NEET-PG 2020 Practice Questions

Q: What does the image of the Capnograph depict?

Capnograph indicating spontaneous respiration. ***Capnograph indicating spontaneous respiration*** - The characteristic dip in the **EtCO2 waveform** during the plateau phase (phaselll) is indicative of a breath taken by the individual which is a classic finding of **spontaneous respiration**. This dip is because when a patient takes a breath in, fresh gas with no CO2 is pulled into the sampling line momentarily decreasing the measured CO2. - This pattern is often referred to as a "**curare cleft**" or "**respiratory indentation**," and it signifies incomplete paralysis or return of spontaneous breathing. *Capnograph during inspiration* - During normal inspiration, there is no CO2 in the inhaled air, so the capnograph reading would theoretically drop to **zero** or near-zero, not exhibit a waveform with a plateau. - The baseline of the capnograph reflects inspiration, which should be flat (zero CO2). *Capnograph showing inspiration with cardiac oscillations* - Cardiac oscillations typically appear as **small rhythmic fluctuations** on the baseline or the expiratory plateau, synchronized with the heartbeat. - These oscillations are usually much smaller and do not present as distinct, sharp dips within the expiratory plateau as seen in the image. *Capnograph during expiration* - During a normal expiration, the capnograph waveform rises from a baseline of zero (phase I, **dead space ventilation**) to a plateau (phase III, **alveolar gas emptying**) with a peak value, before returning to baseline during inspiration. - While the image shows expiration with a plateau, the key feature of the dip during the plateau is more specific to spontaneous respiration than just general expiration.

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: Which antibody is not transmitted from mother to baby?

IgA antibodies. ***IgA antibodies*** - While IgA is found in breast milk and provides **passive immunity** to the infant's gastrointestinal tract, it is **not transferred across the placenta** to the fetus. - This antibody has a larger molecular structure and is primarily involved in **mucosal immunity**, making it unsuitable for transplacental transfer. *Diphtheria IgG antibodies* - **IgG antibodies**, including those for diphtheria, are actively transported across the **placenta** from mother to fetus during the third trimester. - This transfer provides the newborn with **passive immunity** against diphtheria during the first few months of life. *Tetanus IgG antibodies* - Similar to diphtheria IgG, **tetanus IgG antibodies** are efficiently transported across the **placenta** from mother to baby. - This offers crucial **passive protection** against tetanus, particularly important after birth. *Measles IgG antibodies* - **Measles IgG antibodies** from a vaccinated or previously infected mother cross the **placenta** to the fetus. - This maternal transfer provides temporary **passive immunity** to the newborn against measles.

Q: A sexually active female presenting with profuse frothy foul-smelling discharge with intense itching. Strawberry cervix revealed on examination. What will be the diagnosis?

Trichomonas vaginalis. **Trichomonas vaginalis** - The classic presentation of **profuse, frothy, foul-smelling vaginal discharge** with **intense itching** and the presence of a **strawberry cervix** are highly characteristic of a *Trichomonas vaginalis* infection. - *Trichomonas vaginalis* is a **motile protozoan** and a common sexually transmitted infection. *Bacterial vaginosis* - While bacterial vaginosis (BV) causes a **foul-smelling discharge** (often described as "fishy"), it is typically **thin and grayish-white**, not frothy, and does not cause a strawberry cervix. - BV is caused by an **overgrowth of anaerobic bacteria** and a decrease in lactobacilli, leading to an elevated vaginal pH. *Candidiasis* - Candidiasis (yeast infection) presents with a **thick, white, "cottage cheese-like" discharge** and intense itching, but the discharge is usually odorless and it does not cause a frothy discharge or strawberry cervix. - It is caused by an **overgrowth of *Candida* species**, primarily *Candida albicans*, and is not typically sexually transmitted. *None of the options* - Given the classic constellation of symptoms and definitive signs, a specific diagnosis can be made, making this option incorrect.

Q: 60-year-old female with a history of intermittent bleeding. What is the diagnosis based on the ultrasound image?

Endometrial polyp. ***Endometrial polyp*** - The ultrasound image shows a well-defined, **echogenic focal lesion within the endometrial cavity**, which is characteristic of an endometrial polyp. - In a 60-year-old female with intermittent bleeding, a polyp is a common cause of **postmenopausal bleeding** and is often identified as an intracavitary mass on ultrasound. - Endometrial polyps appear as **focal, hyperechoic or isoechoic masses** with a smooth contour projecting into the endometrial cavity. *Ca endometrium* - **Endometrial carcinoma** typically appears as diffuse endometrial thickening (>4-5 mm in postmenopausal women), irregular endometrial-myometrial interface, or heterogeneous endometrial echoes, often with evidence of myometrial invasion. - While bleeding is a cardinal symptom of endometrial carcinoma, the distinct **focal, well-circumscribed nature** of the lesion on ultrasound is less typical for carcinoma, which tends to be more diffuse and irregular. *Submucosal fibroid* - A **submucosal fibroid** (leiomyoma) is a benign smooth muscle tumor originating from the myometrium that protrudes into the endometrial cavity. - While it can appear as an intracavitary mass and cause abnormal bleeding, fibroids often have a more **heterogeneous or hypoechoic appearance** with posterior acoustic shadowing, compared to the isoechoic to hyperechoic appearance of a polyp. - The feeding vessel sign (blood flow at the base) is more characteristic of polyps than fibroids. *Endometrial hyperplasia* - **Endometrial hyperplasia** presents as **diffuse, uniform endometrial thickening** rather than a focal intracavitary mass. - It typically shows homogeneous increased echogenicity of the entire endometrium without a discrete, well-defined lesion as seen with a polyp. - While it can cause postmenopausal bleeding, the focal nature of the lesion in this case makes hyperplasia less likely.

Q: A patient diagnosed with Rheumatoid arthritis was on medications. After 2 years, he developed a blurring vision and was found to have corneal opacity. Which drug is most likely to cause this?

Chloroquine. ***Chloroquine*** - **Chloroquine (and hydroxychloroquine)** can accumulate in the **cornea**, leading to **corneal opacity** (vortex keratopathy or cornea verticillata) and **retinopathy**, manifesting as blurring vision. - While corneal changes are usually reversible upon discontinuation, the retinal toxicity, particularly **maculopathy** (bull's eye maculopathy), can be permanent and severe. *Sulfasalazine* - Common side effects include **gastrointestinal upset**, headache, skin rash, and **bone marrow suppression**. - It is not typically associated with **corneal opacity** or significant ocular toxicity. *Leflunomide* - Known for side effects such as **hepatotoxicity**, gastrointestinal issues (diarrhea), **alopecia**, and **hypertension**. - **Ocular side effects** like corneal opacity are not characteristic of leflunomide use. *Methotrexate* - Primary side effects include **bone marrow suppression**, **hepatotoxicity**, **mucositis**, and **pulmonary fibrosis**. - Although it can cause ocular side effects like **conjunctivitis**, it is not a common cause of **corneal opacity**.

Q: Which of the following is not considered a prokinetic agent?

Diphenylmethane. Diphenylmethane derivatives (e.g., bisacodyl, sodium picosulfate) are stimulant laxatives, not prokinetic agents. While they do increase colonic motility, they work by direct stimulation of the colonic mucosa and myenteric plexus, causing increased water secretion and peristalsis [3]. Prokinetic agents specifically enhance coordinated gastrointestinal motility through modulation of neurotransmitters (acetylcholine, dopamine, serotonin, motilin), whereas laxatives work through different mechanisms (osmotic effects, stimulation, bulk formation). Therefore, diphenylmethane derivatives are classified as laxatives, not prokinetics. Dopamine antagonist - Dopamine antagonists like metoclopramide and domperidone block D2 receptors in the chemoreceptor trigger zone and GI tract, enhancing acetylcholine release and promoting gastric emptying [2]. - They are commonly used as prokinetic agents and antiemetics [2]. 5HT4 agonist - 5HT4 agonists (e.g., cisapride, prucalopride) stimulate serotonin receptors in the enteric nervous system, increasing acetylcholine release and enhancing colonic motility [1]. - They are effective prokinetic agents for conditions like chronic constipation and gastroparesis [1]. Macrolides - Certain macrolide antibiotics, such as erythromycin, act as motilin receptor agonists at sub-antibiotic doses. - By mimicking motilin, they stimulate gastric and intestinal contractions (phase III of migrating motor complex), functioning as prokinetic agents.

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

What does the image of the Capnograph depict?

Accepted Answer

Capnograph indicating spontaneous respiration

Answer

Capnograph during inspiration

Answer

Capnograph showing inspiration with cardiac oscillations

Answer

Capnograph during expiration

Question 2

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 3

Which antibody is not transmitted from mother to baby?

Accepted Answer

IgA antibodies

Answer

Tetanus IgG antibodies

Answer

Diphtheria IgG antibodies

Answer

Measles IgG antibodies

Question 4

A lady on treatment for infertility developed ascites, abdominal pain, and dyspnea. The ultrasound image is shown below. What is the most likely diagnosis?

Accepted Answer

OHSS

Answer

PCOS

Answer

Theca lutein cyst

Answer

Mucinous cystadenomas

Question 5

A sexually active female presenting with profuse frothy foul-smelling discharge with intense itching. Strawberry cervix revealed on examination. What will be the diagnosis?

Accepted Answer

Trichomonas vaginalis

Answer

Bacterial vaginosis

Answer

Candidiasis

Answer

None of the options

Question 6

60-year-old female with a history of intermittent bleeding. What is the diagnosis based on the ultrasound image?

Accepted Answer

Endometrial polyp

Answer

Ca endometrium

Answer

Submucosal fibroid

Answer

Endometrial hyperplasia

Question 7

A patient diagnosed with Rheumatoid arthritis was on medications. After 2 years, he developed a blurring vision and was found to have corneal opacity. Which drug is most likely to cause this?

Accepted Answer

Chloroquine

Answer

Sulfasalazine

Answer

Leflunomide

Answer

Methotrexate

Question 8

Which of the following is not considered a prokinetic agent?

Accepted Answer

Diphenylmethane

Answer

Dopamine antagonist

Answer

5HT4 agonist

Answer

Macrolides

Question 9

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 10

Identify the condition in the X-ray given below:

Accepted Answer

TOF

Answer

TGA

Answer

TAPVC

Answer

Ebstein's anomaly

NEET-PG 2020

Anesthesiology

Dermatology

Microbiology

Obstetrics and Gynecology

Pharmacology

Physiology

Radiology