ENT
2 questionsA 30-year-old male presents to the clinic with a history of recurrent ear infections and a recent "popping" sensation in his left ear. Otoscopic examination of the left ear reveals a central perforation of the tympanic membrane. The pure tone audiometry (PTA) results show the following: Right Ear: Air conduction and bone conduction thresholds are within normal limits. Left Ear: A significant air-bone gap is present, with bone conduction thresholds within the normal range. Based on these findings, what is the most likely diagnosis regarding the type of hearing loss?
A patient presents to the emergency department with significant nasal trauma after a fall. Examination reveals a deviated nasal pyramid and palpation confirms crepitus and mobility of the nasal bones. A lateral nasal bone X-ray confirms a displaced nasal bone fracture. Which of the following instruments is specifically designed for the closed reduction of a displaced nasal bone fracture?
NEET-PG 2025 - ENT NEET-PG Practice Questions and MCQs
Question 81: A 30-year-old male presents to the clinic with a history of recurrent ear infections and a recent "popping" sensation in his left ear. Otoscopic examination of the left ear reveals a central perforation of the tympanic membrane. The pure tone audiometry (PTA) results show the following: Right Ear: Air conduction and bone conduction thresholds are within normal limits. Left Ear: A significant air-bone gap is present, with bone conduction thresholds within the normal range. Based on these findings, what is the most likely diagnosis regarding the type of hearing loss?
- A. Left conductive hearing loss (Correct Answer)
- B. Right sensorineural hearing loss
- C. Left sensorineural hearing loss
- D. Right conductive hearing loss
Explanation: ***Left conductive hearing loss*** - A conductive hearing loss is defined on PTA by the presence of a significant **air-bone gap** (AC threshold worse than BC threshold) with **normal bone conduction** thresholds. - The otoscopic finding of a **central perforation of the tympanic membrane** indicates a pathology in the middle ear/conducting mechanism, which is the classical cause of a conductive loss. *Left sensorineural hearing loss* - This type of loss occurs when both **air conduction** and **bone conduction** thresholds are equally reduced (no air-bone gap) and are outside the normal limits. - It indicates a problem with the **cochlea** or the **auditory nerve**, which contradicts the normal bone conduction found in the left ear. *Right conductive hearing loss* - The PTA results for the right ear showed **air and bone conduction thresholds** within normal limits, confirming **normal hearing** in the right ear. - Therefore, a hearing loss of any type in the right ear is ruled out by the objective audiometric data. *Right sensorineural hearing loss* - This would require both air and bone conduction thresholds in the right ear to be significantly elevated (impaired), which is inconsistent with the **normal audiometry findings** reported for the right ear.
Question 82: A patient presents to the emergency department with significant nasal trauma after a fall. Examination reveals a deviated nasal pyramid and palpation confirms crepitus and mobility of the nasal bones. A lateral nasal bone X-ray confirms a displaced nasal bone fracture. Which of the following instruments is specifically designed for the closed reduction of a displaced nasal bone fracture?
- A. Luc's forceps
- B. Bayonet forceps
- C. Walsham forceps (Correct Answer)
- D. Tilley's forceps
Explanation: ***Walsham forceps*** - The **Walsham forceps** is specifically designed for the **closed reduction** of displaced nasal bone fractures, utilizing an internal blade and an external padded blade for controlled lifting and manipulation. - They allow the surgeon to gain purchase on the fractured segments to safely elevate **depressed nasal bones** and restore the nasal pyramid's shape. *Tilley's forceps* - **Tilley's nasal dressing forceps** are primarily used for general purposes, such as removing foreign bodies, packing the nose, or removing **small polyps** from the nasal cavity. - They lack the necessary structure, leverage, and specialized curve required to successfully engage and **reduce** a bony nasal fracture. *Luc's forceps* - **Luc's forceps** are generally used for applying **anterior nasal packing** or removing dressings, serving primarily as a dressing forceps. - Although used in the nose, they do not have the specialized geometry needed to grasp and elevate the bony cartilage for **fracture reduction**. *Bayonet forceps* - **Bayonet forceps** are commonly used in microscopic or endoscopic procedures (e.g., ear or fine nasal surgery) because their offset handle prevents the surgeon's hand from obstructing the line of sight. - They are used for fine grasping, packing, or dissection, but are entirely unsuitable for the heavy task of **reducing** a **displaced nasal bone fracture**.
Internal Medicine
3 questionsA patient with HIV develops tuberculosis. When should ART be initiated?
A patient is on salbutamol and ipratropium but continues to have nocturnal exacerbations of asthma. What is the next step?
A 25-year-old sewage worker presents with fever for 1 week and weakness for 1 day. Laboratory evaluation reveals elevated bilirubin and decreased urine output. Conjunctival redness? What is the most likely diagnosis?
NEET-PG 2025 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 81: A patient with HIV develops tuberculosis. When should ART be initiated?
- A. Start ART followed by ATT
- B. ART alone
- C. Start ART and ATT simultaneously
- D. Start ATT, then ART after 2 weeks (Correct Answer)
Explanation: ***A. Start ATT, then ART after 2 weeks*** - This strategy is the standard recommendation, particularly for patients with CD4 counts >50 cells/mm³, to reduce the risk of **Tuberculosis-Associated Immune Reconstitution Inflammatory Syndrome (IRIS)** [1]. - Delaying ART by 2 weeks allows patients to establish tolerance to **Anti-Tubercular Treatment (ATT)** and simplifies the management of potential overlapping drug toxicities [2]. *B. Start ART and ATT simultaneously* - Simultaneous initiation significantly increases the risk and severity of developing **IRIS**, which can worsen the patient's clinical status due to paradoxical worsening of TB symptoms [1]. - This approach also makes it challenging to identify the source of **drug-related toxicities** (e.g., hepatotoxicity), as many ATT and ART drugs are metabolized by the liver [2]. *C. Start ART followed by ATT* - Delaying the initiation of **ATT** is dangerous as active tuberculosis is the immediate life-threatening condition that requires urgent treatment [2]. - Treatment priority in HIV-TB co-infection must first focus on effectively treating the active infection to prevent **disseminated disease** and death. *D. ART alone* - Administering **ART alone** will lead to the progression of active tuberculosis, resulting in significant morbidity and high mortality rates. - ART is necessary but must be combined with effective **ATT** as it is not a treatment for Mycobacterium tuberculosis itself.
Question 82: A patient is on salbutamol and ipratropium but continues to have nocturnal exacerbations of asthma. What is the next step?
- A. Montelukast
- B. Increase the dose of salbutamol
- C. Laba plus inhalation steroids (Correct Answer)
- D. Oral corticosteroids
Explanation: ***Laba plus inhalation steroids*** - In a patient with persistent symptoms (nocturnal exacerbations) despite using a SABA (**salbutamol**) and a SAMA (**ipratropium**), the next step is to initiate or step up therapy by adding a long-term controller medication, which is typically a combination of **Inhaled Corticosteroids (ICS)** and a **Long-Acting Beta-Agonist (LABA)** [1]. - This combination is crucial for controlling airway inflammation and providing prolonged bronchodilation, effectively managing nocturnal symptoms [1], [2]. *Oral corticosteroids* - **Oral corticosteroids** are reserved for acute, severe exacerbations, short courses for bridging, or in cases of very severe asthma refractory to high-dose inhaled therapy [3]. - They are not the standard next step for managing persistent nocturnal symptoms in a patient previously stable on SABA/SAMA. *Montelukast* - **Montelukast** (a leukotriene receptor antagonist) is generally considered a less potent controller than the ICS/LABA combination and is often used as an add-on therapy or for specific phenotypes like aspirin-exacerbated respiratory disease (AERD). - Its efficacy in independently controlling moderate-to-severe persistent asthma, characterized by nocturnal symptoms, is lower than that of ICS/LABA [2]. *Increase the dose of salbutamol* - **Salbutamol** is a **Short-Acting Beta-Agonist (SABA)**, used primarily as a reliever for acute symptoms, not as a long-term controller [2], [4]. - Increasing its dose or frequency significantly suggests reliance on relief medication, which indicates poorly controlled asthma and can increase the risk of adverse cardiac side effects like **tachycardia**.
Question 83: A 25-year-old sewage worker presents with fever for 1 week and weakness for 1 day. Laboratory evaluation reveals elevated bilirubin and decreased urine output. Conjunctival redness? What is the most likely diagnosis?
- A. Enteric fever
- B. Acute Viral Hepatitis
- C. Weil's disease (Correct Answer)
- D. Brucellosis
Explanation: ***Weil's disease*** - The clinical triad of fever, **jaundice (elevated bilirubin)**, and **acute kidney injury (decreased urine output)**, particularly in an individual with exposure to contaminated water (**sewage worker**), is the classical presentation of the severe form of leptospirosis, also known as Weil's disease [1]. - **Conjunctival suffusion/redness** without inflammation or discharge is a pathognomonic physical sign highly suggestive of Weil's disease, caused by the spirochete **Leptospira interrogans** [1], [2]. *Brucellosis* - Usually presents with an undulating fever, night sweats, and localized infection in the bones (**spondylitis**) or reticuloendothelial system; it is often linked to consumption of **unpasteurized dairy**. - While mild hepatic involvement can occur, it rarely causes the severe combination of **acute renal failure** and deep jaundice seen in this patient. *Enteric fever* - Characterized by a gradually rising fever, **relative bradycardia**, and often features a dry cough, abdominal discomfort, and sometimes **rose spots**. [2] - Severe organ damage like acute kidney injury and profound jaundice simultaneously is unusual in typhoid fever, and **conjunctival suffusion** is not a feature. *Acute Viral Hepatitis* - Presents with fever, malaise, and eventually **jaundice (elevated bilirubin)**; the primary pathology is hepatocyte necrosis. [2] - It typically does not cause simultaneous severe **acute renal failure** and the specific finding of **conjunctival suffusion**, which are hallmarks of Weil's disease.
Microbiology
3 questionsA patient presents with recurrent infections with Neisseria gonorrhoeae. Which of the following investigations is most appropriate to evaluate the underlying immunodeficiency?
A farmer presents with an ulcerative skin lesion showing signs of necrosis. Smear from the ulcer stained with polychrome methylene blue reveals capsulated bacilli that are McFadyean reaction positive. What is the most likely causative organism?
A middle-aged man from an endemic region presents with progressive swelling of the lower limb. A peripheral blood smear shows the following structure. What is the most likely cause of his limb swelling?
NEET-PG 2025 - Microbiology NEET-PG Practice Questions and MCQs
Question 81: A patient presents with recurrent infections with Neisseria gonorrhoeae. Which of the following investigations is most appropriate to evaluate the underlying immunodeficiency?
- A. Nitroblue tetrazolium test
- B. Terminal complement (C5-C9) assay (Correct Answer)
- C. Quantitative immunoglobulin levels
- D. C1 esterase inhibitor assay
Explanation: ***Terminal complement (C5-C9) assay*** - Recurrent infections with *Neisseria* species (gonorrhoeae or meningitidis) are the classic presentation of a deficiency in the **Terminal Complement Components (C5-C9)**. - These components assemble the **Membrane Attack Complex (MAC)**, which is crucial for the lysis and killing of the thin cell walls of Neisserial organisms. *C1 esterase inhibitor assay* - This assay is used to diagnose **Hereditary Angioedema (HAE)**, which presents with recurrent episodes of swelling, not recurrent bacterial infections like *N. gonorrhoeae*. - HAE involves uncontrolled activation of the complement and kinin pathways, not failure to eliminate bacteria. *Quantitative immunoglobulin levels* - Measuring **IgG, IgA, and IgM** levels evaluates humoral immunity, typically diagnosing conditions like **Common Variable Immunodeficiency (CVID)**. - Antibody deficiencies usually lead to recurrent sinopulmonary infections with encapsulated bacteria (*Strep pneumoniae*, *H flu*), not specifically *Neisseria*. *Nitroblue tetrazolium test* - This test, or the modern DHR assay, screens for **Chronic Granulomatous Disease (CGD)**, a defect in phagocyte function (NADPH oxidase). - CGD patients suffer from severe, deep-seated infections and abscesses caused by **catalase-positive organisms** (e.g., *Staph aureus*, *Aspergillus*), not complement-dependent issues like recurrent *Neisseria*.
Question 82: A farmer presents with an ulcerative skin lesion showing signs of necrosis. Smear from the ulcer stained with polychrome methylene blue reveals capsulated bacilli that are McFadyean reaction positive. What is the most likely causative organism?
- A. Yersinia pestis
- B. Francisella tularensis
- C. Bacillus anthracis (Correct Answer)
- D. Clostridium perfringens
Explanation: ***Bacillus anthracis*** - The combination of a necrotic skin ulcer (eschar) in an exposed individual (farmer) and the specific laboratory findings is diagnostic for **Cutaneous Anthrax**. - The **McFadyean reaction** is a specific test for *Bacillus anthracis*, where the D-glutamic acid polypeptide capsule is stained **pink/purple** against the blue bacilli using **Polychrome Methylene Blue (PMB)** stain. *Clostridium perfringens* - This organism typically causes **gas gangrene** (clostridial myonecrosis) characterized by severe tissue destruction and gas production (crepitus), not usually a single necrotic ulcer. - Although it is a Gram-positive bacillus, it is an **anaerobe**, unlike the aerobic *Bacillus anthracis*, and the McFadyean reaction is not used for its identification. *Yersinia pestis* - This Gram-negative organism causes **plague** and typically presents with painful, swollen lymph nodes called **buboes** (buboes plague). - It is classified as a small, pleomorphic, non-capsulated bacillus and does not exhibit a positive McFadyean reaction with Polychrome Methylene Blue. *Francisella tularensis* - This causative agent of **tularemia** often causes an ulceroglandular syndrome, but it is a small, Gram-negative coccobacillus and does not have the macroscopic capsule visualized by the McFadyean reaction. - It requires specialized culture media like **cysteine-glucose-blood agar** due to its fastidious nature, differentiating it from *Bacillus* species.
Question 83: A middle-aged man from an endemic region presents with progressive swelling of the lower limb. A peripheral blood smear shows the following structure. What is the most likely cause of his limb swelling?
- A. Hypoalbuminemia
- B. Lymphatic obstruction (Correct Answer)
- C. Hypoproteinemia
- D. Increased hydrostatic pressure
Explanation: ***Lymphatic obstruction*** - The image displays **microfilariae** (suggesting **Lymphatic Filariasis**), where the adult worms settle in the lymphatics, physically blocking flow. - This obstruction results in chronic, progressive edema (known as **lymphedema** or **elephantiasis**) due to the failure of lymphatic drainage in the affected limb. *Hypoalbuminemia* - Edema from **hypoalbuminemia** is due to low plasma oncotic pressure and typically results in generalized, pitting edema, which is not characteristic of chronic, localized filarial swelling. - While malnutrition might co-exist, the core pathology shown by the presence of **microfilariae** points specifically to mechanical lymphatic blockage. *Hypoproteinemia* - **Hypoproteinemia** is a general cause of edema via reduced **oncotic pressure**, leading to fluid shift into the interstitial spaces, usually causing generalized rather than localized swelling. - This systemic cause does not account for the specific parasitic damage to the lymphatics demonstrated by the presence of the **filarial worms**. *increased hydrostatic pressure* - Increased hydrostatic pressure (e.g., in conditions like DVT or CHF) leads to fluid leakage from capillaries, causing pitting edema. - The root cause here is the parasitic **destruction and obstruction of lymph nodes and channels**, which specifically impairs lymph return, not capillary hydrostatic pressure regulation.
Pharmacology
1 questionsA patient presents with GERD. Which drug helps in contraction of LES and increases gastric emptying?
NEET-PG 2025 - Pharmacology NEET-PG Practice Questions and MCQs
Question 81: A patient presents with GERD. Which drug helps in contraction of LES and increases gastric emptying?
- A. Vonoprazan
- B. Ranitidine
- C. Pantoprazole
- D. Metoclopramide (Correct Answer)
Explanation: ***Metoclopramide*** - It is a **prokinetic agent** that acts as a D2 dopamine receptor antagonist, which increases esophageal tone, enhances peristalsis, and facilitates **gastric emptying**. - It specifically increases the pressure of the **Lower Esophageal Sphincter (LES)**, reducing reflux associated with GERD. *Pantoprazole* - This is a **Proton Pump Inhibitor (PPI)** that reduces acid production by irreversible inhibition of the H+/K+-ATPase pump in parietal cells [1], [2]. - It does not have any significant effect on **LES contraction** or **gastric motility**. *Vonoprazan* - This is a **Potassium-Competitive Acid Blocker (P-CAB)**, which directly and reversibly inhibits the H+/K+-ATPase pump. - Like other acid suppressants, it decreases acid secretion but does not improve **LES function** or **gastric emptying**. *Ranitidine* - This is an **H2 receptor antagonist** that blocks histamine receptors on parietal cells, leading to decreased acid secretion [3]. - It treats GERD by reducing acidity but has no direct action on **LES tone** or stomach **motility**.
Psychiatry
1 questionsA patient on haloperidol for 2 years presents with orofacial dyskinesia and extrapyramidal symptoms. What is the appropriate treatment?
NEET-PG 2025 - Psychiatry NEET-PG Practice Questions and MCQs
Question 81: A patient on haloperidol for 2 years presents with orofacial dyskinesia and extrapyramidal symptoms. What is the appropriate treatment?
- A. Akathisia - propranolol
- B. Parkinsonism - amantadine
- C. Tardive dyskinesia - valbenazine (Correct Answer)
- D. Acute dystonia - ropinirole
Explanation: ***Tardive dyskinesia - valbenazine*** - The patient's presentation of **orofacial dyskinesia** following **long-term use** (2 years) of a high-potency antipsychotic like haloperidol is highly characteristic of **Tardive Dyskinesia (TD)**, a chronic EPS. - **Valbenazine** (a VMAT2 inhibitor) is one of the primary, FDA-approved treatments specifically used to reduce the severity of abnormal movements in TD. *Acute dystonia - ropinirole* - **Acute dystonia** is an immediate reaction (hours to days) involving severe muscle spasms, not a delayed presentation of dyskinesia. - The treatment for acute dystonia is typically an **anticholinergic** (e.g., benztropine) or diphenhydramine; **ropinirole** is a dopamine agonist used for Parkinson's disease. *Akathisia - propranolol* - **Akathisia** is defined by a subjective feeling of restlessness and an objective inability to sit still, which is different from the involuntary, choreiform movements of **dyskinesia**. - Although **propranolol** is the appropriate treatment for akathisia, the symptom cluster (orofacial dyskinesia) indicates a diagnosis of **TD**. *Parkinsonism - amantadine* - Drug-induced **Parkinsonism** involves bradykinesia, rigidity, and resting tremor, rather than the prominent abnormal mouth and face movements (dyskinesia) seen here. - While **amantadine** is used for drug-induced parkinsonism, it is generally ineffective or potentially worsens the movements associated with **Tardive Dyskinesia**.