NEET-PG 2024 Practice Questions

Q: A patient presents with skin lesions and erosions on the buccal mucosa. The immunofluorescence image is shown. What is the most likely diagnosis?

Pemphigus vulgaris. ***Pemphigus vulgaris*** - The combination of **flaccid blisters/erosions** on the skin and **buccal mucosal lesions** is characteristic of pemphigus vulgaris. The image showing **intercellular IgG deposits** (a "chicken wire" pattern) in the epidermis confirms the diagnosis on immunofluorescence. - Pemphigus vulgaris is an **autoimmune blistering disease** caused by autoantibodies against **desmoglein 1 and 3**, leading to acantholysis (loss of cell adhesion) within the epidermis. *Bullous pemphigoid* - This condition typically presents with **tense bullae** that are less prone to rupture, and **mucosal involvement is rare**. - Immunofluorescence in bullous pemphigoid shows **linear IgG and C3 deposits at the dermoepidermal junction**, not an intercellular epidermal pattern. *Linear IgA disease* - Characterized by **linear IgA deposition along the basement membrane zone** on direct immunofluorescence. - Clinically, it presents with **blisters** that can be variable in appearance, but the pathognomonic immunofluorescence pattern is distinct. *Dermatitis herpetiformis* - Presents with very **pruritic vesicles and papules**, primarily on extensor surfaces, and is strongly associated with **celiac disease**. - Direct immunofluorescence reveals **granular IgA deposits in the dermal papillae**, which is distinct from the intercellular IgG pattern seen here.

Q: A child presents with multiple patchy areas of hair loss, scales, and itching. The sister also had similar lesions. What is the most likely diagnosis?

Tinea capitis. ***Tinea capitis*** - **Tinea capitis** presents with **patchy hair loss**, **scaling**, and **itching** on the scalp, which are classic signs of a fungal infection. - The fact that the sister also had similar lesions indicates a **contagious** condition, consistent with a **dermatophyte infection**. *Alopecia areata* - Characterized by **sudden, non-scarring hair loss** in circular or oval patches, often with no scaling or inflammation. - It is an **autoimmune condition** and typically not associated with itching or contagiousness amongst siblings. *Pediculosis capitis* - This condition involves an **infestation of head lice**, primarily causing **intense itching** of the scalp. - While it is contagious, it typically presents with **nits** (lice eggs) firmly attached to hair shafts and excoriations from scratching, rather than significant hair loss and scaling. *Pyoderma* - **Pyoderma** is a bacterial skin infection, often presenting as **pustules**, **crusts**, or **blisters** on the scalp. - While it can be contagious and cause discomfort, it is primarily characterized by purulent lesions and not the diffuse patchy hair loss and scaling seen in this case.

Q: A 60-year-old person who completed treatment for leprosy many years ago now presents with a punched-out, painless ulcer on the sole of his foot. What is the most appropriate management?

Intense debridement and intravenous antibiotics. ***Intense debridement and intravenous antibiotics*** - The presence of a **punched-out, painless ulcer** in a patient with a history of leprosy suggests a **neuropathic ulcer** that has likely become infected due to compromised sensation and foot care [3]. - **Intense debridement** is crucial to remove necrotic tissue and reduce bacterial load, while **intravenous antibiotics** are necessary to treat the deep-seated infection often associated with such ulcers, especially given the poor vascularity and compromised healing in leprosy [2]. *Restart MDT* - The patient completed **leprosy treatment many years ago**, indicating that the current ulcer is not an active leprosy lesion requiring multidrug therapy (MDT). - Restarting MDT would be inappropriate as there is no evidence of **active Mycobacterium leprae infection**. *Amputation* - Amputation is a **last resort** for severe, uncontrolled infections or extensive tissue damage that cannot be salvaged. - While neuropathic ulcers can lead to amputation, it is not the initial or most appropriate management unless there are signs of **irreversible ischemia or overwhelming sepsis** that are not mentioned here. *Offloading and comprehensive wound care* - While **offloading** and comprehensive wound care are essential components of long-term management and prevention for neuropathic ulcers, they are insufficient as the primary treatment for an already **infected, deep ulcer** [2]. - **Debridement** and **antibiotics** are critical initial steps to control the infection before offloading and routine wound care can effectively promote healing [1].

Q: A person with a history of chronic alcohol consumption who indulged in binge drinking 10 days ago is brought to the emergency department in an unconscious state. A non-contrast CT scan was normal, and his blood glucose level is 45 mg/dL. What is the most appropriate treatment?

IM thiamine followed by dextrose. **IM thiamine followed by dextrose** - Administering **thiamine** prior to **dextrose** is crucial in patients with chronic alcohol use to prevent **Wernicke-Korsakoff syndrome**, as glucose administration can precipitate or worsen Wernicke encephalopathy in thiamine-deficient individuals. - The patient's **hypoglycemia** (45 mg/dL) requires immediate correction with **dextrose**, but **thiamine** must be given first due to the patient's history of chronic alcohol consumption. *Normal saline* - While **normal saline** is used for rehydration and volume expansion, it does not address the patient's immediate and life-threatening **hypoglycemia** or **thiamine deficiency**. - Without addressing **hypoglycemia**, the patient's unconscious state will persist and lead to further neurological damage. *5% dextrose/vitamin K* - **5% dextrose** alone might correct **hypoglycemia**, but administering it without prior **thiamine** in a chronic alcoholic can precipitate **Wernicke encephalopathy**. - **Vitamin K** is typically given for coagulopathies or bleeding disorders, not as a primary treatment for **hypoglycemia** or **alcohol-related neurological emergencies** unless specific indications are present. *25% dextrose* - **25% dextrose** would rapidly correct **hypoglycemia**, but as with 5% dextrose, administering it without prior **thiamine** in a chronic alcoholic can precipitate or worsen **Wernicke encephalopathy**. - The primary concern in this context for an alcoholic patient with hypoglycemia is the potential for **thiamine deficiency**. *IV dextrose followed by thiamine* - While this option includes both necessary treatments, the **incorrect sequence** is critical—administering **dextrose before thiamine** in a chronic alcoholic can precipitate **Wernicke encephalopathy**. - The correct protocol requires **thiamine first** to replenish stores before glucose metabolism is accelerated by dextrose administration.

Q: A patient with multiple sexual exposures is diagnosed with gonorrhea. What is the appropriate treatment?

Ceftriaxone. ***Ceftriaxone*** - **Ceftriaxone** is the **first-line recommended treatment** for uncomplicated gonorrhea according to **CDC and WHO guidelines**. - Administered as a **single intramuscular injection (500 mg IM)**, it provides highly effective coverage against *Neisseria gonorrhoeae* with minimal resistance. - It works by inhibiting bacterial cell wall synthesis, and is the **gold standard therapy** for gonorrhea treatment. - For patients with multiple sexual exposures, empiric treatment for co-infection with *Chlamydia trachomatis* (doxycycline) should also be considered. *Cefixime* - **Cefixime** was previously used as an oral alternative but is **no longer recommended** as first-line therapy due to **increasing resistance** of *N. gonorrhoeae*. - The CDC removed cefixime from recommended regimens due to **inferior efficacy** compared to ceftriaxone and concerns about treatment failures. - While it is an oral cephalosporin, it is **not appropriate first-line therapy** for gonorrhea. *Doxycycline* - **Doxycycline** is commonly used to treat **co-infection with *Chlamydia trachomatis***, which frequently occurs alongside gonorrhea. - The typical regimen is **100 mg twice daily for 7 days** as adjunctive therapy. - However, doxycycline is **not effective as monotherapy for gonorrhea** and should not be used alone to treat *N. gonorrhoeae* infection. *Acyclovir* - **Acyclovir** is an **antiviral medication** used to treat **herpes simplex virus (HSV)** infections. - It works by inhibiting viral DNA replication and has **no activity against bacterial infections** like gonorrhea. - It would be completely ineffective against *Neisseria gonorrhoeae*.

Q: Which of the following drugs is used in opioid maintenance therapy?

Buprenorphine. ***Buprenorphine*** - **Buprenorphine** is a **partial opioid agonist** used in opioid maintenance therapy to reduce cravings and withdrawal symptoms without producing the full euphoric effects of other opioids. - It is often combined with **naloxone** (as Suboxone) to prevent misuse by injection, as naloxone is only active if injected. - Buprenorphine has a **ceiling effect** for respiratory depression, making it safer than full agonists like methadone. *Naltrexone* - **Naltrexone** is an **opioid antagonist** that blocks opioid receptors, preventing the euphoric effects of opioids and reducing cravings. - While used in opioid use disorder treatment, it is primarily for relapse prevention and not typically for the active maintenance phase where agonist effects are desired. *Clonidine* - **Clonidine** is an **alpha-2 adrenergic agonist** primarily used to manage the **autonomic symptoms of opioid withdrawal**, such as anxiety, sweating, and rapid heart rate. - It does not directly act on opioid receptors and is not a primary agent for long-term opioid maintenance therapy. *Disulfiram* - **Disulfiram** is a drug used in the treatment of **alcohol use disorder**, not opioid use disorder. - It works by inhibiting acetaldehyde dehydrogenase, leading to an unpleasant reaction when alcohol is consumed. *Naloxone* - **Naloxone** is an **opioid antagonist** used for **emergency reversal of opioid overdose**, not for maintenance therapy. - It rapidly displaces opioids from receptors and reverses respiratory depression. - While combined with buprenorphine in Suboxone to prevent misuse, naloxone itself is not used for maintenance therapy.

Q: A patient on SSRI sertraline was also prescribed amitriptyline and subsequently developed serotonin toxicity. What is the likely treatment for serotonin toxicity?

Cyproheptadine. ***Cyproheptadine*** - **Cyproheptadine** is a serotonin antagonist that can help reverse the effects of excessive serotonin in the central nervous system. - It works by blocking **serotonin 5-HT2A receptors**, which are implicated in the pathophysiology of serotonin toxicity. *Flumazenil* - **Flumazenil** is a benzodiazepine receptor antagonist used to reverse the effects of benzodiazepine overdose. - It has no role in the treatment of **serotonin toxicity**, as it does not affect serotonin pathways. *L-Carnitine* - **L-Carnitine** is a mitochondrial co-factor used in fatty acid metabolism, sometimes supplemented for certain metabolic disorders or muscle pain. - It does not have any direct action on **serotonin receptors** or the serotonin system, making it ineffective for serotonin toxicity. *Leucovorin* - **Leucovorin** (folinic acid) is used to counteract the effects of methotrexate toxicity or to enhance the effects of fluorouracil in chemotherapy. - It is not involved in modulating **neurotransmitter levels** or reversing the symptoms of serotonin toxicity. *Naloxone* - **Naloxone** is an opioid receptor antagonist used to reverse opioid overdose. - It has no effect on **serotonin receptors** or serotonergic pathways, making it ineffective for treating serotonin toxicity.

Q: A 45-year-old female presents to the OPD with complaints of "feeling tense" and experiencing stomach upset with heartburn and diarrhea. She reports having these symptoms for many years and mentions that her family members also usually feel tense and nervous. Which of the following symptoms is most likely to be seen in this patient?

Tingling of extremities. ***Tingling of extremities*** - The patient's presentation of "feeling tense," **stomach upset, heartburn, and diarrhea** for many years, alongside a family history of similar issues, suggests significant **anxiety**. - **Peripheral neurological symptoms** such as **tingling of extremities (paresthesia)** are common manifestations of anxiety and panic attacks due to **hyperventilation** (causing respiratory alkalosis and decreased ionized calcium) and **physiological arousal**. *Ideas of reference* - **Ideas of reference** are typically seen in **psychotic disorders** (e.g., schizophrenia) where a person believes that unrelated, external events have a special, personal meaning. - While anxiety can sometimes lead to misinterpretations, **ideas of reference** at a delusional level are not characteristic of generalized anxiety. *Hallucination* - **Hallucinations** are perceptual disturbances where an individual experiences sensory perceptions (e.g., hearing voices, seeing things) in the absence of an external stimulus. - These are core symptoms of **psychotic disorders** and are not typical findings in anxiety disorders without comorbid conditions. *Neologism* - A **neologism** is the coining of new words or phrases, often without clear meaning, which is a hallmark feature of disorganized thought in **psychotic disorders** (e.g., schizophrenia). - This symptom is related to severe thought disorganization and is not associated with anxiety disorders.

Q: A 30-year-old male needs to be dressed in female lingerie and high heels to feel aroused and have intercourse with a female. He denies any attraction towards males. What is the most likely diagnosis?

Transvestic Disorder. ***Transvestic Disorder*** - This condition involves **recurrent, intense sexual arousal from cross-dressing** in clothes typically associated with the opposite sex. The man experiences this specifically for sexual arousal and activity with a female partner, rather than for gender identity reasons. - The patient's denial of attraction to males and the context of heterosexual intercourse confirm that this is a paraphilic disorder related to specific sexual arousal patterns. - This diagnosis (formerly called "Transvestic fetishism" in DSM-IV) is the appropriate term in DSM-5-TR. *Gender dysphoria* - This involves a **marked incongruence between one's experienced/expressed gender and one's assigned gender**, often accompanied by distress or impairment. The patient's desire to dress in female clothing is for sexual arousal, not because he identifies as female. - Individuals with gender dysphoria typically experience a persistent and profound discomfort with their birth-assigned gender and a strong desire to be of the other gender, which is not described in this case. *Homosexuality* - This refers to **sexual attraction to individuals of the same sex**. The patient explicitly denies any attraction towards males, indicating that his sexual orientation is not homosexual. - His arousal is tied to a specific activity, cross-dressing, in the context of heterosexual intercourse, not the gender of his partner. *Testicular feminization* - This is an older term for **Androgen Insensitivity Syndrome (AIS)**, a genetic condition where an individual who is genetically male (XY) is resistant to male hormones (androgens). This results in female external sexual characteristics or ambiguous genitalia. - This is a biological developmental disorder, not a psychological or sexual preference, and is unrelated to the behavioral description of sexual arousal from cross-dressing.

Q: A 24-year-old male presents for evaluation. He appears very calm and charming in front of the psychiatrist but often gets into fights with friends, skips classes, breaks traffic rules, and is involved in multiple police cases. What is the most likely diagnosis?

Antisocial personality disorder. ***Antisocial personality disorder*** - The patient's **charming demeanor** while frequently engaging in **fights, rule-breaking**, and **legal issues** is characteristic of antisocial personality disorder. - Individuals with this disorder often display **disregard for social norms**, lack **empathy**, and have a history of **irresponsibility** and **deceitfulness**. *Narcissistic personality disorder* - This disorder is marked by a pervasive pattern of **grandiosity**, a need for **admiration**, and a lack of **empathy**, but it does not typically involve a pattern of recurrent **antisocial behavior** or **criminality** like that described. - While they might be perceived as charming, their primary motivation is self-enhancement and they are less likely to repeatedly engage in behaviors that actively violate the rights of others or societal rules for personal gain or impulsivity. *Paranoid personality disorder* - Characterized by pervasive **distrust and suspiciousness** of others' motives, interpreting them as malevolent, which is not depicted in this patient's presentation. - Individuals with this disorder tend to be **guarded, hold grudges**, and may be **secretive**, rather than openly engaging in antisocial acts and charming manipulation. *Schizotypal personality disorder* - Involves patterns of **eccentric behavior**, peculiar thinking, and extreme discomfort in close relationships, often due to **perceptual distortions** or **magical beliefs**. - This patient's presentation of social charm and calculated antisocial acts is not consistent with the **social isolation** and **oddities** typical of schizotypal personality disorder.

Question 1

A patient presents with skin lesions and erosions on the buccal mucosa. The immunofluorescence image is shown. What is the most likely diagnosis?

Accepted Answer

Pemphigus vulgaris

Answer

Bullous pemphigoid

Answer

Linear IgA disease

Answer

Dermatitis herpetiformis

Question 2

A child presents with multiple patchy areas of hair loss, scales, and itching. The sister also had similar lesions. What is the most likely diagnosis?

Accepted Answer

Tinea capitis

Answer

Alopecia areata

Answer

Pediculosis capitis

Answer

Pyoderma

Question 3

A 60-year-old person who completed treatment for leprosy many years ago now presents with a punched-out, painless ulcer on the sole of his foot. What is the most appropriate management?

Accepted Answer

Intense debridement and intravenous antibiotics

Answer

Restart MDT

Answer

Amputation

Answer

Offloading and comprehensive wound care

Question 4

A person with a history of chronic alcohol consumption who indulged in binge drinking 10 days ago is brought to the emergency department in an unconscious state. A non-contrast CT scan was normal, and his blood glucose level is 45 mg/dL. What is the most appropriate treatment?

Accepted Answer

IM thiamine followed by dextrose

Answer

Normal saline

Answer

5% dextrose/vitamin K

Answer

25% dextrose

Answer

IV dextrose followed by thiamine

Question 5

A patient with multiple sexual exposures is diagnosed with gonorrhea. What is the appropriate treatment?

Accepted Answer

Ceftriaxone

Answer

Acyclovir

Answer

Cefixime

Answer

Doxycycline

Question 6

Which of the following drugs is used in opioid maintenance therapy?

Accepted Answer

Buprenorphine

Answer

Naltrexone

Answer

Clonidine

Answer

Disulfiram

Answer

Naloxone

Question 7

A patient on SSRI sertraline was also prescribed amitriptyline and subsequently developed serotonin toxicity. What is the likely treatment for serotonin toxicity?

Accepted Answer

Cyproheptadine

Answer

Flumazenil

Answer

L-Carnitine

Answer

Leucovorin

Answer

Naloxone

Question 8

A 45-year-old female presents to the OPD with complaints of "feeling tense" and experiencing stomach upset with heartburn and diarrhea. She reports having these symptoms for many years and mentions that her family members also usually feel tense and nervous. Which of the following symptoms is most likely to be seen in this patient?

Accepted Answer

Tingling of extremities

Answer

Ideas of reference

Answer

Hallucination

Answer

Neologism

Question 9

A 30-year-old male needs to be dressed in female lingerie and high heels to feel aroused and have intercourse with a female. He denies any attraction towards males. What is the most likely diagnosis?

Accepted Answer

Transvestic Disorder

Answer

Gender dysphoria

Answer

Homosexuality

Answer

Testicular feminization

Question 10

A 24-year-old male presents for evaluation. He appears very calm and charming in front of the psychiatrist but often gets into fights with friends, skips classes, breaks traffic rules, and is involved in multiple police cases. What is the most likely diagnosis?

Accepted Answer

Antisocial personality disorder

Answer

Narcissistic personality disorder

Answer

Paranoid personality disorder

Answer

Schizotypal personality disorder

NEET-PG 2024

Dermatology

Internal Medicine

Pharmacology

Psychiatry