NEET-PG 2022 Practice Questions

Q: The given histology image is of which structure?

Glomerulus. ***Glomerulus*** - The glomerulus is characterized by a **tuft of capillaries** surrounded by Bowman's capsule, responsible for filtration in the kidney [1]. - Histological examination typically shows a **dense network of capillaries** and **mesangial cells**, which are distinct features of the glomeruli [1]. *Hassall's corpuscles* - Found in the **thymus**, they are round structures composed of epithelial cells, crucial in T-cell maturation. - Histologically, they present as concentric layers of **epithelial cells** and are not found in the kidney. *Leydig cells of testis* - Located in the **interstitial tissue** of the testes, these cells produce testosterone and are typically larger than glomerular cells. - They are characterized by their **eosinophilic cytoplasm** and round nuclei, differing markedly from the structures found in the glomerulus. *Pancreatic islet cells* - Islet cells are involved in **hormone production**, predominantly insulin and glucagon, and are located in the pancreas. - Histologically, they appear as small clusters dispersed among **exocrine pancreas**, which is different from the highly organized structure of the glomerulus. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 522-523.

Q: Cancer cells preferentially utilize glycolysis for energy production even in the presence of adequate oxygen. What is this phenomenon called?

Warburg effect. ***Warburg*** - The **Warburg effect** describes how cancer cells preferentially use glycolysis for energy production even in the presence of oxygen, allowing them to thrive in **hypoxic conditions** [1]. - This metabolic adaptation supports **cell proliferation** and survival in tumor microenvironments where oxygen is limited [1][3]. - Cancer cells upregulate glucose uptake and express specific metabolic enzymes like the M2 isoform of pyruvate kinase that facilitate this altered metabolism [2][4]. *Wanton* - This term typically refers to recklessness or extravagance and is not used in the context of cancer metabolism or hypoxia. - There are no associations with **cancer cell adaptation** under adverse environmental conditions. *Wormian* - **Wormian bones** are extra bone pieces within sutures of the skull, unrelated to cancer cell metabolism or survival mechanisms. - This term does not connect to **hypoxia** or metabolic adaptations in cancer biology. *Wolf* - "Wolf" has no recognized connection to cancer cell biology, particularly regarding metabolic adaptations under **hypoxic stress**. - It does not imply any concept associated with how cancer cells cope with adverse conditions. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 307-308. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 308-310. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 290-291. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. With Illustrations By, pp. 26-27.

Q: Which statement best describes the criteria for starting an urban community health center?

Caters to a population of 1-1.5 lakh. ***Caters to a population of 1-1.5 lakh*** - An **urban community health center (UCHC)** is designed to provide comprehensive primary healthcare services to an urban population of **1 to 1.5 lakh**. - This population criterion ensures effective service delivery and proper resource allocation for a designated urban area. *Referral center for 2-3 primary health centers* - This description typically applies to a **sub-district hospital** or a higher-level facility, which serve as referral centers for multiple primary health centers. - A UCHC primarily focuses on direct provision of primary care, not usually acting as a referral hub for other primary care units. *Should have a 100-bed facility in metro cities* - A **100-bed facility** is characteristic of a larger hospital, such as a district hospital, not an urban community health center. - UCHCs typically have minimal or no inpatient beds, focusing on outpatient services and emergency care rather than extensive hospitalization. *No sub-district and district hospitals present in the area* - This statement is not a criteria for a UCHC; in fact, UCHCs often function within a healthcare system that includes larger hospitals for referral of complex cases. - The presence or absence of higher-level facilities does not define the necessity or establishment of a UCHC.

Q: In triage, which category of patients is classified as green?

Minor injury patients. ***Minor injury patients*** - Patients classified as **green** in triage are those with **minor injuries** that are not immediately life-threatening. - They can often wait for treatment without significant risk of deterioration and may be able to **walk and self-care** to some extent. *Medium risk patients* - This category generally corresponds to **yellow** in triage, indicating patients with **significant injuries** who require care within a few hours. - While not immediately life-threatening, their condition could worsen if treatment is delayed. *High-risk patients* - This category typically corresponds to **red** in triage, signifying patients with **life-threatening injuries** or conditions. - These patients require immediate medical attention to survive. *Dead patients* - Patients who are deceased or have injuries incompatible with life are typically categorized as **black** in triage. - This classification indicates that no medical intervention can save them.

Q: Considering that dogs are the most common carriers of rabies and that the disease predominantly affects children in developing countries, what is the most effective and direct method to significantly reduce the incidence of rabies?

Control the stray dog population and vaccinate all dogs. ***Control the stray dog population and vaccinate all dogs*** - As dogs are the primary reservoirs of rabies, controlling their population, coupled with widespread **dog vaccination**, is the most direct and effective strategy to break the transmission cycle to humans. - This approach tackles the root cause of the disease in areas where dog-mediated transmission is endemic, leading to a significant reduction in human rabies cases. *Conduct rabies testing for all dogs* - While testing identifies infected animals, it is **resource-intensive** and impractical for large dog populations, especially in low-resource settings, and does not prevent future infections. - This strategy is reactive rather than **proactive** in preventing the spread of rabies. *Enhance laboratory testing capabilities* - Improving laboratory testing capabilities is crucial for **surveillance** and accurate diagnosis but does not directly prevent rabies transmission at the source. - It's a supportive measure that helps monitor disease burden but isn't the most effective **primary intervention** for incidence reduction. *Improve healthcare worker training for disease surveillance* - Training healthcare workers enhances case detection and reporting, which is vital for **epidemiological monitoring** and timely post-exposure prophylaxis (PEP). - However, it does not address the fundamental issue of rabies transmission from dogs to humans and is not a direct prevention method for reducing disease incidence.

Q: A male patient presented with a 0.3 cm nodule on the left nasolabial fold. A pathological examination revealed a basaloid appearance with peripheral palisading. What is the most likely diagnosis?

Basal cell carcinoma. ***Basal cell carcinoma*** - The description of a **basaloid appearance with peripheral palisading** on pathological examination is a classic histological feature of basal cell carcinoma (BCC). - BCC commonly presents as a nodule on sun-exposed areas like the **nasolabial fold** and is the most common skin cancer. *Melanoma* - Melanoma is characterized by the **malignant proliferation of melanocytes** and histologically shows atypical melanocytes with pagetoid spread or nest formation. - While it can appear as a nodule, the described **basaloid appearance with peripheral palisading** is not characteristic of melanoma. *Squamous cell carcinoma* - Squamous cell carcinoma typically shows **atypical keratinocytes** with keratinization, intercellular bridges, and sometimes desmoplasia. - It usually presents as an **erythematous, scaly patch** or nodule, often with ulceration, and the described histology does not match. *Nevus* - A nevus (mole) is a benign proliferation of melanocytes, showing **uniform nests of melanocytes** with maturation as they descend into the dermis. - The term **basaloid appearance** refers to cells resembling basal keratinocytes, which is not typical for a nevus.

Q: A male patient presents to the emergency department. The arterial blood gas report is as follows: pH, 7.2; pCO2, 81 mmHg; and HCO3, 40 meq/L. Which of the following is the most likely diagnosis?

Respiratory acidosis. ***Respiratory acidosis*** - The **pH of 7.2** indicates **acidemia**, while the **elevated pCO2 (81 mmHg)** points to a primary respiratory problem [2]. - The elevated **HCO3 (40 meq/L)** suggests **renal compensation** attempting to buffer the increased carbonic acid [1]. *Respiratory alkalosis* - This condition presents with an **elevated pH (alkalemia)** and a **decreased pCO2**, which is opposite to the given ABG values [2]. - While there might be metabolic compensation with a decreased HCO3, the primary disturbance is an increase in respiratory rate leading to excessive CO2 exhalation. *Metabolic acidosis* - Metabolic acidosis is characterized by a **low pH** and a **low HCO3**, with a compensatory decrease in pCO2 [1]. - The given ABG shows a high HCO3, which rules out primary metabolic acidosis. *Metabolic alkalosis* - This condition would typically show an **elevated pH** and an **elevated HCO3**, with a compensatory increase in pCO2. - While both HCO3 and pCO2 are high in the given ABG, the low pH points to a primary acidosis, not alkalosis.

Q: Multidrug-resistant (MDR) tuberculosis shows resistance to which of the following drugs?

Isoniazid and rifampicin only. ***Isoniazid and rifampicin only*** - **Multidrug-resistant (MDR) tuberculosis** is specifically defined by resistance to both **isoniazid** and **rifampicin**. - These two drugs are considered the most effective first-line anti-TB medications, making resistance to both a significant treatment challenge. *Isoniazid, rifampicin, and fluoroquinolone* - Resistance to **isoniazid**, **rifampicin**, and *any* fluoroquinolone defines **pre-extensively drug-resistant (pre-XDR) TB**, not MDR-TB. - Adding resistance to a fluoroquinolone indicates a more severe and harder-to-treat form of tuberculosis. *Fluoroquinolone* - Resistance to **fluoroquinolone** alone does not define MDR-TB; it is only one component of resistance that, when combined with resistance to isoniazid and rifampicin, signifies pre-XDR or XDR-TB. - While fluoroquinolones are important second-line drugs, their resistance in isolation does not meet the criteria for MDR-TB. *Isoniazid, rifampicin, and kanamycin* - Resistance to **isoniazid**, **rifampicin**, and *any* second-line injectable agent (like **kanamycin**, capreomycin, or amikacin) defines **extensively drug-resistant (XDR) TB**, not MDR-TB. - XDR-TB represents an even more complex and difficult form of the disease to treat, requiring highly specialized regimens.

Q: A female patient presents to you with six weeks of amenorrhea, associated with abdominal pain and vaginal bleeding with normal blood pressure. Investigations revealed beta-hCG to be 1400 mIU/mL. An ultrasound scan was done which showed a trilaminar endometrium with normal adnexa. What is the next best step in the management of this patient?

Repeat beta – hCG after 48 hours. ***Repeat beta – hCG after 48 hours*** - With a beta-hCG of 1400 mIU/mL and no intrauterine pregnancy visible on ultrasound, repeating **beta-hCG after 48 hours** is crucial to assess its doubling time, which helps differentiate between a normal intrauterine pregnancy, ectopic pregnancy, or miscarriage. - An hCG level of 1400 mIU/mL is below the discriminatory zone (typically 1500-2000 mIU/mL) where an intrauterine gestational sac should be visible, making serial measurements essential. *Repeat ultrasound after 5 days* - While a repeat ultrasound may eventually be necessary, waiting 5 days without an interim hCG measurement could delay diagnosis and management, especially if the hCG levels are rising rapidly or are in a concerning range. - The current beta-hCG level is below the **discriminatory zone**, meaning a gestational sac would likely still not be visible even after 5 days, making hCG follow-up a more immediate and informative step. *Measurement of serum progesterone* - **Serum progesterone** levels can indicate overall pregnancy viability, but they do not specifically localize the pregnancy or differentiate between an intrauterine pregnancy and an ectopic pregnancy as effectively as serial hCG levels. - A single low progesterone level could indicate a non-viable pregnancy (either intrauterine or ectopic), but it does not guide immediate management for distinguishing between locations. *Laparoscopy* - **Laparoscopy** is an invasive surgical procedure and is not the first diagnostic step unless there are signs of ruptured ectopic pregnancy or hemodynamic instability, which are not present in this patient (normal blood pressure, mild symptoms). - It would be premature to proceed with laparoscopy without further biochemical or sonographic evidence of an ectopic pregnancy or clear signs of clinical deterioration.

Q: A 6-year-old boy came with a history of recurrent urinary tract infections. Imaging was done and showed retrograde flow of urine from the bladder into the ureters. What is the most likely diagnosis based on the imaging findings?

Vesicoureteric reflux (VUR). ***Vesicoureteric reflux (VUR)*** - VUR is defined by the **retrograde flow of urine from the bladder into the ureters**, which directly matches the imaging finding described - This is the **most common cause of recurrent UTIs in children**, as reflux allows bacteria to ascend from the bladder to the kidneys - Diagnosed by **voiding cystourethrogram (VCUG)**, which shows contrast refluxing into ureters during micturition - Graded from I to V based on severity; can lead to **reflux nephropathy** and renal scarring if untreated *Urinary bladder diverticulum* - An **outpouching of the bladder wall** through weakened muscle layers - May predispose to UTIs due to urinary stasis within the diverticulum, but does **not cause retrograde flow into ureters** - Imaging would show a **saccular projection** from the bladder, not ureteral filling *Vesicocolic fistula* - An **abnormal communication between bladder and colon**, typically from inflammatory bowel disease, malignancy, or trauma in adults (rare in children) - Presents with **pneumaturia (air in urine)**, fecaluria, and recurrent UTIs - Would not demonstrate **retrograde ureteral flow** on imaging *Urinary bladder hernia* - Protrusion of bladder through a **hernial defect** (inguinal, femoral, or abdominal wall) - Presents as a **reducible mass** that may increase with Valsalva - Does not cause **ureteral reflux** and has a distinct clinical and radiological presentation

Question 1

The given histology image is of which structure?

Accepted Answer

Glomerulus

Answer

Pancreatic islet cells

Answer

Hassall's corpuscles

Answer

Leydig cells in the testis

Question 2

Cancer cells preferentially utilize glycolysis for energy production even in the presence of adequate oxygen. What is this phenomenon called?

Accepted Answer

Warburg effect

Answer

Hypoxic adaptation

Answer

Anoxic survival

Answer

Oxygen-independent metabolism

Question 3

Which statement best describes the criteria for starting an urban community health center?

Accepted Answer

Caters to a population of 1-1.5 lakh

Answer

Referral center for 2-3 primary health centers

Answer

Should have a 100-bed facility in metro cities

Answer

No sub-district and district hospitals present in the area

Question 4

In triage, which category of patients is classified as green?

Accepted Answer

Minor injury patients

Answer

Medium risk patients

Answer

High-risk patients

Answer

Dead patients

Question 5

Considering that dogs are the most common carriers of rabies and that the disease predominantly affects children in developing countries, what is the most effective and direct method to significantly reduce the incidence of rabies?

Accepted Answer

Control the stray dog population and vaccinate all dogs

Answer

Conduct rabies testing for all dogs

Answer

Enhance laboratory testing capabilities

Answer

Improve healthcare worker training for disease surveillance

Question 6

A male patient presented with a 0.3 cm nodule on the left nasolabial fold. A pathological examination revealed a basaloid appearance with peripheral palisading. What is the most likely diagnosis?

Accepted Answer

Basal cell carcinoma

Answer

Melanoma

Answer

Squamous cell carcinoma

Answer

Nevus

Question 7

A male patient presents to the emergency department. The arterial blood gas report is as follows: pH, 7.2; pCO2, 81 mmHg; and HCO3, 40 meq/L. Which of the following is the most likely diagnosis?

Accepted Answer

Respiratory acidosis

Answer

Respiratory alkalosis

Answer

Metabolic acidosis

Answer

Metabolic alkalosis

Question 8

Multidrug-resistant (MDR) tuberculosis shows resistance to which of the following drugs?

Accepted Answer

Isoniazid and rifampicin only

Answer

Isoniazid, rifampicin, and fluoroquinolone

Answer

Fluoroquinolone

Answer

Isoniazid, rifampicin, and kanamycin

Question 9

A female patient presents to you with six weeks of amenorrhea, associated with abdominal pain and vaginal bleeding with normal blood pressure. Investigations revealed beta-hCG to be 1400 mIU/mL. An ultrasound scan was done which showed a trilaminar endometrium with normal adnexa. What is the next best step in the management of this patient?

Accepted Answer

Repeat beta – hCG after 48 hours

Answer

Laparoscopy

Answer

Repeat ultrasound after 5 days

Answer

Measurement of serum progesterone

Question 10

A 6-year-old boy came with a history of recurrent urinary tract infections. Imaging was done and showed retrograde flow of urine from the bladder into the ureters. What is the most likely diagnosis based on the imaging findings?

Accepted Answer

Vesicoureteric reflux (VUR)

Answer

Urinary bladder diverticulum (UBD)

Answer

Vesicocolic fistula (VCF)

Answer

Urinary bladder hernia (UBH)

NEET-PG 2022

Anatomy

Biochemistry

Community Medicine

Dermatology

Internal Medicine

Microbiology

Obstetrics and Gynecology

Pediatrics