NEET-PG 2024 Practice Questions

Q: What is the pressure required to open the device shown in the image?

30–40 cm H₂O. ***30–40 cm H₂O*** - This pressure range is generally required to open the **Pop-Off Valve** (Pressure Relief Valve) in an Ambu bag (Bag-Valve-Mask) to prevent **barotrauma** to the patient's lungs. - The Pop-Off Valve is a safety feature that vents excess pressure to minimize the risk of **pneumothorax** or other lung injuries during manual ventilation. *10–20 cm H₂O* - This pressure range is typically within the normal ventilatory pressure used for gently inflating the lungs, not specifically for opening the **safety valve**. - While it's a safe pressure for ventilation, it's usually too low to activate the **overpressure relief mechanism** of the Pop-Off Valve. *10–20 mm H₂O* - This unit of millimeters of water (mm H₂O) is incorrect for standard ventilatory pressure measurements in this context; centimeters of water (cm H₂O) is the standard. - Furthermore, the magnitude is too low to represent the pressure required to open a **safety release valve** on a BVM. *30–40 mm H₂O* - Similar to the previous option, the unit of **millimeters of water (mm H₂O)** is not the standard measurement for this type of pressure in respiratory care. - While the numeric value is appropriate for safety valve activation, the ** गलत इकाई ** (wrong unit) makes this option incorrect.

Q: In demographic transition analysis, what does the difference between birth rates and death rates represent when plotting demographic changes over time?

Natural increase. ***Natural increase*** - **Natural increase** is specifically defined as the difference between the **birth rate** and the **death rate** in a population. - When plotted over time in demographic transition models, this difference visually represents the **population growth** or decline due to births and deaths alone, excluding migration. *Birth rate* - The **birth rate** is the number of live births per 1,000 people in a given year. - It is only one component of the calculation for natural increase, not the difference itself. *Death rate* - The **death rate** is the number of deaths per 1,000 people in a given year. - It is another component used to calculate natural increase but does not represent the difference between the two rates. *Growth Rate* - The **growth rate** of a population usually includes the effects of both **natural increase** (births minus deaths) and **net migration** (immigration minus emigration). - While natural increase contributes to the overall growth rate, it specifically refers to the growth stemming only from births and deaths, without considering migration.

Q: A 35-year-old male from a rural village in South Asia is admitted to the hospital with a 5-day history of high-grade fever, severe headache, and progressive breathlessness. His family reports that he has become increasingly disoriented over the past 48 hours, with episodes of confusion and drowsiness. Upon examination, the patient is febrile with a temperature of 39°C (102.2°F), tachypneic with a respiratory rate of 30 breaths per minute, and is displaying signs of altered mental status, including lethargy and difficulty following commands. His oxygen saturation is 92% on room air. There are no signs of a rash or bleeding. What is the diagnosis?

NIPAH. ***NIPAH*** - The combination of **rapidly progressive encephalitis** (disorientation, confusion, lethargy), **respiratory distress** (breathlessness, tachypnea, reduced O2 saturation), and **geographical context** (rural South Asia) strongly points towards NIPAH virus infection. - **Bats** (specifically fruit bats) are the natural reservoir for NIPAH virus, and exposure to bat secretions or contaminated food can lead to outbreaks, especially in rural areas where the image suggests bats are present. - The **distinctive combination of severe respiratory and neurological symptoms** with rapid progression is characteristic of NIPAH. *Ebola* - Ebola typically presents with **hemorrhagic fever**, characterized by severe bleeding (both internal and external), which is not described in the patient's symptoms. - While it causes high fever and altered mental status, the **prominent respiratory symptoms and lack of bleeding** make Ebola less likely. *Zika* - Zika virus infection is usually **mild or asymptomatic** and primarily transmitted by mosquitoes. - While encephalitis can occur in rare cases, the **severe respiratory distress and rapid progression of neurological symptoms** described are not typical for Zika. *Malaria* - Malaria is characterized by **cyclic fevers, chills, and sweats**, and can cause severe symptoms like cerebral malaria leading to altered mental status. - However, the patient's **pronounced respiratory symptoms and rapid onset of encephalitis without typical cyclic fever patterns** make malaria a less fitting diagnosis than NIPAH. *Japanese Encephalitis* - Japanese Encephalitis is endemic in South Asia and does cause **encephalitis with altered mental status**. - However, **prominent respiratory distress and breathlessness** are not typical features of Japanese Encephalitis, which primarily affects the central nervous system. - The **rapid progression with severe respiratory involvement** points more toward NIPAH than Japanese Encephalitis.

Q: A patient presents with features of heart failure. On examination, an irregularly irregular pulse is noted, and the patient has a loud diastolic sound. The jugular venous pressure (JVP) shows a rapid Y descent. What is the most likely diagnosis?

Mitral stenosis. ***Mitral stenosis*** - An **irregularly irregular pulse** suggests **atrial fibrillation**, a common complication of mitral stenosis due to left atrial enlargement. - A **loud diastolic sound**, also known as an **opening snap**, is characteristic of a stenotic mitral valve as it opens, occurring early in diastole. - The **rapid Y descent** on JVP can occur due to elevated right-sided pressures from pulmonary hypertension secondary to mitral stenosis. *Constrictive pericarditis* - While it can cause heart failure and an elevated JVP with a rapid Y descent (**Friedreich's sign**), the description of an "irregularly irregular pulse" and a "loud diastolic sound" (opening snap) is not typical. - The loud diastolic sound in constrictive pericarditis would be a **pericardial knock**, which is usually later than an opening snap and less distinct. *Cardiac tamponade* - Characterized by **Beck's triad** (hypotension, muffled heart sounds, elevated JVP) and often presents with **pulsus paradoxus**. - The JVP in tamponade typically shows an **absent or diminished Y descent**, due to impaired ventricular filling from external compression. *Aortic regurgitation* - Causes a **diastolic murmur**, but not a loud diastolic sound or opening snap. - The pulse is often a **collapsing pulse** or **water-hammer pulse**, and it is not typically irregularly irregular unless atrial fibrillation or another arrhythmia is co-existent. *Mitral regurgitation* - Can cause heart failure and atrial fibrillation, but the characteristic finding is a **pansystolic murmur**, not a loud diastolic sound. - There is no opening snap in mitral regurgitation; instead, there may be an **S3 gallop** in severe cases. - The rapid Y descent is less prominent compared to mitral stenosis.

Q: 274. A young athlete was found to have hypertrophic cardiomyopathy during testing for a competitive sport. Which of the following maneuvers will increase the murmur?

Valsalva maneuver. **Valsalva maneuver** - The **Valsalva maneuver** reduces **preload** by decreasing venous return to the heart. - A decrease in preload reduces the left ventricular chamber size, which in turn exacerbates the **left ventricular outflow tract (LVOT) obstruction** characteristic of hypertrophic cardiomyopathy (HCM), thereby **increasing the intensity of the murmur**. *Handgrip* - **Handgrip** is an isometric exercise that leads to an increase in **afterload** and **peripheral vascular resistance**. - Increased afterload causes the left ventricle to eject blood against higher pressure, which **enlarges the left ventricular chamber** and **reduces the LVOT obstruction**, thus **decreasing the intensity of the murmur** in HCM. *Squatting* - **Squatting** increases both **preload** (due to increased venous return) and **afterload** (due to increased peripheral vascular resistance). - The increased preload and afterload lead to an **increased left ventricular volume**, which **reduces the LVOT obstruction** and therefore **decreases the intensity of the murmur** in HCM. *Passive leg raise* - **Passive leg raise** increases **preload** by increasing venous return to the heart from the lower extremities. - The increased preload leads to an **increased left ventricular chamber size**, which **reduces the LVOT obstruction** and therefore **decreases the intensity of the murmur** in HCM. *Leaning forward* - Leaning forward during auscultation is typically used to better hear **aortic regurgitation murmurs**, as it brings the aorta closer to the chest wall. - This maneuver does not significantly alter **cardiac preload or afterload** in a way that would consistently increase the murmur of hypertrophic cardiomyopathy.

Q: Match the following A. Atrial fibrillation B. Atrial flutter C. PSVT D. Ventricular tachycardia

A-2, B-1, C-3, D-4. ***A-2, B-1, C-3, D-4*** - Image 2 shows irregularly irregular QRS complexes with no discernible P waves, which is characteristic of **atrial fibrillation**. - Image 1 shows a "sawtooth" pattern of atrial activity, indicative of **atrial flutter**. - Image 3 displays a narrow complex tachycardia with a very regular rhythm, consistent with **PSVT**. - Image 4 demonstrates wide, regular QRS complexes without clear P waves, which is the hallmark of **ventricular tachycardia**. *A-1, B-2, C-3, D-4* - This option incorrectly matches atrial fibrillation with the "sawtooth" pattern (image 1) and atrial flutter with the irregularly irregular rhythm (image 2). - Atrial fibrillation is characterized by the absence of discrete P waves and irregular ventricular response (image 2), while atrial flutter shows organized atrial activity with a "sawtooth" pattern (image 1). *A-1, B-2, C-4, D-3* - This option misidentifies image 1 as atrial fibrillation and image 2 as atrial flutter, which are reversed. - It also incorrectly matches PSVT with image 4 (ventricular tachycardia) and ventricular tachycardia with image 3 (PSVT). *A-2, B-1, C-4, D-3* - This option correctly identifies atrial fibrillation (A-2) and atrial flutter (B-1), but incorrectly swaps the ventricular and supraventricular tachycardias. - Image 3 shows narrow complex tachycardia (PSVT), not the wide complex pattern of ventricular tachycardia seen in image 4. *A-4, B-3, C-2, D-1* - This option incorrectly matches all the rhythms to the wrong images, demonstrating a fundamental misunderstanding of their characteristic ECG features. - For example, it matches atrial fibrillation to image 4 (ventricular tachycardia) and ventricular tachycardia to image 1 (atrial flutter).

Q: A 45-year-old male presents to the emergency department following a motor vehicle accident. He complains of severe chest pain and difficulty breathing. On examination, he appears distressed, with a respiratory rate of 28 breaths per minute. His oxygen saturation is 88% on room air. There is visible bruising on the chest, X-ray is done which is shown below. Which of the following is seen in this patient?

Bronchial breathing. ***Bronchial breathing*** - The provided image is a chest X-ray. The question describes a patient with severe chest pain, difficulty breathing, hypoxemia, and visible chest bruising after a motor vehicle accident, which suggests **pulmonary contusion** or **pneumonia**. - In such conditions, **bronchial breathing** might be heard on auscultation due to consolidation or compression of lung tissue. The X-ray shows diffuse infiltrates or opacities indicative of lung injury, making bronchial breathing a plausible physical exam finding. *Kussmaul breathing* - This is a pattern of **deep and labored breathing** associated with severe **metabolic acidosis**, particularly diabetic ketoacidosis. - While the patient is in distress, the chest X-ray and accident history point to acute respiratory injury rather than metabolic acidosis as the primary cause. *Paradisical breathing* - This term is **not a recognized medical breathing pattern**. It appears to be a distracter. - Medical terminology for breathing patterns includes terms like Kussmaul, Cheyne-Stokes, Biot's, etc. *Apneustic breathing* - Characterized by **prolonged inspiratory pauses** followed by short exhalations, indicating severe damage to the **pons (brainstem)**. - This breathing pattern is typically seen with neurological insults like stroke or severe head injury, which is not directly indicated by the information given, although a head injury could theoretically occur in a MVC, it's not the primary finding for the presented complaints and X-ray.

Q: A patient presents with genital grouped vesicles, as shown in the image. What is the most likely causative organism?

Herpes simplex virus. ***Herpes*** - The image shows **grouped vesicles** on an erythematous base, which is the classic presentation of **genital herpes** caused by the **Herpes simplex virus (HSV)**. - These lesions are typically painful and can recur, indicating a viral etiology. *Haemophilus* - *Haemophilus ducreyi* causes **chancroid**, which presents as **painful genital ulcers** with ragged borders and often associated with inguinal lymphadenopathy. - It does not present as grouped vesicles. *Klebsiella* - *Klebsiella granulomatis* causes **donovanosis (granuloma inguinale)**, characterized by progressive, **painless ulcerative lesions** that are highly vascular and bleed easily. - This organism does not cause vesicular lesions. *Treponema* - *Treponema pallidum* causes **syphilis**, which in its primary stage presents as a **painless chancre** (a solitary ulcer) or in secondary stage as a diffuse rash. - It does not cause grouped vesicles.

Q: Based on the educational diagram showing different degrees of perineal tears, which degree involves only the perineal skin and vaginal mucosa without affecting the underlying muscle?

1st degree. ***1st degree*** - Involves only the **perineal skin** and **vaginal mucosa** without affecting underlying muscle tissue. - The **pelvic floor muscles (PFM)** remain completely intact, making this the most superficial type of perineal tear. *2nd degree* - Extends deeper to involve the **perineal muscles** including the pelvic floor muscles, but spares the anal sphincter. - Requires **muscle repair** in addition to skin closure, making it more complex than 1st degree tears. *3rd degree* - Involves the **anal sphincter complex** (external and/or internal anal sphincter) extending toward the anus. - Requires specialized **sphincter reconstruction** to prevent future fecal incontinence complications. *4th degree* - The most severe tear extending through the **anal sphincter** and into the **rectal mucosa**. - Requires **multilayer repair** including rectal mucosa, sphincter complex, and perineal tissues to restore anatomy.

Q: A patient presents with an umbilical mass, which was previously reducible but has now become irreducible with discharge coming out, as shown in the image. What is the most appropriate management?

Umbilical excision with mesh hernioplasty. ***Umbilical excision with mesh hernioplasty*** - The presence of an **irreducible umbilical mass with discharge** indicates a complicated umbilical hernia, likely with **incarceration, strangulation, or infection**. - Management requires **excision of compromised tissue** (umbilicus and surrounding necrotic/infected skin) followed by **hernia defect repair**. - **Mesh hernioplasty** provides strong, durable reinforcement and prevents recurrence. - **Note:** In heavily contaminated fields, primary tissue repair or biologic mesh may be preferred over synthetic mesh, or staged repair may be considered. However, if contamination is minimal after debridement, mesh repair can be performed in the same setting. *Umbilical excision* - While **excision of the compromised umbilical skin and necrotic tissue** is necessary due to the discharge (suggesting infection or necrosis), **excision alone does not address the underlying hernia defect**. - Simply excising the umbilicus without repairing the hernia would lead to **persistent hernia or recurrence**. *Mesh hernioplasty* - A mesh hernioplasty alone is appropriate for **uncomplicated, reducible umbilical hernias** to reinforce the abdominal wall. - However, it **does not account for the irreducibility and skin changes/discharge**, which necessitate **excision of potentially infected or necrotic tissue** first. - Placing mesh without addressing the compromised tissue would risk ongoing infection and mesh complications. *Conservative* - **Conservative management** is reserved for **asymptomatic, reducible umbilical hernias** in adults (especially if small) or for infants where spontaneous closure can occur. - An **irreducible mass with discharge** signifies an **acute surgical emergency** (incarceration, strangulation, or infection) requiring **urgent surgical intervention**, not observation.

Question 1

What is the pressure required to open the device shown in the image?

Accepted Answer

30–40 cm H₂O

Answer

10–20 cm H₂O

Answer

10–20 mm H₂O

Answer

30–40 mm H₂O

Question 2

In demographic transition analysis, what does the difference between birth rates and death rates represent when plotting demographic changes over time?

Accepted Answer

Natural increase

Answer

Birth rate

Answer

Death rate

Answer

Growth Rate

Question 3

A 35-year-old male from a rural village in South Asia is admitted to the hospital with a 5-day history of high-grade fever, severe headache, and progressive breathlessness. His family reports that he has become increasingly disoriented over the past 48 hours, with episodes of confusion and drowsiness. Upon examination, the patient is febrile with a temperature of 39°C (102.2°F), tachypneic with a respiratory rate of 30 breaths per minute, and is displaying signs of altered mental status, including lethargy and difficulty following commands. His oxygen saturation is 92% on room air. There are no signs of a rash or bleeding. What is the diagnosis?

Accepted Answer

NIPAH

Answer

Ebola

Answer

Zika

Answer

Malaria

Answer

Japanese Encephalitis

Question 4

A patient presents with features of heart failure. On examination, an irregularly irregular pulse is noted, and the patient has a loud diastolic sound. The jugular venous pressure (JVP) shows a rapid Y descent. What is the most likely diagnosis?

Accepted Answer

Mitral stenosis

Answer

Constrictive pericarditis

Answer

Cardiac tamponade

Answer

Aortic regurgitation

Answer

Mitral regurgitation

Question 5

274. A young athlete was found to have hypertrophic cardiomyopathy during testing for a competitive sport. Which of the following maneuvers will increase the murmur?

Accepted Answer

Valsalva maneuver

Answer

Handgrip

Answer

Squatting

Answer

Leaning forward

Answer

Passive leg raise

Question 6

Match the following
A. Atrial fibrillation
B. Atrial flutter
C. PSVT
D. Ventricular tachycardia

Accepted Answer

A-2, B-1, C-3, D-4

Answer

A-1, B-2, C-3, D-4

Answer

A-1, B-2, C-4, D-3

Answer

A-4, B-3, C-2, D-1

Answer

A-2, B-1, C-4, D-3

Question 7

A 45-year-old male presents to the emergency department following a motor vehicle accident. He complains of severe chest pain and difficulty breathing. On examination, he appears distressed, with a respiratory rate of 28 breaths per minute. His oxygen saturation is 88% on room air. There is visible bruising on the chest, X-ray is done which is shown below. Which of the following is seen in this patient?

Accepted Answer

Bronchial breathing

Answer

Kussmaul breathing

Answer

Paradisical breathing

Answer

Apneustic breathing

Question 8

A patient presents with genital grouped vesicles, as shown in the image. What is the most likely causative organism?

Accepted Answer

Herpes simplex virus

Answer

Haemophilus

Answer

Klebsiella

Answer

Treponema

Question 9

Based on the educational diagram showing different degrees of perineal tears, which degree involves only the perineal skin and vaginal mucosa without affecting the underlying muscle?

Accepted Answer

1st degree

Answer

2nd degree

Answer

3rd degree

Answer

4th degree

Question 10

A patient presents with an umbilical mass, which was previously reducible but has now become irreducible with discharge coming out, as shown in the image. What is the most appropriate management?

Accepted Answer

Umbilical excision with mesh hernioplasty

Answer

Umbilical excision

Answer

Mesh hernioplasty

Answer

Conservative

NEET-PG 2024

Anesthesiology

Community Medicine

Internal Medicine

Microbiology

Obstetrics and Gynecology

Surgery