NEET-PG 2022 Practice Questions

Q: Which of the following is NOT typically seen in cerebrospinal fluid (CSF) in tubercular meningitis?

Low opening pressure. ***Low opening pressure*** - While **elevated opening pressure** is common in tubercular meningitis due to inflammation and impaired CSF absorption, **low opening pressure** is not a typical finding. - Low opening pressure can occur with conditions like **CSF leak** or **spinal tap headache**, which are not directly characteristic of tubercular meningitis. *Low sugar* - **Low CSF glucose** (hypoglycorrhachia) is highly characteristic of bacterial and tubercular meningitis, as the bacteria or mycobacteria consume glucose. - The **CSF-to-blood glucose ratio** is typically less than 0.4 in tubercular meningitis. *High protein* - **Elevated CSF protein** is a consistent finding in tubercular meningitis, resulting from inflammation, increased vascular permeability, and breakdown of the blood-brain barrier. - Protein levels often range from **100-500 mg/dL** or even higher. *Lymphocytic Pleocytosis* - **Lymphocytic pleocytosis** (increased lymphocytes in CSF) is a hallmark of tubercular meningitis, although early stages might show a mixed cellular response. - The cell count typically ranges from **100-500 cells/µL**, predominantly lymphocytes.

Q: When in labor, a diagnosis of occipito-posterior presentation is made. The most appropriate management would be:

Wait and watch for progress of labor. ***Wait and watch for progress of labor*** - Many **occipito-posterior (OP) presentations** will spontaneously rotate to an occipito-anterior (OA) position with ongoing contractions, especially in multiparous women. - Close monitoring of fetal well-being and labor progress is essential, but immediate intervention is not always required. *Emergency CS* - An emergency cesarean section is typically reserved for cases where there is **fetal distress**, **failure to progress** after a reasonable period of observation, or other clear obstetric indications. - An OP presentation alone, without complications, does not warrant an immediate CS. *Early rupture of membranes* - While sometimes used to evaluate cervical dilation or apply a fetal scalp electrode, **early artificial rupture of membranes (AROM)** in OP presentation is not a definitive management strategy. - It may even increase the risk of cord prolapse or ascending infection without necessarily expediting rotation. *Start oxytocin drip* - **Oxytocin augmentation** may be considered if contractions are inadequate and labor is prolonged, but it's not the first-line management for OP presentation itself. - It should only be initiated after assessing the power, passage, and passenger, and ensuring there are no contraindications to augmentation.

Q: After 3rd stage of labour and expulsion of placenta, the patient is bleeding heavily. Ideal management would include all except:

APGAR scoring. ***APGAR scoring*** - **APGAR scoring** assesses the newborn's health immediately after birth and is not a management step for **postpartum hemorrhage**. - This intervention would divert critical attention from the mother's life-threatening bleeding. *Check for placenta in uterus* - **Retained placental fragments** are a common cause of **postpartum hemorrhage**, obstructing uterine contraction. - Checking for and removing any retained placenta is a crucial and immediate management step to control bleeding. *Check for laceration of labia* - **Lacerations of the birth canal**, including the labia, vagina, or cervix, can cause significant bleeding after delivery, even with a well-contracted uterus. - Identifying and repairing these lacerations is an essential part of managing **postpartum hemorrhage not due to atony**. *Uterine massage and I/V oxytocin* - **Uterine atony** (failure of the uterus to contract) is the most common cause of **postpartum hemorrhage**. - **Uterine massage** helps stimulate contraction, and **intravenous oxytocin** is a uterotonic agent used to promote uterine contraction and reduce bleeding.

Q: Which type of supracondylar fracture of the femur is classified as extra-articular?

Type A. ***Type A*** - **Type A supracondylar fractures** are defined as those that do not involve the joint surface, making them **extra-articular**. - These fractures typically occur proximal to the condyles without extending into the knee articulation. *Type B* - **Type B supracondylar fractures** are considered **partial articular**, meaning they involve only a portion of the articular surface. - While they affect the joint, they are not completely intra-articular in nature. *Type C* - **Type C supracondylar fractures** are classified as **complete articular** fractures. - This type implies that the fracture line extends through the entire joint surface and separates the articular segment from the metaphysis. *Type D* - The classification of supracondylar femoral fractures generally uses A, B, and C types to denote extra-articular, partial articular, and complete articular involvement, respectively. - **Type D** is not a standard classification used to define an extra-articular supracondylar femoral fracture in common orthopedic systems like the Orthopaedic Trauma Association (OTA) classification.

Q: What is the cell of origin of B-cell Acute Lymphoblastic Leukemia (B-ALL)?

Immature B cells. ***Immature B cells*** - B acute lymphoblastic leukemia (B ALL) is primarily derived from the **malignant transformation of precursor B lymphocytes** [1]. - The disease is characterized by the presence of **immature B cell blasts** in the bone marrow and peripheral blood [1]. *T cells* - T cells are involved in a different lineage of leukemia known as T-ALL, not B ALL [1]. - The pathophysiology of B ALL specifically relates to **B cell precursors**, not T cell involvement. *Both T & B cells* - This option is incorrect as B ALL specifically originates from **B cell lineage**, and T cells are unrelated to its pathogenesis [1]. - The presence of both T and B cells together characterizes mixed lineage leukemias, which is not the case here. *Immature T cells* - Immature T cells are precursors for **T acute lymphoblastic leukemia (T-ALL)**, not for B ALL [1]. - B ALL does not involve T cell precursors; the focus is solely on **immature B cells** [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 596-600.

Q: Which of the following is NOT a mechanism of action of theophylline in bronchial asthma?

Beta-2 receptor stimulation. ***Beta-2 receptor stimulation*** - Theophylline is a **non-selective phosphodiesterase inhibitor** and an **adenosine receptor antagonist**, but it does not directly stimulate beta-2 receptors. - **Beta-2 receptor agonists** like salbutamol or formoterol are the medications that work by stimulating these receptors to cause bronchodilation. *Phosphodiesterase inhibition* - Theophylline inhibits **phosphodiesterase enzymes**, leading to an increase in intracellular **cAMP** levels. - This increase in **cAMP** promotes bronchodilation by relaxing airway smooth muscle. *Adenosine receptor antagonism* - Theophylline acts as an antagonist at **adenosine receptors**, particularly A1 and A2B. - Antagonism of adenosine receptors can reduce bronchoconstriction and inflammatory mediator release, contributing to its anti-asthmatic effects. *Increased histone deacetylation* - Theophylline, particularly at lower concentrations, increases the activity of **histone deacetylase (HDAC)**. - This action helps to **repress inflammatory gene expression**, which is a unique anti-inflammatory mechanism separate from its bronchodilatory effects.

Q: Some cells secrete chemicals into the extracellular fluid that act on cells in the same tissue. Which of the following refers to this type of regulation?

Paracrine. ***Paracrine*** - **Paracrine signaling** involves chemical messengers, or **paracrine factors**, that act on **neighboring cells** within the **same tissue** without entering the bloodstream. - This type of regulation is crucial for local communication and coordination, such as in wound healing or immune responses. *Neural* - **Neural regulation** involves communication via **neurons** that transmit **electrical signals** (action potentials) and release **neurotransmitters** at synapses. - Neurotransmitters act on target cells, which can be distant from the neuron, for rapid and precise responses throughout the body. *Endocrine* - **Endocrine regulation** involves glands that secrete **hormones** directly into the **bloodstream**, which then travel to distant target cells in other tissues or organs. - This form of signaling leads to widespread and long-lasting effects, such as growth regulation or metabolic control. *Neuroendocrine* - **Neuroendocrine regulation** is a hybrid system where specialized **neurons** (neurosecretory cells) release **hormones** into the **bloodstream**, rather than releasing neurotransmitters into a synapse. - An example is the hypothalamus secreting ADH and oxytocin, which act on distant target organs.

Q: Which of the following is a primary aim of damage control laparotomy?

Arrest hemorrhage and control contamination.. ***Arrest hemorrhage and control contamination.*** * The overarching goal of a **damage control laparotomy** is to rapidly address immediate life threats, primarily **hemorrhage** and **bowel contamination**, in severely injured, unstable patients. * This approach prioritizes patient survival by performing essential steps quickly, deferring definitive repairs until the patient is physiologically stable. *Control contamination* * While **controlling contamination** is a critical component of damage control laparotomy, it is not the sole primary aim. * Uncontrolled bleeding, even without contamination, can rapidly lead to death in a trauma patient. *Prevent coagulopathy* * Preventing **coagulopathy** is an important consideration during damage control, but it is a consequence of uncontrolled hemorrhage and hypothermia, rather than a primary surgical aim in the initial damage control phase. * The surgical steps in damage control directly address the sources of bleeding and contamination. *Arrest hemorrhage* * **Arresting hemorrhage** is indeed a primary aim, but it is often accompanied by the need to control contamination from injured hollow organs. * Many abdominal trauma cases involve both significant bleeding and potential contamination.

Q: What type of wound is characterized by the scraping away of the skin?

Abrasion. ***Abrasion*** - An **abrasion** is a wound caused by the **scraping or rubbing away of the superficial layers of the skin** (epidermis and sometimes superficial dermis). - It typically results from a fall or friction against a rough surface, common in children's scraped knees or elbows. *Superficial wound* - This is a **general term** and does not specifically describe the mechanism of injury as scraping. - A superficial wound could be a **minor cut or scratch** that doesn't involve scraping. *Tear in the skin* - A **tear in the skin** refers to a **laceration**, which is a wound caused by tearing of soft body tissue, often resulting in irregular edges. - This is distinct from the scraping action characteristic of an abrasion, where tissue is rubbed away rather than torn. *Deep tissue injury* - A **deep tissue injury (DTI)** is a **pressure-related injury** characterized by intact skin with **discoloration** (e.g., maroon or purple) or a blood-filled blister due to damage of underlying soft tissue. - It is not caused by external scraping and involves deeper tissue layers affected by prolonged pressure.

Q: What is the preferred method for removing a foreign body from the lung in children?

Rigid bronchoscopy. ***Rigid bronchoscopy*** - **Rigid bronchoscopy** is the preferred method for removing foreign bodies from the lung in children due to its ability to provide better air control, magnified viewing, and larger working channels for robust grasping tools. - It allows for complete ventilation control and isolation of the airway, which is crucial in children where airway obstruction can rapidly lead to respiratory compromise. *Chest x-ray* - A **chest x-ray** is a diagnostic tool used to identify the presence and location of a foreign body, but it is not a method for removal. - Many foreign bodies, especially non-radiopaque ones like food, may not be visible on an x-ray, making it unreliable for definitive diagnosis of presence or absence. *Flexible endoscopy* - While **flexible bronchoscopy** can be used for foreign body removal in some adults or specific situations, it is generally less effective and carries higher risks in children, especially for larger or lodged objects. - Its smaller working channels and less stable airway control make it less suitable for urgent and complete removal in the pediatric population. *Direct laryngoscopy* - **Direct laryngoscopy** is used to visualize the larynx and vocal cords, primarily to remove foreign bodies from the upper airway or intubate, but not typically for removal of foreign bodies lodged deep within the main bronchi or lungs. - It does not offer direct access or visualization of the lower bronchial tree where most aspirated foreign bodies in children tend to lodge.

Question 1

Which of the following is NOT typically seen in cerebrospinal fluid (CSF) in tubercular meningitis?

Accepted Answer

Low opening pressure

Answer

Low sugar

Answer

High protein

Answer

Lymphocytic Pleocytosis

Question 2

When in labor, a diagnosis of occipito-posterior presentation is made. The most appropriate management would be:

Accepted Answer

Wait and watch for progress of labor

Answer

Emergency CS

Answer

Early rupture of membranes

Answer

Start oxytocin drip

Question 3

After 3rd stage of labour and expulsion of placenta, the patient is bleeding heavily. Ideal management would include all except:

Accepted Answer

APGAR scoring

Answer

Check for laceration of labia

Answer

Uterine massage and I/V oxytocin

Answer

Check for placenta in uterus

Question 4

Which type of supracondylar fracture of the femur is classified as extra-articular?

Accepted Answer

Type A

Answer

Type B

Answer

Type C

Answer

Type D

Question 5

What is the cell of origin of B-cell Acute Lymphoblastic Leukemia (B-ALL)?

Accepted Answer

Immature B cells

Answer

T cells

Answer

Immature T cells

Answer

Both T & B cells

Question 6

Which of the following is NOT a mechanism of action of theophylline in bronchial asthma?

Accepted Answer

Beta-2 receptor stimulation

Answer

Adenosine receptor antagonism

Answer

Increased histone deacetylation

Answer

Phosphodiesterase inhibition

Question 7

Some cells secrete chemicals into the extracellular fluid that act on cells in the same tissue. Which of the following refers to this type of regulation?

Accepted Answer

Paracrine

Answer

Neural

Answer

Endocrine

Answer

Neuroendocrine

Question 8

Which of the following is a primary aim of damage control laparotomy?

Accepted Answer

Arrest hemorrhage and control contamination.

Answer

Control contamination

Answer

Prevent coagulopathy

Answer

Arrest hemorrhage

Question 9

What type of wound is characterized by the scraping away of the skin?

Accepted Answer

Abrasion

Answer

Superficial wound

Answer

Tear in the skin

Answer

Deep tissue injury

Question 10

What is the preferred method for removing a foreign body from the lung in children?

Accepted Answer

Rigid bronchoscopy

Answer

Chest x-ray

Answer

Flexible endoscopy

Answer

Direct laryngoscopy

NEET-PG 2022

Internal Medicine

Obstetrics and Gynecology

Orthopaedics

Pathology

Pharmacology

Physiology

Surgery