NEET-PG 2024 Practice Questions

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: What is the method of delivery for fetuses $A$ and $B$ as shown in the image

LSCS in both. ***LSCS in both*** - Fetus A is in a **breech presentation**, which is an indication for cesarean section in twin pregnancy, especially when it is the first (presenting) twin. - Once the decision is made to perform a **cesarean section (LSCS)** for fetus A, **both twins must be delivered through the same cesarean incision** during the same operative procedure. - It is **not possible or safe** to deliver one twin by cesarean section and then attempt vaginal delivery for the second twin. Once the uterine incision is made, both babies are delivered through that incision. - This is the standard obstetric practice for twin deliveries requiring cesarean section. *LSCS, vaginal* - This option is **medically incorrect** and represents a misunderstanding of cesarean delivery principles. - Once a cesarean section is initiated for twin A, **both twins are delivered through the uterine incision** during the same surgery. - There is no scenario where one twin is delivered by cesarean and the other vaginally in the same delivery episode - this would be unsafe and is not practiced. *Vaginal, LSCS* - This is incorrect because fetus A (the presenting/first twin) is in **breech presentation**, which typically contraindicates vaginal delivery as the first twin. - In twin pregnancies, when the first twin is breech, **cesarean section is generally recommended** to avoid complications such as head entrapment or cord prolapse. - The mode of delivery for the first twin determines the approach, and a breech first twin usually necessitates cesarean delivery for both. *Induce delivery in both* - Induction of labor aims to initiate contractions but does not address the **breech presentation of fetus A**. - With fetus A in breech presentation, induction would still lead to the need for cesarean section due to the unfavorable presentation of the first twin. - Induction is not an appropriate management strategy when the presenting twin is breech in twin pregnancy.

Q: A G2P1L1 woman with a history of previous cesarean section presents with complications related to the placenta. The image below shows the gross appearance of the uterus. What is the most likely diagnosis?

Placenta accreta. ***Placenta accreta*** - A previous **cesarean section** is a strong risk factor for placenta accreta, as it can lead to scarring and defects in the uterine wall, allowing the placenta to implant too deeply. - The image suggests a placenta that is **firmly adhered and possibly invasive** into the uterine wall, making separation difficult, which is characteristic of accreta due to the absence of a proper decidual layer. *Uterine inversion* - This condition involves the **fundus of the uterus collapsing inward** or turning inside out, which is a clinical event during postpartum and not a morphological feature visible in a resected specimen like this. - The image shows an attached placenta within a uterine specimen, not an inverted uterus. *Placental abruption* - Placental abruption is the **premature separation of the placenta** from the uterine wall before delivery, often leading to retroplacental hemorrhage. - While it's a serious complication, the image does not show evidence of a separated placenta or a large retroplacental clot; instead, it depicts an abnormally adherent placenta. *Placenta previa* - Placenta previa occurs when the **placenta implants over the cervical os**, which would be diagnosed prenatally based on its location in the uterus. - The image does not provide information about the placental location relative to the cervix, but rather illustrates the manner of placental attachment.

Q: Identify the instrument shown in the image below: ![img-52.jpeg](img-52.jpeg)

Wrigley. ***Wrigley*** - The image depicts short-bladed forceps with a pelvic curve that is characteristic of Wrigley's forceps. - Wrigley's forceps are designed for **outlet or low-cavity forceps deliveries** where the fetal head is already visible or very low in the birth canal. *Kielland* - Kielland forceps have a very slight pelvic curve or are straight, and they lack a cephalic curve, which is distinct from the instrument shown. - They are primarily used for **rotational deliveries** and can be applied to the fetal head in various positions. *Pipers* - Piper's forceps have very long, curved shanks and are specifically designed for **delivery of the after-coming head in breech presentations**. - The instrument in the image does not show the characteristic long shanks of Piper's forceps. *Simpson* - Simpson's forceps have a prominent **pelvic curve** and a **cephalic curve** with blades that are longer than those depicted in the image. - They are commonly used for **mid-cavity deliveries** when rotation is not the primary concern.

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 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: Identify the condition shown in the given X-ray: ![img-63.jpeg](img-63.jpeg)

Osgood-Schlatter disease. ***Osgood-Schlatter disease*** - The X-ray shows fragmentation and irregularity of the **tibial tuberosity**, which is characteristic of Osgood-Schlatter disease. - This condition typically affects adolescents undergoing rapid growth spurts and presents with **pain and swelling** at the tibial tuberosity. *Tibial tuberosity fracture* - This usually involves a **clear fracture line** and displacement of the tibial tuberosity. - It is typically caused by a **sudden, forceful contraction** of the quadriceps muscle. *Lateral epicondyle of femur* - The X-ray shows changes at the **tibial tuberosity**, not the lateral epicondyle of the femur. - The lateral epicondyle is located at the **distal end of the femur**, near the knee joint. *Gerdy's tubercle fracture* - Gerdy's tubercle is the insertion point of the **iliotibial band** on the lateral aspect of the proximal tibia. - Fractures here are **rare** and would present differently on X-ray compared to the observed tibial tuberosity changes.

Q: A 34-year-old female presented with low hemoglobin, platelet count of 25,000 / mm³, raised PT and APTT. The image shows a peripheral smear. Which of the following fusion genes is affected?

PML-RARA. ***PML-RARA*** - The image shows **promyelocytes** with prominent granules and **Auer rods** (indicated by the arrow), which are characteristic of Acute Promyelocytic Leukemia (APL). [1] - APL is strongly associated with the **t(15;17)** translocation, leading to the **PML-RARA** fusion gene. The patient’s clinical presentation of pancytopenia (low hemoglobin, low platelet count) and prolonged PT/APTT leading to **DIC**, is highly consistent with APL. [1] *RUNX1-RUNX1T1* - This fusion gene is associated with **Acute Myeloid Leukemia (AML) M2** (AML with maturation), often due to t(8;21) translocation. [1] - While it is a type of AML, the peripheral smear and clinical features are more specific to APL, not AML M2. *INV 16* - Inversion 16, denoted as **inv(16)(p13q22)**, is associated with an AML subtype that typically presents with **myelomonocytic differentiation** and **abnormal eosinophils** in the bone marrow. [1] - The image and clinical findings do not suggest myelomonocytic morphology or the presence of abnormal eosinophils, making APL a more likely diagnosis. *IGH-NSD2* - This fusion gene is characteristic of **Multiple Myeloma**, a plasma cell malignancy. - Multiple myeloma would present with plasma cell proliferation, bone lesions, and hypercalcemia, which differ significantly from the acute leukemia presentation seen here. **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. 620-622.

Question 1

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 2

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 3

What is the method of delivery for fetuses $A$ and $B$ as shown in the image

Accepted Answer

LSCS in both

Answer

LSCS, vaginal

Answer

Induce delivery in both

Answer

Vaginal, LSCS

Question 4

A G2P1L1 woman with a history of previous cesarean section presents with complications related to the placenta. The image below shows the gross appearance of the uterus. What is the most likely diagnosis?

Accepted Answer

Placenta accreta

Answer

Uterine inversion

Answer

Placental abruption

Answer

Placenta previa

Question 5

Identify the instrument shown in the image below:
![img-52.jpeg](img-52.jpeg)

Accepted Answer

Wrigley

Answer

Kielland

Answer

Pipers

Answer

Simpson

Question 6

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 7

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 8

Identify the condition shown in the given X-ray:
![img-63.jpeg](img-63.jpeg)

Accepted Answer

Osgood-Schlatter disease

Answer

Lateral epicondyle of femur

Answer

Tibial tuberosity fracture

Answer

Gerdy's tubercle fracture

Question 9

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

Question 10

A 34-year-old female presented with low hemoglobin, platelet count of 25,000 / mm³, raised PT and APTT. The image shows a peripheral smear. Which of the following fusion genes is affected?

Accepted Answer

PML-RARA

Answer

RUNX1-RUNX1T1

Answer

INV 16

Answer

IGH-NSD2

NEET-PG 2024

Community Medicine

Internal Medicine

Obstetrics and Gynecology

Orthopaedics

Pathology