NEET-PG 2019 Practice Questions

Q: Which of the following structures is not a boundary of Calot's triangle shown in the given image?

Gallbladder. ***Gallbladder*** - The image depicts **Calot's triangle**, which is an important anatomical landmark in gallbladder surgery. The gallbladder itself is located within this region, but it is not one of the defined boundaries of the triangle. - While central to the anatomy shown, the **gallbladder** is surrounded by the structures that form the triangle's boundaries rather than bounding it itself. *Common hepatic duct* - The **common hepatic duct** forms the medial boundary of Calot's triangle. - This duct is formed by the union of the right and left hepatic ducts and carries bile from the liver. *Cystic duct* - The **cystic duct** forms the lateral (or inferior) boundary of Calot's triangle. - This duct connects the gallbladder to the common hepatic duct. *Inferior surface of the liver* - The **inferior surface of the liver** forms the superior boundary of Calot's triangle. - Specifically, this refers to the edge of the right lobe of the liver at the base of the gallbladder fossa.

Q: Identify the type of the fibre marked in the image of the internal capsule.

Projection fibers. ***Projection fibers*** - The image shows the **internal capsule**, which is a white matter structure composed of **projection fibers** that connect the cerebral cortex to subcortical structures, brainstem, and spinal cord. - These fibers facilitate communication between different levels of the central nervous system, including motor and sensory pathways. *Short association fibers* - These fibers, also known as **U-fibers**, connect adjacent gyri within the **same cerebral hemisphere**. - They are typically located superficially in the cerebral cortex, not deep within the brain as shown in the internal capsule. *Long association fibers* - These fibers connect **different lobes** within the **same cerebral hemisphere**, such as the arcuate fasciculus connecting temporal and frontal lobes. - While they are white matter tracts, they do not constitute the internal capsule, which is specifically known for its extensive projection pathways. *Commissural fibers* - **Commissural fibers** connect corresponding areas in the **two cerebral hemispheres**, with the most prominent example being the **corpus callosum**. - The internal capsule, shown in the image, primarily consists of fibers projecting superiorly and inferiorly, rather than horizontally across hemispheres.

Q: Inspiratory stridor is found in what kind of lesions:

Supraglottic. ***Supraglottic*** - Lesions in the **supraglottic** region (e.g., epiglottitis, supraglottic foreign body) cause inspiratory stridor due to the collapse of soft tissues above the vocal cords during inspiration. - The narrowed airway during inspiration creates a high-pitched, harsh sound. *Subglottic* - **Subglottic** lesions typically cause a **biphasic stridor**, meaning stridor is present during both inspiration and expiration. - This is because the subglottis is a rigid area; narrowing at this level causes turbulent airflow during both phases of breathing. *Tracheal* - **Tracheal** lesions can produce **biphasic stridor** if they are in the cervical trachea due to fixed airway narrowing. - If the lesion is in the lower, intrathoracic trachea, it might primarily cause **expiratory stridor** or a biphasic stridor depending on the degree of narrowing and its fixity. *Bronchus* - Lesions in the **bronchus** (e.g., foreign body, tumor) typically lead to **expiratory stridor** or wheezing. - Airway narrowing at this level causes air trapping and turbulent flow predominantly during exhalation when the bronchial walls naturally constrict.

Q: Identify the maneuver shown in the image.

Epley. ***Epley*** - The image displays the classic sequence of head and body movements characteristic of the **Epley maneuver**, designed to reposition otoconia from the semicircular canals back into the utricle. - This maneuver involves a series of specific head turns and body positions, often starting in an upright seated position, then lying down while turning the head, and rotating the body, as depicted. *Brandt daroff* - The **Brandt-Daroff exercises** involve rapid, self-administered movements between sitting and lying on one side, then sitting up and lying on the other side. - These exercises are typically performed multiple times a day and differ in their sequence from the repositioning maneuvers shown. *Foster* - The **Foster maneuver**, also known as the "half-somersault maneuver," is a self-administered variant used for posterior canal BPPV, particularly when the Epley maneuver is difficult to perform. - It involves beginning in a kneeling position, looking up, placing the head on the floor, and tucking the chin, which is distinct from the sequence shown. *Semont* - The **Semont maneuver** involves rapid movement from a sitting position to lying on one side with the head turned up, then rapidly moving to lie on the opposite side with the head turned down. - While it is a repositioning maneuver for BPPV, its specific rapid movements and head orientations differ from those illustrated in the image.

Q: Identify the condition of the given image:

Keratosis obturans. ***Keratosis obturans*** - The image shows a **plug of desquamated keratin** filling the external auditory canal. This is the characteristic appearance of keratosis obturans. - This condition is often associated with severe pain, conductive hearing loss, and sometimes **bone erosion** of the external auditory canal. *Acquired cholesteatoma* - This condition involves a **retraction pocket** or **perforation** of the tympanic membrane with ingrowth of keratinizing squamous epithelium into the middle ear, forming a sac. - The image does not show a retraction pocket or a middle ear mass, which are typical features of acquired cholesteatoma. *Congenital cholesteatoma* - This is a **pearly white mass** located behind an intact tympanic membrane, without any history of ear infections or perforations. - The image shows an external auditory canal filled with a plug, not a middle ear mass behind an intact tympanic membrane. *Rupture of tympanic membrane* - A rupture of the tympanic membrane would present as a **visible defect or perforation** in the eardrum. - The image shows an accumulation of material within the ear canal, and the tympanic membrane itself is not clearly visible or perforated in a manner indicative of rupture.

Q: A patient with a history of breast cancer with brain metastases dies following a cerebral hemorrhage. According to standard death certification practices (WHO guidelines), what should be recorded as the immediate cause of death in Part I(a) of the death certificate?

Cerebral Hemorrhage. ***Cerebral Hemorrhage*** - The **immediate cause of death** (Part I(a) of the death certificate) is the final disease, injury, or complication that directly caused death. - In this case, **cerebral hemorrhage** is the terminal event that directly resulted in death, regardless of underlying conditions. - According to WHO ICD-10 guidelines, Part I should list the causal sequence: **(a) Cerebral hemorrhage → (b) Brain metastases → (c) Breast cancer**, with cerebral hemorrhage as the immediate cause. *Breast Cancer (Primary)* - Breast cancer is the **underlying cause of death** (the disease that initiated the morbid sequence), which would be recorded in Part I(c). - While it's the most important cause from a public health perspective, it is **not the immediate cause** that directly precipitated death. - The underlying cause and immediate cause serve different purposes in mortality statistics. *Secondaries* - Brain metastases (secondaries) would be recorded as an **intermediate cause** in Part I(b) of the death certificate. - While they represent the pathological link between breast cancer and cerebral hemorrhage, they are not the **immediate** terminal event. - "Secondaries" alone is too vague without specifying the site and mechanism of death. *Complications of Breast Cancer* - This is an overly broad and **non-specific** term that doesn't identify the actual mechanism of death. - Death certificates require **specific medical conditions**, not generic categories like "complications." - While cerebral hemorrhage is indeed a complication, proper certification requires naming the specific condition.

Q: What are the essential major blood culture criteria for diagnosing infective endocarditis?

Single positive culture of Coxiella burnetii. ***Single positive culture of Coxiella burnetii*** - A single positive blood culture for **Coxiella burnetii** or **anti-phase I IgG antibody titer > 1:800** is considered a major criterion for infective endocarditis due to its highly pathogenic nature in this context [1], [2]. - This organism is a known cause of **culture-negative endocarditis**, and specific serology or molecular tests are often required for diagnosis [1]. *Single positive culture of Corynebacterium species* - **Corynebacterium species** are often considered **contaminants** in blood cultures, especially *Corynebacterium jeikeium*, and typically require multiple positive cultures, often from different sites, to be considered significant pathogens for infective endocarditis [2]. - A single positive culture of these organisms alone is generally insufficient to meet major diagnostic criteria for endocarditis [2]. *Both HACEK and Coxiella cultures* - While both **HACEK organisms** and **Coxiella burnetii** can cause endocarditis, the combination of both is not a specific major criterion in itself. - The diagnostic criteria address each organism individually [2]. *Single positive culture of HACEK group* - **HACEK organisms** (**H**aemophilus, **A**ggregatibacter, **C**ardiobacterium, **E**ikenella, **K**ingella) are well-known causes of endocarditis, but usually require **two separate positive blood cultures** for infective endocarditis major criteria [2]. - A single positive culture of a HACEK organism is typically classified as a minor criterion unless other supporting evidence is present.

Q: A patient with a known case of acute pancreatitis develops breathlessness and bilateral basal crepitations on day 4. What is the most likely diagnosis based on the chest radiography image?

Acute Respiratory Distress Syndrome (ARDS). ***Acute Respiratory Distress Syndrome (ARDS)*** - The chest radiograph shows **bilateral patchy infiltrates** and **diffuse alveolar opacities** consistent with ARDS, especially in the context of **acute pancreatitis** as a known risk factor. - The development of **breathlessness** and **bilateral basal crepitations** (rales) on day 4 further supports ARDS due to fluid accumulation in the lungs. *Bilateral pneumonia* - While pneumonia can cause bilateral infiltrates, the **symmetrical and widespread distribution** seen on this radiograph, combined with the context of acute pancreatitis, makes ARDS a more likely diagnosis. - Pneumonia typically presents with fever, productive cough, and lung consolidation, which are not specifically highlighted as primary symptoms over the breathlessness. *Carcinogenic Pulmonary Embolism* - Pulmonary embolism typically manifests with **sudden onset dyspnea**, pleuritic chest pain, and sometimes hemoptysis, and chest X-rays are often normal or show subtle findings like a **Westermark sign** or Hampton's hump. - The widespread bilateral infiltrates seen in the image are **not characteristic of pulmonary embolism**. *Lung collapse (atelectasis)* - Atelectasis usually appears as a ** localised area of increased opacification**, often with volume loss (e.g., tracheal deviation, elevated hemidiaphragm), and is often unilateral or segmental. - The **diffuse, bilateral, and often fluffy infiltrates** seen in this image are not consistent with typical atelectasis.

Q: A baby born at 34 weeks gestation weighs 3kg. Which of the following conditions is this child most likely to develop in the immediate postnatal period?

Anemia. ***Anemia*** - A 3kg baby at 34 weeks is **large for gestational age (LGA)** and often associated with maternal diabetes, leading to initial **polycythemia** due to chronic intrauterine hypoxia and increased erythropoietin production. - After birth, the excess red blood cells undergo rapid **hemolysis**, resulting in **anemia** in the immediate postnatal period as a recognized complication of LGA babies. *APH* - **Antepartum hemorrhage (APH)** is a maternal obstetric complication involving bleeding before delivery, not a condition that develops in the newborn. - This is a **maternal complication** that occurs during pregnancy, not a neonatal condition that the baby would present with after birth. *Diabetes* - While **maternal diabetes** is often the cause of fetal macrosomia, the newborn does not develop diabetes itself in the immediate postnatal period. - These babies are instead at risk for **hypoglycemia**, **respiratory distress**, and **polycythemia** due to fetal hyperinsulinemia, but not diabetes as a presenting condition. *None of the options* - This is incorrect because **anemia** is indeed a valid condition that LGA babies can develop through the **polycythemia-hemolysis cycle**. - While other complications like **hypoglycemia** are more statistically common, anemia remains a recognized sequela among LGA babies in the immediate postnatal period.

Q: Identify the condition in the image below?

Lacunar infarct. ***Lacunar infarct*** - The image displays a small, well-demarcated **hypodensity** (darker area) in the basal ganglia region, characteristic of a lacunar infarct. - Lacunar infarcts are typically caused by **occlusion of small perforating arteries** and result in small, deep infarcts, often appearing as precise, round or ovoid lesions on CT. *Embolic infarct* - Embolic infarcts tend to be **larger**, wedge-shaped, and often extend to the cortical surface, unlike the deep, small lesion seen. - They are commonly associated with a **cardiac source** or large artery atherosclerosis leading to distal embolization. *Thrombotic infarct* - Thrombotic infarcts are usually **larger** areas of infarction due to occlusion of a major artery, often preceded by symptoms like TIAs. - While they also appear hypodense, they are typically **more extensive** and less precisely defined than a lacunar infarct in the early stages. *Intracerebral hemorrhage* - Intracerebral hemorrhage would appear as a **hyperdense** (bright white) area on a non-contrast CT scan due to the presence of acute blood. - The image clearly shows a **hypodense lesion**, ruling out acute hemorrhage.

Question 1

Which of the following structures is not a boundary of Calot's triangle shown in the given image?

Accepted Answer

Gallbladder

Answer

Common hepatic duct

Answer

Cystic duct

Answer

Inferior surface of the liver

Question 2

Identify the type of the fibre marked in the image of the internal capsule.

Accepted Answer

Projection fibers

Answer

Short association fibers

Answer

Long association fibers

Answer

Commissural fibers

Question 3

Inspiratory stridor is found in what kind of lesions:

Accepted Answer

Supraglottic

Answer

Subglottic

Answer

Tracheal

Answer

Bronchus

Question 4

Identify the maneuver shown in the image.

Accepted Answer

Epley

Answer

Brandt-Daroff

Answer

Foster

Answer

Semont

Question 5

Identify the condition of the given image:

Accepted Answer

Keratosis obturans

Answer

Acquired cholesteatoma

Answer

Congenital cholesteatoma

Answer

Rupture of tympanic membrane

Question 6

A patient with a history of breast cancer with brain metastases dies following a cerebral hemorrhage. According to standard death certification practices (WHO guidelines), what should be recorded as the immediate cause of death in Part I(a) of the death certificate?

Accepted Answer

Cerebral Hemorrhage

Answer

Secondaries

Answer

Breast Cancer (Primary)

Answer

Complications of Breast Cancer

Question 7

What are the essential major blood culture criteria for diagnosing infective endocarditis?

Accepted Answer

Single positive culture of Coxiella burnetii

Answer

Single positive culture of Corynebacterium species

Answer

Both HACEK and Coxiella cultures

Answer

Single positive culture of HACEK group

Question 8

A patient with a known case of acute pancreatitis develops breathlessness and bilateral basal crepitations on day 4. What is the most likely diagnosis based on the chest radiography image?

Accepted Answer

Acute Respiratory Distress Syndrome (ARDS)

Answer

Bilateral pneumonia

Answer

Carcinogenic Pulmonary Embolism

Answer

Lung collapse (atelectasis)

Question 9

A baby born at 34 weeks gestation weighs 3kg. Which of the following conditions is this child most likely to develop in the immediate postnatal period?

Accepted Answer

Anemia

Answer

APH

Answer

Diabetes

Answer

None of the options

Question 10

Identify the condition in the image below?

Accepted Answer

Lacunar infarct

Answer

Embolic infarct

Answer

Thrombotic infarct

Answer

Intracerebral hemorrhage

NEET-PG 2019

Anatomy

ENT

Forensic Medicine

Internal Medicine

Pediatrics

Radiology