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: A 42-year-old woman presents with chronic lower abdominal pain and dysmenorrhea. MRI shows diffuse uterine enlargement with junctional zone thickening and scattered high-signal foci in the myometrium. What is the most likely diagnosis?

Adenomyosis. ***Adenomyosis*** - This diagnosis is strongly suggested by the triad of **chronic lower abdominal pain**, severe **dysmenorrhea**, and an associated **diffusely enlarged uterus** (globular). - MRI typically shows ill-defined thickening of the **junctional zone** (>12 mm) and scattered high-signal intensity foci within the myometrium, representing ectopic endometrial tissue. *Uterine fibroid* - While fibroids cause chronic pain and heavy menstrual bleeding (**menorrhagia**), they less commonly cause severe, primary **dysmenorrhea** compared to adenomyosis. - On imaging, fibroids are typically **well-circumscribed** solid masses with sharply defined borders, unlike the diffuse enlargement of adenomyosis. *Endometriosis* - Endometriosis causes **chronic pelvic pain** and dysmenorrhea, but the symptoms are due to implants outside the uterus (e.g., ovaries, peritoneum). - Imaging (MRI) would primarily show features like **endometriomas** (chocolate cysts) or deep infiltrating nodules, rather than the diffuse myometrial involvement seen here. *Endometrial carcinoma* - The principal symptom of endometrial carcinoma in pre-menopausal women is typically **abnormal uterine bleeding** (menorrhagia or metrorrhagia), not primarily chronic pelvic pain and dysmenorrhea. - MRI would show hallmark features like **focal endometrial thickening** and invasion, which are generally distinct from the diffuse process of adenomyosis.

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 woman is diagnosed with a pituitary microadenoma and has elevated serum prolactin levels. She presents with secondary amenorrhea and infertility. What is the most likely mechanism by which hyperprolactinemia causes these symptoms?

Decreased GnRH secretion from the hypothalamus. ***Decreased GnRH secretion from the hypothalamus*** - High levels of prolactin directly inhibit the pulsatile release of **Gonadotropin-Releasing Hormone (GnRH)** from the hypothalamus. - This inhibition leads to decreased pituitary secretion of **Luteinizing Hormone (LH)** and Follicle-Stimulating Hormone (FSH), causing **hypogonadotropic hypogonadism**, resulting in anovulation, amenorrhea, and infertility. *Antagonism of estrogen receptors* - Prolactin primarily exerts its reproductive effects centrally on the **hypothalamic-pituitary axis**, not by acting as a peripheral antagonist of estrogen receptors. - The resulting symptoms are due to **low estrogen production** secondary to inhibited gonadotropins, not receptor blockade. *Increased pulsatile FSH secretion* - Hyperprolactinemia actually causes **decreased** and non-pulsatile secretion of FSH and LH, rather than an increase. - If FSH were increased, it would stimulate follicular development and likely lead to ovarian hyperfunction, which is the opposite of the clinical presentation. *Increased LH secretion from the pituitary* - Prolactin actively inhibits LH release, causing **low plasma LH** levels and disrupting the mid-cycle LH surge necessary for ovulation. - The resulting state is one of inadequate follicular stimulation and anovulation, causing infertility and oligomenorrhea/amenorrhea.

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: 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

A 42-year-old woman presents with chronic lower abdominal pain and dysmenorrhea. MRI shows diffuse uterine enlargement with junctional zone thickening and scattered high-signal foci in the myometrium. What is the most likely diagnosis?

Accepted Answer

Adenomyosis

Answer

Endometrial carcinoma

Answer

Endometriosis

Answer

Uterine fibroid

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 woman is diagnosed with a pituitary microadenoma and has elevated serum prolactin levels. She presents with secondary amenorrhea and infertility. What is the most likely mechanism by which hyperprolactinemia causes these symptoms?

Accepted Answer

Decreased GnRH secretion from the hypothalamus

Answer

Increased LH secretion from the pituitary

Answer

Antagonism of estrogen receptors

Answer

Increased pulsatile FSH secretion

Question 9

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 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

Surgery