NEET-PG 2015 Practice Questions

Q: Which vitamin/nutrient toxicity is associated with excessive sweating?

Choline. ***Choline*** - **Excessive sweating** is a recognized symptom of choline toxicity, often accompanied by a **fishy body odor**, hypotension, and gastrointestinal distress. - Choline plays a role in various metabolic pathways, and high doses can overwhelm these systems, leading to adverse effects. *Biotin* - **Biotin toxicity** is extremely rare, even at very high doses; there are no well-documented cases of adverse effects from excessive intake. - Symptoms like excessive sweating are not associated with biotin overdose. *Folic acid* - While high doses of **folic acid** can mask a **vitamin B12 deficiency**, side effects like gastrointestinal upset or sleep disturbances are rare. - Excessive sweating is **not a characteristic symptom** of folic acid toxicity. *Niacin (Vitamin B3)* - High doses of niacin, especially its nicotinic acid form, are well-known to cause **flushing, itching, and liver toxicity**. - While skin effects are common with niacin toxicity, **excessive sweating** as a primary symptom is not typically reported.

Q: Which of the following is the most common type of multiple sclerosis?

Relapsing remitting type. ***Relapsing remitting type*** - **Relapsing-remitting multiple sclerosis (RRMS)** is characterized by clearly defined attacks of worsening neurological function (relapses) followed by periods of partial or complete recovery (remissions). - Approximately **85%** of people with MS are initially diagnosed with RRMS, making it the most common form [1]. *Progressive relapsing multiple sclerosis* - This is a rare form of MS characterized by a **steady neurological decline** from the onset, with superimposed acute relapses. - Unlike RRMS, there are **no periods of remission** in PRMS. *Primary progressive multiple sclerosis* - **Primary progressive multiple sclerosis (PPMS)** is characterized by slowly worsening neurological function from the onset, without early relapses or remissions [1]. - It accounts for roughly **15%** of all MS cases, making it less common than RRMS [1]. *Secondary progressive multiple sclerosis* - **Secondary progressive multiple sclerosis (SPMS)** typically develops in individuals who initially had RRMS, where the disease begins to progress steadily, with or without occasional relapses. - It is a **later stage** of MS and not the most common initial presentation.

Q: What would be the type of presentation when the engaging diameter is mentovertical?

Brow. ***Brow*** - The **mentovertical diameter** (13.5 cm) is the engaging diameter in **brow presentation**. - This diameter extends from the **chin (mentum) to the vertex** of the fetal head. - Brow presentation occurs when the fetal head is **partially deflexed**, presenting the area between the orbital ridge and the anterior fontanelle. - This is the **largest anteroposterior diameter** of the fetal head and makes vaginal delivery extremely difficult or impossible. *Face* - In **face presentation**, the fetal head is **completely hyperextended**, and the engaging diameter is **submentobregmatic** (9.5 cm), not mentovertical. - This diameter extends from below the chin to the bregma. - Face presentation can allow vaginal delivery if the mentum is anterior. *Vertex* - **Vertex presentation** is the most common and favorable presentation, with the fetal head fully flexed. - The engaging diameter is **suboccipitobregmatic** (9.5 cm), from the subocciput to the bregma. - The occiput presents first in this presentation. *Breech* - **Breech presentation** involves the fetal buttocks or feet presenting first. - The engaging diameter is **bitrochanteric** (transverse diameter), not related to cephalic diameters like mentovertical.

Q: What is the most common cause of death in cervical cancer?

Renal failure. ***Renal failure*** - As cervical cancer progresses, it can invade surrounding structures, including the **ureters**. - **Ureteral obstruction** leads to **hydronephrosis** and ultimately **renal failure**, which is a common cause of death. *Infection* - While infections can occur due to immunosuppression or compromised tissue integrity in advanced cancer, they are generally **not the most common direct cause of death**. - Infections are often secondary complications rather than the primary mode of mortality. *Haemorrhage* - Local invasion of blood vessels by advanced cervical cancer can cause **significant bleeding** (haemorrhage). - While potentially life-threatening, it is **less frequent** as a direct cause of death compared to renal failure. *Metastasis to vital organs* - Cervical cancer can metastasize to distant organs like the lungs, liver, or bone; however, direct organ failure solely due to metastases is **less common than renal complications** from local tumor spread. - The impact of metastases often contributes to overall decline but is not the most frequent immediate cause of death.

Q: Osteoclasts have all of the following functions except -

Receptor for parathormone. ***Receptor for parathormone*** - **Osteoclasts** do not directly have receptors for **parathormone (PTH)**; instead, **osteoblasts** have PTH receptors. - When PTH binds to osteoblasts, they release factors (like **RANKL**) that stimulate osteoclast activity, thus indirectly regulating bone resorption. *Bone resorption* - **Osteoclasts** are specialized cells primarily responsible for **resorbing bone matrix**, a critical process in bone remodeling. - They secrete **acids and enzymes** to break down the mineral and organic components of bone. *Ruffled border* - The **ruffled border** is a characteristic morphological feature of active osteoclasts, representing a highly folded plasma membrane. - This specialized structure increases the surface area for the secretion of **protons and lysosomal enzymes** into the bone-resorbing compartment. *RANK ligand production* - **Osteoclasts** do not produce **RANK ligand (RANKL)**; rather, they have **RANK receptors** that bind to RANKL produced by **osteoblasts and stromal cells**. - The binding of RANKL to RANK is essential for the **differentiation, activation, and survival** of osteoclasts.

Q: Antimullerian hormone is secreted by ?

Both Sertoli cells and granulosa cells. ***Both Sertoli cells and granulosa cells*** - **Antimullerian hormone (AMH)** is produced by **Sertoli cells in males** and **granulosa cells in females** - In **males**: Sertoli cells secrete AMH during fetal development to cause **regression of Müllerian ducts** (which would otherwise develop into uterus, fallopian tubes, and upper vagina) - In **females**: Granulosa cells of developing ovarian follicles secrete AMH, which serves as a **marker of ovarian reserve** and inhibits excessive follicle recruitment - This is the only option that correctly identifies both cell types that produce AMH *Theca cells* - Theca cells are found in ovarian follicles and produce **androgens** (androstenedione and testosterone), not AMH - These androgens are converted to estrogens by granulosa cells via aromatase enzyme - Theca cells do not produce antimullerian hormone *Leydig cells* - Leydig cells are located in the **testes** and produce **testosterone** - They do not produce antimullerian hormone - Only Sertoli cells (not Leydig cells) produce AMH in males *None of the above* - This is incorrect because AMH is indeed produced by specific cell types: **Sertoli cells in males** and **granulosa cells in females**

Q: The Grayhack shunt is established between which of the following?

Corpora cavernosa and saphenous vein. ***Corpora cavernosa and saphenous vein*** - The **Grayhack shunt** is a proximal **cavernosal-venous shunt** that connects the corpus cavernosum to the **great saphenous vein**. - This procedure surgically manages **refractory priapism** by diverting blood away from the trapped penile cavernosal spaces into the systemic venous circulation. - It is performed when distal and proximal corporeal shunts have failed. *Corpora cavernosa and dorsal vein* - This describes the **Barry shunt**, which connects the corpus cavernosum to the **deep dorsal vein**. - The Al-Ghorab shunt (sometimes confused) is actually a **distal corporo-glanular shunt** involving open excision of glans tissue — not a dorsal vein shunt. *Corpora cavernosa and glans* - This describes **distal cavernosal-glanular shunts** such as the **Winter shunt** (percutaneous needle) or **Ebbehoj shunt** (scalpel incision), which create a communication between the corpus cavernosum and the glans penis. - These are **first-line** surgical options for priapism but are distinct from the proximal Grayhack shunt. *Corpora cavernosa and corpora spongiosa* - This describes the **Quackels shunt**, a **proximal cavernosal-spongiosal shunt** connecting the corpora cavernosa to the corpus spongiosum. - Also used for refractory priapism, but anatomically and surgically distinct from the Grayhack (cavernosal-venous) shunt.

Q: Chvostek sign could be seen after -

Total Thyroidectomy. ***Total Thyroidectomy*** - A total thyroidectomy involves the removal of the entire thyroid gland, which can inadvertently lead to the removal or damage of the **parathyroid glands** as well. - Damage to the parathyroid glands causes **hypoparathyroidism**, leading to **hypocalcemia**, which is characterized by neuromuscular excitability manifesting as a **Chvostek sign**. *Subtotal Thyroidectomy* - In a subtotal thyroidectomy, only a portion of the thyroid gland is removed, leaving some functional parathyroid tissue intact. - This procedure usually preserves enough parathyroid function to prevent severe **hypocalcemia** and the manifestation of a Chvostek sign. *Heller's Cardiomyotomy* - Heller's cardiomyotomy is a surgical procedure performed to treat **achalasia**, involving the cutting of muscle fibers in the esophagus. - This procedure does not involve the neck region or the parathyroid glands and therefore has no direct association with calcium regulation or the **Chvostek sign**. *Gastrojejunostomy* - A gastrojejunostomy is a surgical procedure that creates a bypass between the stomach and the jejunum, typically performed for conditions like gastric outlet obstruction or as part of bariatric surgery. - This operation is limited to the abdominal cavity and has no direct impact on calcium metabolism or the parathyroid glands that would elicit a **Chvostek sign**.

Q: A 70 year old male complaining of per rectal bleeding was diagnosed with rectal/anorectal cancer. The distal margin of the tumor was 5 cm from the anal verge. The treatment of choice would be -

Low anterior resection. ***Low anterior resection*** - A tumor located 5 cm from the anal verge is considered a **low rectal tumor**, which is typically amenable to a **low anterior resection** with sphincter preservation. - This procedure aims for complete tumor removal while preserving anal function, which is often achievable when the distal margin allows for a safe distal resection margin (usually 1-2 cm). *Palliative Radiotherapy* - This is typically reserved for patients with advanced, **unresectable disease** or those who are not candidates for surgery due to comorbidities, aiming to alleviate symptoms rather than cure. - The scenario describes a potentially resectable tumor, making curative surgery the preferred initial approach. *Abdominoperineal resection* - This procedure involves the removal of the rectum, anus, and creation of a permanent colostomy, typically reserved for very **low rectal tumors** that are extremely close to or involve the anal sphincter, and cannot safely achieve a negative distal margin with sphincter preservation. - A tumor 5 cm from the anal verge usually allows for a sphincter-sparing procedure like low anterior resection. *Local Excision* - **Local excision (transanal excision)** is suitable for very superficial, small, well-differentiated tumors without lymph node involvement, typically T1N0M0 tumors. - The question does not provide details on tumor depth or nodal status, but a 5 cm tumor usually indicates a need for a more comprehensive resection to ensure oncological clearance.

Q: Among pathological lead points, the commonest cause of intussusception is -

Meckel's diverticulum. ***Meckel's diverticulum*** - Among **pathological lead points** specifically, **Meckel's diverticulum** is the most common cause of intussusception. - It is a true congenital diverticulum that can act as a lead point when it becomes inverted, inflamed, or has associated ectopic tissue or tumors. - While overall intussusception in children is mostly idiopathic, when a **pathological lesion** is identified, Meckel's diverticulum is the leading cause. - Seen in approximately 2% of the population, it follows the "rule of 2s" and is the most frequent anatomical abnormality causing pathological intussusception in pediatric patients. *Hypertrophy of submucous Peyer's patches* - **Peyer's patch hypertrophy** is the most common cause of intussusception **overall** in children (90% of cases), typically following viral infections. - However, this represents **idiopathic intussusception**, not a true pathological lead point, as no discrete anatomical lesion is identified. - The question specifically asks for pathological lead points, which excludes this idiopathic mechanism. *Submucous lipoma* - A **submucous lipoma** can serve as a pathological lead point for intussusception, but is much rarer. - More commonly seen in adults rather than children. - While it is a true pathological lesion, it is less frequent than Meckel's diverticulum as a lead point. *Polyp* - **Polyps** (adenomatous, hamartomatous, or inflammatory) can act as pathological lead points. - More common in adults and in specific syndromes (e.g., Peutz-Jeghers syndrome). - Less frequent than Meckel's diverticulum among pathological causes in the pediatric population.

Question 1

Which vitamin/nutrient toxicity is associated with excessive sweating?

Accepted Answer

Choline

Answer

Biotin

Answer

Folic acid

Answer

Niacin (Vitamin B3)

Question 2

Which of the following is the most common type of multiple sclerosis?

Accepted Answer

Relapsing remitting type

Answer

Progressive relapsing multiple sclerosis

Answer

Primary progressive multiple sclerosis

Answer

Secondary progressive multiple sclerosis

Question 3

What would be the type of presentation when the engaging diameter is mentovertical?

Accepted Answer

Brow

Answer

Face

Answer

Vertex

Answer

Breech

Question 4

What is the most common cause of death in cervical cancer?

Accepted Answer

Renal failure

Answer

Infection

Answer

Haemorrhage

Answer

Metastasis to vital organs

Question 5

Osteoclasts have all of the following functions except -

Accepted Answer

Receptor for parathormone

Answer

Ruffled border

Answer

Bone resorption

Answer

RANK ligand production

Question 6

Antimullerian hormone is secreted by ?

Accepted Answer

Both Sertoli cells and granulosa cells

Answer

Theca cells

Answer

Leydig cells

Answer

None of the above

Question 7

The Grayhack shunt is established between which of the following?

Accepted Answer

Corpora cavernosa and saphenous vein

Answer

Corpora cavernosa and dorsal vein

Answer

Corpora cavernosa and glans

Answer

Corpora cavernosa and corpora spongiosa

Question 8

Chvostek sign could be seen after -

Accepted Answer

Total Thyroidectomy

Answer

Subtotal Thyroidectomy

Answer

Heller's Cardiomyotomy

Answer

Gastrojejunostomy

Question 9

A 70 year old male complaining of per rectal bleeding was diagnosed with rectal/anorectal cancer. The distal margin of the tumor was 5 cm from the anal verge. The treatment of choice would be -

Accepted Answer

Low anterior resection

Answer

Palliative Radiotherapy

Answer

Local Excision

Answer

Abdominoperineal resection

Question 10

Among pathological lead points, the commonest cause of intussusception is -

Accepted Answer

Meckel's diverticulum

Answer

Submucous lipoma

Answer

Polyp

Answer

Hypertrophy of submucous peyer's patches

NEET-PG 2015

Biochemistry

Internal Medicine

Obstetrics and Gynecology

Physiology

Surgery