NEET-PG 2017 Practice Questions

Q: All are correct about the pressure recording shown below except: (Recent NEET Pattern 2016-17)

Can be used to assess left ventricular function. ***Can be used to assess left ventricular function*** - Central venous pressure (CVP) primarily reflects **right atrial pressure** and, indirectly, **right ventricular end-diastolic pressure**. - It is **not a reliable indicator** for assessing **left ventricular function**, which is better gauged by pulmonary artery wedge pressure (PAWP) or echocardiography. *Normal CVP is 2-10 cm of water* - The image depicts a manometer measuring CVP in **cm of water**. - The generally accepted normal range for CVP is **2-10 cm H2O** (or 0-8 mmHg), reflecting adequate right heart filling and venous return. *Pressure recording of more than 10 cm of water implies restricting IV fluids to the patient* - A CVP **above 10 cm H2O** (or 8 mmHg) typically indicates **fluid overload**, increased right ventricular preload, or right ventricular dysfunction. - In such cases, **restricting intravenous fluids** is often appropriate to prevent further circulatory congestion and potential complications like pulmonary edema. *Venous catheter is advanced into subclavicular IVC* - For CVP measurement, the catheter tip should ideally be positioned in the **superior vena cava (SVC)**, near its junction with the **right atrium**. - Advancing the catheter into the **inferior vena cava (IVC)** is anatomically incorrect for standard CVP measurement, as it would not reflect right atrial pressure as directly or accurately.

Q: A 20-year-old male with no history of any sexual contact presents with following lesions on his penis. What is the diagnosis?

Lichen nitidus. ***Lichen nitidus*** - The image shows numerous small, shiny, **pin-head sized papules** on the penis, which are characteristic of lichen nitidus. - This condition is often **asymptomatic** and benign, and it can occur on the penis without any sexual contact history. *Lichenoides keratosis* - This term is broad and often refers to a benign **inflammatory process** with lichenoid features affecting keratinocytes, usually solitary and often in older adults; it does not typically present as widespread, uniform papules on the penis. - Lichenoides keratosis is often a more **solitary lesion** or a reaction pattern, not a diffuse eruption of small papules like those pictured. *Epstein pearls* - **Epstein pearls** are small, white or yellow cysts found in the mouths of newborns, specifically on the gums or palate, and are remnants of epithelial tissue. - They are a normal finding in neonates and are **not found on the penis** or in a 20-year-old male. *Molluscum contagiosum* - Molluscum contagiosum lesions typically present as **dome-shaped, flesh-colored papules with central umbilication**. - While they can appear on the penis and are sexually transmitted, the lesions in the image lack the characteristic **umbilication** of molluscum contagiosum.

Q: What is the most likely diagnosis of the image given below?

Dermatomyositis. ***Dermatomyositis*** - The image displays a characteristic **heliotrope rash** (violaceous/purple-red discoloration) around the eyes and periorbital area, which is pathognomonic for dermatomyositis. - This condition is an **inflammatory myopathy** distinguished by distinct cutaneous manifestations (including Gottron's papules, shawl sign, and V-sign) alongside proximal muscle weakness. - The periorbital violaceous erythema with associated edema is highly characteristic and helps differentiate it from other facial rashes. *Acne rosacea* - Characterized by **facial erythema**, papules, pustules, and telangiectasias, primarily affecting the central face (cheeks, nose, chin, forehead). - Does not typically involve the marked periorbital (heliotrope) rash with violaceous discoloration seen in dermatomyositis. - Usually presents with flushing and visible blood vessels rather than periorbital edema. *Dermatitis herpetiformis* - Presents with intensely **pruritic (itchy) papules and vesicles** (blisters), typically symmetrical on extensor surfaces like elbows, knees, buttocks, and scalp. - Strongly associated with **celiac disease** (gluten-sensitive enteropathy). - Does not present as facial erythema or periorbital discoloration; the lesions are vesicular and intensely itchy. *Erythema marginatum* - A skin manifestation of **acute rheumatic fever**, characterized by an evanescent, **serpiginous (snake-like) migratory rash** with distinct, raised borders and clear centers. - Typically appears on the trunk and proximal limbs, sparing the face. - Does not present as periorbital discoloration and has a distinctive migrating, annular pattern.

Q: The following clinical presentation is seen in injury to which nerve? (Recent NEET Pattern 2016-17)

Median nerve. ***Median nerve*** - The image illustrates **'ape hand' deformity**, characterized by the inability to oppose the thumb and atrophy of the thenar eminence due to paralysis of the **thenar muscles** (abductor pollicis brevis, opponens pollicis, superficial head of flexor pollicis brevis). - These thenar muscles are primarily innervated by the **recurrent branch of the median nerve**. *Ulnar nerve* - Ulnar nerve injury typically causes **'claw hand' deformity** (hyperextension of MCP joints and flexion of IP joints of 4th and 5th digits) due to paralysis of the intrinsic muscles of the hand (interossei and medial two lumbricals). - It would also cause prominent atrophy of the **hypothenar eminence** and interosseous muscles. *Median and ulnar nerve* - Combined median and ulnar nerve injury would result in a **more severe and widespread paralysis** affecting nearly all intrinsic hand muscles, leading to a profound loss of hand function. - This would present with features of both **ape hand** and **claw hand**, commonly referred to as a **'simian hand'** if severe. *Radial nerve* - Radial nerve injury typically causes **'wrist drop'** and inability to extend the fingers and thumb at the metacarpophalangeal joints. - It primarily affects the **extensor muscles of the forearm** and does not directly result in thenar atrophy or the inability to oppose the thumb.

Q: A 35-year-old HIV+ patient presents with the following lesion in the neck. What is correct about the management?

Gravity drainage + ATT. ***Gravity drainage + ATT*** - The image shows a **scrofula**, presenting as an abscess in the cervical lymph nodes, likely due to **tuberculous lymphadenitis**. In such cases, **gravity drainage** is crucial to evacuate the purulent material effectively, especially in the neck region. - **Anti-tubercular therapy (ATT)** is the mainstay for treating tuberculosis, and it must be initiated in combination with drainage to eradicate the infection. *ATT for another 6 months* - While ATT is essential, it is **insufficient as a standalone treatment** for a mature draining abscess like the one depicted. - Simply continuing ATT without addressing the localized collection of pus would likely result in delayed healing and potential complications. *Anti-gravity drainage + ATT* - **Anti-gravity drainage** is generally not feasible or effective for abscesses in the neck, as gravity aids in the natural flow of exudates. - This approach would go against the principles of surgical drainage for fluid collections. *Incision and drainage* - While **incision and drainage (I&D)** is a standard procedure for many abscesses, caution is exercised in tuberculous lymphadenitis (scrofula) due to the risk of creating a **continuous fistula** or **non-healing sinus**. - **Repeat aspirations** or **gravity drainage** with concurrent ATT are preferred over formal incision and drainage to minimize scarring and fistula formation.

Q: The method of ulcer healing shown below generates a pressure of: (Recent NEET Pattern 2016-17)

Minus 125 mm Hg. ***Minus 125 mm Hg*** - The image depicts **Negative Pressure Wound Therapy (NPWT)**, also known as vacuum-assisted closure (VAC), which applies subatmospheric pressure to promote wound healing. - The standard therapeutic pressure for NPWT is **-125 mmHg**, which aids in wound contraction, granulation tissue formation, removal of exudate, and increased blood flow to the wound bed. - This pressure setting is well-established in clinical practice and supported by surgical literature. *Minus 100 cm of water* - While this represents negative pressure, **mmHg is the standard unit** used for measuring and reporting NPWT pressure settings, not cm H₂O. - Converting -100 cm H₂O to mmHg yields approximately -73.5 mmHg, which is lower than the commonly effective therapeutic pressure range for NPWT. *Plus 100 cm of water* - This indicates **positive pressure**, whereas NPWT fundamentally relies on **negative (subatmospheric) pressure** to achieve its therapeutic effects. - Positive pressure would not facilitate wound fluid removal, tissue contraction, or granulation tissue formation as intended by NPWT. *Plus 125 cm of water* - This represents **positive pressure**, which contradicts the core mechanism of action of **Negative Pressure Wound Therapy**. - Positive pressure would push against the wound rather than creating the suction needed to draw out exudate and promote wound closure.

Q: The following instrument used in split skin grafting is called: (Recent NEET Pattern 2016-17)

Humby's knife. ***Humby's knife*** - The image clearly depicts a **Humby's knife**, which is a type of **manual dermatome** used to harvest split-thickness skin grafts. - This instrument is characterized by its adjustable blade and roller, allowing for collection of skin grafts of varying thicknesses. *Mesher* - A **mesher** is an instrument used to create fenestrations or small slits in a skin graft, allowing it to stretch and cover a larger wound area. - The instrument in the image is designed for harvesting, not for meshing. *Watson's knife* - **Watson's knife** is another type of manual dermatome used for harvesting split-thickness skin grafts. - While similar in purpose to Humby's knife, Watson's knife has distinct design features and the instrument shown in the image is specifically a Humby's knife. *Blair knife* - **Blair knife** is a different type of skin grafting knife, typically used for full-thickness skin graft harvesting. - The instrument in the image has the characteristic roller and adjustable blade design of a Humby's knife, not a Blair knife.

Q: The following instrument used in split skin grafting is called: (Recent NEET Pattern 2016-17)

Humby's knife. ***Humby's knife*** - A **hand-held dermatome** with a long flat blade and an **adjustable calibrated roller/guard** that controls the thickness of the harvested graft. - Specifically designed for **freehand harvesting** of split-thickness skin grafts with precise depth control, making it the primary instrument for this procedure. *Mesher* - A **skin meshing device** used **after graft harvesting** to create perforations and expand the graft for better coverage. - Does not harvest skin grafts but rather processes already harvested grafts to create a mesh pattern. *Eschmann blade* - A type of **dermatome blade** used in powered dermatomes, not a standalone instrument for split skin grafting. - Requires a **motorized dermatome system** to function, unlike the hand-held Humby's knife. *Down's blade* - Another type of **dermatome blade** designed for use with specific dermatome systems. - Like the Eschmann blade, it is a **component blade** rather than a complete harvesting instrument like Humby's knife.

Q: A patient complains of pain and boggy swelling in the frontal region which is warm and tender. He also complains of drowsiness at times. What is the diagnosis?

Pott's puffy tumor. **Pott's puffy tumor** * **Pott's puffy tumor** is characterized by a focal osteomyelitis of the frontal bone, often complicated by a subperiosteal abscess. The description of **pain and boggy swelling in the frontal region, which is warm and tender**, perfectly matches this condition. * The complication of **drowsiness** indicates potential epidural or intracranial extension of the infection, which is a common and severe consequence of Pott's puffy tumor. *Pyogenic granuloma* * A pyogenic granuloma is a **benign vascular lesion** of the skin or mucous membranes. * While it can be warm and tender, it typically presents as an **eruptive, solitary, red papule or nodule** that bleeds easily, and it does not typically cause boggy swelling in the frontal bone or drowsiness. *Orbital cellulitis* * Orbital cellulitis presents with **pain, swelling, redness, and warmth around the eye,** often with proptosis and ophthalmoplegia. * While it is a serious infection, the primary swelling in this case is described in the **frontal region**, not specifically confined to the orbit, and the specific feature of a "boggy" swelling over bone is more indicative of a frontal bone osteomyelitis. *Cavernous sinus thrombosis* * Cavernous sinus thrombosis is characterized by **headache, painful ophthalmoplegia, proptosis, and vision loss**, often with fever and altered mental status. * While **drowsiness** can be a feature, the presentation lacks the prominent **orbital signs** and localizing frontal boggy swelling specific to the described case; instead, it would typically present predominantly with signs related to cranial nerve involvement and venous congestion of the orbit.

Q: What is the most likely diagnosis based on the image provided? The patient had a snake bite at this site 5 years ago.

Marjolin's ulcer. ***Marjolin's ulcer*** - This is a **squamous cell carcinoma** developing in a chronic wound, burn scar, or chronic inflammatory lesion, often after a long latent period (like the 5 years post-snake bite). The image shows a **fungating, ulcerative lesion** consistent with a malignant transformation in a chronic wound. - The history of a **snake bite 5 years ago** indicates a pre-existing chronic wound site, making Marjolin's ulcer the most probable diagnosis for a subsequent malignant change. *Bazin's ulcer* - Bazin's ulcer, also known as **erythema induratum**, is a chronic, recurrent panniculitis typically affecting the calves of young to middle-aged women. - It is associated with **tuberculosis**, presenting as tender, subcutaneous nodules that can ulcerate, which doesn't match the image or history. *Martorell's ulcer* - This is a form of **ischemic ulcer** caused by severe, uncontrolled hypertension, leading to microangiopathy and skin necrosis, usually on the anterior and lateral aspects of the lower leg. - While it presents as a painful ulcer, it is not typically associated with chronic trauma or previous wounds like a snake bite and lacks the fungating appearance shown. *Meleney's ulcer* - Meleney's ulcer, or **progressive bacterial synergistic gangrene**, is a rare, severe skin infection characterized by painful, undermined ulcers with a necrotic center. - It usually develops post-surgery or trauma and involves a synergistic bacterial infection, which is not suggested by the chronic nature (5 years) or the appearance of the lesion in the image.

Question 1

All are correct about the pressure recording shown below except: (Recent NEET Pattern 2016-17)

Accepted Answer

Can be used to assess left ventricular function

Answer

Normal CVP is 2-10 cm of water

Answer

Pressure recording of more than 10 cm of water implies restricting IV fluids to the patient

Answer

Venous catheter is advanced into subclavicular IVC

Question 2

A 20-year-old male with no history of any sexual contact presents with following lesions on his penis. What is the diagnosis?

Accepted Answer

Lichen nitidus

Answer

Lichenoides keratosis

Answer

Epstein pearls

Answer

Molluscum contagiosum

Question 3

What is the most likely diagnosis of the image given below?

Accepted Answer

Dermatomyositis

Answer

Acne rosacea

Answer

Dermatitis herpetiformis

Answer

Erythema marginatum

Question 4

The following clinical presentation is seen in injury to which nerve? (Recent NEET Pattern 2016-17)

Accepted Answer

Median nerve

Answer

Ulnar nerve

Answer

Median and ulnar nerve

Answer

Radial nerve

Question 5

A 35-year-old HIV+ patient presents with the following lesion in the neck. What is correct about the management?

Accepted Answer

Gravity drainage + ATT

Answer

ATT for another 6 months

Answer

Anti-gravity drainage + ATT

Answer

Incision and drainage

Question 6

The method of ulcer healing shown below generates a pressure of: (Recent NEET Pattern 2016-17)

Accepted Answer

Minus 125 mm Hg

Answer

Minus 100 cm of water

Answer

Plus 100 cm of water

Answer

Plus 125 cm of water

Question 7

The following instrument used in split skin grafting is called: (Recent NEET Pattern 2016-17)

Accepted Answer

Humby's knife

Answer

Mesher

Answer

Watson's knife

Answer

Blair knife

Question 8

The following instrument used in split skin grafting is called: (Recent NEET Pattern 2016-17)

Accepted Answer

Humby's knife

Answer

Mesher

Answer

Eschmann blade

Answer

Down's blade

Question 9

A patient complains of pain and boggy swelling in the frontal region which is warm and tender. He also complains of drowsiness at times. What is the diagnosis?

Accepted Answer

Pott's puffy tumor

Answer

Pyogenic granuloma

Answer

Orbital cellulitis

Answer

Cavernous sinus thrombosis

Question 10

What is the most likely diagnosis based on the image provided? The patient had a snake bite at this site 5 years ago.

Accepted Answer

Marjolin's ulcer

Answer

Bazin's ulcer

Answer

Martorell's ulcer

Answer

Meleney's ulcer

NEET-PG 2017

Anesthesiology

Dermatology

General Medicine

Surgery