NEET-PG 2023 Practice Questions

Q: A 45-year-old male patient presents to the emergency department with severe pain and swelling in the big toe joint. He has a history of recurrent joint pain and dietary indiscretion. A specimen from the affected joint is subjected to a test that produces a purple color reaction. What is the test being performed?

Murexide test for uric acid detection. ***Murexide test for uric acid detection*** - The patient's presentation with **severe pain and swelling in the big toe**, recurrent joint pain, and dietary indiscretion is highly suggestive of **gout**, which is caused by the accumulation of **uric acid crystals**. - The **Murexide test** is a specific qualitative chemical test used to detect the presence of **uric acid** and its derivatives, yielding a characteristic **purple** color in the presence of uric acid. *Florence test for choline compounds* - The **Florence test** is used to identify **choline compounds**, primarily in forensic science for detecting **spermatozoa** by reacting with choline to form dark brown or black crystals. - While it involves a chemical reaction, its application and the compounds it detects are unrelated to the diagnosis of **gout** or uric acid. *Teichmann test for blood* - The **Teichmann test** (hemin test) is a microscopic chemical test used to confirm the presence of **blood** by detecting **hemin crystals**. - This test is not used for diagnosing joint conditions like gout or identifying **uric acid**. *Acid phosphatase test for prostate* - The **acid phosphatase test** measures the level of **acid phosphatase**, an enzyme mainly found in the **prostate gland**, and is used as a marker for **prostate cancer** or other prostatic conditions. - This test is entirely unrelated to the diagnosis of **gout** or the detection of **uric acid** in synovial fluid.

Q: In a 10-year-old school child, which of the following vaccines is given as a part of the school immunization program?

TT/Td vaccine. ***TT/Td vaccine*** - The **tetanus toxoid (TT)** or **tetanus and diphtheria (Td) vaccine** is commonly administered to school-aged children as a booster to maintain immunity against these diseases. - This is part of many national immunization programs, including those in schools, to ensure continued protection beyond early childhood vaccinations. *Measles vaccine* - The **measles vaccine (MMR)** is typically given at 9-12 months and a second dose around 4-6 years of age, much earlier than 10 years. - While essential, it's usually completed before a child reaches the age of 10 for primary vaccination. *Rotavirus vaccine* - The **rotavirus vaccine** is administered to infants, usually before 6 months of age, to protect against severe rotavirus gastroenteritis. - It is not part of school immunization programs for 10-year-olds. *Hepatitis B vaccine* - The **Hepatitis B vaccine** is typically given at birth and completed during infancy, with a series of doses before 1 year of age. - While crucial for early protection, it is not a routine vaccination for 10-year-olds within a school immunization program unless for catch-up reasons.

Q: In a patient presented with a fever and a positive filarial antigen test, what is the next appropriate method of management?

Detection of microfilariae in the blood smear. ***Detection of microfilariae in the blood smear*** - A positive **filarial antigen test** indicates the presence of adult worms, and the next step is to confirm active infection by identifying **microfilariae**. [1] - **Nocturnal blood samples** are crucial because microfilariae of *Wuchereria bancrofti* and *Brugia malayi* exhibit **nocturnal periodicity**, meaning they are most abundant in peripheral blood between 10 PM and 2 AM. [1] *Bone marrow biopsy* - This procedure is typically used to diagnose **hematological disorders**, such as leukemia or lymphoma, or investigate causes of unexplained fever, but it is not indicated for filariasis. - While filariasis can rarely lead to **eosinophilia**, a bone marrow biopsy is not a diagnostic tool for filarial infection itself. *DEC provocation test* - The **diethylcarbamazine (DEC) provocation test** is used to bring out microfilariae into the peripheral blood during the daytime for species that exhibit nocturnal periodicity. [1] - However, it carries a risk of severe adverse reactions due to rapid killing of microfilariae, especially in cases of heavy infection, and is generally avoided when antigen tests are positive. [1] *Ultrasound of the scrotum* - Scrotal ultrasound can detect the characteristic "filarial dance sign" (motile adult worms) in the **lymphatic vessels of the scrotum and epididymis**, confirming lymphatic filariasis. [2] - While useful for assessing advanced disease manifestations like **hydrocele**, it does not quantify microfilaremia or replace the need for microscopic confirmation of circulating microfilariae to guide treatment.

Q: A woman presents to you at 36 weeks of gestation with complaints of breathlessness and excessive abdominal distension. Fetal movements are normal. On examination, fetal parts are not easily felt and fetal heartbeat is heard but it is muffled. Her symphysis fundal height is 41 cm. Her abdomen is tense but not tender. What is the most likely diagnosis?

Polyhydramnios. ***Polyhydramnios*** - The patient's symptoms of **breathlessness**, **excessive abdominal distension**, a **symphysis fundal height of 41 cm at 36 weeks** (indicating a significantly larger than expected uterus), and **muffled fetal heart tones** are classic signs of polyhydramnios. - **Difficulty feeling fetal parts** is also consistent with excess amniotic fluid, which cushions the fetus and makes palpation harder. *Abruptio placenta* - This condition typically presents with sudden onset of **painful vaginal bleeding**, uterine tenderness, and fetal distress, none of which are described here. - While the abdomen might be tense due to uterine contractions or concealed bleeding, the lack of pain and bleeding makes this diagnosis unlikely. *Hydrocephalus of fetus* - Fetal hydrocephalus would primarily manifest as an **abnormally large fetal head** upon ultrasound, potentially leading to a higher fundal height. - However, it wouldn't directly explain the generalized excessive abdominal distension or the difficulty in feeling fetal parts due to fluid, though it could be a cause of polyhydramnios itself, it is not the most likely primary diagnosis from the given options directly addressing the symptoms. *Oligohydramnios* - This condition is characterized by **too little amniotic fluid**, which would result in a **smaller than expected symphysis fundal height** and an easily palpable fetus. - The patient's symptoms, particularly the excessive distension and high fundal height, directly contradict the features of oligohydramnios.

Q: A 16-year-old girl presents with cyclical pelvic pain every month. She has not achieved menarche yet. On examination, a suprapubic bulge can be seen in the lower abdomen. PR examination reveals a bulging swelling in the anterior aspect. What is the most likely diagnosis?

Imperforate hymen. ***Imperforate hymen*** - The combination of **cyclical pelvic pain** without menarche (primary amenorrhea) and a **suprapubic bulge** with **bulging swelling on PR examination** strongly suggests an imperforate hymen. - This condition leads to the **accumulation of menstrual blood (hematocolpos)**, causing the observed swelling and pain. - Imperforate hymen is the **most distal obstruction** of the female genital tract, presenting with a characteristic **bulging membrane at the vaginal opening**. *Transverse vaginal septum* - This condition also causes **primary amenorrhea** and **hematocolpos** leading to cyclical pain. - However, a transverse vaginal septum is located **higher in the vagina** (not at the introitus) and would not typically present with such an obvious **bulging swelling on examination** at the vaginal opening. *Vaginal atresia* - **Vaginal atresia** involves the complete or partial absence of the vagina, which would prevent menarche and cause cyclical pain. - While it results in hematocolpos (if the uterus is present), the presentation differs from the classic **bulging membrane** seen with imperforate hymen. *Cervical agenesis* - **Cervical agenesis** is the congenital absence or incomplete formation of the cervix, leading to **primary amenorrhea** and severe cyclical pain due to retained menstrual blood in the uterus (**hematometra**). - This condition would not present with a **bulging mass on PR examination** at the vaginal level, but rather with an enlarged uterus above, as the obstruction is at the cervical level, not at the vaginal outlet.

Q: A 23-year-old woman accompanied by her mother-in-law comes to the infertility clinic. She has been having regular intercourse for 6 months but is not able to conceive. What is the next best step?

Reassure and review the couple after 6 months. ***Reassure and review the couple after 6 months*** - Infertility is defined as the inability to conceive after **12 months** of regular, unprotected intercourse in women under 35 years old. For women aged 35 or older, this period is 6 months. - Since the patient is 23 years old and has been trying for only 6 months, she does not yet meet the diagnostic criteria for infertility. The appropriate action is to advise them to continue trying and to return for evaluation if conception does not occur after a full year. *Semen analysis for husband* - While a semen analysis is a crucial initial step in an infertility workup, it is premature at this stage given the duration of attempted conception. - It would be appropriate to order this test after the couple has met the criteria for infertility (12 months for women under 35). *Hysterolaparoscopy* - This is an invasive procedure typically reserved for more advanced stages of an infertility workup, especially when suspected pathologies like endometriosis or tubal factor infertility are present. - It is not indicated as an initial step for a couple who has only been trying to conceive for 6 months and does not yet meet the definition of infertility. *Diagnostic hysteroscopy* - A diagnostic hysteroscopy is used to visualize the inside of the uterus to identify intrauterine pathologies that could contribute to infertility. - Like hysterolaparoscopy, it is an invasive diagnostic tool and should only be considered after initial, less invasive investigations have been performed and the couple meets the criteria for infertility.

Q: A patient at the orthopedics OPD complains of troubled sleep at night due to numbness and tingling sensation involving his lateral 3 digits. His symptoms are relieved as he lays his arms hanging from the bed. Which of the following options correctly describes his condition and the test used to assess it?

Carpal tunnel syndrome, Durkan's test. ***Carpal tunnel syndrome, Durkan's test*** - The symptoms of **numbness and tingling** in the **lateral 3 digits** (thumb, index, middle, and radial half of the ring finger) are classic for **carpal tunnel syndrome (CTS)**, caused by compression of the **median nerve**. Relief with hanging the arm is due to gravity reducing swelling and pressure. - **Durkan's test** (or **median nerve compression test**) is highly specific for CTS. It involves direct pressure over the carpal tunnel, reproducing symptoms within 30 seconds. *Guyon's canal syndrome, Froment's test* - **Guyon's canal syndrome** involves compression of the **ulnar nerve** at the wrist, primarily affecting the **little finger** and the **ulnar half of the ring finger**, not the lateral 3 digits. - **Froment's test** assesses **ulnar nerve palsy** by observing the strength of adductor pollicis during a pinch grip, which is unrelated to median nerve compression. *Carpal tunnel syndrome, Froment's test* - While **carpal tunnel syndrome** is correctly identified based on the symptoms, **Froment's test** is not used to assess it. - As mentioned, Froment's test evaluates **ulnar nerve function**, particularly the adductor pollicis muscle. *Guyon's canal syndrome, Durkan's test* - The symptoms described (lateral 3 digits) are inconsistent with **Guyon's canal syndrome**, which affects the ulnar nerve distribution. - Although **Durkan's test** is appropriate for carpal tunnel syndrome, the diagnosis for Guyon's canal syndrome is incorrect.

Q: A child was brought with pedal edema and cheilosis. Cardiomegaly was present. What is the vitamin deficiency associated with this clinical presentation?

Thiamine deficiency. ***Thiamine deficiency*** - The combination of **pedal edema** and **cardiomegaly** suggests **wet beriberi**, which is caused by **thiamine (vitamin B1) deficiency**. - **Cheilosis** (cracking at the corners of the mouth) is also a feature that can be seen in various vitamin deficiencies, but the cardiac involvement is highly indicative of thiamine deficiency. *Riboflavin deficiency* - **Riboflavin (vitamin B2) deficiency** is characterized by **cheilosis**, glossitis, angular stomatitis, and seborrheic dermatitis. - It typically does not cause **cardiomegaly** or significant **pedal edema** without other concurrent nutritional deficiencies. *Pyridoxine deficiency* - **Pyridoxine (vitamin B6) deficiency** primarily manifests as **dermatitis**, **microcytic anemia**, and neurological symptoms like **peripheral neuropathy** and **seizures**. - It is not typically associated with **pedal edema** or **cardiomegaly**. *Niacin deficiency* - **Niacin (vitamin B3) deficiency** causes **pellagra**, characterized by the "3 Ds": **dermatitis**, **diarrhea**, and **dementia**. - While it can manifest with systemic issues, it does not typically present with the prominent **cardiomegaly** and **pedal edema** seen in this case.

Q: A chronic smoker was on nicotine replacement therapy and clonidine tablets for smoking de-addiction. He stopped taking clonidine tablets and now presents with a headache. What is the reason behind this condition?

Rebound hypertension. ***Rebound hypertension*** - **Clonidine withdrawal** can cause a sudden surge in blood pressure due to increased sympathetic activity, leading to **rebound hypertension** and symptoms like headaches. - This occurs because chronic clonidine use suppresses sympathetic outflow, and its abrupt discontinuation unmasks this suppressed activity, causing a hypertensive crisis. *Postural hypotension* - **Postural hypotension** is a common side effect of clonidine due to its vasodilatory effects, causing blood pressure to drop when standing. - However, the patient's headache following clonidine cessation is more indicative of a **hypertensive event**, not hypotension. *Receptor upregulation* - **Receptor upregulation** refers to an increase in the number of receptors, often in response to prolonged antagonism or decreased ligand exposure. - While receptor changes occur, the primary mechanism of clonidine withdrawal is the **overcompensation** of the sympathetic nervous system, not simply an increased number of receptors. *Receptor hypersensitivity* - **Receptor hypersensitivity** implies an exaggerated response to a normal concentration of a neurotransmitter, which can contribute to withdrawal symptoms. - While it plays a role, the more immediate and critical cause of the headache is the rapid increase in blood pressure due to **rebound sympathetic activity**.

Q: A patient comes to the casualty with organophosphate poisoning. He was started on atropine infusion and pralidoxime. After 2 hours, the patient had a sudden rise in temperature. What is the most likely cause of the fever?

Fever due to atropine toxicity.. ***Fever due to atropine toxicity.*** - **Atropine** blocks muscarinic receptors, leading to inhibition of **sweat glands** and subsequent rise in body temperature (hyperthermia), especially with high doses or prolonged infusion. - Given the patient is receiving an **atropine infusion** and developed fever, **atropine toxicity** is a primary concern. *Side effect of pralidoxime.* - While pralidoxime can cause side effects like dizziness, blurred vision, or tachycardia, **fever is not a typical side effect** of pralidoxime. - Pralidoxime works by **regenerating acetylcholinesterase** [2, 3] and does not directly interfere with thermoregulation in a way that would cause fever. *Result of organophosphate poisoning.* - **Organophosphate poisoning** typically causes **hypothermia** due to excessive cholinergic stimulation leading to peripheral vasodilation and increased sweating [1]. - **Fever** is not a direct result of the acute phase of organophosphate poisoning itself, but rather a complication of treatment or other factors. *Unrelated or unknown cause.* - While possible, it's less likely to be "unrelated or unknown" when a clear pharmacological explanation (**atropine toxicity**) exists for fever in the context of the patient's treatment. - It would be important to first rule out known causes related to the ongoing treatment before attributing it to an unknown cause.

Question 1

A 45-year-old male patient presents to the emergency department with severe pain and swelling in the big toe joint. He has a history of recurrent joint pain and dietary indiscretion. A specimen from the affected joint is subjected to a test that produces a purple color reaction. What is the test being performed?

Accepted Answer

Murexide test for uric acid detection

Answer

Florence test for choline compounds

Answer

Teichmann test for blood

Answer

Acid phosphatase test for prostate

Question 2

In a 10-year-old school child, which of the following vaccines is given as a part of the school immunization program?

Accepted Answer

TT/Td vaccine

Answer

Measles vaccine

Answer

Rotavirus vaccine

Answer

Hepatitis B vaccine

Question 3

In a patient presented with a fever and a positive filarial antigen test, what is the next appropriate method of management?

Accepted Answer

Detection of microfilariae in the blood smear

Answer

Bone marrow biopsy

Answer

DEC provocation test

Answer

Ultrasound of the scrotum

Question 4

A woman presents to you at 36 weeks of gestation with complaints of breathlessness and excessive abdominal distension. Fetal movements are normal. On examination, fetal parts are not easily felt and fetal heartbeat is heard but it is muffled. Her symphysis fundal height is 41 cm. Her abdomen is tense but not tender. What is the most likely diagnosis?

Accepted Answer

Polyhydramnios

Answer

Abruptio placenta

Answer

Hydrocephalus of fetus

Answer

Oligohydramnios

Question 5

A 16-year-old girl presents with cyclical pelvic pain every month. She has not achieved menarche yet. On examination, a suprapubic bulge can be seen in the lower abdomen. PR examination reveals a bulging swelling in the anterior aspect. What is the most likely diagnosis?

Accepted Answer

Imperforate hymen

Answer

Transverse vaginal septum

Answer

Vaginal atresia

Answer

Cervical agenesis

Question 6

A 23-year-old woman accompanied by her mother-in-law comes to the infertility clinic. She has been having regular intercourse for 6 months but is not able to conceive. What is the next best step?

Accepted Answer

Reassure and review the couple after 6 months

Answer

Hysterolaparoscopy

Answer

Diagnostic hysteroscopy

Answer

Semen analysis for husband

Question 7

A patient at the orthopedics OPD complains of troubled sleep at night due to numbness and    tingling sensation involving his lateral 3 digits. His symptoms are relieved as he lays his arms    hanging from the bed. Which of the following options correctly describes his condition and the    test used to assess it?

Accepted Answer

Carpal tunnel syndrome, Durkan's test

Answer

Guyon's canal syndrome, Froment's test

Answer

Carpal tunnel syndrome, Froment's test

Answer

Guyon's canal syndrome, Durkan's test

Question 8

A child was brought with pedal edema and cheilosis. Cardiomegaly was present. What is the vitamin deficiency associated with this clinical presentation?

Accepted Answer

Thiamine deficiency

Answer

Riboflavin deficiency

Answer

Pyridoxine deficiency

Answer

Niacin deficiency

Question 9

A chronic smoker was on nicotine replacement therapy and clonidine tablets for smoking de-addiction. He stopped taking clonidine tablets and now presents with a headache. What is the reason behind this condition?

Accepted Answer

Rebound hypertension

Answer

Postural hypotension

Answer

Receptor upregulation

Answer

Receptor hypersensitivity

Question 10

A patient comes to the casualty with organophosphate poisoning. He was started on atropine infusion and pralidoxime. After 2 hours, the patient had a sudden rise in temperature. What is the most likely cause of the fever?

Accepted Answer

Fever due to atropine toxicity.

Answer

Side effect of pralidoxime.

Answer

Result of organophosphate poisoning.

Answer

Unrelated or unknown cause.

NEET-PG 2023

Biochemistry

Community Medicine

Microbiology

Obstetrics and Gynecology

Orthopaedics

Pediatrics

Pharmacology