Anatomy
1 questionsIdentify the artery labeled as 'X' in the provided angiography anatomy image.
NEET-PG 2018 - Anatomy NEET-PG Practice Questions and MCQs
Question 121: Identify the artery labeled as 'X' in the provided angiography anatomy image.
- A. Superior mesenteric artery (Correct Answer)
- B. Subclavian artery
- C. Celiac trunk
- D. Brachiocephalic trunk
Explanation: ***Superior mesenteric artery*** - The image displays a selective angiogram highlighting an artery branching off the **aorta** in the abdominal region and supplying multiple loops of bowel, characteristic of the superior mesenteric artery. - The location and extensive branching pattern supplying various abdominal structures confirm its identity as the **superior mesenteric artery**, which typically arises below the celiac trunk. *Subclavian artery* - The **subclavian artery** is located in the chest and shoulder region, supplying the upper limbs and parts of the head and neck. - Its anatomical location and distribution are distinctly different from the abdominal artery shown in the image. *Celiac trunk* - The **celiac trunk** is an earlier branch off the aorta, typically arising just below the diaphragm, and it branches into the splenic, left gastric, and common hepatic arteries. - The artery labeled 'X' arises lower than where the celiac trunk would typically originate and demonstrates a different branching pattern. *Brachiocephalic trunk* - The **brachiocephalic trunk** (also known as the innominate artery) is a major artery in the upper chest, typically the first branch off the aortic arch. - It supplies blood to the right arm and head, not abdominal organs, making it anatomically incorrect for the artery labeled 'X'.
Anesthesiology
2 questionsModified Mallampati grading is used in assessment of -
Murphy's eye is seen in -
NEET-PG 2018 - Anesthesiology NEET-PG Practice Questions and MCQs
Question 121: Modified Mallampati grading is used in assessment of -
- A. Difficulty of intubation (Correct Answer)
- B. Obstruction of the airway
- C. Aspiration-related death
- D. Endotracheal intubation procedure
Explanation: ***Difficulty of intubation*** - The **Modified Mallampati score** assesses the visibility of pharyngeal structures, which directly correlates with the ease or difficulty of performing **direct laryngoscopy** and **endotracheal intubation**. - A higher Mallampati class (e.g., III or IV) indicates less visibility of the soft palate, uvula, and pillars, suggesting a more difficult airway and increased likelihood of a challenging intubation. *Obstruction of the airway* - While a high Mallampati score might indirectly indicate potential for **airway obstruction** during anesthesia due to anatomical features, its primary purpose is not to diagnose or quantify existing airway obstruction. - Airway obstruction is more directly assessed by monitoring breathing sounds, respiratory effort, and oxygen saturation. *Aspiration-related death* - The **Mallampati score** helps predict the difficulty of securing the airway but does not directly assess the risk of **aspiration**. - Aspiration risk is evaluated based on factors like gastric contents, gag reflex, and patient positioning. *Endotracheal intubation procedure* - The **Modified Mallampati score** helps in **planning the intubation procedure** by identifying potential difficulties but is not a measure of the intubation procedure itself. - It is a **pre-procedure assessment tool** to gauge airway anatomy, not a description or evaluation of the steps involved in endotracheal intubation.
Question 122: Murphy's eye is seen in -
- A. Endotracheal tube (Correct Answer)
- B. Flexible laryngoscope
- C. Laryngeal Mask Airway (LMA)
- D. Macintosh laryngoscope
Explanation: ***Endotracheal tube*** - A Murphy's eye is a **hole on the side** of the endotracheal tube, near the distal tip, opposite the main bevel. - Its purpose is to provide an **alternative pathway for gas flow** if the main opening of the tube becomes occluded by secretions or contact with the tracheal wall. *Flexible laryngoscope* - This device is used for **visualizing the airway** and guiding endotracheal tube placement, not for maintaining it. - It does not have a Murphy's eye as it is a diagnostic/guiding tool, not a conduit for ventilation. *Laryngeal Mask Airway (LMA)* - An LMA is a **supraglottic airway device** that creates a seal around the laryngeal inlet. - It does not have a Murphy's eye as its design doesn't involve intralaryngeal distal tip placement where occlusion by the tracheal wall is a primary concern. *Macintosh laryngoscope* - This is a type of **laryngoscope blade** used to visualize the vocal cords during intubation. - It is an instrument for intubation, not the airway device itself, and therefore does not have a Murphy's eye.
Biochemistry
1 questionsGalactosemia is due to deficiency of which enzyme?
NEET-PG 2018 - Biochemistry NEET-PG Practice Questions and MCQs
Question 121: Galactosemia is due to deficiency of which enzyme?
- A. Galactose-1-phosphate uridyltransferase (Correct Answer)
- B. HGPRT
- C. Galactokinase
- D. Epimerase
Explanation: ***Galactose-1-phosphate uridyltransferase*** - Deficiency of **galactose-1-phosphate uridyltransferase (GALT)** leads to the most severe form, **classic galactosemia**. - This enzyme is crucial for converting **galactose-1-phosphate** to **glucose-1-phosphate** in the Leloir pathway. *HGPRT* - **HGPRT** (hypoxanthine-guanine phosphoribosyltransferase) deficiency causes **Lesch-Nyhan syndrome**, a distinct metabolic disorder. - Lesch-Nyhan syndrome is characterized by **hyperuricemia**, neurological dysfunction, and self-mutilation, unrelated to galactose metabolism. *Galactokinase* - Deficiency of **galactokinase** causes Type II galactosemia, a milder form than classic galactosemia. - This defect primarily leads to **cataracts** due to galactitol accumulation but does not result in the severe systemic issues seen in classic galactosemia. *Epimerase* - Deficiency of **UDP-galactose-4'-epimerase** (GALE) causes Type III galactosemia, which has a variable clinical presentation from mild to severe. - While involved in galactose metabolism, it's not the primary enzyme deficient in the most common and severe form of **galactosemia**.
Obstetrics and Gynecology
2 questionsWhich drug regimen is given to a pregnant woman with HIV infection?
What is the most common symptom treated with hormone therapy (HT) in menopausal women?
NEET-PG 2018 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 121: Which drug regimen is given to a pregnant woman with HIV infection?
- A. Tenofovir disoproxil fumarate with emtricitabine
- B. Tenofovir disoproxil fumarate with lamivudine
- C. Abacavir with lamivudine
- D. All of the options (Correct Answer)
Explanation: ***All of the options*** - All listed regimens—**Tenofovir disoproxil fumarate (TDF) with emtricitabine (FTC)**, **TDF with lamivudine (3TC)**, and **Abacavir (ABC) with lamivudine (3TC)**—are commonly used and generally safe combinations of **nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs)** in pregnant women with HIV. - The choice of regimen depends on factors such as individual patient characteristics, viral resistance patterns, and potential side effects, but all mentioned regimens are considered **first-line options** in various guidelines for preventing mother-to-child transmission (PMTCT). *Tenofovir disoproxil fumarate with emtricitabine* - This combination is a common and effective **NRTI backbone** for HIV treatment, including in pregnancy, offering good efficacy and a generally favorable safety profile. - It is frequently paired with a third agent (e.g., a **non-nucleoside reverse transcriptase inhibitor (NNRTI)** or an **integrase strand transfer inhibitor (INSTI)**) as part of a highly active antiretroviral therapy (HAART) regimen. *Tenofovir disoproxil fumarate with lamivudine* - This is another widely used and effective **NRTI combination** and is also a recommended backbone for pregnant women with HIV. - While similar to TDF/FTC, some guidelines might prefer one over the other based on specific regional recommendations or drug availability. *Abacavir with lamivudine* - **Abacavir/lamivudine** is a well-established NRTI combination that is safe and effective in pregnancy, provided the mother is **HLA-B*5701 negative** to avoid hypersensitivity reactions. - It is considered a suitable alternative to TDF-containing regimens, especially when there are contraindications or intolerances to TDF.
Question 122: What is the most common symptom treated with hormone therapy (HT) in menopausal women?
- A. Endometriosis
- B. Uterine bleeding
- C. Hot flashes (Correct Answer)
- D. Breast cancer
Explanation: ***Hot flashes*** - **Vasomotor symptoms**, including hot flashes and night sweats, are the most frequent and bothersome symptoms experienced by menopausal women, leading them to seek medical attention and hormone therapy. - HT is highly effective in reducing the frequency and severity of hot flashes by stabilizing **thermoregulation** in the hypothalamus. *Breast cancer* - **Breast cancer** is a potential risk associated with hormone therapy, particularly with combined estrogen-progestin therapy, not a symptom treated by HT. - Women with a history of breast cancer or those at high risk are generally advised against HT due to this increased risk. *Endometriosis* - While **estrogen-dependent diseases** like endometriosis can be aggravated by HRT, endometriosis itself is a condition that typically improves after menopause. - HT is not used to treat endometriosis; in certain cases, it might be used to manage menopausal symptoms in women with a history of endometriosis after specific surgical interventions. *Uterine bleeding* - **Uterine bleeding** can be a side effect of hormone therapy, especially when progestin is not adequately balanced with estrogen in women with a uterus. - Abnormal uterine bleeding is a symptom that requires investigation to rule out other causes, and it is not a primary symptom treated by HT.
Pediatrics
1 questionsA 1-year-old child weighing 6 kg is suffering from acute gastroenteritis with signs of sunken eyes and skin pinch returning to normal very rapidly. What will be your management?
NEET-PG 2018 - Pediatrics NEET-PG Practice Questions and MCQs
Question 121: A 1-year-old child weighing 6 kg is suffering from acute gastroenteritis with signs of sunken eyes and skin pinch returning to normal very rapidly. What will be your management?
- A. RL infusion 120 ml in the first hour followed by 360 ml in the next 5 hours
- B. RL infusion 180 ml in the first hour followed by 480 ml in the next 5 hours
- C. RL infusion 240 ml in the first hour followed by 360 ml in the next 5 hours
- D. RL infusion 180 ml in the first hour followed by 270 ml in the next 5 hours (Correct Answer)
Explanation: ***RL infusion 180 ml in the first hour followed by 270 ml in the next 5 hours*** - The child shows signs of **some dehydration** (sunken eyes, skin pinch returning very rapidly). According to **WHO Plan B**, some dehydration requires **75 ml/kg over 6 hours** for rehydration. - For a 6 kg child: **75 × 6 = 450 ml total** - **Distribution:** 30 ml/kg in first hour (180 ml) + 45 ml/kg over next 5 hours (270 ml) - This option provides exactly **450 ml (180 + 270)**, perfectly matching WHO guidelines for some dehydration *RL infusion 120 ml in the first hour followed by 360 ml in the next 5 hours* - First hour: 120 ml = only **20 ml/kg**, which is **below the recommended 30 ml/kg** initial bolus for some dehydration - Total volume: **480 ml** exceeds the required **450 ml** for a 6 kg child - Incorrect fluid distribution pattern for WHO Plan B *RL infusion 180 ml in the first hour followed by 480 ml in the next 5 hours* - First hour volume is correct at **30 ml/kg (180 ml)** - However, next 5 hours: **480 ml = 80 ml/kg**, far exceeding the recommended **45 ml/kg** - Total: **660 ml** significantly exceeds **450 ml**, risking **fluid overload** in a small child *RL infusion 240 ml in the first hour followed by 360 ml in the next 5 hours* - Initial rate: **240 ml = 40 ml/kg** is appropriate for **severe dehydration (WHO Plan C)**, not some dehydration - This child shows **some dehydration** signs, not severe (no lethargy, unconsciousness, or very slow skin pinch) - Total: **600 ml** exceeds the **450 ml** requirement, indicating overtreatment for this clinical scenario
Pharmacology
2 questionsWhat is mechanism of action of colchicine in acute gout?
Tadalafil should not be given with:
NEET-PG 2018 - Pharmacology NEET-PG Practice Questions and MCQs
Question 121: What is mechanism of action of colchicine in acute gout?
- A. Inhibition of purine metabolism
- B. Inhibition of uric acid conversion
- C. Migration of leukocytes
- D. Inhibition of leukocyte migration and microtubule function (Correct Answer)
Explanation: ***Inhibition of leukocyte migration and microtubule function*** - Colchicine works by disrupting **microtubule polymerization**, which interferes with the **motility and activity of neutrophils and other inflammatory cells** [1]. - Its anti-inflammatory effect in acute gout is primarily due to the inhibition of **leukocyte migration and phagocytosis of urate crystals**, thereby reducing the inflammatory response [1]. - The mechanism involves binding to **tubulin**, preventing microtubule assembly, which affects multiple cellular processes including chemotaxis and cell division [1]. *Inhibition of purine metabolism* - This mechanism is associated with drugs like **allopurinol**, which inhibit **xanthine oxidase** to reduce uric acid production [2]. - Colchicine does not directly inhibit **purine metabolism** or uric acid synthesis; its effect is on the inflammatory response, not uric acid formation [1]. *Inhibition of uric acid conversion* - This mechanism refers to **uricosuric agents** like probenecid that increase renal excretion of uric acid. - Colchicine's action is primarily anti-inflammatory, not related to uric acid metabolism or excretion [1]. *Migration of leukocytes* - While this is partially correct, as colchicine does inhibit **leukocyte migration**, this option is incomplete. - The complete mechanism must include its action as a **microtubule inhibitor**, which is the underlying basis for all its cellular effects including inhibition of migration, phagocytosis, and inflammatory mediator release [1].
Question 122: Tadalafil should not be given with:
- A. Vasodilators (Correct Answer)
- B. Antibiotics
- C. Vasoconstrictors
- D. Valproate
Explanation: ***Vasodilators*** - Tadalafil is a **phosphodiesterase-5 (PDE5) inhibitor** that causes **vasodilation** by increasing cGMP levels, leading to smooth muscle relaxation. - Combining tadalafil with other **vasodilators**, particularly **nitrates**, can lead to a severe and potentially life-threatening drop in **blood pressure (hypotension)**. *Antibiotics* - While some antibiotics, particularly macrolides or azoles, can inhibit **CYP3A4** and increase tadalafil levels, this interaction is typically managed by dose adjustments rather than an absolute contraindication. - The primary concern with administering antibiotics and tadalafil concurrently is **pharmacokinetic interactions**, not a direct pharmacodynamic synergy leading to acute, severe adverse effects. *Vasoconstrictors* - Vasoconstrictors have an effect **opposite** to tadalafil, as they narrow blood vessels. - There is generally no contraindication for co-administration, and in fact, tadalafil's **vasodilatory effects** could potentially **counteract** some of the vasoconstriction, although concurrent use is not typically recommended for erectile dysfunction. *Valproate* - **Valproate** is an **anticonvulsant** and mood stabilizer, and there is no significant or clinically relevant drug interaction established with tadalafil. - It does not share common metabolic pathways or pharmacodynamic effects that would lead to dangerous interactions with tadalafil.
Surgery
1 questionsWhere will be the placement location for Auditory Brainstem Implant?
NEET-PG 2018 - Surgery NEET-PG Practice Questions and MCQs
Question 121: Where will be the placement location for Auditory Brainstem Implant?
- A. Scala tympani
- B. Recess of 4th ventricle (Correct Answer)
- C. IAC
- D. Back of ear
Explanation: ***Recess of 4th ventricle*** - An **Auditory Brainstem Implant (ABI)** is placed on the **cochlear nucleus** in the brainstem, which is anatomically located near the **lateral recess of the fourth ventricle**. - The implant stimulates these nuclei directly, bypassing the damaged auditory nerve in patients who cannot benefit from cochlear implants. *Scala tympani* - The **scala tympani** is the location for electrode placement in a **cochlear implant**, not an auditory brainstem implant. - Cochlear implants stimulate the intact auditory nerve within the cochlea. *IAC* - The **internal auditory canal (IAC)** houses the auditory and facial nerves, but it is not the target site for an ABI. - The ABI is designed for patients whose auditory nerve (which passes through the IAC) is non-functional. *Back of ear* - The "back of the ear" is the general area where the **external processor of a cochlear implant** or a **bone-anchored hearing aid** is typically worn, not the surgical placement site for an ABI. - The ABI's internal component is surgically placed within the cranium.