NEET-PG 2020 Practice Questions

Q: Which of the following is the etiology of Werner syndrome?

Short telomere with damaged DNA and loss of helicase. ***Short telomere with damaged DNA and loss of helicase*** - **Werner syndrome** is an **autosomal recessive disorder** characterized by **premature aging** due to mutations in the *WRN* gene, which codes for a **RecQ-type DNA helicase**. - The dysfunctional helicase leads to defects in **DNA replication, repair, and transcription**, resulting in **genomic instability**, **damaged DNA**, and **accelerated telomere attrition** (short telomeres). *Increased length of telomere* - **Increased telomere length** is generally associated with a **reduced rate of cellular aging** and is not characteristic of Werner syndrome or other premature aging disorders. - In most aging processes and syndromes like Werner, **telomeres tend to shorten** over time due to incomplete replication and oxidative stress. *Increased advanced glycation end products* - **Advanced glycation end products (AGEs)** accumulate in various tissues during normal aging and in conditions like diabetes, contributing to vascular and organ damage. - While AGEs play a role in the broader aging process, they are not the primary underlying genetic defect or direct etiology of Werner syndrome, which is a **DNA repair disorder**. *Decreased lipid peroxidation* - **Lipid peroxidation** is a process by which **free radicals** attack lipids, leading to cellular damage and is often associated with oxidative stress and aging. - A **decrease in lipid peroxidation** would generally be considered protective against aging-related damage, which is the opposite of what is seen in Werner syndrome, where there's an accelerated aging phenotype and increased cellular stress.

Q: Which of the following is classified as a Category A bioterrorism agent?

Bacillus anthracis. ***Bacillus anthracis*** - **Anthrax**, caused by *Bacillus anthracis*, is a prime example of a Category A bioterrorism agent due to its high mortality, ease of dissemination, and potential for major public health impact. - Category A agents pose the **greatest threat** to public health and national security. *Clostridium perfringens* - *Clostridium perfringens* is classified as a **Category B bioterrorism agent**. - While it causes **gas gangrene** and food poisoning with moderate severity, it lacks the **high transmissibility** and widespread impact characteristic of Category A agents. *NIPAH virus* - **Nipah virus** is classified as a Category C priority pathogen. - It has the potential for high morbidity and mortality, but its **epidemiological characteristics** (e.g., lower transmissibility than Category A agents) preclude its inclusion in Category A. *Coxiella burnetii* - *Coxiella burnetii*, the causative agent of **Q fever**, is classified as a Category B bioterrorism agent. - Category B agents are moderately easy to disseminate and can cause **moderate morbidity** and low mortality, which is less severe than Category A agents.

Q: Baby born with membrane around him at the time of birth. Which of the following conditions is depicted?

Lamellar ichthyosis (collodion membrane at birth). ***Lamellar ichthyosis (collodion membrane at birth)*** - This condition is characterized by a "collodion membrane" at birth, which is a **tight, shiny, parchment-like membrane** that covers the entire body. - The membrane typically **sheds within weeks**, revealing underlying scaling and erythema characteristic of lamellar ichthyosis. *X-linked ichthyosis (steroid sulfatase deficiency)* - Marked by **dark brown, adherent scales**, primarily affecting the neck, trunk, and extensor surfaces. - It usually becomes apparent **several weeks or months after birth** and is not typically associated with a collodion membrane. *Generalized hyperkeratosis (thickened skin)* - This is a general term for **thickening of the outermost layer of the epidermis** and is a feature of many ichthyoses, not a specific condition with a "membrane at birth." - It describes a **symptom** rather than a primary diagnosis presenting with a specific birth membrane. *Ichthyosis vulgaris (dry, scaly skin)* - Presents with **fine, white scaling**, most prominent on the extensor surfaces of the limbs, but it **rarely appears at birth**. - It is typically **mild** and often worsens in dry, cold weather, lacking the characteristic "membrane around him" at birth.

Q: Patient presented with diarrhoea, poor appetite and malabsorption. His duodenal biopsy was taken which showed crypt hyperplasia, villi atrophy and infiltration of CD8+ T cells in the epithelium. What is the likely diagnosis of the patient?

Celiac disease. ***Celiac disease*** - The combination of **diarrhoea**, **malabsorption**, **villi atrophy**, **crypt hyperplasia**, and **CD8+ T-cell infiltration** in the duodenal epithelium is pathognomonic for celiac disease [1]. - This condition is triggered by **gluten ingestion**, leading to an immune-mediated enteropathy [1], [3]. *Whipple disease* - Characterized by **malabsorption**, fever, arthralgia, and neurological symptoms [2]. - Histologically, it shows **foamy macrophages** containing PAS-positive material (Tropheryma whipplei) in the lamina propria, not primarily CD8+ T-cell infiltration [2]. *Environmental enteropathy* - Also known as tropical enteropathy, it causes **villi atrophy** and malabsorption, particularly in individuals living in areas with poor sanitation. - However, the prominent feature is often a diffuse inflammatory infiltrate, and specific **CD8+ T-cell infiltration** in the epithelium is not as specific as in celiac disease. *Pancreatitis* - Presents with **abdominal pain**, nausea, and vomiting, and can lead to malabsorption due to pancreatic enzyme insufficiency. - Histology of the duodenum would typically be normal, as the pathology primarily involves the **pancreas**, not the duodenal mucosa itself.

Q: A 7-week pregnant lady underwent a chest X-ray by mistake. What is to be done?

Reassure the patient and continue the pregnancy.. **Reassure the patient and continue the pregnancy.** - A single chest X-ray delivers a **negligible dose of radiation (around 0.01 mGy)** to the embryo/fetus, which is significantly below the threshold for causing congenital abnormalities or pregnancy loss. - The **teratogenic threshold** for radiation exposure is generally considered to be around **50-100 mGy**, making a single chest X-ray exposure well within safe limits. *Terminate the pregnancy immediately due to radiation exposure.* - There is **no clinical justification** for pregnancy termination based on a single chest X-ray, as the radiation dose is far too low to cause significant harm. - Such an intervention would be based on **misinformation** and could lead to unnecessary emotional distress and ethical concerns. *Perform chromosomal testing to assess fetal damage.* - Chromosomal testing is **not indicated** for low-dose radiation exposure from a single chest X-ray, as this type of exposure is unlikely to cause chromosomal abnormalities. - The radiation dose is simply too low to inflict the kind of damage that would necessitate such invasive and often risky procedures. *Conduct prenatal invasive diagnostic tests to evaluate fetal health.* - Invasive prenatal diagnostic tests, such as **amniocentesis or chorionic villus sampling**, carry their own risks and are not warranted for a benign exposure like a chest X-ray. - These tests are typically reserved for situations with a much higher established risk of fetal anomalies.

Q: What is the first-line drug for post-menopausal osteoporosis?

Bisphosphonates. **Bisphosphonates** - **Bisphosphonates** are the **first-line therapy** for postmenopausal osteoporosis due to their proven efficacy in reducing the risk of fragility fractures. - They work by **inhibiting osteoclast activity**, thereby reducing bone resorption and increasing bone mineral density. *Raloxifene* - **Raloxifene** is a **selective estrogen receptor modulator (SERM)** that can be used for osteoporosis prevention and treatment, but it is typically a second-line option, especially in women who cannot tolerate bisphosphonates or have an increased risk of breast cancer. - While it has a positive effect on bone density, its fracture-reduction efficacy is not as broad as bisphosphonates (e.g., it reduces vertebral fractures but has less consistent data on non-vertebral fractures). *Calcitonin* - **Calcitonin** is generally reserved for patients who cannot tolerate other therapies or for short-term use in acute vertebral fractures to help with pain relief. - Its efficacy in reducing fracture risk is **less robust** compared to bisphosphonates, and it is not considered a first-line agent. *Oestrogen* - **Estrogen (hormone replacement therapy)** was once a primary treatment but is now generally not recommended as first-line for osteoporosis due to concerns about increased risks of breast cancer, cardiovascular events, and stroke, particularly in older women. - It is typically reserved for women with significant menopausal symptoms for whom other therapies are contraindicated or ineffective, and for the shortest duration possible.

Q: The most widely used substance causing dependence worldwide is:

Alcohol. ***Alcohol*** - **Alcohol** is the most widely consumed psychoactive substance globally, leading to a significant burden of dependence and related health issues. - Its widespread availability, social acceptance, and addictive properties contribute to its high rates of dependence across diverse populations. *Cocaine* - While **cocaine** is a powerful and highly addictive stimulant, its use and dependence are not as prevalent globally as alcohol. - The geographical distribution and historical context of cocaine use are more concentrated compared to the ubiquitous nature of alcohol consumption. *Cannabis* - **Cannabis** is one of the most commonly used illicit drugs worldwide, and it can cause dependence, but its overall prevalence of dependence is lower than that of alcohol. - The perception of lower harm and increased legalization in some regions have led to higher rates of use, but alcohol still surpasses it in terms of global dependence rates. *Amphetamines* - **Amphetamines**, including methamphetamine, are potent stimulants known for their high potential for dependence. - However, their global usage and rates of dependence, while significant in certain regions, do not reach the broad societal impact and prevalence seen with alcohol.

Q: A middle-aged man presented with a swelling over the neck since childhood. The swelling is irregular and involves large nerves and their branches. Most probable diagnosis is:

Plexiform neurofibroma. ***Plexiform neurofibroma*** - This condition presents as an **irregular swelling** evident since childhood, which is characteristic of the slow growth associated with **plexiform neurofibromas**. - Its involvement of **large nerves and their branches** is a hallmark feature, distinguishing it from other neck masses. *Toxic nodular goitre* - This would present primarily as a **thyroid swelling** and is typically associated with symptoms of **hyperthyroidism**, which are not mentioned. - It does not involve **peripheral nerves** in the manner described. *Lymphangioma* - Lymphangiomas are **benign lymphatic malformations** that typically present as soft, compressible masses. - While they can occur in the neck and be present from childhood, they do not specifically involve or originate from **nerve branches**. *Vasculitis* - Vasculitis is an **inflammation of blood vessels**, which can cause a variety of symptoms including pain, skin lesions, and organ dysfunction. - It does not present as a localized, irregular neck swelling involving **nerve branches** with a history since childhood.

Question 1

Which of the following is the etiology of Werner syndrome?

Accepted Answer

Short telomere with damaged DNA and loss of helicase

Answer

Increased length of telomere

Answer

Increased advanced glycation end products

Answer

Decreased lipid peroxidation

Question 2

Which of the following is classified as a Category A bioterrorism agent?

Accepted Answer

Bacillus anthracis

Answer

Clostridium perfringens

Answer

NIPAH virus

Answer

Coxiella burnetii

Question 3

Baby born with membrane around him at the time of birth. Which of the following conditions is depicted?

Accepted Answer

Lamellar ichthyosis (collodion membrane at birth)

Answer

X-linked ichthyosis (steroid sulfatase deficiency)

Answer

Generalized hyperkeratosis (thickened skin)

Answer

Ichthyosis vulgaris (dry, scaly skin)

Question 4

Patient presented with diarrhoea, poor appetite and malabsorption. His duodenal biopsy was taken which showed crypt hyperplasia, villi atrophy and infiltration of CD8+ T cells in the epithelium. What is the likely diagnosis of the patient?

Accepted Answer

Celiac disease

Answer

Whipple disease

Answer

Environmental enteropathy

Answer

Pancreatitis

Question 5

Which of the following cannot be used as Post-coital contraceptive?

Accepted Answer

A drug primarily used for endometriosis and fibrocystic breast disease (e.g., Danazol)

Answer

A device that prevents fertilization and implantation (e.g., CuT 200)

Answer

A hormonal method that disrupts ovulation (e.g., high-dose estrogens)

Answer

A progesterone receptor blocker used within 72 hours (e.g., RU 486)

Question 6

A 7-week pregnant lady underwent a chest X-ray by mistake. What is to be done?

Accepted Answer

Reassure the patient and continue the pregnancy.

Answer

Terminate the pregnancy immediately due to radiation exposure.

Answer

Perform chromosomal testing to assess fetal damage.

Answer

Conduct prenatal invasive diagnostic tests to evaluate fetal health.

Question 7

What is the first-line drug for post-menopausal osteoporosis?

Accepted Answer

Bisphosphonates

Answer

Raloxifene

Answer

Calcitonin

Answer

Oestrogen

Question 8

The most widely used substance causing dependence worldwide is:

Accepted Answer

Alcohol

Answer

Cocaine

Answer

Cannabis

Answer

Amphetamines

Question 9

Which of the following statements is true regarding retrosternal goiters?

Accepted Answer

Most retrosternal goiters can be removed through a neck incision

Answer

Majority of the goiters derive their blood supply from mediastinal vessels

Answer

Sternal incision is required in all cases

Answer

Surgery is performed only if the patient is symptomatic

Question 10

A middle-aged man presented with a swelling over the neck since childhood. The swelling is irregular and involves large nerves and their branches. Most probable diagnosis is:

Accepted Answer

Plexiform neurofibroma

Answer

Toxic nodular goitre

Answer

Lymphangioma

Answer

Vasculitis

NEET-PG 2020

Biochemistry

Community Medicine

Dermatology

Internal Medicine

Obstetrics and Gynecology

Pharmacology

Psychiatry

Surgery