Community Medicine
1 questionsA study was conducted to investigate the relationship between COPD and smoking. Data was collected from government hospital records on COPD cases and cigarette sales records from finance and taxation departments. What is the study design?
NEET-PG 2020 - Community Medicine NEET-PG Practice Questions and MCQs
Question 251: A study was conducted to investigate the relationship between COPD and smoking. Data was collected from government hospital records on COPD cases and cigarette sales records from finance and taxation departments. What is the study design?
- A. Cross-sectional study
- B. Operational study
- C. Case-control study
- D. Ecological study (Correct Answer)
Explanation: ***Ecological study*** - This study uses **aggregate data** (COPD cases from hospital records, cigarette sales from taxation departments) at the population level, not individual data. - It investigates the relationship between exposure (smoking) and outcome (COPD) across different populations or groups. *Cross-sectional study* - A **cross-sectional study** collects data on exposure and outcome at a **single point in time** from individuals, which is not the case here as aggregate data is used. - It describes the prevalence of a disease and exposure in a population, but does not examine the relationship using population-level aggregates. *Operational study* - An **operational study** focuses on evaluating the effectiveness and efficiency of health services or programs in real-world settings. - It typically involves assessing how well interventions are implemented and their impact, rather than investigating the relationship between disease and exposure using aggregate data. *Case-control study* - A **case-control study** compares individuals with a disease (cases) to individuals without the disease (controls) and looks back retrospectively to identify exposures. - This design relies on individual-level data and is not suitable when only population-level aggregate data is available.
Internal Medicine
3 questionsWhat is the first line of treatment for osteoporosis in postmenopausal women?
A 70-year-old man is having nasal regurgitation of fluids and hoarseness of voice. On sensory examination, numbness and loss of sensation over the left half of the face with impaired pain and temperature and contralateral pain and temperature loss of the body is noted. Motor examination shows left arm weakness, and cranial nerve examination shows a diminished gag reflex. Which of the following vessel thrombosis leads to this condition?
A 55 year old male presents with tachypnea and mental confusion. Blood glucose 350 mg/dl, pH = 7.0. What is the most likely acid base disorder?
NEET-PG 2020 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 251: What is the first line of treatment for osteoporosis in postmenopausal women?
- A. Ulipristal
- B. Estrogen
- C. Bisphosphonates (Correct Answer)
- D. Calcium and vitamin D supplementation
Explanation: ***Bisphosphonates*** - **Bisphosphonates** are the **first-line therapy** for osteoporosis in postmenopausal women due to their proven efficacy in reducing the risk of fragility fractures [1]. - They work by inhibiting **osteoclast activity**, thereby decreasing bone resorption and increasing bone mineral density [1]. *Ulipristal* - **Ulipristal** is a **selective progesterone receptor modulator** primarily used as an emergency contraceptive or for the treatment of uterine fibroids. - It has no role in the direct treatment or prevention of osteoporosis. *Estrogen* - **Estrogen therapy** can prevent bone loss but is generally not considered first-line for osteoporosis due to potential risks like increased incidence of **venous thromboembolism**, stroke, and certain cancers [1]. - It is typically reserved for women with severe menopausal symptoms who also need osteoporosis prevention [1]. *Calcium and vitamin D supplementation* - While essential for **bone health**, **calcium and vitamin D supplementation** alone is not sufficient to treat established osteoporosis [2]. - They are crucial adjuncts to pharmacotherapy, ensuring adequate building blocks for bone formation, but do not directly address the underlying bone loss mechanism effectively enough as a monotherapy for osteoporosis [1].
Question 252: A 70-year-old man is having nasal regurgitation of fluids and hoarseness of voice. On sensory examination, numbness and loss of sensation over the left half of the face with impaired pain and temperature and contralateral pain and temperature loss of the body is noted. Motor examination shows left arm weakness, and cranial nerve examination shows a diminished gag reflex. Which of the following vessel thrombosis leads to this condition?
- A. Middle cerebral artery
- B. Posterior inferior cerebellar artery (Correct Answer)
- C. Posterior cerebral artery
- D. Anterior inferior cerebellar artery
Explanation: **Posterior inferior cerebellar artery** - The described symptoms, including **nasal regurgitation** (affecting the **palate** due to cranial nerve involvement), **hoarseness** (indicating **vagus nerve** dysfunction) [2], ipsilateral facial numbness with impaired pain and temperature **(trigeminal nerve nucleus** involvement), and contralateral body pain and temperature loss **(spinothalamic tract**), along with a diminished gag reflex, are characteristic of **lateral medullary syndrome (Wallenberg syndrome)** [3]. - **Lateral medullary syndrome** is most commonly caused by **thrombosis of the posterior inferior cerebellar artery (PICA)**, which supplies the **lateral medulla** and inferior cerebellum. *Middle cerebral artery* - **Middle cerebral artery (MCA)** strokes typically affect the **cerebral hemispheres**, leading to contralateral weakness and sensory loss, aphasia (if the **dominant hemisphere** is involved), and visual field deficits [1]. - They do not typically cause the specific brainstem signs of **nasal regurgitation**, hoarseness, or the crossed sensory deficits seen in this patient. *Posterior cerebral artery* - **Posterior cerebral artery (PCA)** strokes primarily affect the **visual cortex** and **thalamus**, causing conditions such as **homonymous hemianopia**, visual agnosia, and sometimes memory deficits or contralateral sensory loss. - They do not cause the constellation of **cranial nerve** and **brainstem** signs described in the patient. *Anterior inferior cerebellar artery* - **Anterior inferior cerebellar artery (AICA)** occlusion can cause **lateral pontine syndrome**, which includes symptoms like ipsilateral deafness or tinnitus **(VIII nerve**), ipsilateral facial weakness **(VII nerve**), ipsilateral gaze palsy, and cerebellar ataxia. - While it can cause some cerebellar and cranial nerve deficits, it does not typically produce the **nasal regurgitation**, hoarseness, or the specific crossed sensory pattern seen with **PICA** occlusion.
Question 253: A 55 year old male presents with tachypnea and mental confusion. Blood glucose 350 mg/dl, pH = 7.0. What is the most likely acid base disorder?
- A. Metabolic acidosis (Correct Answer)
- B. Metabolic alkalosis
- C. Respiratory alkalosis
- D. Respiratory acidosis
Explanation: Metabolic acidosis - A **pH of 7.0** indicates significant acidemia, and **hyperglycemia (350 mg/dL)** in conjunction with clinical symptoms (tachypnea, mental confusion) strongly suggests **diabetic ketoacidosis (DKA)**, a common cause of high anion gap metabolic acidosis [1]. - Tachypnea is often a **compensatory mechanism** (Kussmaul breathing) to blow off carbon dioxide and raise pH in metabolic acidosis [1], [2]. Metabolic alkalosis - This would present with an **elevated pH (alkalemia)**, which is opposite to the patient's measured pH of 7.0 [2]. - It is typically caused by conditions like severe vomiting or diuretic use, which are not suggested by the clinical presentation [3]. Respiratory alkalosis - This condition involves a **high pH** and a **low PCO2**, often due to hyperventilation [2]. - While the patient is tachypneic, the profound acidemia (pH 7.0) contradicts a primary respiratory alkalosis. Respiratory acidosis - While leading to a low pH, respiratory acidosis is characterized by **elevated PCO2** due to hypoventilation. - The patient's **tachypnea** indicates hyperventilation, which would tend to lower PCO2, making primary respiratory acidosis unlikely.
Pathology
1 questionsA middle-aged female presented with a 4cm mass in the upper outer quadrant of the breast. Biopsy showed densely packed cells within large extracellular spaces. Which of the following is the most likely diagnosis of this patient?
NEET-PG 2020 - Pathology NEET-PG Practice Questions and MCQs
Question 251: A middle-aged female presented with a 4cm mass in the upper outer quadrant of the breast. Biopsy showed densely packed cells within large extracellular spaces. Which of the following is the most likely diagnosis of this patient?
- A. Tubular carcinoma of breast
- B. Medullary carcinoma of breast
- C. Colloid carcinoma of breast (Correct Answer)
- D. Papillary carcinoma of breast
Explanation: ***Colloid carcinoma of breast*** - This type of carcinoma is characterized by **malignant cells floating in abundant extracellular mucin (colloid)**, which aligns with the description "densely packed cells within large extracellular spaces." - It often presents as a **well-circumscribed mass** and has a generally **good prognosis**. *Tubular carcinoma of breast* - Characterized by **well-differentiated tubules** with open lumens and a single layer of epithelial cells. - It does not typically feature large extracellular spaces filled with mucin. *Medullary carcinoma of breast* - This typically presents as a **soft, fleshy tumor** with syncytial sheets of large anaplastic cells and a prominent lymphoid infiltrate [1]. - It does not involve significant extracellular mucin or large extracellular spaces. *Papillary carcinoma of breast* - This carcinoma is defined by **papillary growth patterns** with fibrovascular cores lined by epithelial cells. - While it can be associated with cystic spaces, these are not typically described as "large extracellular spaces" filled with mucinous material. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 455-456.
Pediatrics
1 questionsA 24 month child, with a weight of 11 kg, has RR of 38 / min, chest indrawing, cough and fever. Management according to IMNCI?
NEET-PG 2020 - Pediatrics NEET-PG Practice Questions and MCQs
Question 251: A 24 month child, with a weight of 11 kg, has RR of 38 / min, chest indrawing, cough and fever. Management according to IMNCI?
- A. Refer to a higher-level health facility for further management.
- B. Monitor at home without medical treatment.
- C. Give antibiotics (Correct Answer)
- D. Provide symptomatic treatment with antipyretics only.
Explanation: ***Give antibiotics*** - The child presents with **chest indrawing** along with cough and fever, which according to **IMNCI guidelines** classifies as **pneumonia**. - Note: RR of 38/min is **within normal limits** for a 24-month-old child (fast breathing threshold is ≥40/min for 12-59 months age group). - The diagnosis of pneumonia is based on the presence of **chest indrawing**, not fast breathing in this case. - According to **IMNCI**, pneumonia (without danger signs) should be treated with **oral antibiotics** (amoxicillin 250 mg twice daily for 5 days) at the primary care level. - The child should be followed up in 2 days and the mother advised on when to return immediately. *Refer to a higher-level health facility for further management.* - Referral is indicated for **severe pneumonia**, which requires presence of any **general danger sign** (inability to drink/breastfeed, persistent vomiting, convulsions, lethargy/unconsciousness, or stridor in calm child). - This child has **pneumonia** (not severe), so outpatient treatment with oral antibiotics is appropriate. *Monitor at home without medical treatment.* - This would be inappropriate as the child has **pneumonia** requiring antibiotic treatment. - Untreated pneumonia can rapidly progress to severe disease and is a **leading cause of child mortality** in developing countries. *Provide symptomatic treatment with antipyretics only.* - While antipyretics (paracetamol) can be given for fever, they do not treat the underlying **bacterial infection**. - Antibiotics are essential to treat pneumonia and prevent complications and mortality.
Pharmacology
2 questionsAgent that acts through tyrosine kinase receptor is
A boy is planning to travel by bus. Which of the following drugs can be used to prevent motion sickness in this person?
NEET-PG 2020 - Pharmacology NEET-PG Practice Questions and MCQs
Question 251: Agent that acts through tyrosine kinase receptor is
- A. Insulin (Correct Answer)
- B. MSH
- C. TSH
- D. TRH
Explanation: ***Insulin*** - **Insulin** binds to its receptor, which is a **tyrosine kinase receptor**, leading to autophosphorylation and the activation of intracellular signaling pathways. - This activation is crucial for glucose uptake and metabolism by various cells in the body. *MSH* - **Melanocyte-stimulating hormone (MSH)** acts primarily through **G protein-coupled receptors**, specifically melanocortin receptors. - These receptors activate adenylyl cyclase, leading to an increase in intracellular cAMP. *TSH* - **Thyroid-stimulating hormone (TSH)** also acts via a **G protein-coupled receptor** on thyroid follicular cells. - Its binding stimulates adenylyl cyclase, increasing cAMP and thus thyroid hormone synthesis and release. *TRH* - **Thyrotropin-releasing hormone (TRH)** binds to **G protein-coupled receptors** on pituitary thyrotrophs. - This interaction activates the phospholipase C pathway, leading to the release of TSH.
Question 252: A boy is planning to travel by bus. Which of the following drugs can be used to prevent motion sickness in this person?
- A. Fexofenadine
- B. Promethazine (Correct Answer)
- C. Loratadine
- D. Cetirizine
Explanation: **Promethazine** - **Promethazine** is an **H1 antihistamine** with significant **anticholinergic** properties that effectively blocks muscarinic receptors in the **vestibular system**, making it highly effective for preventing motion sickness. - Its **sedating effects** are also beneficial in relieving the discomfort associated with motion sickness. *Fexofenadine* - **Fexofenadine** is a **second-generation H1 antihistamine** that is **non-sedating** and has minimal anticholinergic activity. - While effective for allergies, its lack of central nervous system penetration and anticholinergic action makes it **ineffective for motion sickness**. *Loratadine* - **Loratadine** is another **second-generation H1 antihistamine**, known for being **non-sedating** and having limited entry into the central nervous system. - It does not possess the significant anticholinergic properties necessary to prevent the **vestibular disturbances** that cause motion sickness. *Cetirizine* - **Cetirizine** is a **second-generation H1 antihistamine** that has **moderate sedative effects** (more than other second-generation agents) and some CNS penetration, but lacks the significant **anticholinergic activity** required for motion sickness prevention. - It is primarily used for allergies and is **not recommended** for the prevention or treatment of motion sickness.
Physiology
2 questionsProlactin levels are highest in which of the following?
In a fetus highest oxygen concentration is found in?
NEET-PG 2020 - Physiology NEET-PG Practice Questions and MCQs
Question 251: Prolactin levels are highest in which of the following?
- A. After 24 hrs of ovulation
- B. After nipple stimulation (Correct Answer)
- C. After 24 hours of parturition
- D. Just before parturition
Explanation: ***After nipple stimulation*** - Nipple stimulation is a powerful physiological stimulus for **prolactin release** from the anterior pituitary. - This reflex is essential for **lactation** and milk let-down, as suckling signals directly enhance prolactin secretion. *After 24 hrs of ovulation* - Prolactin levels do not peak significantly 24 hours after ovulation; while some fluctuation occurs during the menstrual cycle, the highest levels are not seen at this time. - **Luteinizing hormone (LH)** and **follicle-stimulating hormone (FSH)** are the primary hormones exhibiting surges related to ovulation. *After 24 hours of parturition* - While prolactin levels are elevated throughout the third trimester and immediately postpartum, they tend to **decline somewhat** if breastfeeding is not initiated within the first 24-48 hours. - Post-partum, prolactin levels are primarily sustained by **frequent nipple stimulation** from breastfeeding. *Just before parturition* - Prolactin levels are **chronically elevated** during the third trimester of pregnancy, but the **acute highest surge** or peak is typically in response to specific triggers like nipple stimulation, rather than just the state of being immediately pre-partum. - High prolactin during late pregnancy prepares the breasts for lactation but is not necessarily the **absolute peak** that nipple stimulation can elicit.
Question 252: In a fetus highest oxygen concentration is found in?
- A. Superior vena cava
- B. Umbilical vein (Correct Answer)
- C. Left ventricle
- D. Ascending aorta
Explanation: ***Umbilical vein*** - The **umbilical vein** carries oxygenated blood from the **placenta**, which serves as the site of gas exchange, making its oxygen concentration the highest in the fetal circulation. - This highly oxygenated blood bypasses the fetal lungs via shunts such as the **ductus venosus** and **foramen ovale** to supply vital organs. *Superior vena cava* - The **superior vena cava** carries deoxygenated blood from the upper body and head back to the heart, mixing with oxygenated blood in the right atrium. - Its blood has a relatively **low oxygen saturation** compared to the umbilical vein. *Left ventricle* - The **left ventricle** receives blood that has already mixed in the atria and passed through the foramen ovale, then the left atrium. - While relatively oxygen-rich for systemic circulation, its oxygen concentration is lower than that in the umbilical vein due to **mixing with deoxygenated blood**. *Ascending aorta* - The **ascending aorta** receives blood from the left ventricle, which has a moderate oxygen content. - The blood in the ascending aorta feeds the upper body, but its oxygen saturation is lower than that in the umbilical vein due to the **physiological shunts** and mixing of blood.