NEET-PG 2013 Practice Questions

Q: Which of the following conditions is primarily treated with Vitamin B6?

Homocystinuria. ***Homocystinuria*** - The most common form of **homocystinuria** is caused by **cystathionine β-synthase (CBS) deficiency**, which requires **pyridoxal phosphate (Vitamin B6)** as a cofactor. - Approximately **50% of patients** with CBS deficiency are **B6-responsive**, making **high-dose Vitamin B6 (100-500 mg/day)** a **first-line primary treatment** for these cases. - This is a **clinically significant condition** that requires treatment, manifesting with features like **ectopia lentis, marfanoid habitus, intellectual disability, and thromboembolism**. - B6 supplementation enhances residual CBS enzyme activity and reduces plasma homocysteine levels. *Cystathionuria* - Caused by **cystathionine γ-lyase deficiency**, which also uses **Vitamin B6** as a cofactor. - This is generally a **benign, asymptomatic condition** that does **NOT require treatment**. - While B6 can reduce cystathionine accumulation, it is **not a primary treatment indication** because the condition is clinically insignificant. *Xanthurenic aciduria* - Caused by **kynureninase deficiency** in the **tryptophan metabolism pathway**, which requires **pyridoxal phosphate**. - This is a **rare and usually benign condition** that does not typically require treatment. - Not a primary indication for B6 therapy. *None of the options* - Incorrect, as **Homocystinuria** (CBS deficiency) is a **primary indication** for high-dose Vitamin B6 therapy in B6-responsive patients.

Q: Which of the following is a complication of total parenteral nutrition?

Hyperglycemia. ***Hyperglycemia*** - Total parenteral nutrition (TPN) solutions contain a high concentration of **dextrose** (glucose), which can lead to elevated blood glucose levels, especially in patients with pre-existing metabolic issues or high infusion rates. - The sudden and continuous infusion of carbohydrates can overwhelm the body's **insulin response**, resulting in hyperglycemia [3]. *Hyperkalemia* - **Hypokalemia**, rather than hyperkalemia, is a more common electrolyte disturbance associated with TPN due to intracellular shifts of potassium with glucose metabolism [2]. - While TPN solutions do contain potassium, hyperkalemia is generally rare unless there is significant renal impairment or excessive potassium supplementation. *Hyperglycemia and Hyperkalemia* - While **hyperglycemia** is a common complication, **hyperkalemia** is not; in fact, hypokalemia is a more frequent concern linked to the significant glucose load in TPN. - This option incorrectly pairs a common complication with one that is rare and generally only seen in specific circumstances. *Hyperosmolar dehydration* - This condition, also known as **hyperosmolar hyperglycemic state (HHS)**, is a severe complication that can arise from uncontrolled hyperglycemia, where high glucose levels lead to osmotic diuresis and severe dehydration [1]. - While hyperglycemia is a precursor to hyperosmolar dehydration, the direct complication of TPN administration itself is the hyperglycemia.

Q: Which of the following is a premalignant lesion for carcinoma of the rectum?

Adenomatous polyps. ***Familial polyposis*** - Familial adenomatous polyposis (FAP) is characterized by numerous **adenomatous polyps** in the colon and rectum, which have a high risk of progressing to colorectal cancer [1]. - Individuals with FAP are at significant risk for developing **carcinoma rectum** at a young age if the condition is not managed properly [1]. *Juvenile polyp* - Juvenile polyps are generally **benign** and occur in children, with a very low risk of malignancy. - They do not contribute significantly to the risk of **carcinoma rectum** like adenomatous polyps do. *Adenomatous polyp* - While adenomatous polyps are indeed premalignant [1], the term **Familial polyposis** indicates a hereditary condition that specifically has a higher and more defined risk for rectal carcinoma. - Adenomatous polyps can occur sporadically and do not imply a genetic syndrome like familial polyposis. *FAP* - FAP refers specifically to **familial adenomatous polyposis** [1], which is the same concept as familial polyposis but less encompassed in terms of broad assessment in this context. - It is important to note that **familial polyposis** is a broader term that includes conditions like FAP and indicates a significant risk factor for rectal cancer [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 817, 821-822.

Q: All of the following are features of prematurity in a neonate, except which of the following?

Thick ear cartilage. ***Thick ear cartilage*** - **Thick ear cartilage with well-formed incurving of the pinna** is a feature of a **mature** or **full-term** neonate. - In premature neonates, the ear cartilage is typically **thin, soft, and flexible**, with less developed incurving. *Abundant lanugo* - **Lanugo**, fine soft hair, is typically abundant on the back and shoulders of **premature neonates**. - This hair is often shed by full-term babies before or shortly after birth. *Empty scrotum* - An **empty scrotum** indicates undescended testes, which is common in **premature male neonates**. - Testicular descent typically occurs later in gestation. *No creases on sole* - The absence or scarcity of **creases on the sole of the foot** is characteristic of **premature neonates**. - As gestational age increases, the number and depth of plantar creases increase.

Q: What is the standard duration used to define apnea of prematurity?

20 sec. ***20 sec*** - Apnea of prematurity is defined as a cessation of breathing lasting **20 seconds or longer**, or a shorter pause in breathing accompanied by **bradycardia** (heart rate <100 bpm), **cyanosis**, or **pallor**. - This duration is crucial for determining the need for intervention and diagnosis in preterm infants. - The definition is standardized by the **American Academy of Pediatrics (AAP)** and is widely accepted in neonatal care. *Between 10 and 15 sec* - While pauses in breathing of this duration can be observed in preterm infants, they are usually considered **central periodic breathing** and not true apnea of prematurity unless accompanied by desaturation or bradycardia. - These shorter pauses are often considered benign, as significant physiological changes like bradycardia or cyanosis are less likely to occur. *More than 30 sec* - While a breathing cessation of more than 30 seconds certainly qualifies as apnea of prematurity, **20 seconds is the established minimum duration** for diagnosis. - Any apnea lasting longer than 20 seconds signifies a more severe event, indicating a greater risk to the infant. *Less than 10 sec* - Pauses in breathing lasting less than 10 seconds are generally considered **normal physiological variations** in both preterm and full-term infants. - These short pauses do not typically lead to significant oxygen desaturation or bradycardia and are not indicative of apnea of prematurity.

Q: What is the average weight gain per day for infants from 6 weeks to 12 weeks of age?

30 g/d. ***30 g/d*** - From **6 to 12 weeks** of age, infants typically experience a rapid growth phase, with an average daily weight gain of approximately **30 grams** (or about 1 ounce per day). - This rate of gain is crucial for monitoring proper nutrition and overall development during this early stage of infancy. *40 g/d* - A daily weight gain of **40 g/d** is higher than the typical average for infants between 6 and 12 weeks of age. - While individual growth rates can vary, sustained gains at this level might raise questions about overfeeding or unusually rapid growth, although it is not usually a cause for concern. *50 g/d* - A weight gain of **50 g/d** is significantly above the expected average for infants in the 6- to 12-week age range. - Such rapid weight gain, if sustained, could indicate excessive caloric intake or potentially signal underlying metabolic issues that need evaluation. *60 g/d* - A daily weight gain of **60 g/d** is an exceptionally high rate for infants between 6 and 12 weeks, far exceeding the average. - This level of growth would be a strong indicator for further investigation into feeding practices and the infant's health to rule out any potential concerns.

Q: Which of the following is the best combination of clinical features of intestinal obstruction?

Abdominal distension and vomiting. ***Abdominal distension and vomiting*** - This combination represents **two of the cardinal clinical features** of intestinal obstruction from the classic tetrad (pain, vomiting, distension, constipation). - **Abdominal distension** occurs due to accumulation of gas and fluid proximal to the obstruction. - **Vomiting** occurs as the body attempts to expel contents that cannot pass through the blocked intestine. - The **combination** makes this the most specific and complete answer among the given options. *Vomiting* - While vomiting is indeed a prominent clinical feature of intestinal obstruction, it can occur in numerous other conditions (gastroenteritis, metabolic disorders, CNS pathology). - **Isolated vomiting lacks specificity** for diagnosing intestinal obstruction. *Fluid level in X-ray > 4* - This refers to **multiple air-fluid levels** seen on erect abdominal X-ray, which is a **radiologic/diagnostic finding**, not a clinical feature. - Clinical features are symptoms and signs (what the patient experiences or what is observed on examination), whereas X-ray findings are **investigative/imaging findings**. *Abdominal distension* - While abdominal distension is a key clinical feature of intestinal obstruction, it can also occur in other conditions (ascites, pregnancy, obesity, bowel perforation). - **Isolated distension lacks specificity** compared to the combination with vomiting.

Q: What is the treatment of choice for squamous cell anal cancer?

Chemoradiotherapy. ***Chemoradiotherapy*** - **Chemoradiotherapy** is the standard and most effective treatment for squamous cell anal cancer, offering high rates of **tumor control** and **anal sphincter preservation**. - This combined approach uses both **radiation** and **chemotherapy** (typically 5-fluorouracil and mitomycin-C) to enhance tumor cell killing and reduce recurrence. *Laser ablation* - **Laser ablation** is a minimally invasive technique generally reserved for very small, early-stage **superficial tumors** or **intraepithelial neoplasia**, not for invasive squamous cell anal cancer. - It does not address potential **lymph node involvement** or deliver the comprehensive treatment required for most anal cancers. *Abdominoperineal resection* - **Abdominoperineal resection (APR)** involves the surgical removal of the anus, rectum, and part of the sigmoid colon, leading to a permanent **colostomy**. - This is considered a **salvage therapy** for recurrent disease or for patients who have failed chemoradiotherapy, not a primary treatment. *Cisplatin-based chemotherapy* - While **cisplatin** can be used as a component of chemotherapy regimens for some cancers, it is not the primary single-agent or cornerstone chemotherapy for **squamous cell anal cancer**. - The standard chemotherapy regimen typically includes **5-fluorouracil** and **mitomycin-C** in combination with radiation.

Q: What is the method of reduction for an inguinal hernia?

Taxis. ***Taxis*** - **Taxis** is the manual reduction of a hernia by applying gentle, sustained pressure to gently guide the herniated contents back into the abdominal cavity. - This technique is typically used for **reducible hernias** to prevent complications like strangulation. *Kugel maneuver* - The **Kugel patch** is a device used in the surgical repair of inguinal hernias, not a method of manual reduction. - It involves a **preperitoneal mesh** placed during an open repair to reinforce the weakened abdominal wall. *Macvay procedure* - The **McVay repair** (also known as Cooper's ligament repair) is a surgical technique for inguinal hernias. - It involves suturing the **conjoint tendon** to Cooper's ligament for a strong repair, not a manual reduction. *Stopa's technique* - "Stopa's technique" is not a recognized medical term or a standard method for hernia reduction or repair. - This option appears to be a **distractor** and does not correspond to any established medical procedure for hernias.

Q: Steroids are injurious to wound healing when administered during which time frame?

Within 2 weeks. ***Within 2 weeks*** - Steroids administered **within the first 2 weeks** of wound healing significantly impair the **inflammatory and proliferative phases**, crucial for new tissue formation. - This early disruption can lead to **decreased collagen synthesis**, reduced wound contraction, and increased risk of **dehiscence**. *On the first day* - While steroids can affect the very early inflammatory response, the most detrimental impact on overall wound healing processes, particularly **collagen deposition**, occurs over a slightly longer initial period. - The effects of a single dose on day one might be less pronounced than sustained steroid exposure during the more critical **proliferative phase**. *2-4 weeks* - By this stage, the wound is typically in the **remodeling phase**, where collagen fibers are being reorganized and strengthened. - While steroids can still mildly affect healing, their **most damaging effects** on crucial initial processes have usually passed. *> 4 weeks* - Beyond 4 weeks, the wound is generally well into the **remodeling or maturation phase**, and often has achieved significant tensile strength. - Steroid administration at this stage would have **minimal impact** on the overall structural integrity of the healed wound, although chronic steroid use has systemic effects.

Question 1

Which of the following conditions is primarily treated with Vitamin B6?

Accepted Answer

Homocystinuria

Answer

Cystathionuria

Answer

None of the options

Answer

Xanthourenic aciduria

Question 2

Which of the following is a complication of total parenteral nutrition?

Accepted Answer

Hyperglycemia

Answer

Hyperkalemia

Answer

Hyperglycemia and Hyperkalemia

Answer

Hyperosmolar dehydration

Question 3

Which of the following is a premalignant lesion for carcinoma of the rectum?

Accepted Answer

Adenomatous polyps

Answer

Juvenile polyposis

Answer

Familial adenomatous polyposis

Answer

Hyperplastic polyps

Question 4

All of the following are features of prematurity in a neonate, except which of the following?

Accepted Answer

Thick ear cartilage

Answer

Abundant lanugo

Answer

Empty scrotum

Answer

No creases on sole

Question 5

What is the standard duration used to define apnea of prematurity?

Accepted Answer

20 sec

Answer

Between 10 and 15 sec

Answer

More than 30 sec

Answer

Less than 10 sec

Question 6

What is the average weight gain per day for infants from 6 weeks to 12 weeks of age?

Accepted Answer

30 g/d

Answer

40 g/d

Answer

50 g/d

Answer

60 g/d

Question 7

Which of the following is the best combination of clinical features of intestinal obstruction?

Accepted Answer

Abdominal distension and vomiting

Answer

Vomiting

Answer

Fluid level in X-ray > 4

Answer

Abdominal distension

Question 8

What is the treatment of choice for squamous cell anal cancer?

Accepted Answer

Chemoradiotherapy

Answer

Laser ablation

Answer

Abdominoperineal resection

Answer

Cisplatin-based chemotherapy

Question 9

What is the method of reduction for an inguinal hernia?

Accepted Answer

Taxis

Answer

Stopa's technique

Answer

Kugel patch

Answer

McVay procedure

Question 10

Steroids are injurious to wound healing when administered during which time frame?

Accepted Answer

Within 2 weeks

Answer

2-4 weeks

Answer

> 4 weeks

Answer

On the first day

NEET-PG 2013

Biochemistry

General Medicine

Pathology

Pediatrics

Surgery