NEET-PG 2020 Practice Questions

Q: Tumour of the uncinate process of the pancreas will compress which artery

Superior mesenteric artery. ***Superior mesenteric artery*** - The **uncinate process** forms the lower and medial part of the head of the pancreas, hooking around and behind the **superior mesenteric vessels**. - A tumor in this region would therefore almost immediately compress the **superior mesenteric artery** and vein due to its close anatomical relationship. *Splenic artery* - The **splenic artery** runs along the superior border of the pancreas, primarily associated with the body and tail. - A tumor in the **uncinate process** (part of the head) would be anatomically distant from the splenic artery, making compression unlikely. *Inferior mesenteric artery* - The **inferior mesenteric artery** arises from the aorta much lower than the pancreas, typically at the L3 vertebral level. - Its anatomical position makes it spatially separated from the uncinate process of the pancreas, so compression is not expected. *Common hepatic artery* - The **common hepatic artery** runs anterior to the portal vein and to the left of the bile duct, supplying the liver. - It is located superior to the head of the pancreas and away from the uncinate process, hence not typically affected by tumors in that specific pancreatic region.

Q: What does the image of the Capnograph depict?

Capnograph indicating spontaneous respiration. ***Capnograph indicating spontaneous respiration*** - The characteristic dip in the **EtCO2 waveform** during the plateau phase (phaselll) is indicative of a breath taken by the individual which is a classic finding of **spontaneous respiration**. This dip is because when a patient takes a breath in, fresh gas with no CO2 is pulled into the sampling line momentarily decreasing the measured CO2. - This pattern is often referred to as a "**curare cleft**" or "**respiratory indentation**," and it signifies incomplete paralysis or return of spontaneous breathing. *Capnograph during inspiration* - During normal inspiration, there is no CO2 in the inhaled air, so the capnograph reading would theoretically drop to **zero** or near-zero, not exhibit a waveform with a plateau. - The baseline of the capnograph reflects inspiration, which should be flat (zero CO2). *Capnograph showing inspiration with cardiac oscillations* - Cardiac oscillations typically appear as **small rhythmic fluctuations** on the baseline or the expiratory plateau, synchronized with the heartbeat. - These oscillations are usually much smaller and do not present as distinct, sharp dips within the expiratory plateau as seen in the image. *Capnograph during expiration* - During a normal expiration, the capnograph waveform rises from a baseline of zero (phase I, **dead space ventilation**) to a plateau (phase III, **alveolar gas emptying**) with a peak value, before returning to baseline during inspiration. - While the image shows expiration with a plateau, the key feature of the dip during the plateau is more specific to spontaneous respiration than just general expiration.

Q: HBsAg is based on which principle

ELISA. ***ELISA*** - **Enzyme-linked immunosorbent assay (ELISA)** is a widely used laboratory test to detect and quantify antigens (like HBsAg) or antibodies in a sample. - It involves an enzyme-linked antibody that reacts with a substrate to produce a detectable signal, making it highly sensitive and specific for **HBsAg detection**. *Immunochromatography assays* - These are typically **rapid diagnostic tests (RDTs)** that provide quick qualitative results, often used for point-of-care testing. - While they can detect HBsAg, they generally have lower sensitivity and specificity compared to ELISA. *Chemiluminescence* - This is a detection method used in some immunoassays where a chemical reaction emits light, often providing higher sensitivity than colorimetric detection. - While it can be incorporated into HBsAg testing platforms, it is a *detection principle* rather than the primary assay principle like ELISA itself. *Immunofluorescence* - This technique uses **fluorescently labeled antibodies** to visualize antigens in cells or tissues under a fluorescence microscope [1]. - It is used for localization and identification of antigens, but not typically the primary method for routine quantitative HBsAg serology [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 259-260.

Q: A sexually active female presenting with profuse frothy foul-smelling discharge with intense itching. Strawberry cervix revealed on examination. What will be the diagnosis?

Trichomonas vaginalis. **Trichomonas vaginalis** - The classic presentation of **profuse, frothy, foul-smelling vaginal discharge** with **intense itching** and the presence of a **strawberry cervix** are highly characteristic of a *Trichomonas vaginalis* infection. - *Trichomonas vaginalis* is a **motile protozoan** and a common sexually transmitted infection. *Bacterial vaginosis* - While bacterial vaginosis (BV) causes a **foul-smelling discharge** (often described as "fishy"), it is typically **thin and grayish-white**, not frothy, and does not cause a strawberry cervix. - BV is caused by an **overgrowth of anaerobic bacteria** and a decrease in lactobacilli, leading to an elevated vaginal pH. *Candidiasis* - Candidiasis (yeast infection) presents with a **thick, white, "cottage cheese-like" discharge** and intense itching, but the discharge is usually odorless and it does not cause a frothy discharge or strawberry cervix. - It is caused by an **overgrowth of *Candida* species**, primarily *Candida albicans*, and is not typically sexually transmitted. *None of the options* - Given the classic constellation of symptoms and definitive signs, a specific diagnosis can be made, making this option incorrect.

Q: A 65-year-old male with a history of hypertension and diabetes presents to the OPD with complaints of diplopia and squint. On examination, the secondary deviation is more than the primary deviation. Which of the following is the most likely diagnosis?

paralytic squint. ***Paralytic squint*** The key finding of **secondary deviation being greater than primary deviation** is a classic sign of **paralytic strabismus**. This occurs because the paretic eye (due to neurological deficit) has to work harder to fixate, leading to an exaggerated innervation to the yoked muscle in the healthy eye, causing a larger deviation (Hering's law of equal innervation). The patient's age and history of **hypertension and diabetes** increase the risk of **cranial nerve palsies** (e.g., oculomotor, trochlear, abducens), which are common causes of paralytic squint due to microvascular ischemia. *Concomitant strabismus* In **concomitant strabismus**, the degree of deviation remains constant in all directions of gaze, meaning **primary and secondary deviations are equal**. This contradicts the clinical finding in the patient. Concomitant strabismus often presents in childhood and is typically non-paralytic, with no underlying neurological deficit affecting muscle action. *Restrictive strabismus* **Restrictive strabismus** is characterized by physical limitation of eye movement due to mechanical restriction of an extraocular muscle, often seen in conditions like **thyroid eye disease** or **orbital trauma**. While restrictive strabismus can cause diplopia and reduced eye movement, it typically involves a **limited range of motion** and usually does not present with secondary deviation being greater than primary deviation in the same manner as a paralytic squint. *Pseudo strabismus* **Pseudo strabismus** is an apparent misalignment of the eyes where the eyes are actually straight. This can be due to features like a **wide epicanthal fold** or a **small interpupillary distance**. In pseudo strabismus, there is **no true deviation** on cover-uncover testing, and therefore, the concepts of primary and secondary deviation do not apply, nor would there be actual diplopia.

Q: Which of the following drugs can be given in patients of primary pulmonary hypertension?

Bosentan. ***Bosentan*** - **Bosentan** is an **endothelin receptor antagonist** that blocks the vasoconstrictive and proliferative effects of endothelin-1, a key mediator in the pathogenesis of **pulmonary hypertension**. - It is an FDA-approved medication specifically used for the treatment of **pulmonary arterial hypertension (PAH)**, improving exercise capacity and delaying clinical worsening. *Icatibant* - **Icatibant** is a **bradykinin B2 receptor antagonist** used in the treatment of **hereditary angioedema**. - It has no known role or efficacy in the management of **primary pulmonary hypertension**. *Labetalol* - **Labetalol** is a **beta-blocker** with **alpha-1 adrenergic blocking activity** used primarily for systemic **hypertension** and **hypertensive emergencies**. - Beta-blockers are generally **contraindicated** in pulmonary hypertension as they can worsen right heart function and lead to clinical deterioration. *Sodium nitroprusside* - **Sodium nitroprusside** is a **direct arterial and venous vasodilator** used in hypertensive crises and severe heart failure by reducing both preload and afterload. - While it can lower systemic blood pressure, its use in pulmonary hypertension is **limited** due to the risk of **systemic hypotension** and the lack of selective pulmonary vasodilation compared to other agents.

Q: A patient diagnosed with Rheumatoid arthritis was on medications. After 2 years, he developed a blurring vision and was found to have corneal opacity. Which drug is most likely to cause this?

Chloroquine. ***Chloroquine*** - **Chloroquine (and hydroxychloroquine)** can accumulate in the **cornea**, leading to **corneal opacity** (vortex keratopathy or cornea verticillata) and **retinopathy**, manifesting as blurring vision. - While corneal changes are usually reversible upon discontinuation, the retinal toxicity, particularly **maculopathy** (bull's eye maculopathy), can be permanent and severe. *Sulfasalazine* - Common side effects include **gastrointestinal upset**, headache, skin rash, and **bone marrow suppression**. - It is not typically associated with **corneal opacity** or significant ocular toxicity. *Leflunomide* - Known for side effects such as **hepatotoxicity**, gastrointestinal issues (diarrhea), **alopecia**, and **hypertension**. - **Ocular side effects** like corneal opacity are not characteristic of leflunomide use. *Methotrexate* - Primary side effects include **bone marrow suppression**, **hepatotoxicity**, **mucositis**, and **pulmonary fibrosis**. - Although it can cause ocular side effects like **conjunctivitis**, it is not a common cause of **corneal opacity**.

Q: What is the reflex in which there is inhibition of gastric emptying when there is acid and hypertonic solution in the duodenum?

Enterogastric. ***Enterogastric*** - The **enterogastric reflex** is initiated when the duodenum detects the presence of acid and hypertonic solutions, signifying that the chyme is not yet ready for further digestion and absorption. - This reflex inhibits **gastric emptying** to allow more time for the stomach to process its contents and for the duodenum to neutralize the acid and dilute the hypertonic solution. *Gastroileal* - The **gastroileal reflex** increases motility in the ileum when the stomach is distended, facilitating the movement of chyme into the large intestine. - This reflex does not primarily involve the inhibition of gastric emptying due to duodenal contents. *Gastrocolic* - The **gastrocolic reflex** increases the motility of the colon in response to the stretching of the stomach by food. - Its main function is to prepare the large intestine for upcoming chyme and does not directly inhibit gastric emptying. *Myenteric* - The **myenteric plexus** (Auerbach's plexus) is a network of neurons located between the longitudinal and circular layers of the muscularis propria throughout the gastrointestinal tract. - While it plays a crucial role in controlling gut motility and is involved in numerous reflexes, it refers to a neural plexus rather than a specific reflex mechanism for inhibiting gastric emptying due to duodenal stimuli.

Q: A middle-aged man presents with a swelling in the neck that has been present since childhood. The swelling has a bag or worm-like appearance and features a central black spot. Based on this description, what is the most likely diagnosis?

Plexiform neurofibroma. ***Plexiform neurofibroma*** - The description of a swelling since childhood with a **bag-of-worms appearance** and a **central black spot** is highly characteristic of a plexiform neurofibroma, a benign tumor of peripheral nerves. - These lesions are often associated with **neurofibromatosis type 1 (NF1)** and can grow quite large, causing cosmetic and functional concerns. - The **central black spot** represents pigmentation often seen in neurofibromas, particularly in NF1. *Cirsoid aneurysm* - A cirsoid aneurysm is a **congenital arteriovenous malformation** characterized by a tortuous mass of dilated blood vessels. - While it can manifest as a swelling, it typically presents with a **palpable thrill and audible bruit**, and its appearance is not usually described as having a central black spot. *Varicocele* - A varicocele is an **abnormal enlargement of the pampiniform plexus veins** in the scrotum, often described as a **bag of worms**, but it occurs exclusively in the scrotum. - It would not be found in the neck and does not feature a central black spot. *Lymphangioma* - A lymphangioma is a **benign malformation of the lymphatic system** that can present as a soft, compressible mass, often in the neck. - While present since childhood, its appearance is typically **cystic or multicystic** and does not usually have the distinct bag-of-worms texture or a central black spot described.

Question 1

Tumour of the uncinate process of the pancreas will compress which artery

Accepted Answer

Superior mesenteric artery

Answer

Inferior mesenteric artery

Answer

Common hepatic artery

Answer

Splenic artery

Question 2

What does the image of the Capnograph depict?

Accepted Answer

Capnograph indicating spontaneous respiration

Answer

Capnograph during inspiration

Answer

Capnograph showing inspiration with cardiac oscillations

Answer

Capnograph during expiration

Question 3

What is the cause of loss of pain and temperature sensation on the ipsilateral face and contralateral body due to thrombosis?

Accepted Answer

Thrombosis of the posterior inferior cerebellar artery (PICA)

Answer

Thrombosis of the superior cerebellar artery

Answer

Thrombosis of the anterior inferior cerebellar artery (AICA)

Answer

Thrombosis of the posterior cerebral artery

Question 4

HBsAg is based on which principle

Accepted Answer

ELISA

Answer

Chemiluminescence

Answer

Immunofluorescence

Answer

Immunochromatography assays

Question 5

A sexually active female presenting with profuse frothy foul-smelling discharge with intense itching. Strawberry cervix revealed on examination. What will be the diagnosis?

Accepted Answer

Trichomonas vaginalis

Answer

Bacterial vaginosis

Answer

Candidiasis

Answer

None of the options

Question 6

A 65-year-old male with a history of hypertension and diabetes presents to the OPD with complaints of diplopia and squint. On examination, the secondary deviation is more than the primary deviation. Which of the following is the most likely diagnosis?

Accepted Answer

paralytic squint

Answer

concomitant strabismus

Answer

restrictive strabismus

Answer

pseudo strabismus

Question 7

Which of the following drugs can be given in patients of primary pulmonary hypertension?

Accepted Answer

Bosentan

Answer

Icatibant

Answer

Sodium nitroprusside

Answer

Labetalol

Question 8

A patient diagnosed with Rheumatoid arthritis was on medications. After 2 years, he developed a blurring vision and was found to have corneal opacity. Which drug is most likely to cause this?

Accepted Answer

Chloroquine

Answer

Sulfasalazine

Answer

Leflunomide

Answer

Methotrexate

Question 9

What is the reflex in which there is inhibition of gastric emptying when there is acid and hypertonic solution in the duodenum?

Accepted Answer

Enterogastric

Answer

Gastroileal

Answer

Gastrocolic

Answer

Myenteric

Question 10

A middle-aged man presents with a swelling in the neck that has been present since childhood. The swelling has a bag or worm-like appearance and features a central black spot. Based on this description, what is the most likely diagnosis?

Accepted Answer

Plexiform neurofibroma

Answer

Cirsoid aneurysm

Answer

Varicocele

Answer

Lymphangioma

NEET-PG 2020

Anatomy

Anesthesiology

Internal Medicine

Microbiology

Obstetrics and Gynecology

Ophthalmology

Pharmacology

Physiology

Surgery