NEET-PG 2024 Practice Questions

Q: Identify the arrow marked nerve

Lateral pectoral nerve. ***Lateral pectoral nerve*** - The arrow points to a nerve originating from the **lateral cord of the brachial plexus**, traveling laterally to innervate the **pectoralis major muscle**. - Its position, lateral to the medial pectoral nerve and supplying the pectoralis major, confirms it as the lateral pectoral nerve. *Medial pectoral nerve* - The medial pectoral nerve typically arises from the **medial cord of the brachial plexus** and passes through both **pectoralis major** and **pectoralis minor**. - It lies more medially and generally pierces the pectoralis minor, unlike the nerve indicated. *Long thoracic nerve* - The long thoracic nerve innervates the **serratus anterior muscle** and runs along the lateral aspect of the chest wall. - Its course is distal and distinct from the nerve shown, which is clearly positioned in the pectoral region. *Thoracodorsal nerve* - The thoracodorsal nerve innervates the **latissimus dorsi muscle** and descends on the posterior axillary wall. - It is not located in the shown pectoral region and has a different trajectory. *Nerve to subclavius* - The nerve to subclavius arises from the **upper trunk of the brachial plexus** (C5-C6) and descends to innervate the **subclavius muscle**. - It has a more superior course compared to the lateral pectoral nerve and is not visible in the position indicated by the arrow.

Q: A female patient presents with mild conductive hearing loss (CHL) and tinnitus. Based on the pure tone audiometry (PTA) shown in the image, what is the most likely diagnosis?

Otosclerosis. ***Otosclerosis*** - The audiogram shows a **conductive hearing loss** with a notable **Carhart notch** (bone conduction dip at 2000 Hz), which is characteristic of otosclerosis. - The patient's symptoms of **mild CHL** and **tinnitus** are consistent with the presentation of otosclerosis, a condition involving abnormal bone growth in the middle ear. *Ménière's disease* - This condition primarily causes **sensorineural hearing loss**, often fluctuating and affecting low frequencies initially, along with **vertigo, tinnitus, and aural fullness**. - The audiogram indicates **conductive hearing loss**, not sensorineural, and **vertigo** is not mentioned as a primary symptom. *Ototoxicity* - Ototoxicity typically results in **sensorineural hearing loss**, often bilateral and affecting high frequencies first. - The audiogram demonstrates **conductive hearing loss**, and there is no information about exposure to ototoxic medications. *Noise-Induced Hearing Loss (NIHL)* - NIHL is characterized by **sensorineural hearing loss**, typically with a **notch at 3000-6000 Hz** (most commonly 4000 Hz notch) on the audiogram. - The audiogram reflects **conductive hearing loss**, and the specific pattern does not match that of NIHL.

Q: A suspicious stain was treated with glacial acetic acid and heated. Examination shows the following crystalline finding. Which confirmatory test is being depicted?

Teichman test. ***Teichman test*** - The Teichman test involves treating bloodstains with **glacial acetic acid** and **heat** to form **hemin crystals**, which are characteristic rhombic crystals of hematin hydrochloride. - This test is a **confirmatory test** for the presence of blood, distinguished by its specific crystalline structure under magnification. *Barberios test* - The Barberio's test is used to detect **spermine**, a component of seminal fluid, not blood. - It involves the formation of yellow, needle-like crystals of **spermine picrate** when treated with picric acid. *Florence test* - The Florence test is another presumptive test for the presence of **spermine** in seminal fluid. - It produces dark brown, rhomboid crystals of **choline periodide** when Lugol's iodine solution is added. *Takayama test* - The Takayama test is a **confirmatory test for blood** that forms characteristic **hemochromogen crystals**. - This test uses a solution containing pyridine, glucose, and dilute sodium hydroxide, which, when heated, forms **pink feathery crystals**, differentiating it from the Teichman test's rhombic crystals.

Q: Based on the image provided, identify the range of fire.

Close range. ***Close range*** - The image clearly shows **tattooing** (unburnt gunpowder particles embedded in the skin) and **scorching/singeing** around the wound entrance, which are pathognomonic features of close-range gunshot wounds. - Close-range wounds occur when the firearm is discharged from **6 inches to 2 feet** away, allowing hot gases and powder particles to reach the skin but without creating a muzzle imprint. *Distant range* - Distant range wounds (beyond 2-3 feet) show **no tattooing or scorching** as the gunpowder particles lose velocity and hot gases cool down before reaching the target. - The wound would appear as a simple **punched-out hole** without surrounding debris, which is clearly not the case in this image. *Contact* - Contact wounds are characterized by a **muzzle imprint**, **star-shaped laceration** from gas expansion, and **absence of surface tattooing** as all residue enters the wound tract. - The image lacks the typical **cruciate tears** and **cherry-red discoloration** from carbon monoxide that are seen in contact wounds. *Cannot be predicted* - The visible **tattooing pattern** and **scorching** provide clear forensic evidence that allows definitive range determination according to **Reddy's Forensic Medicine** principles. - The combination of these specific findings makes range assessment not only possible but straightforward, contradicting the notion that it cannot be predicted.

Q: An adult man presents with the clinical condition shown in the image, and a Gram stain reveals Gram-negative diplococci. What is the most appropriate treatment?

Ceftriaxone. ***Ceftriaxone*** - The image shows **urethritis** (discharge from the urethra), and the Gram stain revealing **Gram-negative diplococci** is characteristic of **Neisseria gonorrhoeae**. - **Ceftriaxone** is the recommended first-line treatment for **gonorrhea**, often administered as a single intramuscular dose. *Azithromycin* - While often co-administered with ceftriaxone to cover potential **Chlamydia coinfection**, it is not the primary treatment for gonorrhea alone. - Azithromycin is the main treatment for uncomplicated **Chlamydia trachomatis** infections. *Doxycycline* - **Doxycycline** is a highly effective antibiotic for treating **Chlamydia trachomatis** infections and certain other bacterial STIs. - It is not the primary treatment for **gonorrhea** due to resistance concerns and preferred efficacy of cephalosporins. *Acyclovir* - **Acyclovir** is an antiviral medication used to treat infections caused by the **herpes simplex virus (HSV)**. - It has no activity against **bacterial infections** like gonorrhea, making it inappropriate for this presentation.

Q: A female presents with dysuria and vaginal discharge. Wet mount examination shows pear-shaped organisms. What is the most likely diagnosis?

Trichomonas. ***Trichomonas*** - The presence of **dysuria**, **vaginal discharge**, and **pear-shaped organisms** on wet mount examination is classic for **Trichomonas vaginalis** infection. - **Microscopic identification of motile trichomonads** confirms the diagnosis. *Candida* - **Candida** infections typically present with **thick, white, curd-like vaginal discharge**, and a wet mount would show **yeast buds or pseudohyphae**, not pear-shaped organisms. - While it can cause dysuria, the discharge characteristics and microscopy findings differentiate it. *Chlamydia* - **Chlamydia trachomatis** causes **mucopurulent cervicitis** with dysuria and vaginal discharge, but requires **specific diagnostic tests** such as **NAAT (nucleic acid amplification test)** or cell culture for diagnosis. - Wet mount examination would **not show pear-shaped organisms**; instead, it may show increased white blood cells but no specific pathogen visualization. *Bacterial vaginosis* - **Bacterial vaginosis** is characterized by a **thin, gray discharge** and a **"fishy" odor**, which is especially noticeable after intercourse. - Wet mount shows **clue cells** (vaginal epithelial cells studded with bacteria), not pear-shaped organisms, and **absent or few white blood cells**.

Q: A 18-year-old boy presents with tenderness, warmth over the bone, and fever, ESR and CRP levels. The radiograph is shown below. What is the most likely diagnosis?

Osteomyelitis. ***Osteomyelitis*** - The clinical presentation of **fever, localized tenderness, and warmth** with elevated **ESR and CRP** levels in an 18-year-old is highly suggestive of **osteomyelitis**, an infection of the bone. - Radiographs in acute osteomyelitis may show soft tissue swelling, periosteal reaction, and areas of **bone destruction**, which can be subtle early in the infection. *Ewing's sarcoma* - This typically presents with local pain and swelling, and can also cause fever and elevated inflammatory markers. - However, characteristic radiographic findings such as an **"onion skin" periosteal reaction** or a **"moth-eaten" appearance** are not clearly visible here. *Osteosarcoma* - This is a primary malignant bone tumor often seen in adolescents, presenting with localized pain and swelling. - Radiographic features typically include a **Codman triangle**, **sunburst appearance**, or a **mixed lytic and blastic lesion**, which are not seen in this image. *Giant cell tumor* - Usually occurs in **young adults (20-40 years old)**, not typically in an 18-year-old, and presents with pain and swelling around the joint. - Radiographically, it is characterized by an **eccentric lytic lesion** in the **epiphysis or metaphysis** of long bones, often described as a **"soap bubble" appearance**, which is not depicted here.

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? ![img-31.jpeg](img-31.jpeg)

Clear Cell Carcinoma. ***Clear Cell Carcinoma*** - The image displays cells with **clear cytoplasm** due to the accumulation of lipids and glycogen, a classic histological feature of **Clear Cell Renal Cell Carcinoma** [1]. - These cells often have **small, round nuclei** and are arranged in nests or cords, supported by a rich vascular network, which aligns with the image provided [1]. *Papillary Cell Carcinoma* - This subtype is characterized by cells arranged in **papillary structures** with fibrovascular cores, which is not clearly evident in the image [1]. - The cells typically have **basophilic cytoplasm** and generally do not exhibit the extensive clear cytoplasm seen here. *Chromophobe Renal Cell Carcinoma (RCC)* - Chromophobe RCC is characterized by cells with **pale, flocculent cytoplasm** and prominent cell membranes, often appearing like a "plant cell" pattern [1]. - The nuclei are typically irregular and often contain perinuclear halos, which are not the predominant features in the provided image [1]. *Bellini Duct Carcinoma* - Also known as collecting duct carcinoma, this is a rare and aggressive subtype originating from the medullary collecting ducts. - Histologically, it features a **tubulointerstitial growth pattern**, often with an infiltrative appearance and significant desmoplasia, distinctly different from the clear cell morphology shown. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 958-961.

Question 1

Identify the arrow marked nerve

Accepted Answer

Lateral pectoral nerve

Answer

Medial pectoral nerve

Answer

Long thoracic nerve

Answer

Thoracodorsal nerve

Answer

Nerve to subclavius

Question 2

Identify the labeled structures correctly in the axial CT image of the thorax

Accepted Answer

A - Ascending aorta, B - Pulmonary trunk, C - Superior vena cava, D - Descending aorta

Answer

A - Pulmonary trunk, B - Ascending aorta, C - Superior vena cava, D - Descending aorta

Answer

A - Superior vena cava, B - Pulmonary trunk, C - Ascending aorta, D - Descending aorta

Answer

A - Ascending aorta, B - Superior vena cava, C - Pulmonary trunk, D - Descending aorta

Answer

A - Pulmonary trunk, B - Superior vena cava, C - Ascending aorta, D - Descending aorta

Question 3

A female patient presents with mild conductive hearing loss (CHL) and tinnitus. Based on the pure tone audiometry (PTA) shown in the image, what is the most likely diagnosis?

Accepted Answer

Otosclerosis

Answer

Ménière's disease

Answer

Ototoxicity

Answer

Noise-Induced Hearing Loss (NIHL)

Question 4

A suspicious stain was treated with glacial acetic acid and heated. Examination shows the following crystalline finding. Which confirmatory test is being depicted?

Accepted Answer

Teichman test

Answer

Barberio's test

Answer

Florence test

Answer

Takayama test

Question 5

Based on the image provided, identify the range of fire.

Accepted Answer

Close range

Answer

Distant range

Answer

Contact

Answer

Cannot be predicted

Question 6

An adult man presents with the clinical condition shown in the image, and a Gram stain reveals Gram-negative diplococci. What is the most appropriate treatment?

Accepted Answer

Ceftriaxone

Answer

Azithromycin

Answer

Doxycycline

Answer

Acyclovir

Question 7

A female presents with dysuria and vaginal discharge. Wet mount examination shows pear-shaped organisms. What is the most likely diagnosis?

Accepted Answer

Trichomonas

Answer

Candida

Answer

Chlamydia

Answer

Bacterial vaginosis

Question 8

A 18-year-old boy presents with tenderness, warmth over the bone, and fever, ESR and CRP levels. The radiograph is shown below. What is the most likely diagnosis?

Accepted Answer

Osteomyelitis

Answer

Ewing's sarcoma

Answer

Osteosarcoma

Answer

Giant cell tumor

Question 9

A patient presents with a renal mass leading to hematuria and flank pain. The histological image below is shown. What is the likely diagnosis?
![img-31.jpeg](img-31.jpeg)

Accepted Answer

Clear Cell Carcinoma

Answer

Papillary Cell Carcinoma

Answer

Chromophobe Renal Cell Carcinoma (RCC)

Answer

Bellini Duct Carcinoma

Question 10

A 40-year-old female presents with an irregular 5 × 6 cm mass in the right breast. Histopathological examination reveals the image shown. What is the most likely diagnosis?

Accepted Answer

Phyllodes tumor

Answer

Fibroadenoma

Answer

Invasive ductal carcinoma

Answer

Intraductal papilloma

NEET-PG 2024

Anatomy

ENT

Forensic Medicine

Internal Medicine

Microbiology

Orthopaedics

Pathology