NEET-PG 2018 Practice Questions

Q: Identify the artery labeled as 'X' in the provided angiography anatomy image.

Superior mesenteric artery. ***Superior mesenteric artery*** - The image displays a selective angiogram highlighting an artery branching off the **aorta** in the abdominal region and supplying multiple loops of bowel, characteristic of the superior mesenteric artery. - The location and extensive branching pattern supplying various abdominal structures confirm its identity as the **superior mesenteric artery**, which typically arises below the celiac trunk. *Subclavian artery* - The **subclavian artery** is located in the chest and shoulder region, supplying the upper limbs and parts of the head and neck. - Its anatomical location and distribution are distinctly different from the abdominal artery shown in the image. *Celiac trunk* - The **celiac trunk** is an earlier branch off the aorta, typically arising just below the diaphragm, and it branches into the splenic, left gastric, and common hepatic arteries. - The artery labeled 'X' arises lower than where the celiac trunk would typically originate and demonstrates a different branching pattern. *Brachiocephalic trunk* - The **brachiocephalic trunk** (also known as the innominate artery) is a major artery in the upper chest, typically the first branch off the aortic arch. - It supplies blood to the right arm and head, not abdominal organs, making it anatomically incorrect for the artery labeled 'X'.

Q: Modified Mallampati grading is used in assessment of -

Difficulty of intubation. ***Difficulty of intubation*** - The **Modified Mallampati score** assesses the visibility of pharyngeal structures, which directly correlates with the ease or difficulty of performing **direct laryngoscopy** and **endotracheal intubation**. - A higher Mallampati class (e.g., III or IV) indicates less visibility of the soft palate, uvula, and pillars, suggesting a more difficult airway and increased likelihood of a challenging intubation. *Obstruction of the airway* - While a high Mallampati score might indirectly indicate potential for **airway obstruction** during anesthesia due to anatomical features, its primary purpose is not to diagnose or quantify existing airway obstruction. - Airway obstruction is more directly assessed by monitoring breathing sounds, respiratory effort, and oxygen saturation. *Aspiration-related death* - The **Mallampati score** helps predict the difficulty of securing the airway but does not directly assess the risk of **aspiration**. - Aspiration risk is evaluated based on factors like gastric contents, gag reflex, and patient positioning. *Endotracheal intubation procedure* - The **Modified Mallampati score** helps in **planning the intubation procedure** by identifying potential difficulties but is not a measure of the intubation procedure itself. - It is a **pre-procedure assessment tool** to gauge airway anatomy, not a description or evaluation of the steps involved in endotracheal intubation.

Q: Murphy's eye is seen in -

Endotracheal tube. ***Endotracheal tube*** - A Murphy's eye is a **hole on the side** of the endotracheal tube, near the distal tip, opposite the main bevel. - Its purpose is to provide an **alternative pathway for gas flow** if the main opening of the tube becomes occluded by secretions or contact with the tracheal wall. *Flexible laryngoscope* - This device is used for **visualizing the airway** and guiding endotracheal tube placement, not for maintaining it. - It does not have a Murphy's eye as it is a diagnostic/guiding tool, not a conduit for ventilation. *Laryngeal Mask Airway (LMA)* - An LMA is a **supraglottic airway device** that creates a seal around the laryngeal inlet. - It does not have a Murphy's eye as its design doesn't involve intralaryngeal distal tip placement where occlusion by the tracheal wall is a primary concern. *Macintosh laryngoscope* - This is a type of **laryngoscope blade** used to visualize the vocal cords during intubation. - It is an instrument for intubation, not the airway device itself, and therefore does not have a Murphy's eye.

Q: Galactosemia is due to deficiency of which enzyme?

Galactose-1-phosphate uridyltransferase. ***Galactose-1-phosphate uridyltransferase*** - Deficiency of **galactose-1-phosphate uridyltransferase (GALT)** leads to the most severe form, **classic galactosemia**. - This enzyme is crucial for converting **galactose-1-phosphate** to **glucose-1-phosphate** in the Leloir pathway. *HGPRT* - **HGPRT** (hypoxanthine-guanine phosphoribosyltransferase) deficiency causes **Lesch-Nyhan syndrome**, a distinct metabolic disorder. - Lesch-Nyhan syndrome is characterized by **hyperuricemia**, neurological dysfunction, and self-mutilation, unrelated to galactose metabolism. *Galactokinase* - Deficiency of **galactokinase** causes Type II galactosemia, a milder form than classic galactosemia. - This defect primarily leads to **cataracts** due to galactitol accumulation but does not result in the severe systemic issues seen in classic galactosemia. *Epimerase* - Deficiency of **UDP-galactose-4'-epimerase** (GALE) causes Type III galactosemia, which has a variable clinical presentation from mild to severe. - While involved in galactose metabolism, it's not the primary enzyme deficient in the most common and severe form of **galactosemia**.

Q: Which drug regimen is given to a pregnant woman with HIV infection?

All of the options. ***All of the options*** - All listed regimens—**Tenofovir disoproxil fumarate (TDF) with emtricitabine (FTC)**, **TDF with lamivudine (3TC)**, and **Abacavir (ABC) with lamivudine (3TC)**—are commonly used and generally safe combinations of **nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs)** in pregnant women with HIV. - The choice of regimen depends on factors such as individual patient characteristics, viral resistance patterns, and potential side effects, but all mentioned regimens are considered **first-line options** in various guidelines for preventing mother-to-child transmission (PMTCT). *Tenofovir disoproxil fumarate with emtricitabine* - This combination is a common and effective **NRTI backbone** for HIV treatment, including in pregnancy, offering good efficacy and a generally favorable safety profile. - It is frequently paired with a third agent (e.g., a **non-nucleoside reverse transcriptase inhibitor (NNRTI)** or an **integrase strand transfer inhibitor (INSTI)**) as part of a highly active antiretroviral therapy (HAART) regimen. *Tenofovir disoproxil fumarate with lamivudine* - This is another widely used and effective **NRTI combination** and is also a recommended backbone for pregnant women with HIV. - While similar to TDF/FTC, some guidelines might prefer one over the other based on specific regional recommendations or drug availability. *Abacavir with lamivudine* - **Abacavir/lamivudine** is a well-established NRTI combination that is safe and effective in pregnancy, provided the mother is **HLA-B*5701 negative** to avoid hypersensitivity reactions. - It is considered a suitable alternative to TDF-containing regimens, especially when there are contraindications or intolerances to TDF.

Q: What is the most common symptom treated with hormone therapy (HT) in menopausal women?

Hot flashes. ***Hot flashes*** - **Vasomotor symptoms**, including hot flashes and night sweats, are the most frequent and bothersome symptoms experienced by menopausal women, leading them to seek medical attention and hormone therapy. - HT is highly effective in reducing the frequency and severity of hot flashes by stabilizing **thermoregulation** in the hypothalamus. *Breast cancer* - **Breast cancer** is a potential risk associated with hormone therapy, particularly with combined estrogen-progestin therapy, not a symptom treated by HT. - Women with a history of breast cancer or those at high risk are generally advised against HT due to this increased risk. *Endometriosis* - While **estrogen-dependent diseases** like endometriosis can be aggravated by HRT, endometriosis itself is a condition that typically improves after menopause. - HT is not used to treat endometriosis; in certain cases, it might be used to manage menopausal symptoms in women with a history of endometriosis after specific surgical interventions. *Uterine bleeding* - **Uterine bleeding** can be a side effect of hormone therapy, especially when progestin is not adequately balanced with estrogen in women with a uterus. - Abnormal uterine bleeding is a symptom that requires investigation to rule out other causes, and it is not a primary symptom treated by HT.

Q: What is mechanism of action of colchicine in acute gout?

Inhibition of leukocyte migration and microtubule function. ***Inhibition of leukocyte migration and microtubule function*** - Colchicine works by disrupting **microtubule polymerization**, which interferes with the **motility and activity of neutrophils and other inflammatory cells** [1]. - Its anti-inflammatory effect in acute gout is primarily due to the inhibition of **leukocyte migration and phagocytosis of urate crystals**, thereby reducing the inflammatory response [1]. - The mechanism involves binding to **tubulin**, preventing microtubule assembly, which affects multiple cellular processes including chemotaxis and cell division [1]. *Inhibition of purine metabolism* - This mechanism is associated with drugs like **allopurinol**, which inhibit **xanthine oxidase** to reduce uric acid production [2]. - Colchicine does not directly inhibit **purine metabolism** or uric acid synthesis; its effect is on the inflammatory response, not uric acid formation [1]. *Inhibition of uric acid conversion* - This mechanism refers to **uricosuric agents** like probenecid that increase renal excretion of uric acid. - Colchicine's action is primarily anti-inflammatory, not related to uric acid metabolism or excretion [1]. *Migration of leukocytes* - While this is partially correct, as colchicine does inhibit **leukocyte migration**, this option is incomplete. - The complete mechanism must include its action as a **microtubule inhibitor**, which is the underlying basis for all its cellular effects including inhibition of migration, phagocytosis, and inflammatory mediator release [1].

Q: Tadalafil should not be given with:

Vasodilators. ***Vasodilators*** - Tadalafil is a **phosphodiesterase-5 (PDE5) inhibitor** that causes **vasodilation** by increasing cGMP levels, leading to smooth muscle relaxation. - Combining tadalafil with other **vasodilators**, particularly **nitrates**, can lead to a severe and potentially life-threatening drop in **blood pressure (hypotension)**. *Antibiotics* - While some antibiotics, particularly macrolides or azoles, can inhibit **CYP3A4** and increase tadalafil levels, this interaction is typically managed by dose adjustments rather than an absolute contraindication. - The primary concern with administering antibiotics and tadalafil concurrently is **pharmacokinetic interactions**, not a direct pharmacodynamic synergy leading to acute, severe adverse effects. *Vasoconstrictors* - Vasoconstrictors have an effect **opposite** to tadalafil, as they narrow blood vessels. - There is generally no contraindication for co-administration, and in fact, tadalafil's **vasodilatory effects** could potentially **counteract** some of the vasoconstriction, although concurrent use is not typically recommended for erectile dysfunction. *Valproate* - **Valproate** is an **anticonvulsant** and mood stabilizer, and there is no significant or clinically relevant drug interaction established with tadalafil. - It does not share common metabolic pathways or pharmacodynamic effects that would lead to dangerous interactions with tadalafil.

Q: Where will be the placement location for Auditory Brainstem Implant?

Recess of 4th ventricle. ***Recess of 4th ventricle*** - An **Auditory Brainstem Implant (ABI)** is placed on the **cochlear nucleus** in the brainstem, which is anatomically located near the **lateral recess of the fourth ventricle**. - The implant stimulates these nuclei directly, bypassing the damaged auditory nerve in patients who cannot benefit from cochlear implants. *Scala tympani* - The **scala tympani** is the location for electrode placement in a **cochlear implant**, not an auditory brainstem implant. - Cochlear implants stimulate the intact auditory nerve within the cochlea. *IAC* - The **internal auditory canal (IAC)** houses the auditory and facial nerves, but it is not the target site for an ABI. - The ABI is designed for patients whose auditory nerve (which passes through the IAC) is non-functional. *Back of ear* - The "back of the ear" is the general area where the **external processor of a cochlear implant** or a **bone-anchored hearing aid** is typically worn, not the surgical placement site for an ABI. - The ABI's internal component is surgically placed within the cranium.

Question 1

Identify the artery labeled as 'X' in the provided angiography anatomy image.

Accepted Answer

Superior mesenteric artery

Answer

Subclavian artery

Answer

Celiac trunk

Answer

Brachiocephalic trunk

Question 2

Modified Mallampati grading is used in assessment of -

Accepted Answer

Difficulty of intubation

Answer

Obstruction of the airway

Answer

Aspiration-related death

Answer

Endotracheal intubation procedure

Question 3

Murphy's eye is seen in -

Accepted Answer

Endotracheal tube

Answer

Flexible laryngoscope

Answer

Laryngeal Mask Airway (LMA)

Answer

Macintosh laryngoscope

Question 4

Galactosemia is due to deficiency of which enzyme?

Accepted Answer

Galactose-1-phosphate uridyltransferase

Answer

HGPRT

Answer

Galactokinase

Answer

Epimerase

Question 5

Which drug regimen is given to a pregnant woman with HIV infection?

Accepted Answer

All of the options

Answer

Tenofovir disoproxil fumarate with emtricitabine

Answer

Tenofovir disoproxil fumarate with lamivudine

Answer

Abacavir with lamivudine

Question 6

What is the most common symptom treated with hormone therapy (HT) in menopausal women?

Accepted Answer

Hot flashes

Answer

Endometriosis

Answer

Uterine bleeding

Answer

Breast cancer

Question 7

A 1-year-old child weighing 6 kg is suffering from acute gastroenteritis with signs of sunken eyes and skin pinch returning to normal very rapidly. What will be your management?

Accepted Answer

RL infusion 180 ml in the first hour followed by 270 ml in the next 5 hours

Answer

RL infusion 120 ml in the first hour followed by 360 ml in the next 5 hours

Answer

RL infusion 180 ml in the first hour followed by 480 ml in the next 5 hours

Answer

RL infusion 240 ml in the first hour followed by 360 ml in the next 5 hours

Question 8

What is mechanism of action of colchicine in acute gout?

Accepted Answer

Inhibition of leukocyte migration and microtubule function

Answer

Inhibition of purine metabolism

Answer

Inhibition of uric acid conversion

Answer

Migration of leukocytes

Question 9

Tadalafil should not be given with:

Accepted Answer

Vasodilators

Answer

Antibiotics

Answer

Vasoconstrictors

Answer

Valproate

Question 10

Where will be the placement location for Auditory Brainstem Implant?

Accepted Answer

Recess of 4th ventricle

Answer

Scala tympani

Answer

IAC

Answer

Back of ear

NEET-PG 2018

Anatomy

Anesthesiology

Biochemistry

Obstetrics and Gynecology

Pediatrics

Pharmacology

Surgery