NEET-PG 2024 Practice Questions

Q: Identify the diagnosis based on the dermatology immunofluorescence (IF) image provided.

Dermatitis herpetiformis. ***Dermatitis herpetiformis*** - The immunofluorescence image shows **granular IgA deposits** at the **dermal papillae region**, which is characteristic of dermatitis herpetiformis. - This condition is strongly associated with **celiac disease** and presents with intensely pruritic papules and vesicles. *Pemphigus vulgaris* - Immunofluorescence in pemphigus vulgaris typically shows a **fishnet pattern** of IgG deposits throughout the **epidermis**, reflecting antibodies against desmoglein 3 and 1. - This pattern is an intercellular deposition, not granular at the dermal papillae. *Pemphigus foliaceus* - Similar to pemphigus vulgaris, pemphigus foliaceus also exhibits **intercellular IgG deposits** in the epidermis, but it is usually more superficial, targeting desmoglein 1. - The image does not show this intercellular epidermal staining. *Bullous pemphigoid* - Bullous pemphigoid is characterized by **linear IgG and C3 deposits along the dermal-epidermal junction** (basement membrane zone). - The image distinctly shows granular IgA, not linear IgG/C3, and specifically in the dermal papillae.

Q: Which of the following statements is correct about Paroxysmal Nocturnal Hemoglobinuria (PNH)?

Flow cytometry is the best investigation. ***Flow cytometry is the best investigation*** - **Flow cytometry** is the gold standard for diagnosing PNH as it directly detects the absence of **GPI-anchored proteins (CD55 and CD59)** on the surface of red blood cells, granulocytes, and monocytes. - This method is highly sensitive and specific, allowing for the precise quantification of PNH clones even when present in small numbers. *Sucrose lysis test is used for the confirmation* - The **sucrose lysis test** (or sugar-water test) was an older screening test for PNH, but it is **not specific or sensitive enough** for confirmation. - It works by inducing complement activation on PNH cells in low ionic strength sucrose solution [1], but it has a high rate of false positives and negatives. *The most common cause of death is heart failure* - The most common cause of death in patients with PNH is **thrombosis**, particularly in unusual sites such as hepatic, cerebral, or abdominal veins, due to the prothrombotic state caused by the disease. - While heart complications can occur, they are not the leading cause of mortality. *It is an inherited disorder* - PNH is an **acquired clonal disorder** of hematopoietic stem cells, not an inherited genetic disorder [1]. - It results from a somatic mutation in the **PIG-A gene** in a hematopoietic stem cell, leading to the deficiency of GPI-anchored proteins.

Q: A patient presents with pulmonary hemorrhage and is P-ANCA positive. What is the most likely diagnosis?

Microscopic polyangiitis. ***Microscopic polyangiitis*** - This condition is characterized by **pulmonary hemorrhage** (often manifesting as diffuse alveolar hemorrhage) and **P-ANCA positivity**, which is typically associated with antibodies against **myeloperoxidase (MPO)**. [1] - It is a **small-vessel vasculitis** that frequently affects the kidneys (glomerulonephritis) and lungs without granuloma formation. *Churg-Strauss syndrome* - While Churg-Strauss syndrome (now known as **Eosinophilic Granulomatosis with Polyangiitis**, EGPA) can be P-ANCA positive, it is typically associated with a history of **asthma**, **allergic rhinitis**, and **eosinophilia**. [1] - Pulmonary involvement often includes **infiltrates** and nodules, but diffuse alveolar hemorrhage with severe pulmonary hemorrhage is less common as the primary presentation compared to MPA. *Wegener granulomatosis* - Wegener granulomatosis (now known as **Granulomatosis with Polyangiitis**, GPA) primarily presents with **upper and lower respiratory tract granulomatous inflammation** and **glomerulonephritis**. - It is typically associated with **C-ANCA positivity** (antibodies against proteinase 3, PR3), not P-ANCA. *Polyarteritis nodosa (PAN)* - Polyarteritis nodosa is a **medium-vessel vasculitis** that typically affects the **kidneys, gastrointestinal tract, skin, and nervous system**. [1] - It is classically **ANCA-negative** and does not typically cause pulmonary hemorrhage or diffuse alveolar hemorrhage.

Q: Which of the following is typically observed in the investigation results for a patient with iron deficiency anemia (IDA)?

Decreased transferrin saturation. ***Decreased transferrin saturation*** - In **iron deficiency anemia**, there is insufficient iron to bind to **transferrin**, leading to a reduction in the percentage of transferrin that is iron-bound. - This reflects the body's struggle to supply iron for erythropoiesis due to depleted iron stores. *Increased serum ferritin* - **Serum ferritin** is a key indicator of the body's iron stores; in **iron deficiency anemia**, these stores are depleted, leading to a *decreased* rather than increased serum ferritin level. - An increased serum ferritin is typically seen in conditions of **iron overload** or **inflammation**. *Increased serum iron* - **Serum iron** measures the iron circulating in the blood, and in **iron deficiency anemia**, iron levels are *low* due to inadequate intake or excessive loss. - An increased serum iron level would contradict the diagnosis of iron deficiency. *Normal total iron-binding capacity (TIBC)* - **Total iron-binding capacity (TIBC)** typically *increases* in iron deficiency anemia as the liver produces more transferrin in an attempt to capture any available iron. - A normal TIBC would not reflect the compensatory mechanisms seen in iron deficiency. *Increased mean corpuscular volume (MCV)* - **Iron deficiency anemia** is a **microcytic anemia**, characterized by *decreased* MCV due to inadequate hemoglobin synthesis within red blood cells. - An increased MCV is seen in **macrocytic anemias** such as vitamin B12 or folate deficiency, not in iron deficiency.

Q: An adult female presents with pallor and fatigue. Blood investigations show low hemoglobin ( Hb ), low serum iron, low ferritin, low transferrin saturation, and increased total iron-binding capacity (TIBC). What is the likely diagnosis?

Iron Deficiency Anemia (IDA). ***Iron Deficiency Anemia (IDA)*** - The unique constellation of **low hemoglobin**, **low serum iron**, **low ferritin**, **low transferrin saturation**, and **increased total iron-binding capacity (TIBC)** is the hallmark of Iron Deficiency Anemia. - **Ferritin** is a direct measure of iron stores, and its low level confirms depletion, while **increased TIBC** signifies the body's attempt to absorb more iron due to deficiency. *Anemia of Chronic Disease* - While also presenting with **low hemoglobin** and often **low serum iron**, Anemia of Chronic Disease is characterized by **normal or increased ferritin** (as ferritin is an acute phase reactant) and **decreased TIBC**. - There is a functional iron deficiency, but iron stores are typically adequate, and inflammation plays a central role. *Hemolytic Anemia* - Hemolytic anemia is characterized by the premature destruction of red blood cells, leading to **low hemoglobin** but typically **normal or elevated serum iron** and ferritin due to iron release from lysed red cells. - Key indicators, such as **elevated bilirubin**, **lactate dehydrogenase (LDH)**, and **reticulocytosis**, are absent in the given scenario. *Thalassemia* - Thalassemia is a genetic disorder causing defective hemoglobin synthesis, resulting in **microcytic hypochromic anemia** with **low hemoglobin**. - However, thalassemia typically presents with **normal to high serum iron** and ferritin levels, as iron absorption may be increased, and there's no primary iron deficiency. *Sideroblastic Anemia* - Sideroblastic anemia is characterized by defective heme synthesis with iron accumulation in mitochondria, forming characteristic ring sideroblasts on bone marrow examination. - Laboratory findings typically show **normal to increased serum iron**, **increased ferritin**, and **increased transferrin saturation**, distinguishing it from iron deficiency anemia.

Q: A patient presents with respiratory distress and is diagnosed with panacinar emphysema. Which of the following is deficient?

Alpha-1 antitrypsin. **Alpha-1 antitrypsin** * **Alpha-1 antitrypsin (A1AT) deficiency** is a genetic disorder that leads to the development of panacinar emphysema, especially in non-smokers or at a young age [1], [2]. * A1AT protects the lung tissue from destruction by **elastase** released by neutrophils; without it, this enzyme breaks down alveolar walls [1], [2]. *Surfactant* * **Surfactant** is responsible for reducing surface tension in the alveoli, preventing their collapse in the lungs. * A deficiency primarily causes **neonatal respiratory distress syndrome** or adult respiratory distress syndrome, not predominantly emphysema. *Albumin* * **Albumin** is a primary protein in plasma that maintains oncotic pressure and transports various substances in the blood. * A deficiency in albumin (e.g., in liver disease or malnutrition) typically leads to **edema** and impaired drug transport, not emphysema. *Type II pneumocytes* * **Type II pneumocytes** are responsible for producing and secreting surfactant, as well as acting as progenitor cells for Type I pneumocytes. * While abnormalities in these cells can lead to surfactant deficiency, the direct cause of genetic panacinar emphysema is the lack of protection against elastase, not a primary defect in pneumocyte number or function in this context.

Q: A patient presents with a renal mass leading to hematuria and flank pain. The histological image below is shown. What is the likely diagnosis?

Clear Cell Carcinoma. ***Clear Cell Carcinoma*** - **Clear cell carcinoma** is the most common type of renal cell carcinoma, classically presenting with a triad of **hematuria**, **flank pain**, and a **palpable mass**. - Histologically, it is characterized by cells with **clear cytoplasm** due to lipid and glycogen accumulation, forming nests or cords, often with a rich **vascular network** [1]. *Chromophobe Renal Cell Carcinoma (RCC)* - This subtype typically presents with **eosinophilic cytoplasm** and prominent cell membranes, often with perinuclear halos, which is distinct from the clear cytoplasm seen in the image [1]. - It generally has a **better prognosis** and differs genetically from clear cell carcinoma [1]. *Bellini Duct Carcinoma* - Also known as **collecting duct carcinoma**, this is a rare and aggressive subtype originating from the medullary collecting ducts. - It usually presents with a **poorly differentiated infiltrative growth pattern** and high-grade nuclear features, which are not typical of the image provided. *Papillary Cell Carcinoma* - Histologically, **papillary renal cell carcinoma** is characterized by cells arranged in a papillary or tubulopapillary architecture with fibrovascular cores [1]. - The cells typically have basophilic cytoplasm and are not noted for the prominent clear cell appearance seen in the image. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 959-961.

Q: An elderly male patient presented with clinical symptoms and signs consistent with possible multiple myeloma. Electrophoresis shows an M spike, and immunofixation findings are shown below. Which of the following statements best corresponds to the findings?

Multiple myeloma with increased IgG. ***Multiple myeloma with increased IgG*** - The immunofixation image shows a distinct, *monoclonal band (M spike)* in the **IgG lane (G)**, corresponding to the initial electrophoresis (ELP) M spike [1]. There is also a corresponding band in the **kappa light chain (K)** lane [1]. - The presence of a dominant band in IgG, along with a matching light chain (either kappa or lambda), indicates an **IgG monoclonal gammopathy**, which is characteristic of the most common type of multiple myeloma [1]. *Multiple myeloma with increased IgM* - This option would correspond to a strong, monoclonal band in the **IgM lane (M)**, which is not the case here. The 'M' lane in the image shows a faint/normal band, not an increased M spike. - Increased IgM monoclonal protein (M spike) is characteristic of **Waldenström macroglobulinemia**, not typically multiple myeloma [2]. *Multiple myeloma with increased IgA* - If the patient had IgA multiple myeloma, there would be a prominent monoclonal band in the **IgA lane (A)**, which is not observed in this immunofixation result. The 'A' lane shows a considerably smaller band compared to IgG. - IgA multiple myeloma is a less common subtype than IgG myeloma and would present with an IgA M spike [1]. *Waldenström macroglobulinemia* - Waldenström macroglobulinemia is characterized by a monoclonal gammopathy of the **IgM type**, which would present as a distinct M spike in the IgM lane [2]. - The immunofixation clearly shows an **IgG M spike**, ruling out Waldenström macroglobulinemia based on the type of monoclonal gammopathy [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 608-609. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 606-607.

Question 1

An adult male presented with a protruding abdomen, diarrhea, visual symptoms, and neurological manifestations. His LDL is low. Based on the peripheral smear finding shown in the image, what is the likely diagnosis?

Accepted Answer

Abetalipoproteinemia

Answer

EDTA changes

Answer

Uremia

Answer

Burns

Answer

Liver disease

Question 2

Identify the diagnosis based on the dermatology immunofluorescence (IF) image provided.

Accepted Answer

Dermatitis herpetiformis

Answer

Pemphigus vulgaris

Answer

Pemphigus foliaceus

Answer

Bullous pemphigoid

Question 3

Which of the following statements is correct about Paroxysmal Nocturnal Hemoglobinuria (PNH)?

Accepted Answer

Flow cytometry is the best investigation

Answer

Sucrose lysis test is used for the confirmation

Answer

The most common cause of death is heart failure

Answer

It is an inherited disorder

Question 4

A patient presents with pulmonary hemorrhage and is P-ANCA positive. What is the most likely diagnosis?

Accepted Answer

Microscopic polyangiitis

Answer

Churg-Strauss syndrome

Answer

Wegener granulomatosis

Answer

Polyarteritis nodosa (PAN)

Question 5

Which of the following is typically observed in the investigation results for a patient with iron deficiency anemia (IDA)?

Accepted Answer

Decreased transferrin saturation

Answer

Increased serum ferritin

Answer

Increased serum iron

Answer

Normal total iron-binding capacity (TIBC)

Answer

Increased mean corpuscular volume (MCV)

Question 6

An adult female presents with pallor and fatigue. Blood investigations show low hemoglobin ( Hb ), low serum iron, low ferritin, low transferrin saturation, and increased total iron-binding capacity (TIBC). What is the likely diagnosis?

Accepted Answer

Iron Deficiency Anemia (IDA)

Answer

Anemia of Chronic Disease

Answer

Hemolytic Anemia

Answer

Thalassemia

Answer

Sideroblastic Anemia

Question 7

A patient presents with respiratory distress and is diagnosed with panacinar emphysema. Which of the following is deficient?

Accepted Answer

Alpha-1 antitrypsin

Answer

Surfactant

Answer

Albumin

Answer

Type II pneumocytes

Question 8

A patient presents with a renal mass leading to hematuria and flank pain. The histological image below is shown. What is the likely diagnosis?

Accepted Answer

Clear Cell Carcinoma

Answer

Chromophobe Renal Cell Carcinoma (RCC)

Answer

Bellini Duct Carcinoma

Answer

Papillary Cell Carcinoma

Question 9

Identify the diagnosis from the given image

Accepted Answer

Malakoplakia

Answer

TB

Answer

BCC

Answer

Drug induced lesion

Question 10

An elderly male patient presented with clinical symptoms and signs consistent with possible multiple myeloma. Electrophoresis shows an M spike, and immunofixation findings are shown below. Which of the following statements best corresponds to the findings?

Accepted Answer

Multiple myeloma with increased IgG

Answer

Multiple myeloma with increased IgM

Answer

Multiple myeloma with increased IgA

Answer

Waldenström macroglobulinemia

NEET-PG 2024

Biochemistry

Dermatology

Internal Medicine

Pathology