NEET-PG 2020 Practice Questions

Q: The most common site of origin of the diverticulum of the pharynx seen in the barium swallow given below is

Between thyropharyngeus and cricopharyngeus. ***Between thyropharyngeus and cricopharyngeus*** - The diverticulum shown is a **Zenker's diverticulum**, which typically arises in **Killian's triangle** (Killian's dehiscence), a weak spot located between the **thyropharyngeus** and **cricopharyngeus** parts of the inferior pharyngeal constrictor. - This anatomical location represents an area of **muscular dehiscence** where increased intraluminal pressure during swallowing can lead to posterior herniation of the pharyngeal mucosa. - Killian's triangle is the **most common site** for pharyngeal diverticula. *Between stylopharyngeus and palatopharyngeus* - This region is located higher in the pharynx, and a diverticulum here would be extremely rare and not characteristic of a Zenker's diverticulum. - The stylopharyngeus and palatopharyngeus muscles primarily influence **pharyngeal elevation** and **soft palate movement** during swallowing, not the typical site of diverticular formation. *Between middle and inferior constrictor* - This area is located more superiorly in the pharynx and is **not a recognized site** for pharyngeal diverticula. - Diverticula at this level would be extremely rare as there is no significant anatomical weakness or dehiscence comparable to Killian's triangle. - This should not be confused with other posterior pharyngeal weak points like Killian's triangle or the Killian-Jamieson area (which is lateral, not posterior). *Between inferior constrictor and esophagus* - This description is broadly anatomically similar but less precise than specifying the exact muscular components. - While Zenker's diverticulum does occur at the pharyngoesophageal junction, the specific weak point is **Killian's triangle** between the thyropharyngeus and cricopharyngeus muscles within the inferior constrictor complex.

Q: Identify the cell type marked in the cerebellum.

Purkinje cells. ***Purkinje cells*** - These are **large, flask-shaped neurons** with extensive dendritic trees, forming a single layer in the cerebellar cortex. - The image clearly shows these characteristic large, pear-shaped cell bodies with a surrounding paler area (Purkinje layer), distinguishing them from the smaller, more numerous cells in the granular layer below. *Basket cells* - These are **inhibitory interneurons** located within the **molecular layer** of the cerebellum, superficial to the Purkinje cells. - They are typically smaller than Purkinje cells and send axons that form a "basket" around the somata of Purkinje cells, which is not what is highlighted here. *Granule cells* - These are the **smallest and most numerous neurons** in the brain, found in the **granular layer** of the cerebellum, deep to the Purkinje cells. - They appear as small, densely packed, dark nuclei in the image, distinct from the larger, paler cells indicated by the arrow. *Golgi cells* - These are inhibitory interneurons located in the **granular layer** of the cerebellum, below the Purkinje cell layer. - While larger than granule cells, they are generally smaller and less distinct than Purkinje cells, and their morphology does not match the prominent cells pointed out by the arrow.

Q: Nosocomial infections are defined as infections that develop after how many hours of hospital admission?

A) 48 hours. ***A) 48 hours*** - Nosocomial infections, also known as **hospital-acquired infections (HAI)**, are defined as infections that develop **48 hours or more** after hospital admission. - This is the **standard definition** used by the **CDC, WHO**, and major medical textbooks including **Park's Textbook of Preventive and Social Medicine**. - The 48-hour threshold helps differentiate infections acquired during hospitalization from those that were **incubating at the time of admission** (typical incubation periods for most common infections are less than 48 hours). - Infections can also be classified as nosocomial if they occur **within 3 days after discharge** or **within 30 days after surgery**. *B) 72 hours* - While **72 hours** is occasionally mentioned in some contexts or specific institutional protocols, it is **not the standard definition** for nosocomial infections. - Using 72 hours would be too restrictive and could miss true hospital-acquired infections that manifest between 48-72 hours. - The universally accepted standard remains **48 hours**. *C) 24 hours* - An infection developing within **24 hours** is very likely to have been **present or incubating prior to admission**. - This timeframe is too short to establish that the infection was acquired during hospitalization. - Most common bacterial and viral infections have incubation periods longer than 24 hours. *D) 50 hours* - This is **not a standard threshold** for defining nosocomial infections. - The conventional definitions use **48 hours** as the cutoff point, which is based on typical incubation periods and epidemiological evidence.

Q: Relatives of a patient told during postmortem examination that the person had a tattoo - which was now invisible. How to identify?

Examine the Lymph node. ***Examine the Lymph node*** - Tattoo ink particles are **phagocytosed** by macrophages and subsequently transported to and deposited in the regional **lymph nodes**. - Even if a tattoo is no longer visible on the skin due to decomposition or other factors, the pigment can often still be found in the associated **lymph nodes upon histological examination**. *Spectrophotometer* - A spectrophotometer is used to **measure the absorption or transmission of light** by a sample, which could identify pigments in a *prepared tissue sample*. - However, it would not be the **primary method for initial detection of an invisible tattoo** within a body as it requires a specific tissue sample containing the pigment to work, and would not help in locating the tattoo's original site or the presence of pigment in regional lymph nodes. *Ordinary light* - Ordinary light is suitable for examining **visible surface features** or visible tattoos. - If a tattoo is already described as **invisible**, ordinary light will not reveal its presence, as the pigments are either degraded, covered, or too deep to be seen. *X-ray* - X-rays are primarily used to visualize **bone or dense structures** and can detect foreign bodies that are radiopaque (like some metals). - Tattoo pigments are generally **not sufficiently radiopaque** to be visible on X-ray, making this method ineffective for detecting tattoos.

Q: Renal tubular acidosis with ABG value pH = 7.24 PO2=80; PaCO2= 36 Na = 131; HCO3 = 14 Cl= 90; BE = -13 Glucose = 135 the above ABG picture suggests –

Metabolic acidosis. The ABG shows a pH of 7.24, indicating **acidemia** [1]. The HCO3 is 14 mEq/L, which is significantly **low**, and the base excess (BE) is -13 [1]. The PaCO2 of 36 mmHg is within the normal range, indicating no significant primary respiratory derangement [2]. The overall picture is consistent with an uncompensated or partially compensated **metabolic acidosis** [1][2]. ***Metabolic acidosis*** - The **low pH (acidemia)**, **low bicarbonate (HCO3)**, and **negative base excess (BE)** are direct indicators of metabolic acidosis [1]. - The **PaCO2 within normal limits** or slightly decreased suggests either no respiratory compensation or insufficient compensation for the metabolic derangement [1][2]. *Respiratory acidosis* - This would present with a **low pH** and an **elevated PaCO2** as the primary defect, which is not seen here (PaCO2 is normal) [1]. - Bicarbonate would typically be normal or elevated if compensated, not significantly decreased. *Respiratory alkalosis* - This would be characterized by an **elevated pH** and a **low PaCO2**, which is the opposite of the findings in this ABG [1]. - HCO3 would be normal or low if compensated. *Metabolic alkalosis* - This would present with an **elevated pH** and an **elevated HCO3**, which contradicts the given ABG values (low pH and low HCO3) [2].

Q: What is the diagnosis of a 55-year-old woman with chronic low backache?

Osteoporosis. ***Osteoporosis*** - The image shows **loss of bone density** and **vertebral compression fractures**, especially visible in the lumbar spine, which are characteristic findings in osteoporosis. - Osteoporosis is common in post-menopausal women, and **chronic low backache** is a frequent symptom due to microfractures or vertebral collapse. *Hurler's syndrome* - This is a lysosomal storage disease (mucopolysaccharidosis type I) that primarily affects **children** and presents with distinct **skeletal deformities** (dysostosis multiplex), facial features, and organ involvement. - It would not typically present as chronic low backache in a 55-year-old woman, and the radiological findings are not consistent with Hurler's syndrome. *Paget’s disease* - Paget's disease of bone involves abnormal bone remodeling, leading to **enlarged and weakened bones**, often with a characteristic **cotton wool appearance** on X-ray, which is not seen here. - While it can cause bone pain and affect the spine, the primary radiological features seen in this image are more consistent with generalized bone density loss and fractures rather than focal expansion and abnormal bone architecture. *Renal osteodystrophy* - This condition occurs in patients with **chronic kidney disease** and results from imbalances in calcium, phosphate, and parathyroid hormone. - Radiographic features include **osteosclerosis (rugger jersey spine)**, bone erosions, or osteomalacia, which are different from the generalized osteopenia and compression fractures observed in this X-ray.

Q: Which of the following is not considered an absolute contraindication for the use of an Intra Uterine Contraceptive Device (IUD)?

Uterine malformation. ***Uterine malformation*** - While a uterine malformation can make IUD insertion more difficult or reduce its effectiveness, it is often considered a **relative contraindication**, depending on the specific anomaly and the patient's desire for contraception. - In certain cases, an IUD might still be a viable option, but it requires careful consideration and specialized insertion techniques. *Pregnancy* - The presence of an existing pregnancy is an **absolute contraindication** for IUD insertion, as it can lead to complications such as miscarriage or ectopic pregnancy. - An IUD is a contraceptive device, and inserting it when a woman is already pregnant directly contradicts its purpose and poses significant risks. *Undiagnosed vaginal bleeding* - This is an **absolute contraindication** because it could be a symptom of a serious underlying condition, such as cervical cancer, endometrial cancer, or ectopic pregnancy. - Inserting an IUD before diagnosing the cause of the bleeding could delay treatment of a potentially life-threatening condition and exacerbate the bleeding. *Pelvic inflammatory disease* - Current or recent (within the last 3 months) **pelvic inflammatory disease (PID)** is an **absolute contraindication** due to the increased risk of worsening infection. - IUD insertion can introduce bacteria from the vagina into the uterus, potentially exacerbating an existing infection or causing a new one.

Q: What is the most common cause of sympathetic ophthalmia?

Penetrating injury to the eye. **Penetrating injury to the eye** - **Sympathetic ophthalmia** is a rare, bilateral granulomatous inflammation that occurs after a **penetrating ocular injury** to one eye. - The injury to the affected eye (the **exciting eye**) exposes intraocular antigens to the immune system, leading to an autoimmune response that affects both eyes. *Blunt ocular trauma* - While blunt trauma can cause significant ocular damage, it typically does not expose the intraocular antigens necessary to trigger **sympathetic ophthalmia**. - **Blunt trauma** often leads to conditions like hyphema, orbital fractures, or commotio retinae, but not generalized autoimmune inflammation of both eyes. *Chemical injury to the eye* - **Chemical injuries** primarily cause damage to the ocular surface and anterior segment structures through direct tissue necrosis. - This type of injury rarely leads to the exposure of deep intraocular antigens required to initiate an autoimmune response like that seen in sympathetic ophthalmia. *Retinal detachment* - **Retinal detachment** is the separation of the neurosensory retina from the underlying retinal pigment epithelium. - Although it is a serious ocular condition, it is not a typical prerequisite for **sympathetic ophthalmia** as it generally does not involve a penetrating wound that exposes uveal tissue.

Q: All-trans retinoic acid is primarily used in the treatment of which of the following tumors?

PML-RARA. ***PML-RARA*** - **All-trans retinoic acid (ATRA)** is a cornerstone treatment for **acute promyelocytic leukemia (APML)**, which is characterized by the **PML-RARA fusion gene**. - ATRA works by inducing differentiation of leukemic promyelocytes, overcoming the maturation block caused by the **PML-RARA** oncoprotein. *BCR-ABL* - The **BCR-ABL fusion gene** is characteristic of **chronic myeloid leukemia (CML)**, and sometimes in acute lymphoblastic leukemia (ALL). - The primary treatment for **BCR-ABL positive leukemias** involves **tyrosine kinase inhibitors (TKIs)**, such as imatinib, not ATRA. *CMYC* - **CMYC** is an oncogene whose dysregulation is frequently implicated in various cancers, including **Burkitt lymphoma** and some forms of acute myeloid leukemia (AML). - There is no direct therapeutic role for ATRA specifically targeting tumors driven by **CMYC overexpression**. *CEBPA* - **CEBPA** mutations are found in a subset of **acute myeloid leukemia (AML)**, often leading to a favorable prognosis. - While ATRA can be used in some AML subtypes, it is not specifically indicated or primarily effective for AML characterized solely by **CEBPA mutations**; its role is specific to **PML-RARA**.

Q: Identify the sleep stage marked in the EEG during the sleep-wake cycle?

REM sleep. ***REM sleep*** - The marked EEG pattern shows **low-amplitude, mixed-frequency waves** which are characteristic of REM sleep, often resembling an awake state. - This stage is associated with **rapid eye movements**, vivid dreams, and muscle atonias. *Stage 1 sleep* - Characterized by a transition from alpha waves to **theta waves**, which are slightly slower than alpha waves and have a higher amplitude than the waves shown. - This is the **lightest stage of sleep**, with the person easily aroused. *Stage 2 sleep* - Marked by the presence of **sleep spindles** (bursts of high-frequency waves) and **K-complexes** (large, slow waves), which are not visible in the image. - The background activity consists of **theta waves,** which are slower and higher amplitude than the waves present in the image. *Stage 3 sleep* - This is **deep non-REM sleep**, also known as slow-wave sleep, characterized by **delta waves** (high-amplitude, low-frequency waves). - The waves in the image are much faster and lower amplitude than delta waves characteristic of Stage 3 sleep.

Question 1

The most common site of origin of the diverticulum of the pharynx seen in the barium swallow given below is

Accepted Answer

Between thyropharyngeus and cricopharyngeus

Answer

Between stylopharyngeus and palatopharyngeus

Answer

Between middle and inferior constrictor

Answer

Between inferior constrictor and esophagus

Question 2

Identify the cell type marked in the cerebellum.

Accepted Answer

Purkinje cells

Answer

Basket cells

Answer

Granule cells

Answer

Golgi cells

Question 3

Nosocomial infections are defined as infections that develop after how many hours of hospital admission?

Accepted Answer

A) 48 hours

Answer

B) 72 hours

Answer

C) 24 hours

Answer

D) 50 hours

Question 4

Relatives of a patient told during postmortem examination that the person had a tattoo - which was now invisible. How to identify?

Accepted Answer

Examine the Lymph node

Answer

Spectrophotometer

Answer

Ordinary light

Answer

X-ray

Question 5

Renal tubular acidosis with ABG value pH = 7.24 PO2=80; PaCO2= 36 Na = 131; HCO3 = 14 Cl= 90; BE = -13 Glucose = 135 the above ABG picture suggests –

Accepted Answer

Metabolic acidosis

Answer

Respiratory alkalosis

Answer

Metabolic alkalosis

Answer

Respiratory acidosis

Question 6

What is the diagnosis of a 55-year-old woman with chronic low backache?

Accepted Answer

Osteoporosis

Answer

Hurler's syndrome

Answer

Paget’s disease

Answer

Renal osteodystrophy

Question 7

Which of the following is not considered an absolute contraindication for the use of an Intra Uterine Contraceptive Device (IUD)?

Accepted Answer

Uterine malformation

Answer

Undiagnosed vaginal bleeding

Answer

Pregnancy

Answer

Pelvic inflammatory disease

Question 8

What is the most common cause of sympathetic ophthalmia?

Accepted Answer

Penetrating injury to the eye

Answer

Blunt ocular trauma

Answer

Chemical injury to the eye

Answer

Retinal detachment

Question 9

All-trans retinoic acid is primarily used in the treatment of which of the following tumors?

Accepted Answer

PML-RARA

Answer

BCR-ABL

Answer

CMYC

Answer

CEBPA

Question 10

Identify the sleep stage marked in the EEG during the sleep-wake cycle?

Accepted Answer

REM sleep

Answer

Stage 1 sleep

Answer

Stage 2 sleep

Answer

Stage 3 sleep

NEET-PG 2020

Anatomy

Community Medicine

Forensic Medicine

Internal Medicine

Obstetrics and Gynecology

Ophthalmology

Pharmacology

Physiology