NEET-PG 2020 Practice Questions

Q: Elderly man with a long-standing mole on his face that is increasing in size and showing an irregular border. Diagnosis:

Lentigo maligna. ***Lentigo maligna*** - This type of melanoma commonly affects **elderly individuals** and presents as a **slowly enlarging, irregularly bordered, flat or slightly raised pigmented lesion** on sun-exposed areas like the face. - It often has a **long radial growth phase** before progressing to invasive lentigo maligna melanoma. *Superficial spreading melanoma* - While common, it typically presents on the **trunk or extremities** and has a faster growth rate compared to lentigo maligna. - It often appears as a **flat, asymmetrical lesion with varied colors and irregular borders**, but the age and location details point away from this. *Nodular melanoma* - This is an **aggressive form** that grows vertically from the start, presenting as a **dark, raised, often ulcerated nodule** and typically has a shorter history of rapid growth. - It lacks the characteristic long-standing, flat growth pattern described in the elderly patient's face. *Acral melanoma* - This rare type occurs on the **palms, soles, or under the nails (subungual)**, not typically on the face. - It often appears as a **pigmented streak or patch** in these acral locations.

Q: Fungal infection which is acquired by traumatic inoculation is?

Sporothrix. ***Sporothrix*** - **Sporotrichosis** is characteristically acquired through **traumatic inoculation** of the fungus, often from contact with soil, thorns, or decaying vegetation. - The organism causes **cutaneous lymphatic disease**, presenting as nodular lesions along lymphatic drainage paths. *Blastomyces* - **Blastomycosis** is typically acquired by inhaling airborne fungal spores, usually from **soil rich in organic matter** or decaying wood. - It primarily affects the **lungs** and can disseminate to the skin, bones, and other organs, but is not primarily associated with traumatic inoculation. *Coccidioides* - **Coccidioidomycosis** (Valley Fever) is acquired by inhaling **arthroconidia** present in dust or soil in endemic areas. - It is a **pulmonary infection** that can disseminate to other body sites, and its entry is almost exclusively respiratory, not traumatic. *Paracoccidioides* - **Paracoccidioidomycosis** is acquired by inhaling airborne fungal propagules, typically found in **soil in Latin America**. - It primarily causes **chronic pulmonary disease** and can spread to mucous membranes, skin, and lymph nodes, with no known association with traumatic inoculation.

Q: The image of an immunoglobulin is shown below. Which type of immunoglobulin is it?

Immunoglobulin A (IgA). ***Immunoglobulin A (IgA)*** - The image depicts two Y-shaped immunoglobulin monomers linked by a central purple component, which represents the **J-chain**, and enveloped by a yellow structure, which represents the **secretory component**. This **dimeric** structure with a secretory component is characteristic of secretory IgA. - **Secretory IgA** is primarily found in mucosal secretions such as saliva, tears, breast milk, and gastrointestinal fluids, where it plays a crucial role in **mucosal immunity** by preventing pathogen adhesion. *Immunoglobulin G (IgG)* - IgG exists as a **monomer** (single Y-shaped unit) in its functional form. - It is the most abundant immunoglobulin in serum and plays a major role in **secondary immune responses** and can cross the placenta. *Immunoglobulin M (IgM)* - In serum, IgM typically exists as a **pentamer**, meaning five Y-shaped units are joined together by a J-chain, forming a star-like structure. - It is the first antibody produced in a **primary immune response** and is effective in complement activation. *Immunoglobulin E (IgE)* - IgE exists as a **monomer** and is primarily associated with **allergic reactions** and defense against parasites. - It binds to receptors on mast cells and basophils, triggering immune responses upon allergen exposure.

Q: A 22-year-old primigravida visits ANC OPD with 20 weeks POG. On examination uterine height reveals a 16-week size. USG shows reduced liquor. What will be the diagnosis?

Bilateral renal agenesis. ***Renal agenesis*** - **Bilateral renal agenesis** leads to **oligohydramnios** because the fetal kidneys are the primary producers of amniotic fluid after 16 weeks of gestation. - The reduced amniotic fluid (liquor) is consistent with the decreased uterine size (16-week size at 20 weeks POG) and is a hallmark of this condition, often resulting in **Potter sequence**. *Bartter’s syndrome* - This is a rare, inherited renal tubulopathy characterized by significant electrolyte disturbances (hypokalemia, metabolic alkalosis, hypercalciuria) due to impaired ion transport. - While it affects kidney function, it does not typically cause severe **oligohydramnios** or **renal agenesis** and would not explain the small uterine size in this scenario. *Liddle syndrome* - This is a rare genetic disorder characterized by early-onset hypertension, hypokalemia, and metabolic alkalosis, due to constitutive activation of the epithelial sodium channel (ENaC) in the collecting ducts. - It does not involve structural kidney abnormalities or significantly impact amniotic fluid volume during pregnancy to cause the described findings. *Fetal anemia* - Fetal anemia can lead to complications such as **hydrops fetalis**, which would typically cause **polyhydramnios** or a uterine size larger than expected due to fluid accumulation, not oligohydramnios or a smaller uterine size. - Reduced liquor and a small uterine size are not characteristic presentations of fetal anemia.

Q: A 36-week pregnant lady with previous twin delivery. What is the Obstetric score?

G2P1. ***G2P1*** - **Gravida (G)** refers to the total number of pregnancies, including the current one, so the current pregnancy (1) plus the previous twin delivery (1) equals **G2**. - **Parity (P)** refers to the number of times a woman has given birth to a fetus (or fetuses) beyond 20 weeks gestation, irrespective of whether the baby was born alive or is now living. A **twin delivery counts as one parity event** because it was one pregnancy that resulted in a delivery. *G2P2* - This option incorrectly counts the twin delivery as two separate parity events, whereas **parity is counted per pregnancy event** resulting in live birth or stillbirth beyond 20 weeks. - While G2 is correct (current pregnancy + previous pregnancy), P2 incorrectly implies two separate delivery events. *G3P2* - This option correctly identifies the parity as P2, but incorrectly states the gravida as G3. - **Gravida is 2** (current pregnancy + previous twin pregnancy), not 3. *G3P3* - This option is incorrect for both gravida and parity. - The patient has had **two pregnancies** (G2) and **one delivery event** (P1).

Q: Which of the following is not used for postcoital contraception?

Danazol. ***Danazol*** - **Danazol** is an androgen derivative primarily used to treat conditions like **endometriosis** and **fibrocystic breast disease** due to its ability to suppress gonadotropin secretion. - It is **not effective** as a postcoital contraceptive as it does not reliably prevent ovulation, fertilization, or implantation when taken after unprotected intercourse. *CuT* - The **copper-T intrauterine device (CuT IUD)** can be inserted within **5 days** of unprotected intercourse as an effective form of emergency contraception. - Its mechanism involves releasing **copper ions** that are toxic to sperm and eggs, inhibiting fertilization and implantation. *Ru 486* - **Mifepristone (RU 486)** is an **anti-progestin** that can be used for emergency contraception (often referred to as the morning-after pill). - It works by delaying or inhibiting ovulation and preventing implantation by altering the **endometrium**. *High dose estrogen* - High doses of **estrogen**, often in combination with progestin (**Yuzpe regimen**), can be used as emergency contraception. - This method primarily works by **disrupting ovulation** and altering the endometrium to prevent implantation.

Q: A 33-year-old man presents with a 5-week history of calf pain, swelling, and low-grade fever. Serum levels of creatinine kinase are elevated. A muscle biopsy reveals numerous eosinophils and he also has peripheral blood eosinophilia. Which of the following interleukins is primarily responsible for the increase in eosinophils in this patient?

IL-5. ***IL-5*** - **Interleukin-5 (IL-5)** is the **most potent and direct cytokine** responsible for the **differentiation, maturation, activation, and survival of eosinophils**. - IL-5 is produced primarily by **Th2 cells**, mast cells, and eosinophils themselves, and acts directly on eosinophil progenitors in the bone marrow. - In this patient with eosinophilic myositis (likely parasitic infection such as trichinosis), **IL-5 is the primary mediator** of the peripheral blood eosinophilia and tissue eosinophil infiltration. - **Clinical correlation:** Anti-IL-5 therapies (mepolizumab, reslizumab) are used to treat hypereosinophilic conditions, confirming IL-5's central role. *IL-4* - **Interleukin-4 (IL-4)** is produced by Th2 cells and mast cells and promotes the **differentiation of naive T cells into Th2 cells**. - While IL-4 initiates the Th2 immune response that eventually leads to IL-5 production, it does **not directly stimulate eosinophil production or recruitment**. - IL-4 is more involved in IgE class switching and allergic inflammation rather than direct eosinophil regulation. *IL-6* - **Interleukin-6 (IL-6)** is a pleiotropic cytokine involved in the **acute phase response**, inflammation, and hematopoiesis. - While it has broad effects on immune cells, it is **not primarily responsible** for eosinophil production or recruitment. - Elevated in many inflammatory conditions but not specific for eosinophilia. *IL-2* - **Interleukin-2 (IL-2)** is primarily involved in the **proliferation and differentiation of T lymphocytes** and activation of natural killer (NK) cells. - It plays no significant direct role in eosinophil production or recruitment. - More important for T cell-mediated immunity rather than eosinophilic responses.

Q: A 35-year-old female experiences a tingling sensation in her arm after watching TV for long hours with her hands under her head. Which type of nerve fibers is most likely to be affected due to this position?

A-beta (Aβ) sensory nerve fibers. ***A-beta (Aβ) sensory nerve fibers*** - The tingling sensation (paresthesia) described is a classic symptom of **A-beta fiber compression**. - **A-beta fibers** are large, myelinated sensory fibers that transmit light touch, pressure, vibration, and proprioception. - These fibers are **most susceptible to mechanical compression** due to their position and structure. - Positioning the hands under the head for extended periods compresses superficial nerves, causing temporary A-beta fiber dysfunction, which manifests as the characteristic "pins and needles" sensation. *B-fibers (autonomic)* - **B-fibers** are preganglionic autonomic fibers that mediate visceral functions, such as organ control and glandular secretions. - Compression of these fibers would lead to symptoms related to autonomic dysfunction (e.g., changes in sweating, blood pressure), not a tingling sensation in the arm. *C-fibers (pain and temperature)* - **C-fibers** are unmyelinated fibers that transmit slow, dull, aching pain and contribute to temperature sensation. - They are **less susceptible to compression** than larger myelinated fibers. - The primary sensation described (tingling/paresthesia) is characteristic of large myelinated fiber (A-beta) dysfunction, not C-fiber involvement. *Sympathetic nerve fibers* - **Sympathetic nerve fibers** regulate involuntary functions like heart rate, blood pressure, and sweating. - Their compression would cause symptoms such as changes in skin temperature, altered sweating, or blood vessel constriction (Horner's syndrome if severe), not a tingling sensation.

Q: Identify the condition in the X-ray given below:

TOF. ***TOF*** - The chest X-ray shows a **boot-shaped heart (coeur en sabot)**, which is highly characteristic of **Tetralogy of Fallot** due to right ventricular hypertrophy and pulmonary artery hypoplasia. - There is also **reduced pulmonary vascular markings** (oligemia), indicating decreased blood flow to the lungs, a typical finding in TOF. *TGA* - Transposition of the Great Arteries (TGA) typically presents with a **"egg-on-a-string" appearance** on chest X-ray, characterized by a narrow mediastinum and cardiomegaly, which is not seen here. - Pulmonary vascularity can be increased or normal in TGA, unlike the decreased vascularity observed in the image. *TAPVC* - Total Anomalous Pulmonary Venous Connection (TAPVC) usually shows a **"snowman" or "figure-of-8" heart** shadow on chest X-ray, due to enlarged SVC and innominate vein. - This condition is also associated with **increased pulmonary vascular markings** and often cardiomegaly, which are absent in the provided image. *Ebstein's anomaly* - Ebstein's anomaly is characterized by a **massively enlarged heart** on chest X-ray due to right atrial enlargement and tricuspid regurgitation. - It often shows **reduced pulmonary vascular markings** due to functional pulmonary stenosis, but the characteristic "boot shape" is not typically present.

Question 1

Elderly man with a long-standing mole on his face that is increasing in size and showing an irregular border. Diagnosis:

Accepted Answer

Lentigo maligna

Answer

Superficial spreading melanoma

Answer

Nodular melanoma

Answer

Acral melanoma

Question 2

Fungal infection which is acquired by traumatic inoculation is?

Accepted Answer

Sporothrix

Answer

Coccidioides

Answer

Paracoccidioides

Answer

Blastomyces

Question 3

The image of an immunoglobulin is shown below. Which type of immunoglobulin is it?

Accepted Answer

Immunoglobulin A (IgA)

Answer

Immunoglobulin G (IgG)

Answer

Immunoglobulin M (IgM)

Answer

Immunoglobulin E (IgE)

Question 4

A 22-year-old primigravida visits ANC OPD with 20 weeks POG. On examination uterine height reveals a 16-week size. USG shows reduced liquor. What will be the diagnosis?

Accepted Answer

Bilateral renal agenesis

Answer

Bartter’s syndrome

Answer

Liddle syndrome

Answer

Fetal anemia

Question 5

A 36-week pregnant lady with previous twin delivery. What is the Obstetric score?

Accepted Answer

G2P1

Answer

G2P2

Answer

G3P2

Answer

G3P3

Question 6

Which of the following is not used for postcoital contraception?

Accepted Answer

Danazol

Answer

CuT

Answer

Ru 486

Answer

High dose estrogen

Question 7

A 33-year-old man presents with a 5-week history of calf pain, swelling, and low-grade fever. Serum levels of creatinine kinase are elevated. A muscle biopsy reveals numerous eosinophils and he also has peripheral blood eosinophilia. Which of the following interleukins is primarily responsible for the increase in eosinophils in this patient?

Accepted Answer

IL-5

Answer

IL-4

Answer

IL-6

Answer

IL-2

Question 8

A 35-year-old female experiences a tingling sensation in her arm after watching TV for long hours with her hands under her head. Which type of nerve fibers is most likely to be affected due to this position?

Accepted Answer

A-beta (Aβ) sensory nerve fibers

Answer

B - fibers (autonomic)

Answer

C - fibers (pain and temperature)

Answer

Sympathetic nerve fibers

Question 9

Identify the condition in the X-ray given below:

Accepted Answer

TOF

Answer

TGA

Answer

TAPVC

Answer

Ebstein's anomaly

Question 10

A 68-year-old asymptomatic male is found to have an abdominal aortic aneurysm (AAA) measuring 4.5 cm on routine ultrasound screening. What is the most appropriate management?

Accepted Answer

Monitor regularly and consider surgery if size reaches 55mm or symptomatic

Answer

Ultrasound monitoring until size exceeds 70mm

Answer

No treatment unless symptomatic

Answer

Immediate surgical repair for all diagnosed aneurysms regardless of size

NEET-PG 2020

Dermatology

Microbiology

Obstetrics and Gynecology

Physiology

Radiology

Surgery