NEET SS Medicine Most important MCQS 

Q1. You are counselling a 61-year-old woman with a 15-year history of type-2 diabetes mellitus. Her GP referred her due to persistent hyperkalaemia for the last 2 months. She has diabetic nephropathy, diabetic retinopathy, and diabetic neuropathy. In addition, she used to take over-the-counter NSAIDs for osteoarthritic joint pains. The reason for the referral is to manage her elevated potassium that did not normalise even after following a low potassium diet, stoppage of losartan, and avoidance of NSAIDs. Her current medications include insulin detemir, insulin glulisine, amlodipine, and aspirin. Clinical examination revealed a pulse of 80 beats per minute, a blood pressure of 136 /80 mmHg, and mild bilateral ankle oedema.Her most recent laboratory results show the following:

Investigation	Result
Creatinine	1.13 mg/dL
eGFR (using CKD-EPI)	64.3 mL/min/1.73m2
Sodium	138 mEq/L
Potassium	5.8 mEq/L
Blood PH (venous)	7.30
Blood HCO3 - (Venous)	24 mmol/L
Anion gap	9 mEq/L
Urine PH	5.6
Fasting glucose	162 mg/dL
HbA1c	8.2 %
Haemoglobin	14 g/dL
Cortisol level (9 a.m.)	16 micro g/L
Serum aldosterone (Supine)	2.16ng/ml
Plasma renin activity (PRA) (Supine)	37.9pg/ml/hr

What is the best course of treatment to be advised in this case ?

1. Calcium gluconate
2. Hydrochlorothiazide
3. Hydrocortisone

Ans. 3  - Hydrochlorothiazide

Q2. The 65-year-old male was admitted from the Emergency room with a two day history of sudden onset abnormal jerky movements involving the right arm. He had four previous admissions with hyperosmolar hyperglycaemic states in the last five years, with the most recent admission occurring two months ago. There is no prior history of seizures or abnormal jerks in the past.

He has a background history of Type 2 diabetes for 15 years, hypertension, hypercholesterolemia and chronic hepatitis B. His diabetes over the past five years has been uncontrolled due to noncompliance with drugs and poor motivation, despite repeated sessions with the clinical psychologist. His current medications include insulin, metformin, atorvastatin, perindopril, amlodipine, and lamivudine. Recently, his perindopril dose was increased to 8 mg from 4 mg. He is a non smoker and denies taking alcohol or illicit drugs.

On examination, his vital signs were stable. He was fully oriented and coherent. A neurological examination showed choreiform movements involving the right arm occurring at rest. The rest of his sensory, motor, cranial nerves and cerebellar examination was normal. His systemic examination was also unremarkable.

His blood test showed normal full blood counts, electrolytes, renal function, thyroid function, liver function and ECG. His random blood sugar on admission was 27, serum osmolality 308 mOsm/kg and HbA1c was 13%.

His MRI brain showed hyperintensity at the caudate nucleus on T1W1 and hypointensity on T2W and FLAIR images.

What is the likely underlying diagnosis?

1. Acute ischaemic stroke
2. Diabetic striatopathy
3. Hepatic encephalopathy
4. Hyperglycaemic hyperosmolar state

Ans. 2 - Diabetic striatopathy

Q3. A 32-year-old female presents with complaints of a recent cough and shortness of breath for the last 4 days. The patient suffers from intermittent urinary tract infections, which are managed with therapy as needed with nitrofurantoin. You suspect nitrofurantoin is the cause of her likely drug-induced pulmonary symptoms. Which of the following statements is accurate regarding acute nitrofurantoin-induced pulmonary complications?

1. The patient is more likely to have pulmonary vasculitis with eosinophilia
2. The pulmonary reaction seen in this patient is a less common pulmonary reaction associated with nitrofurantoin
3. The patient is more likely to have diffuse interstitial fibrosis
4. Treatment with corticosteroids has shown a benefit in recovery.

Ans. 1 - The patient is more likely to have pulmonary vasculitis with eosinophilia

Q4. A 27-year-old female with a history of asthma presents to the ER in severe respiratory distress. Her fiancé states that she has been intubated in the ICU twice. This episode started 30 minutes ago and they came straight to the ED after her rescue medications failed to help. Her vitals are currently BP 126/86 mmHg, RR 24/min and O₂ Saturation 84% on 100% O₂ via non-rebreather with continuous albuterol. While nursing staff prepare methylprednisolone, magnesium, and BIPAP, you determine intubation is likely necessary. Which of the following is the preferred induction agent for this patient?

1. Etomidate
2. Midazolam
3. Ketamine
4. Lorazepam

Ans. 3 - Ketamine

Q5. A 65-year-old female presents with 2 days of fatigue. She has a history of hypertension and reports compliance with home medications. The patient reports beginning a new exercise program 4 weeks ago that her grandson recommended to her. She reports taking oil of wintergreen to manage her muscle aches since increasing her activity level. Temperature is 99.5ºF, pulse is 99 bpm, RR is 26/min, BP is 148/86 mm of Hg, and SpO2 is 97% of room air. She has mild generalized abdominal tenderness on exams. Arterial blood gas is pH 7.31, PaCO2 28, PaO2 89, and HCO3 15. Urine drug screen is negative. What will help make the diagnosis?

1. Abdominal ultrasound
2. Chest X-ray
3. Serum creatine kinase level
4. Serum salicylate level

Ans. 4 - Serum salicylate level

Q6. A 57-year-old male presents to the emergency room, complaining of chest pain, with a past medical history of concern for hypertension and hyperlipidemia. Vital signs are unremarkable. Initial ECG concerning left bundle branch block (LBBB). When looking through his old records, you find that previous ECGs also showed a LBBB. Which of the following criteria is not consistent with new-onset myocardial infarction?

1. Concordant ST elevation >1mm in leads with positive QRS complex
2. Excessively discordant ST elevation >5mm in leads with a negative QRS complex
3. Concordant ST depression >1mm in V1-V3
4. Discordant ST depression >1mm in leads II and III

 Ans. 4 - Discordant ST depression >1mm in leads II and III

Q7. A 78-year-old female with cellulitis is admitted overnight with shortness of breath. The excited admitting intern sends a battery of tests, including urinalysis and urine culture. You get a call at midnight asking if the patient should be started on antibiotics for possible UTI.

Urine culture is in process. Urinalysis reports reveal the following:

White cell count 2-5 cells/hpf

Epithelial cells: many

Bacteria: +

Which of the following is an indication for the treatment of asymptomatic bacteriuria?

1. Women of childbearing age
2. Prior to transurethral resection of the prostate
3. Elderly women with an indwelling Foley catheter to prevent sepsis
4. Nursing home residents

Ans. 2 - Prior to transurethral resection of the prostate

Q8. A cigarette smoker with a history of lower-extremity claudication is started on an ACE inhibitor for hypertension that failed to improve with lifestyle modifications. His serum Cr doubled after the initiation of the ACE inhibitor. This is suggestive of which finding?

1. Significant bilateral renal artery stenosis
2. Pheochromocytoma
3. Primary aldosteronism
4. Atherosclerotic emboli from the aorta

Ans. 1  - Significant bilateral renal artery stenosis

Q9. A 56-year-old male with type 2 diabetes presents to the emergency department with acute sinusitis, nasal congestion, purulent nasal discharge, headache, and sinus pain. He is also found to be in a state of profound diabetic ketoacidosis. On an exam, the patient has the following vital signs: temperature 38℃, blood pressure 136/86 mmHg, heart rate 102 beats per minute, and respiratory rate 24 breaths per minute. Additional findings include left periorbital edema and palatal eschars. The remainder of the physical examination is unremarkable. Which of the following would be the appropriate therapeutic intervention for this patient?

1. Amphotericin B (deoxycholate)
2. Amphotericin B (lipid formulation)
3. Voriconazole
4. Fluconazole

Ans. 2 - Amphotericin B (lipid formulation)

Q10. A 34-year-old male with no significant past medical history presents to the ER with altered mental status. His wife reports that he was in his usual state of health in the morning but over the course of the day developed chills, a headache, and vomiting. He became confused, responding inappropriately, which prompted her to bring him to the ER. His vitals on presentation show a fever of 102°F. The physical exam reveals marked nuchal rigidity. What is the next step in management?

1. Obtain lumbar puncture first
2. Obtain CT of the head with and without contrast
3. Obtain blood culture and start empiric antibiotics plus steroids
4. Start antiviral therapy

Ans. 3 - Obtain blood culture and start empiric antibiotics plus steroids

Q11. A 56-year-old male presents to the emergency department via ambulance. The patient was reported to have had vomiting, followed by a sudden syncopal episode while walking that was witnessed by his wife. The paramedics were called and found the patient with shallow breaths and hypoxic at 76% O₂ saturation so the patient was intubated immediately. The patient was brought into the emergency department. HR is 56/min and blood pressure is 216/100 mmHg. Pupils are pinpoint, fixed, and non-reactive. The patient has a GCS of 3. CT head was ordered, demonstrating a massive pontine hemorrhage and vasogenic edema. Which of the following is most likely true regarding his neurological exam?

1. Oculocephalic (doll’s eye) testing will demonstrate eye movement in the direction of the head when the head is turned.
2. Oculovestibular (cold water caloric) testing will demonstrate fixed gaze without deviation
3. Downward-going toes on Babinski
4. Diffuse hyporeflexia on extremities

Ans. 2 - Oculovestibular (cold water caloric) testing will demonstrate fixed gaze without deviation

Q12. Which of the following is the appropriate utilization of p24 antigen testing?

1. As testing for HIV positivity during the acute phase
2. For HIV testing in children 2 years of age and younger
3. For HIV testing in newborns
4. As a component of fourth-generation HIV enzyme immunoassays

Ans. 4 - As a component of fourth-generation HIV enzyme immunoassays

Q13. A 56-year-old female with type 2 DM arrives in the ER complaining of a sore throat for the past day. She states it hurts her to swallow and she reports painful swelling under her jaw. She has mild pain when she moves her head around. In the ER her vitals are BP - 150/90 mmHg, HR - 102/min, RR - 18/min, Temperature - 100.5°F, O₂ saturation - 99%. On examination, you note mild pharyngeal erythema with a few exudates, tender submandibular adenopathy, and clear lungs. She has mild discomfort when you range her neck and her voice is slightly muffled. She is not drooling and appears in NAD. What is the appropriate workup for this patient?

1. Clinically, she has strep throat based on 3/4 Centor criteria and should be treated with Augmentin and can be discharged
2. She has a viral pharyngitis and laryngitis and can be reassured, and treatment with IM dexamethasone for symptom relief
3. She needs either a lateral soft tissue X-ray or laryngoscopy to evaluate for epiglottis versus retropharyngeal abscess
4. She needs dexamethasone and ceftriaxone for suspected Ludwig's angina and admission to the oral surgery service

Ans. 3 - She needs either a lateral soft tissue X-ray or laryngoscopy to evaluate for epiglottis versus retropharyngeal abscess

Q14. Which of the following describes the risk factors associated with post-transplant lymphocytic disorder in hematopoietic stem cell transplant recipients?

1. Associated with an increased risk in alemtuzumab use
2. Associated with Epstein-Barr virus originating from donor-derived memory B-cells
3. Associated with cytomegalovirus mismatching
4. Associated with the concurrent presence of hepatitis C infection

Ans. 2 - Associated with Epstein-Barr virus originating from donor-derived memory B-cells

Q15. A 36-year-old G3P3 female presents 5 days after an unremarkable delivery. She presents with fatigue and dyspnea on exertion. A bedside ultrasound shows decreased cardiac function. Given these findings, what is the mainstay of treatment?

1. Immunosuppressive therapy
2. Lasix
3. Digoxin
4. IV immunoglobulin (IVIG)

Ans. 2 - Lasix

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