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Neet pg pyq

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Here are NEET PG Previous Year Questions - Medicine (2020-2024) across all major topics, with answers and explanations:

NEET PG Medicine PYQs (2020-2024)

CARDIOLOGY

1. (NEET PG 2023) A 60-year-old man presents with chest pain radiating to the jaw. ECG shows ST elevation in leads II, III, aVF. Which artery is most likely occluded?
  • A) Left anterior descending
  • B) Right coronary artery
  • C) Left circumflex
  • D) Left main coronary artery
Answer: B) Right coronary artery Explanation: ST elevation in II, III, aVF = inferior MI. The RCA supplies the inferior wall of the left ventricle in ~80% of people (right-dominant circulation).
2. (NEET PG 2022) Which of the following is NOT a feature of cardiac tamponade?
  • A) Raised JVP
  • B) Hypotension
  • C) Muffled heart sounds
  • D) Wide pulse pressure
Answer: D) Wide pulse pressure Explanation: Beck's triad = raised JVP + hypotension + muffled heart sounds. Cardiac tamponade causes NARROW pulse pressure (not wide), due to reduced stroke volume.
3. (NEET PG 2021) A patient with mitral stenosis - the best indicator of severity is:
  • A) Loud S1
  • B) Opening snap
  • C) Length of mid-diastolic murmur
  • D) Pulmonary hypertension
Answer: C) Length of mid-diastolic murmur Explanation: In mitral stenosis, the longer the mid-diastolic murmur, the more severe the stenosis (larger gradient persists longer). S1 loudness and opening snap timing also correlate with severity, but murmur length is the best single indicator.
4. (NEET PG 2020) Wolff-Parkinson-White (WPW) syndrome - which drug is CONTRAINDICATED?
  • A) Flecainide
  • B) Adenosine
  • C) Digoxin
  • D) Procainamide
Answer: C) Digoxin Explanation: In WPW, digoxin (and verapamil) are contraindicated because they slow AV nodal conduction while accelerating conduction through the accessory pathway, potentially causing life-threatening ventricular fibrillation.

RESPIRATORY

5. (NEET PG 2023) A patient with COPD has PaO2 of 55 mmHg and PaCO2 of 50 mmHg. The most appropriate long-term therapy is:
  • A) Bronchodilators
  • B) Long-term oxygen therapy (LTOT)
  • C) Inhaled corticosteroids
  • D) Pulmonary rehabilitation
Answer: B) Long-term oxygen therapy (LTOT) Explanation: LTOT is indicated when PaO2 ≤55 mmHg (or ≤60 mmHg with cor pulmonale/polycythemia). It is the only therapy proven to improve survival in COPD with respiratory failure.
6. (NEET PG 2022) Which lung cancer is most centrally located and associated with smoking and PTH-related peptide (PTHrP) secretion?
  • A) Adenocarcinoma
  • B) Small cell carcinoma
  • C) Squamous cell carcinoma
  • D) Large cell carcinoma
Answer: C) Squamous cell carcinoma Explanation: Squamous cell carcinoma is centrally located, strongly associated with smoking, and produces PTHrP causing hypercalcemia. Small cell produces ACTH/ADH (not PTHrP). Adenocarcinoma is peripheral.
7. (NEET PG 2021) A 35-year-old woman with fever, night sweats, and hilar lymphadenopathy. Serum ACE is elevated. Most likely diagnosis?
  • A) Tuberculosis
  • B) Sarcoidosis
  • C) Lymphoma
  • D) Histoplasmosis
Answer: B) Sarcoidosis Explanation: Elevated serum ACE + bilateral hilar lymphadenopathy in a young adult = classic sarcoidosis. ACE is produced by epithelioid granulomas. TB rarely causes bilateral hilar LAP.

NEPHROLOGY

8. (NEET PG 2023) A patient develops nephrotic syndrome. Biopsy shows diffuse effacement of podocyte foot processes with no immune deposits. Diagnosis?
  • A) Membranous nephropathy
  • B) Focal segmental glomerulosclerosis (FSGS)
  • C) Minimal change disease
  • D) IgA nephropathy
Answer: C) Minimal change disease Explanation: Minimal change disease - LM normal, EM shows foot process effacement, IF negative (no immune deposits). Most common nephrotic syndrome in children. Responds to steroids.
9. (NEET PG 2022) In chronic kidney disease, the earliest electrolyte abnormality is:
  • A) Hyperkalemia
  • B) Hyperphosphatemia
  • C) Hypocalcemia
  • D) Hypernatremia
Answer: B) Hyperphosphatemia Explanation: As GFR falls, phosphate excretion decreases first. This leads to hyperphosphatemia, which then drives secondary hyperparathyroidism and hypocalcemia. Hyperkalemia is a later manifestation.

NEUROLOGY

10. (NEET PG 2024) A patient presents with sudden onset severe headache ("thunderclap headache"). CT scan is normal. Next best step?
  • A) MRI brain
  • B) Lumbar puncture
  • C) CT angiography
  • D) Start sumatriptan
Answer: B) Lumbar puncture Explanation: Thunderclap headache with normal CT - LP is mandatory to look for xanthochromia (subarachnoid hemorrhage). CT detects SAH in ~95% within 6 hours, but LP is needed if CT is negative to rule out SAH definitively.
11. (NEET PG 2023) A 70-year-old develops sudden-onset unilateral facial weakness involving the forehead, with inability to close the eye. Most likely diagnosis?
  • A) UMN facial palsy (stroke)
  • B) Bell's palsy (LMN facial palsy)
  • C) Ramsay Hunt syndrome
  • D) Acoustic neuroma
Answer: B) Bell's palsy (LMN facial palsy) Explanation: LMN facial palsy involves ALL branches including forehead (forehead sparing occurs in UMN lesions because the forehead receives bilateral cortical input). Bell's palsy is the most common LMN cause.
12. (NEET PG 2021) Drug of choice for absence seizures:
  • A) Phenytoin
  • B) Carbamazepine
  • C) Ethosuximide
  • D) Phenobarbitone
Answer: C) Ethosuximide Explanation: Ethosuximide is DOC for pure absence seizures (blocks T-type calcium channels in thalamic neurons). Valproate is used if absence + other seizure types coexist. Phenytoin and carbamazepine can WORSEN absence seizures.

ENDOCRINOLOGY

13. (NEET PG 2024) A patient has hypertension, hypokalemia, and metabolic alkalosis. Plasma renin is low. Most likely diagnosis?
  • A) Renovascular hypertension
  • B) Primary hyperaldosteronism (Conn's syndrome)
  • C) Cushing's syndrome
  • D) Pheochromocytoma
Answer: B) Primary hyperaldosteronism (Conn's syndrome) Explanation: Low renin + high aldosterone + hypokalemia + metabolic alkalosis = primary hyperaldosteronism. Renovascular HTN has HIGH renin. Cushing's has cortisol excess with different hormonal profile.
14. (NEET PG 2022) In diabetic ketoacidosis (DKA), which electrolyte is MOST urgently needed?
  • A) Sodium
  • B) Potassium
  • C) Bicarbonate
  • D) Phosphate
Answer: B) Potassium Explanation: In DKA, total body potassium is depleted (lost in urine). Serum K+ may appear normal/high initially due to acidosis-driven shift out of cells. Once insulin is started, K+ drops rapidly. Potassium replacement must begin before/with insulin to avoid life-threatening hypokalemia.

GASTROENTEROLOGY

15. (NEET PG 2023) A patient with jaundice - bilirubin is elevated, urine bilirubin positive, urine urobilinogen absent. Most likely diagnosis?
  • A) Hemolytic jaundice
  • B) Hepatocellular jaundice
  • C) Obstructive jaundice
  • D) Gilbert's syndrome
Answer: C) Obstructive jaundice Explanation: In obstructive jaundice: conjugated bilirubin elevated (water soluble, appears in urine = dark urine), bile cannot reach intestine so urobilinogen is absent from urine and stool (pale stool). Hemolytic jaundice has elevated urobilinogen.
16. (NEET PG 2021) Which hepatitis virus is associated with hepatocellular carcinoma and has a circular partially double-stranded DNA genome?
  • A) Hepatitis A
  • B) Hepatitis B
  • C) Hepatitis C
  • D) Hepatitis E
Answer: B) Hepatitis B Explanation: HBV has a partially double-stranded DNA genome (hepadnavirus), integrates into host DNA, and is strongly associated with HCC. HCV (RNA virus) also causes HCC but via cirrhosis only, not direct DNA integration.

HEMATOLOGY

17. (NEET PG 2022) A patient has anemia with MCV 110 fL, hypersegmented neutrophils, and normal serum B12. Most likely diagnosis?
  • A) Iron deficiency anemia
  • B) Folate deficiency anemia
  • C) Pernicious anemia
  • D) Aplastic anemia
Answer: B) Folate deficiency anemia Explanation: Megaloblastic anemia with normal B12 = folate deficiency. Both B12 and folate deficiency cause macrocytosis + hypersegmented neutrophils, but B12 level is normal here. Common in alcoholics, pregnant women, and those on methotrexate.
18. (NEET PG 2020) Hemophilia A - which factor is deficient?
  • A) Factor VII
  • B) Factor VIII
  • C) Factor IX
  • D) Factor XI
Answer: B) Factor VIII Explanation: Hemophilia A = Factor VIII deficiency (X-linked recessive). Hemophilia B = Factor IX deficiency. Both present with prolonged aPTT, normal PT, and hemarthrosis.

RHEUMATOLOGY

19. (NEET PG 2023) Anti-dsDNA antibody is most specific for:
  • A) Rheumatoid arthritis
  • B) Systemic lupus erythematosus (SLE)
  • C) Sjogren's syndrome
  • D) Systemic sclerosis
Answer: B) SLE Explanation: Anti-dsDNA and anti-Smith (anti-Sm) are most specific for SLE. ANA is sensitive but not specific. Anti-dsDNA also correlates with disease activity and nephritis in SLE.
20. (NEET PG 2024) A patient with rheumatoid arthritis is started on methotrexate. Which supplement must be co-prescribed?
  • A) Vitamin B12
  • B) Folic acid
  • C) Vitamin D
  • D) Iron
Answer: B) Folic acid Explanation: Methotrexate is a folate antagonist. Folic acid (5 mg/week, on non-MTX days) is co-prescribed to reduce side effects (mucositis, nausea, hepatotoxicity, megaloblastic anemia) without reducing efficacy.

INFECTIOUS DISEASES

21. (NEET PG 2022) The Weil-Felix test is used for diagnosis of:
  • A) Typhoid
  • B) Brucellosis
  • C) Rickettsial infections
  • D) Leptospirosis
Answer: C) Rickettsial infections Explanation: Weil-Felix test uses Proteus species agglutination as a proxy for Rickettsia antibodies (cross-reactive antigens). OX-19 and OX-2 are positive in typhus; OX-K is positive in scrub typhus.
22. (NEET PG 2021) A patient returning from sub-Saharan Africa has fever with a periodicity of 48 hours. Thick blood smear shows ring forms and banana-shaped gametocytes. Diagnosis?
  • A) Plasmodium vivax
  • B) Plasmodium malariae
  • C) Plasmodium falciparum
  • D) Plasmodium ovale
Answer: C) Plasmodium falciparum Explanation: Banana-shaped (crescent-shaped) gametocytes = pathognomonic for P. falciparum. It causes tertian fever (48h cycle) and is the most deadly species. P. vivax and P. ovale also cause 48h cycles but have different morphology (Schuffner's dots, ameboid trophozoites).

QUICK SUMMARY TABLE

YearTopicKey Point
2024SAHThunderclap HA + normal CT → LP for xanthochromia
2024Conn's syndromeLow renin, hypokalemia, metabolic alkalosis
2024MethotrexateAlways co-prescribe folic acid
2023Inferior MIST elevation II, III, aVF → RCA
2023SarcoidosisBilateral hilar LAP + elevated ACE
2023MCDFoot process effacement, no immune deposits
2023Anti-dsDNAMost specific for SLE
2022Cardiac tamponadeNarrow (not wide) pulse pressure
2022Squamous cell CACentral, PTHrP → hypercalcemia
2022Weil-FelixRickettsial infections (OX-K = scrub typhus)
2021Bell's palsyLMN - forehead involved
2021EthosuximideDOC for absence seizures
2020WPWDigoxin contraindicated
2020Hemophilia AFactor VIII deficiency
Tips for Medicine NEET PG:
  • Focus on one-liners and pathognomonic findings
  • Know contraindications of common drugs (digoxin in WPW, NSAIDs in CKD, etc.)
  • ECG pattern recognition is heavily tested
  • Nephrotic vs. nephritic differentiation is a recurring theme
  • Always know the DOC for each condition
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