NEET-PG 2020 Practice Questions

Q: Remnants of Wolffian ducts in a female are found in

Broad ligament. ***Broad ligament*** - In females, remnants of the **Wolffian (mesonephric) ducts** can persist as structures such as the **epoophoron**, **paroophoron**, and **Gartner's duct cysts**, which are typically found within the broad ligament [1]. - The **broad ligament** is a fold of peritoneum that extends from the lateral walls of the uterus to the sidewalls of the pelvis, enclosing these developmental remnants. *Uterovesical pouch* - This is a peritoneal reflection between the **uterus and the bladder** and does not typically contain remnants of the Wolffian ducts. - It is a common site for fluid accumulation but not for developmental anomalies related to the mesonephric system. *Pouch of Douglas* - Also known as the **recto-uterine pouch**, this is the most dependent part of the peritoneal cavity in females, located between the **uterus and the rectum**. - While it can accumulate fluid or pathology, it is not where Wolffian duct remnants are primarily located. *Iliac fossa* - The **iliac fossa** contains structures like the **iliacus muscle**, **lymph nodes**, and parts of the bowel, but it is not the anatomical location for the remnants of the Wolffian ducts in females. - This region is more involved in supporting abdominal contents and housing major blood vessels and nerves rather than reproductive developmental remnants.

Q: Which of the following binds to Tyrosine Kinase receptor?

Insulin. ***Insulin*** - **Insulin** is a classic example of a hormone that binds to and activates a **tyrosine kinase receptor**, leading to a cascade of intracellular signaling events for glucose uptake and metabolism. - The **insulin receptor** is a heterodimeric protein with intrinsic tyrosine kinase activity that phosphorylates itself and other proteins upon insulin binding. *Glucagon* - **Glucagon** primarily acts on **G protein-coupled receptors (GPCRs)**, specifically the glucagon receptor, to increase cyclic AMP (cAMP) and activate protein kinase A. - Its main roles are to stimulate **glycogenolysis** and **gluconeogenesis** in the liver. *Prolactin* - **Prolactin** binds to a receptor that is a member of the **cytokine receptor superfamily**, which lacks intrinsic enzyme activity. - Upon ligand binding, these receptors associate with and activate **Janus kinases (JAKs)**, leading to the JAK-STAT signaling pathway. *Growth Hormone* - **Growth hormone (GH)** also binds to a receptor belonging to the **cytokine receptor superfamily** (similar to prolactin), which then associates with and activates **JAKs**. - This activation subsequently initiates the **JAK-STAT signaling pathway**, mediating its diverse growth-promoting and metabolic effects.

Q: A 35 year old male presenting with recurrent episodes of abdominal pain, jaundice and fatigue underwent MRCP (shown below). What is the most likely diagnosis?

Primary Sclerosing Cholangitis. ***Primary Sclerosing Cholangitis*** - The MRCP image showing **multiple strictures** and dilatations within the intrahepatic and extrahepatic bile ducts (often described as a **"beaded" appearance**), along with the patient's symptoms of recurrent abdominal pain, jaundice, and fatigue, are classic findings for Primary Sclerosing Cholangitis (PSC). - PSC is a chronic cholestatic liver disease, often associated with **inflammatory bowel disease (IBD)**, particularly ulcerative colitis, and more commonly affects young to middle-aged men. *Oriental Cholangitis* - This condition (also known as recurrent pyogenic cholangitis) is characterized by **intrahepatic bile duct stones** and recurrent bacterial cholangitis, particularly prevalent in East Asia. - While it involves strictures and dilations, the primary driver is often stones and infection, and the demographic and typical MRCP findings are different from the diffuse "beading" seen in PSC. *Primary Biliary Cirrhosis* - Primary Biliary Cirrhosis (PBC) primarily affects the **small intrahepatic bile ducts** and is an autoimmune disease mainly seen in middle-aged women. - While it causes chronic cholestasis and can lead to cirrhosis, the characteristic imaging findings on MRCP as seen here (large duct involvement with diffuse stricturing and beading) are not typical for PBC. *Caroli's Disease* - Caroli's disease is a rare congenital disorder characterized by **segmental cystic dilatation of the intrahepatic bile ducts**. - The imaging findings would show sac-like or cystic dilations of the bile ducts, which is distinct from the diffuse, multifocal strictures and beading pattern observed in the provided MRCP.

Q: A 30-year-old female complaints of fatigue and is unable to gain weight. On examination, her body felt warm. Which of the following investigation can be helpful in reaching the diagnosis?

Suppressed TSH with elevated thyroid hormone levels. Suppressed TSH with elevated thyroid hormone levels - The patient's symptoms of **fatigue** (despite being warm) and **difficulty gaining weight**, coupled with her body feeling **warm**, are classic signs of **hyperthyroidism**. [1] - In hyperthyroidism, the thyroid gland produces **excessive thyroid hormones (T3 and T4)**, which in turn **suppresses TSH** production from the pituitary gland through negative feedback. [2] *Elevated TSH with normal thyroid hormone levels* - This pattern is characteristic of **subclinical hypothyroidism**, where the thyroid gland is beginning to fail, leading to increased TSH to maintain normal thyroid hormone levels. [3] - The patient's symptoms of feeling warm and difficulty gaining weight are inconsistent with hypothyroidism. [1] *Elevated TSH with low thyroid hormone levels* - This indicates **primary hypothyroidism**, where the thyroid gland is underactive and produces insufficient thyroid hormones, leading to a compensatory rise in TSH. [2] - Hypothyroidism typically presents with **weight gain**, **cold intolerance**, and fatigue, which contradict the patient's presentation. [1] *Normal TSH with abnormal thyroid hormone levels* - This scenario usually suggests **central hypothyroidism** (pituitary or hypothalamic dysfunction affecting TSH production) or **thyroid hormone resistance**. [3] - While possible in some rare cases, it does not fit the typical clinical picture of hyperthyroidism presented by the patient's symptoms.

Q: Which of the following doesn't cause urethritis in males?

H. Ducreyi. ***H. Ducreyi*** - *Haemophilus ducreyi* is the causative agent of **chancroid**, a sexually transmitted infection characterized by painful **genital ulcers** and **lymphadenopathy**. - It does not primarily cause **urethritis**, which is inflammation of the urethra. *Trichomonas vaginalis* - **Trichomonas vaginalis** is a protozoan parasite that commonly causes **trichomoniasis**, a sexually transmitted infection. - In males, it can lead to **urethritis** with symptoms such as dysuria and urethral discharge. *Chlamydia trachomatis* - **Chlamydia trachomatis** is a very common bacterial cause of **urethritis** in males, often presenting with a **mucopurulent discharge** and dysuria. - It is frequently asymptomatic, making it a significant cause of undiagnosed sexually transmitted infections. *N. gonorrhoeae* - **Neisseria gonorrhoeae** is the bacterium responsible for **gonorrhea**, a well-known cause of **purulent urethritis** in males. - Symptoms typically include a profuse, **purulent urethral discharge** and painful urination.

Q: 26 yr lady with delayed cycles presents to the infertility clinic. After diagnosing her to be a case anovulation of 'Normogonadotropic Hypogonadism' type she was put on human menopausal gonadotropin (HMG) for ovulation induction from the second day of her menstrual period. She was 'Triggered' for follicular rupture with Human chorionic gonadotropin (hCG) and on the 19th day of this cycle she developed dyspnoea, reduced urine output, abdominal bloating and pain. What condition is this patient likely suffering from?

Ovarian hyperstimulation syndrome. ***Ovarian hyperstimulation syndrome*** - The patient's history of **ovulation induction** using **HMG** followed by an **hCG trigger** and subsequent symptoms of **dyspnea**, **reduced urine output**, **abdominal bloating**, and pain strongly indicate **ovarian hyperstimulation syndrome (OHSS)**. - **hCG** exacerbates OHSS by increasing vascular permeability, leading to fluid shifts into the third space and resulting in effusions (e.g., ascites, pleural effusion) and hemoconcentration. *Ruptured ectopic pregnancy* - While an **ectopic pregnancy** can cause abdominal pain, it typically presents with a **positive pregnancy test** and **vaginal bleeding**, which are not mentioned. - Dyspnea and reduced urine output are not typical initial symptoms of ruptured ectopic pregnancy; rather, **hypovolemic shock** would be expected. *Theca lutein cysts* - **Theca lutein cysts** are usually **asymptomatic** and benign, often resolving spontaneously. - Although associated with high **hCG levels**, they typically do not cause the acute, severe systemic symptoms like dyspnea and reduced urine output seen in this patient. *Ruptured corpus luteum cyst* - A **ruptured corpus luteum cyst** can cause sudden abdominal pain due to **hemoperitoneum**, but it usually does not lead to severe systemic symptoms like significant dyspnea or reduced urine output unless there is massive hemorrhage. - The clinical picture with **dyspnea** and **reduced urine output** points more towards systemic fluid shifts rather than localized bleeding alone.

Q: A 2-year-old child presented with the following x-ray finding. What is the most likely diagnosis?

Acute laryngotracheobronchitis. ***Acute laryngotracheobronchitis*** - The x-ray finding of a **steeple sign** (subglottic narrowing) is a classic radiographic feature of **croup**, also known as acute laryngotracheobronchitis. - Croup is characterized by a **barking cough**, hoarseness, and inspiratory stridor, primarily affecting the **larynx** and **trachea**. *Acute pharyngitis* - Acute pharyngitis is an **inflammation of the pharynx** and does not typically involve the subglottic region or cause the characteristic steeple sign on radiographs. - It presents with symptoms like **sore throat**, fever, and difficulty swallowing, without the prominent stridor or barking cough of croup. *Acute epiglottitis* - Acute epiglottitis, though a serious airway emergency, typically shows a **thumb sign** on a lateral neck x-ray due to a swollen epiglottis, not a steeple sign. - It presents with rapid onset of **high fever**, **dysphagia**, drooling, and muffled voice, often without a cough. *Parapharyngeal abscess* - A parapharyngeal abscess is a deep neck infection that would likely present with a **mass effect**, **displacement of airway structures**, and **soft tissue swelling** on imaging, not subglottic narrowing. - Symptoms include severe **sore throat**, **fever**, **trismus**, and neck swelling, with potential airway compromise from external compression.

Q: Pulmonary plethora in a child presenting with cyanosis, is seen in?

Total Anomalous Pulmonary Venous Connection (TAPVC). ***Total Anomalous Pulmonary Venous Connection (TAPVC)*** - In **non-obstructed TAPVC**, all pulmonary veins drain anomalously into the right atrium (or its tributaries) instead of the left atrium. - This causes **complete mixing of oxygenated pulmonary venous blood with deoxygenated systemic venous blood** in the right atrium → **cyanosis**. - Since an obligatory **atrial septal defect (ASD)** allows blood to reach the left heart, and there is **increased volume load on the right heart**, there is **increased pulmonary blood flow → pulmonary plethora** on chest X-ray. - Key point: **Obstructed TAPVC** causes pulmonary venous congestion and oligemia, NOT plethora. *Coarctation of the aorta* - **Coarctation of the aorta** is an **acyanotic** congenital heart disease involving systemic outflow obstruction. - It does **not cause cyanosis** unless there is differential cyanosis (lower body only) with a PDA and pulmonary hypertension causing right-to-left shunt. - Does not cause pulmonary plethora. *Tetralogy of Fallot (TOF)* - **Tetralogy of Fallot** presents with **cyanosis** due to right-to-left shunting through a VSD. - However, it has **pulmonary oligemia (decreased pulmonary blood flow)** due to right ventricular outflow tract obstruction and pulmonary stenosis. - Chest X-ray shows **boot-shaped heart** with decreased pulmonary vascular markings, NOT plethora. *Tricuspid Atresia (TA)* - **Tricuspid atresia** causes **cyanosis** due to obligatory right-to-left shunting at the atrial level. - Pulmonary blood flow is typically **decreased or normal** (depending on presence of VSD/PDA), NOT increased. - Does not typically cause pulmonary plethora.

Q: A boy after playing football complaining fatigue and abdominal pain. He also had a history of hand swelling in past. On ultrasonography, he has shrunken spleen. What is the likely diagnosis of this patient?

Sickle cell anemia. ### Sickle cell anemia - This patient's history of **hand swelling** (dactylitis), current **fatigue**, and **abdominal pain** are classic symptoms of sickle cell crises in **sickle cell anemia**. - The finding of a **shrunken spleen** on ultrasonography is consistent with **autosplenectomy**, a common complication of sickle cell disease due to repeated infarctions [1]. *Acute pancreatitis* - While acute pancreatitis can cause **severe abdominal pain**, it typically presents with elevated amylase/lipase, and does not explain the history of **hand swelling** or **shrunken spleen**. - There is no specific connection between playing football and developing acute pancreatitis in this context. *Iron deficiency anemia* - **Iron deficiency anemia** can cause **fatigue**, but it does not typically cause **abdominal pain**, **hand swelling**, or **autosplenectomy**. - A definitive diagnosis would require iron studies, which are not mentioned here. *Intermittent porphyria* - **Intermittent porphyria** can cause **abdominal pain** and neurological symptoms, but it does not manifest with **hand swelling** or **splenic atrophy**. - Its clinical presentation is distinctly different from the symptoms described.

Q: In which of the following conditions would the cortisol level be highest?

Normal person in the early morning. ***Normal person in the early morning*** - Cortisol secretion follows a **circadian rhythm**, with levels naturally peaking in the early morning (typically between 6-8 AM) to prepare the body for the day's activities. - This **diurnal variation** is a key physiological characteristic of cortisol, regulated by the **hypothalamic-pituitary-adrenal (HPA) axis**. *Normal person after receiving dexamethasone* - **Dexamethasone** is a potent synthetic glucocorticoid that **suppresses ACTH secretion** via negative feedback, leading to a significant **reduction in endogenous cortisol production**. - This is the principle behind the **dexamethasone suppression test**, used to diagnose Cushing's syndrome (failure of suppression). *Normal person in the late evening* - Cortisol levels are typically at their **lowest point** in the late evening (around midnight to early morning hours) as part of the normal **circadian rhythm**. - This nadir reflects the body's decreased need for metabolic and stress response hormones during rest. *Addison's disease* - **Addison's disease** is characterized by **primary adrenal insufficiency**, meaning the adrenal glands are unable to produce sufficient amounts of cortisol. - Patients with Addison's disease have **chronically low cortisol levels** due to glandular damage, often accompanied by high ACTH levels.

Question 1

Remnants of Wolffian ducts in a female are found in

Accepted Answer

Broad ligament

Answer

Uterovesical pouch

Answer

Pouch of Douglas

Answer

Iliac fossa

Question 2

Which of the following binds to Tyrosine Kinase receptor?

Accepted Answer

Insulin

Answer

Glucagon

Answer

Prolactin

Answer

Growth Hormone

Question 3

A 35 year old male presenting with recurrent episodes of abdominal pain, jaundice and fatigue underwent MRCP (shown below). What is the most likely diagnosis?

Accepted Answer

Primary Sclerosing Cholangitis

Answer

Oriental Cholangitis

Answer

Primary Biliary Cirrhosis

Answer

Carolis Disease

Question 4

A 30-year-old female complaints of fatigue and is unable to gain weight. On examination, her body felt warm. Which of the following investigation can be helpful in reaching the diagnosis?

Accepted Answer

Suppressed TSH with elevated thyroid hormone levels

Answer

Elevated TSH with normal thyroid hormone levels

Answer

Elevated TSH with low thyroid hormone levels

Answer

Normal TSH with abnormal thyroid hormone levels

Question 5

Which of the following doesn't cause urethritis in males?

Accepted Answer

H. Ducreyi

Answer

Trichomonas vaginalis

Answer

Chlamydia trachomatis

Answer

N. gonorrhoeae

Question 6

26 yr lady with delayed cycles presents to the infertility clinic. After diagnosing her to be a case anovulation of 'Normogonadotropic Hypogonadism' type she was put on human menopausal gonadotropin (HMG) for ovulation induction from the second day of her menstrual period. She was 'Triggered' for follicular rupture with Human chorionic gonadotropin (hCG) and on the 19th day of this cycle she developed dyspnoea, reduced urine output, abdominal bloating and pain. What condition is this patient likely suffering from?

Accepted Answer

Ovarian hyperstimulation syndrome

Answer

Ruptured ectopic pregnancy

Answer

Ruptured corpus luteum cyst

Answer

Theca lutein cysts

Question 7

A 2-year-old child presented with the following x-ray finding. What is the most likely diagnosis?

Accepted Answer

Acute laryngotracheobronchitis

Answer

Acute pharyngitis

Answer

Acute epiglottitis

Answer

Parapharyngeal abscess

Question 8

Pulmonary plethora in a child presenting with cyanosis, is seen in?

Accepted Answer

Total Anomalous Pulmonary Venous Connection (TAPVC)

Answer

Coarctation of the aorta

Answer

Tetralogy of Fallot (TOF)

Answer

Tricuspid Atresia (TA)

Question 9

A boy after playing football complaining fatigue and abdominal pain. He also had a history of hand swelling in past. On ultrasonography, he has shrunken spleen. What is the likely diagnosis of this patient?

Accepted Answer

Sickle cell anemia

Answer

Acute pancreatitis

Answer

Iron deficiency anemia

Answer

Intermittent porphyria

Question 10

In which of the following conditions would the cortisol level be highest?

Accepted Answer

Normal person in the early morning

Answer

Normal person after receiving dexamethasone

Answer

Normal person in the late evening

Answer

Addison's disease

NEET-PG 2020

Anatomy

Biochemistry

Internal Medicine

Microbiology

Obstetrics and Gynecology

Pediatrics

Physiology