NEET-PG 2017 - Internal Medicine Practice Questions

Q: A 50-year-old hypertensive patient develops sudden onset drooping of right face and hemiplegia. What is the diagnosis?

MCA area hemorrhage. ***MCA area hemorrhage*** - The **hyperdense lesion** on CT scan indicates **acute hemorrhage** in the MCA territory, which correlates with the sudden onset right facial droop and hemiplegia. - **Hypertension** is the most common risk factor for primary **intracerebral hemorrhage**, and MCA territory involvement typically causes contralateral face and arm weakness. *MCA area infarction* - **Infarctions** appear as **hypodense (dark) areas** on CT scan, not hyperdense lesions as described in this case. - While MCA infarction can cause similar clinical symptoms, the imaging findings clearly show hemorrhage rather than ischemic changes. *ACA area infarction* - **ACA infarction** typically presents with **leg weakness** more prominent than face/arm weakness, as the ACA supplies the medial motor cortex for lower limbs. - The imaging shows a **hyperdense hemorrhage**, not the **hypodense appearance** characteristic of infarction. *ACA area hemorrhage* - **ACA territory hemorrhage** would affect the **frontal lobe**, causing symptoms like leg weakness, **abulia** (lack of motivation), and urinary incontinence. - The clinical presentation of **facial droop and hemiplegia** involving face and arm is more characteristic of **MCA involvement** rather than ACA territory.

Q: A patient presents with GCS of 7 with nuchal rigidity and bloody CSF. Which is incorrect regarding this condition? (Recent NEET Pattern 2016-17)

IV ceftriaxone. **IV ceftriaxone** - The clinical presentation of **GCS of 7**, **nuchal rigidity**, and **bloody CSF** is highly suggestive of a **subarachnoid hemorrhage (SAH)**, not a bacterial infection like meningitis. - **Ceftriaxone** is an antibiotic commonly used to treat bacterial meningitis, which is not indicated here as the primary issue is hemorrhage, not infection. *Blood in sylvian fissure* - **Blood in the sylvian fissure** is a common finding in **subarachnoid hemorrhage**, as this area contains major cerebral arteries susceptible to aneurysm rupture. - CT scans often show hyperdense (bright) blood within the sulci and cisterns, including the sylvian fissure. *Seizures* - **Seizures** are a relatively common complication of **subarachnoid hemorrhage**, especially in the acute phase due to blood irritating the cerebral cortex. - They can occur in up to 10-20% of SAH patients and are a significant predictor of poorer outcomes. *Intraventricular extension* - **Intraventricular extension** of blood indicates a more severe hemorrhage and is often associated with a worse prognosis in **subarachnoid hemorrhage**. - The presence of blood within the ventricles can lead to **hydrocephalus** and increased intracranial pressure.

Q: A 35-year-old woman presents with breathlessness at rest. She also complains of a skin lesion on nose which has increased in size for last 6 months. What is the diagnosis?

Sarcoidosis. ***Sarcoidosis*** - Sarcoidosis is a multisystem **granulomatous disease** that commonly involves the lungs (causing **breathlessness**) and skin (manifesting as **lesions on the nose**, such as lupus pernio). The chest X-ray likely shows lung involvement like **bilateral hilar lymphadenopathy** or interstitial infiltrates. - The combination of **pulmonary symptoms** and characteristic **skin lesions** in a young to middle-aged adult is highly suggestive of sarcoidosis. *Phakomatosis* - Phakomatoses are a group of syndromes characterized by tumors or malformations of the skin, nervous system, and sometimes other organs. - While they can have skin lesions (e.g., neurofibromas, angiomas) and sometimes central nervous system or visceral involvement, **breathlessness is not a primary or typical presenting symptom**, and their CXR findings are usually normal unless there is specific lung involvement not characteristic of sarcoidosis. *Pulmonary lymphangiomatosis* - Pulmonary lymphangiomatosis is a rare, benign disease involving the proliferation of **lymphatic vessels** within the lung parenchyma, mediastinum, and pleura. - While it can cause breathlessness, **skin lesions on the nose are not a feature** of this condition, making it an unlikely diagnosis in this clinical context. *DRESS syndrome* - **DRESS (Drug Rash with Eosinophilia and Systemic Symptoms) syndrome** is a severe adverse drug reaction characterized by a widespread skin rash, fever, eosinophilia, and internal organ involvement (e.g., liver, kidneys). - While it presents with a skin lesion and systemic symptoms, the **onset is usually acute** following drug exposure, and the skin lesion on the nose described as increasing in size over 6 months is not typical for DRESS. Additionally, the pulmonary involvement differs from granulomatous disease.

Q: A patient of swine flu has developed severe respiratory distress. Which of the following findings confirm the diagnosis of ARDS in this patient?

PaO₂/FiO₂ ratio < 300 and PCWP 18 mm Hg - A PaO₂/FiO₂ ratio less than 200 mmHg would indicate severe ARDS, but the elevated PCWP > 18 mm Hg suggests that the primary issue is cardiogenic pulmonary edema, not ARDS. - In ARDS, the problem is non-cardiogenic pulmonary edema secondary to capillary leakage in the lungs, thus a low PCWP is a diagnostic criterion [1]. PaO₂/FiO₂ ratio 18 mm Hg - A PaO₂/FiO₂ ratio less than 400 mmHg is not a specific criterion for ARDS; the cutoff is 300 mmHg. - An elevated PCWP > 18 mm Hg indicates fluid overload due to cardiac dysfunction, which points away from ARDS. PaO₂/FiO₂ ratio < 100 and PCWP < 18 mm Hg - While a PaO₂/FiO₂ ratio less than 100 mmHg indicates profound hypoxemia consistent with severe ARDS, the diagnosis of ARDS is made at a ratio of < 300 mmHg. - This option describes a very severe form of ARDS but the key diagnostic cutoff for ARDS is < 300 mmHg, not specifically less than 100 mmHg for the confirmation of ARDS per the Berlin definition.

Q: A 40-year-old woman with history of progressive shortness of breath has lesions on her legs as shown. HbA1C of the patient is 5.8%. Lipid profile shows serum cholesterol 175 mg%. What is the diagnosis? (Recent NEET Pattem 2016-17)

Erythema nodosum. ***Erythema Nodosum*** - The image shows **tender, red nodules** primarily on the shins, consistent with the characteristic presentation of erythema nodosum. - While exact values for **HbA1c** and **cholesterol** don't directly diagnose this, erythema nodosum is often associated with systemic conditions, and the patient's progressive shortness of breath prompts further investigation into potential underlying causes. *Necrobiosis lipoidica diabeticorum* - This condition presents as **well-demarcated, yellow-brown patches** with a waxy or atrophic center, often with telangiectasias, not the acute tender nodules seen here. - Although it is associated with **diabetes**, the patient's HbA1c (5.8%) is within the prediabetic range, not typically indicative of established diabetes that commonly precedes significant necrobiosis lipoidica. *Xanthoma* - Xanthomas are **yellowish plaques or nodules** caused by lipid deposits in the skin, which can vary in appearance depending on the type (e.g., eruptive, tendinous, planar). - While hyperlipidemia can cause xanthomas, the patient's **normal cholesterol level** (175 mg%) makes this diagnosis less likely, and the lesions in the image are more erythematous and nodular than typical xanthomas. *Carotenemia* - **Carotenemia** is characterized by a harmless **yellow-orange discoloration of the skin**, particularly on the palms and soles, caused by excessive intake of carotene-rich foods. - This condition does not present with discrete, erythematous nodules as depicted in the image.

Q: The EEG of the patient shows which of the following? (Recent NEET Pattern 2016-17)

Burst suppression pattern. ***Burst suppression pattern*** - The EEG shows periods of high amplitude, mixed-frequency **bursts of activity** alternating with periods of **relative electrical silence** (suppression). - This pattern is often seen in conditions like severe **hypoxic-ischemic encephalopathy**, deep **anesthesia**, or severe brain injury. *Rademecker complex* - This refers to periodic trifasic complexes, often associated with subacute sclerosing panencephalitis (SSPE), which is a **slow viral infection** of the brain. - The complexes are typically **bilateral, synchronous, and repetitive**, not characterized by alternating bursts and suppression. *3/sec spike and slow wave pattern* - This pattern is characteristic of **absence seizures (petit mal epilepsy)**, where there are generalized, synchronous 3 Hz spike-and-wave discharges. - The image does not show continuous, rhythmic 3 Hz activity but rather alternating periods of activity and flat-lining. *4-6 Hz Polyspike* - Polyspikes are a series of two or more spikes or sharp waves clustered together, often associated with **myoclonic seizures** or other generalized epilepsies. - While there are some sharp waves in the burst phases, the overall pattern is dominated by the distinct periods of suppression, not continuous polyspike activity.

Q: The EEG of a 16-year-old boy with early morning involuntary movements of hands in his sleep noticed by parents, was performed. Immunization is complete. What does EEG show? (Recent NEET Pattern 2016-17)

Juvenile myoclonic epilepsy. ***Juvenile myoclonic epilepsy*** - The EEG shows generalized **polyspike-and-slow-wave discharges**, which are characteristic of juvenile myoclonic epilepsy (JME), especially when associated with early morning myoclonus. - The clinical presentation of a **16-year-old boy** with **involuntary movements of hands in his sleep** (suggesting myoclonic jerks), particularly in the morning, is highly consistent with JME. *SSPE* - Subacute sclerosing panencephalitis (SSPE) typically presents with characteristic EEG patterns like **Radermacker complexes** or **periodic complexes**, which are not seen here. - Clinical features of SSPE include progressive cognitive decline, myoclonus, and other neurological deficits, usually following a measles infection, which are not described. *Benign rolandic epilepsy* - Benign rolandic epilepsy (BRE) is characterized by **centrotemporal spikes** on EEG, often exacerbated by sleep, and presents with focal seizures affecting the face and mouth. - The generalized polyspike-and-slow-wave pattern and the clinical description of hand myoclonus do not fit the profile of BRE. *Huntington chorea* - Huntington's chorea is a **neurodegenerative genetic disorder** characterized by involuntary movements (chorea), cognitive decline, and psychiatric problems. - EEG findings in Huntington's chorea are often non-specific or show generalized slowing, and it is not an epilepsy syndrome with specific high-amplitude epileptiform discharges like those seen.

Q: Which of the following infections in most commonly seen in this transfusion dependant child shown below?

Yersinia enterocolitica. ***Yersinia enterocolitica*** - Transfusion-dependent patients, especially those with **iron overload** (common in thalassemia), are particularly susceptible to **Yersinia enterocolitica** infections because *Yersinia* thrives in iron-rich environments. - The image shows a child with marked hepatosplenomegaly (outlined on the abdomen), which is characteristic of conditions leading to transfusion dependence and subsequent iron overload, such as **thalassemia major**. *Listeria monocytogenes* - While *Listeria* can cause serious infections, particularly in immunocompromised individuals and neonates, its association with **iron overload** from transfusions is not as prominent as *Yersinia*. - **Listeriosis** typically presents as meningitis, sepsis, or febrile gastroenteritis. *Acinetobacter* - *Acinetobacter* species are often associated with **nosocomial infections**, affecting critically ill or immunocompromised patients in hospital settings, but not specifically linked to iron overload or transfusion dependence as a primary risk factor like *Yersinia*. - Infections commonly include pneumonia, urinary tract infections, and wound infections. *Pneumococcus* - **Pneumococcal infections** are common in children, especially those with asplenia or functional asplenia (which can occur in thalassemia due to splenic sequestration), but a direct link to **transfusion-associated iron overload** as a specific risk factor for severe pneumococcal disease is not the primary association like *Yersinia*. - These infections typically manifest as pneumonia, meningitis, and otitis media.

Q: Comment on the diagnosis in the patient shown below?

Hand and foot syndrome. ***Hand and foot syndrome*** - The image shows **swelling and dactylitis** of the fingers, along with a peripheral blood smear demonstrating **sickle cells** (indicated by arrows). This combination is characteristic of hand-foot syndrome, also known as **dactylitis**, which is often the first manifestation of **sickle cell disease** in infants and young children. - **Dactylitis** results from **vaso-occlusion** in the small bones of the hands and feet, leading to painful swelling. *Squaring of metacarpals* - **Squaring of metacarpals** is not a typical finding in sickle cell disease and does not correlate with the observed hand swelling and erythrocyte morphology. - This term is sometimes used to describe changes seen in conditions like **rheumatoid arthritis**, but not in the context of dactylitis associated with sickle cells. *Sub-periosteal resorption* - **Sub-periosteal resorption** is a hallmark radiological finding in **hyperparathyroidism**, affecting bones, typically in the phalanges. - It is not directly suggested by the hand swelling (which is soft tissue/marrow oedema) or the presence of sickle cells in the blood smear. *Peripheral oedema with iron deficiency anemia* - While the picture shows **peripheral oedema** (swelling), the concomitant finding of **sickle cells** in the blood smear strongly indicates **sickle cell disease**, not iron deficiency anemia. - **Iron deficiency anemia** typically presents with microcytic hypochromic red cells, not sickle-shaped cells, and while it can cause fatigue and pallor, it does not directly lead to the dactylitis seen here.

Q: The child is having skeletal abnormality in arms and hands. Which possible heart disease is seen in this condition?

ASD. ***ASD*** - The image shows a child with **phocomelia** or **hypoplastic radius/ulna**, a characteristic skeletal abnormality of the arms and hands, strongly associated with **Holt-Oram syndrome** - **Holt-Oram syndrome** is an **autosomal dominant** disorder caused by mutations in the **TBX5** gene, characterized by upper limb defects (absent/hypoplastic thumb, triphalangeal thumb, radial hypoplasia) and congenital heart defects - The most common cardiac defect is **ASD (ostium secundum type)**, followed by VSD — making ASD the correct answer *PDA* - **Patent ductus arteriosus (PDA)** is a common congenital heart defect but is **not specifically associated** with the upper limb skeletal abnormalities of Holt-Oram syndrome - PDA is classically seen in **premature infants** or associated with **rubella** infection, without specific upper limb skeletal anomalies *VSD* - **Ventricular septal defect (VSD)** is the **second most common** cardiac defect in Holt-Oram syndrome (after ASD), but it is less frequently associated than ASD - VSD is also the most common congenital heart defect overall, but without the specific upper limb skeletal findings, it would not be the first-line answer here *TOF* - **Tetralogy of Fallot (TOF)** comprises pulmonary stenosis, VSD, overriding aorta, and right ventricular hypertrophy - TOF is **not characteristically associated** with Holt-Oram syndrome or upper limb skeletal abnormalities; it is classically associated with cyanotic "tet spells" in infants

Question 1

A 50-year-old hypertensive patient develops sudden onset drooping of right face and hemiplegia. What is the diagnosis?

Accepted Answer

MCA area hemorrhage

Answer

ACA area infarction

Answer

ACA area hemorrhage

Answer

MCA area infarction

Question 2

A patient presents with GCS of 7 with nuchal rigidity and bloody CSF. Which is incorrect regarding this condition? (Recent NEET Pattern 2016-17)

Accepted Answer

IV ceftriaxone

Answer

Blood in sylvian fissure

Answer

Seizures

Answer

Intraventricular extension

Question 3

A 35-year-old woman presents with breathlessness at rest. She also complains of a skin lesion on nose which has increased in size for last 6 months. What is the diagnosis?

Accepted Answer

Sarcoidosis

Answer

Phakomatosis

Answer

Pulmonary lymphagiomatosis

Answer

DRESS syndrome

Question 4

A patient of swine flu has developed severe respiratory distress. Which of the following findings confirm the diagnosis of ARDS in this patient?

Accepted Answer

PaO₂/FiO₂ ratio < 300 and PCWP < 18 mm Hg

Answer

PaO₂/FiO₂ ratio < 200 and PCWP > 18 mm Hg

Answer

PaO₂/FiO₂ ratio < 400 and PCWP > 18 mm Hg

Answer

PaO₂/FiO₂ ratio < 100 and PCWP < 18 mm Hg

Question 5

A 40-year-old woman with history of progressive shortness of breath has lesions on her legs as shown. HbA1C of the patient is 5.8%. Lipid profile shows serum cholesterol 175 mg%. What is the diagnosis? (Recent NEET Pattem 2016-17)

Accepted Answer

Erythema nodosum

Answer

Necrobiosis lipidoica diabeticorum

Answer

Xanthoma

Answer

Carotenemia

Question 6

The EEG of the patient shows which of the following? (Recent NEET Pattern 2016-17)

Accepted Answer

Burst suppression pattern

Answer

Rademecker complex

Answer

3/sec spike and slow wave pattern

Answer

4-6 Hz Polyspike

Question 7

The EEG of a 16-year-old boy with early morning involuntary movements of hands in his sleep noticed by parents, was performed. Immunization is complete. What does EEG show? (Recent NEET Pattern 2016-17)

Accepted Answer

Juvenile myoclonic epilepsy

Answer

SSPE

Answer

Benign rolandic epilepsy

Answer

Huntington chorea

Question 8

Which of the following infections in most commonly seen in this transfusion dependant child shown below?

Accepted Answer

Yersinia enterocolitica

Answer

Listeria monocytogenes

Answer

Acinetobacter

Answer

Pneumococcus

Question 9

Comment on the diagnosis in the patient shown below?

Accepted Answer

Hand and foot syndrome

Answer

Squaring of metacarpals

Answer

Sub-periosteal resorption

Answer

Peripheral oedema with iron deficiency anemia

Question 10

The child is having skeletal abnormality in arms and hands. Which possible heart disease is seen in this condition?

Accepted Answer

ASD

Answer

PDA

Answer

VSD

Answer

TOF

NEET-PG 2017 — Internal Medicine