114 NEET PG previous year questions, with answers and explanations.

Q1. Tenderness is maximal in the anatomical snuffbox after a fall on the outstretched hand. Which tendons form its lateral boundary?

• A. Extensor pollicis longus and extensor indicis
• B. Abductor pollicis longus and extensor pollicis brevis
• C. Flexor carpi radialis and abductor pollicis longus
• D. Extensor carpi radialis longus and brevis

Correct answer: B. Abductor pollicis longus and extensor pollicis brevis

High-yield takeaway. The lateral boundary of the anatomical snuffbox is formed by APL and EPB.

Q2. Which cranial nerve does NOT pass through the jugular foramen?

• A. Glossopharyngeal nerve
• B. Vagus nerve
• C. Accessory nerve
• D. Hypoglossal nerve

Correct answer: D. Hypoglossal nerve

High-yield takeaway. CN IX, X and XI traverse the jugular foramen; CN XII exits through the hypoglossal canal.

Q3. What is the normal vascular content of the umbilical cord?

• A. One artery and two veins
• B. Two arteries and one vein
• C. Two arteries and two veins
• D. One artery and one vein

Correct answer: B. Two arteries and one vein

High-yield takeaway. A normal umbilical cord contains two umbilical arteries and one umbilical vein.

Q4. After harvesting the great saphenous vein, a patient has numbness along the medial leg and medial border of the foot. Which nerve was most likely injured?

• A. Sural nerve
• B. Saphenous nerve
• C. Superficial fibular nerve
• D. Tibial nerve

Correct answer: B. Saphenous nerve

High-yield takeaway. The saphenous nerve accompanies the great saphenous vein and supplies the medial leg and foot.

Q5. The long head of triceps brachii arises from which bony landmark?

• A. Supraglenoid tubercle
• B. Infraglenoid tubercle
• C. Coracoid process
• D. Lateral epicondyle

Correct answer: B. Infraglenoid tubercle

High-yield takeaway. The long head of triceps originates from the infraglenoid tubercle of the scapula.

Q6. A footballer sustains a forceful eversion injury of the ankle. Which ligament is most directly stressed?

• A. Anterior talofibular ligament
• B. Calcaneofibular ligament
• C. Deltoid ligament
• D. Posterior talofibular ligament

Correct answer: C. Deltoid ligament

High-yield takeaway. Eversion stresses the medial deltoid ligament; inversion more often injures the lateral complex.

Q1. A preterm neonate has surfactant deficiency. Which change is expected in the lungs?

• A. Decreased surface tension with increased compliance
• B. Increased surface tension with decreased compliance
• C. Increased surface tension with increased compliance
• D. Decreased surface tension with decreased compliance

Correct answer: B. Increased surface tension with decreased compliance

High-yield takeaway. Surfactant lowers alveolar surface tension and increases compliance; deficiency reverses both effects.

Q2. Hyperprolactinemia commonly causes amenorrhea by suppressing which hypothalamic hormone?

• A. TRH
• B. GnRH
• C. CRH
• D. GHRH

Correct answer: B. GnRH

High-yield takeaway. High prolactin suppresses pulsatile GnRH, lowering gonadotropins and impairing ovulation.

Q3. Hydrochlorothiazide helps prevent recurrent calcium stones mainly by:

• A. Increasing urinary calcium excretion
• B. Decreasing distal tubular calcium reabsorption
• C. Increasing distal tubular calcium reabsorption and lowering urinary calcium
• D. Blocking intestinal calcium absorption

Correct answer: C. Increasing distal tubular calcium reabsorption and lowering urinary calcium

High-yield takeaway. Thiazides increase distal calcium reabsorption and reduce urinary calcium excretion.

Q4. Soon after rapidly ascending to high altitude, a healthy adult hyperventilates. What is the initial acid-base disturbance?

• A. Metabolic acidosis
• B. Metabolic alkalosis
• C. Respiratory acidosis
• D. Respiratory alkalosis

Correct answer: D. Respiratory alkalosis

High-yield takeaway. Hypoxemia drives hyperventilation, lowering PaCO2 and causing acute respiratory alkalosis.

Q5. The baroreceptor reflex is best described as which type of physiological control?

• A. Positive feedback
• B. Negative feedback
• C. Feed-forward only
• D. Open-loop control

Correct answer: B. Negative feedback

High-yield takeaway. The baroreceptor reflex opposes acute deviations in arterial pressure and is a classic negative-feedback loop.

Q6. In a completely ventilated but non-perfused alveolus, the ventilation-perfusion ratio approaches:

• A. Zero
• B. One
• C. Infinity
• D. Negative one

Correct answer: C. Infinity

High-yield takeaway. Dead-space units are ventilated without perfusion, so V/Q approaches infinity.

Q1. Urine that turns dark on standing with ochronotic joint disease suggests deficiency of which enzyme?

• A. Phenylalanine hydroxylase
• B. Homogentisate 1,2-dioxygenase
• C. Tyrosinase
• D. Branched-chain alpha-ketoacid dehydrogenase

Correct answer: B. Homogentisate 1,2-dioxygenase

High-yield takeaway. Alkaptonuria results from homogentisate oxidase deficiency and accumulation of homogentisic acid.

Q2. A patient has marked hyperphenylalaninemia despite normal phenylalanine hydroxylase protein. Deficiency of which cofactor can explain this?

• A. Biotin
• B. Tetrahydrobiopterin
• C. Thiamine pyrophosphate
• D. Pyridoxal phosphate

Correct answer: B. Tetrahydrobiopterin

High-yield takeaway. Phenylalanine hydroxylase requires tetrahydrobiopterin, so BH4 deficiency can cause hyperphenylalaninemia.

Q3. Vitamin B12 deficiency causes accumulation of which metabolite in addition to homocysteine?

• A. Methylmalonic acid
• B. Uric acid
• C. Homogentisic acid
• D. Orotic acid

Correct answer: A. Methylmalonic acid

High-yield takeaway. B12 is required for methylmalonyl-CoA mutase, so methylmalonic acid rises in deficiency.

Q4. Perifollicular hemorrhages, gum bleeding and poor wound healing in a deficient child are linked to impaired activity of:

• A. Prolyl hydroxylase
• B. Pyruvate carboxylase
• C. Glucose-6-phosphatase
• D. HMG-CoA reductase

Correct answer: A. Prolyl hydroxylase

High-yield takeaway. Vitamin C is required for proline and lysine hydroxylation during collagen synthesis.

Q5. Primaquine-induced hemolysis in a susceptible patient is caused by impaired generation of NADPH in which pathway?

• A. Glycolysis
• B. Pentose phosphate pathway
• C. TCA cycle
• D. Urea cycle

Correct answer: B. Pentose phosphate pathway

High-yield takeaway. G6PD in the pentose phosphate pathway generates NADPH needed to keep glutathione reduced.

Q6. After several days of starvation, the brain increasingly uses which fuel?

• A. Free fatty acids directly
• B. Ketone bodies
• C. Chylomicrons
• D. Glycogen from skeletal muscle

Correct answer: B. Ketone bodies

High-yield takeaway. During prolonged fasting the liver makes ketone bodies that become an important brain fuel.

Q1. Which molecular abnormality is characteristic of chronic myeloid leukemia?

• A. JAK2 V617F
• B. BCR-ABL1 fusion from t(9;22)
• C. PML-RARA fusion
• D. MYC t(8;14)

Correct answer: B. BCR-ABL1 fusion from t(9;22)

High-yield takeaway. CML is driven by the Philadelphia chromosome producing the BCR-ABL1 tyrosine kinase.

Q2. A child has a calcified suprasellar mass and histology shows wet keratin. What is the most likely diagnosis?

• A. Craniopharyngioma
• B. Pituitary adenoma
• C. Meningioma
• D. Ependymoma

Correct answer: A. Craniopharyngioma

High-yield takeaway. Wet keratin is a classic feature of adamantinomatous craniopharyngioma.

Q3. Acute promyelocytic leukemia is most strongly associated with:

• A. t(15;17) PML-RARA
• B. t(9;22) BCR-ABL1
• C. t(8;14) MYC
• D. t(11;14) CCND1

Correct answer: A. t(15;17) PML-RARA

High-yield takeaway. APL carries PML-RARA from t(15;17) and responds to differentiation therapy such as ATRA.

Q4. Follicular lymphoma is classically associated with which translocation?

• A. t(8;14)
• B. t(9;22)
• C. t(14;18)
• D. t(11;14)

Correct answer: C. t(14;18)

High-yield takeaway. t(14;18) places BCL2 under immunoglobulin heavy-chain control and inhibits apoptosis.

Q5. A thyroid tumor contains amyloid stroma and cells positive for calcitonin. What is the diagnosis?

• A. Papillary carcinoma
• B. Follicular carcinoma
• C. Medullary thyroid carcinoma
• D. Anaplastic carcinoma

Correct answer: C. Medullary thyroid carcinoma

High-yield takeaway. Medullary thyroid carcinoma arises from parafollicular C cells and may deposit calcitonin-derived amyloid.

Q6. Which type of regulated cell death prominently involves activation of caspases?

• A. Coagulative necrosis
• B. Apoptosis
• C. Liquefactive necrosis
• D. Fat necrosis

Correct answer: B. Apoptosis

High-yield takeaway. Caspase activation is central to the execution phase of apoptosis.

Q1. A woman with chronic hypertension is planning pregnancy. Which drug should be discontinued because of fetal toxicity?

• A. Labetalol
• B. Nifedipine
• C. Methyldopa
• D. Enalapril

Correct answer: D. Enalapril

High-yield takeaway. ACE inhibitors and ARBs are contraindicated in pregnancy because of fetal renal toxicity.

Q2. Pegloticase lowers uric acid by:

• A. Blocking xanthine oxidase
• B. Increasing renal urate reabsorption
• C. Converting uric acid to allantoin
• D. Inhibiting purine synthesis

Correct answer: C. Converting uric acid to allantoin

High-yield takeaway. Pegloticase is a recombinant uricase that converts uric acid to the more soluble allantoin.

Q3. Which carbapenem has the greatest recognized seizure risk?

• A. Meropenem
• B. Ertapenem
• C. Imipenem
• D. Doripenem

Correct answer: C. Imipenem

High-yield takeaway. Imipenem has a higher seizure liability than other commonly used carbapenems.

Q4. A patient taking digoxin develops toxicity after clarithromycin is added. The interaction is best explained by:

• A. Increased renal filtration of digoxin
• B. Reduced digoxin exposure
• C. Inhibition of P-glycoprotein increasing digoxin levels
• D. Induction of digoxin metabolism by CYP2E1

Correct answer: C. Inhibition of P-glycoprotein increasing digoxin levels

High-yield takeaway. Macrolides can increase digoxin exposure, including through P-glycoprotein inhibition and altered gut flora.

Q5. Which drug improves gastric emptying and increases lower esophageal sphincter tone through dopamine D2 antagonism?

• A. Metoclopramide
• B. Loperamide
• C. Ondansetron
• D. Sucralfate

Correct answer: A. Metoclopramide

High-yield takeaway. Metoclopramide is a prokinetic D2 antagonist that can increase LES tone and gastric emptying.

Q6. Benralizumab used in eosinophilic asthma targets:

• A. IgE
• B. IL-4 receptor
• C. IL-5 receptor alpha
• D. TNF alpha

Correct answer: C. IL-5 receptor alpha

High-yield takeaway. Benralizumab binds IL-5 receptor alpha on eosinophils and promotes eosinophil depletion.

Q1. Several people develop abrupt vomiting a few hours after eating cream-filled pastries. The most likely cause is:

• A. Staphylococcus aureus preformed enterotoxin
• B. Salmonella Typhi
• C. Campylobacter jejuni
• D. Clostridioides difficile

Correct answer: A. Staphylococcus aureus preformed enterotoxin

High-yield takeaway. Rapid vomiting after cream or dairy foods points to a preformed heat-stable staphylococcal enterotoxin.

Q2. A brain abscess yields branching filamentous bacteria that are weakly acid-fast and can grow on paraffin bait. The organism is:

• A. Actinomyces israelii
• B. Nocardia species
• C. Streptomyces species
• D. Bacillus anthracis

Correct answer: B. Nocardia species

High-yield takeaway. Nocardia are aerobic branching filamentous bacteria that are weakly acid-fast.

Q3. A child with intense nocturnal perianal itching is best diagnosed using:

• A. Thick blood smear
• B. Cellophane tape test
• C. Widal test
• D. Sputum microscopy

Correct answer: B. Cellophane tape test

High-yield takeaway. Enterobius vermicularis eggs are collected from the perianal area using the tape test.

Q4. Haemophilus influenzae can show satellitism around Staphylococcus aureus because it requires:

• A. Only factor X
• B. Only factor V
• C. Factors X and V
• D. Factor K

Correct answer: C. Factors X and V

High-yield takeaway. H. influenzae requires hemin (X factor) and NAD (V factor); staphylococci supply V factor locally.

Q5. A patient develops inflammatory diarrhea after unpasteurized milk. A curved gram-negative rod is isolated. The likely organism is:

• A. Campylobacter jejuni
• B. Vibrio cholerae
• C. Shigella dysenteriae
• D. Yersinia pestis

Correct answer: A. Campylobacter jejuni

High-yield takeaway. Campylobacter is a curved gram-negative rod associated with poultry and unpasteurized milk.

Q6. A painless black eschar with capsulated bacilli showing a positive McFadyean reaction suggests:

• A. Bacillus cereus
• B. Bacillus anthracis
• C. Clostridium tetani
• D. Corynebacterium diphtheriae

Correct answer: B. Bacillus anthracis

High-yield takeaway. The McFadyean reaction demonstrates the capsule of Bacillus anthracis.

Q1. Under the POCSO Act, a child is defined as a person:

• A. Below 14 years
• B. Below 16 years
• C. Below 18 years
• D. Below 21 years

Correct answer: C. Below 18 years

High-yield takeaway. POCSO protects every person below 18 years of age.

Q2. After a high-speed road traffic accident, CT is initially unremarkable but autopsy shows petechial hemorrhages in the corpus callosum. The diagnosis is:

• A. Extradural hemorrhage
• B. Diffuse axonal injury
• C. Subdural hemorrhage
• D. Cerebral abscess

Correct answer: B. Diffuse axonal injury

High-yield takeaway. Diffuse axonal injury follows rotational acceleration-deceleration and commonly affects the corpus callosum.

Q3. In a medical certificate of cause of death, which should NOT be used as the underlying cause by itself?

• A. Bronchopneumonia
• B. Metastatic malignancy
• C. Cardiorespiratory arrest
• D. Intracerebral hemorrhage

Correct answer: C. Cardiorespiratory arrest

High-yield takeaway. Terminal mechanisms such as cardiorespiratory arrest should not replace the disease or injury in the causal sequence.

Q4. Chronic lead exposure classically inhibits which enzymes in heme synthesis?

• A. ALA dehydratase and ferrochelatase
• B. Pyruvate kinase and hexokinase
• C. G6PD and transketolase
• D. Aminotransferase and glutaminase

Correct answer: A. ALA dehydratase and ferrochelatase

High-yield takeaway. Lead inhibits ALA dehydratase and ferrochelatase, contributing to anemia and neurotoxicity.

Q5. A farmer with organophosphate poisoning is treated with atropine. Which additional antidote reactivates acetylcholinesterase if given early?

• A. Pralidoxime
• B. Naloxone
• C. Flumazenil
• D. Methylene blue

Correct answer: A. Pralidoxime

High-yield takeaway. Oximes such as pralidoxime can reactivate phosphorylated acetylcholinesterase before aging occurs.

Q6. Curved scratch abrasions and grouped bruises over the neck with deep neck injury most strongly suggest:

• A. Smothering
• B. Manual strangulation
• C. Drowning
• D. Hanging without neck compression

Correct answer: B. Manual strangulation

High-yield takeaway. Fingernail abrasions and fingertip bruises over the neck are classic clues to throttling or manual strangulation.

Q1. Disease incidence is 30 per 1,000 in an exposed group and 10 per 1,000 in an unexposed group. The attributable risk is:

• A. 3 per 1,000
• B. 20 per 1,000
• C. 30 per 1,000
• D. 40 per 1,000

Correct answer: B. 20 per 1,000

High-yield takeaway. Attributable risk is incidence in exposed minus incidence in unexposed: 30 - 10 = 20 per 1,000.

Q2. Earlier diagnosis by screening appears to prolong survival even though the time of death is unchanged. This is:

• A. Selection bias
• B. Lead-time bias
• C. Recall bias
• D. Berkson bias

Correct answer: B. Lead-time bias

High-yield takeaway. Lead-time bias creates an apparent survival advantage simply because diagnosis occurs earlier.

Q3. Which mosquito larva rests parallel to the water surface and lacks a respiratory siphon?

• A. Culex
• B. Aedes
• C. Anopheles
• D. Mansonia

Correct answer: C. Anopheles

High-yield takeaway. Anopheles larvae lie parallel to the surface and characteristically lack a siphon.

Q4. Years of potential life lost primarily measures:

• A. Years lived with disability
• B. Premature mortality
• C. Health-care utilization
• D. Point prevalence

Correct answer: B. Premature mortality

High-yield takeaway. YPLL gives greater weight to deaths occurring at younger ages and reflects premature mortality.

Q5. Which sequence best represents the core flow of a randomized controlled trial?

• A. Outcome assessment, enrollment, randomization, intervention
• B. Enrollment, randomization, intervention, outcome assessment
• C. Randomization, outcome assessment, enrollment, intervention
• D. Intervention, enrollment, randomization, outcome assessment

Correct answer: B. Enrollment, randomization, intervention, outcome assessment

High-yield takeaway. RCTs proceed from enrollment and eligibility to random allocation, intervention or control, and outcome assessment.

Q6. In the de facto census method, a person is counted:

• A. At the usual residence
• B. Where the person is physically found on the census date
• C. At the place of birth
• D. At the place of employment

Correct answer: B. Where the person is physically found on the census date

High-yield takeaway. De facto enumeration counts individuals at the place where they are found at the specified census time.

Q1. Cough triggered by stimulation of the external auditory canal is carried by the auricular branch of:

• A. Trigeminal nerve
• B. Vagus nerve
• C. Facial nerve
• D. Glossopharyngeal nerve

Correct answer: B. Vagus nerve

High-yield takeaway. Arnold's ear-cough reflex is mediated by the auricular branch of the vagus nerve.

Q2. A child has conductive hearing loss, a dull retracted tympanic membrane and an air-fluid level without acute pain or fever. The likely diagnosis is:

• A. Otitis media with effusion
• B. Otitis externa
• C. Otosclerosis
• D. Meniere disease

Correct answer: A. Otitis media with effusion

High-yield takeaway. Otitis media with effusion causes conductive hearing loss with middle-ear fluid but without acute inflammatory features.

Q3. A child aspirates a radiopaque foreign body into a main bronchus and has significant airway symptoms. The preferred definitive removal is by:

• A. Flexible nasal endoscopy
• B. Rigid bronchoscopy
• C. Thoracentesis
• D. Myringotomy

Correct answer: B. Rigid bronchoscopy

High-yield takeaway. Rigid bronchoscopy is the standard definitive procedure for removal of an airway foreign body in a child.

Q4. After thyroidectomy, both vocal cords remain near the midline and the patient has severe airway obstruction. The likely injury is:

• A. Unilateral superior laryngeal nerve palsy
• B. Bilateral recurrent laryngeal nerve palsy
• C. Hypoglossal nerve palsy
• D. Glossopharyngeal nerve palsy

Correct answer: B. Bilateral recurrent laryngeal nerve palsy

High-yield takeaway. Bilateral recurrent laryngeal nerve palsy can leave the cords in a paramedian position and obstruct the airway.

Q5. Severe tonsillitis can cause referred ear pain through which cranial nerve?

• A. Facial nerve
• B. Glossopharyngeal nerve
• C. Hypoglossal nerve
• D. Accessory nerve

Correct answer: B. Glossopharyngeal nerve

High-yield takeaway. CN IX supplies the tonsillar region and contributes sensory innervation to the middle ear, producing referred otalgia.

Q6. A 16-year-old boy has recurrent profuse epistaxis and anterior bowing of the posterior maxillary wall on CT. The diagnosis is:

• A. Antrochoanal polyp
• B. Juvenile nasopharyngeal angiofibroma
• C. Inverted papilloma
• D. Nasopharyngeal carcinoma

Correct answer: B. Juvenile nasopharyngeal angiofibroma

High-yield takeaway. Adolescent male, severe epistaxis and Holman-Miller sign are classic for JNA.

Q1. A child with leukocoria has Flexner-Wintersteiner rosettes on histology. The diagnosis is:

• A. Retinoblastoma
• B. Medulloblastoma
• C. Coats disease
• D. Retinal astrocytoma

Correct answer: A. Retinoblastoma

High-yield takeaway. Flexner-Wintersteiner rosettes are a classic histologic feature of retinoblastoma.

Q2. A left optic tract lesion most characteristically produces:

• A. Left monocular blindness
• B. Right homonymous hemianopia
• C. Left homonymous hemianopia
• D. Bitemporal hemianopia

Correct answer: B. Right homonymous hemianopia

High-yield takeaway. Post-chiasmal lesions produce contralateral homonymous visual field defects.

Q3. Intracorneal ring segments such as INTACS are primarily used in selected patients with:

• A. Keratoconus
• B. Acute angle-closure glaucoma
• C. Retinal detachment
• D. Optic neuritis

Correct answer: A. Keratoconus

High-yield takeaway. INTACS can regularize corneal shape in selected keratoconus patients.

Q4. Nyctalopia followed by progressive peripheral field constriction most strongly suggests:

• A. Retinitis pigmentosa
• B. Optic neuritis
• C. Central serous chorioretinopathy
• D. Age-related macular degeneration

Correct answer: A. Retinitis pigmentosa

High-yield takeaway. Rod dysfunction causes early night blindness followed by progressive peripheral field loss in retinitis pigmentosa.

Q5. A young patient has a golden-brown ring at the corneal periphery. Which investigation best supports the suspected systemic diagnosis?

• A. Serum ferritin
• B. Serum ceruloplasmin
• C. Serum alpha-1 antitrypsin
• D. Serum transferrin

Correct answer: B. Serum ceruloplasmin

High-yield takeaway. A Kayser-Fleischer ring suggests Wilson disease, in which serum ceruloplasmin is typically low.

Q6. Dandruff-like deposits on the anterior lens capsule and pupillary margin suggest:

• A. Pseudoexfoliation syndrome
• B. Posterior capsular opacification
• C. Phacolytic glaucoma
• D. Fuchs dystrophy

Correct answer: A. Pseudoexfoliation syndrome

High-yield takeaway. Pseudoexfoliative material is associated with secondary open-angle glaucoma.

Q1. A patient with rheumatic mitral stenosis develops atrial fibrillation. Which oral anticoagulant is preferred for embolic prevention?

• A. Aspirin alone
• B. Warfarin
• C. No anticoagulation
• D. Clopidogrel alone

Correct answer: B. Warfarin

High-yield takeaway. Rheumatic mitral stenosis with AF is a high-risk valvular setting in which a vitamin K antagonist is standard.

Q2. A patient with type 2 diabetes and heart failure remains above glycemic target. Which class offers important heart-failure benefit?

• A. Sulfonylureas
• B. SGLT2 inhibitors
• C. Alpha-glucosidase inhibitors
• D. Meglitinides

Correct answer: B. SGLT2 inhibitors

High-yield takeaway. SGLT2 inhibitors reduce heart-failure hospitalization and have cardio-renal benefits.

Q3. Fever, altered behavior and seizures with temporal-lobe involvement should prompt immediate treatment for HSV encephalitis with:

• A. Acyclovir
• B. Oseltamivir
• C. Ceftriaxone only
• D. Amphotericin B

Correct answer: A. Acyclovir

High-yield takeaway. HSV encephalitis classically affects temporal lobes and requires urgent intravenous acyclovir.

Q4. Oral ulcers, arthralgia, proteinuria, hematuria and RBC casts in a young woman most strongly suggest:

• A. Lupus nephritis
• B. Minimal change disease
• C. Diabetic nephropathy
• D. Polycystic kidney disease

Correct answer: A. Lupus nephritis

High-yield takeaway. Systemic lupus features plus an active urinary sediment point to lupus nephritis.

Q5. Acromegaly is most appropriately confirmed by demonstrating failure of growth hormone suppression after:

• A. Water deprivation test
• B. Oral glucose tolerance test
• C. ACTH stimulation test
• D. Dexamethasone suppression test

Correct answer: B. Oral glucose tolerance test

High-yield takeaway. In normal physiology glucose suppresses GH; failure of suppression supports acromegaly.

Q6. A mid-diastolic murmur at the lower left sternal border with prominent a waves in the JVP suggests:

• A. Mitral stenosis
• B. Tricuspid stenosis
• C. Aortic regurgitation
• D. Pulmonary regurgitation

Correct answer: B. Tricuspid stenosis

High-yield takeaway. Tricuspid stenosis impairs right atrial emptying and produces prominent a waves and an inspiratory diastolic murmur.

Q1. Dohlman's endoscopic procedure is classically used for:

• A. Zenker diverticulum
• B. Achalasia
• C. Boerhaave syndrome
• D. Diffuse esophageal spasm

Correct answer: A. Zenker diverticulum

High-yield takeaway. Dohlman's procedure divides the common wall and cricopharyngeal bar in Zenker diverticulum.

Q2. Rapidly progressive perineal pain, swelling, crepitus and systemic toxicity in a diabetic patient suggests Fournier gangrene. The cornerstone of treatment is:

• A. Oral antibiotics alone
• B. Urgent aggressive surgical debridement plus broad-spectrum antibiotics
• C. Observation
• D. Topical antifungal therapy

Correct answer: B. Urgent aggressive surgical debridement plus broad-spectrum antibiotics

High-yield takeaway. Necrotizing soft-tissue infection requires immediate source control with debridement and broad-spectrum antibiotics.

Q3. A patient with a stab wound to the abdomen is hypotensive and has generalized guarding. The immediate definitive step is:

• A. Discharge after observation
• B. Emergency exploratory laparotomy
• C. Elective colonoscopy
• D. Oral contrast CT before resuscitation in all cases

Correct answer: B. Emergency exploratory laparotomy

High-yield takeaway. Hemodynamic instability with peritonitis after penetrating trauma is an indication for urgent laparotomy.

Q4. A fit patient has a localized 3 cm renal cell carcinoma. When technically feasible, the preferred nephron-sparing operation is:

• A. Radical nephrectomy
• B. Partial nephrectomy
• C. Chemotherapy alone
• D. Observation in every patient

Correct answer: B. Partial nephrectomy

High-yield takeaway. Partial nephrectomy is preferred for many small T1a renal masses when feasible.

Q5. Chronic pancreatitis with a markedly dilated pancreatic duct and multiple ductal stones is classically treated surgically by:

• A. Whipple procedure in every case
• B. Lateral pancreaticojejunostomy
• C. Total gastrectomy
• D. Heller myotomy

Correct answer: B. Lateral pancreaticojejunostomy

High-yield takeaway. A drainage procedure such as the Puestow operation is used for a dilated obstructed pancreatic duct.

Q6. A circumferential full-thickness limb burn is compromising distal perfusion. The urgent procedure is:

• A. Routine fasciotomy in every case
• B. Escharotomy
• C. Skin grafting before release
• D. Debridement only

Correct answer: B. Escharotomy

High-yield takeaway. A rigid circumferential eschar can act as a tourniquet; escharotomy releases it.

Q1. Failure to lactate followed by amenorrhea after severe postpartum hemorrhage suggests:

• A. Sheehan syndrome
• B. Asherman syndrome
• C. Turner syndrome
• D. PCOS

Correct answer: A. Sheehan syndrome

High-yield takeaway. Postpartum pituitary ischemic necrosis can cause lactational failure, amenorrhea and other pituitary deficits.

Q2. During labor, umbilical cord prolapse is diagnosed with a viable fetus. What is the immediate priority while arranging emergency delivery?

• A. Push the presenting part further down
• B. Manually elevate the presenting part to relieve cord compression
• C. Wait for spontaneous correction
• D. Give oxytocin to intensify contractions

Correct answer: B. Manually elevate the presenting part to relieve cord compression

High-yield takeaway. Relieve cord compression immediately while preparing for urgent cesarean delivery unless vaginal birth is imminent.

Q3. The first recommended maneuver for shoulder dystocia after calling for help is usually:

• A. McRoberts maneuver with suprapubic pressure
• B. Fundal pressure
• C. Zavanelli maneuver first
• D. Immediate symphysiotomy in every case

Correct answer: A. McRoberts maneuver with suprapubic pressure

High-yield takeaway. McRoberts positioning, commonly combined with suprapubic pressure, is a first-line maneuver for shoulder dystocia.

Q4. At 36 weeks and 6 days, a multiparous woman has a transverse lie, adequate liquor and no contraindication to vaginal delivery. The appropriate attempt to correct presentation is:

• A. Immediate induction
• B. External cephalic version
• C. Internal podalic version as routine
• D. No assessment until labor

Correct answer: B. External cephalic version

High-yield takeaway. External cephalic version can be offered near term when there are no contraindications and urgent delivery is available.

Q5. What is the total loading dose in the classic Pritchard regimen for magnesium sulfate?

• A. 4 g
• B. 8 g
• C. 10 g
• D. 14 g

Correct answer: D. 14 g

High-yield takeaway. The Pritchard loading dose is 4 g IV plus 10 g IM, totaling 14 g.

Q6. In a regular 28-day cycle, days 21 to 25 are characterized by:

• A. High progesterone with relatively suppressed gonadotropins
• B. LH surge with minimal progesterone
• C. Absent estrogen with high FSH
• D. Low progesterone with rising LH

Correct answer: A. High progesterone with relatively suppressed gonadotropins

High-yield takeaway. The mid-luteal phase has high corpus-luteum progesterone and negative feedback on FSH and LH.

Q1. Where should a pulse oximeter probe be placed to measure preductal oxygen saturation in a newborn?

• A. Left hand
• B. Right hand
• C. Either foot
• D. Left great toe

Correct answer: B. Right hand

High-yield takeaway. The right upper limb is preductal and is used for preductal oxygen saturation.

Q2. A child with neurodegeneration, a cherry-red spot and hexosaminidase A deficiency has:

• A. Gaucher disease
• B. Tay-Sachs disease
• C. Niemann-Pick type C
• D. Hurler syndrome

Correct answer: B. Tay-Sachs disease

High-yield takeaway. Tay-Sachs disease is caused by hexosaminidase A deficiency with GM2 ganglioside accumulation.

Q3. A child has a generalized seizure during a high fever and the seizure is ongoing. First-line acute seizure control is with:

• A. A benzodiazepine
• B. Oral phenytoin only
• C. Aspirin
• D. No medication even if prolonged

Correct answer: A. A benzodiazepine

High-yield takeaway. A benzodiazepine is first-line for an ongoing convulsive seizure, including a prolonged febrile seizure.

Q4. A child fed a very low-protein diet develops edema, abdominal distension and hypoalbuminemia. The diagnosis is:

• A. Marasmus
• B. Kwashiorkor
• C. Scurvy
• D. Rickets

Correct answer: B. Kwashiorkor

High-yield takeaway. Protein deficiency with edema and hypoalbuminemia is characteristic of kwashiorkor.

Q5. Alpha-L-iduronidase deficiency causes accumulation of:

• A. Dermatan sulfate and heparan sulfate
• B. GM2 ganglioside
• C. Glucocerebroside
• D. Sphingomyelin only

Correct answer: A. Dermatan sulfate and heparan sulfate

High-yield takeaway. Hurler syndrome causes accumulation of dermatan sulfate and heparan sulfate.

Q6. A conscious 2-year-old has severe foreign-body airway obstruction and cannot cough or speak. The immediate maneuver is:

• A. Blind finger sweep
• B. Abdominal thrusts
• C. Give water
• D. Observe only

Correct answer: B. Abdominal thrusts

High-yield takeaway. For a conscious child older than 1 year with severe choking, abdominal thrusts are recommended.

Q1. A toddler refuses to use an arm after sudden longitudinal traction on the pronated forearm. The diagnosis is:

• A. Supracondylar fracture
• B. Radial head subluxation
• C. Clavicle fracture
• D. Posterior elbow dislocation

Correct answer: B. Radial head subluxation

High-yield takeaway. Nursemaid elbow is radial head subluxation caused by traction on the pronated forearm.

Q2. Severe pain out of proportion after limb trauma with pain on passive stretch raises concern for compartment syndrome. Definitive urgent treatment is:

• A. Ice only
• B. Fasciotomy
• C. Cast tightening
• D. Delayed physiotherapy

Correct answer: B. Fasciotomy

High-yield takeaway. Acute compartment syndrome requires urgent decompressive fasciotomy.

Q3. Respiratory distress, neurologic changes and petechiae after a long-bone fracture suggest:

• A. Fat embolism syndrome
• B. Tension pneumothorax only
• C. Septic arthritis
• D. Acute osteomyelitis

Correct answer: A. Fat embolism syndrome

High-yield takeaway. The classic triad of fat embolism syndrome is respiratory compromise, neurologic features and petechial rash.

Q4. A young adult has inflammatory low-back pain, morning stiffness and heel enthesitis that improve with activity. The likely diagnosis is:

• A. Ankylosing spondylitis
• B. Mechanical back pain
• C. Lumbar strain
• D. Osteomalacia

Correct answer: A. Ankylosing spondylitis

High-yield takeaway. Inflammatory back pain with enthesitis strongly suggests axial spondyloarthritis.

Q5. Multiple fractures with minimal trauma and blue sclerae in a child most strongly suggest a defect in:

• A. Type I collagen
• B. Type II collagen
• C. Fibrillin
• D. Dystrophin

Correct answer: A. Type I collagen

High-yield takeaway. Osteogenesis imperfecta most commonly involves type I collagen.

Q6. Plain radiographs are normal in a patient with suspected early axial spondyloarthritis. The most useful imaging study is:

• A. MRI of the sacroiliac joints
• B. Repeat X-ray the same day
• C. Ultrasound of lumbar spine
• D. Chest CT

Correct answer: A. MRI of the sacroiliac joints

High-yield takeaway. MRI detects active sacroiliitis and marrow edema before plain radiographic structural change.

Q1. Which topical nail-lacquer antifungal belongs to the morpholine class?

• A. Amorolfine
• B. Terbinafine
• C. Fluconazole
• D. Griseofulvin

Correct answer: A. Amorolfine

High-yield takeaway. Amorolfine is a morpholine antifungal used topically in selected cases of onychomycosis.

Q2. A chronic plaque of cutaneous tuberculosis shows apple-jelly nodules on diascopy. The diagnosis is:

• A. Lupus vulgaris
• B. Lepromatous leprosy
• C. Psoriasis
• D. Tinea corporis

Correct answer: A. Lupus vulgaris

High-yield takeaway. Lupus vulgaris is a form of cutaneous tuberculosis classically showing apple-jelly nodules.

Q3. Flaccid bullae with oral erosions and intercellular fish-net IgG on direct immunofluorescence indicate:

• A. Pemphigus vulgaris
• B. Bullous pemphigoid
• C. Dermatitis herpetiformis
• D. Linear IgA disease

Correct answer: A. Pemphigus vulgaris

High-yield takeaway. Pemphigus vulgaris is caused by antibodies to desmogleins and shows intercellular IgG deposition.

Q4. Condylomata lata, a generalized rash and moth-eaten alopecia are classic for:

• A. Secondary syphilis
• B. Alopecia areata
• C. Tinea versicolor
• D. Trichotillomania

Correct answer: A. Secondary syphilis

High-yield takeaway. This cluster is highly characteristic of secondary syphilis.

Q5. An itchy eczematous eruption develops after exposure to hair dye containing PPD. The immunologic mechanism is:

• A. Type I hypersensitivity
• B. Type II hypersensitivity
• C. Type III hypersensitivity
• D. Type IV hypersensitivity

Correct answer: D. Type IV hypersensitivity

High-yield takeaway. Allergic contact dermatitis is a delayed T-cell-mediated type IV hypersensitivity reaction.

Q6. Intensely pruritic grouped vesicles on extensor surfaces with celiac disease and granular IgA deposition indicate:

• A. Dermatitis herpetiformis
• B. Pemphigus vulgaris
• C. Bullous pemphigoid
• D. Epidermolysis bullosa

Correct answer: A. Dermatitis herpetiformis

High-yield takeaway. Dermatitis herpetiformis shows granular IgA at dermal papillae and is associated with gluten-sensitive enteropathy.

Q1. An uncomfortable urge to move the legs that worsens at rest and at night and improves with movement is most consistent with:

• A. Restless legs syndrome
• B. Akathisia from antipsychotics only
• C. Catatonia
• D. Somatic delusion

Correct answer: A. Restless legs syndrome

High-yield takeaway. Restless legs syndrome has an urge to move the legs, worse at rest and at night, relieved by movement.

Q2. A perfectionistic person is preoccupied with order and control, has difficulty discarding items, and sees these traits as appropriate. The diagnosis is:

• A. Obsessive-compulsive disorder
• B. Obsessive-compulsive personality disorder
• C. Generalized anxiety disorder
• D. Schizotypal personality disorder

Correct answer: B. Obsessive-compulsive personality disorder

High-yield takeaway. OCPD is ego-syntonic and characterized by perfectionism, control and preoccupation with order.

Q3. Confusion, ataxia and ophthalmoplegia in a malnourished chronic alcohol user require urgent:

• A. Thiamine before carbohydrate loading
• B. Haloperidol before glucose
• C. Naloxone only
• D. Lithium

Correct answer: A. Thiamine before carbohydrate loading

High-yield takeaway. Suspected Wernicke encephalopathy requires prompt parenteral thiamine, ideally before glucose.

Q4. A severely depressed patient believes that his organs have disappeared and that he no longer exists. This is:

• A. Capgras syndrome
• B. Cotard syndrome
• C. Fregoli syndrome
• D. De Clerambault syndrome

Correct answer: B. Cotard syndrome

High-yield takeaway. Cotard syndrome consists of nihilistic delusions about nonexistence, death or loss of organs.

Q5. A patient on long-term haloperidol develops persistent orofacial choreoathetoid movements. The most appropriate drug class for targeted treatment is:

• A. VMAT2 inhibitor
• B. Acetylcholinesterase inhibitor
• C. SSRI only
• D. Beta-lactam antibiotic

Correct answer: A. VMAT2 inhibitor

High-yield takeaway. Tardive dyskinesia can be treated with VMAT2 inhibitors such as valbenazine or deutetrabenazine.

Q6. Three days after stopping heavy alcohol use, a patient has delirium, tremor, autonomic hyperactivity and visual hallucinations. The diagnosis is:

• A. Delirium tremens
• B. Alcoholic hallucinosis without delirium
• C. Wernicke encephalopathy
• D. Acute stress reaction

Correct answer: A. Delirium tremens

High-yield takeaway. Delirium tremens typically occurs 48 to 96 hours after alcohol cessation and includes delirium plus autonomic hyperactivity.

Q1. Which IV induction agent causes relatively little cardiovascular depression and is useful when hemodynamic stability is important?

• A. Propofol
• B. Thiopentone
• C. Etomidate
• D. Midazolam

Correct answer: C. Etomidate

High-yield takeaway. Etomidate has comparatively little cardiovascular depression but can suppress adrenal steroid synthesis.

Q2. Which common IV induction agent is particularly known for pain on injection?

• A. Propofol
• B. Ketamine
• C. Etomidate only
• D. Dexmedetomidine

Correct answer: A. Propofol

High-yield takeaway. Pain on injection is a well-known adverse effect of propofol.

Q3. Large-volume infusion of 0.9% saline can produce:

• A. High-anion-gap lactic acidosis
• B. Hyperchloremic normal-anion-gap metabolic acidosis
• C. Respiratory alkalosis
• D. Metabolic alkalosis

Correct answer: B. Hyperchloremic normal-anion-gap metabolic acidosis

High-yield takeaway. The high chloride load of normal saline can produce hyperchloremic metabolic acidosis.

Q4. Which drug is classically used to reverse residual non-depolarizing neuromuscular blockade?

• A. Neostigmine
• B. Succinylcholine
• C. Dantrolene
• D. Naloxone

Correct answer: A. Neostigmine

High-yield takeaway. Neostigmine raises acetylcholine at the neuromuscular junction and is usually paired with an antimuscarinic.

Q5. Which non-depolarizing neuromuscular blocker is especially associated with histamine release, flushing and hypotension?

• A. Rocuronium
• B. Atracurium
• C. Vecuronium
• D. Pancuronium

Correct answer: B. Atracurium

High-yield takeaway. Atracurium can cause dose-related histamine release with flushing and hypotension.

Q6. A patient develops rigidity, rapidly rising end-tidal CO2 and hyperthermia after sevoflurane and succinylcholine. The specific treatment is:

• A. Dantrolene
• B. Neostigmine
• C. Naloxone
• D. Atropine

Correct answer: A. Dantrolene

High-yield takeaway. Malignant hyperthermia is treated with dantrolene and immediate supportive crisis management.

Q1. A child has a mixed cystic and calcified suprasellar mass. The most likely diagnosis is:

• A. Craniopharyngioma
• B. Pituitary microadenoma
• C. Acoustic schwannoma
• D. Pineal cyst

Correct answer: A. Craniopharyngioma

High-yield takeaway. A calcified suprasellar cystic mass in a child is classic for adamantinomatous craniopharyngioma.

Q2. A nonfunctioning calcified kidney with putty-like opacification on urinary tract imaging is classically associated with:

• A. Genitourinary tuberculosis
• B. Simple renal cyst
• C. Acute pyelonephritis
• D. Minimal change disease

Correct answer: A. Genitourinary tuberculosis

High-yield takeaway. A putty kidney is a classic late radiologic appearance of genitourinary tuberculosis.

Q3. After pelvic trauma, blood is seen at the urethral meatus. Before catheterization, the preferred investigation is:

• A. Retrograde urethrogram
• B. Barium swallow
• C. IV pyelogram only
• D. Hysterosalpingogram

Correct answer: A. Retrograde urethrogram

High-yield takeaway. Suspected urethral injury should be assessed with retrograde urethrography before urethral catheter placement.

Q4. Which imaging modality is most sensitive for early active sacroiliitis before changes are visible on plain radiographs?

• A. MRI
• B. Plain radiography
• C. Ultrasound
• D. Fluoroscopy

Correct answer: A. MRI

High-yield takeaway. MRI can detect marrow edema and active sacroiliitis before structural radiographic changes.

Q5. An anterior mediastinal mass containing fat, soft tissue and calcification in a young adult is most suggestive of:

• A. Thymoma
• B. Teratoma
• C. Lymphoma
• D. Bronchogenic cyst

Correct answer: B. Teratoma

High-yield takeaway. A mature teratoma can contain multiple tissue densities including fat and calcification.

Q6. A barium swallow in achalasia classically shows:

• A. Bird-beak narrowing at the gastroesophageal junction
• B. Apple-core lesion
• C. Corkscrew esophagus only in all cases
• D. Thumbprinting of colon

Correct answer: A. Bird-beak narrowing at the gastroesophageal junction

High-yield takeaway. Achalasia classically produces smooth distal tapering described as a bird-beak appearance.