NEET-PG 2019 Practice Questions

Q: Which muscle originates from 1st pharyngeal arch?

Masseter. ***Masseter*** - The **masseter muscle** is a strong muscle of mastication that originates from the **first pharyngeal arch**. - Muscles derived from the first pharyngeal arch are innervated by the **trigeminal nerve (CN V)**, which also innervates the masseter. *Posterior belly of digastric* - The **posterior belly of the digastric muscle** originates from the **second pharyngeal arch**. - It is innervated by the **facial nerve (CN VII)**, which is associated with the second pharyngeal arch. *Buccinator* - The **buccinator muscle** is a muscle of facial expression that also originates from the **second pharyngeal arch**. - Like other muscles of facial expression, it is innervated by the **facial nerve (CN VII)**. *Stylopharyngeus* - The **stylopharyngeus muscle** originates from the **third pharyngeal arch**. - It is innervated by the **glossopharyngeal nerve (CN IX)**, which is associated with the third pharyngeal arch.

Q: Polyuria in adults is commonly defined as urine output exceeding:

40 ml / Kg/ day. ***40 ml / Kg/ day*** - **Polyuria** is clinically defined as urine output exceeding 3 liters per 24 hours (L/day) in adults. - Converting this to a weight-based measurement for an average 75 kg adult, 3 L/day equates to approximately **40 ml/kg/day**. *50 ml/ kg / day* - This value represents a significantly higher urine output than the standard clinical definition of **polyuria**, making it an unlikely threshold. - While excessive, it would indicate a more severe and less common degree of diuresis, not the general definition. *30 ml / Kg/ day* - This value is below the typical threshold for **polyuria** and is closer to what might be considered normal or slightly elevated urine output. - Normal urine output is typically between **0.5-1 ml/kg/hour**, which translates to 12-24 ml/kg/day. *60 ml/ kg / day* - This is a substantially high urine output, indicating a profound level of **diuresis**, well beyond the standard definition of polyuria. - While possible in extreme cases, it is not the common cutoff used for defining polyuria.

Q: Patient with ascending paralysis, areflexia and sphincter sparing is seen in?

G.B.S. **G.B.S** - **Guillain-Barré Syndrome (GBS)** is characterized by **ascending paralysis** and **areflexia**, meaning loss of deep tendon reflexes [1]. - **Sphincter sparing** is also typical in GBS, differentiating it from other causes of paralysis where autonomic involvement can lead to bladder and bowel dysfunction [1]. *Botulism* - Botulism typically presents with **descending paralysis**, weakness starting in the cranial nerves and progressing downwards. - While it causes significant muscle weakness and can lead to **areflexia**, the pattern of paralysis (descending vs. ascending) and the presence of prominent cranial nerve involvement help distinguish it. *Snake bite* - Neurotoxic snake bites can cause **flaccid paralysis** and **areflexia**, but the paralysis often starts at the site of the bite or affects cranial nerves preferentially before generalized ascending paralysis. - The history of a **snake bite** and presence of **local envenomation signs** (swelling, pain) would also be prominent. *Polio* - Polio primarily causes **asymmetric flaccid paralysis** and **areflexia**, due to the destruction of anterior horn cells in the spinal cord. - Unlike GBS, polio does not typically present with an ascending pattern affecting both sides symmetrically and often involves sensory sparing.

Q: Not an AIDS defining illness?

Tertiary Syphilis. ***Tertiary Syphilis*** - While a serious late-stage manifestation of **syphilis**, it is not specifically listed as an **AIDS-defining illness** by the CDC, although HIV-positive individuals may be more susceptible to its complications [1]. - **Neurosyphilis**, a form of tertiary syphilis affecting the central nervous system, is also not an AIDS-defining condition on its own, unlike some other opportunistic infections [1]. *Progressive multifocal leukoencephalopathy (PML)* - PML, caused by the **JC virus**, is an **AIDS-defining illness** characterized by the progressive destruction of myelin in the brain, leading to severe neurological deficits. - It occurs almost exclusively in individuals with severe **immunodeficiency**, such as those with untreated HIV infection. *Lymphoma of brain < 60 years of age* - **Primary central nervous system (CNS) lymphoma** in individuals with HIV, especially those under 60 years of age, is an **AIDS-defining condition** [2]. - Its occurrence is strongly linked to severe immunosuppression in HIV-infected patients [2]. *Extrapulmonary Cryptococcosis* - **Cryptococcosis**, when it affects sites outside the lungs (e.g., **cryptococcal meningitis**), is an **AIDS-defining illness**. - This fungal infection is a common opportunistic infection in individuals with advanced HIV disease.

Q: A lady primigravida developed fluctuant painful mass of breast and fever after 14 days of delivery. Preferred treatment option is:-

Incision and drainage. ***Incision and drainage*** - A **fluctuant, painful mass** in the breast combined with **fever** 14 days postpartum strongly indicates a **breast abscess**, which requires surgical drainage as the definitive treatment. - **I&D removes the pus collection** and is the preferred treatment for an established abscess, usually combined with **appropriate antibiotics** (though the primary intervention is drainage). - After drainage, breastfeeding can typically be **continued from the unaffected breast** while the affected side heals. *Analgesics and continue breast feeding* - While analgesics can relieve pain and continuing breastfeeding is appropriate for **simple mastitis**, these measures are **insufficient for an established abscess** with a fluctuant collection. - An abscess requires drainage; conservative management alone will not resolve a loculated pus collection. *Antipyretic* - An antipyretic will help reduce the **fever symptomatically**, but it does not address the underlying **purulent collection or infection**. - It would only mask symptoms without treating the cause, potentially delaying appropriate surgical intervention. *Stop lactation* - Stopping lactation abruptly can lead to **breast engorgement** and may worsen milk stasis, potentially complicating the infection. - While temporary cessation from the affected breast during acute infection might be considered, outright stopping lactation is **not the preferred primary treatment** for an abscess and may interfere with recovery.

Q: Caspase involved in activation of IL-1 is which of the following?

Caspase 1. ***Caspase 1*** - **Caspase 1** (also known as interleukin-1 beta converting enzyme or ICE) is the primary caspase responsible for the proteolytic cleavage and activation of pro-IL-1β and pro-IL-18 into their mature, active forms. - This activation occurs within the **inflammasome complex**, a multiprotein oligomer that assembles in response to various pathogens and danger signals. *Caspase 5* - While **Caspase 5** is an inflammatory caspase, similar to Caspase 1, it primarily functions in the direct activation of pro-IL-1β in certain contexts, particularly in response to *Gram-negative bacteria* through the non-canonical inflammasome. - However, **Caspase 1** is the canonical and most well-known activator of IL-1 in the classical inflammasome pathway. *Caspase 8* - **Caspase 8** is a key **initiator caspase** in the extrinsic pathway of apoptosis, activated by death receptors like Fas and TNF receptors. - Its primary role is in **apoptotic signaling** and it is not directly involved in the proteolytic activation of IL-1. *Caspase 3* - **Caspase 3** is a major **effector caspase** in both the intrinsic and extrinsic pathways of apoptosis. - It executes apoptosis by cleaving numerous cellular substrates and is not directly involved in the **processing of cytokines** like IL-1.

Q: Congenital Rubella Syndrome includes all except

Intracerebral hemorrhage. ***Intracerebral hemorrhage*** - This is not a typical manifestation of **Congenital Rubella Syndrome** (CRS). Symptoms of CRS primarily include sensory, cardiac, and ocular defects, not bleeding into the brain. *SN deafness* - **Sensorineural (SN) deafness** is a very common and characteristic symptom of **Congenital Rubella Syndrome**, often bilateral, due to damage to the organ of Corti. - It is one of the classic triad of manifestations of CRS. *Cataract* - **Cataracts** (clouding of the lens) are a prominent ocular defect in CRS, often leading to significant vision impairment or blindness. - Ocular defects like cataracts and **microphthalmia** are part of the classic clinical picture. *VSD* - **Ventricular Septal Defect (VSD)** is a common cardiac anomaly seen in CRS, caused by rubella virus infection during heart development. - Other common cardiac defects include **Patent Ductus Arteriosus (PDA)** and **Pulmonary Artery Stenosis**.

Q: Which of the following is a contraindication to the use of Beta Blockers:

Severe asthma with bronchospasm. ***Severe asthma with bronchospasm*** - Beta-blockers, especially **non-selective ones**, can block beta-2 receptors in the lungs, leading to **bronchoconstriction** and worsening asthma symptoms. - This can precipitate a severe **asthma attack** and respiratory distress, making it an **absolute contraindication**. - Even cardioselective beta-blockers should be avoided in severe asthma. *Thyroid storm* - Beta-blockers are often used in **thyroid storm** to manage hyperadrenergic symptoms like **tachycardia** and **tremors**. - Propranolol also has the added benefit of inhibiting peripheral conversion of T4 to T3. - They are not contraindicated but rather an important part of treatment. *Glaucoma* - Topical beta-blockers (e.g., timolol) are commonly used to treat **glaucoma** by **reducing aqueous humor production**, thereby lowering intraocular pressure. - Oral beta-blockers also have this effect and are not contraindicated in glaucoma. *AV nodal reentrant tachycardia (AVNRT)* - Beta-blockers are frequently used in the management of **AVNRT** by slowing AV nodal conduction. - They are effective in both acute termination and prophylaxis of AVNRT episodes. - **Note:** Beta-blockers ARE contraindicated in **atrial fibrillation with Wolff-Parkinson-White syndrome** (pre-excited AF), as blocking the AV node can preferentially conduct through the accessory pathway, potentially causing ventricular fibrillation.

Q: Reason for preferring Cisatracurium over Atracurium is:-

Lesser provocation of histamine release. ***Lesser provocation of histamine release*** - **Cisatracurium** is preferred over atracurium primarily due to its significantly **lower potential to induce histamine release**, leading to fewer cardiovascular side effects like hypotension and tachycardia. - This property makes cisatracurium a **safer option** for patients prone to hemodynamic instability or allergic reactions. *Faster acting than Atracurium* - Both atracurium and cisatracurium are **intermediate-acting** neuromuscular blockers, and their onset times are quite similar, with cisatracurium sometimes having a slightly *slower* onset. - The difference in onset time is **not clinically significant** enough to be a primary reason for preference. *Shorter action than Atracurium* - **Cisatracurium** has a slightly **longer duration of action** compared to atracurium, although both are considered intermediate-acting drugs. - Therefore, a shorter duration of action is **not a reason for its preference**; instead, it might even be a slight disadvantage in certain clinical scenarios requiring rapid reversal. *Does not undergo Hoffman elimination* - Both atracurium and cisatracurium undergo **Hoffman elimination** (non-enzymatic degradation) and ester hydrolysis, which allows for their use in patients with renal or hepatic dysfunction. - This is a shared characteristic, not a distinguishing factor that makes cisatracurium superior, and cisatracurium actually relies *more* heavily on Hoffman elimination.

Q: Most commonly used approach for retrosternal goitre:-

Transcervical. ***Transcervical*** - The transcervical approach is the **most common and preferred method** for resecting retrosternal goitres, as the majority can be delivered through the **thoracic inlet**. - This approach minimizes morbidity and avoids the need for a **sternotomy** in most cases. *Transthoracic second intercostal space* - This approach is typically reserved for **mediastinal masses** or procedures requiring direct access to the **pleural cavity**, which is generally not necessary for retrosternal goitres. - It would involve a more invasive incision than typically required for a goitre that can be delivered transcervically. *Axillary approach* - The axillary approach is primarily used for **lymph node dissection** in breast cancer or for certain **thoracoscopic procedures**, not for accessing the thyroid gland for retrosternal goitre removal. - Its anatomical location does not provide adequate exposure to the **cervical and mediastinal structures** involved in a retrosternal goitre. *Trans-sternal through anterior mediastinum* - A trans-sternal approach (sternotomy) is a **major surgical procedure** typically reserved for very large, irreducible retrosternal goitres that have significant **mediastinal extension** or are adherent to surrounding structures. - It is avoided whenever possible due to increased morbidity and longer recovery compared to the transcervical approach, making it less commonly used overall.

Question 1

Which muscle originates from 1st pharyngeal arch?

Accepted Answer

Masseter

Answer

Posterior belly of digastric

Answer

Buccinator

Answer

Stylopharyngeus

Question 2

Polyuria in adults is commonly defined as urine output exceeding:

Accepted Answer

40 ml / Kg/ day

Answer

50 ml/ kg / day

Answer

30 ml / Kg/ day

Answer

60 ml/ kg / day

Question 3

Patient with ascending paralysis, areflexia and sphincter sparing is seen in?

Accepted Answer

G.B.S

Answer

Botulinism

Answer

Snake bite

Answer

Polio

Question 4

Not an AIDS defining illness?

Accepted Answer

Tertiary Syphilis

Answer

Progressive multifocal leukoencephalopathy

Answer

Lymphoma of brain < 60 years of age

Answer

Extrapulmonary Cryptococcosis

Question 5

A lady primigravida developed fluctuant painful mass of breast and fever after 14 days of delivery. Preferred treatment option is:-

Accepted Answer

Incision and drainage

Answer

Analgesics and continue breast feeding

Answer

Antipyretic

Answer

Stop lactation

Question 6

Caspase involved in activation of IL-1 is which of the following?

Accepted Answer

Caspase 1

Answer

Caspase 5

Answer

Caspase 8

Answer

Caspase 3

Question 7

Congenital Rubella Syndrome includes all except

Accepted Answer

Intracerebral hemorrhage

Answer

SN deafness

Answer

Cataract

Answer

VSD

Question 8

Which of the following is a contraindication to the use of Beta Blockers:

Accepted Answer

Severe asthma with bronchospasm

Answer

Thyroid storm

Answer

Glaucoma

Answer

AV nodal reentrant tachycardia (AVNRT)

Question 9

Reason for preferring Cisatracurium over Atracurium is:-

Accepted Answer

Lesser provocation of histamine release

Answer

Faster acting than Atracurium

Answer

Shorter action than Atracurium

Answer

Does not undergo Hoffman elimination

Question 10

Most commonly used approach for retrosternal goitre:-

Accepted Answer

Transcervical

Answer

Transthoracic second intercostal space

Answer

Axillary approach

Answer

Trans-sternal through anterior mediastinum

NEET-PG 2019

Anatomy

Internal Medicine

Obstetrics and Gynecology

Pathology

Pediatrics

Pharmacology

Surgery