NEET-PG 2012 Practice Questions

Q: Calcium homeostasis disturbance is the predominant pathophysiological mechanism in

Malignant hyperthermia. ***Malignant hyperthermia*** - Malignant hyperthermia is caused by a genetic defect in the **ryanodine receptor (RYR1)** in skeletal muscle, leading to an uncontrolled release of **intracellular calcium** from the sarcoplasmic reticulum. - This excessive calcium release results in sustained muscle contraction, increased metabolism, and a rapid rise in body temperature. *Duchenne Muscular Dystrophy (DMD)* - DMD is primarily caused by a mutation in the **dystrophin gene**, which leads to the absence or severe deficiency of the **dystrophin protein**. - This deficiency results in muscle fiber fragility, cycles of degeneration and regeneration, and eventual replacement of muscle with fibrous and fatty tissue, rather than a primary calcium homeostasis disturbance. *Limb Girdle Muscular Dystrophy* - This group of disorders is characterized by progressive weakness and wasting of muscles, primarily affecting the **shoulders and hips**. - The pathophysiology involves genetic defects in various proteins that are crucial for muscle function and integrity, such as **sarcoglycans** or **calpain-3**, not primarily calcium dysregulation. *Tibial Muscular Dystrophy* - Tibial muscular dystrophy is a rare, late-onset disorder characterized by progressive weakness of the **anterior tibial muscles**. - It is typically caused by mutations in the **TTN gene**, encoding for the protein **titin**, which plays a vital role in muscle elasticity and structural integrity, rather than a primary calcium imbalance.

Q: Which of the following statements about Sickle Cell Anemia is FALSE?

Patients usually present before the age of 6 months. ***Patients usually present before the age of 6 months*** - This statement is **FALSE** because sickle cell anemia patients typically become symptomatic **after 6 months of age**, when **fetal hemoglobin (HbF)** levels decline. - **HbF is protective** against sickling, so symptoms like **dactylitis** and **splenic sequestration** usually manifest once HbF is replaced by HbS. *There is a positive correlation between HBS and polymerization of HBS* - This statement is **TRUE** as higher levels of **hemoglobin S (HbS)** lead to increased **polymerization** and sickling of red blood cells. - The **polymerization of deoxygenated HbS** is the primary pathophysiologic mechanism causing vaso-occlusive crises and hemolysis. *Recurrent infections is the most common cause of death* - This statement is **TRUE**, particularly in children with sickle cell anemia due to **functional asplenia** from repeated splenic infarctions. - **Splenic dysfunction** impairs clearance of **encapsulated bacteria**, increasing risk of severe infections like **pneumococcal sepsis** and **meningitis**. *Patients require frequent blood transfusions* - This statement is **TRUE** as **chronic transfusion therapy** is a standard treatment for managing severe complications and preventing stroke. - Transfusions help **suppress HbS production**, dilute existing sickle cells, and reduce the frequency of **vaso-occlusive crises**.

Q: Fibrosis of upper lobe is due to

ABPA. ***ABPA*** - **Allergic bronchopulmonary aspergillosis (ABPA)** is a hypersensitivity reaction to *Aspergillus* species, particularly *A. fumigatus*, which colonize the airways, and commonly leads to **upper lobe fibrosis** and **bronchiectasis**. - The chronic inflammation and recurrent immune responses result in progressive airway damage, characterized on imaging by centrilobular nodules, mucoid impaction, and ultimately **fibrosis in the upper lobes**. Other conditions causing similar upper lobe conglomerate masses include Progressive Massive Fibrosis (PMF) seen in coal worker's pneumoconiosis [1]. *Certain types of pneumonia* - While pneumonia can cause inflammation, it typically leads to **lobar consolidation** or diffuse infiltrates rather than specific upper lobe fibrosis. - **Resolution of pneumonia** usually occurs without significant fibrotic changes, unlike chronic conditions that predispose to fibrosis. *Bronchiectasis* - **Bronchiectasis** is a general term for permanent dilation of the bronchi, which can occur in any lobe, but alone **does not directly cause upper lobe fibrosis** as a primary etiology. - While it often coexists with conditions that cause fibrosis (like ABPA or CF), it's a consequence of airway damage, not the direct cause of the fibrotic process itself; it can however predispose to recurrent infections leading to scarring. *Rheumatoid arthritis* - **Rheumatoid arthritis** can cause interstitial lung disease, including **pulmonary fibrosis**, but it typically manifests as a **basilar or diffuse pattern** rather than predominantly upper lobe fibrosis [2]. - The fibrosis associated with RA-ILD is commonly of a **usual interstitial pneumonia (UIP)** or **non-specific interstitial pneumonia (NSIP)** pattern [2].

Q: Preferred treatment for menorrhagia in reproductive age group?

OCPs. ***OCPs*** - **Combined oral contraceptives (OCPs)** are a common and effective first-line treatment for menorrhagia in reproductive-aged women, particularly when contraception is also desired. - They work by stabilizing the **endometrial lining**, reducing menstrual blood loss and regulating cycles. *NOVA T* - NOVA T is a type of **copper IUD (intrauterine device)**, which is known to potentially *increase* menstrual bleeding and dysmenorrhea, making it unsuitable for menorrhagia. - Its primary function is contraception, not the management of heavy menstrual bleeding. *Cu IUD* - The **copper intrauterine device (Cu IUD)** is generally contraindicated in women with menorrhagia because it can exacerbate heavy menstrual bleeding. - While an effective contraceptive, it does not offer therapeutic benefits for managing heavy periods. *Hysterectomy* - **Hysterectomy** is a surgical procedure for removing the uterus and is considered a definitive treatment for menorrhagia. - However, it is an **invasive procedure** with irreversible loss of fertility, typically reserved for severe cases where conservative treatments have failed or when other uterine pathology is present.

Q: What is the primary pathology associated with Congenital Dislocation of the Hip (CDH)?

Shallow acetabulum. ***Shallow acetabulum*** - A **shallow or dysplastic acetabulum** is the primary pathological feature in CDH, leading to an unstable or dislocated femoral head. - This anatomical abnormality prevents the femoral head from seating properly, causing **instability** and potential **dislocation**. *Large head of femur* - While femoral head abnormalities can occur, a **disproportionately large femoral head** is not the primary or most common pathological feature causing CDH. - The issue primarily lies with the **acetabular socket** rather than the size of the femoral head itself. *Excessive retroversion* - **Femoral retroversion** (backward twisting of the femoral neck relative to the femoral condyles) can be a contributing factor or an associated finding, but it is not the primary anatomical defect. - The principal pathology is the **inadequate containment** of the femoral head by a poorly formed acetabulum. *Coxa vara deformity* - **Coxa vara** is a deformity where the angle between the head and shaft of the femur is decreased. - While it can be associated with or contribute to hip instability in some conditions, it is not the primary or defining pathological feature of CDH.

Q: Which of the following substances is known to cause predominantly sensory neuropathy?

Cisplatin. ***Cisplatin*** - **Cisplatin** is a platinum-based chemotherapy drug well-known for causing **dose-dependent peripheral neuropathy**, primarily affecting sensory neurons. - Patients often present with **numbness**, **tingling**, and **loss of proprioception** in a glove-and-stocking distribution. - This is the **most characteristic** drug for **predominantly sensory neuropathy** among chemotherapeutic agents. *Pyridoxine excess* - While **pyridoxine (vitamin B6) excess** can cause sensory neuropathy, it is less commonly observed as a primary cause compared to cisplatin in the context of drug-induced neuropathies. - High doses of pyridoxine can lead to **dorsal root ganglionopathy**, affecting sensory nerve fibers. *Suramin* - **Suramin** is an anthelmintic agent primarily used for treating sleeping sickness, and it is known to cause a variety of side effects, including **renal toxicity** and **neurological symptoms**. - While neurological side effects can occur, they are not typically characterized as a **predominantly sensory neuropathy** in the same way as cisplatin. *Vincristine* - **Vincristine** is a vinca alkaloid chemotherapy agent that causes peripheral neuropathy. - However, vincristine typically causes **mixed motor and sensory neuropathy** with prominent motor involvement (foot drop, wrist drop). - This differs from cisplatin's **predominantly sensory** presentation.

Q: Which amino acid-derived neurotransmitter is primarily targeted in the pharmacological treatment of depression?

Serotonin. ***Serotonin*** - **Serotonin** is an amino acid-derived neurotransmitter (from **tryptophan**) known to play a crucial role in mood regulation, sleep, appetite, and other functions, making it a primary target for **antidepressant medications**. - Medications like **Selective Serotonin Reuptake Inhibitors (SSRIs)** increase serotonin levels in the brain to alleviate symptoms of depression. *Histamine* - **Histamine** is an amino acid-derived neurotransmitter (from **histidine**) primarily involved in allergic reactions, inflammation, and regulating wakefulness. - While it has some central nervous system effects, its primary role is not directly in the treatment of **depression**. *Acetylcholine* - **Acetylcholine** is a neurotransmitter involved in muscle contraction, learning, memory, and attention, and is not derived from amino acids; it is synthesized from **choline** and acetyl-CoA. - It is not directly used for treating **depression**, although imbalances can play a role in cognitive aspects of some psychiatric disorders. *None of the options* - This option is incorrect because **Serotonin** is indeed an amino acid-derived neurotransmitter (from tryptophan) targeted for treating **depression**. - Many antidepressant drugs work by modulating **serotonergic pathways**.

Q: Which chamber enlargement shows a double right heart border with a wide subcarinal angle?

Left atrium. ***Left atrium*** - A **double right heart border** on a chest X-ray is a classic sign of **left atrial enlargement**, as the enlarged left atrium bulges into the right atrial silhouette. - The **wide subcarinal angle** (angle between the mainstem bronchi) also indicates left atrial enlargement, as the expanding left atrium pushes the bronchi apart. *Left ventricle* - **Left ventricular enlargement** primarily manifests as a **downward and leftward displacement of the apex** and increased cardiac silhouette on the left. - It does not typically cause a double right heart border or widening of the subcarinal angle. *Right atrium* - **Right atrial enlargement** usually presents as a **prominent right heart border** that extends further to the right than normal. - It does not result in a double right heart border or affect the subcarinal angle. *Right ventricle* - **Right ventricular enlargement** leads to an **anterior bowing of the sternum** (in severe cases) and an upward and leftward displacement of the cardiac apex. - It pushes the left ventricle posteriorly and does not produce a double right heart border or a wide subcarinal angle.

Q: Step ladder pattern of gas shadow is seen in

Intestinal obstruction. ***Intestinal obstruction*** - A **step-ladder pattern** of gas shadows is a classic radiological sign seen in **small bowel obstruction** due to dilated, fluid-filled loops of small bowel stacked on top of each other. - This pattern results from the accumulation of gas and fluid proximal to the obstruction, causing dilated bowel loops to arrange horizontally. *Gastric outlet obstruction* - This condition primarily results in a **dilated stomach** with fluid and gas, not typically a step-ladder pattern in the small bowel. - Vomiting is usually a prominent symptom, and imaging would show a large fluid-filled stomach. *Duodenal obstruction* - Causes dilatation of the stomach and duodenum, leading to a "**double-bubble sign**" (dilated stomach and proximal duodenum). - It does not typically produce the extensive, stacked small bowel loops seen in a step-ladder pattern. *Sigmoid volvulus* - Characterized by a distinctive large, dilated loop of sigmoid colon, often described as a "**coffee bean sign**" or an **inverted U-shape**. - This is a large bowel obstruction and does not typically present with a step-ladder pattern of small bowel gas.

Q: A 10 cm tumor is found on the anterior surface of the thigh. What is the most appropriate procedure to obtain a diagnosis?

Incision biopsy. ***Incision biopsy*** - An **incision biopsy** is most appropriate for a large tumor (10 cm) to obtain a tissue diagnosis without performing a potentially morbid or disfiguring complete excision upfront. - It involves removing a representative section of the tumor for histopathological analysis, providing adequate tissue for diagnosis, grading, and subtyping. - This allows definitive treatment planning based on confirmed histopathology. *Excision biopsy* - **Excision biopsy** is generally reserved for smaller tumors (typically <3-5 cm) that can be completely resected with acceptable cosmetic and functional outcomes. - Excision of a 10 cm tumor on the thigh would be a significant surgical procedure, potentially causing substantial morbidity, without a prior definitive diagnosis. - Could compromise subsequent definitive surgery if margins are inadequate. *FNAC* - **FNAC (Fine Needle Aspiration Cytology)** provides only cytological diagnosis, which is insufficient for definitive diagnosis, grading, and subtyping of soft tissue tumors, especially sarcomas. - It misses crucial architectural features and tissue patterns needed for accurate classification. - May yield inadequate or non-diagnostic samples from large heterogeneous tumors. *USG* - **USG (Ultrasound)** is an imaging modality, not a tissue diagnosis procedure. - While useful for characterizing mass features (size, location, vascularity, solid vs cystic), it cannot provide histopathological diagnosis. - The question specifically asks for a procedure to "obtain a diagnosis," which requires tissue sampling for microscopic examination.

Question 1

Calcium homeostasis disturbance is the predominant pathophysiological mechanism in

Accepted Answer

Malignant hyperthermia

Answer

Duchenne Muscular Dystrophy (DMD)

Answer

Limb Girdle Muscular Dystrophy

Answer

Tibial Muscular Dystrophy

Question 2

Which of the following statements about Sickle Cell Anemia is FALSE?

Accepted Answer

Patients usually present before the age of 6 months

Answer

There is a positive correlation between HBS and polymerization of HBS

Answer

Recurrent infections is the most common cause of death

Answer

Patients require frequent blood transfusions

Question 3

Fibrosis of upper lobe is due to

Accepted Answer

ABPA

Answer

Rheumatoid arthritis

Answer

Certain types of pneumonia

Answer

Bronchiectasis

Question 4

Preferred treatment for menorrhagia in reproductive age group?

Accepted Answer

OCPs

Answer

Cu IUD

Answer

Hysterectomy

Answer

NOVA T

Question 5

What is the primary pathology associated with Congenital Dislocation of the Hip (CDH)?

Accepted Answer

Shallow acetabulum

Answer

Large head of femur

Answer

Excessive retroversion

Answer

Coxa vara deformity

Question 6

Which of the following substances is known to cause predominantly sensory neuropathy?

Accepted Answer

Cisplatin

Answer

Pyridoxine excess

Answer

Suramin

Answer

Vincristine

Question 7

Which amino acid-derived neurotransmitter is primarily targeted in the pharmacological treatment of depression?

Accepted Answer

Serotonin

Answer

Histamine

Answer

None of the options

Answer

Acetylcholine

Question 8

Which chamber enlargement shows a double right heart border with a wide subcarinal angle?

Accepted Answer

Left atrium

Answer

Left ventricle

Answer

Right atrium

Answer

Right ventricle

Question 9

Step ladder pattern of gas shadow is seen in

Accepted Answer

Intestinal obstruction

Answer

Gastric outlet obstruction

Answer

Duodenal obstruction

Answer

Sigmoid volvulus

Question 10

A 10 cm tumor is found on the anterior surface of the thigh. What is the most appropriate procedure to obtain a diagnosis?

Accepted Answer

Incision biopsy

Answer

Excision biopsy

Answer

FNAC

Answer

USG

NEET-PG 2012

Anesthesiology

Internal Medicine

Obstetrics and Gynecology

Orthopaedics

Pharmacology

Radiology

Surgery