NEET-PG 2012 Practice Questions

Q: Which structures are located anterior to the transverse sinus?

Aorta. ***Aorta*** - The **transverse sinus of the pericardium** is a passage within the pericardial cavity that separates the great arteries (aorta and pulmonary trunk) anteriorly from the atria and great veins posteriorly. - The **ascending aorta** and **pulmonary trunk** are both located anterior to the transverse sinus. - This anatomical relationship is clinically important during cardiac surgery, as the transverse sinus can be used to pass ligatures around the great vessels. *Right atrium* - The **right atrium** is located posterior to the transverse sinus. - It forms part of the posterior wall of the pericardial cavity and receives the superior and inferior venae cavae. - The transverse sinus separates the atria from the anteriorly positioned great arteries. *Left atrium* - The **left atrium** is also positioned posterior to the transverse sinus. - It forms the base of the heart and receives the pulmonary veins. - Like the right atrium, it lies behind the plane of the transverse sinus. *Right pulmonary artery* - The **right pulmonary artery** is a branch of the pulmonary trunk that passes to the right lung. - While the **pulmonary trunk** itself is anterior to the transverse sinus, the **right pulmonary artery** branch courses laterally and posteriorly, passing behind the ascending aorta and superior vena cava. - Therefore, the right pulmonary artery is NOT considered anterior to the transverse sinus in the same way the main great vessels (aorta and pulmonary trunk) are.

Q: Which of these best describes the renal angle?

The angle between the 12th rib and the erector spinae. ***The angle between the 12th rib and the erector spinae*** - The **renal angle** (also known as the costovertebral angle) is the space formed by the junction of the **12th rib** and the **erector spinae muscles** laterally. - This anatomical landmark is clinically significant for assessing **kidney pain** or inflammation (e.g., in pyelonephritis) through percussion. *The angle between the latissimus dorsi and the 12th rib* - While the **latissimus dorsi** is a significant back muscle, it is not the primary anatomical landmark that defines the renal angle. - The renal angle specifically refers to the relationship between the rib cage and the deeper spinal muscles. *The angle between the erector spinae and the iliac crest* - This description refers to a region lower down on the back, closer to the **pelvis**, and not directly related to the position of the kidneys. - The **iliac crest** defines the upper border of the pelvis, far from the kidney's typical location relative to the 12th rib. *The angle between the 12th rib and the rectus abdominis* - The **rectus abdominis** muscle is located on the anterior (front) aspect of the abdomen, involved in trunk flexion. - This muscle is anatomically distinct and separate from the posterior flank region where the kidneys are located and where the renal angle is assessed.

Q: Acute intermittent porphyria is due to deficiency of?

Porphobilinogen deaminase. ***Porphobilinogen deaminase*** - **Acute intermittent porphyria (AIP)** results from a deficiency in **porphobilinogen deaminase** (also known as hydroxymethylbilane synthase). - This enzyme deficiency leads to the accumulation of **aminolevulinic acid (ALA)** and **porphobilinogen (PBG)**, which are neurotoxic and cause the characteristic symptoms of AIP. *Uroporphyrinogen III synthase* - A deficiency in **uroporphyrinogen III synthase** causes **congenital erythropoietic porphyria (Günther disease)**, which is characterized by severe photosensitivity and hemolytic anemia. - This enzyme defect leads to the accumulation of uroporphyrinogen I and coproporphyrinogen I, not the ALA and PBG associated with AIP. *Ferrochelatase* - Deficiency in **ferrochelatase** causes **erythropoietic protoporphyria (EPP)**, which presents with photosensitivity and chronic liver disease due to the accumulation of **protoporphyrin**. - This condition does not cause the acute neurological attacks seen in AIP. *ALA synthase* - **ALA synthase** is the **rate-limiting enzyme** in heme synthesis; while its activity is crucial, a congenital *deficiency* is not the cause of AIP. - Instead, the *upregulation* of ALA synthase activity in AIP (due to the PBG deaminase block) contributes to the accumulation of ALA and PBG.

Q: Which enzyme is primarily associated with the reduction of NADP+ to NADPH in the pentose phosphate pathway?

G6PD. ***G6PD*** - **Glucose-6-phosphate dehydrogenase (G6PD)** catalyzes the first committed step in the pentose phosphate pathway, converting **glucose-6-phosphate** to **6-phosphogluconolactone**. - This reaction involves the reduction of **NADP+ to NADPH**, making G6PD the primary enzyme for NADPH production in this pathway. *APDH* - **APDH (adenosine phosphosulfate reductase)** is involved in sulfur metabolism and has no direct role in the pentose phosphate pathway or NADPH production. - This enzyme primarily functions in prokaryotes for the **reduction of APS (adenosine 5'-phosphosulfate)**. *α-keto glutarate dehydrogenases* - **Alpha-ketoglutarate dehydrogenase** is a mitochondrial enzyme part of the **Krebs cycle**, converting **alpha-ketoglutarate to succinyl-CoA**. - This enzyme is crucial for ATP production and generates **NADH**, not NADPH, in its reaction. *None of the options* - This option is incorrect because **G6PD** is indeed the primary enzyme responsible for NADPH generation in the pentose phosphate pathway.

Q: Which of the following is not affected in Abetalipoproteinemia ?

HDL. ***HDL*** - **Abetalipoproteinemia** is caused by a defect in the **microsomal triglyceride transfer protein (MTP)**, which is essential for the assembly and secretion of **chylomicrons**, **VLDL**, and subsequently **LDL** and **IDL**. - **HDL synthesis** and secretion occur independently of MTP, as nascent HDL particles are formed in the plasma from lipids and apolipoproteins (primarily apoA-I) released from other lipoproteins and cells. *LDL* - **LDL** is critically affected in abetalipoproteinemia because it is a metabolic product of **VLDL**. - Since **VLDL** production is severely impaired due to the MTP defect, there is a profound deficiency of **LDL** in the plasma. *VLDL* - **VLDL** production is severely impaired in abetalipoproteinemia because **microsomal triglyceride transfer protein (MTP)** is required for its assembly and secretion from the liver. - The inability to load triglycerides onto apoB leads to very low or absent plasma **VLDL** levels. *IDL* - **IDL** is an intermediate lipoprotein in the metabolism of **VLDL** to **LDL**. - Given that both **VLDL** and **LDL** are severely deficient in abetalipoproteinemia, **IDL** levels are also consequently very low or absent.

Q: The primary site of lipogenesis is:

Liver. ***Liver*** - The **liver** is the principal organ for **de novo lipogenesis**, converting excess carbohydrates into fatty acids and triglycerides. - This process is highly active in response to a high-carbohydrate diet, with the synthesized lipids packaged into **VLDL** for transport. *Skeletal muscles* - **Skeletal muscles** primarily utilize fatty acids for **energy production** rather than synthesizing large amounts of new lipids. - While they can store some triglycerides, their capacity for de novo lipogenesis is significantly lower compared to the liver. *Myocardium* - The **myocardium** (heart muscle) primarily relies on fatty acids for its continuous **energy demands** and has limited capacity for de novo lipogenesis. - Its metabolic focus is on efficient **ATP generation** to maintain cardiac function. *Lungs* - The **lungs** are not a primary site for general lipogenesis, though they are involved in the synthesis of specific lipids like **surfactant**. - Surfactant synthesis is a specialized process crucial for lung function, distinct from general energy storage lipogenesis.

Q: What is the primary function of reverse transcription?

Synthesis of DNA from an RNA template. ***Synthesis of DNA from an RNA template*** - **Reverse transcription** is catalyzed by the enzyme **reverse transcriptase**, which uses an **RNA template** to synthesize a complementary DNA (cDNA) strand. - This process is fundamental in the life cycle of **retroviruses** like HIV, allowing them to integrate their genetic material into the host genome. *Synthesis of RNA from a DNA template* - This process is known as **transcription**, where genetic information is copied from **DNA to RNA**, not the reverse. - It is a key step in gene expression, leading to the production of various types of RNA molecules. *Synthesis of DNA from a DNA template* - This describes **DNA replication**, the process by which DNA makes copies of itself, ensuring genetic continuity during cell division. - It involves enzymes like **DNA polymerase** and creates two identical DNA molecules from one original DNA molecule. *Synthesis of RNA from an RNA template* - This process is known as **RNA replication** and is characteristic of certain **RNA viruses** (e.g., influenza virus), where RNA serves as both the template and the genetic material. - It involves an enzyme called **RNA-dependent RNA polymerase**.

Q: What is a Klatskin tumor?

Hilar cholangiocarcinoma. ***Nodular type of cholangiocarcinoma*** - Klatskin tumors are a specific form of **cholangiocarcinoma** occurring at the junction of the left and right hepatic bile ducts [1]. - These tumors are characterized by **biliary obstruction** and often present with **jaundice** as a prominent clinical feature. *Fibrolamellar hepatocellular carcinoma* - This is a variant of **hepatocellular carcinoma** known for its fibrous stroma, distinct from Klatskin tumors which arise from bile ducts. - **Fibrolamellar** is more common in younger patients and typically does not cause **biliary obstruction** characteristic of Klatskin tumors. *Gall bladder carcinoma* - Gall bladder carcinoma originates from the **gallbladder epithelium**, not the bile ducts, differentiating it from Klatskin tumors. - It may present with symptoms such as **abdominal pain** and **weight loss**, rather than the specific obstructive jaundice seen in Klatskin cases. *Hepatocellular carcinoma* - This cancer arises directly from hepatocytes and is unrelated to bile duct tumors like Klatskin tumors. - Commonly linked to **chronic liver disease** and liver cirrhosis, it does not typically present with **obstructive jaundice** as seen in cholangiocarcinomas [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, pp. 880-881.

Q: Peripheral and central chemoreceptors may both contribute to the increased ventilation that occurs as a result of which of the following?

An increase in arterial carbon dioxide tension. ***An increase in arterial carbon dioxide tension*** - An increase in **arterial PCO2** (hypercapnia) leads to a rapid decrease in the **pH of the cerebrospinal fluid (CSF)**, which strongly stimulates **central chemoreceptors** in the medulla. - While overwhelmingly driven by central chemoreceptors, a significant increase in **arterial PCO2** also causes a slight decrease in **arterial pH**, which can additionally stimulate **peripheral chemoreceptors** in the carotid and aortic bodies, leading to increased ventilation. *A decrease in arterial oxygen content* - A decrease in **arterial oxygen content** (e.g., due to anemia or carbon monoxide poisoning) without a significant drop in **arterial PO2** primarily affects oxygen delivery to tissues. - It does not directly stimulate peripheral chemoreceptors, which are sensitive to **PO2**, not content, nor does it affect central chemoreceptors directly to increase ventilation in this manner. *A decrease in arterial blood pressure* - A decrease in **arterial blood pressure** is sensed by **baroreceptors** and primarily triggers cardiovascular reflexes (e.g., increased heart rate and vasoconstriction) to restore blood pressure. - It does not directly stimulate peripheral or central chemoreceptors to significantly increase ventilation unless severe hypoperfusion leads to significant changes in arterial blood gases. *A decrease in arterial oxygen tension* - A decrease in **arterial oxygen tension (PO2)**, especially when it falls below approximately 60 mmHg, acts as a potent stimulus for **peripheral chemoreceptors**. - However, **central chemoreceptors** are primarily sensitive to **PCO2** and CSF pH, and a decrease in **arterial PO2** alone has little direct effect on their activity.

Question 1

Which structures are located anterior to the transverse sinus?

Accepted Answer

Aorta

Answer

Right atrium

Answer

Left atrium

Answer

Right pulmonary artery

Question 2

Which of these best describes the renal angle?

Accepted Answer

The angle between the 12th rib and the erector spinae

Answer

The angle between the latissimus dorsi and the 12th rib

Answer

The angle between the erector spinae and the iliac crest

Answer

The angle between the 12th rib and the rectus abdominis

Question 3

Which statement accurately describes a characteristic of synovial joints?

Accepted Answer

Hyaline cartilage covers the articular surfaces of synovial joints.

Answer

The metacarpo-phalangeal joint is a condyloid joint.

Answer

Cartilage can sometimes divide the joint into two cavities.

Answer

Stability is inversely proportional to mobility in synovial joints.

Question 4

Acute intermittent porphyria is due to deficiency of?

Accepted Answer

Porphobilinogen deaminase

Answer

Uroporphyrinogen III synthase

Answer

Ferrochelatase

Answer

ALA synthase

Question 5

Which enzyme is primarily associated with the reduction of NADP+ to NADPH in the pentose phosphate pathway?

Accepted Answer

G6PD

Answer

APDH

Answer

α-keto glutarate dehydrogenases

Answer

None of the options

Question 6

Which of the following is not affected in Abetalipoproteinemia ?

Accepted Answer

HDL

Answer

LDL

Answer

IDL

Answer

VLDL

Question 7

The primary site of lipogenesis is:

Accepted Answer

Liver

Answer

Skeletal muscles

Answer

Myocardium

Answer

Lungs

Question 8

What is the primary function of reverse transcription?

Accepted Answer

Synthesis of DNA from an RNA template

Answer

Synthesis of RNA from a DNA template

Answer

Synthesis of DNA from a DNA template

Answer

Synthesis of RNA from an RNA template

Question 9

What is a Klatskin tumor?

Accepted Answer

Hilar cholangiocarcinoma

Answer

Fibrolamellar hepatocellular carcinoma

Answer

Gall bladder carcinoma

Answer

Hepatocellular carcinoma

Question 10

Peripheral and central chemoreceptors may both contribute to the increased ventilation that occurs as a result of which of the following?

Accepted Answer

An increase in arterial carbon dioxide tension

Answer

A decrease in arterial oxygen content

Answer

A decrease in arterial blood pressure

Answer

A decrease in arterial oxygen tension

NEET-PG 2012

Anatomy

Biochemistry

Pathology

Physiology