NEET-PG 2024 Practice Questions

Q: A 45-year-old patient presents with symptoms of anemia, depigmented hair, and myelopathy. Which of the following mineral deficiencies is most likely associated with this clinical presentation?

Copper. ***Copper*** - **Copper deficiency** can lead to anemia due to its role in iron metabolism, **depigmented hair** (achromotrichia) due to impaired melanin synthesis, and **myelopathy** due to its involvement in maintaining the myelin sheath. - Symptoms often mimic those of **vitamin B12 deficiency**, including neurological manifestations like ataxia and spasticity. *Iron* - **Iron deficiency** is the most common cause of anemia but does not typically cause **depigmented hair** or **myelopathy**. - Its neurological symptoms are usually limited to **restless legs syndrome** and **pica**, not demyelination. *Fluoride* - **Fluoride deficiency** is primarily associated with an increased risk of dental caries and does not cause anemia, hair depigmentation, or myelopathy. - Excessive intake (fluorosis) can lead to **bone and tooth abnormalities**. *Zinc* - **Zinc deficiency** can cause immune dysfunction, **dermatitis**, impaired wound healing, and growth retardation. - It may rarely cause anemia in severe cases but does not typically cause hair depigmentation or myelopathy as primary symptoms. *Selenium* - **Selenium deficiency** is associated with **Keshan disease** (cardiomyopathy) and **Kashin-Beck disease** (osteoarthropathy). - While it can cause muscle weakness and fatigue, it does not typically present with the specific triad of anemia, hair depigmentation, and myelopathy seen in copper deficiency.

Q: A young patient in an endemic area presents with pleural fluid showing LDH level greater than 0.6 times the serum LDH, protein level greater than 0.5 times the serum protein, and lymphocytic predominance. What is the most likely diagnosis?

Tuberculosis. ***Tuberculosis*** - The patient's presentation with **exudative pleural fluid** (LDH > 0.6 times serum LDH, protein > 0.5 times serum protein) in an **endemic area** strongly suggests tuberculosis. - The **lymphocytic predominance** in the pleural fluid is a hallmark characteristic of tuberculous pleurisy. - **Young age** and **endemic area** further support TB as the most likely diagnosis. *Heart failure* - Pleural effusions due to heart failure are typically **transudative**, meaning they have low protein and LDH levels. - While heart failure can lead to pleural effusions, the fluid characteristics (exudative, lymphocytic predominance) do not fit this diagnosis. *Hepatic failure* - Pleural effusions in hepatic failure (e.g., due to cirrhosis) are usually **transudative** and result from fluid shifting from the abdomen (hepatic hydrothorax). - The fluid analysis in this scenario (exudative, lymphocytic predominance) is inconsistent with hepatic failure. *Renal failure* - Pleural effusions associated with renal failure (e.g., uremic pleurisy) can be exudative, but they often present with a **neutrophilic predominance** or may be hemorrhagic. - The specific lymphocytic predominance points away from typical renal failure-associated effusions. *Malignancy* - While malignant pleural effusions (lymphoma, metastatic carcinoma) can present with **lymphocytic predominance** and exudative characteristics, the clinical context is crucial. - The patient's **young age** and presentation in an **endemic area for tuberculosis** makes TB far more likely than malignancy. - In endemic areas, TB should be ruled out first before considering malignancy in young patients with lymphocytic pleural effusions.

Q: A 62-year-old patient presents with left-sided arm and leg weakness, right-sided facial paralysis with lateral rectus gaze palsy, and nystagmus. Based on the clinical presentation, which of the following syndromes is most consistent with these symptoms?

Foville syndrome. ***Foville syndrome*** - This syndrome is characterized by a **pontine lesion** affecting the **abducens nucleus (cranial nerve VI)**, leading to ipsilateral gaze palsy, and the **facial nucleus (cranial nerve VII)**, causing ipsilateral facial weakness. [1] - The **crossed hemiparesis (left-sided arm and leg weakness)** results from involvement of the corticospinal tracts, and **nystagmus** can occur due to vestibular nucleus involvement, consistent with the patient's presentation. [1] *Benedict's syndrome* - This is a midbrain syndrome involving the **red nucleus** and **oculomotor nerve (cranial nerve III)**, causing ipsilateral oculomotor palsy and contralateral cerebellar ataxia. - It does not explain the patient's **facial weakness** or **abducens palsy**. *Millard-Gubler syndrome* - This pontine syndrome involves the **abducens nerve (cranial nerve VI)** and **facial nerve (cranial nerve VII)** in the pontine base, leading to ipsilateral gaze palsy and ipsilateral facial paralysis. - However, the hemiparesis in Millard-Gubler syndrome is typically **contralateral** to the lesion, but the facial paralysis and gaze palsy are usually due to direct nerve involvement rather than nuclear involvement, and **nystagmus** is not a characteristic feature. *Wallenberg syndrome* - This syndrome, also known as **lateral medullary syndrome**, is caused by a lesion in the **dorsolateral medulla** and presents with a constellation of symptoms including **ipsilateral ataxia**, **Horner's syndrome**, **high-pitched dysphagia**, and **contralateral loss of pain and temperature sensation**. [1] - It does not typically involve **facial weakness**, **abducens palsy**, or **hemiparesis** in the manner described.

Q: The PR interval was measured at 0.21 seconds on a routine ECG of a patient. What is the correct interpretation?

First degree heart block. ***First degree heart block*** - A **PR interval** greater than **0.20 seconds** (or 200 milliseconds) is the defining characteristic of **first-degree atrioventricular (AV) block** [1]. - In this condition, every atrial impulse is conducted to the ventricles, but the conduction is **delayed** [1]. *Second degree heart block* - This involves some, but not all, **P waves** being followed by a **QRS complex**, indicating **intermittent conduction failure** at the AV node [1]. - It presents as either **Mobitz type I (Wenckebach)** with progressive PR lengthening before a dropped beat, or **Mobitz type II** with sudden, unexpected dropped beats without prior PR prolongation [1]. *Normal rhythm* - A **normal PR interval** typically falls between **0.12 and 0.20 seconds** (120-200 milliseconds). - A measurement of **0.21 seconds** is outside this normal range, indicating an abnormality in AV conduction. *Complete heart block* - This is characterized by a complete dissociation between atrial and ventricular activity, where **no atrial impulses** are conducted to the ventricles. - On the ECG, this appears as P waves and QRS complexes occurring independently, with **regular but asynchronous** rhythms.

Q: In Type 1 Diabetes Mellitus (DM) stage 3 beta cell destruction, which of the following is the most likely presentation?

Hyperglycemia symptomatic. ***Hyperglycemia symptomatic*** - **Type 1 DM stage 3** is characterized by sufficient **beta-cell destruction** to cause overt hyperglycemia. - This level of hyperglycemia typically leads to classic symptoms such as **polyuria, polydipsia, and weight loss**. *Dysglycemic symptomatic* - **Dysglycemic** refers to abnormal blood sugar levels, but this term is too broad and doesn't specify the degree or symptomatic nature as precisely as **hyperglycemia symptomatic**. - While patients are symptomatic, the primary issue is **hyperglycemia**, making that a more specific and accurate description. *Normoglycemic symptomatic* - **Normoglycemic** implies normal blood sugar levels, which is inconsistent with **Type 1 DM stage 3** where significant beta-cell destruction has occurred. - This stage is defined by definite hyperglycemia, so a patient cannot be symptomatic while having normal glucose levels due to the disease. *Dysglycemic asymptomatic* - While there is **dysglycemia**, **asymptomatic presentation** is more characteristic of earlier stages (Type 1 DM stage 2), where hyperglycemia is present but not yet severe enough to cause overt symptoms. - In **stage 3**, beta-cell destruction is substantial, leading to glucose levels that are high enough to cause noticeable symptoms. *Normoglycemic asymptomatic* - **Normoglycemic asymptomatic** describes **Type 1 DM stage 1**, where autoimmunity is present but beta-cell destruction has not yet progressed enough to affect glucose levels. - This is the earliest stage of Type 1 DM, well before the overt hyperglycemia seen in stage 3.

Q: What is the most common cause of death in idiopathic pulmonary fibrosis (IPF)?

Respiratory failure. ***Respiratory failure*** - **Progressive fibrosis** of the lung tissue in idiopathic pulmonary fibrosis (IPF) directly impairs gas exchange, leading to **hypoxemia** and hypercapnia. - This deterioration ultimately culminates in **respiratory failure**, which is the primary cause of mortality in most IPF patients. *Pulmonary edema* - While pulmonary edema can occur in systemic conditions, it is not the **primary or most common cause of death** specifically in IPF. - IPF is characterized by **fibrotic remodeling**, not primarily fluid overload in the alveoli. *Cancer* - Patients with IPF have an **increased risk of lung cancer**, but it is not the most common cause of death compared to respiratory failure. - The development of cancer is a **complication**, not the direct mechanism by which most IPF patients succumb to the disease. *Pulmonary arterial hypertension (PAH)* - PAH can be a significant complication of IPF, contributing to increased morbidity and mortality, but it is typically a **secondary contributor to death**, often by worsening respiratory mechanics. - Its presence usually **compounds respiratory failure**, rather than being the standalone, most common cause of death. *Acute exacerbation of IPF* - Acute exacerbations represent episodes of **rapid clinical deterioration** with worsening dyspnea and hypoxemia, often idiopathic or triggered by infections. - While they are a **significant cause of mortality** (accounting for a substantial proportion of IPF deaths), the underlying mechanism still relates to respiratory failure, making chronic progressive respiratory failure the most common overall cause of death.

Q: A Myasthenia Gravis patient on mycophenolate and pyridostigmine presents with hypercalcemia. Apart from the obvious drug-related cause, what other condition could be associated with hypercalcemia in this patient?

Non-Small Cell Lung Cancer (NSCLC). ***Non-Small Cell Lung Cancer (NSCLC)*** - **Hypercalcemia of malignancy** is a common paraneoplastic syndrome in NSCLC, particularly squamous cell carcinoma, due to the production of **parathyroid hormone-related protein (PTHrP)**. - Patients with myasthenia gravis, especially those with thymoma, have an increased risk of developing other malignancies, including lung cancer, making this an important consideration. *Drug induced* - While certain medications can cause hypercalcemia, the question specifically asks for a condition **apart from the obvious drug-related cause**. - Medications like **thiazide diuretics**, **lithium**, or excessive **vitamin D** supplementation are known causes of hypercalcemia. *Parathyroid adenoma* - A parathyroid adenoma causes **primary hyperparathyroidism**, characterized by elevated PTH and hypercalcemia. - While possible, the association with myasthenia gravis and the increased risk of malignancy make **paraneoplastic syndrome** a more contextual answer here given the prompt. *Small Cell Lung Cancer (SCLC)* - SCLC is more commonly associated with other paraneoplastic syndromes like **SIADH (syndrome of inappropriate antidiuretic hormone secretion)** due to ectopic ADH production, or **Cushing's syndrome** due to ectopic ACTH production. - While hypercalcemia can rarely occur, it is **less common** and typically not due to PTHrP in SCLC compared to NSCLC. *Sarcoidosis* - Sarcoidosis can cause hypercalcemia through increased production of **1,25-dihydroxyvitamin D** by activated macrophages in granulomas, leading to enhanced intestinal calcium absorption. - However, in the context of a myasthenia gravis patient with the clinical scenario described, **malignancy-associated hypercalcemia** (particularly NSCLC) is a more likely and clinically relevant consideration.

Question 1

A 45-year-old patient presents with symptoms of anemia, depigmented hair, and myelopathy. Which of the following mineral deficiencies is most likely associated with this clinical presentation?

Accepted Answer

Copper

Answer

Iron

Answer

Fluoride

Answer

Zinc

Answer

Selenium

Question 2

A young patient in an endemic area presents with pleural fluid showing LDH level greater than 0.6 times the serum LDH, protein level greater than 0.5 times the serum protein, and lymphocytic predominance. What is the most likely diagnosis?

Accepted Answer

Tuberculosis

Answer

Heart failure

Answer

Hepatic failure

Answer

Renal failure

Answer

Malignancy

Question 3

A patient presents with acute epigastric pain and an increase in serum lipase. Several days after stabilization, a chest X-ray shows bilateral diffuse infiltrates. What is the most common pathology explaining the chest X-ray findings?

Accepted Answer

Non-cardiogenic pulmonary edema

Answer

Increased PCWP

Answer

Pulmonary thromboembolism

Answer

Aspiration pneumonitis

Answer

Pleural effusion

Question 4

A 62-year-old patient presents with left-sided arm and leg weakness, right-sided facial paralysis with lateral rectus gaze palsy, and nystagmus. Based on the clinical presentation, which of the following syndromes is most consistent with these symptoms?

Accepted Answer

Foville syndrome

Answer

Benedict's syndrome

Answer

Millard-Gubler syndrome

Answer

Wallenberg syndrome

Question 5

A patient with a history of hypertension presents with atrial fibrillation, shortness of breath, and bilateral basal crackles on auscultation. Which of the following would be the least important in the management of this patient?

Accepted Answer

IV Digoxin for control rate

Answer

Start on anticoagulants

Answer

Start β-blocker

Answer

Cardioversion to correct rhythm if hemodynamically remains unstable even after medical management

Answer

Administer diuretics for fluid overload

Question 6

The PR interval was measured at 0.21 seconds on a routine ECG of a patient. What is the correct interpretation?

Accepted Answer

First degree heart block

Answer

Second degree heart block

Answer

Normal rhythm

Answer

Complete heart block

Question 7

In Type 1 Diabetes Mellitus (DM) stage 3 beta cell destruction, which of the following is the most likely presentation?

Accepted Answer

Hyperglycemia symptomatic

Answer

Dysglycemic symptomatic

Answer

Normoglycemic symptomatic

Answer

Dysglycemic asymptomatic

Answer

Normoglycemic asymptomatic

Question 8

What is the most common cause of death in idiopathic pulmonary fibrosis (IPF)?

Accepted Answer

Respiratory failure

Answer

Pulmonary edema

Answer

Cancer

Answer

Pulmonary arterial hypertension (PAH)

Answer

Acute exacerbation of IPF

Question 9

An athlete collapsed and expired while playing school basketball. Histology of the cardiac specimen is most likely to indicate which of the following conditions?

Accepted Answer

Hypertrophic cardiomyopathy (HCM)

Answer

Dilated cardiomyopathy (DCM)

Answer

Restrictive cardiomyopathy (RCM)

Answer

Arrhythmogenic right ventricular dysplasia (ARVD)

Question 10

A Myasthenia Gravis patient on mycophenolate and pyridostigmine presents with hypercalcemia. Apart from the obvious drug-related cause, what other condition could be associated with hypercalcemia in this patient?

Accepted Answer

Non-Small Cell Lung Cancer (NSCLC)

Answer

Drug induced

Answer

Parathyroid adenoma

Answer

Small Cell Lung Cancer (SCLC)

Answer

Sarcoidosis

NEET-PG 2024

Biochemistry

Internal Medicine

Pathology

Pharmacology