Internal Medicine
5 questionsAnomic aphasia is due to defect in
What is the preferred test for confirming H. pylori eradication?
Distal renal tubular acidosis is associated with:
In Marfan's syndrome, Aortic aneurysm occurs most commonly in:
In a patient with acute cholecystitis, referred pain to the shoulder is known as
NEET-PG 2012 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 931: Anomic aphasia is due to defect in
- A. Left inferior parietal lobe
- B. Left temporal lobe
- C. Temporal occipital lobe (Correct Answer)
- D. Cerebellum
Explanation: ***Temporal occipital lobe*** - Anomic aphasia, characterized by difficulty recalling **words or names (anomia)**, is most commonly associated with lesions in the **left temporo-occipital region**. - This area is crucial for **semantic processing** and word retrieval. *Left inferior parietal lobe* - Damage to the left inferior parietal lobe is more commonly associated with **conduction aphasia**, characterized by impaired repetition despite fluent speech and good comprehension. - It is also involved in aspects of **reading (alexia)** and **writing (agraphia)**. *Left temporal lobe* - While portions of the left temporal lobe (especially Wernicke's area) are critical for language comprehension, damage primarily to this area typically results in **Wernicke's aphasia**, where speech is fluent but meaningless, and comprehension is severely impaired. - Anomia can be a feature of Wernicke's aphasia, but the primary deficit is comprehension. *Cerebellum* - The cerebellum plays a significant role in **motor control**, balance, and coordination, but it is not directly involved in the **generation or comprehension of language** in the same way as cortical areas. - Damage to the cerebellum might lead to **dysarthria** (speech motor difficulties), but not typical aphasia.
Question 932: What is the preferred test for confirming H. pylori eradication?
- A. Urease breath test (Correct Answer)
- B. Culture
- C. Serological test
- D. Biopsy urease test
Explanation: ***Urease breath test*** - The **urea breath test** is highly sensitive and specific for detecting active *H. pylori* infection and its eradication by measuring radioactive or non-radioactive labeled carbon dioxide released from metabolizing urea. - It is a non-invasive test preferred after treatment to confirm eradication, as it directly detects bacterial urease activity. *Culture* - **Culture** requires an invasive endoscopic biopsy, is expensive, and takes several days to yield results; therefore, it is not the preferred method for routine eradication confirmation. - While it offers the advantage of **antibiotic susceptibility testing**, its invasiveness and turnaround time make it less practical for post-treatment assessment. *Serological test* - **Serological tests** (blood tests for antibodies) remain positive for **H. pylori antibodies** for extended periods even after successful eradication, rendering them unsuitable for confirming eradication. - These tests primarily indicate past exposure rather than current, active infection. *Biopsy urease test* - A **biopsy urease test** involves an invasive endoscopy to obtain a tissue sample, which is then tested for urease activity. - Although useful for initial diagnosis, its invasiveness makes it less preferred for confirming eradication compared to the non-invasive breath test.
Question 933: Distal renal tubular acidosis is associated with:
- A. Hypocitraturia
- B. Oxalate stones
- C. Calcium stones (Correct Answer)
- D. Uric acid stones
Explanation: ***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.
Question 934: In Marfan's syndrome, Aortic aneurysm occurs most commonly in:
- A. Ascending aorta (Correct Answer)
- B. Descending aorta
- C. Abdominal aorta
- D. Arch of aorta
Explanation: ***Ascending aorta*** - The **ascending aorta** is the most common site for aortic aneurysm and dissection in Marfan syndrome due to cystic medial degeneration weakening the vessel wall [1]. - This predisposition is linked to defects in the **fibrillin-1 gene (FBN1)**, severely impacting the structural integrity of the arterial media primarily in the ascending aorta [1]. *Descending aorta* - While possible, **descending aortic** involvement is less common than ascending aortic involvement in Marfan syndrome [2]. - Aneurysms here are more frequently associated with atherosclerosis or other connective tissue disorders. *Abdominal aorta* - **Abdominal aortic aneurysms** are relatively rare in Marfan syndrome and are more typically seen in older patients with atherosclerosis [3]. - The disease primarily affects the elastic tissue content, which is most abundant in the proximal aorta. *Arch of aorta* - Aortic arch aneurysms can occur, but they are still less frequent than those in the **ascending aorta** as the primary initial site of dilation and dissection in Marfan syndrome. - Arch involvement often represents an extension of a more proximal ascending aortic pathology.
Question 935: In a patient with acute cholecystitis, referred pain to the shoulder is known as
- A. Murphy's sign
- B. Gray Turner sign
- C. Boas' sign (Correct Answer)
- D. Cullen's sign
Explanation: ***Boas' sign*** - **Boas' sign** refers to the presence of hyperesthesia below the right scapula, which can also manifest as referred pain to the **right shoulder** or back [1]. - This symptom in acute cholecystitis is due to the **irritation** of the **phrenic nerve**, which shares sensory pathways with the shoulder region. *Murphy's sign* - **Murphy's sign** is elicited by asking the patient to exhale, then placing the examiner's hand below the costal margin on the right mid-clavicular line, and then asking the patient to inhale deeply [1]. - A positive sign is indicated by a sudden cessation of inspiration due to pain, which is specific for **acute cholecystitis** and not referred shoulder pain [1]. *Gray Turner sign* - The **Gray Turner sign** involves ecchymosis or discoloration of the flanks. - It is a severe indicator of **retroperitoneal hemorrhage**, often associated with acute pancreatitis, not cholecystitis [2]. *Cullen's sign* - **Cullen's sign** presents as periumbilical ecchymosis or discoloration around the navel. - This sign is also indicative of **retroperitoneal hemorrhage**, typically seen in serious conditions like ruptured ectopic pregnancy or acute pancreatitis.
Ophthalmology
1 questionsWhich structures are most commonly involved in a ciliary staphyloma?
NEET-PG 2012 - Ophthalmology NEET-PG Practice Questions and MCQs
Question 931: Which structures are most commonly involved in a ciliary staphyloma?
- A. Choroid and sclera
- B. Cornea and conjunctiva
- C. Iris and sclera
- D. Ciliary body and sclera (Correct Answer)
Explanation: ***Ciliary body and sclera*** - A **staphyloma** is a localized bulging of the outer coat of the eye (sclera or cornea) lined internally by uveal tissue. - A **ciliary staphyloma** specifically involves the **ciliary body** and **sclera** at the region of the ciliary body, typically presenting as a dark bluish bulge at the limbal or perilimbal area. - This occurs due to weakening and ectasia of the sclera with prolapse of the underlying ciliary body, commonly seen following scleritis, perforating injuries, or surgeries. *Choroid and sclera* - This combination describes a **posterior staphyloma**, which occurs at the posterior pole of the eye, commonly seen in pathological myopia. - While medically accurate for posterior type, it does not describe a **ciliary staphyloma**. *Iris and sclera* - An **anterior staphyloma** primarily involves bulging of the **cornea** with incarceration of iris tissue, rather than sclera alone. - It occurs after corneal perforation with iris prolapse. *Cornea and conjunctiva* - This does not describe a staphyloma. Bulging of the cornea alone is termed **keratectasia** or **keratoconus**. - The **conjunctiva** is a superficial membrane and is not a structural component of staphyloma formation.
Pediatrics
2 questionsWhat is the correct dose of i.v. adrenaline in term infants during neonatal resuscitation?
Rehydration therapy in a 2 year old severely dehydrated child is -
NEET-PG 2012 - Pediatrics NEET-PG Practice Questions and MCQs
Question 931: What is the correct dose of i.v. adrenaline in term infants during neonatal resuscitation?
- A. 0.1-0.3 ml/kg in 1:10,000 (Correct Answer)
- B. 0.03-0.05 ml/kg in 1:1,000
- C. 0.01-0.03 ml/kg in 1:1,000
- D. 0.3-0.5 ml/kg in 1:10,000
Explanation: ***0.1-0.3 ml/kg in 1:10,000*** - The recommended intravenous adrenaline dose for neonatal resuscitation is **0.01-0.03 mg/kg** using a **1:10,000 solution (0.1 mg/mL)**. - Volume calculation: 0.01-0.03 mg/kg ÷ 0.1 mg/mL = **0.1-0.3 mL/kg**. - This is the standard dose as per **NRP (Neonatal Resuscitation Program)** and **AHA guidelines** [2]. - The 1:10,000 concentration is safer for IV/umbilical venous catheter administration in neonates. *0.01-0.03 ml/kg in 1:1,000* - This volume is far too low for a 1:1,000 solution. - Would deliver only 0.01-0.03 mg total (not per kg), resulting in a **sub-therapeutic dose**. - The 1:1,000 concentration contains 1 mg/mL, which is **10 times more concentrated** than the recommended dilution. *0.3-0.5 ml/kg in 1:10,000* - This volume would deliver 0.03-0.05 mg/kg, which **exceeds the recommended maximum** of 0.03 mg/kg. - Higher doses can cause **severe adverse effects** including hypertension, arrhythmias, decreased myocardial function, and compromised coronary perfusion. - Not recommended as the standard initial dose. *0.03-0.05 ml/kg in 1:1,000* - The 1:1,000 concentration (1 mg/mL) is **too concentrated for IV use** in neonates [1]. - This volume would deliver 0.03-0.05 mg/kg from a highly concentrated solution, increasing risk of **severe cardiovascular complications**. - The 1:1,000 solution is reserved for **endotracheal administration** (at higher volumes of 0.5-1 mL/kg), not IV route.
Question 932: Rehydration therapy in a 2 year old severely dehydrated child is -
- A. 75 ml/kg in 4 hours
- B. 30 ml/kg in 1 hour, 70 ml/kg in 5 hours
- C. 20 ml/kg in 30 min, 80 ml/kg in 2.5 hours
- D. 30 ml/kg in 30 min, 70 ml/kg in 2.5 hours (Correct Answer)
Explanation: ***30 ml/kg in 30 min, 70 ml/kg in 2.5 hours*** - This option reflects the recommended rehydration protocol for a severely dehydrated child aged **12 months to 5 years**, where the first 30 ml/kg are given rapidly over 30 minutes, followed by 70 ml/kg over the next 2.5 hours. - This rapid initial infusion helps to quickly restore **circulating volume** and improve perfusion during severe dehydration. *30 ml/kg in 1 hour, 70 ml/kg in 5 hours* - This protocol is typically used for children with **some dehydration**, not severe dehydration, and is usually administered orally when possible. - The slower rate of rehydration would be insufficient for a severely dehydrated child requiring more urgent fluid replacement. *20 ml/kg in 30 min, 80 ml/kg in 2.5 hours* - While reflecting a rapid initial phase, the total volume and distribution of fluids differ from the WHO guidelines for **severe dehydration** in this age group. - The **initial 20 ml/kg over 30 minutes** is generally a slightly lower first bolus than recommended for very severe cases, and the subsequent phase is also adjusted. *75 ml/kg in 4 hours* - This represents a **lower total volume** (75 ml/kg compared to 100 ml/kg) and a different time distribution for severely dehydrated children in the 12 month to 5 year age group. - This protocol is more aligned with the management of **some dehydration** rather than the urgent requirements of severe dehydration.
Physiology
1 questionsWhich of the following is used for the diagnosis of asthma?
NEET-PG 2012 - Physiology NEET-PG Practice Questions and MCQs
Question 931: Which of the following is used for the diagnosis of asthma?
- A. Measurement of tidal volume
- B. End expiratory flow rate
- C. Total lung capacity
- D. FEV1 (Correct Answer)
Explanation: ***FEV1*** - **Forced expiratory volume in 1 second (FEV1)** is the gold standard spirometric parameter for asthma diagnosis - Key diagnostic criteria include: - Reduced **FEV1/FVC ratio** (<0.70 or <0.75-0.80 in adults) - **Bronchodilator reversibility**: ≥12% and ≥200 mL increase in FEV1 after inhaled short-acting β2-agonist - This reversibility distinguishes asthma from fixed obstructive diseases like COPD - Serial **peak expiratory flow (PEF)** monitoring can also demonstrate variability characteristic of asthma *Measurement of tidal volume* - **Tidal volume** measures the amount of air inhaled or exhaled during normal breathing (typically ~500 mL at rest) - Not a diagnostic parameter for asthma as it doesn't assess **airway obstruction** or **hyperresponsiveness** - May be reduced during acute exacerbations but lacks specificity for asthma diagnosis *End expiratory flow rate* - Not a standard diagnostic parameter for asthma - While **mid-expiratory flow rates** (FEF25-75%) and **peak expiratory flow (PEF)** are assessed, **FEV1** remains the primary diagnostic measure - FEV1 provides better reproducibility and standardization for diagnosis *Total lung capacity* - **Total lung capacity (TLC)** represents total lung volume after maximal inhalation - May be normal or increased in asthma due to **air trapping** and hyperinflation - Not used as a primary diagnostic criterion as asthma diagnosis focuses on demonstrating **reversible airflow limitation**, not lung volumes
Psychiatry
1 questionsWhat does Pica refer to?
NEET-PG 2012 - Psychiatry NEET-PG Practice Questions and MCQs
Question 931: What does Pica refer to?
- A. Ice sucking
- B. Thumb sucking
- C. An appetite for non-nutritive substances (Correct Answer)
- D. None of the options
Explanation: ***An appetite for non-nutritive substances*** - Pica is an eating disorder characterized by a persistent and compulsive craving for and consumption of **non-nutritive, non-food substances** for at least one month. - Common ingested substances include **dirt, clay, ice, hair, paint chips, and laundry starch**, often associated with **nutritional deficiencies** like iron deficiency anemia or **developmental disabilities**. *Ice sucking* - While **pagophagia (ice craving)** is a specific form of Pica, it represents only one manifestation and not the overarching definition of the disorder. - Isolated ice sucking can sometimes be a sign of **iron deficiency anemia**. *Thumb sucking* - **Thumb sucking** is a common habit, especially in infants and young children, typically associated with self-soothing and comfort. - It is not considered an eating disorder and does not involve the consumption of non-nutritive substances. *None of the options* - This option is incorrect because "An appetite for non-nutritive substances" accurately defines Pica.