NEET-PG 2018 Practice Questions

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: Phenylketonuria is due to deficiency of:

Phenylalanine hydroxylase (PAH). ***Phenylalanine hydroxylase (PAH)*** - **Phenylketonuria (PKU)** is an inherited metabolic disorder caused by a deficiency of the enzyme **phenylalanine hydroxylase (PAH)**. - This enzyme is crucial for converting the amino acid **phenylalanine** into **tyrosine**, and its deficiency leads to an accumulation of phenylalanine in the body. - PKU follows an **autosomal recessive** inheritance pattern. *Phenylalanine (amino acid)* - While **phenylalanine** accumulates to toxic levels in PKU, it is the substrate, not the deficient component. - The disease stems from the body's inability to metabolize this amino acid due to the enzyme deficiency. *Tyrosine* - **Tyrosine** is the product of the reaction catalyzed by PAH, and its production is limited in PKU. - However, the deficiency of tyrosine is a secondary effect, not the primary cause of PKU. *None of the options* - This option is incorrect because the deficiency of **phenylalanine hydroxylase (PAH)** is precisely the cause of Phenylketonuria.

Q: Which of the following constitutional articles is not related to children?

42. ***Article 42*** - Article 42 of the Indian Constitution deals with **provision for just and humane conditions of work** and **maternity relief**, primarily concerning adult workers, particularly women. - While maternity relief indirectly benefits children by supporting mothers, the article's direct focus is not on children's rights or welfare. *Article 23* - Article 23 prohibits **traffic in human beings and forced labor**, including **begar** and other forms of forced labor. - This article is directly related to children as it safeguards them from exploitation, such as **child trafficking** and forced labor. *Article 21-A* - Article 21-A guarantees the **right to education** for all children between the ages of six and fourteen years. - It mandates that the state shall provide free and compulsory education, making it fundamentally related to children's rights. *Article 24* - Article 24 prohibits the **employment of children below the age of fourteen years** in any factory or mine or engages them in any other hazardous employment. - This article directly protects children from various forms of child labor and is thus related to child welfare.

Q: Identify the skin lesion shown in the image.

Becker nevus. ***Becker nevus*** - This image clearly shows a large, **hyperpigmented patch with overlying coarse terminal hairs**, characteristic of a Becker nevus. - Becker nevi typically develop in adolescence and are often found on the shoulder or upper trunk, as seen here. *Hypopigmented macule* - A **hypopigmented macule** would appear as an area of skin with **reduced pigmentation** (lighter than the surrounding skin), which is contrary to the darker lesion shown. - There would also be no indication of **increased hair growth** within a typical hypopigmented macule. *Spitz nevus* - A Spitz nevus is a benign melanocytic nevus often appearing as a **dome-shaped, pink or red papule or nodule**, commonly on the face or limbs. - It does not present as a large, hairy, **hyperpigmented patch** as depicted in the image. *Epidermal nevus* - An epidermal nevus is a **congenital lesion** formed by an overgrowth of epidermal cells, but its appearance is typically a **verrucous (wart-like) plaque** or linearly arranged papules. - While it can be hyperpigmented, it generally **lacks the prominent hypertrichosis** (excessive hair growth) seen in the image.

Q: What is the characteristic smell of a properly mummified body?

Odourless. ***Odourless*** - A **properly mummified body** is characterized by **complete desiccation (drying) of tissues**, which prevents decomposition and eliminates putrefactive odors. - In **forensic contexts**, mummification typically occurs through **natural processes** in dry, well-ventilated environments, or through **artificial embalming** that removes moisture and inhibits bacterial growth. - The **absence of moisture** makes the body largely **odorless**, as decomposition bacteria cannot survive without water. *Sweet* - A **sweet smell** is associated with **early decomposition stages**, particularly due to the formation of **adipocere** (grave wax) or **ketone production** during fat breakdown. - This smell indicates **active decomposition**, which is **absent in properly mummified remains**. *Offensive* - An **offensive smell** indicates active **putrefaction** with significant microbial activity producing foul-smelling gases (hydrogen sulfide, cadaverine, putrescine). - Mummification **prevents putrefaction** by removing the moisture necessary for bacterial growth. - An offensive odor in supposed mummified remains suggests **incomplete mummification** or **environmental degradation**. *Pungent* - A **pungent smell** arises from **ammonia and volatile amines** produced during protein decomposition by bacteria. - This indicates **active autolysis and putrefaction**, processes that are **arrested in true mummification** due to tissue desiccation. - A properly preserved mummy should **not produce decomposition-related odors**.

Q: Which condition is associated with the ECG pattern known as pseudo P pulmonale?

Hypercalcemia. ***Hypercalcemia*** - **Hypercalcemia** can cause a characteristic ECG pattern known as pseudo P pulmonale due to its effects on **myocardial repolarization**. - This condition leads to a **shortened QT interval** which causes the T wave to merge with the P wave, giving the appearance of a tall, peaked P wave. *Hypokalemia* - **Hypokalemia** typically presents with **flattened T waves**, prominent U waves, and ST-segment depression on an ECG [1]. - It can prolong repolarization, which is the opposite effect observed with pseudo P pulmonale [1]. *Hyponatremia* - **Hyponatremia** has a less defined direct effect on ECG patterns compared to other electrolyte imbalances. - Severe hyponatremia may lead to **QRS widening** or **bradycardia**, but not pseudo P pulmonale [1]. *Hypocalcemia* - **Hypocalcemia** characteristically causes **prolongation of the QT interval** on an ECG due to delayed ventricular repolarization [2]. - This is distinct from the shortened QT seen in hypercalcemia that contributes to pseudo P pulmonale.

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: 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 indication for performing a tracheostomy?

Prolonged mechanical ventilation. ***Prolonged mechanical ventilation*** - Maintaining an **endotracheal tube** for an extended period carries risks like **tracheal injury**, **vocal cord damage**, and difficulty with oral intake. - A tracheostomy provides a more comfortable and stable airway for **long-term respiratory support**, facilitates weaning from the ventilator, and reduces the risk of **ventilator-associated pneumonia**. *Severe obstructive sleep apnea* - While tracheostomy can effectively treat severe OSA by bypassing the upper airway obstruction, it is generally considered a **last resort** after less invasive treatments have failed. - The most common initial treatments for OSA include **CPAP**, weight loss, and oral appliances. *Tracheal stenosis* - Tracheal stenosis itself is a **structural narrowing** of the trachea that may or may not require tracheostomy, depending on its severity and location. - While a tracheostomy can bypass a severe stenosis, surgical repair of the trachea is often the definitive treatment for **severe tracheal stenosis**. *Vocal cord paralysis* - Unilateral vocal cord paralysis typically causes **hoarseness** and may not always necessitate a tracheostomy. - Bilateral vocal cord paralysis can lead to **airway obstruction**, but intervention usually involves vocal cord lateralization procedures or, in severe cases, a tracheostomy for airway patency.

Q: Which is the best investigation for carcinoma of the head of pancreas?

EUS. ***EUS*** - **Endoscopic ultrasound (EUS)** provides the highest resolution imaging of the pancreas and allows for **fine-needle aspiration (FNA)** of suspicious lesions, offering definitive tissue diagnosis. - Its ability to visualize small, early-stage tumors and regional lymph nodes makes it the **most accurate method for diagnosis and staging** of pancreatic head carcinoma. *Guided biopsy* - While a biopsy is necessary for definitive diagnosis, 'guided biopsy' is a broad term that doesn't specify the highly effective EUS guidance. - Other biopsy methods that are not guided by EUS may be less accurate and carry higher risks for pancreatic lesions. *ERCP* - **Endoscopic retrograde cholangiopancreatography (ERCP)** is primarily a therapeutic procedure used for **biliary drainage** in cases of obstruction caused by pancreatic head tumors. - Although it can visualize ductal abnormalities and allow brush cytology, it is **less sensitive for direct tumor visualization** and tissue acquisition compared to EUS-FNA. *Transduodenal/transperitoneal sampling* - These are **invasive surgical approaches** for obtaining tissue samples, typically reserved when less invasive methods like EUS-FNA are unsuccessful or when intraoperative confirmation is needed. - They carry **higher risks** and are not considered the "best investigation" for initial diagnosis due to their invasiveness and potential for complications.

Question 1

Murphy's eye is seen in -

Accepted Answer

Endotracheal tube

Answer

Flexible laryngoscope

Answer

Laryngeal Mask Airway (LMA)

Answer

Macintosh laryngoscope

Question 2

Phenylketonuria is due to deficiency of:

Accepted Answer

Phenylalanine hydroxylase (PAH)

Answer

Phenylalanine (amino acid)

Answer

Tyrosine

Answer

None of the options

Question 3

Which of the following constitutional articles is not related to children?

Accepted Answer

42

Answer

23

Answer

24

Answer

21-A

Question 4

Identify the skin lesion shown in the image.

Accepted Answer

Becker nevus

Answer

Hypopigmented macule

Answer

Spitz nevus

Answer

Epidermal nevus

Question 5

What is the characteristic smell of a properly mummified body?

Accepted Answer

Odourless

Answer

Sweet

Answer

Offensive

Answer

Pungent

Question 6

Which condition is associated with the ECG pattern known as pseudo P pulmonale?

Accepted Answer

Hypercalcemia

Answer

Hyponatremia

Answer

Hypocalcemia

Answer

Hypokalemia

Question 7

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 8

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 9

What is the most common indication for performing a tracheostomy?

Accepted Answer

Prolonged mechanical ventilation

Answer

Severe obstructive sleep apnea

Answer

Tracheal stenosis

Answer

Vocal cord paralysis

Question 10

Which is the best investigation for carcinoma of the head of pancreas?

Accepted Answer

EUS

Answer

Transduodenal/transperitoneal sampling

Answer

Guided biopsy

Answer

ERCP

NEET-PG 2018

Anesthesiology

Biochemistry

Community Medicine

Dermatology

Forensic Medicine

Internal Medicine

Obstetrics and Gynecology

Surgery