NEET-PG 2025 Practice Questions

Q: Patient came with severe headache and seizures. Sodium on admission was 98 meq/L. We have started correction with 3 % saline and now after 24 hours of infusion sodium is 110 meq/L. Patient develops mutism and altered sensorium. Which investigation will you perform now?

MRI Head. ***MRI Head*** - A rapid correction of **severe chronic hyponatremia** (from 98 to 110 mEq/L in 24 hours, exceeding the recommended limit of 8-10 mEq/L) puts the patient at very high risk for **Osmotic Demyelination Syndrome (ODS)** (previously Central Pontine Myelinolysis). [1] - The new onset of **mutism** and **altered sensorium** are classic, late symptoms of ODS, necessitating an **MRI head** to visualize characteristic **pontine** (and sometimes extrapontine) lesions. *LP for CSF biochemistry* - LP is primarily indicated for diagnosing infections or inflammatory conditions of the CNS, which is less likely given the clear history of electrolyte imbalance and complication following rapid correction. - While CSF analysis can reveal demyelination products, an **MRI** is the definitive, non-invasive imaging modality for diagnosing ODS. *Brainstem evoked potentials* - Brainstem auditory evoked potentials (BAEP) primarily assess the **integrity of the auditory pathways** through the brainstem. [2] - While ODS affects the brainstem, BAEP is not the standard or most sensitive first-line investigation for confirming demyelinating lesions in the pons. *EEG* - EEG measures the electrical activity of the cerebral cortex and is primarily useful for localizing seizure foci or assessing the severity of encephalopathy. [2] - The symptoms (mutism, altered sensorium) point strongly to a structural brainstem lesion (ODS), which is best confirmed by **MRI head**, not EEG.

Q: A 68-year-old male with a history of COPD presents to the emergency room with severe dyspnea and altered mental status. An arterial blood gas (ABG) is drawn with the following results: pH: 7.28 PaCO2: 60 mmHg HCO3-: 28 mEq/L Na+: 142 mEq/L Cl-: 100 mEq/L Based on these results, what is the calculated anion gap?

B. 14 mEq/L. ***14 mEq/L*** - The **anion gap (AG)** is calculated using the formula: $\text{AG} = [\text{Na}^+] - ([\text{Cl}^-] + [\text{HCO}_3^-])$. [1] - Plugging in the patient's values: $142 - (100 + 28) = 142 - 128 = **14 \text{ mEq/L}**$. *10 mEq/L* - This value is below the calculated 14 mEq/L and would be considered low if the normal range upper limit is 12, suggesting a calculation error. [1] - An anion gap of 10 mEq/L is typically a normal value, but it is not the mathematically correct result based on the patient's **serum electrolyte** values. *18 mEq/L* - Obtaining this value would imply that $[\text{Cl}^-] + [\text{HCO}_3^-]$ equaled 124 mEq/L ($142 - 18$), which is incorrect as the sum is **128 mEq/L**. - An anion gap of 18 mEq/L indicates a **High Anion Gap Metabolic Acidosis (HAGMA)**, which is metabolically possible but mathematically inconsistent with the provided electrolyte numbers. [1] *24 mEq/L* - This value is significantly higher than 14 mEq/L and would suggest a severe uncompensated **HAGMA** (e.g., severe ketoacidosis or lactic acidosis). [1] - The calculation based on the given **plasma concentrations** of sodium, chloride, and bicarbonate simply does not support this result.

Q: Based on the image provided, what is the most appropriate confirmatory investigation?

Manometry. ***Manometry*** - Esophageal manometry is the **gold standard** (confirmatory test) for achalasia, as it directly evaluates the motility and pressure patterns of the esophagus. - It definitively demonstrates the two key pathognomonic findings: **absent esophageal peristalsis** and **incomplete relaxation of the lower esophageal sphincter (LES)**. *pH monitoring* - This test is used primarily to diagnose **Gastroesophageal Reflux Disease (GERD)** by quantifying abnormal acid exposure in the distal esophagus. - It is not relevant for confirming achalasia, which is a **motor disorder** causing functional obstruction, not acid reflux. *Upper GI Endoscopy* - Endoscopy is crucial for **ruling out secondary achalasia** (pseudoachalasia), caused by underlying conditions like malignancy, which can structurally mimic the radiologic findings. - Although mandatory in evaluation, it does not confirm the **functional motor deficit** (aperistalsis and failed relaxation) required for definitive diagnosis of primary achalasia. *Barium swallow study* - The image provided is a Barium swallow study, which serves as the **initial screening tool** for achalasia by showing the classic **"bird-beak" appearance** of the distal esophagus. - While suggestive, this radiological study reports morphology and transit, but **manometry** is required to confirm the associated physiological defect (abnormal pressures and motility).

Q: A woman diagnosed with cervical cancer is found to have unilateral hydroureteronephrosis on imaging due to tumor invasion. What is the FIGO stage of her disease?

Stage IIIB. ***Stage IIIB*** - According to the FIGO 2018 staging, the presence of **hydronephrosis** or a non-functioning kidney due to the primary tumor classifies the disease as **Stage IIIB**. - This signifies locally advanced disease where the tumor has extended to the **pelvic wall** or caused ureteral obstruction. *Stage IIB* - Stage IIB involves tumor extension to the parametrium (the fibrous tissue surrounding the uterus) but specifically **without reaching the pelvic wall** or causing hydronephrosis. - While there is parametrial involvement, it is not sufficient in extent to cause clinical or radiological evidence of **ureteral obstruction**. *Stage IIIA* - This stage is defined by tumor extension to the **lower third of the vagina**, which is a local but not a distant spread criterion. - Importantly, Stage IIIA implies no involvement of the pelvic wall and no **hydronephrosis** or non-functioning kidney based on obstruction. *Stage IIIC* - **Stage IIIC** is defined solely by the presence of lymph node metastases, regardless of the size or extent of the primary tumor. - This includes involvement of either **pelvic lymph nodes (IIIC1)** or **para-aortic lymph nodes (IIIC2)**, which is a different criterion from ureteral obstruction.

Q: A pregnant woman is undergoing a vaginal breech delivery. After delivering the baby's body up to the umbilicus, the obstetrician notices winging of the baby's scapula. To facilitate safe delivery of the baby's shoulders and head, which of the following maneuvers is most appropriate?

Lovset maneuver. ***Lovset maneuver*** - The clinical sign of **winging of the scapula** indicates a **nuchal arm** (arm trapped behind the baby's head), which is a specific complication during breech delivery. - The Lovset maneuver is specifically designed to deliver nuchal arms and impacted **shoulders** in breech presentation by causing the posterior shoulder to rotate anteriorly under the symphysis pubis. - The obstetrician achieves this by grasping the baby's pelvis and rotating the trunk **180 degrees** while applying **gentle downward traction**, which releases the trapped arm and allows delivery of the shoulders. *Pinard maneuver* - This maneuver is used to deliver the **legs** when they are extended in breech presentation, by flexing the thigh and performing **outward sweeping** pressure in the popliteal fossa. - It is performed earlier in the delivery to address extended legs, not for addressing nuchal arm or shoulder complications after the body has reached the level of the umbilicus. *Burns Marshall maneuver* - This technique is used for delivery of the **aftercoming head** when the head is already flexed; the baby's body is allowed to **hang down** until the nape of the neck appears under the symphysis pubis. - It is inappropriate at this stage, as the shoulders and nuchal arm must be delivered first before the head is addressed. *Mauriceau-Smellie-Veit maneuver* - This maneuver is specifically designed for the safe delivery and **flexion of the aftercoming head**, using the operator's hand within the vagina to flex the head while applying traction on the baby's shoulders. - The primary concern here is the **delivery of the nuchal arm and shoulders**, which must precede the use of any maneuver for the aftercoming head.

Q: A 25-year old patient who had a Road traffic accident was initially conscious but later became unconscious and subsequently died. On postmortem examination, multiple petechial hemorrhages are seen in the corpus callosum, what is the probable diagnosis?

Diffuse axonal injury. ***Diffuse axonal injury*** - The characteristic finding of **multiple petechial hemorrhages** (microhemorrhages) specifically in deep structures like the **corpus callosum** and brainstem is the pathological hallmark of **Diffuse Axonal Injury** (DAI) [1]. - DAI results from severe acceleration/deceleration (shearing) forces during trauma, leading to widespread axonal disruption, which explains the progression from initial consciousness to coma [1]. *EDH* - Epidural Hematoma (EDH) involves an arterial bleed, typically from the **middle meningeal artery**, causing a hematoma external to the dura mater [1]. - Although EDH often presents with a clinical **lucid interval**, the post-mortem findings are limited to the hematoma collection external to the brain substance, not deep parenchymal petechiae [1]. *SDH* - Subdural hematoma (SDH) is caused by the tearing of **bridging veins** and collects between the dura and arachnoid mater. - While SDH can cause delayed deterioration due to haematoma expansion, the specific microscopic deep white matter hemorrhages described are the defining feature of **DAI**, not SDH. *Contusion* - Cerebral contusions present as focal areas of hemorrhagic necrosis, typically at the site of impact (coup) or opposite side (contrecoup), commonly affecting the frontal and temporal poles [1]. - Unlike DAI, contusions are macroscopic hemorrhagic lesions visible on gross examination, not the characteristic microscopic petechial hemorrhages in deep white matter structures like the corpus callosum [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1262-1264.

Q: A man is climbing a mountain for trekking. Based on his physiological response to the high altitude, what is the most likely primary acid-base abnormality in his blood?

Respiratory alkalosis. ***Respiratory alkalosis*** - Exposure to **high altitude** causes decreased ambient partial pressure of oxygen (PO₂), leading to **hypoxemia**. - The physiological response to hypoxemia is reflex **hyperventilation** mediated by peripheral chemoreceptors, which blows off excessive **carbon dioxide (CO₂)**, causing decreased PaCO₂ and consequently elevated blood pH (alkalosis). - This is the **primary and immediate** acid-base abnormality at high altitude. *Metabolic acidosis* - This condition occurs due to the accumulation of **non-volatile acids** (e.g., lactic acid, ketoacids) or loss of bicarbonate. - While the kidney eventually compensates for the respiratory alkalosis by excreting bicarbonate (leading to compensatory **metabolic acidosis**), this is the **secondary, not the primary**, abnormality. *Metabolic alkalosis* - This abnormality is typically caused by loss of acid (e.g., severe vomiting, gastric suction) or excessive administration of alkali. - It is not related to the immediate respiratory compensatory response to **high-altitude hypoxemia**. *Respiratory acidosis* - This is caused by **hypoventilation** or impaired alveolar ventilation, leading to retention of **CO₂** and decreased pH. - At high altitude, the body actively **hyperventilates** to improve oxygen uptake, making respiratory acidosis the opposite of the expected primary response.

Q: What is the most probable diagnosis based on the image provided?

RUL collapse. ***RUL collapse*** - RUL collapse (atelectasis) is identified radiographically by signs of **volume loss**, including superior displacement of the right hilum and cephalic bowing/displacement of the **minor fissure**. - The collapsed lobe causes increased opacification in the upper zone, often associated with the **"S" sign of Golden** if an obstructing hilar mass is present. *RUL consolidation* - Consolidation is characterized by filling of the airspaces with fluid/exudate, causing increased density but typically **without volume loss** (unlike collapse). - A key differentiating feature is the presence of a **patent air bronchogram**, meaning air-filled bronchi are visible against the opaque lung parenchyma. *Bronchogenic carcinoma* - While **bronchogenic carcinoma** is a very common cause of RUL collapse (due to endobronchial obstruction), the primary diagnosis based on the visible lung changes (**volume loss and opacification**) is the collapse itself. - The term carcinoma refers to the underlying **etiology**, not the specific radiological pattern of atelectasis shown in the image. *Lung abscess* - A lung abscess is defined by a localized area of necrosis and pus formation, typically appearing as a **thick-walled cavity**. - The defining characteristic feature that differentiates it from collapse is the presence of an **air-fluid level** within the cavity.

Q: A 30-year-old female was brought to the emergency room after a fire. On examination, full-thickness burns and deep partial-thickness burns were present involving the lower limb circumferentially. A procedure was performed to relieve vascular compromise. Identify the procedure?

Escharotomy. ***Escharotomy*** - Performed for **full-thickness (circumferential)** burns to relieve pressure caused by the rigid, constricting **eschar** (necrotic tissue). - Indicated when there are signs of **compartment syndrome** or impaired distal circulation (e.g., absent pulses, cyanosis) in the affected limb. *Debridement* - Involves removing dead, contaminated, or foreign material from a wound to promote healing. - While necessary for complex burns, simply debridement does not address the acute vascular compromise caused by circumferential full-thickness burns. *Excised to healthy tissue* - Refers to **tangential** or **fascial excision** of the burn wound, an operative procedure typically done under general anesthesia for definitive wound management. - This is performed later for wound bed preparation, not an immediate, bedside procedure to restore circulation and prevent limb loss like **escharotomy**. *Early skin grafting* - The definitive procedure used to close the wound after it is excised and prepared. - Cannot be performed until severe vascular constriction is relieved and the wound bed is adequately prepared, making it a later step in management.

Question 1

Patient came with severe headache and seizures. Sodium on admission was 98 meq/L. We have started correction with 3 % saline and now after 24 hours of infusion sodium is 110 meq/L. Patient develops mutism and altered sensorium. Which investigation will you perform now?

Accepted Answer

MRI Head

Answer

LP for CSF biochemistry

Answer

EEG

Answer

Brainstem evoked potentials

Question 2

A 30-year-old man with 6 month past history of PND and SOB. On examination, JVP is elevated with irregularly irregular pulse and tender hepatomegaly and MDM. past medical history of ARF. Which of the following is not seen in this patient?

Accepted Answer

Presystolic accentuation of mid-diastolic murmur is hallmark feature

Answer

Right heart failure

Answer

Absent a wave in JVP

Answer

Patient has increased risk of embolic stroke

Question 3

A 68-year-old male with a history of COPD presents to the emergency room with severe dyspnea and altered mental status. An arterial blood gas (ABG) is drawn with the following results:
pH: 7.28
PaCO2: 60 mmHg
HCO3-: 28 mEq/L
Na+: 142 mEq/L
Cl-: 100 mEq/L
Based on these results, what is the calculated anion gap?

Accepted Answer

B. 14 mEq/L

Answer

A. 10 mEq/L

Answer

D. 24 mEq/L

Answer

C. 18 mEq/L

Question 4

Based on the image provided, what is the most appropriate confirmatory investigation?

Accepted Answer

Manometry

Answer

Barium swallow study

Answer

Upper GI Endoscopy

Answer

pH monitoring

Question 5

A woman diagnosed with cervical cancer is found to have unilateral hydroureteronephrosis on imaging due to tumor invasion. What is the FIGO stage of her disease?

Accepted Answer

Stage IIIB

Answer

Stage IIIC

Answer

Stage IIIA

Answer

Stage IIB

Question 6

A pregnant woman is undergoing a vaginal breech delivery. After delivering the baby's body up to the umbilicus, the obstetrician notices winging of the baby's scapula. To facilitate safe delivery of the baby's shoulders and head, which of the following maneuvers is most appropriate?

Accepted Answer

Lovset maneuver

Answer

Burns Marshall maneuver

Answer

Pinard maneuver

Answer

Mauriceau-Smellie-Veit maneuver

Question 7

A 25-year old patient who had a Road traffic accident was initially conscious but later became unconscious and subsequently died. On postmortem examination, multiple petechial hemorrhages are seen in the corpus callosum, what is the probable diagnosis?

Accepted Answer

Diffuse axonal injury

Answer

Epidural hematoma

Answer

Subdural hematoma

Answer

Contusion

Question 8

A man is climbing a mountain for trekking. Based on his physiological response to the high altitude, what is the most likely primary acid-base abnormality in his blood?

Accepted Answer

Respiratory alkalosis

Answer

Metabolic acidosis

Answer

Respiratory acidosis

Answer

Metabolic alkalosis

Question 9

What is the most probable diagnosis based on the image provided?

Accepted Answer

RUL collapse

Answer

Bronchogenic carcinoma

Answer

Lung abscess

Answer

RUL consolidation

Question 10

A 30-year-old female was brought to the emergency room after a fire. On examination, full-thickness burns and deep partial-thickness burns were present involving the lower limb circumferentially. A procedure was performed to relieve vascular compromise. Identify the procedure?

Accepted Answer

Escharotomy

Answer

Debridement

Answer

Early skin grafting

Answer

Excised to healthy tissue

NEET-PG 2025

Internal Medicine

Obstetrics and Gynecology

Pathology

Physiology

Radiology

Surgery