NEET-PG 2012 Practice Questions

Q: Which of the following statements about the popliteus muscle is false?

Causes locking of knee. ***Causes locking of knee*** - The popliteus muscle acts as the key to **unlocking the knee** from its fully extended, locked position, not causing it to lock. [1] - It achieves this by producing **internal rotation of the tibia** on the femur (or external rotation of the femur on the tibia) at the beginning of knee flexion. *Flexor of knee* - The popliteus muscle contributes to **flexion of the knee joint**, working in conjunction with the hamstrings. - This action is particularly important during the initial phases of knee flexion. *Intracapsular origin* - The popliteus muscle originates from the **lateral condyle of the femur**, specifically from an impression just anterior and inferior to the groove for the popliteal tendon. - This origin point is indeed **intracapsular**, lying within the fibrous capsule of the knee joint. *Supplied by tibial nerve* - The popliteus muscle receives its innervation from the **tibial nerve**, a branch of the sciatic nerve. - The nerve typically arises from the posterior aspect of the tibial nerve trunk as it passes through the popliteal fossa.

Q: What is the most reliable indicator to prevent esophageal intubation?

Measurement of CO2 in exhaled air (EtCO2).. ***Measurement of CO2 in exhaled air (EtCO2)*** - The presence of **carbon dioxide** in exhaled air confirms tracheal intubation as the esophagus does not contain CO2. - This method provides a **real-time**, objective assessment of tube placement that is highly reliable because even small amounts of CO2 are detected. *Oxygen saturation on pulse oximeter* - This indicator measures **oxygenation**, which can remain adequate for several minutes after esophageal intubation due to pre-oxygenation. - A **delayed drop in saturation** might indicate esophageal intubation, but it's not immediate and therefore not the most reliable early indicator. *Direct visualization of passing tube beneath vocal cords* - While helpful, **direct visualization** can sometimes be misleading due to difficult airways or poor visibility, where the tube might appear to pass correctly but enter the esophagus. - This method is **operator-dependent** and its reliability can vary based on the intubator's experience and the patient's anatomy. *Auscultation over chest* - **Auscultation** can detect breath sounds; however, sounds can be transmitted from the stomach or surrounding tissues, leading to false positives. - It is also very difficult to reliably distinguish between **esophageal and tracheal sounds**, especially in noisy environments or with inexperienced personnel, making it less reliable than EtCO2.

Q: What is a significant disadvantage of ketamine?

Delirium. ***Delirium*** - Ketamine is known to cause **emergence phenomena**, which include **vivid dreams, hallucinations**, and **delirium**, particularly during recovery from anesthesia. - This psychotomimetic effect can be distressing for patients and may necessitate the co-administration of a **benzodiazepine** to mitigate these symptoms. *Increased heart rate* - While ketamine does cause an **increase in heart rate** and **blood pressure** due to sympathetic stimulation, this is often considered a disadvantage but not the *most significant* when compared to the unique cognitive side effects. - This effect can be beneficial in patients with **hemodynamic instability**, but can be problematic in those with **cardiovascular disease**. *Increased ICT* - It is often considered a contraindication in patients with **elevated intracranial pressure (ICP)** as it can potentially increase **cerebral blood flow** and thus ICP. - However, recent studies suggest that in adequately ventilated patients, the effect on ICP may be less pronounced than previously thought, making delirium a more consistent and prominent disadvantage for many patients. *All of the options* - While ketamine can cause an **increased heart rate** and potentially affect **intracranial pressure**, **delirium** and other emergence phenomena are often highlighted as a unique and significant disadvantage because they are highly distressing and difficult to manage. - The psychotomimetic effects are a hallmark side effect that often governs its cautious use without concurrent medication.

Q: India started 2-dose vaccination strategy for measles, in -

2010. ***2010*** - India implemented the **two-dose measles vaccination strategy** as part of its Universal Immunization Program starting in **2010**. - This decision was based on recommendations to improve immunity and reduce measles incidence, moving from a single-dose to a more effective **two-dose schedule**. *2008* - While important immunization initiatives were ongoing, the specific policy of a **two-dose measles vaccination strategy** had not yet been introduced in India during 2008. - At this time, the focus was primarily on ensuring high coverage of the **first dose** of measles vaccine. *2009* - The year 2009 saw continued efforts to strengthen the Universal Immunization Program, but the official launch of the **two-dose measles vaccination strategy** in India occurred later. - Discussions and planning for the transition were likely underway, but implementation began in the subsequent year. *2011* - By 2011, the **two-dose measles vaccination strategy** was already being implemented across India, having been introduced in 2010. - This year marked a period of expanding coverage and consolidation of the new 2-dose schedule rather than its initial introduction.

Q: Distal renal tubular acidosis is associated with:

Calcium stones. ***Calcium stones*** - Distal renal tubular acidosis (Type 1 RTA) causes metabolic acidosis due to impaired distal tubular **hydrogen ion secretion**. - This leads to **increased urinary calcium excretion** (hypercalciuria) and decreased urinary citrate, creating an environment favorable for the formation of **calcium phosphate renal stones**. *Oxalate stones* - While oxalate is a component of some calcium stones (calcium oxalate), **primary hyperoxaluria** or dietary excess of oxalate are the main causes, not directly distal RTA. - Distal RTA specifically promotes **calcium phosphate stone formation** due to pH changes and hypercalciuria. *Hypocitraturia* - **Hypocitraturia** is indeed a feature of distal RTA as the kidney attempts to excrete acid by reabsorbing citrate, making the urine less inhibitory to stone formation. - However, the most direct and common clinically observed consequence in stone formation is the development of **calcium stones**, as hypocitraturia combined with hypercalciuria facilitates their formation. *Uric acid stones* - **Uric acid stones** typically form in persistently **acidic urine** and are associated with conditions like gout or myeloproliferative disorders. - While distal RTA results in systemic acidosis, the urine pH in distal RTA is typically **alkaline or inappropriately neutral**, which does not favor uric acid stone formation.

Q: A person experiences asthma attacks more than twice during the day and at least once during the night. What is the most likely classification of their asthma?

Severe persistent asthma. ***Severe persistent asthma*** - This classification is characterized by **frequent symptoms**, specifically asthma attacks occurring more than twice daily and at least once nightly. - Individuals with severe persistent asthma often experience significant limitations in their daily activities and may have a **FEV1 (forced expiratory volume in 1 second)** less than 60% of predicted. *Intermittent asthma* - This classification is characterized by symptoms occurring less than two days per week and **nighttime awakenings less than two times per month**. - Symptoms are generally well-controlled with a short-acting beta-agonist (SABA) as needed. *Mild persistent asthma* - Patients with mild persistent asthma typically experience symptoms more than twice a week but **less than once a day**, and **nighttime awakenings 3-4 times per month**. - Their lung function (FEV1) is usually 80% or more of predicted. *Moderate persistent asthma* - This category involves daily symptoms and **nighttime awakenings more than once per week but not nightly**. - Lung function (FEV1) in moderate persistent asthma typically falls between 60% and 80% of predicted.

Q: The immunoglobulin most commonly involved in Multiple Myeloma is:

IgG. ***IgG*** - In Multiple Myeloma, the most commonly involved immunoglobulin is **IgG**, which is often produced in excess by malignant plasma cells [1][2]. - The presence of **monoclonal IgG** in serum is a key indicator of this malignancy, evident in diagnostic tests like serum protein electrophoresis. *IgM* - While **elevated IgM** levels can occur in other conditions like Waldenström's macroglobulinemia, it is not typically associated with Multiple Myeloma [2]. - IgM is produced by a different type of plasma cell and does not reflect the classic presentation of Multiple Myeloma. *IgA* - Although **IgA** can be involved in some cases of Multiple Myeloma, it is much less common than IgG [1][2]. - Patients with predominately **IgA Multiple Myeloma** are relatively rare compared to those with IgG. *IgD* - **IgD** myeloma is a very rare type of Multiple Myeloma, accounting for less than 2% of cases [1][2]. - It is not typically associated with the classic symptoms and conditions that characterize the more common IgG or IgA forms. **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. 608-609. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 616-617.

Q: The recommended ambient temperature for NICU is

22-26° C. ***22-26° C*** - Maintaining an ambient temperature of **22-26°C** in the NICU is crucial for preventing **cold stress** in neonates. - This temperature range helps to maintain the baby's **core body temperature**, reducing metabolic demands and ensuring optimal thermal regulation. *20-22° C* - While this might be a comfortable room temperature for adults, it is generally **too cold** for newborns in the NICU. - Temperatures below the recommended range can lead to significant **cold stress**, increasing oxygen consumption and metabolic rate in vulnerable infants. *26-30° C* - This temperature range is generally **too warm** for a NICU environment. - Excessive warmth can lead to **hyperthermia** and sweating, which increases fluid loss and can be detrimental to a neonate's health. *30-35°C* - This temperature is **dangerously high** for neonates in the NICU. - Such high temperatures would significantly increase the risk of **hyperthermia, dehydration**, and other severe complications, compromising the infant's well-being.

Q: What is the recommended CPR ratio for infants when performed by 2 rescuers?

15 : 2. ***15 : 2*** - For **infants and children**, when there are **two or more rescuers**, the recommended compression-to-ventilation ratio is **15 compressions to 2 breaths**. - This ratio provides a better balance between compressions and ventilations to optimize outcomes in pediatric cardiac arrest. *30 : 2* - The **30:2 ratio** is primarily recommended for **adult CPR**, or for **single rescuers** performing CPR on infants and children. - Using this ratio for two-rescuer infant CPR would likely lead to inadequate ventilation and potentially worse outcomes. *1 : 3* - A 1:3 ratio (1 compression to 3 breaths) is not a standard recommended ratio for CPR in any age group based on current guidelines. - This ratio would significantly prioritize ventilations over chest compressions, which is not ideal for maintaining circulation. *1 : 5* - A 1:5 ratio (1 compression to 5 breaths) is not a standard recommended ratio for CPR in any age group. - This ratio heavily emphasizes ventilations and would result in insufficient chest compressions, which are crucial for blood flow.

Question 1

Which of the following statements about the popliteus muscle is false?

Accepted Answer

Causes locking of knee

Answer

Intracapsular origin

Answer

Supplied by tibial nerve

Answer

Flexor of knee

Question 2

What is the most reliable indicator to prevent esophageal intubation?

Accepted Answer

Measurement of CO2 in exhaled air (EtCO2).

Answer

Oxygen saturation on pulse oximeter

Answer

Direct visualization of passing tube beneath vocal cords

Answer

Auscultation over chest

Question 3

What is a significant disadvantage of ketamine?

Accepted Answer

Delirium

Answer

Increased heart rate

Answer

Increased ICT

Answer

All of the options

Question 4

India started 2-dose vaccination strategy for measles, in -

Accepted Answer

2010

Answer

2008

Answer

2009

Answer

2011

Question 5

Distal renal tubular acidosis is associated with:

Accepted Answer

Calcium stones

Answer

Hypocitraturia

Answer

Oxalate stones

Answer

Uric acid stones

Question 6

A person experiences asthma attacks more than twice during the day and at least once during the night. What is the most likely classification of their asthma?

Accepted Answer

Severe persistent asthma

Answer

Intermittent asthma

Answer

Mild persistent asthma

Answer

Moderate persistent asthma

Question 7

The immunoglobulin most commonly involved in Multiple Myeloma is:

Accepted Answer

IgG

Answer

IgM

Answer

IgA

Answer

IgD

Question 8

What is the PRIMARY pathophysiological mechanism underlying the most common cause of neonatal hyperbilirubinemia?

Accepted Answer

Immature liver enzyme

Answer

Inefficient erythropoiesis

Answer

RBC hemolysis

Answer

Decreased bilirubin excretion

Question 9

The recommended ambient temperature for NICU is

Accepted Answer

22-26° C

Answer

20-22° C

Answer

26-30° C

Answer

30-35° C

Question 10

What is the recommended CPR ratio for infants when performed by 2 rescuers?

Accepted Answer

15 : 2

Answer

30 : 2

Answer

1 : 3

Answer

1 : 5

NEET-PG 2012

Anatomy

Anesthesiology

Community Medicine

Internal Medicine

Pathology

Pediatrics