NEET-SS Medical Group Guide and Cross-Group Clinical Review Study Guide

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A patient's creatinine increases from 0.7 to 1.1 mg/dL over 36 hours after surgery. Recognise AKI from the 0.4 mg/dL increase, even though the final concentration may appear unremarkable in isolation.

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A 70-kg adult produces 280 mL over 14 hours. Dividing 280 by 70 and then by 14 gives approximately 0.29 mL/kg/hour. The documented duration establishes stage 2 by urine output, not stage 3.

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Creatinine rises from 2.0 to 4.2 mg/dL within 48 hours. The acute increase establishes AKI, and the final concentration establishes stage 3 despite being only 2.1 times baseline. Separately, creatinine rising from 1.0 to 1.7 mg/dL with 13 hours of anuria is stage 3 by urine output.

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If stroke volume rises from 60 to 66 mL during passive leg raising, the increase is 10%, meeting the FRESH criterion. A rise from 60 to 64 mL is approximately 6.7% and does not meet it. In a responsive patient, assess ongoing hypoperfusion, such as delayed capillary refill, alongside fluid tolerance before considering another bolus.

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A patient develops abrupt aphasia and right-sided weakness. Initial CT excludes haemorrhage but shows no infarct. Continue the acute stroke pathway and assess the cerebral vessels rather than attributing the deficits to a normal scan.

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A patient with rising creatinine develops recurrent hyperkalaemia despite temporising treatment and worsening pulmonary oedema despite appropriate medical management. Recognise the uncontrolled complications as the reason for urgent kidney replacement therapy rather than waiting for another creatinine measurement.

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A patient remains above the agreed glycaemic target despite tolerated metformin and an SGLT2 inhibitor. Recognise a long-acting GLP-1 receptor agonist as the recommended additional class rather than duplicating an existing drug class.

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A patient requiring kidney support has confirmed HIT and no severe liver failure. Stop systemic and circuit heparin and consider argatroban rather than substituting low-molecular-weight heparin.

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A patient with established diabetic kidney disease has eGFR 38 mL/min/1.73 m² and urine ACR 180 mg/g documented over six months. Record diabetic kidney disease, G3b A2: diabetes identifies the established cause, 38 falls within G3b, and 180 falls within A2. An eGFR of 52 would instead indicate G3a.

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Before immunosuppressive treatment, a patient's triple panel shows negative HBsAg and positive anti-HBs and total anti-HBc. Record resolved infection and assess reactivation risk rather than documenting vaccination immunity alone.

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An adult with established CKD and heart failure has a low ACR. Recognise that low albuminuria does not remove the heart-failure indication when evaluating suitability for SGLT2 inhibitor treatment.

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Tumour sequencing identifies a pathogenic BRCA2 variant in a patient with cancer. Explain that this finding may affect tumour treatment, while germline assessment is needed before drawing conclusions about inherited risk for the patient's children.

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An ultrasound obtained for an unrelated concern reveals gallbladder stones in a patient who has never experienced biliary pain or a stone complication. Explain why immediate stone-directed intervention is generally unnecessary and review symptoms requiring reassessment.

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A patient has jaundice and a confirmed common bile duct stone. Recognise ERCP as a procedure capable of clearing the duct, while separately considering the appropriate management of the gallbladder after the duct problem is addressed.

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During staging of a clinically node-negative breast cancer, mapping identifies two first draining axillary nodes. Both can be sentinel nodes; their pathological examination supplies regional information without assuming every axillary node must initially be removed.

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A learner interprets a negative sentinel biopsy as proof that regional spread is impossible. Correct the inference: the result is reassuring staging evidence, but a false-negative result remains possible if other regional nodes contain disease.

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After a tibial fracture, a patient develops escalating pain despite analgesia and marked pain when the toes are passively moved. Escalate urgently for assessment even though the foot remains warm and pedal pulses are palpable.

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A patient's diastolic pressure is 62 mmHg and measured compartment pressure is 38 mmHg. The differential is 24 mmHg, an increased-risk result that strengthens concern and requires urgent interpretation with the injury and examination findings.

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Soon after fracture fixation, progressive compartment syndrome persists despite releasing restrictive dressings. Arrange immediate operative decompression; this is the acute, evolving pathway.

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A newborn fails hearing screening and is assessed at 12 days of age. Obtain appropriate CMV testing promptly while the congenital diagnostic window remains open rather than postponing testing until a later routine follow-up visit.

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A 10-day-old infant has a positive saliva CMV PCR collected immediately after breastfeeding. Arrange urine confirmation promptly and review the collection timing rather than concluding that the saliva result alone definitively establishes congenital CMV infection.

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A six-week-old infant develops nasal symptoms, takes substantially less milk and has pauses in breathing without fever. Treat the apnoea and feeding deterioration as important warning features rather than dismissing RSV because the infant is afebrile.

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Two infants have similar nasal symptoms, but one was born very prematurely and has chronic lung disease. Recognise the greater vulnerability while assessing both infants for current respiratory effort, feeding tolerance and signs of dehydration.

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An unaffected woman has a confirmed germline pathogenic BRCA1 variant after family-based assessment. Explain the distinction between increased future susceptibility and a current cancer diagnosis, then discuss gene-specific prevention and reproductive implications through specialist counselling.

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A woman with a BRCA2 VUS requests ovary removal solely because the report contains the word variant. Explain the uncertainty and base risk assessment on her history rather than converting the VUS into a positive pathogenic result.

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A pathogenic BRCA carrier who has completed childbearing asks whether normal annual ultrasound eliminates the need to discuss surgery. Explain the limits of screening and review risk-reducing surgery, menopause consequences and the persistence of some residual risk.

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A patient with established malignant hyperthermia susceptibility requires surgery. Review the proposed anaesthetic list and identify sevoflurane and succinylcholine as triggers, prompting selection of a complete nontriggering technique and appropriate equipment preparation.

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An anaesthetic plan for an MH-susceptible patient uses propofol, fentanyl and rocuronium. Recognise these agents as nontriggering, then evaluate the rest of the technique and equipment rather than assuming drug selection alone completes all preparation.

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An MH-susceptible patient is offered a local anaesthetic procedure with nitrous oxide where appropriate. Explain that both are nontriggering, while ensuring that any additional sedation or contingency general anaesthesia also avoids triggering agents.

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A patient develops sudden aphasia and unilateral weakness. Initial noncontrast CT shows no haemorrhage and no obvious infarction. Continue the acute ischaemic stroke assessment rather than interpreting the absence of a visible infarct as exclusion of stroke.

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A patient with a disabling acute neurological deficit has no haemorrhage on initial CT. The team needs to establish whether a proximal cerebral artery is occluded. Angiographic imaging directly addresses that vessel-level question.

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A patient presents with an uncertain stroke onset time and a demonstrated arterial occlusion. Perfusion imaging is requested to assess the tissue-level effect and potential salvageable region, adding information that the vessel image alone cannot provide.

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Pleural protein is 3.6 g/dL and serum protein is 6.0 g/dL. The ratio is 0.60, meeting an exudate criterion. Continue investigating the cause instead of assuming that this calculation alone diagnoses a malignant effusion.

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Pleural LDH is 210 U/L and serum LDH is 300 U/L, giving a ratio of 0.70. Classify the effusion as exudative even if the protein ratio is only 0.45, because one positive criterion suffices.

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The laboratory serum LDH upper limit is 240 U/L, while the patient's serum LDH is 180 U/L. The relevant threshold is 160 U/L. Pleural LDH of 175 U/L therefore meets the absolute LDH criterion.

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A patient with pneumonia has an accessible pleural collection and nonpurulent fluid with pH 7.12 from a correctly handled sample. Recognise this as a high-risk pleural infection finding supporting drainage alongside antimicrobial treatment.

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A clinician reviews negative HBsAg, positive anti-HBs and negative total anti-HBc in a patient with documented vaccination. Explain that the absence of core antibody supports vaccine-induced immunity rather than evidence of a previous natural infection.

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Before immunosuppressive therapy, a patient has negative HBsAg but positive anti-HBs and total anti-HBc. Identify resolved natural infection and ensure the previous exposure is considered in reactivation risk assessment rather than labelling the pattern vaccination alone.

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A patient with previously documented chronic hepatitis B develops a marked biochemical flare and positive IgM anti-HBc. Consider a flare or reactivation rather than automatically classifying the illness as a newly acquired primary acute infection.

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A trainee describes HER2 IHC as a direct gene-copy assay. Correct the description: IHC evaluates protein staining, while ISH evaluates amplification and can clarify an equivocal result when the testing algorithm calls for it.

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An invasive breast tumour is reported as HER2 IHC 2+, with ISH pending. Describe the result as equivocal and await the integrated classification rather than telling the patient that HER2 amplification has already been demonstrated.

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A breast tumour shows intense complete membrane staining in 70% of invasive cells. This pattern supports IHC 3+, unlike a specimen with weak incomplete staining or intense staining confined to only a very small cell population.

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A tumour is ER-positive and HER2-positive. Report both findings rather than assuming HER2 positivity makes endocrine sensitivity irrelevant. The treating team needs the combined profile to evaluate appropriate systemic treatment options for the disease setting.

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An older inpatient who usually converses reliably becomes inattentive, drowsy and intermittently disoriented over one day. Compare with the baseline supplied by family and assess for delirium despite the absence of disruptive agitation.

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A previously attentive patient becomes confused after surgery while receiving several new medicines and drinking poorly. Review medications and investigate clinical contributors alongside the mental-state assessment rather than treating the confusion as an isolated psychiatric disorder.

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An older postoperative patient becomes inattentive and frightened overnight, cannot hear staff, has missing glasses, poor oral intake and untreated pain. Restore sensory aids, explain the surroundings, involve familiar family, assess and treat pain, support hydration and nutrition, arrange safe daytime mobilisation, protect sleep and reassess device necessity. Continue evaluating medical causes. If frightening hallucinations remain severely distressing despite these measures and de-escalation, medication may then be considered under the stated criteria.

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A sensitive CYP substrate has AUC 100 units alone and 650 units with another drug. The ratio is 6.5, supporting strong inhibition for the studied pathway and prompting assessment of the substrate's clinical exposure risks.

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A sensitive substrate's AUC decreases from 100 to 15 units during coadministration. The 85% reduction supports strong induction for the studied enzyme and raises concern about inadequate exposure when the parent compound supplies the desired effect.

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A learner predicts a sixfold increase for every medicine given with a strong CYP3A inhibitor. Challenge the inference: a drug minimally dependent on CYP3A may show a much smaller change than the sensitive substrate used for classification.

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An adult with tobacco exposure has persistent progressive hoarseness but no palpable neck mass. Arrange laryngeal evaluation rather than waiting for advanced airway symptoms or lymphadenopathy before considering an underlying glottic lesion.

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A confirmed glottic cancer is confined to both vocal cords, with normal movement and no extension beyond the glottis. Classify the primary tumour as T1b rather than upgrading it solely because the lesion crosses between cords.

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A glottic tumour remains within the larynx but fixes a vocal cord. Recognise a T3 feature rather than T2 impaired mobility, then assess nodal and distant disease separately before assigning an overall stage group.

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An adult with septic shock remains hypotensive after initial fluid treatment and reassessment. Start norepinephrine as the first-line vasopressor while continuing cause-directed care and monitoring clinical perfusion rather than repeatedly administering fluid without reassessing its likely benefit.

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An adult with sepsis needs initial volume expansion without a separate indication for another fluid type. Select a crystalloid, usually a balanced solution, and reassess response and congestion before deciding whether further fluid is beneficial.

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A patient with ARDS weighs 110 kg but has a predicted body weight of 60 kg. An initial 6 mL/kg calculation gives 360 mL, not 660 mL, with subsequent adjustment guided by the ventilation strategy.

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An ARDS patient has peak pressure 40 cm H2O but plateau pressure 25 cm H2O during a valid measurement. Recognise that peak pressure alone does not establish excessive plateau pressure; evaluate airway resistance and the wider ventilatory picture.

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A newly diagnosed invasive breast cancer is ER-positive. Explain why endocrine therapy enters treatment planning, while making clear that the biomarker does not alone determine whether surgery, chemotherapy, radiotherapy or other systemic treatment is also needed.

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A breast tumour has IHC 2+ staining and subsequent ISH demonstrates amplification. The integrated result can support HER2-directed treatment planning, whereas the earlier equivocal protein result alone could not establish the same conventional HER2-positive classification.

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A tumour is ER-negative, PR-negative and HER2-negative by completed testing. Identify the triple-negative profile, then recognise that other clinically appropriate biomarker assessments may still influence treatment rather than concluding that all systemic options are unavailable.

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Years after an ER-positive, HER2-negative primary tumour, a patient develops an accessible liver lesion. Biopsy can confirm metastatic breast cancer and provide current ER, PR and HER2 results. If technically reliable testing shows HER2 positivity, consider that result in selecting systemic treatment rather than automatically carrying forward the original HER2-negative classification.