NEET-PG 2022 Practice Questions

Q: A patient presents with an anesthetic patch in areas of the face. Which of the following nerves is the most commonly involved in this condition?

Trigeminal nerve. ***Trigeminal nerve*** - The **trigeminal nerve** (CN V) is responsible for **sensory innervation of the face, scalp, and mucous membranes** of the mouth and nose [1]. An anesthetic patch suggests a loss of sensation in these areas. - Involvement of the trigeminal nerve, particularly its branches (ophthalmic, maxillary, mandibular), would lead to **paresthesia, numbness, or anesthesia** in the corresponding dermatomes of the face. *Abducens nerve* - The **abducens nerve** (CN VI) primarily controls the **lateral rectus muscle**, responsible for **abduction of the eye**. - Dysfunction of this nerve would lead to **diplopia (double vision)** and an inability to move the eye laterally, not facial anesthesia. *Facial nerve* - The **facial nerve** (CN VII) is mainly responsible for **motor innervation of the muscles of facial expression** and taste from the anterior two-thirds of the tongue. - Damage to this nerve causes **facial weakness or paralysis** (e.g., Bell's palsy) and taste disturbances, not loss of sensation (anesthesia) in facial skin. *Optic nerve* - The **optic nerve** (CN II) is solely responsible for **vision**. - Damage to the optic nerve results in **visual field defects or blindness**, not sensory changes on the face.

Q: A 45-year-old patient complained of pain on one side of the neck. She is afraid of eating food as it worsens the pain. An ultrasound of the salivary glands is shown below. What is the most likely diagnosis?

Sialolithiasis. ***Sialolithiasis*** - The ultrasound image shows an **echogenic focus** with clear **posterior acoustic shadowing** within the salivary gland, which is characteristic of a salivary gland stone. - The patient's symptoms of **pain on one side of the neck** and **worsening pain with eating** (likely due to salivary stimulation) are classic for **sialolithiasis**, as the stone obstructs salivary flow. *Salivary gland foreign body* - While a foreign body could present with similar pain, it would typically appear as a distinct object on ultrasound, but its echogenicity and shading characteristics might differ depending on the material. - The history of a foreign body ingestion or insertion would be crucial, which is not mentioned here. *Cervical lymphadenopathy* - **Lymph nodes** on ultrasound typically appear as oval-shaped structures with a **hypoechoic cortex** and an **echogenic hilum**; they do not usually show significant acoustic shadowing unless calcified. - While cervical lymphadenopathy can cause neck pain, it is not typically exacerbated by eating in the same way an obstructed salivary gland would be. *Osteoma of the floor of the mouth* - An **osteoma** is a **benign bone tumor** that would present as a very **dense, highly echogenic mass** with severe posterior acoustic shadowing on ultrasound, originating from bony structures. - While an osteoma could cause pain, its location (floor of the mouth) and nature would not typically explain pain worsening specifically with eating due to salivary gland obstruction.

Q: A female patient presented with fatigue and a history of piles. Routine complete blood count analysis showed hemoglobin of 9 g/dL, MCV 60fL, and RBC count of 5.2 million. A peripheral smear is provided. Which of the following is the next best investigation after the smear for this patient?

Serum ferritin levels. ***Serum ferritin levels*** - The **low hemoglobin** and **low MCV (microcytic anemia)** indicate a likely iron deficiency, commonly assessed by serum ferritin levels [1]. - The patient's **history of piles** suggests possible gastrointestinal bleeding, further pointing to the need for iron studies. *Serum folate levels* - Typically evaluated in cases of **macrocytic anemia**, which is not indicated here due to a **low MCV**. - Folate deficiency leads to larger, immature red cells, contrasting the findings of microcytic anemia in this patient. *Serum homocysteine levels* - While elevated levels can indicate **vitamin B12 or folate deficiency**, they are not specific for iron deficiency anemia. - The current presentation does not suggest deficiencies of B12 or folate, making this test less relevant. *HbA2 levels* - Useful in diagnosing **beta-thalassemia**, but not indicated in the context of evident **microcytic anemia** and fatigue without hemolysis or family history [1]. - The patient's profile does not align with thalassemia, thus making this investigation unnecessary. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 590-591.

Q: A patient diagnosed to be HIV-positive was started on highly active antiretroviral therapy (HAART). Which of the following can be used to monitor treatment efficacy?

Viral load. ***Viral load*** - **Viral load** (HIV RNA copies per milliliter of plasma) is the most direct and sensitive measure of HAART efficacy, as it indicates the amount of actively replicating virus [1]. - A successful HAART regimen aims to reduce the **viral load** to undetectable levels, signaling effective suppression of viral replication [1]. *CD4+ T cell count* - While important for monitoring immune status and disease progression, **CD4+ T cell count** changes more slowly than viral load [1]. - An increase in **CD4+ T cell count** is a positive sign of immune reconstitution but is a lagging indicator of immediate treatment efficacy [1]. *p24 antigen* - **p24 antigen** is a core structural protein of HIV, primarily detectable early in acute infection and in advanced stages when viral replication is very high. - It is generally not used for routine monitoring of HAART efficacy in chronic HIV infection because its levels fluctuate and become undetectable as the immune system produces antibodies. *Viral serotype* - **Viral serotype** refers to the specific strain or subtype of HIV (e.g., HIV-1 vs. HIV-2, or different clades within HIV-1). - It is determined at diagnosis to understand the specific virus but does not change significantly during the course of treatment and is not used to monitor HAART efficacy.

Q: A farmer presents you with a cauliflower-shaped mass on foot, which developed after a minor injury. Microscopy shows copper penny bodies. What is the most likely diagnosis?

Chromoblastomycosis. **Chromoblastomycosis** - The characteristic "cauliflower-shaped" lesion on the foot following a minor injury, especially in a farmer (indicating outdoor exposure), is highly suggestive of chromoblastomycosis. - The presence of **copper penny bodies** (also known as **sclerotic** or **muriform cells**) on microscopy is **pathognomonic** for chromoblastomycosis. *Blastomycosis* - Blastomycosis typically presents with **granulomatous lesions** that can ulcerate but are rarely described as cauliflower-shaped. - Microscopic examination would reveal **broad-based budding yeast cells**, not copper penny bodies. *Sporotrichosis* - Sporotrichosis usually presents as **subcutaneous nodules** that can ulcerate and spread lymphatically, forming a chain of lesions. - Microscopy shows **cigar-shaped budding yeasts** within macrophages or neutrophils, which are distinct from copper penny bodies. *Phaeohyphomycosis* - Phaeohyphomycosis encompasses a broad group of infections by dematiaceous fungi that produce **dark-walled hyphae** or yeast-like cells in tissue. - While it can cause subcutaneous nodules or cysts, the presence of distinct copper penny bodies points away from phaeohyphomycosis as the primary diagnosis.

Q: A patient comes with a history of asthma and sinusitis. On looking into his medical records, you notice this has been attributed to Samter’s triad. Which drug should be avoided in this patient due to its potential to exacerbate respiratory symptoms?

Aspirin. ***Aspirin (Correct Answer)*** - Samter's triad, or **aspirin-exacerbated respiratory disease (AERD)**, is characterized by **asthma**, **nasal polyps with chronic rhinosinusitis**, and a severe reaction to **aspirin** and other **NSAIDs**. - **Aspirin** inhibits COX-1, leading to an overproduction of **leukotrienes**, which causes bronchoconstriction and exacerbates respiratory symptoms in susceptible individuals. - This is the drug that **must be avoided** in patients with Samter's triad. *Cotrimoxazole (Incorrect)* - **Cotrimoxazole** (trimethoprim-sulfamethoxazole) is an antibiotic not directly involved in the cyclooxygenase pathway. - While allergic reactions can occur, it is **not specifically contraindicated** in Samter's triad. *Co-amoxiclav (Incorrect)* - **Co-amoxiclav** (amoxicillin/clavulanic acid) is a penicillin-class antibiotic, and its mechanism of action does not involve prostaglandin synthesis. - It does not pose a specific risk for exacerbating respiratory symptoms in patients with **Samter's triad**. *Chloramphenicol (Incorrect)* - **Chloramphenicol** is an antibiotic that inhibits bacterial protein synthesis and is not associated with the pathogenesis of Samter's triad. - It does not impact the **cyclooxygenase or lipoxygenase pathways** that are central to AERD.

Q: A 16-year-old girl has intense cravings for food and consumes large amounts of it, followed by purging behaviors. What is the most likely diagnosis?

Bulimia nervosa. ***Bulimia nervosa*** - **Bulimia nervosa** is characterized by recurrent episodes of **binge eating** (consuming large amounts of food with a sense of lack of control), followed by inappropriate **compensatory behaviors** such as self-induced vomiting, laxative abuse, or excessive exercise. - The patient's presentation of "intense cravings for food," consuming "large amounts," and "purging behaviors" directly aligns with DSM-5 diagnostic criteria for bulimia nervosa. - Peak onset is typically in **adolescence and early adulthood**, and it is more common in females. *Anorexia nervosa* - **Anorexia nervosa** is primarily characterized by **restriction of energy intake** leading to significantly low body weight, intense fear of gaining weight, and disturbance in body image. - While the binge-eating/purging subtype of anorexia exists, the defining feature is **persistent restriction** and significantly **low body weight**, which is not mentioned in this clinical scenario. *Major depressive disorder* - **Depression** is a mood disorder with persistent sadness, anhedonia, and neurovegetative symptoms. - While depression commonly co-occurs with eating disorders and may cause appetite changes, the specific cyclical pattern of **binge eating followed by compensatory purging** is not a characteristic feature of depression itself. *Binge eating disorder* - **Binge eating disorder** involves recurrent episodes of consuming large amounts of food with a sense of lack of control, accompanied by marked distress. - The key distinguishing feature is the **absence of regular compensatory behaviors** (purging, excessive exercise, fasting) that are present in bulimia nervosa.

Q: A delayed intravenous urogram of a patient is given below. What is the likely diagnosis?

Pelviureteric junction obstruction. ***Pelviureteric junction obstruction*** - The image shows marked **dilatation of the renal pelvis and calyces** on the right side, with a relatively abrupt narrowing at the junction of the pelvis and ureter. - The delayed nature of the urogram suggests **impaired drainage** of contrast from the renal pelvis, accumulating proximal to the obstruction. *Putty kidney* - A "putty kidney" (or **autonecrotic kidney**) refers to a chronic, severely diseased kidney, often seen in end-stage **renal tuberculosis**, that has become calcified and non-functional. - This image demonstrates active contrast excretion and pelvicalyceal dilatation, not a calcified, non-functional organ. *Staghorn calculus* - A staghorn calculus is a **large, branched kidney stone** that occupies a significant portion of the renal collecting system. - While it can cause hydronephrosis, the image does not show a dense, radiopaque calculus filling the collecting system. *Cystic kidney* - **Cystic kidneys**, such as in polycystic kidney disease, are characterized by multiple fluid-filled sacs within the kidney parenchyma. - The image depicts dilatation of the collecting system, not diffuse cystic changes throughout the renal parenchyma.

Q: The image below shows a pressure sore. Which stage does this belong to?

Stage 4. ***Stage 4*** - The image clearly shows **extensive tissue loss**, including exposed bone and muscle, indicating a **deep tissue injury**. - The presence of large areas of **dead tissue (eschar)**, undermining, and tunneling are characteristic features of a stage 4 pressure sore. *Stage 1* - This stage involves **intact skin** with non-blanchable redness, indicating only superficial damage. - There is no **break in the skin** or tissue loss in Stage 1 pressure sores. *Stage 2* - Characterized by **partial-thickness skin loss**, presenting as an open blister or shallow ulcer. - **No visible deeper tissue** such as fat, muscle, or bone is exposed in this stage. *Stage 3* - Involves **full-thickness skin loss** with visible subcutaneous fat, but bone, tendon, or muscle are not exposed. - While there may be **undermining or tunneling**, the deep structures are not yet visible as seen in the image.

Question 1

A patient presents with an anesthetic patch in areas of the face. Which of the following nerves is the most commonly involved in this condition?

Accepted Answer

Trigeminal nerve

Answer

Facial nerve

Answer

Abducens nerve

Answer

Optic nerve

Question 2

A 45-year-old patient complained of pain on one side of the neck. She is afraid of eating food as it worsens the pain. An ultrasound of the salivary glands is shown below. What is the most likely diagnosis?

Accepted Answer

Sialolithiasis

Answer

Salivary gland foreign body

Answer

Cervical lymphadenopathy

Answer

Osteoma of the floor of the mouth

Question 3

A female patient presented with fatigue and a history of piles. Routine complete blood count analysis showed hemoglobin of 9 g/dL, MCV 60fL, and RBC count of 5.2 million. A peripheral smear is provided. Which of the following is the next best investigation after the smear for this patient?

Accepted Answer

Serum ferritin levels

Answer

HbA2 levels

Answer

Serum folate levels

Answer

Serum homocysteine levels

Question 4

A patient diagnosed to be HIV-positive was started on highly active antiretroviral therapy (HAART). Which of the following can be used to monitor treatment efficacy?

Accepted Answer

Viral load

Answer

CD4+ T cell count

Answer

p24 antigen

Answer

Viral serotype

Question 5

A farmer presents you with a cauliflower-shaped mass on foot, which developed after a minor injury. Microscopy shows copper penny bodies. What is the most likely diagnosis?

Accepted Answer

Chromoblastomycosis

Answer

Sporotrichosis

Answer

Blastomycosis

Answer

Phaeohyphomycosis

Question 6

A woman with recurrent diarrhea is prescribed a broad-spectrum antibiotic. Which of the following statements is not true regarding Clostridium difficile infection?

Accepted Answer

IgM assay is used to confirm the diagnosis of Clostridium difficile infection.

Answer

Pseudomembrane is a layer of inflammatory debris

Answer

Oral fidaxomicin is used for treatment

Answer

It is toxin mediated

Question 7

A patient comes with a history of asthma and sinusitis. On looking into his medical records, you notice this has been attributed to Samter’s triad. Which drug should be avoided in this patient due to its potential to exacerbate respiratory symptoms?

Accepted Answer

Aspirin

Answer

Cotrimoxazole

Answer

Co-amoxiclav

Answer

Chloramphenicol

Question 8

A 16-year-old girl has intense cravings for food and consumes large amounts of it, followed by purging behaviors. What is the most likely diagnosis?

Accepted Answer

Bulimia nervosa

Answer

Anorexia nervosa

Answer

Major depressive disorder

Answer

Binge eating disorder

Question 9

A delayed intravenous urogram of a patient is given below. What is the likely diagnosis?

Accepted Answer

Pelviureteric junction obstruction

Answer

Putty kidney

Answer

Staghorn calculus

Answer

Cystic kidney

Question 10

The image below shows a pressure sore. Which stage does this belong to?

Accepted Answer

Stage 4

Answer

Stage 1

Answer

Stage 2

Answer

Stage 3

NEET-PG 2022

Anatomy

ENT

Internal Medicine

Microbiology

Pharmacology

Psychiatry

Radiology

Surgery