NEET-PG 2025 Practice Questions

Q: Which of the following organs does this epithelium most likely belong to?

Ureter. ***Ureter*** - The image displays **transitional epithelium** (urothelium), which is characterized by multiple cell layers and large, dome-shaped (**umbrella**) cells on the apical surface. - This specialized stratified epithelium is highly stretchable and is exclusively found lining the urinary tract, including the renal pelvis, ureter, and bladder. *Gallbladder* - The gallbladder is lined by **simple columnar epithelium**, which is specialized for water reabsorption and concentration of bile, lacking the stratified layers seen here. - It has a single layer of cells with microvilli but does not possess the unique apical **umbrella cells** of the urothelium. *Trachea* - The trachea is lined by **pseudostratified ciliated columnar epithelium**, which includes numerous **goblet cells** and distinct cilia on the apical surface. - This tissue type appears stratified but all cells contact the basement membrane, unlike the true stratification seen in the image. *Intestine* - The small and large intestines are lined by **simple columnar epithelium** with prominent **microvilli** (forming a striated border) and numerous **goblet cells**. - This is a single-layered epithelium primarily designed for absorption and secretion, which is structurally distinct from the urinary epithelium shown.

Q: A 20-year-old patient presents with a non-progressive hypopigmented lesion on the trunk. On Wood's lamp examination, there is white accentuation. Diascopy is negative. What is the most likely diagnosis?

Nevus depigmentosus. ***Nevus depigmentosus*** - This disorder is a congenital, non-progressive **hypopigmentation** (reduced melanin), which remains constant in size and shape, fitting the clinical scenario. - The lesion shows accentuation (brighter white) under **Wood's lamp**, confirming reduced melanin, and **diascopy is negative** as it is a pigmentary, not vascular, change. *Vitiligo* - Vitiligo is characterized by complete **depigmentation** (leukoderma) due to melanocyte destruction, leading to a stark, **chalk-white** appearance under Wood's lamp. - It is typically a **progressive** symmetrical condition, unlike the static, non-progressive lesion described. *Nevus anemicus* - This is a vascular lesion caused by local exquisite sensitivity to catecholamines, causing **localized vasoconstriction**; hence it is not a true pigment disorder. - The defining feature is a **positive diascopy** (the patch disappears when blanched), which contradicts the negative diascopy in the patient. *Indeterminate leprosy* - Leprosy lesions are hypopigmented patches, but the essential diagnostic criterion is **impaired sensation** (anesthesia or hypoaesthesia), a feature absent from the description. - These patches usually do not show the distinct **white accentuation** seen under Wood's lamp typical of true pigmentary nevi.

Q: A patient presents with an indurated plaque on the cheek with central atrophy. Chest X-ray reveals apical calcification. Which of the following tests is most appropriate to confirm the diagnosis?

PCR. ***PCR*** - The clinical picture of an indurated plaque (often exhibiting **apple-jelly nodules** on diascopy) with central atrophy, coupled with radiological evidence of old pulmonary TB (apical calcification), strongly suggests **Lupus Vulgaris** (cutaneous tuberculosis). - **PCR (Polymerase Chain Reaction)** is the most sensitive and specific method for confirming the diagnosis by detecting *Mycobacterium tuberculosis* DNA, which is essential as Lupus Vulgaris is typically a **paucibacillary** condition where AFB staining and culture often fail. *Mantoux test* - The **Mantoux test** assesses delayed-type hypersensitivity (Type IV reaction) to tuberculin antigens and indicates prior exposure to TB or BCG vaccination. - It is useful for screening but **does not confirm active disease** (Lupus Vulgaris) and can be negative in immunocompromised patients or anergic forms. *Slit skin smear* - **Slit skin smear** is the diagnostic method primarily used to detect **acid-fast bacilli** (*M. leprae*) and classify **Leprosy** (Hansen's disease). - It is **not the investigation of choice** for diagnosing tuberculosis. *Probe test* - Nucleic acid **probe tests** (hybridization) are molecular techniques used to identify *M. tuberculosis* but are generally less sensitive than modern **PCR** assays, especially when dealing with limited tissue samples or low bacterial load. - **PCR** is the superior and more widely employed molecular diagnostic standard for confirming paucibacillary TB.

Q: A patient presents with orange-colored tonsils. Laboratory investigations reveal triglyceride level of 140 mg/dL and HDL cholesterol of 5 mg/dL. What is the most likely diagnosis?

Tangier disease. ***Tangier disease*** - This condition is a rare genetic disorder characterized by a mutation in the **ATP-binding cassette transporter A1 (ABCA1)** gene, leading to accelerated catabolism of HDL. - The clinical hallmarks are extremely low **HDL cholesterol** (often < 5 mg/dL) and the accumulation of cholesterol esters in macrophages, resulting in enlarged, characteristic **orange-colored tonsils** [1]. *Familial hypercholesterolemia* - Caused by defects in the **LDL receptor** or ApoB, resulting in severely elevated **LDL cholesterol** levels and premature atherosclerosis [1]. - It typically presents with tendon xanthomas and arcus senilis, but does not cause extremely low HDL or visible changes in the tonsils. *Type I hyperlipoproteinemia* - This type is characterized by functional deficiency of **lipoprotein lipase (LPL)** or its cofactor ApoC-II, leading to massive accumulation of **chylomicrons** in the plasma. - The primary finding is severe **hypertriglyceridemia** (often > 1000 mg/dL), leading to eruptive xanthomas and pancreatitis; HDL levels are not the primary diagnostic feature. *Abetalipoproteinemia* - Caused by a defect in the **microsomal triglyceride transfer protein (MTP)**, preventing the synthesis of ApoB-containing lipoproteins (chylomicrons, VLDL, LDL) [1]. - It presents with severe fat malabsorption, neurological deficits due to Vitamin E deficiency, and **acanthocytosis** (spiculated RBCs), rather than tonsillar changes.

Q: A person with jaundice presented with a history of bleeding and symptoms normalised after giving Vitamin K injection. The probable cause is?

Biliary obstruction. ***Biliary obstruction*** - **Biliary obstruction** (Cholestasis) prevents the flow of bile into the duodenum, impairing the absorption of **fat-soluble vitamins** (A, D, E, K) [1]. - **Vitamin K** deficiency leads to impaired synthesis of **coagulation factors II, VII, IX, and X** in the liver, causing a coagulopathy (bleeding tendency) that is corrected by parenteral Vitamin K administration [2]. *Alpha antitrypsin deficiency* - This typically causes liver disease (cirrhosis) and emphysema, but the bleeding issues are due to general hepatic synthetic failure, meaning the coagulopathy would usually be **refractory to simple Vitamin K injection** [1]. - The deficiency is mainly linked to **panacinar emphysema** and pediatric/adult liver failure presentations, not primarily a **Vitamin K-responsive coagulopathy**. *Autoimmune hepatitis* - This condition causes chronic inflammation and destruction of hepatocytes, leading to liver failure and cirrhosis; the resulting coagulopathy is due to **synthetic dysfunction**. - Coagulopathy from severe autoimmune hepatitis is typically **not fully corrected** by Vitamin K injection alone, requiring fresh frozen plasma (FFP) if bleeding is severe. *Factor XI deficiency* - This is a rare, **autosomal recessive** congenital deficiency (Hemophilia C) not usually associated with jaundice or liver disease. - The bleeding tendency is **not due to Vitamin K malabsorption** or deficiency, and thus would not be corrected by Vitamin K injection.

Q: A 20-year-old man presents with chronic back pain that is worse in the morning and improves with physical activity. He also has a history of anterior uveitis. A lumbar spine X-ray shows no abnormalities. Which of the following is the most appropriate next investigation for early diagnosis?

MRI sacroiliac joints. The presentation (inflammatory back pain improving with activity, and anterior uveitis) strongly suggests **Ankylosing Spondylitis (AS)** [1]. MRI is the **most sensitive imaging modality** for early diagnosis, as it can detect acute, reversible inflammatory changes (like **bone marrow edema**) in the sacroiliac joints before they are visible on X-ray [1]. CT is superior for visualizing **bony changes** like erosions or fusion but is significantly less sensitive than MRI for detecting active **bone marrow inflammation** in the early stages of sacroiliitis [1]. X-ray of the spine is usually performed after SI joint films but will often be **normal in early disease** (as suggested by the clinical case, where lumbar X-ray was negative) [1]. Radiographic changes like squaring of vertebrae or **syndesmophytes** only appear much later in the disease course, making it inadequate for *early* diagnosis [1]. Bone scintigraphy (bone scan) is a **non-specific** test that shows increased uptake but has poor anatomical resolution for assessing the sacroiliac joint specifically [1].

Q: A 25-year-old man presents to the emergency department following a motorbike accident and is found to have a closed midshaft fracture of the left tibia. Six hours later, he develops severe leg pain that is disproportionate to the injury and worsens with passive dorsiflexion of the foot. The pain is not relieved by analgesics. On examination, dorsalis pedis and posterior tibial pulses are present, but there is no sensation over the first dorsal webspace. What is the most appropriate next step in management?

Immediate fasciotomy. ***Immediate fasciotomy*** - The clinical presentation of severe, disproportionate pain, pain on passive stretching, and altered sensation (**paresthesia**) in the setting of a major fracture is highly indicative of **acute compartment syndrome**. - **Fasciotomy** is the definitive, urgent treatment to decompress the muscle compartments and prevent irreversible tissue necrosis and nerve damage. *Elevate the limb and observe* - Elevating the limb may further decrease the **arterial-venous pressure gradient**, potentially worsening an already compromised perfusion. - Observation is inappropriate because **acute compartment syndrome** requires immediate surgical intervention to prevent serious, permanent deficits or loss of function. *Administer opioid analgesics and continue observation* - Analgesics, even strong opioids, will only mask the classic symptom (**disproportionate pain**) but will not address the underlying pathology (increased intracompartmental pressure). - Continued observation will lead to progression of **ischemia**, resulting in irreversible muscle and nerve damage after approximately 6-8 hours. *Apply cast and follow up* - Applying a cast in the setting of suspected **compartment syndrome** is contraindicated, as the rigid cast can contribute to or exacerbate the compartment pressure. - Following up later is dangerous and negligent, as this condition is a surgical emergency requiring intervention within the **golden hour(s)** to salvage limb function.

Q: Effect of pulmonary embolism on graph of V/Q?

Increased V/Q ratio approaching infinity (dead space). ***Increased V/Q ratio approaching infinity (dead space)*** - In pulmonary embolism, an embolus obstructs a pulmonary artery, leading to a significant reduction or complete cessation of **perfusion (Q)** to the downstream lung tissue, while **ventilation (V)** remains unaffected. - This creates a V/Q mismatch where the ratio V/Q becomes very high, approaching infinity. This ventilated but unperfused lung region is known as **physiological dead space**. *Decreased V/Q ratio approaching zero* - A decreased V/Q ratio occurs when ventilation is impaired relative to perfusion (V<Q), a condition known as a **shunt**. - This is characteristic of conditions like **pneumonia**, **pulmonary edema**, or **atelectasis**, where alveoli are filled with fluid or collapsed but still receive blood flow. *Normal V/Q ratio* - Pulmonary embolism is a classic cause of a severe **V/Q mismatch**, specifically creating high V/Q units; therefore, the ratio in the affected area is not normal. - A normal V/Q ratio (approximately 0.8) implies well-matched ventilation and perfusion, which is the state PE directly disrupts. *Increased perfusion (Q) and decreased ventilation (V)* - This describes the opposite of what occurs in pulmonary embolism, where the primary problem is a **decrease in perfusion (Q)** due to the arterial blockage. - Increased perfusion with decreased ventilation would result in a **low V/Q ratio (shunt)**, not the high V/Q dead space seen in PE.

Q: A man is extremely particular about being on time and consistently shows a strong need for order, control, and perfectionism. Which personality disorder does this behavior most likely suggest?

Obsessive-Compulsive Personality Disorder. ***Obsessive-Compulsive Personality Disorder*** - Core features include a pervasive pattern of preoccupation with **orderliness**, **perfectionism**, and **mental and interpersonal control**. - The extreme need to be on time and the consistent focus on control and order align perfectly with the diagnostic criteria for **OCPD**. *Paranoid Personality Disorder* - Characterized by a pervasive distrust and **suspiciousness** of others, often interpreting their motives as malevolent. - The primary concern is not order or perfectionism, but rather the fear of being **deceived** or **exploited**. *Narcissistic Personality Disorder* - Defined by a pervasive pattern of **grandiosity**, a need for admiration, and a lack of empathy; they believe they are special or unique. - While they may demand perfection from others, their own behavior is motivated by maintaining high **self-esteem** and status, not inherent orderliness or control for its own sake. *Schizoid Personality Disorder* - Involves profound detachment from social relationships and a restricted range of emotional expression; they typically prefer **solitary activities**. - This disorder does not involve the characteristic preoccupation with rules, control, or **perfectionism** seen in the patient described.

Q: A patient on long-term antipsychotics develops involuntary mouth and lip movements (perioral dyskinesia). What is the best treatment?

Stop antipsychotic and give tetrabenazine. ***Stop antipsychotic and give tetrabenazine*** - Managing **Tardive Dyskinesia (TD)** involves either switching to a less potent antipsychotic (like clozapine) or, ideally, reducing or discontinuing the offending antipsychotic if clinically feasible. - **Tetrabenazine** (or its analogues valbenazine/deutetrabenazine) are **VMAT2 inhibitors** that decrease presynaptic dopamine release, making them the **first-line pharmacological treatment** for established TD. - This combination represents the most definitive approach when the underlying psychiatric condition allows antipsychotic discontinuation. *Increase the antipsychotic dose* - Increasing the antipsychotic dose temporarily masks TD by increasing central dopamine receptor blockade, but this worsens the underlying **striatal dopamine receptor upregulation** that causes TD. - This strategy only delays definitive treatment and prolongs the risk of severe, irreversible dyskinesia. - While it may suppress movements transiently, it is **never** appropriate long-term management. *Start benzodiazepines* - **Benzodiazepines** (GABA agonists) are generally ineffective for the core involuntary movements of established **Tardive Dyskinesia**. - They may be useful for acute movement disorders or anxiety but lack efficacy against chronic, persistent dopamine-related dyskinesia. *Give anticholinergics* - **Anticholinergic drugs** (e.g., benztropine, trihexyphenidyl) are the treatment of choice for **acute dystonia** and drug-induced Parkinsonism. - These agents are generally **contraindicated** in Tardive Dyskinesia because they often worsen or reveal underlying dyskinetic movements.

Question 1

Which of the following organs does this epithelium most likely belong to?

Accepted Answer

Ureter

Answer

Trachea

Answer

Gallbladder

Answer

Intestine

Question 2

A 20-year-old patient presents with a non-progressive hypopigmented lesion on the trunk. On Wood's lamp examination, there is white accentuation. Diascopy is negative. What is the most likely diagnosis?

Accepted Answer

Nevus depigmentosus

Answer

Nevus anemicus

Answer

Indeterminate leprosy

Answer

Vitiligo

Question 3

A patient presents with an indurated plaque on the cheek with central atrophy. Chest X-ray reveals apical calcification. Which of the following tests is most appropriate to confirm the diagnosis?

Accepted Answer

PCR

Answer

Mantoux test

Answer

Slit skin smear

Answer

Probe test

Question 4

A patient presents with orange-colored tonsils. Laboratory investigations reveal triglyceride level of 140 mg/dL and HDL cholesterol of 5 mg/dL. What is the most likely diagnosis?

Accepted Answer

Tangier disease

Answer

Abetalipoproteinemia

Answer

Type I hyperlipoproteinemia

Answer

Familial hypercholesterolemia

Question 5

A person with jaundice presented with a history of bleeding and symptoms normalised after giving Vitamin K injection. The probable cause is?

Accepted Answer

Biliary obstruction

Answer

Autoimmune hepatitis

Answer

Alpha antitrypsin deficiency

Answer

Factor XI deficiency

Question 6

A 20-year-old man presents with chronic back pain that is worse in the morning and improves with physical activity. He also has a history of anterior uveitis. A lumbar spine X-ray shows no abnormalities. Which of the following is the most appropriate next investigation for early diagnosis?

Accepted Answer

MRI sacroiliac joints

Answer

X-ray thoracolumbar spine

Answer

Bone scan

Answer

CT spine

Question 7

A 25-year-old man presents to the emergency department following a motorbike accident and is found to have a closed midshaft fracture of the left tibia. Six hours later, he develops severe leg pain that is disproportionate to the injury and worsens with passive dorsiflexion of the foot. The pain is not relieved by analgesics. On examination, dorsalis pedis and posterior tibial pulses are present, but there is no sensation over the first dorsal webspace. What is the most appropriate next step in management?

Accepted Answer

Immediate fasciotomy

Answer

Administer opioid analgesics and continue observation

Answer

Apply cast and follow up

Answer

Elevate the limb and observe

Question 8

Effect of pulmonary embolism on graph of V/Q?

Accepted Answer

Increased V/Q ratio approaching infinity (dead space)

Answer

Decreased V/Q ratio approaching zero

Answer

Normal V/Q ratio

Answer

Increased perfusion (Q) and decreased ventilation (V)

Question 9

A man is extremely particular about being on time and consistently shows a strong need for order, control, and perfectionism. Which personality disorder does this behavior most likely suggest?

Accepted Answer

Obsessive-Compulsive Personality Disorder

Answer

Narcissistic Personality Disorder

Answer

Paranoid Personality Disorder

Answer

Schizoid Personality Disorder

Question 10

A patient on long-term antipsychotics develops involuntary mouth and lip movements (perioral dyskinesia). What is the best treatment?

Accepted Answer

Stop antipsychotic and give tetrabenazine

Answer

Start benzodiazepines

Answer

Give anticholinergics

Answer

Increase the antipsychotic dose

NEET-PG 2025

Anatomy

Dermatology

Internal Medicine

Orthopaedics

Physiology

Psychiatry