NEET-PG 2019 Practice Questions

Q: Amino acid required for conversion of norepinephrine to epinephrine:-

Methionine. ***Methionine*** - **Norepinephrine** is converted to **epinephrine** by the enzyme **phenylethanolamine N-methyltransferase (PNMT)**. - This enzyme uses **S-adenosylmethionine (SAM)** as a **methyl donor**, which is derived from methionine. *Lysine* - **Lysine** is an essential amino acid primarily involved in **protein synthesis**, **calcium absorption**, and the production of **carnitine**. - It does not directly participate in the methylation reaction converting norepinephrine to epinephrine. *Tryptophan* - **Tryptophan** is a precursor for **serotonin** and **niacin** synthesis. - It is not involved in the catecholamine synthesis pathway from norepinephrine to epinephrine. *Phenylalanine* - **Phenylalanine** is the initial amino acid in the **catecholamine synthesis pathway**, being converted to **tyrosine**, then to DOPA, dopamine, and norepinephrine. - While it's crucial for the synthesis *up to* norepinephrine, it is not directly involved in the *conversion of norepinephrine to epinephrine*.

Q: For the population of 10,000, how much area is required per year for a trench method sanitary landfill pit of 2m depth?

1 acre. ***1 acre*** - For a **trench method sanitary landfill** with a 2m depth, the required area per year for a population of 10,000 is approximately **1 acre**. - This estimation accounts for the typical volume of solid waste generated by this population size and the compaction achieved in well-managed landfills. *3 acres* - An area of **3 acres** would be significantly larger than typically required for a population of 10,000 for a 2m deep trench landfill. - This might be needed for a much larger population, less compaction, or a shallower landfill depth. *4 acres* - **4 acres** is an excessive amount of land for the stated population and landfill depth, suggesting inefficiency or a miscalculation in waste volume or density. - Such a large area would likely imply either very low waste compaction or a much larger population than specified. *2 acres* - While closer than 3 or 4 acres, **2 acres** is still generally more than what is needed for a 10,000 population with a 2m deep trench landfill. - This could be considered if the waste generation rate is higher than average or if compaction is less efficient.

Q: A 26-year-old female patient presented with oral ulcers, sensitivity to light and rash over the malar area of the face sparing the nasolabial folds of both sides. Which of the following is most characteristic of this condition?

Butterfly rash sparing the nasolabial folds. ***Butterfly rash sparing the nasolabial folds*** - The patient's presentation with oral ulcers, sensitivity to light (photosensitivity), and a rash over the malar area **sparing the nasolabial folds** is highly characteristic of **Systemic Lupus Erythematosus (SLE)**, a condition where a butterfly rash is a hallmark. - This specific distribution of the malar rash is a key diagnostic feature differentiating it from other facial rashes. *Heliotrope rash on upper eyelid, bilateral hilar lymphadenopathy* - A **heliotrope rash** on the upper eyelids is characteristic of **dermatomyositis**, which also presents with muscle weakness, not typically oral ulcers or a malar rash. - **Bilateral hilar lymphadenopathy** is a classic finding in **sarcoidosis**, a granulomatous disease, not directly related to the patient's symptoms. *Port-wine stain, CNS malformations: seen in Sturge-Weber syndrome* - A **port-wine stain** (nevus flammeus) is a congenital capillary malformation, often on the face, and is a principal feature of **Sturge-Weber syndrome**, which involves CNS malformations and seizures. - This condition has no association with oral ulcers, photosensitivity, or the described malar rash. *Silvery scales or plaques: seen in psoriasis* - **Silvery scales or plaques** are the characteristic dermatological lesions of **psoriasis**, a chronic inflammatory skin condition. - Psoriasis typically presents with well-demarcated erythematous plaques and is not associated with oral ulcers, photosensitivity, or a lupus-specific malar rash.

Q: Which of the following is the best treatment for refractory ITP?

Splenectomy. ***Splenectomy*** - **Splenectomy** is considered the most effective treatment for **refractory immune thrombocytopenic purpura (ITP)**, especially in patients who have failed multiple lines of medical therapy [1]. - The spleen is the primary site of **platelet destruction** and **antibody production** against platelets in ITP, so its removal can lead to a sustained increase in platelet count [1]. *Platelet transfusion* - While platelet transfusions can temporarily increase platelet counts, they are generally reserved for **acute, life-threatening bleeding** in ITP, not as a definitive treatment for refractory cases. - Transfused platelets are rapidly destroyed by the same **autoantibodies** that target endogenous platelets, making their effect short-lived. *Azathioprine* - **Azathioprine** is an **immunosuppressant** that can be used in ITP, but it is typically a **second-line** or **third-line agent** and its response takes time [1]. - It is not considered the "best" treatment for refractory ITP compared to splenectomy, which offers a more immediate and often sustained response [1]. *Prednisolone* - **Prednisolone** (corticosteroids) is often the **first-line treatment** for ITP due to its rapid immunosuppressive effects. - However, for **refractory ITP** (meaning it has not responded adequately to initial treatments), corticosteroids alone are usually insufficient to achieve long-term remission [1].

Q: Contact isolation is done for:

MRSA. ***MRSA*** - **Methicillin-resistant *Staphylococcus aureus* (MRSA)** is transmitted primarily through direct contact with infected patients or contaminated environmental surfaces, necessitating **contact isolation** measures. - These measures include the use of **gloves and gowns** upon entering the patient's room to prevent spread. *Mumps* - Mumps is a viral infection primarily transmitted via **respiratory droplets**, requiring **droplet isolation** rather than contact isolation. - The virus spreads through coughing and sneezing, necessitating measures like wearing a surgical mask. *Diphtheria* - Diphtheria, caused by *Corynebacterium diphtheriae*, is spread through **respiratory droplets** from close contact with an infected person, requiring **droplet isolation**. - This typically involves wearing a mask and sometimes eye protection. *Typhoid* - Typhoid fever is a **fecal-oral disease** caused by *Salmonella Typhi*, transmitted through contaminated food and water. - While proper hand hygiene is crucial, it generally does not require specific isolation precautions beyond **standard precautions** in a hospital setting for most patients.

Q: 12 years male came with swelling of lower end tibia which is surrounded by rim of reactive bone. What is most likely diagnosis?

Brodie's Abscess. ***Brodie's Abscess*** - A **Brodie's abscess** is a subacute or chronic osteomyelitis characterized by a localized bone abscess, typically with a surrounding **sclerotic rim of reactive bone**. - It often occurs in the **metaphysis of long bones** (like the lower end of the tibia) in children and adolescents, presenting with localized pain and swelling. *GCT* - **Giant cell tumor (GCT)** typically occurs in **skeletally mature adults** (20-40 years old) and is a lytic lesion often found in the **epiphysis** of long bones, rarely with a distinct sclerotic rim. - GCTs are generally more aggressive and demonstrate a **soap-bubble appearance** with cortical expansion rather than a thick reactive bone rim. *Hyper PTH* - **Hyperparathyroidism** causes bone changes such as **osteopenia**, **subperiosteal bone resorption**, especially in the phalanges, and **brown tumors** (lytic lesions). - It does not typically present as a localized lesion with a **sclerotic rim of reactive bone** in a child. *Osteomyelitis* - While chronic osteomyelitis can involve local bone destruction and reactive bone formation, a **Brodie's abscess** is a specific, well-circumscribed form of **subacute osteomyelitis**. - Acute osteomyelitis presents with more diffuse systemic symptoms (fever, malaise) and less defined reactive bone in its early stages compared to the distinct **sclerotic rim** seen in a Brodie's abscess.

Q: Glanzmann thrombasthenia is due to defect in:-

Gp IIb/IIIa. ***Gp IIb/IIIa*** - Glanzmann thrombasthenia is a **rare, inherited bleeding disorder** characterized by a defect or deficiency in the **glycoprotein IIb/IIIa (Gp IIb/IIIa) complex** on the platelet surface [1]. - This complex is crucial for platelet aggregation as it acts as the receptor for **fibrinogen**, which links activated platelets together [1]. *Gp VI* - **Glycoprotein VI (Gp VI)** is a collagen receptor on platelets, important for initial **platelet adhesion and activation** at sites of vascular injury. - Defects in Gp VI are associated with milder bleeding disorders, not Glanzmann thrombasthenia. *Thromboxane A2* - **Thromboxane A2 (TXA2)** is a potent **vasoconstrictor** and **platelet aggregator** synthesized by platelets. - Disorders in TXA2 synthesis or response, such as aspirin-induced platelet dysfunction, cause bleeding but are biochemically distinct from Glanzmann thrombasthenia. *Gp Ia/IIa* - The **glycoprotein Ia/IIa (Gp Ia/IIa) complex** (also known as integrin ̡2̢1) is another **collagen receptor** on platelets, mediating platelet adhesion to collagen. - Defects in Gp Ia/IIa lead to a different type of mild bleeding disorder, affecting initial adhesion rather than aggregation. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 668-669.

Q: Which of the following conditions is characterized by intense depression and misery?

Major depressive disorder. ***Major depressive disorder*** - This condition is primarily defined by a period of at least two weeks of **depressed mood** or **loss of interest or pleasure** (anhedonia). - Patients often experience profound **feelings of sadness, hopelessness, and misery**, along with other symptoms like changes in sleep, appetite, energy, and concentration. - **MDD is the primary diagnostic category** for conditions characterized by intense depression and misery. *Schizophrenia* - Schizophrenia is characterized by **psychotic symptoms** such as hallucinations, delusions, disorganized thought, and negative symptoms. - While people with schizophrenia might experience periods of low mood, the primary defining features are not intense depression and misery, but rather a **break from reality**. *Mania* - Mania is characterized by an **elevated or irritable mood**, increased energy, and hyperactivity, which are the opposite of depression. - Symptoms include **racing thoughts, decreased need for sleep, grandiosity, and impulsive behavior**, not intense depression. *Melancholia* - Melancholia is a **specifier for major depressive disorder**, not a standalone condition in DSM-5/ICD-11. - While melancholia describes a **particularly severe form** of depression with profound despondency, it is a **subtype or qualifier** applied to MDD, not a separate diagnostic entity. - **The question asks for a "condition"** - MDD is the primary condition, while melancholic features describe characteristics within that condition.

Q: What is the typical IQ range for males affected with Fragile X syndrome?

IQ range of 60-80. **IQ range of 60-80** - Males affected with **Fragile X syndrome** typically experience **moderate intellectual disability**, corresponding to an IQ range of 60-80. - This range indicates significant cognitive impairment, yet usually allows for some level of independent living and vocational skills with support. *IQ range of 20-40* - An IQ range of 20-40 represents **severe intellectual disability**, which is less common for the typical presentation of Fragile X syndrome in males. - While some individuals with Fragile X may fall into this range, it is not considered the most typical or average outcome. *IQ range of 50-70* - An IQ range of 50-70 represents **mild to moderate intellectual disability**, which overlaps with but is generally slightly lower than the most typical presentation. - While many males with Fragile X syndrome may score in this range, the typical range cited in literature extends slightly higher to 60-80. *IQ range of 80-100* - An IQ range of 80-100 is considered **borderline to low-average intelligence**, which is generally higher than the typical impact of Fragile X syndrome on male cognitive function. - This range is not indicative of the moderate intellectual disability characteristic of the syndrome. *Normal IQ range (90-110)* - A **normal IQ range (90-110)** is inconsistent with the diagnosis of Fragile X syndrome, which is a leading cause of inherited intellectual disability. - While females with Fragile X may have a wider range of IQs, including normal intelligence, males are typically more severely affected.

Question 1

Amino acid required for conversion of norepinephrine to epinephrine:-

Accepted Answer

Methionine

Answer

Lysine

Answer

Tryptophan

Answer

Phenylalanine

Question 2

For the population of 10,000, how much area is required per year for a trench method sanitary landfill pit of 2m depth?

Accepted Answer

1 acre

Answer

3 acres

Answer

4 acres

Answer

2 acres

Question 3

A 26-year-old female patient presented with oral ulcers, sensitivity to light and rash over the malar area of the face sparing the nasolabial folds of both sides. Which of the following is most characteristic of this condition?

Accepted Answer

Butterfly rash sparing the nasolabial folds

Answer

Heliotrope rash on upper eyelid, bilateral hilar lymphadenopathy

Answer

Port-wine stain with CNS malformations

Answer

Silvery scales or plaques

Question 4

Which of the following is the best treatment for refractory ITP?

Accepted Answer

Splenectomy

Answer

Platelet transfusion

Answer

Azathioprine

Answer

Prednisolone

Question 5

Contact isolation is done for:

Accepted Answer

MRSA

Answer

Mumps

Answer

Diphtheria

Answer

Typhoid

Question 6

12 years male came with swelling of lower end tibia which is surrounded by rim of reactive bone. What is most likely diagnosis?

Accepted Answer

Brodie's Abscess

Answer

GCT

Answer

Hyper PTH

Answer

Osteomyelitis

Question 7

Glanzmann thrombasthenia is due to defect in:-

Accepted Answer

Gp IIb/IIIa

Answer

Gp VI

Answer

Thromboxane A2

Answer

Gp Ia/IIa

Question 8

Which of the following conditions is characterized by intense depression and misery?

Accepted Answer

Major depressive disorder

Answer

Schizophrenia

Answer

Mania

Answer

Melancholia

Question 9

What is the typical IQ range for males affected with Fragile X syndrome?

Accepted Answer

IQ range of 60-80

Answer

IQ range of 20-40

Answer

IQ range of 80-100

Answer

Normal IQ range (90-110)

Answer

IQ range of 50-70

Question 10

Which of the following best describes a degloving injury?

Accepted Answer

Separation of skin, subcutaneous tissue, and fascia with tendon exposure

Answer

Separation of only the skin layer

Answer

Separation of skin and subcutaneous tissue without fascia involvement

Answer

Exposure of tendons without skin and fascia separation

NEET-PG 2019

Biochemistry

Community Medicine

Dermatology

Internal Medicine

Microbiology

Orthopaedics

Pathology

Psychiatry

Surgery