NEET-PG 2015 Practice Questions

Q: Bilateral parotid enlargement occurs in all, Except:

Chronic pancreatitis. ***SLE*** - **Systemic Lupus Erythematosus (SLE)** typically does not present with **bilateral parotid enlargement**, which is more characteristic of other conditions. - Salivary gland involvement in SLE is less prevalent and usually not the primary clinical feature associated with the disease. *HIV* - **HIV** infection can lead to **bilateral parotid enlargement** due to associated conditions such as lymphadenopathy and infections like **salivary gland infections**. [1] - **Lymphoid tissue** hyperplasia in response to HIV is another factor contributing to this enlargement. *Sjogren's syndrome* - **Sjogren's syndrome** is a common cause of **bilateral parotid enlargement** due to inflammatory infiltrates affecting the salivary glands. - Patients typically experience **xerostomia** (dry mouth) and **xerophthalmia** (dry eyes) alongside gland enlargement [2]. *Chronic pancreatitis* - Patients with **chronic pancreatitis** may develop **bilateral parotid enlargement** due to associated changes such as **sialadenosis** from malnutrition and electrolyte imbalances. - The enlargement occurs as a **compensatory mechanism** related to the pancreatic pathology affecting nearby structures.

Q: Which of the following sites is responsible for the amnestic defect in Wernicke's Korsakoff syndrome:

Thalamus. ***Thalamus*** - Damage to the **medial dorsal nucleus of the thalamus** is a key pathological finding in Wernicke's Korsakoff syndrome, directly contributing to the severe **anterograde and retrograde amnesia** [1]. - The thalamus plays a crucial role in memory consolidation and retrieval, acting as a relay station for information processing between cortical and subcortical structures. *Mammillary body* - While **mammillary body damage** is characteristic of Wernicke-Korsakoff syndrome, it is primarily associated with the **acute Wernicke encephalopathy phase** and contributes to the overall amnesia through its connections with the thalamus and hippocampus, rather than being the sole site for the amnestic defect [1]. - The mammillary bodies are part of the **Papez circuit**, which is important for episodic memory, but their lesion alone doesn't fully explain the complete amnestic syndrome. *Hippocampus* - The **hippocampus** is critical for the formation of new memories, and its damage typically causes **anterograde amnesia**, as seen in conditions like temporal lobe epilepsy or anoxia. - While memory is affected, direct **hippocampal lesions are not the primary pathology** in Wernicke-Korsakoff syndrome; the memory impairment arises from damage to structures *connected* to the hippocampus, such as the thalamus and mammillary bodies. *Periventricular Grey matter* - The **periventricular grey matter** is involved in various autonomic functions and pain modulation, not directly in memory formation or retrieval. - While lesions in this area can occur in Wernicke-Korsakoff syndrome, they are not considered the primary cause of the **amnestic defect**.

Q: The best method for inducing mid trimester abortion is :

Prostaglandins. ***Prostaglandins*** - **Prostaglandins** (e.g., dinoprostone, misoprostol) are highly effective in inducing uterine contractions and cervical ripening, making them the preferred method for **mid-trimester abortion**. - They can be administered through various routes (vaginal, oral, buccal) and offer a good balance of efficacy and safety for this gestational age. - Prostaglandins are considered the **current gold standard** for second-trimester medical termination of pregnancy. *Injection of Hypertonic Saline* - Historically used, but **intra-amniotic hypertonic saline** carries significant risks, including hypernatremia, disseminated intravascular coagulation (DIC), and uterine rupture. - It has largely been replaced by safer and more effective methods like prostaglandins due to its adverse event profile. - This method is now considered obsolete in most clinical settings. *Ethacrydine Lactate* - **Ethacrydine lactate** (ethacridine lactate/Rivanol) is an antiseptic agent that was historically used for mid-trimester abortion via intra-amniotic injection. - While it was effective in inducing abortion, it has been largely abandoned due to complications, prolonged induction time, and the availability of safer alternatives. - It is **not the preferred method** compared to prostaglandins, which have better safety profiles and efficacy. *Dilation and Curettage (D&C)* - **Dilation and curettage (D&C)** is primarily used for first-trimester abortions or for managing incomplete abortions and miscarriages. - In the mid-trimester, the uterus is larger and the fetal tissue is more substantial, making D&C less safe and often requiring extensive dilation or potentially leading to complications like uterine perforation or hemorrhage. - **Dilation and evacuation (D&E)** may be used in mid-trimester but requires specialized training and equipment.

Q: Duration of second stage of labor (propulsive stage) in multipara

Approximately 20 minutes. ***Approximately 20 minutes*** - In **multiparas**, the second stage of labor, also known as the **propulsive stage**, is typically shorter due to prior experience with childbirth. - While there is variability, an average duration of **20 minutes** for this stage is commonly observed in multiparous women. *40 minutes* - A duration of 40 minutes for the propulsive stage would be considered on the longer side for a **multipara**, often approaching the upper limits of normal. - While not necessarily abnormal, it is longer than the **average expected time** for multiparous women. *1 hour* - A second stage duration of **1 hour** in a multipara would generally be considered prolonged and might warrant intervention or closer monitoring. - This duration is more consistent with the **upper limit of normal** in nulliparous women or cases of arrest of labor in multiparas. *10 minutes* - While some multiparous women may have a very rapid second stage, **10 minutes** is on the shorter end of the average. - This could indicate a **precipitous labor**, which can carry its own risks such as maternal lacerations and neonatal complications.

Q: Alzheimer type II astrocytes are seen in which condition?

Hepatic encephalopathy. ***Hepatic encephalopathy*** - **Alzheimer type II astrocytes** are characteristic histological findings in cases of **hepatic encephalopathy**, reflecting the brain's response to elevated ammonia levels. - These astrocytes show enlarged, pale nuclei with prominent nucleoli and marginal chromatin, indicating cellular stress from metabolic dysfunction in the setting of liver failure. *Alzheimer's* - Alzheimer's disease is characterized by the presence of **neurofibrillary tangles** (tau protein) and **amyloid plaques** (beta-amyloid protein), not Alzheimer type II astrocytes. - Astrocytes in Alzheimer's disease may show reactive changes, but they do not typically manifest as the specific "Alzheimer type II" morphology. *Parkinsonism* - Parkinsonism is primarily characterized by the degeneration of **dopaminergic neurons** in the substantia nigra and the presence of **Lewy bodies** (alpha-synuclein aggregates). - While glial cells (astrocytes and microglia) do play a role in neuroinflammation in Parkinson's, they do not exhibit the specific Alzheimer type II astrocytic change. *Binswanger disease* - Binswanger disease is a form of **vascular dementia** characterized by diffuse white matter lesions due to chronic ischemia and damage to small cerebral blood vessels. - The pathology primarily involves demyelination and axonal loss in the white matter, with reactive gliosis, but not the specific changes seen in Alzheimer type II astrocytes.

Q: Which of the following is a long-acting local anesthetic?

Dibucaine. ***Dibucaine*** - **Dibucaine** is a **long-acting amide local anesthetic** with a duration of action up to 10 hours. - Its high **lipid solubility** contributes to its prolonged effect and greater potency compared to other local anesthetics. *Prilocaine* - **Prilocaine** is considered an **intermediate-duration amide local anesthetic**, with a duration of action typically 1-2 hours. - It carries a risk of **methemoglobinemia** at higher doses, which differentiates it from longer-acting agents. *Procaine* - **Procaine** is a **short-acting ester local anesthetic**, with a duration of action usually less than 1 hour. - It is known for its relatively **high allergenicity** due to its metabolism to para-aminobenzoic acid (PABA). *Lignocaine* - **Lignocaine (Lidocaine)** is an **intermediate-acting amide local anesthetic**, with a duration of action around 1-3 hours. - It is one of the most commonly used local anesthetics, but its duration is not as long as that of dibucaine.

Q: Testes are not palpable in

SRY deletion. ***SRY deletion*** - **SRY (Sex-determining Region Y) gene** is the master regulator of male sex determination on the Y chromosome; its deletion in 46,XY individuals results in **Swyer syndrome** (pure gonadal dysgenesis). - Without functional SRY, **testes fail to develop entirely**, and the gonads remain as non-functional **streak gonads** rather than differentiating into either testes or ovaries. - Result: **No palpable testes** because testicular tissue never forms; individuals develop female external genitalia despite XY karyotype. *DAX1 deletion* - DAX1 (NR0B1) normally **antagonizes testicular development** and supports adrenal/gonadal development. - **Deletion of DAX1** would actually **reduce anti-testis effects**, allowing testicular development to proceed more readily if SRY is present. - DAX1 **duplications** (not deletions) can impair male development; deletions cause **adrenal hypoplasia congenita** but do not prevent testicular formation. *WNT-4 gene mutation* - **WNT4** promotes **ovarian development** and opposes male differentiation pathways in normal female development. - **Loss-of-function mutations** in WNT4 do not prevent testicular development in 46,XY individuals where SRY is present and functional. - WNT4 overexpression (not loss-of-function mutation) could theoretically interfere with male development, but standard WNT4 mutations do not cause absent testes. *RSPO-1 gene mutation* - **RSPO1** (R-spondin 1) enhances **Wnt/β-catenin signaling** and supports ovarian differentiation; primarily relevant in 46,XX sex development. - Loss-of-function mutations in RSPO1 lead to **46,XX testicular/ovotesticular DSD**, where testicular tissue develops inappropriately in XX individuals. - In 46,XY individuals with functional SRY, RSPO1 mutations would **not prevent testicular development**, so testes would be palpable.

Q: What type of respiratory failure is most commonly observed in post-operative patients?

Hypoxemic respiratory failure. ***Hypoxemic respiratory failure*** - **Hypoxemic respiratory failure** (Type I) is characterized by a **PaO2 less than 60 mmHg** with a normal or low PaCO2, often due to **V/Q mismatch** and **shunt**. - Post-operative patients frequently develop **atelectasis**, **pneumonia**, or **pulmonary edema**, leading to impaired gas exchange and reduced oxygenation. - This is the **most commonly observed type** in the immediate post-operative period. *Hypercapnic respiratory failure* - **Hypercapnic respiratory failure** (Type II) is primarily due to **alveolar hypoventilation**, resulting in a **PaCO2 greater than 50 mmHg**. - While it can occur post-operatively, it is less common than hypoxemic failure and is typically seen with significant **sedation**, **neuromuscular blockade**, or severe **obstructive lung disease**. *Mixed respiratory failure* - **Mixed respiratory failure** involves both **hypoxemia** and **hypercapnia**, indicating severe impairment in both oxygenation and ventilation. - Although it can occur in severe post-operative complications, it is not the *most commonly observed initial presentation* compared to isolated hypoxemia. *Perioperative respiratory failure* - **Perioperative respiratory failure** (Type III) occurs specifically in the surgical setting and involves atelectasis from changes in chest wall mechanics. - While this occurs in the post-operative context, the term is less commonly used, and the **underlying mechanism is primarily hypoxemic** in nature.

Q: A 45-year-old male is diagnosed with carcinoma of the penis. Which lymph nodes should the surgeon primarily consider for potential metastasis?

Inguinal lymph nodes (located in the groin region). ***Inguinal lymph nodes (located in the groin region)*** - The lymphatic drainage of the penis primarily bypasses the internal nodal basins and drains directly to the **superficial and deep inguinal lymph nodes**. - Metastasis to these nodes is the **most common initial spread** in penile carcinoma, making them the primary targets for surgical evaluation and dissection. *Para-aortic lymph nodes (located near the aorta)* - These nodes are typically involved in more advanced or widespread metastatic disease, following initial spread to the pelvic nodes. - They are not considered the primary draining lymph nodes for penile carcinoma. *External iliac lymph nodes (located along the external iliac vessels)* - While part of the pelvic lymph node chain, the external iliac nodes are usually involved after metastasis to the inguinal nodes, or in cases of direct invasion of the pelvic floor. - They are not the first echelon of lymphatic drainage for the penis. *Internal iliac lymph nodes (located along the internal iliac vessels)* - These nodes are involved in lymphatic drainage from organs like the bladder, prostate, and rectum. - The lymphatic drainage of the penis primarily bypasses these nodes for initial metastasis.

Q: Which of the following is resected in Whipple's operation, except?

Neck of pancreas. ***Neck of pancreas*** - In a **Whipple procedure** (pancreaticoduodenectomy), the **neck of the pancreas** is the site of transection (division), not resection. - The pancreas is divided at the neck, and the remaining **body and tail** are preserved and anastomosed to the jejunum for pancreatic drainage. *Duodenum* - The **entire duodenum** is resected during a Whipple operation as it shares intimate anatomical relations with the pancreatic head. - Complete duodenal removal is necessary to achieve adequate **oncological margins** and remove all associated lymphatic drainage. *Head of pancreas* - The **head of the pancreas** is the primary structure resected in a Whipple procedure. - This resection is typically performed for **pancreatic adenocarcinoma** or **periampullary tumors** requiring en bloc removal. *Common bile duct* - The **distal common bile duct** is resected as part of the specimen to ensure complete tumor excision. - The remaining **proximal bile duct** is reconstructed via **hepaticojejunostomy** to restore biliary drainage.

Question 1

Bilateral parotid enlargement occurs in all, Except:

Accepted Answer

Chronic pancreatitis

Answer

HIV

Answer

SLE

Answer

Mumps

Question 2

Which of the following sites is responsible for the amnestic defect in Wernicke's Korsakoff syndrome:

Accepted Answer

Thalamus

Answer

Hippocampus

Answer

Mammillary body

Answer

Periventricular Grey matter

Question 3

The best method for inducing mid trimester abortion is :

Accepted Answer

Prostaglandins

Answer

Dilation and Curettage (D&C)

Answer

Injection of Hypertonic Saline

Answer

Ethacrydine Lactate

Question 4

Duration of second stage of labor (propulsive stage) in multipara

Accepted Answer

Approximately 20 minutes

Answer

40 minutes

Answer

1 hour

Answer

10 minutes

Question 5

Alzheimer type II astrocytes are seen in which condition?

Accepted Answer

Hepatic encephalopathy

Answer

Parkinsonism

Answer

Alzheimer's

Answer

Binswanger disease

Question 6

Which of the following is a long-acting local anesthetic?

Accepted Answer

Dibucaine

Answer

Prilocaine

Answer

Procaine

Answer

Lignocaine

Question 7

Testes are not palpable in

Accepted Answer

SRY deletion

Answer

DAX 1 deletion

Answer

WNT- 4 gene mutation

Answer

RSPO-1 gene mutation

Question 8

What type of respiratory failure is most commonly observed in post-operative patients?

Accepted Answer

Hypoxemic respiratory failure

Answer

Hypercapnic respiratory failure

Answer

Mixed respiratory failure

Answer

Perioperative respiratory failure

Question 9

A 45-year-old male is diagnosed with carcinoma of the penis. Which lymph nodes should the surgeon primarily consider for potential metastasis?

Accepted Answer

Inguinal lymph nodes (located in the groin region)

Answer

Para-aortic lymph nodes (located near the aorta)

Answer

External iliac lymph nodes (located along the external iliac vessels)

Answer

Internal iliac lymph nodes (located along the internal iliac vessels)

Question 10

Which of the following is resected in Whipple's operation, except?

Accepted Answer

Neck of pancreas

Answer

Duodenum

Answer

Head of pancreas

Answer

Common bile duct

NEET-PG 2015

General Medicine

Internal Medicine

Obstetrics and Gynecology

Pathology

Pharmacology

Physiology

Surgery