NEET-PG 2018 Practice Questions

Q: Wallenberg syndrome involves which artery?

Posterior inferior cerebellar artery. ***Posterior inferior cerebellar artery*** - **Wallenberg syndrome**, also known as **lateral medullary syndrome**, is most commonly caused by an infarction in the territory supplied by the **posterior inferior cerebellar artery (PICA)**. - The PICA supplies the **lateral medulla**, which contains several crucial nuclei and tracts, including the nucleus ambiguus, trigeminal nucleus, vestibular nuclei, and spinothalamic tract, leading to the characteristic clinical presentation of Wallenberg syndrome. *Subclavian artery* - The **subclavian artery** is a large artery in the upper thorax that supplies blood to the upper limbs, head, and neck. - While it can be involved in conditions like **subclavian steal syndrome**, it does not directly supply the lateral medulla responsible for Wallenberg syndrome. *Posterior cerebral artery* - The **posterior cerebral artery** primarily supplies the occipital lobe, temporal lobe, and parts of the thalamus and midbrain. - Infarction in the PCA territory typically leads to symptoms like **hemianopia**, visual field defects, and memory deficits, not the constellation of symptoms seen in Wallenberg syndrome. *Anterior inferior cerebellar artery* - The **anterior inferior cerebellar artery (AICA)** supplies the anterior and lateral parts of the cerebellum and the pontomedullary junction, leading to **lateral pontine syndrome** when infarcted. - Symptoms of AICA infarction include ipsilateral facial paralysis, hearing loss, and cerebellar ataxia, which are distinct from Wallenberg syndrome.

Q: The enzyme deficient in Galactosemia is:-

Galactose-1-phosphate uridyltransferase (GALT). ***Galactose-1-phosphate uridyltransferase (GALT)*** - Deficiency of **GALT** leads to the accumulation of **galactose-1-phosphate** in tissues, which is toxic and causes the symptoms of **classical galactosemia**. - This enzyme is crucial for the second step in the Leloir pathway, converting **galactose-1-phosphate** and UDP-glucose into UDP-galactose and glucose-1-phosphate. *Sphingomyelinase (associated with Niemann-Pick disease)* - Deficiency in **sphingomyelinase** causes the accumulation of **sphingomyelin**, leading to **Niemann-Pick disease**, characterized by hepatosplenomegaly and neurological deterioration. - This enzyme is involved in the catabolism of lipids, distinct from carbohydrate metabolism. *Glucocerebrosidase (associated with Gaucher's disease)* - Deficiency of **glucocerebrosidase** results in the accumulation of **glucocerebroside**, leading to **Gaucher's disease**, which affects the spleen, liver, bone marrow, and sometimes the brain. - This is a lysosomal storage disorder involving glycosphingolipids, not galactose metabolism. *Hexosaminidase (associated with Tay-Sachs disease)* - Deficiency of **hexosaminidase A** causes the accumulation of **GM2 ganglioside**, resulting in **Tay-Sachs disease**, a severe neurodegenerative disorder. - This enzyme primarily functions in the breakdown of gangliosides, which are complex lipids, not galactose.

Q: Serotonin is also known as?

5-hydroxytryptamine (5-HT). ***5-hydroxytryptamine (5-HT)*** - **Serotonin** is the common name for the neurotransmitter **5-hydroxytryptamine (5-HT)**. - This chemical name reflects its structure, derived from tryptophan, indicating a **hydroxyl group** at the 5-position of the **indole ring** and an **ethylamine side chain**. *3-Methoxytyramine* - **3-Methoxytyramine** is a metabolite of **dopamine**, not serotonin. - It is formed by the action of **catechol-O-methyltransferase (COMT)** on dopamine. *Phenethylamine* - **Phenethylamine** is a naturally occurring trace amine that acts as a **neuromodulator** or neurotransmitter. - It is structurally similar to certain recreational drugs but is not serotonin. *N-methyl phenylamine* - **N-methyl phenylamine** or N-methylaniline is an **organic chemical** used in dyes and other industrial applications. - It is not a neurotransmitter and has no relation to serotonin.

Q: VMA is elevated in which of the following condition?

Pheochromocytoma. Pheochromocytoma - Pheochromocytoma is a tumor of the adrenal medulla that secretes excessive amounts of catecholamines (epinephrine and norepinephrine). - Vanillylmandelic acid (VMA) is a breakdown product of these catecholamines [1], so its levels are elevated in the urine of patients with pheochromocytoma. Tuberous sclerosis - Tuberous sclerosis is a genetic disorder characterized by the growth of numerous non-cancerous tumors in various organs. - While it can be associated with renal angiomyolipomas or brain lesions, it does not directly cause elevated VMA levels. Addison disease - Addison disease is characterized by adrenal insufficiency [2], meaning the adrenal glands produce insufficient amounts of hormones like cortisol and aldosterone. - This condition is not associated with the overproduction of catecholamines or elevated VMA. Conn Syndrome - Conn syndrome (primary hyperaldosteronism) is due to an overproduction of aldosterone by the adrenal glands, often caused by an adrenal adenoma [3]. - Aldosterone is a mineralocorticoid, and its overproduction does not lead to increased catecholamine metabolism or elevated VMA levels.

Q: All of the following are true about ulcerative colitis except:

Steroid dependent cases need surgery. ***Steroid dependent cases need surgery*** - While **steroid dependency** in ulcerative colitis (UC) indicates a need for alternative or escalate medications, it does not automatically necessitate surgery [1]. - Many steroid-dependent patients can be managed effectively with **immunomodulators** or **biologic therapies**, avoiding surgery. *Surgery is required in a subset of severe cases.* - **Severe ulcerative colitis** that is refractory to medical therapy, or complicated by toxic megacolon, perforation, or severe bleeding, often requires surgical intervention [1]. - This statement is true, as surgery can be curative for UC by removing the affected colon [1]. *Extra-intestinal problems of UC are managed medically* - **Extra-intestinal manifestations** of ulcerative colitis, such as arthritis, skin lesions (erythema nodosum), and eye inflammation (uveitis), are typically managed with medications specific to those conditions, often in conjunction with UC treatment [1], [2]. - This statement is true, as these manifestations rarely require surgical intervention themselves. *The highest risk of UC requiring surgery in 1st year* - The risk of surgery in ulcerative colitis is indeed highest in the **first year after diagnosis**, particularly for patients presenting with severe disease. - This initial period often determines the disease course and responsiveness to medical treatment.

Q: Shoulder dystocia is managed by all of the following except:-

Fundal pressure by an able nurse. ***Fundal pressure by an able nurse*** - **Fundal pressure** is contraindicated in shoulder dystocia because it can worsen the impaction of the anterior shoulder against the symphysis pubis and potentially lead to uterine rupture or fetal injury. - Applying pressure from above pushes the fetus further into the birth canal obstruction, increasing the risk of **fetal asphyxia** and **brachial plexus injury**. *Woods cork screw method* - This maneuver involves rotating the fetal shoulders by applying pressure to the posterior aspect of the **posterior shoulder**, which often helps to disimpact the anterior shoulder. - It is a recognized and effective technique used to resolve **shoulder dystocia**. *Supra pubic pressure* - **Suprapubic pressure** is applied externally over the maternal suprapubic bone to dislodge the anterior shoulder from behind the symphysis pubis. - This maneuver is often performed first after the initial attempts at fetal head traction and **McRoberts maneuver** to help release the impacted shoulder. *Zavanelli maneuver* - The **Zavanelli maneuver** involves pushing the fetal head back into the uterus and performing an immediate cesarean section. - It is considered a **last-resort maneuver** for severe shoulder dystocia when other techniques have failed, carrying significant risks but sometimes necessary to prevent fetal death.

Q: In Peripartum cardiomyopathy, cardiac failure occurs at:-

Within 5 months after delivery.. ***Within 5 months after delivery.*** - Peripartum cardiomyopathy (PPCM) is defined as the development of **cardiac failure** in the **last month of pregnancy** or within **5 months after delivery**, in the absence of any other identifiable cause. - Among the given options, "within 5 months after delivery" represents the **postpartum component** of the diagnostic timeframe and is the most complete answer. - This time frame is a key diagnostic criterion recognized by major cardiology societies (some recent guidelines extend this to 6 months postpartum). - **Note:** The complete definition includes both antepartum (last month of pregnancy) and postpartum (up to 5 months) periods. *Within 24 months after delivery.* - This timeframe is **too broad** and does not align with the standard diagnostic criteria for PPCM. - While some women may experience ongoing cardiac dysfunction or relapse, the initial diagnosis of PPCM is restricted to within 5 months postpartum. - Extended cardiac issues beyond 5 months may represent persistent PPCM or dilated cardiomyopathy rather than new-onset PPCM. *Within 6 weeks after delivery.* - While many cases of PPCM manifest within **6 weeks postpartum** (the traditional puerperium), this definition is **too restrictive**. - Symptoms can appear up to **5 months after delivery**, and using only 6 weeks would miss a significant proportion of cases. - This period captures the most acute presentations but doesn't encompass the entire recognized diagnostic window. *Within 7 days after delivery.* - The onset within **7 days after delivery** represents only the **immediate postpartum period** and is an overly narrow definition. - PPCM can develop much later in the postpartum period (up to 5 months), making this timeframe inadequate for diagnosis. - Using this restrictive criterion would result in many missed diagnoses.

Q: Hyperacute rejection occurs within:-

Minutes to hours. ***Minutes to hours*** - **Hyperacute rejection** is a rapidly occurring complication post-transplant, characterized by its onset within minutes to hours after **organ reperfusion** [1]. - This type of rejection is mediated by pre-formed **recipient antibodies** that recognize donor antigens, leading to immediate graft damage [1]. *12 hours* - While plausible, 12 hours is a bit too broad as **hyperacute rejection** primarily begins much sooner, typically within the first few hours [1]. - This timeframe might overlap with the initial stages of **acute cellular rejection**, which typically occurs days to weeks later [1]. *24 hours* - **Hyperacute rejection** is almost always observed and causes graft failure well before the 24-hour mark, if it is going to happen. - Rejection occurring within this extended period is more indicative of **accelerated acute rejection** rather than true hyperacute rejection. *6 hours* - While hyperacute rejection certainly can occur within 6 hours, "minutes to hours" better captures the immediate onset, often within seconds or minutes [1]. - Some cases of **hyperacute rejection** can be so rapid that the 6-hour mark would be considered a late presentation. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 241-242.

Q: Most common site of chronic gastric ulcer:

Lesser curve near incisura. ***Lesser curve near incisura*** - The **lesser curve** of the stomach, particularly the **incisura angularis** or the angular notch, is the most common site for gastric ulcers. - This area is susceptible to ulceration due to its anatomical location, which experiences significant **acid exposure** and **motility stress**. *Lesser curve near proximal stomach* - While the lesser curve is a common site, ulcers tend to be more prevalent in the **distal part** of the lesser curve, near the incisura, rather than the proximal stomach (cardia or fundus). - Gastric ulcers in the proximal stomach are less frequent compared to the **antrum** and **incisura region**. *Pylorus of stomach* - The **pylorus** is more commonly associated with duodenal ulcers but can occasionally be a site for gastric ulcers. - However, it is not the most common location for **chronic gastric ulcers** when compared to the lesser curve near the incisura. *Greater curvature* - Ulcers on the **greater curvature** are relatively rare and often raise suspicion for **malignancy**, necessitating careful biopsy and investigation. - The greater curvature is less exposed to the erosive effects of gastric acid and pepsin compared to the lesser curve, making ulcers there less common.

Q: Using a small fine probe, a single lactiferous duct is excised. What is the name of the procedure:

Microdochectomy. ***Microdochectomy*** - This procedure involves the **excision of a single, lactiferous duct** often identified using a fine probe or ductoscope. - It is typically performed to investigate or treat **pathological nipple discharge** originating from a specific duct. *Hadfield operation* - This is a more extensive procedure known as a **total duct excision** or **subareolar duct excision**. - It involves the removal of **all major lactiferous ducts** under the nipple, not just a single one. *Webster operation* - The Webster operation refers to an **inferior pedicle reduction mammoplasty** technique. - It is a type of **breast reduction surgery** and is not related to the excision of an isolated lactiferous duct. *Macrodochectomy* - This term is **not a recognized medical procedure** in the context of duct excision. - While "macro" implies large, it does not describe a specific surgical technique for duct removal.

Question 1

Wallenberg syndrome involves which artery?

Accepted Answer

Posterior inferior cerebellar artery

Answer

Subclavian artery

Answer

Posterior cerebral artery

Answer

Anterior inferior cerebellar artery

Question 2

The enzyme deficient in Galactosemia is:-

Accepted Answer

Galactose-1-phosphate uridyltransferase (GALT)

Answer

Sphingomyelinase

Answer

Glucocerebrosidase

Answer

Hexosaminidase

Question 3

Serotonin is also known as?

Accepted Answer

5-hydroxytryptamine (5-HT)

Answer

3-Methoxytyramine

Answer

Phenethylamine

Answer

N-methyl phenylamine

Question 4

VMA is elevated in which of the following condition?

Accepted Answer

Pheochromocytoma

Answer

Tuberous sclerosis

Answer

Addison disease

Answer

Conn Syndrome

Question 5

All of the following are true about ulcerative colitis except:

Accepted Answer

Steroid dependent cases need surgery

Answer

Surgery is required in a subset of severe cases.

Answer

Extra-intestinal problems of UC are managed medically

Answer

The highest risk of UC requiring surgery in 1st year

Question 6

Shoulder dystocia is managed by all of the following except:-

Accepted Answer

Fundal pressure by an able nurse

Answer

Woods cork screw method

Answer

Supra pubic pressure

Answer

Zavanelli maneuver

Question 7

In Peripartum cardiomyopathy, cardiac failure occurs at:-

Accepted Answer

Within 5 months after delivery.

Answer

Within 24 months after delivery.

Answer

Within 6 weeks after delivery.

Answer

Within 7 days after delivery.

Question 8

Hyperacute rejection occurs within:-

Accepted Answer

Minutes to hours

Answer

12 hours

Answer

24 hours

Answer

6 hours

Question 9

Most common site of chronic gastric ulcer:

Accepted Answer

Lesser curve near incisura

Answer

Lesser curve near proximal stomach

Answer

Pylorus of stomach

Answer

Greater curvature

Question 10

Using a small fine probe, a single lactiferous duct is excised. What is the name of the procedure:

Accepted Answer

Microdochectomy

Answer

Hadfield operation

Answer

Webster operation

Answer

Macrodochectomy

NEET-PG 2018

Anatomy

Biochemistry

Internal Medicine

Obstetrics and Gynecology

Pathology

Surgery