NEET-PG 2012 Practice Questions

Q: In which condition is paradoxical splitting of the second heart sound observed?

Left Bundle Branch Block (LBBB). ***Left Bundle Branch Block (LBBB)*** - In LBBB, the **left ventricle** depolarizes and contracts *after* the right ventricle, causing the **aortic valve (A2)** to close *after* the **pulmonic valve (P2)** [1]. - During inspiration, right ventricular ejection time is prolonged, which further delays P2. However, in LBBB, A2 is already delayed, and the inspiratory delay of P2 can bring P2 closer to A2, or even cause them to merge, making the splitting *less wide* or *disappear* on inspiration, which is paradoxical. *Right Bundle Branch Block (RBBB)* - RBBB causes a **delay in right ventricular depolarization**, leading to a **delayed P2** (pulmonic valve closure). - This typically results in **wide and fixed splitting of S2**, where the splitting persists during expiration and widens further with inspiration, which is not paradoxical. *Ventricular Septal Defect (VSD)* - A VSD can cause a **loud holosystolic murmur** and may lead to increased pulmonary blood flow. - While it can affect the timing of heart sounds, it does not typically cause paradoxical splitting of S2. *Atrial Septal Defect (ASD)* - An ASD causes a **left-to-right shunt**, leading to chronic volume overload of the right ventricle and increased pulmonary blood flow. - This often results in a **widely fixed splitting of S2**, where the split between A2 and P2 is constant regardless of respiration, which is different from paradoxical splitting.

Q: Which of the following statements about tuberculosis (TB) of the uterus is NOT true?

Most common is ascending infection. ***Most common is ascending infection*** - Uterine tuberculosis is overwhelmingly due to **hematogenous spread** from a primary site, often the lungs, rather than an ascending infection from the lower genital tract. - Tuberculosis typically reaches the female genital tract by the **bloodstream**, with the fallopian tubes being the most common initial site of involvement. *Mostly secondary* - Genital tuberculosis, including uterine involvement, is almost always a **secondary infection**, meaning it results from the spread of Mycobacterium tuberculosis from another primary site in the body, most commonly the lungs. - The initial infection establishes elsewhere, and then the bacteria **disseminate hematogenously** to the reproductive organs. *Increase incidence of ectopic pregnancy* - Tubal damage and scarring caused by tuberculosis, particularly in the fallopian tubes (**salpingitis**), disrupt the normal passage of the ovum. - This anatomical alteration significantly **increases the risk** of the fertilized egg implanting outside the uterus, leading to ectopic pregnancy. *Involvement of endosalpinx* - The **fallopian tubes (endosalpinx)** are the most common site of genital tuberculosis, with eventual spread to the uterus through the lymphatic system or direct extension. - Tubal involvement can lead to **salpingitis isthmica nodosa** and hydrosalpinx, contributing to infertility and ectopic pregnancy.

Q: What is the most common complication that can arise from vacuum delivery during childbirth?

Cephalohematoma. ***Cephalohematoma*** - A cephalohematoma is a collection of blood between the **periosteum and the skull bone**, typically forming over the parietal bone. - It is the **most common complication** of vacuum delivery, occurring in **6-26% of vacuum-assisted deliveries**. - It presents as a firm, fluctuant swelling that **does not cross suture lines** and typically appears several hours after delivery. - Usually **self-limiting** and resolves spontaneously over weeks to months, though it may be associated with hyperbilirubinemia. *Subgaleal hemorrhage* - This is a more serious but **less common** complication (0.4-0.6% incidence) involving bleeding into the **potential space between the galea aponeurotica and the periosteum**. - Can lead to significant blood loss and hypovolemic shock due to the large potential space that can accommodate substantial blood volume. - Requires immediate recognition and management, but its lower incidence makes it less common than cephalohematoma. *Scalp lacerations* - Occur in approximately **13% of vacuum deliveries** but are less common than cephalohematoma. - Typically superficial and heal well with minimal intervention. - Result from the rim of the vacuum cup causing trauma to the scalp tissue. *Retinal hemorrhages* - Occur in up to **40-50% of all vaginal deliveries** (both spontaneous and assisted), making them common but not specific to vacuum delivery. - Usually **asymptomatic and self-limiting**, resolving within days to weeks without sequelae. - While common, cephalohematoma remains the most frequently documented **specific complication** of vacuum extraction.

Q: Corneal tattooing is done by ?

India ink. ***India ink*** - **India ink (carbon black)** is the traditional and most commonly used pigment for corneal tattooing due to its stable black color and inert properties. - It is applied to the **corneal stroma** to mask corneal opacities or for cosmetic purposes in cases of unsightly leucomatous corneal scars. - India ink has been the **gold standard** for corneal tattooing since the 19th century. *Gold chloride* - While **gold preparations** (including platinum-gold) have been used historically for corneal tattooing, they are much less common than India ink. - Gold chloride specifically is not the standard or preferred agent for this procedure. - India ink remains the pigment of choice due to better cosmetic results and established safety profile. *Titanium chloride* - **Titanium chloride** is a corrosive chemical and is not used in corneal tattooing; its application would cause severe damage to the delicate corneal tissue. - It is primarily used in industrial applications and chemical synthesis, not in ophthalmic procedures. *Aluminium chloride* - **Aluminium chloride** is an astringent and antiseptic, often used in dermatological products, but it is not a tattooing pigment for the cornea. - Its chemical properties would be highly irritating to the eye and potentially damaging to corneal cells.

Q: Cloacae are openings found in which of the following?

Involucrum. ***Involucrum*** - **Cloacae** are openings or sinuses that develop in the **involucrum**, which is the new bone formation that surrounds a segment of necrotic bone (sequestrum) during osteomyelitis. - These openings act as channels for the discharge of **pus** and inflammatory debris from the infected bone to the external environment. *Sequestrum* - A **sequestrum** is a piece of **necrotic (dead) bone** that has become separated from the surrounding healthy bone due to osteomyelitis. - While central to the pathology, the cloacae are openings *through the involucrum* that encases the sequestrum, not in the sequestrum itself. *Normal bone* - **Normal bone** does not contain cloacae; these structures are a pathological feature indicative of chronic osteomyelitis. - Healthy bone remodels and resorbs normally, without the formation of channels for pus drainage. *Myositis* - **Myositis** is an inflammation of the **muscles**, not bone, and does not involve the formation of cloacae. - While it can be caused by infection, the pathological changes are localized to muscle tissue.

Q: Heterotopic ossification is primarily associated with which of the following?

Soft tissues. ***Soft tissues*** - **Heterotopic ossification** is the pathological formation of mature, lamellar bone in **non-osseous (soft tissues)** where bone does not normally exist. - This process often occurs in muscles, tendons, ligaments, or fascia, particularly after trauma or neurological injury. *Bone* - Heterotopic ossification is the formation of bone *outside* of normal skeletal structures, not within existing bone. - While it involves bone formation, its defining characteristic is its location in **extraskeletal sites**, not within the bone itself. *Joint* - Although heterotopic ossification can occur around joints, leading to **joint stiffness** and limited range of motion, it is the formation of bone within the **soft tissues surrounding the joint**, not within the joint capsule or articular cartilage itself. - The primary location is the adjacent soft tissue, which then secondarily impacts joint mobility. *None of the options* - This option is incorrect because "Soft tissues" accurately describes the primary location where heterotopic ossification occurs. - The condition is specifically defined by bone formation in these non-skeletal sites.

Q: Narcolepsy is due to abnormality in ?

Hypothalamus. **Hypothalamus** - Narcolepsy is primarily caused by the loss of **orexin (hypocretin)** producing neurons in the **hypothalamus**, which are crucial for maintaining wakefulness. - This deficiency leads to dysregulation of **sleep-wake cycles**, causing excessive daytime sleepiness and other narcolepsy symptoms. *Neocortex* - The neocortex is involved in higher-level cognitive functions, sensory perception, and voluntary movement, but it is not the primary site of pathology in narcolepsy. - While sleep stages involve cortical activity, the core deficit in narcolepsy does not originate here. *Cerebellum* - The cerebellum is mainly responsible for motor control, coordination, and balance. - Its dysfunction is associated with ataxic gait and coordination problems, not the sleep disturbances characteristic of narcolepsy. *Medulla oblongata* - The medulla oblongata controls vital autonomic functions like breathing, heart rate, and blood pressure. - While involved in sleep regulation pathways, it is not the primary anatomical location affected in narcolepsy.

Q: Which of the following is a first-line treatment for bipolar affective (manic-depressive) disorder:

Lithium carbonate. **Lithium carbonate** - **Lithium** is a well-established and highly effective **mood stabilizer**, considered a first-line treatment for managing both **manic** and **depressive episodes** in bipolar disorder. - It helps prevent recurrent episodes and reduces the severity of mood swings, acting as a prophylactic agent. *Chlorpromazine* - **Chlorpromazine** is a **first-generation antipsychotic** that is primarily used to treat **schizophrenia** and other psychotic disorders. - While it can be used acutely to manage severe manic agitation, it is not a first-line agent for the long-term mood stabilization characteristic of bipolar disorder. *Haloperidol* - **Haloperidol** is another **first-generation antipsychotic** often used for acute treatment of **psychotic symptoms** or severe agitation, including in mania. - It is not a primary long-term mood stabilizer for bipolar disorder due to its side effect profile and lack of efficacy in preventing future mood episodes compared to lithium. *Diazepam* - **Diazepam** is a **benzodiazepine** primarily used for treating **anxiety**, muscle spasms, and acute seizures. - While it can help manage acute agitation and insomnia during a manic episode, it does not have mood-stabilizing properties and is not a long-term treatment for bipolar disorder.

Q: In the context of blunt trauma affecting the entire body, what is the estimated daily nitrogen loss in grams due to protein metabolism?

Approximately 35 grams. ***Approximately 35 grams*** - In **severe trauma**, such as blunt trauma affecting the entire body, the body undergoes a significant stress response leading to marked **protein catabolism**. Approximately **35 grams of nitrogen** can be lost daily under such conditions. - This represents a highly catabolic state where muscle protein is broken down to provide amino acids for energy and synthesis of acute-phase proteins, impacting overall nitrogen balance. *Approximately 45 grams* - While severe trauma does lead to substantial nitrogen loss, **45 grams** would typically indicate an even more extreme or prolonged catabolic state, which is less common in the initial stages of post-trauma protein metabolism than 35 grams. - Such a high nitrogen loss might be seen in very extensive burns or sepsis, which are different clinical contexts. *Approximately 55 grams* - A daily nitrogen loss of **55 grams** is beyond what is commonly observed even in severe, whole-body blunt trauma. This level of catabolism would likely be unsustainable or indicative of a rare, super-catabolic condition. - This magnitude of protein breakdown would lead to rapid and severe muscle wasting and organ dysfunction if sustained. *Approximately 65 grams* - Losing **65 grams of nitrogen** per day is an exceptionally high rate of protein catabolism, rarely, if ever, observed in blunt trauma alone. - This level of protein breakdown would represent a profound and life-threatening metabolic derangement, far exceeding typical post-trauma responses.

Question 1

In which condition is paradoxical splitting of the second heart sound observed?

Accepted Answer

Left Bundle Branch Block (LBBB)

Answer

Right Bundle Branch Block (RBBB)

Answer

Ventricular Septal Defect (VSD)

Answer

Atrial Septal Defect (ASD)

Question 2

What is a feature of short bowel syndrome?

Accepted Answer

Malabsorption leading to diarrhea, dehydration, and malnutrition.

Answer

Hypergastrinemia & high gastric secretion is seen

Answer

Diarrhea, dehydration and malnutrition

Answer

Chronic TPN dependence

Question 3

Which of the following statements about tuberculosis (TB) of the uterus is NOT true?

Accepted Answer

Most common is ascending infection

Answer

Increase incidence of ectopic pregnancy

Answer

Involvement of endosalpinx

Answer

Mostly secondary

Question 4

What is the most common complication that can arise from vacuum delivery during childbirth?

Accepted Answer

Cephalohematoma

Answer

Subgaleal hemorrhage

Answer

Scalp lacerations

Answer

Retinal hemorrhages

Question 5

Corneal tattooing is done by ?

Accepted Answer

India ink

Answer

Titanium chloride

Answer

Aluminium chloride

Answer

Gold chloride

Question 6

Cloacae are openings found in which of the following?

Accepted Answer

Involucrum

Answer

Sequestrum

Answer

Normal bone

Answer

Myositis

Question 7

Heterotopic ossification is primarily associated with which of the following?

Accepted Answer

Soft tissues

Answer

Bone

Answer

Joint

Answer

None of the options

Question 8

Narcolepsy is due to abnormality in ?

Accepted Answer

Hypothalamus

Answer

Neocortex

Answer

Cerebellum

Answer

Medulla oblongata

Question 9

Which of the following is a first-line treatment for bipolar affective (manic-depressive) disorder:

Accepted Answer

Lithium carbonate

Answer

Chlorpromazine

Answer

Haloperidol

Answer

Diazepam

Question 10

In the context of blunt trauma affecting the entire body, what is the estimated daily nitrogen loss in grams due to protein metabolism?

Accepted Answer

Approximately 35 grams

Answer

Approximately 45 grams

Answer

Approximately 55 grams

Answer

Approximately 65 grams

NEET-PG 2012

Internal Medicine

Obstetrics and Gynecology

Ophthalmology

Orthopaedics

Physiology

Psychiatry

Surgery