NEET-PG 2018 Practice Questions

Q: Hard palate contains:

Keratinised, submucosa, minor salivary gland. ***Keratinised, submucosa, minor salivary gland*** - The oral epithelium of the **hard palate** is predominantly **keratinized stratified squamous epithelium**, which provides protection against mechanical stress during mastication. - The hard palate has a **unique structure**: in the **median raphe and anterior region**, the mucosa is directly attached to periosteum (mucoperiosteum with no submucosa), but in the **anterolateral and posterolateral regions**, a **submucosa IS present** containing **minor salivary glands** (predominantly mucous type). - Since the question asks what the hard palate "contains," and it DOES contain submucosa in the lateral regions where glands are located, this is the correct answer. *Keratinised, absent submucosal layer, minor salivary gland* - While it is true that the **submucosa is absent in the midline/anterior region** of the hard palate, this option is incorrect because the hard palate DOES contain submucosa in the **lateral and posterior regions** where the **minor salivary glands** are located. - The presence of glands requires underlying submucosa for their placement. *Non keratinised, submucosal layer, minor salivary gland* - The hard palate is primarily covered by **keratinized epithelium**, not non-keratinized epithelium, which makes this option incorrect. - Non-keratinized epithelium is typically found in areas like the **soft palate, buccal mucosa, and ventral tongue** where less mechanical stress occurs. *Non keratinised, absent submucosa, minor salivary gland* - This option is incorrect on both counts: the epithelium is **keratinized** (not non-keratinized) and the **submucosa is present** in lateral/posterior regions where glands are located. - This combination does not accurately describe any region of the hard palate.

Q: What is a potential cause of cardiogenic shock other than myocardial infarction (MI)?

Acute mitral regurgitation. ***Acute mitral regurgitation*** - **Acute mitral regurgitation** is a severe form of valvular heart disease where the mitral valve fails to close properly, leading to a sudden backflow of blood into the left atrium during systole. [1] - This significantly reduces **forward cardiac output** and increases left atrial pressure, which can rapidly lead to pulmonary edema and cardiogenic shock, even in the absence of MI. [1] *Ventricular septal rupture* - While a **ventricular septal rupture** can cause cardiogenic shock, it is typically a **complication of myocardial infarction**, meaning it would fall under MI as the underlying cause. [2] - This condition involves a hole in the septum separating the ventricles, leading to a shunt and increased workload on the right ventricle, causing cardiogenic shock. *Isolated right ventricular shock* - **Isolated right ventricular shock** is often caused by conditions like a **massive pulmonary embolism** or a right ventricular infarction. [2] - While it can lead to shock, it is distinct from general cardiogenic shock which often implies left ventricular dysfunction or severe myocardial compromise, and the question asks for a cause *other than* MI, which can cause right ventricular shock. *None of the options* - This option is incorrect because **acute mitral regurgitation** is a distinct and significant cause of cardiogenic shock, independent of MI. [1]

Q: Urea breath test is used for diagnosis of:

H. pylori. ***H. pylori*** - The **urea breath test** is a common and accurate non-invasive method to detect current **Helicobacter pylori** infection. - H. pylori produces the enzyme **urease**, which breaks down ingested urea into ammonia and carbon dioxide, which is then exhaled and measured. *Campylobacter jejuni* - **Campylobacter jejuni** is a common cause of **bacterial gastroenteritis** and typically diagnosed via **stool culture**. - It does not possess the **urease** enzyme, so a urea breath test would not be positive. *E.coli* - **E. coli** is a diverse group of bacteria, some strains causing gastrointestinal illness, but it is not associated with **urease production** for diagnostic purposes. - Diagnosis for diarrheagenic E. coli strains usually involves **stool culture** and specific toxin assays. *Lactobacillus* - **Lactobacillus** are beneficial bacteria commonly found in the gut and are not typically associated with pathogenic infections requiring a **urea breath test**. - They do not produce the **urease** enzyme in quantities relevant for this diagnostic test.

Q: In Rheumatoid arthritis, which type of cells are prominently present ?

Macrophages. ***Macrophages*** - **Macrophages** are abundant in the inflamed synovial tissue of patients with **rheumatoid arthritis**, contributing significantly to inflammation and joint destruction [1]. - They produce various **pro-inflammatory cytokines** (e.g., TNF-̑, IL-1, IL-6) and enzymes that degrade cartilage and bone. *B cells* - While **B cells** play a role in **rheumatoid arthritis** by producing autoantibodies like **rheumatoid factor (RF)**, they are not the most prominently present immune cell type in the synovium compared to macrophages [2]. - Their presence is often concentrated in lymphocytic aggregates within the synovium [1]. *T cells* - **T cells**, particularly **CD4+ helper T cells**, are important in orchestrating the immune response in **rheumatoid arthritis** and are found in the inflamed synovium [2]. - However, **macrophages** are generally more numerous and critical for the sustained inflammatory destruction. *Dendritic cells* - **Dendritic cells** are **antigen-presenting cells** that initiate and shape immune responses in **rheumatoid arthritis**. - While present in the synovium, their numbers are generally lower than those of **macrophages** and **T cells**. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 677-678. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1212-1214.

Q: Anaerobes are resistant intrinsically against which of the following?

Aminoglycosides. ***Aminoglycosides*** - **Aminoglycosides** require an **oxygen-dependent transport system** to enter bacterial cells. [3] - Since **anaerobes** thrive in low-oxygen environments, this transport system is inactive, making them intrinsically resistant to aminoglycosides. [3] *Azithromycin* - **Azithromycin** (a macrolide) inhibits protein synthesis by binding to the 50S ribosomal subunit. - Many anaerobes are susceptible to **azithromycin**, making it an effective treatment for certain anaerobic infections. *Metronidazole* - **Metronidazole** is a potent prodrug that requires reduction by **anaerobic metabolism** to become active. [1], [2] - Its mechanism of action involves creating **cytotoxic free radicals** that damage DNA, making it highly effective against most anaerobes. [2] *Beta lactam antibiotics* - **Beta-lactam antibiotics**, such as **penicillins** and **cephalosporins**, interfere with bacterial cell wall synthesis. - While some anaerobes are susceptible, others have developed resistance mechanisms like producing **beta-lactamase enzymes**, but they are not intrinsically resistant across the board. [4]

Q: What is the current preferred term for the condition previously known as mental retardation?

Intellectual disability. ***Correct: Intellectual disability*** - This term was adopted to replace "mental retardation" due to its less stigmatizing nature and its focus on **cognitive and adaptive functioning** - It emphasizes the need for supports and services to help individuals achieve their potential, rather than simply labeling a deficit - Officially adopted in **DSM-5 (2013)** and mandated by **Rosa's Law (2010)** in federal terminology *Incorrect: Feeble Mindedness* - This is an **outdated and derogatory term** that was used historically to describe individuals with cognitive impairments - Its use has been discontinued due to its negative and dehumanizing connotations *Incorrect: Madness* - This term typically refers to severe **mental illness** or **psychosis**, not intellectual impairment - It is an informal and often stigmatizing term that is not used in clinical or diagnostic contexts for intellectual functioning *Incorrect: Mentally unstable* - This term is often used to describe individuals experiencing **fluctuations in mood**, **behavior**, or **thought processes**, usually associated with mental health conditions - It does not specifically refer to global cognitive deficits or intellectual functioning

Q: What type of lesions in the skull calvarium can be identified on this X-ray?

Brain metastases. ***Brain metastases (Skull metastases)*** - The image shows multiple **lytic lesions** in the skull calvarium, which are characteristic of metastatic disease that has spread to bone - Metastases from primary cancers (lung, breast, kidney, thyroid, prostate) commonly involve the skull and appear as **punched-out or moth-eaten lytic lesions** - While plain X-rays cannot visualize brain parenchyma, they can detect **bony destruction** caused by metastatic deposits in the skull - These appear as well-defined osteolytic lesions without sclerotic margins *Multiple myeloma* - Multiple myeloma typically presents with **multiple punched-out lytic lesions** in the skull that can appear very similar to metastases - However, multiple myeloma is a **primary bone marrow malignancy** rather than metastatic disease - Key differentiator: myeloma lesions are usually more uniform in size and distribution - Clinical context (monoclonal protein, anemia, renal dysfunction) helps distinguish from metastases *Osteosarcoma* - Osteosarcoma is a **primary bone tumor** that usually causes a mixture of lytic and blastic (bone-forming) lesions - Typically presents with **sunburst or spiculated periosteal reaction** and soft tissue mass - Usually occurs as a **solitary aggressive lesion** in younger patients, not multiple scattered lesions - Rarely occurs in the skull compared to long bones *Osteomyelitis* - Osteomyelitis is an **infection of the bone** that causes bone destruction and reactive new bone formation - Shows features of **bone destruction, periosteal reaction**, and possibly sequestra (dead bone fragments) - Typically presents as a **focal process** with surrounding inflammatory changes - Does not produce the multiple discrete lytic lesions pattern seen in metastatic disease

Q: Which of the following statements about the management of haematomas is NOT correct?

Haematoma must be operated.. ***Haematoma must be operated.*** - This statement is **incorrect** because not all hematomas require surgical intervention. - The decision to operate depends on **size**, **location**, **neurological status**, **mass effect**, and rate of expansion. - Small, asymptomatic hematomas can be managed **conservatively** with serial imaging and close neurological monitoring. - Absolute statements like "must be operated" are incorrect in clinical practice where individualized management is essential. *Some haematomas require surgical intervention.* - This statement is **correct** - many hematomas necessitate surgical evacuation. - Indications for surgery include: **significant mass effect**, **midline shift >5mm**, **neurological deterioration**, **large volume** (>30mL for SDH, >50mL for ICH), or **posterior fossa hematomas** causing brainstem compression. - Surgical intervention aims to relieve intracranial pressure and prevent secondary brain injury. *GCS assessment is helpful in prognosis.* - This statement is **correct** - the **Glasgow Coma Scale (GCS)** is a critical prognostic tool. - GCS is used to assess severity of neurological injury and predict outcomes in head trauma patients. - Lower GCS scores (≤8) indicate severe injury with poorer prognosis, while higher scores suggest better outcomes. - GCS also guides management decisions including need for intubation and intensive monitoring. *CT scan is the investigation of choice for acute haemorrhage.* - This statement is **correct** - **Non-contrast CT (NCCT)** is the gold standard for acute intracranial hemorrhage. - CT is rapid, widely available, and highly sensitive for detecting acute blood. - It helps identify location, size, mass effect, and associated injuries like skull fractures. - MRI has limited role in acute settings but is useful for subacute/chronic hemorrhage and detecting diffuse axonal injury.

Q: What is the most common indication for performing a tracheostomy?

Prolonged mechanical ventilation. ***Prolonged mechanical ventilation*** - Maintaining an **endotracheal tube** for an extended period carries risks like **tracheal injury**, **vocal cord damage**, and difficulty with oral intake. - A tracheostomy provides a more comfortable and stable airway for **long-term respiratory support**, facilitates weaning from the ventilator, and reduces the risk of **ventilator-associated pneumonia**. *Severe obstructive sleep apnea* - While tracheostomy can effectively treat severe OSA by bypassing the upper airway obstruction, it is generally considered a **last resort** after less invasive treatments have failed. - The most common initial treatments for OSA include **CPAP**, weight loss, and oral appliances. *Tracheal stenosis* - Tracheal stenosis itself is a **structural narrowing** of the trachea that may or may not require tracheostomy, depending on its severity and location. - While a tracheostomy can bypass a severe stenosis, surgical repair of the trachea is often the definitive treatment for **severe tracheal stenosis**. *Vocal cord paralysis* - Unilateral vocal cord paralysis typically causes **hoarseness** and may not always necessitate a tracheostomy. - Bilateral vocal cord paralysis can lead to **airway obstruction**, but intervention usually involves vocal cord lateralization procedures or, in severe cases, a tracheostomy for airway patency.

Q: Which is the best investigation for carcinoma of the head of pancreas?

EUS. ***EUS*** - **Endoscopic ultrasound (EUS)** provides the highest resolution imaging of the pancreas and allows for **fine-needle aspiration (FNA)** of suspicious lesions, offering definitive tissue diagnosis. - Its ability to visualize small, early-stage tumors and regional lymph nodes makes it the **most accurate method for diagnosis and staging** of pancreatic head carcinoma. *Guided biopsy* - While a biopsy is necessary for definitive diagnosis, 'guided biopsy' is a broad term that doesn't specify the highly effective EUS guidance. - Other biopsy methods that are not guided by EUS may be less accurate and carry higher risks for pancreatic lesions. *ERCP* - **Endoscopic retrograde cholangiopancreatography (ERCP)** is primarily a therapeutic procedure used for **biliary drainage** in cases of obstruction caused by pancreatic head tumors. - Although it can visualize ductal abnormalities and allow brush cytology, it is **less sensitive for direct tumor visualization** and tissue acquisition compared to EUS-FNA. *Transduodenal/transperitoneal sampling* - These are **invasive surgical approaches** for obtaining tissue samples, typically reserved when less invasive methods like EUS-FNA are unsuccessful or when intraoperative confirmation is needed. - They carry **higher risks** and are not considered the "best investigation" for initial diagnosis due to their invasiveness and potential for complications.

Question 1

Hard palate contains:

Accepted Answer

Keratinised, submucosa, minor salivary gland

Answer

Keratinised, absent submucosal layer, minor salivary gland

Answer

Non keratinised, submucosal layer, minor salivary gland

Answer

Non keratinised, absent submucosa, minor salivary gland

Question 2

What is a potential cause of cardiogenic shock other than myocardial infarction (MI)?

Accepted Answer

Acute mitral regurgitation

Answer

Ventricular septal rupture

Answer

Isolated right ventricular shock

Answer

None of the options

Question 3

Urea breath test is used for diagnosis of:

Accepted Answer

H. pylori

Answer

E. coli

Answer

Lactobacillus

Answer

Campylobacter jejuni

Question 4

In Rheumatoid arthritis, which type of cells are prominently present ?

Accepted Answer

Macrophages

Answer

B cells

Answer

T cells

Answer

Dendritic cells

Question 5

Anaerobes are resistant intrinsically against which of the following?

Accepted Answer

Aminoglycosides

Answer

Azithromycin

Answer

Metronidazole

Answer

Beta lactam antibiotics

Question 6

What is the current preferred term for the condition previously known as mental retardation?

Accepted Answer

Intellectual disability

Answer

Feeble Mindedness

Answer

Madness

Answer

Mentally unstable

Question 7

What type of lesions in the skull calvarium can be identified on this X-ray?

Accepted Answer

Brain metastases

Answer

Multiple myeloma

Answer

Osteosarcoma

Answer

Osteomyelitis

Question 8

Which of the following statements about the management of haematomas is NOT correct?

Accepted Answer

Haematoma must be operated.

Answer

Some haematomas require surgical intervention.

Answer

GCS assessment is helpful in prognosis.

Answer

CT scan is the investigation of choice for acute haemorrhage.

Question 9

What is the most common indication for performing a tracheostomy?

Accepted Answer

Prolonged mechanical ventilation

Answer

Severe obstructive sleep apnea

Answer

Tracheal stenosis

Answer

Vocal cord paralysis

Question 10

Which is the best investigation for carcinoma of the head of pancreas?

Accepted Answer

EUS

Answer

Transduodenal/transperitoneal sampling

Answer

Guided biopsy

Answer

ERCP

NEET-PG 2018

Anatomy

Internal Medicine

Microbiology

Pathology

Pharmacology

Psychiatry

Radiology

Surgery