NEET-PG 2012 Practice Questions

Q: In a patient with suspected vitamin B12 deficiency, which condition would result in an abnormal Schilling test?

Intrinsic factor deficiency. ***Intrinsic factor deficiency*** - The Schilling test assesses the absorption of **vitamin B12**. **Intrinsic factor** is crucial for B12 absorption in the ileum. - Deficiency of intrinsic factor, as seen in **pernicious anemia**, directly impairs B12 absorption, leading to an abnormal Schilling test result [1]. *Amylase deficiency* - **Amylase** is an enzyme involved in the digestion of carbohydrates, not vitamin B12 absorption [2]. - Its deficiency would primarily cause carbohydrate malabsorption symptoms, not an abnormal Schilling test. *Pancreatic endocrine insufficiency* - **Pancreatic endocrine function** relates to hormone production (e.g., insulin, glucagon), while exocrine function involves digestive enzymes. - Impairment of endocrine function does not directly affect vitamin B12 absorption or the Schilling test. *Lipase deficiency* - **Lipase** is an enzyme essential for the digestion of fats [2]. - Its deficiency would lead to fat malabsorption (steatorrhea) but would not affect vitamin B12 absorption or the Schilling test results.

Q: What is the daily temperature variation in remittent fever?

> 1.0 °C. ***> 1.0 °C*** - In **remittent fever**, the temperature fluctuates by **more than 1.0 °C** (or 2°F) over a 24-hour period. [1] - Despite the significant variation, the temperature **never returns to normal** during the day. [1] *< 0.5 °C* - A variation of less than 0.5 °C (or 1°F) is more characteristic of a **sustained or continuous fever**, where the temperature remains elevated with minimal fluctuation. [1] - This pattern is seen in conditions like **typhoid fever** or **pneumonia**. * 2.0 °C* - While a variation greater than 2.0 °C would certainly fall under the definition of remittent fever (as it's > 1.0 °C), the defining lower limit for remittent fever is typically **> 1.0 °C (or 2°F)**. - A larger fluctuation might occur, but > 1.0 °C is the minimum threshold.

Q: Most common symptom of genitourinary TB

Hematuria. ***Hematuria*** - **Gross or microscopic hematuria** is the most common symptom of genitourinary tuberculosis, often occurring early in the disease course. - It results from the **inflammatory and destructive changes** caused by Mycobacterium tuberculosis in the urinary tract. *Renal colic* - Renal colic is typically associated with **acute obstruction of the ureter**, often by a renal stone. - While TB can cause strictures leading to obstruction, **colic** itself is not the most common initial symptom. *Increased frequency* - Increased urinary frequency is a common symptom in genitourinary TB, especially with **bladder involvement**. - However, it ranks below hematuria in terms of overall prevalence as the *most common* symptom. *Painful micturition* - **Dysuria** or painful micturition is frequently observed in genitourinary TB, particularly with **bladder or urethral inflammation**. - While common, it is generally less prevalent than hematuria as the presenting complaint.

Q: Secretory diarrhea is not typically associated with which of the following conditions?

Celiac disease. ***Celiac disease*** [1] - Characterized by **malabsorption** due to immune-mediated damage to the intestinal mucosa, leading to **osmotic diarrhea** rather than secretory diarrhea [1]. - Symptoms include **bloating**, **weight loss**, and **steatorrhea**, which are not consistent with secretory processes. *Cholera* - Caused by **Vibrio cholerae**, leading to **massive secretory diarrhea** due to the action of cholera toxin on intestinal epithelial cells. - Presents with **watery diarrhea**, potentially leading to **dehydration** and electrolyte imbalances. *Addison's Disease* - This condition may cause **diarrhea** but typically results in **non-secretory diarrhea**, often associated with adrenal insufficiency symptoms. - Presenting features include **fatigue**, **weight loss**, and **hyperpigmentation**, not primarily secretory processes. *Phenolphthalein* - A laxative that can induce **secretory diarrhea** through its stimulant effects on the bowel. - Its mechanism leads to increased fluid secretion in the intestines, thus contributing to secretory diarrhea.

Q: 35 yr old with 4 months amenorrhea with increased FSH, decreased estrogen. What is the diagnosis?

Premature ovarian failure. ***Premature ovarian failure*** - The combination of **amenorrhea** for 4 months in a 35-year-old, with **increased FSH** and **decreased estrogen**, is characteristic of premature ovarian failure, indicating the ovaries are no longer responding to FSH stimulation. - This condition signifies the cessation of ovarian function before the age of 40, leading to menopausal symptoms and infertility. *Pituitary dysfunction* - Pituitary dysfunction might lead to **decreased FSH** (hypogonadotropic hypogonadism) due to insufficient stimulation of the ovaries, not increased FSH. - In cases of pituitary adenomas, increased prolactin can cause amenorrhea, but FSH would not be elevated in the manner described. *Hypothalamic dysfunction* - Hypothalamic dysfunction, such as **functional hypothalamic amenorrhea**, typically presents with **low or normal FSH and LH levels** (hypogonadotropic hypogonadism) due to reduced GnRH pulsatility. - This condition is often associated with stress, excessive exercise, or low body weight, and would not cause elevated FSH as seen here. *Polycystic Ovary Syndrome* - **Polycystic Ovary Syndrome (PCOS)** is characterized by **anovulation**, resulting in amenorrhea or oligomenorrhea, but typically involves **elevated androgens** and a **high LH-to-FSH ratio**, with FSH levels generally normal or low, and estrogen levels often normal or slightly elevated. - It would not present with simultaneously high FSH and low estrogen, which points to ovarian failure rather than anovulation with intact ovarian reserve.

Q: What is the maximum gestational age (from LMP) for performing medical termination of early pregnancy using mifepristone and misoprostol?

7 weeks. ***7 weeks (49 days)*** - Medical termination of pregnancy using **mifepristone and misoprostol** is most effective up to **49 days (7 weeks) of gestation** from the first day of the last menstrual period (LMP). - This is the **FDA-approved and WHO-recommended timeframe** for medical abortion with optimal efficacy (95-98% success rate). - The **MTP Act in India** allows medical methods up to **63 days (9 weeks)**, but 49 days represents the timeframe with highest efficacy and lowest complication rates. - Beyond this period, success rates decline and surgical methods may be more appropriate. *21 days* - This is only **3 weeks of gestation**, far too early and restrictive for medical abortion guidelines. - Most women wouldn't have confirmed pregnancy by this time. - This is not aligned with any standard medical abortion protocol. *4 weeks* - At **4 weeks gestation**, pregnancy has just been missed (around time of expected period). - This is too restrictive and not the maximum allowable timeframe for medical abortion. - Medical abortion can safely be performed well beyond this point. *14 days* - This is only **2 weeks of gestation** (around the time of ovulation in a typical cycle). - Pregnancy cannot even be reliably detected at this point. - This timeframe has no relevance to medical abortion guidelines.

Q: Spinnbarkeit is maximum shown at which phase?

Ovulatory. ***Ovulatory*** - **Spinnbarkeit** refers to the stringy, stretchy quality of cervical mucus, which is maximal during the ovulatory phase due to high **estrogen levels**. - This highly elastic mucus facilitates **sperm transport** to the uterus and fallopian tubes for fertilization. *Menstrual phase* - During the menstrual phase, **cervical mucus** is typically minimal and sticky, making it unfavorable for sperm survival. - This phase is characterized by low estrogen and progesterone levels, leading to the **shedding of the uterine lining**. *Post ovulatory* - After ovulation, under the influence of **progesterone**, cervical mucus becomes thick, sticky, and opaque, decreasing **spinnbarkeit**. - This change in mucus consistency forms a **barrier to sperm penetration** into the uterus. *Follicular phase* - In the early follicular phase, **estrogen levels** are low, resulting in thick, scanty, and opaque cervical mucus with low **spinnbarkeit**. - As the follicular phase progresses and estrogen levels rise, the mucus gradually becomes more **watery and elastic**, but it doesn't reach its peak stretchiness until ovulation.

Q: A baby is born at 27 weeks of gestation and required mechanical ventilation for 4 weeks and CPAP for 1 week. He was maintained on room air subsequently. Based on the new definition of Bronchopulmonary Dysplasia (BPD), and assuming he remained on room air at 36 weeks post-menstrual age, what is the most appropriate classification of his condition?

Mild BPD. ***Mild BPD*** - The infant required respiratory support (ventilation and CPAP) for an extended period (5 weeks total, far exceeding the 28-day oxygen requirement for BPD diagnosis). - Being on **room air at 36 weeks post-menstrual age** despite prior prolonged support classifies his condition as mild BPD according to the diagnostic criteria. - For infants born <32 weeks gestation, mild BPD is defined as needing oxygen for ≥28 days but breathing room air at 36 weeks PMA. *Moderate BPD* - Moderate BPD would be diagnosed if the infant still required **less than 30% oxygen (FiO2 0.22-0.29) at 36 weeks post-menstrual age**. - This infant was on room air (FiO2 0.21), indicating less severe lung disease than moderate BPD. *Severe BPD* - Severe BPD involves the ongoing need for **30% or greater oxygen (FiO2 ≥0.30)** and/or positive pressure support (CPAP/ventilator) at 36 weeks post-menstrual age. - This infant did not meet these criteria, as he was on room air without any support. *No BPD* - No BPD would require **less than 28 days of oxygen/respiratory support** during the neonatal period. - This infant required mechanical ventilation for 4 weeks and CPAP for 1 week (total 5 weeks = 35 days), clearly exceeding the 28-day threshold for BPD diagnosis. - Despite being stable on room air at 36 weeks PMA, the prolonged earlier support establishes the diagnosis of BPD (mild severity).

Q: All of the following are used for treatment of *H. pylori*, except:

Gentamicin. ***Gentamicin*** - **Gentamicin** is an **aminoglycoside antibiotic** primarily used for severe Gram-negative bacterial infections and is **not effective** against *H. pylori*. - Its mechanism of action and **toxicity profile** (ototoxicity, nephrotoxicity) make it unsuitable for typical *H. pylori* eradication regimens. *Clarithromycin* - **Clarithromycin** is a **macrolide antibiotic** frequently used in **triple therapy regimens** for *H. pylori* eradication. - It works by **inhibiting bacterial protein synthesis**, significantly contributing to the eradication of the bacteria. *Metronidazole* - **Metronidazole** is an **antibiotic** and **antiprotozoal agent** commonly included in *H. pylori* **quadruple therapy** or when penicillin allergies are present. - It acts by forming **cytotoxic compounds** that disrupt bacterial DNA, making it effective against anaerobic and microaerophilic bacteria like *H. pylori*. *Amoxicillin* - **Amoxicillin** is a **beta-lactam antibiotic** that is a cornerstone of many *H. pylori* **eradication regimens**, particularly in standard triple therapy. - It works by **inhibiting bacterial cell wall synthesis**, leading to bacterial lysis.

Q: Which hormone surge indicates the fertile period in females?

LH. ***LH*** - The **luteinizing hormone (LH) surge** triggers **ovulation**, releasing a mature egg from the follicle. - This surge is a key indicator of the **fertile window** in a woman's menstrual cycle. *FSH* - **Follicle-stimulating hormone (FSH)** primarily stimulates the growth and development of **ovarian follicles** early in the menstrual cycle, prior to the fertile period. - While essential for follicle maturation, it does not directly signal the immediate fertile window or ovulation. *Estrogen* - **Estrogen levels peak** just before the LH surge, playing a role in triggering the surge itself through positive feedback. - However, estrogen itself does not directly indicate the onset of the fertile period; rather, the subsequent LH surge does. *Oxytocin* - **Oxytocin** is largely involved in processes like **uterine contractions during childbirth** and **milk ejection during lactation**. - It has no direct role in indicating a female's fertile period or timing of ovulation.

Question 1

In a patient with suspected vitamin B12 deficiency, which condition would result in an abnormal Schilling test?

Accepted Answer

Intrinsic factor deficiency

Answer

Amylase deficiency

Answer

Pancreatic endocrine insufficiency

Answer

Lipase deficiency

Question 2

What is the daily temperature variation in remittent fever?

Accepted Answer

> 1.0 °C

Answer

< 0.5 °C

Answer

< 1.0 °C

Answer

> 2.0 °C

Question 3

Most common symptom of genitourinary TB

Accepted Answer

Hematuria

Answer

Increased frequency

Answer

Renal colic

Answer

Painful micturition

Question 4

Secretory diarrhea is not typically associated with which of the following conditions?

Accepted Answer

Celiac disease

Answer

Phenolphthalein

Answer

Cholera

Answer

VIPoma

Question 5

35 yr old with 4 months amenorrhea with increased FSH, decreased estrogen. What is the diagnosis?

Accepted Answer

Premature ovarian failure

Answer

Pituitary dysfunction

Answer

Hypothalamic dysfunction

Answer

Polycystic Ovary Syndrome

Question 6

What is the maximum gestational age (from LMP) for performing medical termination of early pregnancy using mifepristone and misoprostol?

Accepted Answer

7 weeks

Answer

21 days

Answer

4 weeks

Answer

14 days

Question 7

Spinnbarkeit is maximum shown at which phase?

Accepted Answer

Ovulatory

Answer

Menstrual phase

Answer

Post ovulatory

Answer

Follicular phase

Question 8

A baby is born at 27 weeks of gestation and required mechanical ventilation for 4 weeks and CPAP for 1 week. He was maintained on room air subsequently. Based on the new definition of Bronchopulmonary Dysplasia (BPD), and assuming he remained on room air at 36 weeks post-menstrual age, what is the most appropriate classification of his condition?

Accepted Answer

Mild BPD

Answer

Moderate BPD

Answer

Severe BPD

Answer

No BPD

Question 9

All of the following are used for treatment of *H. pylori*, except:

Accepted Answer

Gentamicin

Answer

Metronidazole

Answer

Amoxicillin

Answer

Clarithromycin

Question 10

Which hormone surge indicates the fertile period in females?

Accepted Answer

LH

Answer

FSH

Answer

Estrogen

Answer

Oxytocin

NEET-PG 2012

Biochemistry

General Medicine

Internal Medicine

Obstetrics and Gynecology

Pediatrics

Pharmacology

Physiology