NEET-PG 2019 Practice Questions

Q: Which type of collagen is maximum in skin?

Type I. ***Type I*** - **Type I collagen** is the most abundant type of collagen in the human body, constituting about 90% of total collagen [1]. - It provides **strength and structural support** to tissues like skin, bone, tendons, and ligaments [1]. *Type III* - **Type III collagen** is often found alongside Type I collagen in many tissues, but it is typically more prominent in **distensible tissues** like blood vessel walls and intestine. - While present in the skin, it is not the most abundant type; it contributes to **skin elasticity** and is abundant in early wound healing. *Type II* - **Type II collagen** is primarily found in **cartilage**, providing resistance to pressure and flexibility. - It is not a major component of the skin. *Type IV* - **Type IV collagen** is a major component of the **basement membrane**, forming a mesh-like network that provides support and acts as a filter. - It is found beneath epithelial cells, including those in the skin, but it is not the predominant collagen type within the dermal layer itself.

Q: Frey's syndrome occurs due to aberrant misdirection of fibers from salivary glands to sweat glands. These fibers come from which of the following?

Glossopharyngeal. ***Glossopharyngeal*** - Frey's syndrome (auriculotemporal syndrome) is caused by injury to the **auriculotemporal nerve**, a branch of the **mandibular division of the trigeminal nerve**, which carries postganglionic parasympathetic fibers from the **otic ganglion** that originated in the glossopharyngeal nerve. - These parasympathetic fibers, normally destined for the **parotid gland** to stimulate salivation, aberrantly regenerate and innervate sweat glands and blood vessels in the skin over the parotid region, leading to sweating and flushing upon mastication. *Facial* - The facial nerve primarily controls **muscles of facial expression**, taste sensation from the anterior two-thirds of the tongue, and parasympathetic innervation of the **submandibular** and **sublingual glands**, and lacrimal gland. - While it has some parasympathetic function, its fibers are not involved in innervating the parotid gland or the aberrant sweating seen in Frey's syndrome. *Trigeminal* - The trigeminal nerve is responsible for general sensation in the face and mastication, but its fibers are **not the source of the parasympathetic neurons** causing Frey's syndrome. - The auriculotemporal nerve, a branch of the trigeminal's mandibular division, *carries* these aberrant fibers, but they originate from the glossopharyngeal nerve. *Vagus* - The vagus nerve supplies efferent parasympathetic innervation to many organs in the thorax and abdomen, and sensory innervation for the pharynx, larynx, and taste from the epiglottis. - It plays no role in the innervation of the salivary glands relevant to Frey's syndrome or in the aberrant sweating mechanism.

Q: Inhalational anesthetic with highest respiratory irritation is:-

Desflurane. ***Desflurane*** - **Desflurane** has the highest **pungency** among common inhalational anesthetics, leading to significant respiratory irritation. - This irritation can manifest as **coughing**, **laryngospasm**, and **bronchospasm**, particularly during induction. *Halothane* - **Halothane** is a less pungent anesthetic and is generally well-tolerated by the respiratory system. - It was historically known for its **bronchodilating properties**, making it less irritating than Desflurane. *Nitrous oxide* - **Nitrous oxide** is a gaseous anesthetic with a very low solubility and virtually no respiratory irritant properties. - It is often used as a carrier gas and is known for its quick onset and offset without causing airway reactivity. *Sevoflurane* - **Sevoflurane** is known for its sweet smell and is considered a non-pungent agent, making it suitable for inhalational induction, especially in children. - It causes minimal respiratory irritation and has **bronchodilating effects**, which are beneficial in patients with reactive airway disease.

Q: A 26 year old female patient presented with fever, oral ulcers, sensitivity to light and rash over the malar area of the face sparing the nasolabial folds of both side. Which of the following indicates the condition associated with these manifestations?

SLE. ***SLE*** - The combination of **fever**, **oral ulcers**, **photosensitivity**, and a **malar rash** (which typically spares the nasolabial folds), particularly in a young female, is classic for **Systemic Lupus Erythematosus (SLE)** [1]. - SLE is a **chronic autoimmune inflammatory disease** that can affect multiple organ systems [2]. *Rosacea* - Rosacea often presents with **facial erythema**, **telangiectasias**, and papulopustules, primarily on the central face, but it does not typically involve oral ulcers, fever, or photosensitivity in the same way as SLE [4]. - The rash of rosacea is usually not a classic malar rash sparing the nasolabial folds, and it is not an autoimmune systemic disease. *Dermatomyositis* - Dermatomyositis is characterized by **proximal muscle weakness** and specific skin manifestations like **Gottron's papules** (over joints), **heliotrope rash** (periorbital edema), and a **shawl sign**, which differ from the presented symptoms [3]. - While it can cause light sensitivity and a rash, the distribution and associated symptoms (like no mention of muscle weakness) are not typical for a primary presentation of dermatomyositis. *Psoriasis* - Psoriasis typically presents with **well-demarcated erythematous plaques** covered with **silvery scales**, commonly on extensor surfaces like elbows and knees, and can also affect nails and joints. - It does not typically cause fever, oral ulcers, or a malar rash with nasolabial fold sparing, which are hallmarks of SLE.

Q: Rubella is caused by

Togavirus. ***Correct Answer: Togavirus*** - Rubella virus is classified under the genus *Rubivirus* within the family **Togaviridae** - Togaviruses are **enveloped, positive-sense, single-stranded RNA viruses** - Rubella causes German measles, characterized by mild fever and maculopapular rash - Important for congenital rubella syndrome when infection occurs during pregnancy *Incorrect: Paramyxovirus* - This family includes viruses like **measles (rubeola)** and **mumps** - Paramyxoviruses are enveloped, negative-sense, single-stranded RNA viruses - Different structural and genetic characteristics from rubella virus *Incorrect: Orthomyxovirus* - This family primarily consists of **influenza viruses** (types A, B, and C) - Orthomyxoviruses are enveloped, **negative-sense, segmented** RNA viruses - The segmented genome distinguishes them from rubella virus *Incorrect: Flavivirus* - This family includes **dengue virus**, **yellow fever virus**, and **Zika virus** - While flaviviruses are also enveloped, positive-sense, single-stranded RNA viruses, they belong to the family *Flaviviridae*, not Togaviridae - Different envelope proteins and replication strategies distinguish them from rubella virus

Q: A 35 year old man presented with dry cough and rusty colored sputum. He has a history of eating in a Chinese restaurant very often with consumption of crabs. What is the probable causative agent in this condition?

Paragonimus westermani. ***Paragonimus westermani*** - The key clinical features are **dry cough**, **rusty-colored sputum**, and a history of consuming **crabs**. These are classic indicators of **paragonimiasis**. - *Paragonimus westermani* is a **lung fluke** acquired by eating undercooked freshwater crabs or crayfish. *Pneumocystis jirovecii* - This fungus typically causes pneumonia in **immunocompromised individuals**, like those with HIV/AIDS. - While it can cause a dry cough, **rusty-colored sputum** is not a characteristic sign, and there's no mention of immunocompromise. *Strongyloides stercoralis* - This parasite primarily causes **gastrointestinal symptoms** (e.g., abdominal pain, diarrhea) and can lead to cutaneous manifestations (larva currens). - While lung involvement can occur in severe cases (hyperinfection), it does not typically present with **rusty sputum** or a direct association with crab consumption. *Diphyllobothrium latum* - This is the **fish tapeworm**, acquired by eating undercooked freshwater fish. - It primarily causes **gastrointestinal symptoms** such as abdominal pain and diarrhea, and is known for causing **vitamin B12 deficiency** leading to megaloblastic anemia, not pulmonary symptoms.

Q: Bellini duct cancer is seen in which of the following?

Kidney. ***Kidney*** - Bellini duct carcinoma is a **rare and aggressive subtype of renal cell carcinoma (RCC)**, originating from the collecting ducts of Bellini in the kidney. [1] - It accounts for a very small percentage of all RCCs and is characterized by a **poor prognosis**. *Liver* - The liver is affected by primary cancers like **hepatocellular carcinoma** and **cholangiocarcinoma**, or by metastatic disease, none of which arise from Bellini ducts. - Bellini ducts are structures **exclusive to the kidney**, not found in the liver. *Spleen* - Primary cancers of the spleen are **extremely rare**, with most malignant lesions being **lymphomas** or metastases. [2] - The spleen is a **lymphoid organ** and does not contain Bellini ducts. *Heart* - Primary cardiac tumors are uncommon, with the majority being **benign myxomas**. Malignant tumors include **sarcomas**. - The heart's anatomy is distinct and **does not contain any structures analogous to Bellini ducts**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 959-961. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 605-606.

Q: Which type of necrosis is characterized by deposition of immune complexes and fibrin in the walls of blood vessels?

Fibrinoid necrosis. ***Fibrinoid necrosis*** - This type of necrosis is classically associated with **immune-mediated vascular damage**, where antigen-antibody complexes are deposited in arterial walls [2]. - The microscopic appearance is characterized by bright pink, amorphous material composed of **fibrin and immune complexes**, giving a fibrin-like staining pattern [1]. *Liquefactive necrosis* - Characterized by the **dissolution of dead cells into a viscous liquid mass**, often seen in bacterial infections or brain infarcts. - The necrotic tissue is replaced by inflammatory cells and fluid, rather than immune complex deposits. *Coagulative necrosis* - Occurs due to **ischemia**, leading to protein denaturation and preservation of cell outlines for a period. - It does not involve the deposition of immune complexes or fibrin in vessel walls. *Caseous necrosis* - A form of coagulative necrosis associated with **tuberculosis**, characterized by a friable, "cheese-like" appearance. - It primarily involves granulomatous inflammation and macrophage accumulation, not immune complex deposition in blood vessels. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 514-518. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 214-242.

Q: Oral factor Xa inhibitor is:

Rivaroxaban. ***Rivaroxaban*** - **Rivaroxaban** is a direct oral anticoagulant (DOAC) that specifically inhibits **factor Xa**, preventing thrombin generation and clot formation. - It is administered **orally** and is widely used for preventing and treating venous thromboembolism and stroke in atrial fibrillation. *Bivalirudin* - **Bivalirudin** is a **direct thrombin inhibitor** (DTI), not a factor Xa inhibitor. - It is administered **intravenously**, primarily used in percutaneous coronary interventions. *Dabigatran* - **Dabigatran** is an **oral direct thrombin inhibitor** (DTI), which directly inhibits thrombin (factor IIa). - It does not inhibit factor Xa; its mechanism of action is distinct from that of factor Xa inhibitors. *Fondaparinux* - **Fondaparinux** is an **indirect factor Xa inhibitor** that requires antithrombin for its anticoagulant activity. - It is administered **subcutaneously**, distinguishing it from oral factor Xa inhibitors like rivaroxaban.

Q: A 40 years old male was brought emergency with severe abdominal pain. On examination, pulse rate was 112/minute and systolic BP was 80 mmHg. Chest x-ray is given below. What is the most appropriate management?

Exploratory laparotomy. ***Exploratory laparotomy*** - The chest x-ray shows **pneumoperitoneum (air under the diaphragm)**, which, combined with severe abdominal pain, tachycardia, and hypotension (signs of **septic shock**), is highly indicative of a **perforated viscus**. - **Emergency exploratory laparotomy** is the definitive treatment to identify and repair the perforation, control contamination, and prevent further deterioration. *Saline wash of stomach* - This procedure is typically used for gastric lavage in cases of **poisoning or drug overdose**, or to clear the stomach in preparation for endoscopy. - It does not address a viscus perforation or the widespread abdominal contamination and systemic septic response seen in this patient. *Intercostal tube drainage* - **Intercostal tube drainage** (chest tube placement) is used to drain air (pneumothorax) or fluid (pleural effusion, hemothorax, empyema) from the pleural space, not the abdominal cavity. - While there is air visible on the x-ray, it is **subdiaphragmatic (pneumoperitoneum)**, not within the pleural space, and thus a chest tube would be ineffective and inappropriate. *IV antibiotics* - **Intravenous antibiotics** are crucial for managing sepsis associated with a perforated viscus and should be administered promptly. - However, antibiotics alone are **not sufficient** to treat the underlying mechanical problem of a perforation, which requires surgical repair to prevent ongoing bacterial contamination and sepsis.

Question 1

Which type of collagen is maximum in skin?

Accepted Answer

Type I

Answer

Type III

Answer

Type II

Answer

Type IV

Question 2

Frey's syndrome occurs due to aberrant misdirection of fibers from salivary glands to sweat glands. These fibers come from which of the following?

Accepted Answer

Glossopharyngeal

Answer

Facial

Answer

Trigeminal

Answer

Vagus

Question 3

Inhalational anesthetic with highest respiratory irritation is:-

Accepted Answer

Desflurane

Answer

Halothane

Answer

Nitrous oxide

Answer

Sevoflurane

Question 4

A 26 year old female patient presented with fever, oral ulcers, sensitivity to light and rash over the malar area of the face sparing the nasolabial folds of both side. Which of the following indicates the condition associated with these manifestations?

Accepted Answer

SLE

Answer

Rosacea

Answer

Dermatomyositis

Answer

Psoriasis

Question 5

Rubella is caused by

Accepted Answer

Togavirus

Answer

Paramyxovirus

Answer

Orthomyxovirus

Answer

Flavivirus

Question 6

A 35 year old man presented with dry cough and rusty colored sputum. He has a history of eating in a Chinese restaurant very often with consumption of crabs. What is the probable causative agent in this condition?

Accepted Answer

Paragonimus westermani

Answer

Pneumocystis jirovecii

Answer

Strongyloides stercoralis

Answer

Diphyllobothrium latum

Question 7

Bellini duct cancer is seen in which of the following?

Accepted Answer

Kidney

Answer

Liver

Answer

Spleen

Answer

Heart

Question 8

Which type of necrosis is characterized by deposition of immune complexes and fibrin in the walls of blood vessels?

Accepted Answer

Fibrinoid necrosis

Answer

Liquefactive necrosis

Answer

Coagulative necrosis

Answer

Caseous necrosis

Question 9

Oral factor Xa inhibitor is:

Accepted Answer

Rivaroxaban

Answer

Bivalirudin

Answer

Dabigatran

Answer

Fondaparinux

Question 10

A 40 years old male was brought emergency with severe abdominal pain. On examination, pulse rate was 112/minute and systolic BP was 80 mmHg. Chest x-ray is given below. What is the most appropriate management?

Accepted Answer

Exploratory laparotomy

Answer

Saline wash of stomach

Answer

Intercostal tube drainage

Answer

IV antibiotics

NEET-PG 2019

Anatomy

Anesthesiology

Internal Medicine

Microbiology

Pathology

Pharmacology

Surgery