's triangle**, or mixed lytic and blastic lesions, not indicative of acute infection. *Giant cell tumor* - This is a usually **benign aggressive bone tumor** that causes **pain** and **swelling** around joints. - It does not typically present with systemic signs of infection such as **fever** and significantly elevated **ESR** and **CRP** unless there is a secondary infection, and it usually affects the **epiphyses** of long bones in young adults.
Pediatrics
1 questionsA 3-year-old child presents with respiratory distress and a history of recurrent respiratory infections. Based on the provided imaging, what is the most likely diagnosis?
NEET-PG 2024 - Pediatrics NEET-PG Practice Questions and MCQs
Question 321: A 3-year-old child presents with respiratory distress and a history of recurrent respiratory infections. Based on the provided imaging, what is the most likely diagnosis?
- A. CPAM (Congenital Pulmonary Airway Malformation) (Correct Answer)
- B. Lung abscess
- C. Pyopneumothorax
- D. CDH (Congenital Diaphragmatic Hernia)
- E. Pulmonary sequestration
Explanation: ***CPAM (Congenital Pulmonary Airway Malformation)*** - The imaging shows **cystic lesions** within the lung parenchyma, which are characteristic of CPAM. These lesions can cause **respiratory distress** and predispose to **recurrent infections**. - The age of the child (3 years old) and the history of recurrent respiratory infections are consistent with CPAM, as these malformations often manifest with symptoms in early childhood. *Lung abscess* - A lung abscess typically presents as a **cavity with an air-fluid level** and surrounding consolidation, usually in a single, well-defined area. - While recurrent infections can occur, the widespread cystic appearance on imaging makes an abscess less likely than CPAM. *Pyopneumothorax* - Pyopneumothorax is characterized by the presence of both **pus and air in the pleural space**, leading to a visible air-fluid level that occupies the pleural cavity. - The imaging does not show evidence of gas and fluid within the pleural space, nor the typical chest wall separation seen in pneumothorax. *CDH (Congenital Diaphragmatic Hernia)* - CDH involves the **herniation of abdominal contents** into the chest cavity, displacing lung tissue and often causing severe respiratory distress from birth due to pulmonary hypoplasia. - The images show cystic changes within the lung parenchyma, not abdominal organs in the chest, and the age of presentation makes a new diagnosis of uncorrected CDH less likely, as it usually presents as a neonatal emergency. *Pulmonary sequestration* - Pulmonary sequestration is a congenital malformation characterized by **non-functioning lung tissue with aberrant systemic arterial supply**, typically from the aorta. - While it can present with recurrent infections, the imaging typically shows a **solid or mixed solid-cystic mass**, often in the lower lobes with visible feeding vessels on contrast imaging, rather than the predominantly multicystic appearance seen in CPAM.
Pharmacology
2 questionsA patient on SSRI sertraline was also prescribed amitriptyline and subsequently developed serotonin toxicity. What is the likely treatment for serotonin toxicity?
A mother reports that her daughter ingested a substance in an unknown dose. The girl presents with hypertension, tachycardia, mydriasis, and hyperthermia. What is the most likely substance?
NEET-PG 2024 - Pharmacology NEET-PG Practice Questions and MCQs
Question 321: A patient on SSRI sertraline was also prescribed amitriptyline and subsequently developed serotonin toxicity. What is the likely treatment for serotonin toxicity?
- A. Flumazenil
- B. Cyproheptadine (Correct Answer)
- C. L-Carnitine
- D. Leucovorin
- E. Naloxone
Explanation: ***Cyproheptadine*** - **Cyproheptadine** is a serotonin antagonist that can help reverse the effects of excessive serotonin in the central nervous system. - It works by blocking **serotonin 5-HT2A receptors**, which are implicated in the pathophysiology of serotonin toxicity. *Flumazenil* - **Flumazenil** is a benzodiazepine receptor antagonist used to reverse the effects of benzodiazepine overdose. - It has no role in the treatment of **serotonin toxicity**, as it does not affect serotonin pathways. *L-Carnitine* - **L-Carnitine** is a mitochondrial co-factor used in fatty acid metabolism, sometimes supplemented for certain metabolic disorders or muscle pain. - It does not have any direct action on **serotonin receptors** or the serotonin system, making it ineffective for serotonin toxicity. *Leucovorin* - **Leucovorin** (folinic acid) is used to counteract the effects of methotrexate toxicity or to enhance the effects of fluorouracil in chemotherapy. - It is not involved in modulating **neurotransmitter levels** or reversing the symptoms of serotonin toxicity. *Naloxone* - **Naloxone** is an opioid receptor antagonist used to reverse opioid overdose. - It has no effect on **serotonin receptors** or serotonergic pathways, making it ineffective for treating serotonin toxicity.
Question 322: A mother reports that her daughter ingested a substance in an unknown dose. The girl presents with hypertension, tachycardia, mydriasis, and hyperthermia. What is the most likely substance?
- A. Heroin
- B. Morphine
- C. Cocaine (Correct Answer)
- D. Chlorpheniramine
- E. Organophosphate
Explanation: ***Cocaine*** - The presented symptoms of **hypertension, tachycardia, mydriasis, and hyperthermia** are characteristic of a **sympathomimetic toxidrome**, frequently caused by cocaine overdose. - Cocaine acts as a **norepinephrine-dopamine-serotonin reuptake inhibitor**, leading to excessive stimulation of the central and peripheral nervous systems. *Heroin* - Heroin is an **opioid**, and overdose generally presents with **respiratory depression, bradycardia, miosis (pinpoint pupils)**, and hypotension, which are contrary to the patient's symptoms. - Patients typically exhibit central nervous system **depression**, rather than the hyperactive state seen here. *Morphine* - Similar to heroin, morphine is an **opioid** and causes symptoms like **respiratory depression, bradycardia, miosis**, and hypotension. - These effects are the opposite of the **sympathomimetic** signs observed in the patient. *Chlorpheniramine* - Chlorpheniramine is an **antihistamine** with significant **anticholinergic effects**. An overdose might cause **mydriasis and tachycardia**, but not typically severe hypertension or hyperthermia as the primary features. - Other anticholinergic signs such as **dry mucous membranes, urinary retention, and altered mental status (delirium)** would also be expected. *Organophosphate* - Organophosphate poisoning causes a **cholinergic toxidrome** due to **acetylcholinesterase inhibition**, resulting in excessive cholinergic stimulation. - Classic presentation includes **SLUDGE syndrome** (Salivation, Lacrimation, Urination, Defecation, GI upset, Emesis) along with **miosis (pinpoint pupils), bradycardia, bronchospasm**, and muscle fasciculations. - These findings are the **opposite** of the sympathomimetic signs seen in this patient.
Psychiatry
4 questionsA 24-year-old male presents for evaluation. He appears very calm and charming in front of the psychiatrist but often gets into fights with friends, skips classes, breaks traffic rules, and is involved in multiple police cases. What is the most likely diagnosis?
A 40-year-old female has visited multiple plastic surgeons requesting correction of a perceived facial deformity. She was referred to a psychiatrist because she repeatedly checks her face, insists that it is deformed and needs surgery despite no evidence on examination. She persists with her demand despite reassurances by family members and doctors. What is the most appropriate management?
Untreated ADHD persisting from childhood increases the risk of developing which of the following in adolescence?
A young girl presents with a history of multiple episodes of loss of consciousness lasting for 20 minutes. These episodes occur only in front of family members and only during the daytime. There is no history of tongue biting or incontinence, and EEG and MRI studies are normal. What is the most appropriate management?
NEET-PG 2024 - Psychiatry NEET-PG Practice Questions and MCQs
Question 321: A 24-year-old male presents for evaluation. He appears very calm and charming in front of the psychiatrist but often gets into fights with friends, skips classes, breaks traffic rules, and is involved in multiple police cases. What is the most likely diagnosis?
- A. Narcissistic personality disorder
- B. Paranoid personality disorder
- C. Schizotypal personality disorder
- D. Antisocial personality disorder (Correct Answer)
Explanation: ***Antisocial personality disorder*** - The patient's **charming demeanor** while frequently engaging in **fights, rule-breaking**, and **legal issues** is characteristic of antisocial personality disorder. - Individuals with this disorder often display **disregard for social norms**, lack **empathy**, and have a history of **irresponsibility** and **deceitfulness**. *Narcissistic personality disorder* - This disorder is marked by a pervasive pattern of **grandiosity**, a need for **admiration**, and a lack of **empathy**, but it does not typically involve a pattern of recurrent **antisocial behavior** or **criminality** like that described. - While they might be perceived as charming, their primary motivation is self-enhancement and they are less likely to repeatedly engage in behaviors that actively violate the rights of others or societal rules for personal gain or impulsivity. *Paranoid personality disorder* - Characterized by pervasive **distrust and suspiciousness** of others' motives, interpreting them as malevolent, which is not depicted in this patient's presentation. - Individuals with this disorder tend to be **guarded, hold grudges**, and may be **secretive**, rather than openly engaging in antisocial acts and charming manipulation. *Schizotypal personality disorder* - Involves patterns of **eccentric behavior**, peculiar thinking, and extreme discomfort in close relationships, often due to **perceptual distortions** or **magical beliefs**. - This patient's presentation of social charm and calculated antisocial acts is not consistent with the **social isolation** and **oddities** typical of schizotypal personality disorder.
Question 322: A 40-year-old female has visited multiple plastic surgeons requesting correction of a perceived facial deformity. She was referred to a psychiatrist because she repeatedly checks her face, insists that it is deformed and needs surgery despite no evidence on examination. She persists with her demand despite reassurances by family members and doctors. What is the most appropriate management?
- A. Behavior therapy (Correct Answer)
- B. SSRI
- C. Atypical antipsychotics
- D. Allow her to have surgery
Explanation: ***Behavior therapy*** - This patient presents with **body dysmorphic disorder (BDD)**, characterized by preoccupation with a perceived defect in appearance that is not observable to others, leading to significant distress and impairment. - **Cognitive behavioral therapy (CBT)**, specifically **CBT-BDD with exposure and response prevention (ERP)**, is the **first-line treatment** with the strongest evidence base for BDD. - CBT-BDD addresses the core cognitive distortions, reduces checking behaviors, and provides sustained long-term improvement without medication side effects. - **Most appropriate management** involves CBT as primary treatment, often combined with pharmacotherapy for optimal outcomes. *SSRI* - **Selective serotonin reuptake inhibitors (SSRIs)** are the first-line **pharmacotherapy** for BDD, often requiring higher doses than those used for major depressive disorder. - SSRIs are highly effective and can be used as monotherapy or preferably in combination with CBT. - While SSRIs are appropriate, CBT has superior evidence as the primary intervention for BDD. *Atypical antipsychotics* - **Atypical antipsychotics** may be considered as an augmentation strategy for BDD in cases that do not respond to SSRI monotherapy, especially with significant delusional features or severe functional impairment. - They are not first-line pharmacological treatment. *Allow her to have surgery* - Allowing plastic surgery is **contraindicated** in patients with BDD because it rarely alleviates distress and often leads to dissatisfaction with surgical outcomes, potentially worsening symptoms or causing further unnecessary procedures. - The core problem is distorted perception of self, not an actual physical defect that can be remedied surgically.
Question 323: Untreated ADHD persisting from childhood increases the risk of developing which of the following in adolescence?
- A. Selective mutism
- B. Conduct disorder (Correct Answer)
- C. Binge eating disorder
- D. Separation anxiety disorder
Explanation: ***Conduct disorder*** - **Untreated ADHD**, marked by impulsivity and difficulty with emotional regulation, significantly increases the risk of developing **conduct disorder** in adolescence. - Adolescents with untreated ADHD may struggle with following rules, exhibiting aggressive behaviors, and engaging in antisocial acts, which are hallmarks of conduct disorder. *Selective mutism* - This is an **anxiety disorder** characterized by a child's consistent failure to speak in specific social situations where there is an expectation for speaking despite speaking in other situations. - While it can co-occur with ADHD, it is not a direct consequence of untreated ADHD and involves distinct psychological mechanisms. *Binge eating disorder* - This disorder is characterized by recurrent episodes of **eating unusually large amounts of food** in a short period, often accompanied by a sense of loss of control. - While there is a higher prevalence of eating disorders in individuals with ADHD, it is not a primary or direct developmental risk from untreated ADHD in adolescence. *Separation anxiety disorder* - This disorder involves **excessive fear or anxiety** concerning separation from home or from attachment figures, beyond what is expected for the individual's developmental level. - While it can co-occur with ADHD, it is not a direct developmental risk that emerges from untreated ADHD in adolescence.
Question 324: A young girl presents with a history of multiple episodes of loss of consciousness lasting for 20 minutes. These episodes occur only in front of family members and only during the daytime. There is no history of tongue biting or incontinence, and EEG and MRI studies are normal. What is the most appropriate management?
- A. Treat with aversive therapy
- B. Insight-oriented psychotherapy (Correct Answer)
- C. Valproate
- D. Ketogenic diet
Explanation: ***Insight-oriented psychotherapy*** - The presentation strongly suggests **non-epileptic seizures (NES)**, also known as **psychogenic non-epileptic seizures (PNES)**, which are usually of psychological origin. - **Insight-oriented psychotherapy** is the most appropriate management, aiming to address underlying psychological conflicts or stress that manifest as these episodes. *Treat with aversive therapy* - **Aversive therapy** is typically used for behavioral modification in conditions like substance abuse or paraphilias, where a negative stimulus is paired with an undesirable behavior. - It is not indicated for **psychogenic non-epileptic seizures**, where the underlying cause is psychological distress rather than a learned undesirable behavior. *Valproate* - **Valproate** is an **antiepileptic drug** used to treat various types of seizures, including generalized tonic-clonic and absence seizures. - Since EEG and MRI are normal, and the clinical features (no tongue biting/incontinence, specific timing/audience) rule out epilepsy, antiepileptic medication like Valproate is **inappropriate**. *Ketogenic diet* - The **ketogenic diet** is a high-fat, low-carbohydrate diet used as a medical treatment for **drug-resistant epilepsy**, particularly in children. - Given that the episodes are **non-epileptic** and investigations are normal, a ketogenic diet would be ineffective and unnecessary.
Radiology
2 questionsA 38-year-old patient presents with chest pain and hoarseness of voice for the past month. Based on the radiographic image below, what is the most likely diagnosis?
Identify the condition shown in the plain abdominal radiograph.
NEET-PG 2024 - Radiology NEET-PG Practice Questions and MCQs
Question 321: A 38-year-old patient presents with chest pain and hoarseness of voice for the past month. Based on the radiographic image below, what is the most likely diagnosis?
- A. Saccular aneurysm of distal arch
- B. Aortic dissection of the arch (Correct Answer)
- C. Coarctation of the aorta
- D. Stenosis of the aorta
Explanation: ***Aortic dissection of the arch*** - The image suggests a dissection flap within the **aortic arch**, creating a true and false lumen, which is characteristic of an aortic dissection. - Chest pain and **hoarseness of voice** (due to recurrent laryngeal nerve compression by the expanding aorta) are classic symptoms of aortic dissection affecting the aortic arch. - Aortic dissection involves an **intimal tear** with blood entering the media, creating separate lumens, which differentiates it from a simple aneurysm. *Saccular aneurysm of distal arch* - A **saccular aneurysm** would appear as a focal, out-pouching dilatation of the aorta, without evidence of an intimal flap or separate lumens seen in the image. - While an aneurysm can cause symptoms like chest pain or hoarseness, the imaging features specifically point to dissection rather than a simple saccular aneurysm. *Coarctation of the aorta* - **Coarctation of the aorta** is a congenital narrowing of the aorta, typically distal to the left subclavian artery, which would appear as a localized constriction, not a dissection. - While it can manifest with chest pain, hoarseness is not a typical symptom, and classic imaging would show a "shelf-like" indentation or rib notching on X-ray. *Stenosis of the aorta* - **Aortic stenosis** usually refers to narrowing of the aortic valve or a focal narrowing of the aorta. The image displays a complex abnormality of the aortic wall and lumen, not simple stenosis. - While severe aortic stenosis can cause chest pain (angina), hoarseness is not a common associated symptom.
Question 322: Identify the condition shown in the plain abdominal radiograph.
- A. Pancreatic calcification (Correct Answer)
- B. Mesenteric calcification
- C. Horseshoe kidney
- D. Jejunal fecolith
Explanation: ***Pancreatic calcification*** - The radiograph displays **multiple, punctate, and amorphous calcifications** clustered in the upper abdomen, characteristic of **chronic pancreatitis**. - These calcifications represent **calcium deposits within the pancreatic ducts and parenchyma**, a hallmark sign of chronic inflammation and damage to the pancreas. *Mesenteric calcification* - **Mesenteric calcifications** are typically more scattered and linear, often following the distribution of blood vessels or lymph nodes within the mesentery, which is not seen here. - They are generally less dense and less granular than the calcifications observed in the image. *Horseshoe kidney* - A **horseshoe kidney** is a congenital anomaly where the kidneys are fused at their lower poles, forming a U-shape, and is typically located lower in the abdomen, often overlying the spine. - This condition presents with the characteristic **renal outlines** and not diffuse calcifications as shown. *Jejunal fecolith* - A **jejunal fecolith** would appear as a singular or a few discrete, dense, and typically rounded or oval radio-opacities within the lumen of the jejunum. - The diffuse, scattered pattern of calcifications displayed in the image is inconsistent with a fecolith, which is usually composed of inspissated fecal material.