NEET-PG 2019 Practice Questions

Q: In patients with Retinitis pigmentosa, which of the following substances is known to have decreased levels?

Docosahexaenoic acid (DHA). ***Docosahexaenoic acid (DHA)*** - **Docosahexaenoic acid (DHA)** is a crucial **omega-3 fatty acid** abundantly found in the **photoreceptor cell membranes**, particularly in the retina. - Reduced levels of DHA are frequently observed in patients with **retinitis pigmentosa**, suggesting its role in disease pathogenesis and retinal health. *Arachidonic acid* - **Arachidonic acid** is an **omega-6 fatty acid** and a precursor to many signaling molecules, but its levels are **not typically decreased** in retinitis pigmentosa. - It plays a **pro-inflammatory role** and is involved in various physiological processes, distinct from the primary metabolic defects in retinitis pigmentosa. *Linoleic acid* - **Linoleic acid** is an essential **omega-6 fatty acid** and a precursor to arachidonic acid, but its deficiencies are not characteristic of retinitis pigmentosa. - It is crucial for **skin barrier function** and overall health, but its metabolic pathways are distinct from those primarily affected in retinal degenerations. *Thromboxane* - **Thromboxane** is a **lipid mediator** primarily involved in **platelet aggregation** and vasoconstriction. - It is not directly associated with the metabolic pathways or structural integrity of the retina, and its levels are not typically altered in retinitis pigmentosa.

Q: In the context of gunshot injuries, which of the following describes the characteristics of a close shot entry wound, including signs such as burning, blackening, tattooing around the wound, and the presence of a dirt collar?

Close shot entry wound. ***Close shot entry wound*** - **Burning, blackening, tattooing**, and a **dirt collar** around the wound are classic signs of a **close-range gunshot entry wound**. These findings result from the burning of skin by hot gases, deposition of soot (blackening), and impact of unburnt gunpowder particles (tattooing/stippling) from a firearm discharged at a close distance. - The **"dirt collar"** (also known as a **grease collar** or **abrasion collar**) is caused by the passage of the bullet through the skin, wiping off lubricants, dirt, and residue from the bullet onto the skin around the wound. *Close shot exit wound* - An **exit wound** is typically larger, more irregular, and lacks the characteristics of burning, blackening, or tattooing because the bullet has lost momentum and often tumbles or deforms as it exits the body. - There would also be no dirt collar or soot deposits, as these are associated with the initial entry of the bullet and propellant gases. *Distant shot entry wound* - A **distant shot entry wound** would likely show an abrasion collar and a circular or oval defect, but it would lack the burning, blackening (soot), and tattooing (stippling) as the firearm was discharged from a distance preventing these elements from reaching the skin. - The lack of unburnt powder and gases impacting the skin differentiates it from a close-range shot. *Distant shot exit wound* - A **distant shot exit wound** would exhibit the same characteristics as any exit wound: larger, irregular, and without the signs of burning, blackening, or tattooing. - The absence of close-range effects like soot and stippling on a distant entry wound similarly means they would not be present on a distant exit wound.

Q: Which murmur increases on standing?

HOCM. ***HOCM*** - Standing decreases **venous return** and **left ventricular volume**, which reduces the size of the LV outflow tract and thus exacerbates the obstruction in **hypertrophic obstructive cardiomyopathy (HOCM)**, making the murmur louder [1]. - This maneuver is a key diagnostic feature as reduced preload intensifies the dynamic obstruction. *MR* - **Mitral regurgitation (MR)** is typically a volume overload lesion, and standing (which reduces preload) generally causes the murmur to **decrease** in intensity due to less blood volume ejected back into the atrium [3]. - The murmur of MR is usually a holosystolic murmur radiating to the axilla [3]. *MS* - **Mitral stenosis (MS)** is a fixed obstruction to left ventricular filling. Changes in preload (like standing) do not significantly alter the gradient across the mitral valve or the intensity of the murmur [2]. - Its characteristic murmur is a **mid-diastolic rumble** with an opening snap [1]. *VSD* - A **ventricular septal defect (VSD)** murmur is caused by blood flowing from the high-pressure left ventricle to the low-pressure right ventricle. Standing, by reducing systemic vascular resistance, would typically cause the murmur to **decrease** in intensity as less blood shunts left-to-right. - The murmur is usually a **holosystolic murmur** best heard at the lower left sternal border.

Q: Most characteristic cardiovascular defect seen in Rubella-

Patent ductus arteriosus. ***Patent ductus arteriosus*** - **Patent ductus arteriosus (PDA)** is the most characteristic cardiovascular defect associated with congenital rubella syndrome [1]. - The rubella virus can interfere with the normal closure of the **ductus arteriosus** during fetal development [1]. *Coarctation of the aorta* - **Coarctation of the aorta** is a narrowing of the aorta and is not typically linked to congenital rubella syndrome [1]. - It is often associated with syndromes like **Turner syndrome** or bicuspid aortic valve, which are not mentioned here [1]. *Ventricular septal defect* - **Ventricular septal defects (VSDs)** are common congenital heart defects, but they are not specifically characteristic of congenital rubella [1]. - VSDs are more frequently associated with conditions like **Down syndrome** or can occur in isolation [1]. *Pulmonary artery stenosis* - While **pulmonary artery stenosis** can occur as a congenital heart defect, it is less commonly the primary cardiovascular manifestation of congenital rubella syndrome. - **Peripheral pulmonary artery stenosis** can be seen in rubella, but PDA is the most characteristic overarching defect [1].

Q: Identify the diagnosis based on the provided ECG image.

PSVT. ***PSVT*** - The ECG shows a **narrow complex tachycardia** with a regular rhythm and a high heart rate, characteristic of **paroxysmal supraventricular tachycardia (PSVT)**. - P waves are often **buried within the QRS complex** or T waves, or may be retrograde, which can be seen as small deflections or changes in the baseline in some leads. *VT* - **Ventricular tachycardia** is characterized by a **wide QRS complex** (>0.12 seconds), which is not observed in this ECG. - While VT can be regular, the primary distinguishing feature is the QRS duration. *AT* - **Atrial tachycardia (AT)** is another form of supraventricular tachycardia, but it typically shows **distinct P waves** with an abnormal morphology, often separate from the T wave, which are not clearly visible or consistently distinct in this tracing. - While it can present with narrow complex tachycardia, the mechanism differs from re-entrant PSVT. *Ventricular fibrillation* - **Ventricular fibrillation** is characterized by **chaotic, irregular electrical activity** with no distinguishable P waves, QRS complexes, or T waves, representing disorganized ventricular depolarization. - The ECG in the image shows a consistent, regular rhythm with identifiable, albeit narrow, QRS complexes.

Q: Female with 41 wk gestation confirmed by radiological investigation, very sure of her LMP, no uterine contractions, no effacement and no dilatation. What should be done to induce labor?

PGE1 tab. ***PGE1 tab*** - **Misoprostol (PGE1)** is an effective agent for **cervical ripening** and labor induction in cases of an unfavorable cervix (no effacement, no dilatation). - It is cost-effective, stable at room temperature, and widely used in resource-limited settings. - Can be administered orally or vaginally with good efficacy for cervical ripening at term. - In this post-term pregnancy with unfavorable cervix, pharmacological ripening is appropriate. *PGE2 gel* - **PGE2 (dinoprostone)** gel or cervical insert is also an effective option for cervical ripening. - Both PGE1 and PGE2 are acceptable first-line agents; the choice may depend on availability, cost, and institutional protocols. - PGE2 formulations are FDA-approved and widely used, though may be more expensive than misoprostol. *PGF2alpha* - **PGF2alpha (carboprost)** is primarily used for the **management of postpartum hemorrhage** due to its potent myometrial contracting effect. - It is **not indicated** for induction of labor at term as its strong uterine contractions can cause excessive uterine stimulation and fetal distress. *Intracervical foley's* - An **intracervical Foley catheter** is a mechanical method that causes cervical ripening through direct pressure and stimulation of local prostaglandin release. - It is an evidence-based alternative with lower risk of uterine hyperstimulation compared to pharmacological methods. - Both mechanical and pharmacological methods are acceptable first-line options for cervical ripening in post-term pregnancy with unfavorable cervix.

Q: Which of the following statements about conjunctival lesions is NOT true?

Surgery is treatment of choice. ***Surgery is treatment of choice*** - While surgery can be used to treat conjunctival lesions, it is not always the **treatment of choice**, especially for smaller, asymptomatic lesions like **pinguecula** which may only require observation and lubrication. - Many conjunctival lesions, such as uncomplicated **pterygium** or **pinguecula**, are managed conservatively unless they cause significant symptoms, vision impairment, or cosmetic concerns. *Arise from any part of conjunctiva* - **Conjunctival lesions** can indeed arise from various parts of the conjunctiva, including the palpebral, bulbar, and forniceal conjunctiva. - For example, **pterygium** typically arises from the bulbar conjunctiva, while **pinguecula** also originates in the bulbar conjunctiva, specifically in the interpalpebral fissure. *Can cause Astigmatism* - Larger **conjunctival lesions**, particularly a **pterygium** that encroaches onto the cornea, can induce or alter astigmatism. - The growth of the lesion can change the **curvature of the cornea**, leading to optical distortion and astigmatism. *UV exposure is risk factor* - **Ultraviolet (UV) light exposure** is a well-established risk factor for the development of many conjunctival lesions, including **pterygium** and **pinguecula**. - Chronic UV exposure leads to **elastotic degeneration** of the conjunctival collagen and is thought to play a key role in the pathogenesis of these growths.

Q: What is the recommended dose of diphtheria antitoxin for adults?

20000 to 50000 IU. ***20000 to 50000 IU*** - For adults with **diphtheria**, the recommended dose of **diphtheria antitoxin (DAT)** in the range of 20,000 to 50,000 IU is appropriate for **pharyngeal or laryngeal diphtheria** of moderate severity (typically disease present for 48-72 hours). - This dosage aims to neutralize the **diphtheria toxin** circulating in the bloodstream and prevent further tissue damage. - **Note:** More severe or extensive disease (>3 days duration or with bull neck) may require higher doses (80,000-120,000 IU). *1000 to 2000 IU* - This dosage is **too low** for therapeutic treatment of diphtheria in adults. - Such a low dose would be insufficient to neutralize the substantial amount of **toxin** produced during an active infection, regardless of disease severity. *10000 to 20000 IU* - This dose is **suboptimal** for most forms of diphtheria in adults. - Even for **mild cutaneous diphtheria**, doses typically start at 20,000 IU or higher. - For respiratory diphtheria, this range would be inadequate to effectively counteract the toxin. *None of the options* - This is incorrect because **20,000 to 50,000 IU** is a recognized and recommended range for diphtheria antitoxin in adult treatment of moderate pharyngeal/laryngeal disease. - Diphtheria antitoxin is a crucial and **specific treatment** for diphtheria, and evidence-based dosage ranges exist based on disease severity and location.

Q: Achondroplasia shows which type of inheritance?

Autosomal dominant inheritance. ***Autosomal dominant inheritance*** - Achondroplasia is caused by a **mutation in the FGFR3 gene**, which is located on an **autosomal chromosome** (chromosome 4). - The disease manifests with only **one copy of the mutated gene**, hence it follows an autosomal dominant pattern. *X-linked dominant (XLD)* - X-linked dominant disorders are caused by mutations on the **X chromosome** and typically affect females more severely or frequently than males. - Achondroplasia does not show sex-linked inheritance patterns, as its causative gene is on an autosome. *Autosomal recessive inheritance* - Autosomal recessive disorders require **two copies of the mutated gene** (one from each parent) for the disease to manifest. - Achondroplasia can occur with only one copy of the mutated gene, distinguishing it from recessive inheritance. *X-linked recessive (XLR)* - X-linked recessive disorders primarily affect **males** and are carried by females, who are usually asymptomatic carriers. - The inheritance pattern of achondroplasia is independent of sex, ruling out X-linked recessive inheritance.

Q: Identify the surgical instrument based on its characteristics: a small, triangular blade used for precise incisions.

Blade no. 11. ***Blade no. 11*** - This blade has a **triangular shape** with a strong, pointed tip, making it ideal for **stab incisions** and precise, short cuts. - Its design allows for sharp, accurate penetration, often used in procedures requiring **minimal tissue disruption**. *Blade no. 15* - This is a small, curved blade, primarily used for **fine, precise cuts** in superficial tissues. - Its small size and rounded belly make it suitable for tasks like excising skin lesions or making incisions in delicate areas, not for triangular stab incisions. *Blade no. 10* - The No. 10 blade has a **large, curved cutting edge** and is generally used for making large incisions in skin and muscle. - It is not designed for precise, triangular stab incisions, but rather for broader, sweeping cuts. *Blade no. 12* - This blade is **sickle-shaped** with the cutting edge on the inside curve, used primarily for mucogingival surgery or removing sutures. - Its unique shape allows it to get into tight spaces and cut from a different angle, but it does not have a triangular tip for precise stab incisions.

Question 1

In patients with Retinitis pigmentosa, which of the following substances is known to have decreased levels?

Accepted Answer

Docosahexaenoic acid (DHA)

Answer

Thromboxane

Answer

Arachidonic acid

Answer

Linoleic acid

Question 2

In the context of gunshot injuries, which of the following describes the characteristics of a close shot entry wound, including signs such as burning, blackening, tattooing around the wound, and the presence of a dirt collar?

Accepted Answer

Close shot entry wound

Answer

Close shot exit wound

Answer

Distant shot entry wound

Answer

Distant shot exit wound

Question 3

Which murmur increases on standing?

Accepted Answer

HOCM

Answer

MR

Answer

MS

Answer

VSD

Question 4

Most characteristic cardiovascular defect seen in Rubella-

Accepted Answer

Patent ductus arteriosus

Answer

Coarctation of the aorta

Answer

Ventricular septal defect

Answer

Pulmonary artery stenosis

Question 5

Identify the diagnosis based on the provided ECG image.

Accepted Answer

PSVT

Answer

VT

Answer

AT

Answer

Ventricular fibrillation

Question 6

Female with 41 wk gestation confirmed by radiological investigation, very sure of her LMP, no uterine contractions, no effacement and no dilatation. What should be done to induce labor?

Accepted Answer

PGE1 tab

Answer

PGE2 gel

Answer

PGF2alpha

Answer

Intracervical foley’s

Question 7

Which of the following statements about conjunctival lesions is NOT true?

Accepted Answer

Surgery is treatment of choice

Answer

Arise from any part of conjunctiva

Answer

Can cause Astigmatism

Answer

UV exposure is risk factor

Question 8

What is the recommended dose of diphtheria antitoxin for adults?

Accepted Answer

20000 to 50000 IU

Answer

1000 to 2000 IU

Answer

10000 to 20000 IU

Answer

None of the options

Question 9

Achondroplasia shows which type of inheritance?

Accepted Answer

Autosomal dominant inheritance

Answer

X-linked dominant (XLD)

Answer

Autosomal recessive inheritance

Answer

X-linked recessive (XLR)

Question 10

Identify the surgical instrument based on its characteristics: a small, triangular blade used for precise incisions.

Accepted Answer

Blade no. 11

Answer

Blade no. 15

Answer

Blade no. 10

Answer

Blade no. 12

NEET-PG 2019

Biochemistry

Forensic Medicine

Internal Medicine

Obstetrics and Gynecology

Ophthalmology

Pharmacology

Physiology

Surgery