NEET-PG 2019 Practice Questions

Q: What is the nerve supply of the structure marked in the image?

Median nerve. ***Median nerve*** - The image points to the **lateral two lumbricals**. The **median nerve** innervates the first and second (lateral two) lumbrical muscles. - These muscles contribute to **flexion of the metacarpophalangeal joints** and **extension of the interphalangeal joints** of the index and middle fingers. *Anterior interosseous nerve* - The anterior interosseous nerve is a branch of the **median nerve** and primarily supplies deep muscles of the forearm, such as the **flexor pollicis longus**, **flexor digitorum profundus (lateral half),** and **pronator quadratus**. - It does not directly innervate the lumbricals in the hand. *Posterior interosseous nerve* - The posterior interosseous nerve is a branch of the **radial nerve**. - It primarily innervates the **extensor muscles of the forearm** and wrist, not the lumbrical muscles. *Ulnar nerve* - The **ulnar nerve** innervates the **medial two lumbricals** (third and fourth), as well as most of the other intrinsic hand muscles, including the interossei. - The nerve supply of the lumbricals is split between the median and ulnar nerves, with the lateral two supplied by the median nerve.

Q: Cholecystocaval line:-

Separate right and left hepatic lobes. ***Separate right and left hepatic lobes*** - The **cholecystocaval line**, also known as **Cantlie's line**, is an imaginary plane that divides the **anatomical right and left lobes** of the liver [1]. - This line runs from the **gallbladder fossa** anteriorly to the **inferior vena cava (IVC)** posteriorly. *Separate left medial and left lateral sectors* - The division between the **left medial (segment IV)** and **left lateral (segments II and III)** sectors of the liver is demarcated by the **left hepatic vein** or the falciform ligament internally [3], [4]. - The cholecystocaval line's primary function is not to separate these specific left lobe sectors. *Separate right anterior and right posterior sectors* - The division between the **right anterior (segments V and VIII)** and **right posterior (segments VI and VII)** sectors of the liver is typically defined by the **right hepatic vein** [2]. - This anatomical landmark is distinct from the cholecystocaval line. *Separate gall bladder from portal vein* - The cholecystocaval line is a plane that **originates from the gallbladder**, but it divides the liver parenchyma rather than separating the gallbladder itself from the portal vein. - The gallbladder is a separate organ adjacent to the liver, and the portal vein is a major vessel within the liver parenchyma [1].

Q: In case of LPL deficiency, which of the following will increase after a fat rich diet?

Chylomicron. ***Chylomicron*** - **LPL (lipoprotein lipase)** is crucial for the breakdown of **chylomicrons** and VLDL. A deficiency leads to an accumulation of undigested chylomicrons in the bloodstream after a fat-rich meal. - **Chylomicrons** transport dietary triglycerides from the intestines to tissues. Without LPL, these triglycerides remain packaged in chylomicrons. *LDL* - **LDL (low-density lipoprotein)** levels are not directly increased by a short-term fat-rich diet in the context of LPL deficiency. LDL primarily carries cholesterol and is formed from VLDL remnants, a process that is also impaired by LPL deficiency indirectly. - While chronic LPL deficiency can affect overall lipid metabolism, the immediate post-meal increase is not in LDL but in triglyceride-rich lipoproteins. *HDL* - **HDL (high-density lipoprotein)** is involved in reverse cholesterol transport and is generally not directly increased after a fat-rich diet, especially in LPL deficiency. - In fact, severe hypertriglyceridemia, often seen in LPL deficiency, can sometimes lead to lower HDL levels due to altered lipid exchange. *Lipoprotein (a)* - **Lipoprotein (a)**, or Lp(a), is a genetically determined lipoprotein similar to LDL but with an added apolipoprotein (a) and its levels are not acutely affected by dietary fat intake or LPL deficiency. - Lp(a) levels are determined primarily by genetic factors and do not participate in the post-prandial handling of dietary fats.

Q: Which of the following is a risk factor for Alzheimer's disease?

Down’s syndrome. ***Down’s syndrome*** - Individuals with **Down's syndrome** have an extra copy of chromosome 21, which carries the **amyloid precursor protein (APP) gene**. - This **triplication of the APP gene** leads to increased production of **beta-amyloid protein**, a key component of the plaques found in Alzheimer's disease [1]. *Klinefelter syndrome* - **Klinefelter syndrome** is a genetic condition characterized by an extra X chromosome (XXY), primarily affecting males. - While it can be associated with various health issues, it is **not a known risk factor** for Alzheimer's disease. *Low blood pressure* - **Low blood pressure** (hypotension) is generally not considered a direct risk factor for Alzheimer's disease. - In fact, some studies suggest that **midlife hypertension** (high blood pressure) is a risk factor for later cognitive decline and Alzheimer's. *None of the options* - This option is incorrect because **Down's syndrome** is a well-established and significant risk factor for Alzheimer's disease due to the genetic link involving the APP gene.

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: The most common cause of proptosis in adults:-

Thyroid eye disease. ***Thyroid eye disease*** - **Thyroid eye disease (TED)**, also known as Graves' ophthalmopathy, is the most common cause of **proptosis** in adults. - It results from an autoimmune process leading to inflammation and expansion of the **extraocular muscles** and orbital fat, which pushes the eyeball forward. *Preseptal cellulitis* - **Preseptal cellulitis** is an infection of the eyelid and periorbital tissue anterior to the orbital septum, typically presenting with **eyelid swelling** and redness. - While it causes periorbital swelling, it generally does not cause true **proptosis**, which is the anterior displacement of the eyeball itself. *Capillary hemangioma* - **Capillary hemangiomas** are benign vascular tumors and are the most common orbital tumor in **infancy and childhood**, not adults. - They typically cause proptosis in young children, often presenting as a **reddish-blue mass** that may increase in size with crying. *Orbital cellulitis* - **Orbital cellulitis** is a serious infection of the tissues within the orbit, posterior to the orbital septum, which can cause **proptosis**, pain, and ophthalmoplegia. - While it is a cause of proptosis, it is an **acute infectious process** and not the most common overall cause of proptosis in the adult population compared to thyroid eye disease.

Q: A 25-year-old male presents with localized pain in the tibia and swelling. Imaging reveals a bone abscess. Identify the condition.

Brodie abscess. ***Brodie abscess*** - A Brodie abscess is a **subacute or chronic osteomyelitis** characterized by a well-circumscribed, **radiolucent lesion** (an abscess cavity) often surrounded by a zone of **sclerosis**, representing the body's attempt to wall off the infection. - The presentation of localized pain and swelling in the tibia, with imaging revealing a bone abscess, is consistent with this condition, which is a common form of localized osteomyelitis. *Osteoid osteoma* - This is a **benign bone tumor** characterized by a small, radiolucent nidus surrounded by a large area of **sclerotic bone**. The pain from an osteoid osteoma is typically **worse at night** and dramatically relieved by NSAIDs. - While it can cause localized pain and swelling, the imaging features of a distinct abscess cavity are not characteristic of an osteoid osteoma. *Intracortical hemangioma* - An intracortical hemangioma is a **rare benign vascular lesion** within the cortex of a bone. - Imaging typically shows a **lytic lesion** with a characteristic **"honeycomb" or "sunburst" appearance**, not a well-defined abscess. *Chondromyxoid fibroma* - This is a rare, **benign cartilaginous tumor** that usually presents as an **eccentric lytic lesion** in the metaphysis of long bones, often with a scalloped border and sclerotic rim. - While it can cause localized pain and swelling, the imaging appearance of an abscess with sclerotic margins is not typical of a chondromyxoid fibroma.

Q: 30 year old woman with complaint of dysmenorrhoea, dyspareunia with chronic pelvic pain undergoes hysterectomy. From the cut section of hysterectomy specimen below identify the condition.

Adenomyosis. ***Adenomyosis*** - The image shows a **thickened uterine wall** with poorly demarcated, **cystic or hemorrhagic areas** within the myometrium, which are characteristic macroscopic findings of adenomyosis. - The clinical symptoms of **dysmenorrhea, dyspareunia, and chronic pelvic pain** are classic presentations for adenomyosis, caused by the presence of endometrial glands and stroma within the myometrium. - The **globular uterine enlargement** with diffuse involvement distinguishes this from discrete lesions. *Fibroids (Leiomyoma)* - Fibroids are **well-circumscribed, discrete, rubbery masses** within the myometrium, often bulging from the surface or cut section with a characteristic **whorled appearance**. - While fibroids can cause menorrhagia and bulk symptoms, the diffuse thickening and **ill-defined hemorrhagic foci** in the image are inconsistent with the **sharply defined borders** of leiomyomas. *Endometrial hyperplasia* - Endometrial hyperplasia involves **thickening of the endometrial lining** due to excess estrogen stimulation, typically presenting with abnormal uterine bleeding. - This condition affects the **endometrium (lining) rather than the myometrium (muscle wall)**, and would not show the deep myometrial involvement with cystic spaces seen in the image. - The clinical picture of dysmenorrhea and dyspareunia is more consistent with adenomyosis than hyperplasia. *Endometriosis* - Endometriosis involves the presence of **endometrial tissue outside the uterus**, such as on the ovaries, peritoneum, or pelvic organs. - While it shares similar symptoms like dysmenorrhea and dyspareunia, endometriosis is a **separate condition from adenomyosis** (which is endometrial tissue within the uterine wall). - The image shows the **uterine cut section with myometrial involvement**, not external implants characteristic of endometriosis.

Q: Fast breathing in a 6-month-old infant is taken as:

>50 breaths/min. ***>50 breaths/min*** - For infants aged 2 to 12 months, a respiratory rate of **greater than 50 breaths per minute** is considered consistent with **tachypnea** or fast breathing. - This is an important indicator of respiratory distress, often used in clinical assessment frameworks like the **Integrated Management of Childhood Illness (IMCI)**. *>30 breaths/min* - A respiratory rate of **>30 breaths/min** would be considered fast breathing for an older child or adult, but it is within the normal range for an infant. - Normal respiratory rates are **higher in infants** and gradually decrease with age. *>60 breaths/min* - While a respiratory rate of **>60 breaths/min** is indeed fast and indicates severe respiratory distress, it is not the initial threshold for defining fast breathing in a 6-month-old infant. - This rate would suggest a more **severe clinical presentation** than simply "fast breathing." *>40 breaths/min* - A respiratory rate **>40 breaths/min** is typically considered fast breathing for children aged 1 to 5 years, but not for infants under 12 months. - For a 6-month-old, this rate is still within the **normal or upper-normal range**, depending on activity and state.

Q: Identify the triangle in the image below.

Gastrinoma triangle. ***Gastrinoma triangle*** - The image displays the **gastrinoma triangle** (also known as the **Passaro triangle**), which is the most common location for **gastrinomas** within the abdomen. - This triangle is formed by the superior border of the **duodenum** (first part), the inferior border of the **duodenum** (third part), and the junction of the **cystic duct** and **common bile duct**. *Koch’s triangle* - **Koch's triangle** is an anatomical region within the **right atrium of the heart**, defined by the septal leaflet of the tricuspid valve, the coronary sinus ostium, and the tendon of Todaro. - It is significant as it contains the **atrioventricular (AV) node**, crucial for cardiac conduction. *Hesselbach’s triangle* - **Hesselbach's triangle** is located in the **inguinal region** on the anterior abdominal wall, bounded by the inferior epigastric artery, the lateral border of the rectus abdominis muscle, and the inguinal ligament. - It is a clinically important landmark for differentiating between **direct and indirect inguinal hernias**. *Sherren’s triangle* - **Sherren's triangle** refers to a zone of **hyperesthesia** (increased tactile sensitivity) in the right iliac fossa that can be indicative of **acute appendicitis**. - It is bounded by the umbilicus, the anterior superior iliac spine, and the pubic symphysis, and differs from the anatomical triangles shown in the image.

Question 1

What is the nerve supply of the structure marked in the image?

Accepted Answer

Median nerve

Answer

Anterior interosseous nerve

Answer

Posterior interosseous nerve

Answer

Ulnar nerve

Question 2

Cholecystocaval line:-

Accepted Answer

Separate right and left hepatic lobes

Answer

Separate left medial and left lateral sectors

Answer

Separate right anterior and right posterior sectors

Answer

Separate gall bladder from portal vein

Question 3

In case of LPL deficiency, which of the following will increase after a fat rich diet?

Accepted Answer

Chylomicron

Answer

LDL

Answer

HDL

Answer

Lipoprotein (a)

Question 4

Which of the following is a risk factor for Alzheimer's disease?

Accepted Answer

Down’s syndrome

Answer

Low blood pressure

Answer

Klinefelter syndrome

Answer

None of the options

Question 5

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 6

The most common cause of proptosis in adults:-

Accepted Answer

Thyroid eye disease

Answer

Preseptal cellulitis

Answer

Capillary hemangioma

Answer

Orbital cellulitis

Question 7

A 25-year-old male presents with localized pain in the tibia and swelling. Imaging reveals a bone abscess. Identify the condition.

Accepted Answer

Brodie abscess

Answer

Osteoid osteoma

Answer

Intracortical hemangioma

Answer

Chondromyxoid fibroma

Question 8

30 year old woman with complaint of dysmenorrhoea, dyspareunia with chronic pelvic pain undergoes hysterectomy. From the cut section of hysterectomy specimen below identify the condition.

Accepted Answer

Adenomyosis

Answer

Fibroids

Answer

Endometrial hyperplasia

Answer

Endometriosis

Question 9

Fast breathing in a 6-month-old infant is taken as:

Accepted Answer

>50 breaths/min

Answer

>30 breaths/min

Answer

>60 breaths/min

Answer

>40 breaths/min

Question 10

Identify the triangle in the image below.

Accepted Answer

Gastrinoma triangle

Answer

Hesselbach’s triangle

Answer

Koch’s triangle

Answer

Sherren’s triangle

NEET-PG 2019

Anatomy

Biochemistry

Internal Medicine

Obstetrics and Gynecology

Ophthalmology

Orthopaedics

Pathology

Pediatrics

Surgery