NEET-PG 2015 Practice Questions

Q: Creatinine is formed from -

Creatine. ***Creatine*** - **Creatinine** is a waste product formed from the non-enzymatic, irreversible degradation of **creatine** and **creatine phosphate**, primarily in muscles. - **Creatine** itself is synthesized endogenously from three amino acids: **glycine, arginine, and methionine** (as S-adenosylmethionine) through a two-step enzymatic process in the kidney and liver. - The amount of creatinine produced daily is relatively constant and directly proportional to an individual's **muscle mass**, making it a useful marker for renal function. *Lysine* - **Lysine** is an **essential amino acid** and a precursor for various compounds like **carnitine** but is not involved in creatinine or creatine formation. - Deficiency can lead to impaired protein synthesis but does not impact creatinine levels. *Leucine* - **Leucine** is another **essential amino acid** and a **branched-chain amino acid (BCAA)** crucial for muscle protein synthesis and repair. - It does not serve as a direct precursor for creatinine or creatine. *Histidine* - **Histidine** is an **essential amino acid** and a precursor for **histamine** and other important compounds, but not creatinine or creatine. - It plays roles in immune response and gastric acid secretion.

Q: C4, C5, and N7 in the purine ring are derived from which of the following?

Glycine. ***Glycine*** - The entire **glycine molecule** contributes C4, C5, and N7 to the purine ring structure. - This amino acid provides a significant portion of the backbone to the imidazole ring within the purine. *Aspartate* - **Aspartate** contributes N1 to the purine ring. - It does not involve C4, C5, or N7, which are distinct atoms within the purine molecule. *CO₂* - **CO₂** contributes C6 to the purine ring through a carboxylation step. - It is not involved in providing the atoms at positions C4, C5, or N7. *Glutamine* - The nitrogen atoms N3 and N9 in the purine ring are derived from the **amide nitrogen of glutamine**. - Glutamine's contributions are different from the carbons and nitrogen provided by glycine.

Q: What type of bond is involved in the side chain linkage of proteoglycans?

Covalent. ***Covalent*** - Proteoglycans are formed by **glycosaminoglycan (GAG)** chains that are covalently linked to a protein core. - Specifically, an **O-glycosidic bond** forms between a xylose residue on the GAG chain and a serine residue on the core protein. *Hydrogen bond* - **Hydrogen bonds** are weaker intermolecular forces that stabilize protein secondary structures and interactions between water molecules. - They are not strong enough to form the primary structural linkage between the GAG chains and the core protein in proteoglycans. *Electrostatic bond* - **Electrostatic bonds**, or ionic bonds, involve attraction between oppositely charged ions. While proteoglycans have many charged groups, these bonds are not the primary linkage connecting the GAG chains to the protein core. - They contribute to the overall structure and interactions of proteoglycans with other molecules but do not form the main side chain linkage. *Van-der Waal's force* - **Van der Waals forces** are weak, short-range intermolecular forces that arise from temporary fluctuations in electron distribution. - These forces play a role in tertiary and quaternary protein structure and molecular packing, but they are far too weak to establish the covalent attachments of GAG chains to the proteoglycan core protein.

Q: Which of the following statements about the enzymes involved in the conversion of glucose to glucose-6-phosphate in glycolysis is true?

Glucokinase is induced by insulin.. ***Glucokinase is induced by insulin.*** - **Insulin** promotes glucose uptake and utilization in the liver and pancreatic beta cells, where glucokinase is primarily expressed. - Induction of **glucokinase** by insulin ensures that glucose is efficiently phosphorylated and trapped within hepatocytes when blood glucose levels are high. - This is a key mechanism for postprandial glucose homeostasis. *Incorrect: Hexokinase is specific for glucose.* - **Hexokinase** is NOT specific for glucose; it can phosphorylate various hexoses including **fructose**, **mannose**, and **galactose**. - Its broad substrate specificity distinguishes it from glucokinase, which has greater specificity for glucose. *Incorrect: Glucokinase is inhibited by glucose-6-phosphate.* - Unlike **hexokinase**, which is subject to product inhibition by glucose-6-phosphate, **glucokinase is NOT inhibited** by its product. - This lack of feedback inhibition allows glucokinase to continue phosphorylating glucose even when glucose-6-phosphate levels are elevated, which is appropriate for its role as a glucose sensor in liver and pancreatic beta cells. *Incorrect: Hexokinase has a high Km for glucose.* - **Hexokinase** has a **low Km** (~0.1 mM) for glucose, meaning it has high affinity and is saturated at normal blood glucose levels. - In contrast, **glucokinase** has a high Km (~10 mM), allowing it to respond proportionally to changes in blood glucose concentration.

Q: First mediator of inflammation to be released is

Histamine. ***Histamine*** - Histamine is the **first mediator of inflammation released** by mast cells and basophils during an allergic or inflammatory response [1][3]. - It promotes **vasodilation** and increased vascular permeability, leading to typical symptoms of inflammation [1][2]. *PAF* - Platelet-activating factor (PAF) is released later in the inflammatory process and is primarily involved in **amplifying** the response rather than initiating it. - It plays a role in **platelet aggregation** and acting on vascular smooth muscle but is not the first released mediator. *Nitric oxide* - Nitric oxide is produced by endothelial cells and plays a role in **vascular relaxation and inflammation**, but it is not among the first mediators released. - It is involved in more **regulatory functions** in the inflammatory response rather than the initial trigger. *IL-1* - Interleukin-1 (IL-1) is a cytokine that is important for the **inflammatory response**, but it is produced after the initial release of mediators like histamine [2]. - It is primarily secreted by **activated macrophages** and contributes to the **amplification** of the immune response [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 84-85. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, p. 101. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 93-94.

Q: High volume of distribution is primarily determined by:

High lipid solubility. ***High lipid solubility***- Highly **lipid-soluble** drugs readily cross biological membranes and distribute extensively into tissues, including adipose tissue, CNS, and intracellular compartments, leading to a **high volume of distribution (Vd)** [1, 2].- This property allows the drug to move out of the bloodstream and into various body compartments, increasing the apparent volume in which the drug is dissolved [1].*High plasma protein binding*- **High plasma protein binding** generally **restricts** drug distribution to tissues because only the **unbound (free) fraction** can diffuse across capillary membranes into interstitial fluid and cells [1].- This typically leads to a **lower Vd**, as the drug is largely retained within the plasma compartment.*Elimination rate*- The **elimination rate** determines how quickly the drug is removed from the body, affecting the **duration of action** rather than the extent of distribution.- It influences drug concentration changes over time but does not directly determine the physical space (volume) into which the drug distributes.*Half-life of the drug*- The **half-life (t½)** is the time required for drug concentration to reduce by half, and it is **determined by** both Vd and clearance (t½ = 0.693 × Vd/CL).- Half-life is a **consequence** of Vd and clearance, not a primary determinant of how widely a drug distributes [3].

Q: Which drug is not administered as a transdermal patch?

Morphine. ***Morphine*** - **Morphine** is generally not administered transdermally due to its **poor lipid solubility** [1] and **large molecular size**, which limit its ability to penetrate the skin effectively. - While experimental patches have been developed, they are **not widely available** or commonly used in clinical practice for systemic delivery. *Fentanyl* - **Fentanyl** is a potent opioid that is commonly administered via a **transdermal patch** for chronic pain management [2]. - Its **high lipid solubility** and small molecular size allow it to be effectively absorbed through the skin, providing sustained analgesia. *Clonidine* - **Clonidine** is an alpha-2 adrenergic agonist available as a **transdermal patch** for the treatment of **hypertension**. - The patch provides a **continuous and steady release** of the drug, leading to consistent blood pressure control. *Diclofenac* - **Diclofenac** is a non-steroidal anti-inflammatory drug (NSAID) available in **transdermal patch** formulations for topical pain relief. - These patches are used for localized pain conditions like **osteoarthritis** and provide targeted drug delivery with reduced systemic side effects.

Q: Thymidine is responsible for resistance to which antibiotic ?

Sulfonamide. ***Sulfonamide*** - **Thymidine** can contribute to **sulfonamide resistance** because sulfonamides interfere with **folate metabolism** and the subsequent synthesis of purines and pyrimidines, including thymidine. - An excess of thymidine can bypass the metabolic block caused by sulfonamides, allowing bacteria to continue DNA synthesis and grow. *Erythromycin* - **Erythromycin** resistance is primarily mediated by **methylation of ribosomal RNA**, which prevents the antibiotic from binding to the 50S ribosomal subunit. - It does not directly involve thymidine or the folate synthesis pathway. *Tetracycline* - Resistance to **tetracyclines** is commonly due to **efflux pumps** that actively pump the drug out of the bacterial cell or **ribosomal protection proteins** that prevent tetracycline binding. - Thymidine production or metabolism is not a mechanism of tetracycline resistance. *Nitrofurantoin* - **Nitrofurantoin** resistance typically involves **mutations** in bacterial enzymes (like **nitrofuran reductase**) that are responsible for activating the drug into its active form. - These mutations prevent the drug from becoming bactericidal, and thymidine does not play a role in this mechanism.

Q: What is the primary process involved in Wallerian degeneration?

Nerve degeneration. ***Nerve degeneration*** - **Wallerian degeneration** specifically refers to the process of **axon degeneration** that occurs distal to the site of injury when a nerve fiber is severed [2]. - This process involves the breakdown of the **axon** and its myelin sheath, leading to loss of function [1]. *Muscle degeneration* - While prolonged nerve degeneration can lead to muscle **atrophy** due to denervation, **muscle degeneration itself** is not the primary process of Wallerian degeneration. - Wallerian degeneration focuses on the **nerve itself**, not the target tissue. *Nerve regeneration* - **Nerve regeneration** is the process where damaged nerves attempt to regrow and re-establish connections [2]. - This is a subsequent, and not always successful, event that can occur *after* Wallerian degeneration has cleared the debris [1]. *Muscle regeneration* - **Muscle regeneration** refers to the repair and regrowth of damaged muscle tissue, typically involving satellite cells. - It is unrelated to Wallerian degeneration, which is a process affecting the **nerve**. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 697-698. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 109-110.

Question 1

Creatinine is formed from -

Accepted Answer

Creatine

Answer

Lysine

Answer

Leucine

Answer

Histidine

Question 2

C4, C5, and N7 in the purine ring are derived from which of the following?

Accepted Answer

Glycine

Answer

CO₂

Answer

Aspartate

Answer

Glutamine

Question 3

What type of bond is involved in the side chain linkage of proteoglycans?

Accepted Answer

Covalent

Answer

Hydrogen bond

Answer

Electrostatic bond

Answer

Van-der Waal's force

Question 4

Which of the following statements about the enzymes involved in the conversion of glucose to glucose-6-phosphate in glycolysis is true?

Accepted Answer

Glucokinase is induced by insulin.

Answer

Hexokinase is specific for glucose.

Answer

Glucokinase is inhibited by glucose-6-phosphate.

Answer

Hexokinase has a high Km for glucose.

Question 5

Which of the following is not considered an example of excess tissue growth?

Accepted Answer

Granulation tissue

Answer

Neoplasia

Answer

Hyperplasia

Answer

Fibrosis

Question 6

First mediator of inflammation to be released is

Accepted Answer

Histamine

Answer

Nitric oxide

Answer

PAF

Answer

IL-1

Question 7

High volume of distribution is primarily determined by:

Accepted Answer

High lipid solubility

Answer

High plasma protein binding

Answer

Elimination rate

Answer

Half-life of the drug

Question 8

Which drug is not administered as a transdermal patch?

Accepted Answer

Morphine

Answer

Fentanyl

Answer

Clonidine

Answer

Diclofenac

Question 9

Thymidine is responsible for resistance to which antibiotic ?

Accepted Answer

Sulfonamide

Answer

Erythromycin

Answer

Tetracycline

Answer

Nitrofurantoin

Question 10

What is the primary process involved in Wallerian degeneration?

Accepted Answer

Nerve degeneration

Answer

Muscle degeneration

Answer

Nerve regeneration

Answer

Muscle regeneration

NEET-PG 2015

Biochemistry

Pathology

Pharmacology

Physiology