NEET-PG 2017 Practice Questions

Q: Name the antigen marked as X determining blood group A.

N-Acetyl-Galactosamine. ***N-Acetyl-Galactosamine*** - Blood group A antigens are formed by the addition of **N-acetylgalactosamine** to the H antigen precursor molecule on the surface of red blood cells. - This sugar modification is catalyzed by the **A transferase enzyme**, which is specific for N-acetylgalactosamine. *N-Acetyl-Glucosamine* - While N-acetylglucosamine is a component of many glycans, it is not the terminal sugar that defines the **blood group A antigen**. - **N-acetylglucosamine** is a key building block for the H antigen and other blood group precursors, but not the specific modifying sugar for A. *Dermatan sulphate* - **Dermatan sulfate** is a **glycosaminoglycan** primarily found in connective tissues, skin, and blood vessels. - It plays a role in wound healing and coagulation, but is not involved in **ABO blood group determination**. *Keratan sulfate* - **Keratan sulfate** is another **glycosaminoglycan** found in cartilage, cornea, and bone. - It contributes to tissue hydration and structural integrity, but it is not part of the **ABO blood group antigens**.

Q: Which of the following will occur on efferent arteriolar constriction?

Increased GFR. ***Increased GFR*** - **Efferent arteriolar constriction** increases resistance to blood flow out of the glomerulus, causing blood to 'back up' and increase the **glomerular hydrostatic pressure (PGC)** - Higher **glomerular hydrostatic pressure** leads to increased net filtration pressure, which directly results in **increased glomerular filtration rate (GFR)** - This is the **primary and most clinically significant effect** of efferent arteriolar constriction - The increased PGC helps maintain GFR even when renal blood flow decreases slightly *Decreased GFR* - This is incorrect because **efferent arteriolar constriction** increases glomerular hydrostatic pressure, thereby **increasing GFR**, not decreasing it - Only severe efferent constriction that critically reduces renal plasma flow would eventually decrease GFR - The immediate and primary effect is always an increase in GFR *Increase flow in vasa recta* - This is incorrect; **efferent arteriolar constriction** actually **decreases** flow to the vasa recta - The constriction reduces blood flow exiting the glomerulus, which means less blood reaches the downstream peritubular capillaries and vasa recta - This decreased perfusion of the vasa recta can enhance urine concentration by reducing washout of the medullary concentration gradient *Decreased flow in vasa recta* - While this is physiologically true (efferent constriction does reduce peritubular and vasa recta blood flow), it is **not the primary or most significant effect** being tested - In the context of efferent arteriolar constriction, the **increased GFR** is the dominant and most clinically relevant consequence - The question asks "which will occur" expecting the primary hemodynamic effect on glomerular function - Decreased vasa recta flow is a secondary consequence, whereas increased GFR is the direct and immediate result

Q: The A wave in His bundle electrogram shows presence of:

Atrial depolarization. ***Atrial depolarization*** - The **A wave** in a His bundle electrogram represents the electrical activity corresponding to **atrial depolarization**. This is the first electrical event recorded prior to ventricular activation. - It signifies the activation of the atria, preceding the impulse transmission through the AV node and His bundle. *Atrial repolarization* - **Atrial repolarization** is generally not clearly visible as a distinct wave in a His bundle electrogram, as its electrical signal is usually small and often obscured by the much larger QRS complex from ventricular depolarization. - The T-wave on a surface ECG corresponds to ventricular repolarization, and there isn't a directly analogous, easily identifiable wave for atrial repolarization in standard His bundle recordings. *AV node activation* - **AV node activation** itself is a slow electrical process that does not generate a distinct, sharply defined wave in the His bundle electrogram. - The time taken for conduction through the AV node is represented by the **AH interval**, which is the duration between the A wave (atrial activation) and the H wave (His bundle activation). *Atrial depolarization to AV node activation* - This option describes a **duration or interval**, specifically the **AH interval**, which reflects the time from the beginning of atrial activation (A wave) to the beginning of His bundle activation (H wave) and primarily represents AV nodal conduction. - The A wave itself signifies a specific electrical event (**atrial depolarization**), not the entire period from atrial depolarization up to AV node activation.

Q: Which of the following is correct about the pressure volume loop of left ventricle?

Aortic valve opens at 2. ***Aortic valve opens at 2*** - Point 2 marks the moment when **left ventricular pressure exceeds aortic pressure**, causing the aortic valve to open. - This is the transition point between **isovolumetric contraction** (1→2) and **ventricular ejection** (2→3). - From point 2 onwards, blood is actively ejected from the left ventricle into the aorta during **systole**. *1 to 2 indicates isovolumetric relaxation* - The phase from point 1 to point 2 shows an increase in **pressure at constant volume**, which represents **isovolumetric contraction**, not relaxation. - During **isovolumetric contraction**, both the mitral and aortic valves are closed, and the ventricle contracts without changing volume, building up pressure. - **Isovolumetric relaxation** occurs from point 3 to point 4, where pressure drops at constant volume after the aortic valve closes. *2 to 3 indicates ventricular diastole* - The period from point 2 to point 3 represents **ventricular ejection**, which is part of **ventricular systole**, not diastole. - During this phase, the aortic valve is open, and blood is being ejected from the left ventricle into the aorta while ventricular volume decreases. - **Ventricular diastole** includes isovolumetric relaxation (3→4) and ventricular filling (4→1). *Pulmonic valve opens at 3* - Point 3 represents the **closure of the aortic valve** at the end of ventricular ejection, not its opening. - The **pulmonic valve** is part of the right ventricular circuit, not the left ventricle; it opens during right ventricular ejection into the pulmonary artery. - This question specifically addresses the **left ventricular** pressure-volume loop.

Q: Which of the following is correct about the point marked $Z$ on the cardiac cycle?

Aortic valve opens. ***Aortic valve opens*** - At point Z, the **left ventricular pressure (LVP)** curve (solid red line) intersects and surpasses the **aortic pressure (AP)** curve (dashed line), marking the moment the **aortic valve opens** and blood begins to be ejected into the aorta. - This event signifies the transition from **isovolumetric contraction** to rapid **ventricular ejection phase** during systole. *Mitral valve opens* - The **mitral valve opens** during diastole, when the **left ventricular pressure (LVP)** falls below the **left atrial pressure (LAP)**, allowing ventricular filling. - This event would typically occur much later in the cardiac cycle, around point 5 or 6, after the aortic valve closes. *Tricuspid valve opens* - The **tricuspid valve opens** during diastole when the right ventricular pressure falls below the right atrial pressure. This event is not directly depicted for the left side of the heart in this Wigger's diagram. - It plays a role in right heart filling and is not related to the events occurring at point Z in the left heart cycle. *Mid systolic click* - A **mid-systolic click** is typically associated with **mitral valve prolapse**, occurring during mid-systole as the mitral leaflets prolapse into the left atrium. - Point Z represents the beginning of ejection, not a valvular abnormality.

Q: The pressure-volume loop of left ventricle tracing of the patient indicates:

Diastolic dysfunction. ***Diastolic dysfunction*** - The pressure-volume loop for the patient is shifted to the **left and upward** relative to the control loop, indicating higher left ventricular pressure for a given volume during diastole. - The **end-diastolic pressure-volume relationship (EDPVR)**, shown by the lower right curve, is steeper for the patient, meaning the ventricle is **stiffer or less compliant** during filling. *Systolic dysfunction* - Systolic dysfunction would be characterized by a **reduced stroke volume** (narrower loop horizontally) and a **lower ejection fraction**, often accompanied by a shift to the right due to increased end-diastolic volume. - The **end-systolic pressure-volume relationship (ESPVR)**, which represents contractility, would be shifted downwards and to the right in systolic dysfunction, indicating impaired contractility. *Decreased atrial compliance* - Decreased atrial compliance would primarily affect **atrial pressures** and the force of atrial contraction, which might indirectly impact ventricular filling, but is not directly represented by the ventricular pressure-volume loop's morphology in this manner. - The primary indicator of atrial compliance is often via atrial pressure-volume relationships or specific atrial function studies, not the ventricular loop's overall shift. *Increased atrial compliance* - Increased atrial compliance would allow the atria to accommodate more volume at lower pressures, potentially *improving* ventricular filling if the ventricle itself is compliant, but it would not explain the **elevated ventricular diastolic pressures** seen in the patient's tracing. - This condition would typically lead to lower atrial pressures, which is the opposite of what would contribute to the observed ventricular diastolic dysfunction.

Q: Which of the following dissociation curve mentioned is for myoglobin?

Green. ***Green*** - The **green curve** represents **myoglobin**, which has a much higher affinity for oxygen than hemoglobin. It binds oxygen at very low partial pressures and releases it only when oxygen levels are significantly depleted, as in active muscle tissue. - Myoglobin's dissociation curve is typically **hyperbolic** due to its single oxygen-binding site, reflecting its role in oxygen storage rather than transport. *Purple* - The **purple curve** represents normal **hemoglobin**, which exhibits a **sigmoidal** shape due to its **cooperative binding** of oxygen. This allows hemoglobin to efficiently load oxygen in the lungs and unload it in tissues. - Hemoglobin has a lower oxygen affinity than myoglobin and is designed for oxygen transport, adapting its binding based on oxygen partial pressure. *Red* - The **red curve** likely represents a **right-shifted hemoglobin dissociation curve**, indicating **decreased oxygen affinity**. This shift facilitates oxygen unloading to tissues. - Right shifts occur due to increased temperature, decreased pH (Bohr effect), increased 2,3-DPG, or increased CO₂. These physiological adaptations help deliver more oxygen to metabolically active tissues. *None* - This option is incorrect because the **green curve** clearly represents the characteristic oxygen dissociation curve for myoglobin.

Q: Which protein is responsible for the effect shown in RBC marked as $X$ ?

Band 3 protein. ***Band 3 protein*** - The image indicates that **X** facilitates the exchange of **bicarbonate (HCO₃⁻)** out of the red blood cell and **chloride (Cl⁻)** into the red blood cell, a process known as the **chloride shift** or **Hamburger phenomenon**. - This specific transporter is the **Band 3 anion exchanger 1 (AE1)**, also known as **Band 3 protein**, which is crucial for maintaining electrical neutrality during CO₂ transport. - **Band 3 protein** is the most abundant membrane protein in RBCs and accounts for approximately **25% of RBC membrane protein**. *Spectrin* - Spectrin is a **cytoskeletal protein** that forms a structural network on the inner surface of the RBC membrane. - It provides **mechanical stability and flexibility** to RBCs but does not participate in anion exchange. - Defects in spectrin cause hereditary spherocytosis and elliptocytosis. *Glycophorin* - Glycophorins are **surface glycoproteins** that carry many of the carbohydrate groups on the RBC surface. - They play roles in **membrane stability and blood group antigens** (MN blood group system). - They do not function as anion exchangers or transporters for bicarbonate/chloride. *Ankyrin* - Ankyrin is an **anchoring protein** that links the cytoskeletal protein spectrin to Band 3 protein. - It provides **structural support** and maintains membrane integrity but does not transport ions. - Ankyrin deficiency can cause hereditary spherocytosis.

Q: A head trauma patient is shown below. Diagnosis is?

Decerebrate rigidity. ***Decerebrate rigidity*** - The image shows **extension and internal rotation of the arms** with pronation, and **extension of the legs** with plantar flexion. This posture is characteristic of decerebrate rigidity. - This posturing indicates severe damage to the **brainstem**, specifically below the red nucleus, which is a more ominous sign than decorticate posturing. *Decorticate rigidity* - Decorticate rigidity would present with **flexion of the arms** at the elbows and wrists (to the core), adduction of the shoulders, and extension of the lower limbs. - This posturing is typically due to damage to the **corticospinal tracts above the red nucleus** (e.g., cerebral hemispheres, internal capsule, thalamus). *Acute dystonia* - Acute dystonia involves sustained or repetitive muscle contractions leading to **twisting and repetitive movements** or abnormal fixed postures. - It often affects specific muscle groups, such as the neck (torticollis), eyes (oculogyric crisis), or trunk, and is not typically a generalized rigidity pattern seen in head trauma as extensively as shown. *Catatonia* - Catatonia is a neuropsychiatric syndrome characterized by a variety of motor or behavioral abnormalities, including **immobility, mutism, stupor, waxy flexibility, and negativism**. - While it can involve abnormal posturing, it is a conscious state often associated with psychiatric conditions or general medical conditions, and doesn't manifest as the specific brainstem-related rigidity evident in the image.

Question 1

What is incorrect about the shown basement membrane?

Accepted Answer

Only molecules which are larger than 50,000 Daltons can traverse the filtration barrier

Answer

Part of filtration barrier

Answer

Stained with PAS

Answer

It has Lamina Densa and Lamina Rara

Question 2

Name the antigen marked as X determining blood group A.

Accepted Answer

N-Acetyl-Galactosamine

Answer

N-Acetyl-Glucosamine

Answer

Dermatan sulphate

Answer

Keratan sulfate

Question 3

Which of the following will occur on efferent arteriolar constriction?

Accepted Answer

Increased GFR

Answer

Decreased GFR

Answer

Increase flow in vasa recta

Answer

Decreased flow in vasa recta

Question 4

The A wave in His bundle electrogram shows presence of:

Accepted Answer

Atrial depolarization

Answer

Atrial repolarization

Answer

AV node activation

Answer

Atrial depolarization to AV node activation

Question 5

Which of the following is correct about the pressure volume loop of left ventricle?

Accepted Answer

Aortic valve opens at 2

Answer

1 to 2 indicates isovolumetric relaxation

Answer

2 to 3 indicates ventricular diastole

Answer

Pulmonic valve opens at 3

Question 6

Which of the following is correct about the point marked $Z$ on the cardiac cycle?

Accepted Answer

Aortic valve opens

Answer

Mitral valve opens

Answer

Tricuspid valve opens

Answer

Mid systolic click

Question 7

The pressure-volume loop of left ventricle tracing of the patient indicates:

Accepted Answer

Diastolic dysfunction

Answer

Systolic dysfunction

Answer

Decreased atrial compliance

Answer

Increased atrial compliance

Question 8

Which of the following dissociation curve mentioned is for myoglobin?

Accepted Answer

Green

Answer

Purple

Answer

Red

Answer

None

Question 9

Which protein is responsible for the effect shown in RBC marked as $X$ ?

Accepted Answer

Band 3 protein

Answer

Spectrin

Answer

Glycophorin

Answer

Ankyrin

Question 10

A head trauma patient is shown below. Diagnosis is?

Accepted Answer

Decerebrate rigidity

Answer

Decorticate rigidity

Answer

Acute dystonia

Answer

Catatonia

NEET-PG 2017

Anatomy

Biochemistry

Physiology

Surgery