NEET-PG 2012 Practice Questions

Q: A person inhaled a peanut two days ago and is now unable to cough it out. Where is the possible location?

Right lower lobe. ***Right lower lobe*** - Due to the **angle** of the right main bronchus, which is less acute than the left, aspirated foreign bodies, like a peanut, tend to preferentially enter the **right bronchial tree**. - Within the right lung, foreign bodies are most commonly found in the **right lower lobe** because its **bronchus is the most direct continuation** of the right main bronchus, especially in an upright position. *Right superior lobe* - While material can go into the right lung, the **right upper lobe bronchus** branches off at a more acute angle, making aspiration into this lobe less common than into the lower lobes when a person is in an upright or semi-recumbent position. - Aspiration into the superior lobes is more common with specific body positions or in cases of massive aspiration. *Right middle lobe* - The **right middle lobe bronchus** is smaller and branches off at an angle that is less favorable for direct aspiration compared to the right lower lobe. - Aspiration to this lobe is less frequent than to the lower lobes. *Left lower lobe* - The **left main bronchus** is narrower and branches off at a much more acute angle from the trachea compared to the right main bronchus. - This anatomical difference makes aspiration into the left lung, including the **left lower lobe**, significantly less common than into the right lung.

Q: Which of the following cannot be given by epidural anaesthesia?

Remifentanil. ***Remifentanil*** - **Remifentanil** is specifically designed for **intravenous administration** and is rapidly metabolized by plasma esterases, making it unsuitable for epidural use. - Due to its short half-life and rapid metabolism, epidural administration would provide inconsistent and fleeting analgesia, and its breakdown products are not inert in the epidural space, potentially causing **neurotoxicity**. *Morphine* - **Morphine** is a commonly used opioid for **epidural analgesia** due to its hydrophilicity, allowing for prolonged action in the cerebrospinal fluid. - It provides effective **postoperative pain relief** and has a relatively slow onset but long duration of action when administered epidurally. *Alfentanil* - **Alfentanil** is a synthetic opioid that has been used for **epidural analgesia**, though less commonly than fentanyl or sufentanil, sometimes in conjunction with local anesthetics. - It has a faster onset and shorter duration of action compared to morphine, but still provides effective **analgesia** when administered epidurally. *Fentanyl* - **Fentanyl** is a widely used lipophilic opioid for **epidural analgesia**, often combined with local anesthetics, for both surgical and obstetric pain. - Its lipophilicity allows for rapid absorption and a relatively quick onset of action, providing effective **segmental analgesia**.

Q: Which organelle is primarily affected in Fabry's disease?

Lysosome. ***Lysosome*** - Fabry's disease is a **lysosomal storage disorder** caused by a deficiency of the enzyme **alpha-galactosidase A**. - This enzyme deficiency leads to the accumulation of **globotriaosylceramide (Gb3)** within lysosomes in various cells throughout the body. *Endoplasmic Reticulum* - The **endoplasmic reticulum** is involved in protein synthesis and folding, and lipid metabolism. - While cellular stress from Gb3 accumulation can indirectly affect the ER, it is not the primary organelle involved in the storage of the accumulated substrate in Fabry's disease. *Golgi apparatus* - The **Golgi apparatus** modifies, sorts, and packages proteins and lipids. - It is not the site of primary pathology or substrate accumulation in lysosomal storage diseases. *Cell membrane* - The **cell membrane** regulates passage of substances into and out of the cell. - While lysosomal dysfunction can ultimately impact overall cell function, the cell membrane itself is not the organelle where the undigested substrate accumulates in Fabry's disease.

Q: What is the most common presentation for IgA nephropathy?

Repeated gross hematuria. ***Repeated gross hematuria*** - The hallmark of **IgA nephropathy** is recurrent episodes of **gross hematuria**, particularly following **respiratory infections** [1]. - It is often associated with **renal impairment** but can present initially with **visible blood** in the urine [1]. *Nephritic syndrome* - While IgA nephropathy can lead to nephritic features, it does not commonly present primarily as **nephritic syndrome**, which includes hypertension and edema. - Nephritic syndrome is characterized by significant **proteinuria** and acute renal failure, rather than the classic presentation of hematuria [2]. *Microscopic hematuria* - Although **microscopic hematuria** can occur in IgA nephropathy, it is not the most common and noticeable presentation; **gross hematuria** is more characteristic [1]. - Microscopic hematuria lacks the acute visual symptoms seen in cases proving the diagnosis. *Nephritic syndrome* - This option is a repetition of and does not provide any additional unique characteristics specific to **IgA nephropathy**. - It shares the same clinical features discussed previously and is thus not representative of the most common presentation.

Q: Which of the following is NOT a common pathogen causing pneumonia in COPD patients?

Legionella spp. ***Legionella spp*** - While *Legionella* can cause pneumonia, it is **not a common pathogen** specifically in COPD exacerbations or community-acquired pneumonia in these patients [1]. - *Legionella* pneumonia often presents with **extrapulmonary symptoms** like diarrhea and hyponatremia and is typically associated with contaminated water sources [1]. *Haemophilus influenzae* - This is a very common pathogen causing both **acute exacerbations of COPD (AECOPD)** and pneumonia in patients with underlying COPD [1]. - COPD patients often have **impaired mucociliary clearance** and altered airway microbiology, making them susceptible to *H. influenzae* colonization and infection [1]. *Pseudomonas aeruginosa* - *Pseudomonas aeruginosa* is an important pathogen in **severe COPD exacerbations**, especially in patients with frequent exacerbations, bronchiectasis, or prior antibiotic use. - Its presence often indicates a **more severe disease course** and requires specific antibiotic coverage. *Klebsiella pneumoniae* - *Klebsiella pneumoniae* is a significant cause of **pneumonia in immunocompromised individuals**, including those with COPD, diabetes, or alcoholism. - It often leads to **severe, necrotizing pneumonia**, particularly in the upper lobes, and can cause abscess formation.

Q: Which of the following is a characteristic of Wilson's disease?

Increased copper in liver. ***Increased copper in liver*** - Wilson's disease is characterized by **accumulation of copper** in liver tissues due to defective copper transport [1]. - This excess leads to **hepatocellular damage**, resulting in liver dysfunction and potential cirrhosis [1]. *Decreased copper excretion in urine* - In Wilson's disease, there is actually **decreased excretion of copper**, which results in accumulation in the liver [1]. - **Urine copper levels** are typically low to normal in early stages because the liver fails to excrete excess copper effectively. *Autosomal dominant* - Wilson's disease is inherited in an **autosomal recessive** pattern, not dominant. - It is caused by mutations in the gene responsible for copper transport (ATP7B) [1]. *Increased serum ceruloplasmin* - Serum ceruloplasmin levels are often **decreased** in Wilson's disease due to impaired copper incorporation into this protein [1]. - Low ceruloplasmin is a key laboratory finding, contrasting the assertion of this option.

Q: Coloboma, most common site?

Inferonasal. ***Inferonasal*** - This is the **most common site** for coloboma because it corresponds to the location of the **fetal optic fissure** (choroidal fissure) during development. - Coloboma results from the **incomplete closure** of the fetal optic fissure, which normally occurs around the fifth to seventh week of gestation. *Superotemporal* - While coloboma can occur in various locations, the **superotemporal quadrant** is not the typical site. - Colobomas are usually found in areas consistent with the path of the optic fissure. *Inferotemporal* - This location is less common for colobomas compared to the inferonasal region. - The inferotemporal region does not align with the usual embryological fusion line of the optic fissure. *Superonasal* - Colobomas in the **superonasal quadrant** are rare. - This area is typically unaffected because it is not part of the fetal optic fissure's normal closure pathway.

Q: Investigation of choice for studying Renal Cortical mass

99mTc DMSA. ***99mTc DMSA*** - **99mTc DMSA** (Technetium-99m dimercaptosuccinic acid) is the radiopharmaceutical of choice for imaging the **renal cortex** and assessing **renal cortical mass** and scarring. - It binds preferentially to the cells of the **renal tubules**, allowing for excellent visualization of cortical tissue. *99mTc DTPA* - **99mTc DTPA** (Technetium-99m Diethylenetriaminepentaacetic acid) is primarily used to assess **glomerular filtration rate (GFR)** and renal blood flow. - It is filtered by the **glomeruli** but not reabsorbed or secreted by the tubules, making it suitable for functional studies rather than morphological assessment of cortical mass. *53Cr Study* - **53Cr** (Chromium-51) is used in studies to measure **red blood cell mass**, survival, or gastrointestinal protein loss. - It has no role in the direct assessment of **renal cortical mass** or function. *99mTc Pyrophosphate* - **99mTc Pyrophosphate** is primarily used to evaluate **myocardial infarction** (hot spots) or detect bone lesions. - It is not indicated for, nor does it provide useful information about, **renal cortical mass**.

Q: In the context of inflammatory breast cancer, what is the TNM stage associated with the peau d'orange appearance?

T4b. ***T4b*** * The **TNM staging system** classifies T4b specifically for inflammatory breast cancer, which is characterized by the presence of **peau d'orange** (edema) of the skin of the breast. * This T stage also encompasses **ulceration of the skin** of the breast or satellite nodules confined to the same breast. *T4a* * T4a describes an **extension to the chest wall**, which includes the ribs, intercostal muscles, and serratus anterior muscle, but **not** the pectoralis muscle, which is generally not considered part of the chest wall for this classification. * This stage does **not** include the characteristic skin changes associated with inflammatory breast cancer. *T3* * T3 describes a tumor with a **size greater than 5 cm** in its greatest dimension, without direct extension to the chest wall or skin involvement. * This stage is based solely on tumor size and **does not account for the skin changes** like peau d'orange. *T2* * T2 describes a tumor with a **size greater than 2 cm but not more than 5 cm** in its greatest dimension. * Similar to T3, this stage is also based on tumor size and **does not include any skin involvement** or inflammatory features.

Q: What is the primary condition treated by the Kasai operation?

Biliary atresia. ***Biliary atresia*** - The **Kasai operation**, or **hepatoportoenterostomy**, is the primary surgical treatment for **biliary atresia**, a condition where the bile ducts are blocked or absent. - The procedure aims to establish bile flow from the liver to the small intestine to prevent liver damage. *Choledochal cyst* - A **choledochal cyst** is a congenital dilation of the bile ducts and is typically treated by surgical excision of the cyst and a **Roux-en-Y hepaticojejunostomy**. - While it involves the biliary system, it is a distinct condition from biliary atresia and requires a different surgical approach. *Hepatocellular carcinoma* - **Hepatocellular carcinoma** is a primary liver cancer, and its treatment options range from **surgical resection** and **transplantation** to **chemotherapy** and **radiation**, which are distinctly different from the Kasai operation. - The Kasai operation is not used for malignant conditions of the liver or bile ducts. *Primary biliary cirrhosis* - **Primary biliary cirrhosis** is a chronic autoimmune disease affecting the small bile ducts within the liver, causing progressive cholestasis. - Its management is primarily medical, focusing on symptom control and preventing disease progression with drugs like **ursodeoxycholic acid**, and surgery is not a primary treatment.

Question 1

A person inhaled a peanut two days ago and is now unable to cough it out. Where is the possible location?

Accepted Answer

Right lower lobe

Answer

Right superior lobe

Answer

Left lower lobe

Answer

Right middle lobe

Question 2

Which of the following cannot be given by epidural anaesthesia?

Accepted Answer

Remifentanil

Answer

Morphine

Answer

Alfentanil

Answer

Fentanyl

Question 3

Which organelle is primarily affected in Fabry's disease?

Accepted Answer

Lysosome

Answer

Endoplasmic Reticulum

Answer

Golgi apparatus

Answer

Cell membrane

Question 4

What is the most common presentation for IgA nephropathy?

Accepted Answer

Repeated gross hematuria

Answer

Nephritic syndrome

Answer

Nephrotic syndrome

Answer

Microscopic hematuria

Question 5

Which of the following is NOT a common pathogen causing pneumonia in COPD patients?

Accepted Answer

Legionella spp

Answer

Klebsiella pneumoniae

Answer

Pseudomonas aeruginosa

Answer

Haemophilus influenzae

Question 6

Which of the following is a characteristic of Wilson's disease?

Accepted Answer

Increased copper in liver

Answer

Autosomal dominant

Answer

Increased serum ceruloplasmin

Answer

Decreased copper excretion in urine

Question 7

Coloboma, most common site?

Accepted Answer

Inferonasal

Answer

Superotemporal

Answer

Inferotemporal

Answer

Superonasal

Question 8

Investigation of choice for studying Renal Cortical mass

Accepted Answer

99mTc DMSA

Answer

99mTc DTPA

Answer

53Cr Study

Answer

99mTc Pyrophosphate

Question 9

In the context of inflammatory breast cancer, what is the TNM stage associated with the peau d'orange appearance?

Accepted Answer

T4b

Answer

T4a

Answer

T3

Answer

T2

Question 10

What is the primary condition treated by the Kasai operation?

Accepted Answer

Biliary atresia

Answer

Choledochal cyst

Answer

Hepatocellular carcinoma

Answer

Primary biliary cirrhosis

NEET-PG 2012

Anatomy

Anesthesiology

Biochemistry

Internal Medicine

Ophthalmology

Radiology

Surgery