Medicine top neet pg questions with explanation

Reading File

Finding Sources

Reading File

Finding Sources

Reading File

Here is a comprehensive set of top NEET PG Medicine MCQs with detailed explanations, drawn from authoritative textbooks including Harrison's 22E, Frameworks for Internal Medicine, and Rosen's Emergency Medicine.

🩺 Top NEET PG Medicine Questions with Explanations

Q1. Nephrotic Syndrome

A 30-year-old man presents with bilateral pedal edema, frothy urine, and anasarca. Labs show proteinuria of 4.2 g/day, albumin 1.8 g/dL, cholesterol 280 mg/dL. Which is NOT a feature of nephrotic syndrome?

A. Proteinuria >3.5 g/day
B. Hypoalbuminemia
C. Hyperlipidemia
D. Hematuria with RBC casts ✅

Answer: D - Hematuria with RBC casts

Explanation: Nephrotic syndrome = "Protein loss triad":

Proteinuria >3.5 g/day (massive)
Serum albumin <2.5 g/dL
Hyperlipidemia (total cholesterol usually >180 mg/dL)

RBC casts are the hallmark of nephritic syndrome (e.g., post-streptococcal GN, IgA nephropathy), NOT nephrotic syndrome. In nephrotic syndrome, the glomerular basement membrane, endothelial cells, and podocytes lose their charge and size selectivity, allowing large proteins like albumin to escape.

Mnemonic: Nephrotic = Protein lost, fat kept (lipids rise). Nephritic = Blood (hematuria, RBC casts).

Complications to remember:

Thromboembolism (loss of antithrombin III, proteins C and S in urine; most common site = renal vein thrombosis)
Infection (loss of IgG, reduced complement; e.g., spontaneous bacterial peritonitis with Streptococcus pneumoniae)
Muehrcke's lines (white transverse nail bands)

- Frameworks for Internal Medicine

Q2. Thyroid Storm

A 45-year-old woman with known Graves' disease presents to ER with temperature 40.2°C, heart rate 148/min, agitation, and vomiting after missing her medications. What is the correct sequence of treatment for thyroid storm?

A. Iodine → PTU → Beta blocker → Steroids
B. PTU → Iodine → Beta blocker → Steroids ✅
C. Beta blocker → PTU → Iodine → Steroids
D. Steroids → PTU → Iodine → Beta blocker

Answer: B - PTU first, then Iodine

Explanation: The order matters critically in thyroid storm:

Step	Drug	Why
1st	PTU (Propylthiouracil)	Blocks NEW thyroid hormone synthesis AND peripheral T4→T3 conversion
2nd	Iodine (Lugol's, 1-2 hours AFTER PTU)	Blocks thyroid hormone RELEASE (Wolff-Chaikoff effect). Given AFTER PTU so new hormone is not synthesized from the iodine load
3rd	Beta blocker (Propranolol)	Controls heart rate and also blocks T4→T3 conversion
4th	Corticosteroids (Hydrocortisone/Dexamethasone)	Prevent adrenal crisis, inhibit T4→T3 conversion

Why PTU before Iodine? If iodine is given first, the excess iodine can be used as substrate to make even MORE thyroid hormone before the synthesis is blocked - this is the Jod-Basedow effect.

Key fact: PTU is preferred over Methimazole in thyroid storm because PTU also blocks peripheral conversion of T4 to T3 (the active form).

- Rosen's Emergency Medicine

Q3. SIADH (Syndrome of Inappropriate ADH)

A 62-year-old smoker presents with confusion. Labs: Na 122 mEq/L, serum osmolality 258 mOsm/kg, urine osmolality 620 mOsm/kg, urine Na 55 mEq/L. Chest X-ray shows hilar mass. What is the diagnosis?

A. Psychogenic polydipsia
B. SIADH ✅
C. Adrenal insufficiency
D. Cerebral salt wasting

Answer: B - SIADH

Explanation: SIADH diagnostic criteria (all must be present):

Serum hypo-osmolality ≤275 mOsm/kg ✓ (258 here)
Hyponatremia ≤135 mEq/L ✓ (122 here)
Urine osmolality >100 mOsm/kg (inappropriately concentrated) ✓ (620 here)
Urine Na >40-60 mEq/L ✓ (55 here)
Euvolemic (no edema, no volume depletion)

Differentiating points:

Feature	SIADH	Psychogenic Polydipsia	Hypovolemic Hyponatremia
Urine Na	>40 mEq/L	<20 mEq/L	<10-20 mEq/L
Urine osmolality	High (250-1400)	Low (<plasma)	High
Volume status	Euvolemic	Euvolemic	Hypovolemic

The hilar mass = Small cell lung cancer = #1 cause of ectopic ADH/SIADH. Other causes: CNS disorders, pulmonary TB, drugs (chlorpropamide, carbamazepine, SSRIs, vincristine).

Treatment: Fluid restriction (first-line). Demeclocycline or vaptans (tolvaptan) for chronic cases. Never correct Na faster than 8-10 mEq/L per 24 hours (risk of osmotic demyelination syndrome/central pontine myelinolysis).

- Tietz Textbook of Laboratory Medicine

Q4. Wells Score for Pulmonary Embolism

A 55-year-old post-operative patient develops sudden dyspnea, pleuritic chest pain, and tachycardia (HR 108/min). He has no prior DVT/PE history, no hemoptysis, no malignancy, and PE is the most likely diagnosis. What is his Wells score?

A. 3
B. 4.5 ✅
C. 6
D. 7.5

Answer: B - 4.5 (Intermediate probability)

Explanation - Wells Criteria for PE (from Harrison's 22E):

Clinical Feature	Points
Clinical signs of DVT	3
Alternative diagnosis less likely than PE	3
Heart rate >100 bpm	1.5
Immobilization ≥3 days or surgery in prior 4 weeks	1.5
Prior DVT or PE	1.5
Hemoptysis	1
Malignancy (treatment within 6 months)	1

Scoring:

This patient: PE most likely (+3) + HR >100 (+1.5) + post-op (+1.5) = 4.5 points

Score	Probability
>6.0	High
2.0-6.0	Intermediate ✓
<2.0	Low

Management by probability:

Low: D-dimer (if negative, PE excluded)
Intermediate: CT Pulmonary Angiography (CTPA) - gold standard
High: Start anticoagulation, confirm with CTPA

- Harrison's Principles of Internal Medicine 22E

Q5. Wilson Disease

A 16-year-old boy presents with jaundice, tremors, and behavioral changes. Slit-lamp exam shows golden-brown rings at the corneal periphery. Which finding is MOST diagnostic?

A. Elevated serum copper
B. Elevated serum ceruloplasmin
C. Decreased serum ceruloplasmin with increased 24-hour urine copper ✅
D. Decreased 24-hour urine copper

Answer: C

Explanation: Wilson disease = ATP7B gene mutation (autosomal recessive) causing failure of:

Copper secretion into bile
Copper incorporation into ceruloplasmin

Lab findings in Wilson Disease:

Parameter	Result
Serum ceruloplasmin	LOW (<20 mg/dL)
Total serum copper	LOW (bound to ceruloplasmin)
Free (non-ceruloplasmin) copper	HIGH
24-hr urine copper	HIGH (>100 mcg/day)
Liver copper content	HIGH

Kayser-Fleischer rings (golden-brown corneal deposits of copper) = pathognomonic for neurological Wilson disease.

Triad: Liver disease + Neuropsychiatric symptoms + Kayser-Fleischer rings.

Treatment: D-penicillamine (chelating agent - first-line), Trientine, Zinc acetate (blocks intestinal copper absorption). Liver transplant for fulminant hepatic failure.

- Tietz Textbook of Laboratory Medicine; Yamada's Textbook of Gastroenterology

Q6. Rheumatoid Arthritis

A 40-year-old woman presents with symmetric joint pain involving both MCPs, PIPs, and wrists for 8 weeks. Morning stiffness lasts 2 hours. RF is positive. Which ACR criterion is she missing that is needed to diagnose RA?

A. Duration criterion (met - >6 weeks ✓)
B. At least 4 of 7 ACR criteria must be fulfilled
C. Imaging changes (erosions on X-ray)
D. She meets RA criteria already ✅

Answer: D - She already meets RA criteria

Explanation - ACR 1987 Criteria for RA (4/7 required, criteria 1-4 must be present ≥6 weeks):

Morning stiffness >1 hour ✓ (2 hours)
Arthritis of 3 or more joint areas ✓ (MCPs, PIPs, wrists = 3+)
Arthritis of hand joints (MCP, PIP, or wrist) ✓
Symmetric arthritis ✓
Rheumatoid nodules
Serum RF positive ✓
Radiographic changes

This patient scores: 1+2+3+4+6 = 5 criteria - RA is diagnosed.

Key NEET facts:

PIPs and MCPs involved - DIP spared (DIP involvement = OA or Psoriatic arthritis)
Morning stiffness >1 hour = RA (OA = <30 min)
Pannus formation erodes cartilage (synovitis → pannus → bone erosion)
Anti-CCP antibody = most specific for RA (>95% specificity)
RF = sensitive but not specific (also positive in SLE, Sjogren's, infections)

Q7. Diabetes - Key High-Yield Fact

Which insulin has the longest duration of action and is used once daily as basal insulin?

A. Regular insulin (6-8 hours)
B. NPH insulin (12-18 hours)
C. Insulin Glargine ✅ (20-24 hours, peakless)
D. Insulin Lispro (3-5 hours)

Answer: C - Insulin Glargine

Insulin Duration Summary (NEET Favorite):

Insulin	Onset	Peak	Duration
Lispro/Aspart (rapid)	10-15 min	1-2 hr	3-5 hr
Regular (short)	30 min	2-4 hr	6-8 hr
NPH (intermediate)	1-3 hr	5-8 hr	12-18 hr
Glargine (long)	1-2 hr	Peakless	20-24 hr
Detemir (long)	1-3 hr	Minimal	18-22 hr
Degludec (ultra-long)	30-90 min	Peakless	>42 hr

Key: Glargine cannot be mixed with other insulins (acidic pH). It is the prototype basal insulin.

- Katzung's Basic and Clinical Pharmacology 16E; Guyton & Hall Medical Physiology

Quick Revision: NEET PG Medicine High-Yield One-Liners

Topic	Key Fact
Conn syndrome	Primary hyperaldosteronism - HTN + hypokalemia + metabolic alkalosis; low renin
Addison's disease	Hyperpigmentation + hyponatremia + hyperkalemia + hypotension
Cushing syndrome	Most common cause overall = exogenous steroids; most common endogenous = pituitary adenoma (Cushing's disease)
Acute pancreatitis	Most common cause = gallstones; Cullen sign (periumbilical bruising), Grey Turner sign (flank bruising)
Acromegaly	IGF-1 is the best screening test; GH suppression with oral glucose = gold standard
Myasthenia Gravis	Anti-AChR antibodies; Edrophonium (Tensilon) test; thymoma association
Infective Endocarditis	Duke criteria; most common organism = Streptococcus viridans (native valve); IVDU = Staph aureus
Aortic stenosis	Exertional syncope/angina/dyspnea triad; narrow pulse pressure; slow rising pulse
Liver cirrhosis	Spider nevi, caput medusae, gynecomastia, asterixis; portal HTN
SLE	Butterfly rash, anti-dsDNA (most specific), anti-Smith (most specific), anti-Ro/La (neonatal lupus, Sjogren's)

These cover the most repeatedly tested NEET PG Medicine topics. The Wells score table is from Harrison's Principles of Internal Medicine 22E, the thyroid storm protocol from Rosen's Emergency Medicine, and SIADH criteria from the Tietz Textbook of Laboratory Medicine. Want me to expand any specific topic further (cardiology, nephrology, endocrinology, etc.)?

This is a shared conversation. Sign in to Orris to start your own chat.