NEET-PG 2021 Practice Questions

Q: A 12-year-old boy presents with weak pulses in the upper limbs, a blood pressure of 90/60 mmHg , and retinal hemorrhages. What is the most likely diagnosis?

Takayasu arteritis. ***Takayasu arteritis*** - **Weak pulses** in the upper limbs, **lower blood pressure** (90/60 mmHg), and **retinal hemorrhages** are classic signs of Takayasu arteritis, which primarily affects the aortic arch and its major branches. [1] - This condition is also known as "pulseless disease" due to the significant narrowing of peripheral arteries, leading to diminished or absent pulses. [1] *Henoch-Schönlein purpura (HSP)* - HSP is characterized by a **palpable purpuric rash**, **arthralgia**, **abdominal pain**, and **renal involvement** (hematuria/proteinuria), none of which are explicitly mentioned here. - It typically affects **small vessels** and does not cause weak pulses in the upper limbs or systemic hypotension in this manner. *Polyarteritis nodosa (PAN)* - PAN is a **necrotizing vasculitis** of medium-sized arteries, often presenting with **fever**, **weight loss**, **myalgia**, and visceral infarcts. - While it can affect various organs, it does not typically cause the specific pattern of weak upper limb pulses and retinal hemorrhages observed here, which points to large vessel involvement. *Microscopic polyangiitis* - This is a **small-vessel vasculitis** characterized by **glomerulonephritis** and **pulmonary capillaritis**, often presenting with hemoptysis and rapidly progressive renal failure. - It does not cause the large vessel symptoms like weak upper limb pulses or significant systemic hypotension seen in the patient.

Q: What is the characteristic metabolic finding in a baby with Congenital Hypertrophic Pyloric Stenosis (CHPS)?

Hypochloremic metabolic alkalosis. ***Hypochloremic metabolic alkalosis*** - The persistent **vomiting** in CHPS leads to a significant loss of gastric acid (HCl), causing profound **hypochloremia** and an increase in serum bicarbonate. - This loss of stomach acid results in a shift towards alkalinity, manifesting as a **metabolic alkalosis**. - **Hypokalemia** also develops due to renal compensation mechanisms and urinary potassium losses. *Mixed acid-base disorder with hyperkalemia* - While electrolyte imbalances can be complex, **hyperkalemia** is not a characteristic finding; rather, **hypokalemia** is common due to renal compensation for metabolic alkalosis. - A **mixed acid-base disorder** is less specific than the classic hypochloremic metabolic alkalosis seen in CHPS. *Metabolic acidosis with hyperchloremia* - **Metabolic acidosis** would imply a gain of acid or loss of alkali, which is contrary to the loss of acid from vomiting in CHPS. - **Hyperchloremia** is also incorrect; the characteristic finding is **hypochloremia** due to the loss of gastric HCl. *Respiratory alkalosis with hyponatremia* - **Respiratory alkalosis** is caused by hyperventilation and is not directly related to the pathophysiology of CHPS. - While **hyponatremia** can occur in severe dehydration, it is not the primary or most characteristic electrolyte derangement in CHPS, which is marked by hypochloremia and hypokalemia. *Hyperchloremic metabolic acidosis with hypokalemia* - This combines incorrect elements: **hyperchloremia** and **metabolic acidosis** are opposite to what occurs in CHPS. - While **hypokalemia** is correct, the acid-base and chloride abnormalities are wrong. - CHPS causes **hypochloremia** and **metabolic alkalosis**, not hyperchloremia and acidosis.

Q: A child presents with rachitic changes in the limbs that are not responding to Vitamin D supplementation. Investigations reveal the following results: - Calcium: $9.5 \mathrm{mg} / \mathrm{dl}$ - Phosphorus: $1.6 \mathrm{mg} / \mathrm{dl}$ - Alkaline phosphatase (ALP): 814 IU - Serum PTH: $24.2 \mathrm{pg} / \mathrm{ml}$ - Serum electrolytes, creatinine, and blood gases: Normal. What is the most likely diagnosis?

Hypophosphatemic rickets. ***Hypophosphatemic rickets*** - The combination of **rachitic changes** not responding to Vitamin D, **low serum phosphorus (1.6 mg/dl)**, and **normal calcium and PTH levels** strongly points to hypophosphatemic rickets, a condition characterized by impaired renal phosphate reabsorption. - The **elevated alkaline phosphatase** indicates increased bone turnover as the body tries to mineralize bone despite phosphate deficiency. *Vitamin D-dependent rickets type 2* - This condition involves resistance to **1,25-dihydroxyvitamin D**, leading to **hypocalcemia** and elevated PTH, none of which are present here. - It would also typically show an inadequate response to Vitamin D, but the primary biochemical derangement is different. *Vitamin D-dependent rickets type 1* - This type is caused by a defect in **1-alpha-hydroxylase**, leading to an inability to convert 25-hydroxyvitamin D to its active form, resulting in **hypocalcemia** and elevated PTH, which are not observed. - It would also show a poor response to standard Vitamin D supplementation. *Vitamin D deficiency rickets* - This is the most common form of rickets caused by inadequate Vitamin D intake or synthesis, presenting with **hypocalcemia**, **elevated PTH**, and **low phosphorus**. - However, it typically responds well to Vitamin D supplementation, unlike the presentation here, and would show elevated PTH levels. *Chronic renal failure* - Chronic renal failure would present with **elevated creatinine**, and typically leads to **secondary hyperparathyroidism** (elevated PTH), **hyperphosphatemia**, and metabolic acidosis, none of which are suggested by the provided lab results. - The serum electrolytes, creatinine, and blood gases are explicitly stated as normal.

Q: Which vaccine is contraindicated in a 3-monthold infant with recurrent respiratory illness?

DPT (Diphtheria, Pertussis, Tetanus). ***DPT (Diphtheria, Pertussis, Tetanus)*** - While DPT is routinely given in infancy, the **pertussis component** (particularly the whole-cell vaccine formulation) can exacerbate existing **respiratory conditions** or be problematic in infants with a history of **unstable neurological disorders**. - Recurrent respiratory illness in a 3-month-old may indicate underlying pulmonary compromise, for which the pertussis component's side effects (e.g., fever, fussiness) could be poorly tolerated or confound diagnosis. *Measles vaccine* - The measles vaccine (MMR) is typically administered at **12-15 months of age**, not at 3 months. - Measles vaccine is a **live attenuated vaccine**, but its contraindications are primarily related to severe immunosuppression or recent immunoglobulin receipt, not recurrent respiratory illness in this age group. *DT (Diphtheria and Tetanus)* - The DT vaccine (without the pertussis component) is generally considered **safe** for infants and often used if the pertussis component is *contraindicated*. - This option does not address the specific concern regarding the pertussis component in the context of recurrent respiratory illness. *Inactivated polio vaccine (IPV)* - IPV is an **inactivated vaccine**, meaning it contains killed virus, and thus carries a very low risk of vaccine-related adverse events. - Recurrent respiratory illness is **not a contraindication** for IPV, which is part of routine infant immunization schedules. *Hepatitis B vaccine* - Hepatitis B vaccine is an **inactivated vaccine** routinely given at birth and as part of the infant immunization schedule. - Recurrent respiratory illness is **not a contraindication** for Hepatitis B vaccine, which is safe and well-tolerated in infants.

Q: In a child with a height-for-age Z-score of less than -2 standard deviations (SD), what is the most likely cause?

Chronic malnutrition. ***Chronic malnutrition*** - A **height-for-age Z-score of less than -2 SD** is a key indicator for **stunting**, which is primarily caused by prolonged periods of **inadequate nutrition** and/or recurrent infections. - This reflects **long-term nutritional deprivation** impacting linear growth, rather than recent or acute issues. *No malnutrition* - A Z-score below -2 SD for height-for-age is a critical threshold indicating **significant growth faltering**, making the absence of malnutrition highly unlikely. - This measurement directly reflects that the child's height is significantly below the expected range for their age, signifying a nutritional problem. *Acute malnutrition* - **Acute malnutrition** is typically assessed by **weight-for-height Z-score** (wasting) or Mid-Upper Arm Circumference (MUAC). - While acute malnutrition impairs growth, a low height-for-age Z-score specifically points to a problem of **longer duration (chronic)** rather than immediate weight loss. *Recent infection* - While **recent infections** can lead to temporary weight loss and affect appetite, they typically do not cause a **pronounced and sustained reduction in height-for-age** (stunting) unless they are recurrent or chronic, contributing to overall chronic malnutrition. - A single, recent infection is more likely to impact **weight-for-height** acutely. *Genetic short stature* - While **genetic factors** can influence height, a height-for-age Z-score of less than -2 SD in the context of population-based assessment typically indicates **pathological growth failure** due to chronic malnutrition. - Genetic short stature typically maintains **proportional growth** with consistent growth velocity, whereas stunting shows **growth faltering** over time.

Q: A child presents with myoclonic jerks and decreasing school performance. The child had a history of fever and rash at the age of 1 year. What is the most likely diagnosis?

Subacute sclerosing panencephalitis (SSPE). ***Subacute sclerosing panencephalitis (SSPE)*** - SSPE is a **rare, progressive, and fatal neurodegenerative disease** caused by persistent measles virus infection of the central nervous system. - The presentation of **myoclonic jerks** (stage 2 SSPE) and **decreasing school performance** (stage 1 - cognitive decline) in a child with a history of measles (fever and rash) at 1 year of age is **pathognomonic** for SSPE. - SSPE typically manifests **7-10 years after measles infection**, with male predominance (M:F = 2-4:1). - EEG shows characteristic **Radermecker complexes** (periodic high-amplitude slow wave complexes). - CSG findings include elevated measles antibodies with high CSF:serum antibody ratio. *Measles* - While the child had measles in infancy, the current neurological symptoms are **not acute measles** but rather a late complication (SSPE). - Acute measles is a self-limiting illness; these progressive neurological symptoms occurring years later indicate SSPE, not active measles. *Mesial temporal sclerosis* - This is the most common cause of **drug-resistant temporal lobe epilepsy** characterized by hippocampal atrophy. - Presents with **focal seizures with impaired awareness**, not generalized myoclonic jerks. - **No link to prior measles infection** and typically associated with history of febrile seizures or status epilepticus in childhood. - Progressive cognitive decline is not a primary feature. *Polio* - Polio is caused by **poliovirus** affecting anterior horn cells of the spinal cord, causing **acute flaccid paralysis**. - Presents with **asymmetric lower motor neuron weakness**, not myoclonic jerks or cognitive decline. - **No association with measles** or rash in history. - Would not cause the progressive encephalopathy seen in this case.

Q: A child presents with a webbed neck, short stature, and a low posterior hairline. What is the most likely diagnosis?

Turner syndrome. ***Turner syndrome*** - **Turner syndrome** is characterized by the presence of a **single X chromosome (45,XO)** and is associated with a **webbed neck**, **short stature**, and a **low posterior hairline**. - Other classic features include **gonadal dysgenesis**, **cardiac anomalies** (e.g., coarctation of the aorta), and **renal anomalies**. - **Occurs only in females** due to the chromosomal abnormality. *Edwards syndrome* - **Edwards syndrome** (Trisomy 18) is characterized by severe developmental delays, a **rocker-bottom feet deformity**, **micrognathia**, and **clenched hands with overlapping fingers**. - **Webbed neck** and **short stature** are not primary distinguishing features of Edwards syndrome. *Patau syndrome* - **Patau syndrome** (Trisomy 13) is associated with severe midline defects, including **cleft lip and palate**, **polydactyly**, **microphthalmia**, and **holoprosencephaly**. - It does not typically present with a **webbed neck** or a **low posterior hairline**. *Down syndrome* - **Down syndrome** (Trisomy 21) is typically characterized by **upslanting palpebral fissures**, a **single palmar crease**, **intellectual disability**, and **cardiac defects**. - While **short stature** can be present, the classic combination of a **webbed neck** and **low posterior hairline** is not characteristic of Down syndrome. *Noonan syndrome* - **Noonan syndrome** shares phenotypic similarities with Turner syndrome, including **webbed neck**, **short stature**, and **cardiac defects** (especially pulmonary stenosis). - However, it occurs in **both males and females** with a **normal karyotype** and is caused by mutations in genes of the RAS-MAPK pathway. - Key differentiating features include **pectus excavatum**, **cryptorchidism in males**, and the absence of gonadal dysgenesis.

Q: A 10-year-old male presents with generalized edema. His cholesterol level is $238 \mathrm{mg} / \mathrm{dl}$, urine protein is $3+$, and stool microscopy shows fat in the stool. What is the most likely diagnosis?

Nephrotic syndrome. ***Nephrotic syndrome*** - **Nephrotic syndrome** is characterized by **generalized edema**, **massive proteinuria** (3+ in urine protein), and **hyperlipidemia** (elevated cholesterol). - **Fat in the stool** (steatorrhea) can be an associated finding due to malabsorption or metabolic derangements, though not a primary diagnostic criterion for nephrotic syndrome. - This is the **syndrome** that encompasses the entire clinical presentation. *Minimal change disease* - **Minimal change disease** is the **most common etiology** of nephrotic syndrome in children (accounting for ~80% of cases in this age group). - While this child likely has minimal change disease as the underlying cause, the question asks for the **syndrome/diagnosis** based on the clinical presentation, which is **nephrotic syndrome**. - Minimal change disease is the pathologic diagnosis that would be confirmed on **renal biopsy**. *Nephritic syndrome* - **Nephritic syndrome** typically presents with **hematuria**, **hypertension**, **azotemia**, and mild to moderate proteinuria, rather than massive proteinuria and generalized edema. - It is characterized by inflammation of the glomeruli, often leading to a decrease in **glomerular filtration rate (GFR)**. *Goodpasture syndrome* - **Goodpasture syndrome** is an autoimmune disease characterized by **rapidly progressive glomerulonephritis** and **pulmonary hemorrhage**. - While it causes renal involvement, its distinct feature is the presence of **anti-glomerular basement membrane (GBM) antibodies**, and the clinical picture does not align with the given symptoms. *Urine infection* - A **urine infection** (urinary tract infection) typically presents with dysuria, frequency, urgency, and sometimes fever, with positive urine cultures and pyuria. - It does not explain the presence of **generalized edema**, **hyperlipidemia**, or **massive proteinuria**.

Q: An X-ray of a 5-year-old child is shown below. The bone mineral density is normal. What is the most likely diagnosis?

Scurvy. ***Scurvy*** - The X-ray image shows a characteristic **white line of Fraenkel** (dense provisional zone of calcification) and a **Trümmerfeld zone** (lucent zone beneath the white line due to microfractures) in the metaphysis, as indicated by the arrow. - These findings, along with a **normal bone mineral density** in a 5-year-old child, are highly suggestive of scurvy, often seen in cases of **vitamin C deficiency**. *Metaphyseal dysplasia* - This is a rare disorder characterized by abnormal modeling of the metaphyses, leading to **flared and irregular metaphyses**, but does not typically present with the specific "white line" or "lucent zone" seen here. - Bone mineral density can be variable, but the described features are not typical for scurvy. *Osteopetrosis* - Osteopetrosis is characterized by **increased bone density** (marble bone disease) due to defective osteoclast function, leading to **thickened and dense bones**. - This contradicts the information provided that states **normal bone mineral density**. *Rickets* - Rickets results from **vitamin D deficiency** and causes defective mineralization of growing bone, leading to **widened, cupped, and frayed metaphyses**. - While it affects the metaphyses, the specific radiographic signs described in the image (**white line of Fraenkel** and **Trümmerfeld zone**) are characteristic of scurvy, not rickets. *Hypophosphatasia* - This is a rare inherited metabolic disorder caused by **deficiency of tissue-nonspecific alkaline phosphatase (TNSALP)**, leading to defective bone mineralization. - Radiographic features include **irregular and poorly mineralized metaphyses** with tongues of radiolucency extending into the diaphysis, but the specific **white line of Fraenkel** and **Trümmerfeld zone** pattern is characteristic of scurvy, not hypophosphatasia.

Q: Examine the abdominal X-ray shown. What is the most likely diagnosis based on the findings?

Intestinal Obstruction. ***Intestinal Obstruction*** - The abdominal X-ray demonstrates **distended loops of bowel** with **multiple air-fluid levels**, which are classic radiographic signs of intestinal obstruction. - The presence of multiple, wide air-fluid levels visible in a **stepladder pattern** is a hallmark of bowel obstruction. - **Valvulae conniventes** (transverse folds crossing the entire width of bowel) suggest **small bowel** involvement when visible with distension. *Small bowel ileus* - While ileus can show distended bowel loops, it typically presents with **gas distributed throughout the small and large bowel** without a clear transition point. - Ileus shows **less pronounced air-fluid levels** and lacks the characteristic stepladder pattern seen in mechanical obstruction. - The clinical context and presence of multiple distinct air-fluid levels favor mechanical obstruction over ileus. *Large bowel obstruction* - Large bowel obstruction would show **dilated colon** with **haustrations** (incomplete folds that don't cross the entire lumen). - The obstruction would typically show dilation **proximal to the obstruction** with collapsed bowel distally. - The pattern in this image is more consistent with small bowel or generalized intestinal obstruction rather than isolated large bowel obstruction. *Pneumoperitoneum* - Pneumoperitoneum (free air in the peritoneal cavity) appears as **air under the diaphragm** on upright films or as **Rigler's sign** (both sides of bowel wall visible) on supine films. - This is a sign of **bowel perforation**, not obstruction with air-fluid levels within the bowel lumen. - The air-fluid levels seen here are **intraluminal**, not free intraperitoneal air.

Question 1

A 12-year-old boy presents with weak pulses in the upper limbs, a blood pressure of 90/60 mmHg , and retinal hemorrhages. What is the most likely diagnosis?

Accepted Answer

Takayasu arteritis

Answer

Henoch-Schönlein purpura (HSP)

Answer

Polyarteritis nodosa (PAN)

Answer

Microscopic polyangiitis

Question 2

What is the characteristic metabolic finding in a baby with Congenital Hypertrophic Pyloric Stenosis (CHPS)?

Accepted Answer

Hypochloremic metabolic alkalosis

Answer

Mixed acid-base disorder with hyperkalemia

Answer

Metabolic acidosis with hyperchloremia

Answer

Respiratory alkalosis with hyponatremia

Answer

Hyperchloremic metabolic acidosis with hypokalemia

Question 3

A child presents with rachitic changes in the limbs that are not responding to Vitamin D supplementation. Investigations reveal the following results:

- Calcium: $9.5 \mathrm{mg} / \mathrm{dl}$
- Phosphorus: $1.6 \mathrm{mg} / \mathrm{dl}$
- Alkaline phosphatase (ALP): 814 IU
- Serum PTH: $24.2 \mathrm{pg} / \mathrm{ml}$
- Serum electrolytes, creatinine, and blood gases: Normal.
What is the most likely diagnosis?

Accepted Answer

Hypophosphatemic rickets

Answer

Vitamin D-dependent rickets type 2

Answer

Vitamin D-dependent rickets type 1

Answer

Chronic renal failure

Answer

Vitamin D deficiency rickets

Question 4

Which vaccine is contraindicated in a 3-monthold infant with recurrent respiratory illness?

Accepted Answer

DPT (Diphtheria, Pertussis, Tetanus)

Answer

DT (Diphtheria and Tetanus)

Answer

Measles vaccine

Answer

Inactivated polio vaccine (IPV)

Answer

Hepatitis B vaccine

Question 5

In a child with a height-for-age Z-score of less than -2 standard deviations (SD), what is the most likely cause?

Accepted Answer

Chronic malnutrition

Answer

No malnutrition

Answer

Acute malnutrition

Answer

Recent infection

Answer

Genetic short stature

Question 6

A child presents with myoclonic jerks and decreasing school performance. The child had a history of fever and rash at the age of 1 year. What is the most likely diagnosis?

Accepted Answer

Subacute sclerosing panencephalitis (SSPE)

Answer

Measles

Answer

Mesial temporal sclerosis

Answer

Polio

Question 7

A child presents with a webbed neck, short stature, and a low posterior hairline. What is the most likely diagnosis?

Accepted Answer

Turner syndrome

Answer

Edwards syndrome

Answer

Patau syndrome

Answer

Down syndrome

Answer

Noonan syndrome

Question 8

A 10-year-old male presents with generalized edema. His cholesterol level is $238 \mathrm{mg} / \mathrm{dl}$, urine protein is $3+$, and stool microscopy shows fat in the stool. What is the most likely diagnosis?

Accepted Answer

Nephrotic syndrome

Answer

Nephritic syndrome

Answer

Goodpasture syndrome

Answer

Urine infection

Answer

Minimal change disease

Question 9

An X-ray of a 5-year-old child is shown below. The bone mineral density is normal. What is the most likely diagnosis?

Accepted Answer

Scurvy

Answer

Metaphyseal dysplasia

Answer

Osteopetrosis

Answer

Rickets

Answer

Hypophosphatasia

Question 10

Examine the abdominal X-ray shown. What is the most likely diagnosis based on the findings?

Accepted Answer

Intestinal Obstruction

Answer

Small bowel ileus

Answer

Pneumoperitoneum

Answer

Large bowel obstruction

NEET-PG 2021

Internal Medicine

Pediatrics

Radiology