Biochemistry
1 questionsFemale, on maize as a staple diet. History of diarrhoea and lesion in the neck region. This is due to deficiency of which of the following?
NEET-PG 2020 - Biochemistry NEET-PG Practice Questions and MCQs
Question 241: Female, on maize as a staple diet. History of diarrhoea and lesion in the neck region. This is due to deficiency of which of the following?
- A. Pyridoxine
- B. Niacin (Correct Answer)
- C. Thiamine
- D. Zinc
Explanation: ***Niacin*** * The constellation of **diarrhea**, **dermatitis** (neck lesion, often a "Casal's necklace"), and the exclusive reliance on a **maize staple diet** is highly characteristic of **pellagra**, which is caused by a **niacin (vitamin B3) deficiency**. * Maize contains niacin in a bound form (niacytin) that is largely **unbioavailable** unless treated with alkali (e.g., historical limewater soaking in some cultures). *Pyridoxine* * Deficiency of **pyridoxine (vitamin B6)** can lead to symptoms such as **skin inflammation (seborrheic dermatitis)**, **glossitis**, **cheilosis**, and neurological issues like **peripheral neuropathy** or **seizures**. * It does not typically present with the classic **diarrhea** and **dermatitis** pattern associated with pellagra in the context of a maize-based diet. *Thiamine* * **Thiamine (vitamin B1) deficiency** is associated with **beriberi**, characterized by cardiovascular symptoms (**wet beriberi** with edema and heart failure) or neurological symptoms (**dry beriberi** with neuropathy and muscle wasting). * It does not cause the specific dermatological lesion on the neck or the triad of symptoms (dermatitis, diarrhea, and dementia) seen with niacin deficiency. *Zinc* * **Zinc deficiency** can manifest as **dermatitis (acrodermatitis enteropathica)**, **diarrhea**, **impaired immune function**, and **poor wound healing** or **growth retardation**. * While it can cause skin lesions and diarrhea, the distinct **photosensitive dermatosis** on the neck and the strong association with a maize staple diet specifically point away from zinc deficiency and towards pellagra.
Community Medicine
1 questionsWhich vaccine protocol is recommended for health workers in disaster scenarios?
NEET-PG 2020 - Community Medicine NEET-PG Practice Questions and MCQs
Question 241: Which vaccine protocol is recommended for health workers in disaster scenarios?
- A. Only routine immunization vaccines are needed
- B. Tetanus toxoid, typhoid, and hepatitis A vaccines are recommended (Correct Answer)
- C. Cholera vaccine alone is sufficient for health workers
- D. Tetanus toxoid alone provides adequate protection
Explanation: ***Tetanus toxoid, typhoid, and hepatitis A vaccines are recommended*** - Health workers in disaster scenarios face increased exposure to infectious diseases due to unsanitary conditions, contaminated food and water, and potential injuries. Current **WHO and CDC guidelines** recommend a comprehensive vaccination protocol including **tetanus toxoid**, **typhoid**, and **hepatitis A** vaccines. - **Tetanus toxoid** is essential due to increased risk of injuries and potential exposure to *Clostridium tetani* through contaminated wounds, which are common in disaster settings. - **Typhoid vaccine** protects against *Salmonella typhi* transmitted through contaminated food and water, a major risk in disaster-affected areas with disrupted sanitation. - **Hepatitis A vaccine** is crucial as the virus spreads through the fecal-oral route, prevalent in areas with compromised water supply and sanitation infrastructure. *Only routine immunization vaccines are needed* - While routine immunizations provide baseline protection, they are insufficient to cover the specific occupational risks health workers face in disaster environments. - Disaster scenarios introduce unique exposures that require additional targeted vaccination beyond standard schedules. *Tetanus toxoid alone provides adequate protection* - **Tetanus toxoid** is vital for preventing tetanus from wounds and injuries. - However, it does not protect against other significant threats like **typhoid fever** and **hepatitis A**, which are major causes of morbidity in disaster settings with compromised sanitation. *Cholera vaccine alone is sufficient for health workers* - **Cholera vaccine** has limited role in disaster settings (50-60% efficacy, short duration). - Current guidelines do NOT recommend routine cholera vaccination for health workers; it offers no protection against **typhoid**, **hepatitis A**, or **tetanus**, leaving workers vulnerable to more prevalent risks.
ENT
1 questionsTuberculous otitis media of the middle ear has all of the following except:-
NEET-PG 2020 - ENT NEET-PG Practice Questions and MCQs
Question 241: Tuberculous otitis media of the middle ear has all of the following except:-
- A. Multiple perforations are seen
- B. Pale granulomas are seen
- C. Painful otorrhea is seen (Correct Answer)
- D. ATT should be started
Explanation: ***Painful otorrhea is seen*** - **Tuberculous otitis media** is often characterized by **painless otorrhea**, making painful otorrhea an unlikely finding. - The absence of pain is attributed to the **insidious** and slow-growing nature of the infection, which often delays diagnosis. *Multiple perforations are seen* - **Multiple tympanic membrane perforations** are a classic sign of tuberculous otitis media, differentiating it from other chronic otitis media forms. - These perforations are often **small and non-healing**, contributing to persistent discharge. *Pale granulomas are seen* - The presence of **pale granulomas** in the middle ear is a histological hallmark of tuberculosis, reflecting the characteristic **caseating granulomatous inflammation**. - These granulomas can lead to **ossicular erosion** and subsequent conductive hearing loss. *ATT should be started* - **Anti-tubercular treatment (ATT)** is the definitive therapy for tuberculous otitis media, targeting the underlying Mycobacterium tuberculosis infection. - Early initiation of ATT is crucial to prevent further **destruction** of middle ear structures and hearing loss.
Internal Medicine
1 questionsAfter a renal transplant, what is the most common opportunistic infection?
NEET-PG 2020 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 241: After a renal transplant, what is the most common opportunistic infection?
- A. Varicella Zoster Virus (VZV)
- B. Coxsackie Virus
- C. Epstein-Barr Virus (EBV)
- D. Cytomegalovirus (CMV) (Correct Answer)
Explanation: ***Cytomegalovirus (CMV)*** - **CMV** is the most common opportunistic infection after renal transplantation, particularly in the first 6 months due to immunosuppression [1]. - It can cause a range of clinical syndromes, including **fever**, **leukopenia**, **gastroenteritis**, **pneumonitis**, and **hepatitis**, and can also have indirect effects that increase the risk of graft rejection. *Varicella Zoster Virus (VZV)* - While VZV can cause opportunistic infections in transplant recipients (e.g., **shingles**), it is less common than CMV [1]. - VZV typically occurs later post-transplant and is characterized by a **vesicular rash** in a dermatomal distribution. *Coxsackie Virus* - **Coxsackie virus** infections are less frequently reported as significant opportunistic infections in renal transplant recipients compared to other viral pathogens. - They are generally associated with hand-foot-and-mouth disease, herpangina, or myocarditis, which are not the most common post-transplant complications. *Epstein-Barr Virus (EBV)* - **EBV** can cause post-transplant lymphoproliferative disorder (PTLD), which is a serious complication, but EBV infection itself is not the most common opportunistic infection overall [1]. - PTLD is more common in the first year after transplant and often presents with **lymphadenopathy**, **fever**, or **graft dysfunction**.
Microbiology
2 questionsSuperantigen is produced by which of the following?
A 29 year old male was brought to ED with complaints of nausea, vomiting and abdominal cramps 3-4 hours after eating meat at dinner. What is the likely cause of this condition?
NEET-PG 2020 - Microbiology NEET-PG Practice Questions and MCQs
Question 241: Superantigen is produced by which of the following?
- A. Clostridium perfringens
- B. Vibrio cholerae
- C. Staphylococcus epidermidis
- D. Streptococcus pyogenes (Correct Answer)
Explanation: ***Streptococcus pyogenes*** - *Streptococcus pyogenes* produces **superantigens** such as **streptococcal pyrogenic exotoxins (SPE-A, SPE-B, SPE-C)**. - These superantigens cause massive non-specific T-cell activation, leading to **toxic shock syndrome** and **scarlet fever**. - Superantigens bypass normal antigen processing by directly binding MHC class II molecules to T-cell receptors. *Clostridium perfringens* - *Clostridium perfringens* primarily produces **alpha-toxin** (phospholipase C) and other toxins causing **gas gangrene** and **food poisoning**. - It does not produce superantigens. *Vibrio cholerae* - *Vibrio cholerae* produces **cholera toxin**, an **enterotoxin** that causes massive fluid secretion in the intestine, leading to profuse watery diarrhea. - Cholera toxin is not a superantigen; it acts by activating adenylate cyclase through ADP-ribosylation. *Staphylococcus epidermidis* - *Staphylococcus epidermidis* is a common skin commensal that can cause infections related to **medical devices** and **biofilm formation**. - Unlike *Staphylococcus aureus* (which produces TSST-1 and enterotoxins), *S. epidermidis* does not produce superantigens.
Question 242: A 29 year old male was brought to ED with complaints of nausea, vomiting and abdominal cramps 3-4 hours after eating meat at dinner. What is the likely cause of this condition?
- A. Clostridium perfringens
- B. Clostridium botulinum
- C. Staphylococcus aureus (Correct Answer)
- D. Salmonella Enteritidis
Explanation: ***Staphylococcus aureus*** - The rapid onset of symptoms (3-4 hours) after eating meat, characterized by **nausea**, **vomiting**, and **abdominal cramps**, is highly suggestive of preformed toxin-mediated food poisoning, with **Staphylococcus aureus** being a common culprit. - *S. aureus* produces heat-stable enterotoxins that, when ingested, cause prompt gastrointestinal symptoms due to their direct irritant effect on the gut. *Clostridium perfringens* - This bacterium typically causes food poisoning with an incubation period of **8-16 hours** and symptoms primarily include **abdominal cramps** and **diarrhea**, with vomiting being less common. - Symptoms arise from toxins produced *in vivo* after spore ingestion, not preformed toxins, which leads to a longer incubation time. *Clostridium botulinum* - While *Clostridium botulinum* produces a potent neurotoxin, its food poisoning primarily manifests as **neurological symptoms** (e.g., flaccid paralysis, diplopia, dysphagia), not acute gastrointestinal upset like vomiting and cramps. - The incubation period is typically **12-36 hours**, longer than the reported 3-4 hours, and it is usually associated with improperly canned foods. *Salmonella Enteritidis* - *Salmonella* infections usually have a longer incubation period of **6 hours to 6 days**, and while they can cause nausea, vomiting, cramps, and diarrhea, the rapid onset in this case makes *S. aureus* more likely. - Infection typically leads to **inflammatory gastroenteritis**, sometimes with fever, which is not mentioned as a prominent symptom here.
Pathology
1 questionsWhy is citrate phosphate dextrose (CPD) better than acid citrate dextrose (ACD) for storage of blood?
NEET-PG 2020 - Pathology NEET-PG Practice Questions and MCQs
Question 241: Why is citrate phosphate dextrose (CPD) better than acid citrate dextrose (ACD) for storage of blood?
- A. Maintains pH stability during storage
- B. Contains phosphate and dextrose (Correct Answer)
- C. Prevents hemolysis in stored blood
- D. Reduces metabolic activity in stored blood
Explanation: ***Contains phosphate and dextrose*** - CPD contains **phosphate**, which acts as a buffer and helps maintain crucial 2,3-bisphosphoglycerate (2,3-BPG) levels in red blood cells, improving oxygen delivery capacity. - The presence of **dextrose** provides a substrate for glycolysis, which is essential for ATP production and red blood cell viability during storage. - This combination allows CPD to extend blood storage life to approximately **35 days** compared to ACD's **21 days**. *Maintains pH stability during storage* - Both ACD and CPD help maintain pH stability due to their **citrate** content, which acts as an anticoagulant and buffer. - However, CPD's phosphate component offers superior buffering capacity, but pH maintenance alone is not the primary distinguishing advantage. - This is a shared characteristic of both solutions, not the key reason CPD is preferred. *Prevents hemolysis in stored blood* - Both CPD and ACD prevent hemolysis by chelating **calcium**, which prevents coagulation and maintains red blood cell integrity. - While both solutions successfully prevent hemolysis, this is not the distinguishing feature that makes CPD superior. - The primary advantage of CPD lies in its better support of red blood cell metabolism and viability through phosphate and dextrose. *Reduces metabolic activity in stored blood* - This is **incorrect** - the purpose of anticoagulant solutions is to preserve blood components, not to reduce metabolic activity. - The dextrose in CPD is provided precisely to **fuel essential metabolic activity** (glycolysis) to sustain red blood cells during storage. - While refrigeration at 1-6°C slows metabolism, CPD actively supports rather than reduces the metabolic processes necessary for RBC survival.
Pediatrics
1 questionsA 3-year-old boy presents with fever, throat pain, and difficulty swallowing. On examination, there is unilateral tonsillar swelling with deviation of the uvula. What is the most likely diagnosis?
NEET-PG 2020 - Pediatrics NEET-PG Practice Questions and MCQs
Question 241: A 3-year-old boy presents with fever, throat pain, and difficulty swallowing. On examination, there is unilateral tonsillar swelling with deviation of the uvula. What is the most likely diagnosis?
- A. Parapharyngeal abscess
- B. Ludwig's angina
- C. Peritonsillar abscess (Correct Answer)
- D. Retropharyngeal abscess
Explanation: ***Peritonsillar abscess*** - This is the most common deep neck infection and typically presents with **unilateral tonsillar swelling**, **uvular deviation**, fever, and severe sore throat with difficulty swallowing (dysphagia) or speaking (muffled voice). - It usually develops as a complication of **acute tonsillitis**, where infection spreads from the tonsil into the peritonsillar space. *Parapharyngeal abscess* - While it can cause fever and severe throat pain, it typically presents with **trismus**, neck swelling below the angle of the mandible, and medial displacement of the lateral pharyngeal wall, rather than direct uvula deviation. - This type of abscess is located in the **parapharyngeal space**, which is lateral to the pharynx, and causes more diffuse swelling. *Ludwig's angina* - This is a rapidly spreading cellulitis of the **submandibular** and **sublingual spaces** and does not primarily involve the tonsils or cause uvular deviation. - Patients typically present with **symmetrical submental swelling**, painful swallowing, and tongue elevation, which can lead to airway obstruction. *Retropharyngeal abscess* - This abscess forms in the space behind the posterior pharyngeal wall and is more common in young children. - It often causes **neck stiffness**, muffled voice, stridor, and difficulty breathing, but less commonly presents with unilateral tonsillar swelling and uvular deviation.
Radiology
1 questionsWhich of the following is a FALSE statement regarding radiation?
NEET-PG 2020 - Radiology NEET-PG Practice Questions and MCQs
Question 241: Which of the following is a FALSE statement regarding radiation?
- A. GI mucosa is one of the most radiosensitive tissues in the body
- B. Rapidly dividing cells are highly sensitive to Radiation
- C. Small blood vessels are relatively resistant to radiation compared to other tissues (Correct Answer)
- D. The intensity of Radiation is inversely proportional to the square of distance from the source
Explanation: ***Small blood vessels are relatively resistant to radiation compared to other tissues*** - This statement is **false**. Endothelial cells of **small blood vessels** are highly sensitive to radiation, and their damage contributes significantly to late radiation effects like **fibrosis** and **tissue necrosis**. - **Vascular damage** is a critical factor in the pathogenesis of radiation injury to normal tissues, making this statement incorrect. *GI mucosa is one of the most radiosensitive tissues in the body* - This statement is **true**. The **gastrointestinal mucosa** consists of rapidly dividing cells (e.g., crypt cells), which makes it highly vulnerable to radiation-induced damage. - This high sensitivity explains common side effects like **nausea, vomiting**, and **diarrhea** in patients undergoing abdominal or pelvic radiation. *Rapidly dividing cells are highly sensitive to Radiation* - This statement is **true**. Tissues with a high proliferative rate, such as **bone marrow, germinal cells**, and **GI epithelium**, are particularly susceptible to radiation damage. - This principle, known as the **Law of Bergonié and Tribondeau**, states that cells are more radiosensitive if they are undifferentiated, have a long mitotic future, and divide rapidly. *The intensity of Radiation is inversely proportional to the square of distance from the source* - This statement is **true**. This is the **inverse square law**, which applies to electromagnetic radiation and dictates that the intensity (and thus dose rate) of radiation decreases rapidly as the distance from the source increases. - This principle is fundamental in **radiation protection** and **dosimetry**, as it explains why maintaining distance is an effective shielding strategy.
Surgery
1 questionsA patient is on follow-up for recurrent abdominal pain. USG reveals an aortic aneurysm of 40 mm. What should be the next immediate step?
NEET-PG 2020 - Surgery NEET-PG Practice Questions and MCQs
Question 241: A patient is on follow-up for recurrent abdominal pain. USG reveals an aortic aneurysm of 40 mm. What should be the next immediate step?
- A. Establish surveillance protocol with repeat imaging in 6-12 months. (Correct Answer)
- B. Initiate medical management with beta-blockers.
- C. Perform surgical intervention immediately.
- D. Start antihypertensive therapy immediately.
Explanation: ***Establish surveillance protocol with repeat imaging in 6-12 months.*** - A **40mm abdominal aortic aneurysm (AAA)** is below the threshold for elective surgical repair (typically **55mm for men, 50mm for women**). - The **immediate next step** is to establish a **surveillance protocol** with repeat imaging at appropriate intervals (every **6-12 months** for 40-44mm AAAs). - Surveillance allows monitoring of aneurysm growth rate and timely intervention if it expands to surgical threshold or becomes symptomatic. - **Risk factor modification** (smoking cessation, BP control, statin therapy) should accompany surveillance but is secondary to establishing the monitoring plan. *Initiate medical management with beta-blockers.* - **Beta-blockers are NOT recommended** for AAA management and may actually be harmful by reducing aortic wall stress detection. - Current guidelines do not support routine pharmacological therapy specifically to prevent AAA expansion, though **statins** may have some benefit. *Perform surgical intervention immediately.* - A **40mm AAA is well below surgical threshold** and does not require immediate intervention. - Surgery is considered when AAA reaches **≥55mm (men) or ≥50mm (women)**, growth rate **>10mm/year**, or when **symptomatic/ruptured**. *Start antihypertensive therapy immediately.* - While **blood pressure control is important** in AAA management, it is not the immediate next step without first establishing a surveillance protocol. - Antihypertensive therapy should be part of overall cardiovascular risk management but assumes the patient is hypertensive (not specified in the question).