NEET-PG 2019 Practice Questions

Q: Maximum Airway Irritation caused by:-

Desflurane. ***Desflurane*** - **Desflurane** has a pungent odor and is known to cause significant **airway irritation**, leading to coughing, breath-holding, laryngospasm, and secretions, especially during induction. - Its high volatility and low blood-gas solubility contribute to its rapid onset and offset, but also increase its propensity for airway irritation. *Halothane* - **Halothane** has a sweet, non-pungent odor and is generally well-tolerated during induction, causing minimal airway irritation. - Although it causes myocardial depression and is associated with hepatotoxicity, airway irritation is not a primary concern. *Enflurane* - **Enflurane** has a mild, sweet odor and causes less airway irritation than **desflurane**, but more than halothane or sevoflurane. - It can cause central nervous system excitation at high concentrations, but airway irritation is not its most prominent side effect. *Sevoflurane* - **Sevoflurane** has a pleasant, non-pungent odor and is known for its minimal airway irritation, making it an excellent choice for inhalational inductions, particularly in pediatric patients. - It is often preferred over other volatile anesthetics when airway reactivity is a concern. *Isoflurane* - **Isoflurane** has a pungent odor and can cause moderate airway irritation, but generally less than desflurane. - It is associated with a higher incidence of coughing and breath-holding during induction compared to sevoflurane.

Q: Which amino acid is involved in the synthesis of creatinine, NO, and urea?

Arginine. ***Arginine*** - **Arginine** is a precursor for **Nitric Oxide (NO)** synthesis via **nitric oxide synthase**. - It is also a substrate for **creatinine** synthesis (along with glycine and methionine) and plays a key role in the **urea cycle**. *Glycine* - **Glycine** is a precursor for **creatinine** synthesis, but not directly involved in NO or urea production as the primary amino acid. - It is also a component of glutathione and purine synthesis. *Aspartate* - **Aspartate** is a key intermediate in the **urea cycle**, contributing one nitrogen atom to urea. - It is not directly a precursor for NO or creatinine. *Citrulline* - **Citrulline** is an intermediate in the **urea cycle** and is converted to arginine. - It is not directly involved in the synthesis of creatinine or as the primary precursor for NO.

Q: Which of the following is not a dietary fiber?

Starch. ***Starch*** - **Starch** is a **complex carbohydrate** that serves as a major energy source for humans and can be digested into glucose. - Unlike dietary fiber, starch is broken down by enzymes (like **amylase**) in the digestive tract, absorbed, and used for energy. *Cellulose* - **Cellulose** is a **polysaccharide** found in the cell walls of plants and is a major component of dietary fiber. - Humans lack the enzymes to digest cellulose, so it passes through the digestive system largely intact, adding **bulk to stool**. *Pectin* - **Pectin** is a **soluble dietary fiber** found in fruits, particularly apples and citrus. - It forms a gel-like substance when mixed with water and is known for its ability to lower cholesterol and regulate blood sugar. *Inulin* - **Inulin** is a **soluble dietary fiber** and a type of fructan, found in many plants like chicory root, onions, and garlic. - It acts as a **prebiotic**, promoting the growth of beneficial gut bacteria in the colon.

Q: Most peripheral unit for planning of family planning and other services under RCH program is

Sub-centre. ***Sub-centre*** - The **Sub-centre** is the most peripheral and first contact point between the primary healthcare system and the community. - It serves a population of 3,000-5,000 people and is responsible for delivering basic health services, including **family planning** and **RCH (Reproductive and Child Health) services**, directly to the community. *PHC* - A **Primary Health Centre (PHC)** is a more central facility, serving a larger population (20,000-30,000) and acting as a referral unit for 6 sub-centres. - While PHCs provide comprehensive primary care, the **planning and direct delivery** at the grassroots level occur at the Sub-centre. *District* - The **District level** involves overarching planning, supervision, and resource allocation for health services within the entire district. - It is not the most peripheral unit for direct service delivery or planning with the community. *Block/Taluka* - The **Block/Taluka level** often corresponds to a Community Health Centre (CHC) or block-level administrative health office. - These facilities supervise PHCs and manage health programs for a larger administrative block, but are not the immediate point of contact for service planning with the community.

Q: HIV patient presented with diarrhea. On stool examination, acid-fast organisms (Isospora belli) were seen. What is the drug of choice in this patient?

TMP-SMX. ***TMP-SMX*** - **Trimethoprim-sulfamethoxazole (TMP-SMX)** is the primary treatment for **Isospora belli** infections, especially in HIV-positive patients [1]. - It is highly effective in eradicating the parasite and preventing relapses in immunocompromised individuals [1]. *Niclosamide* - **Niclosamide** is an antihelminthic drug primarily used for treating **tapeworm infections** [2]. - It is not effective against protozoal parasites like *Isospora belli*. *Nitazoxanide* - **Nitazoxanide** is an antiparasitic drug that can be used for various protozoal and helminthic infections, including *Cryptosporidium* and *Giardia*. - While it has some efficacy against *Isospora belli*, it is generally considered a second-line agent, with **TMP-SMX** being the drug of choice [1]. *Primaquine* - **Primaquine** is an antimalarial drug specifically used to prevent relapse of **Plasmodium vivax** and **Plasmodium ovale** malaria by targeting hypnozoites. - It has no role in the treatment of **Isospora belli** infection.

Q: Which of the following features distinguishes Crohn's disease from Ulcerative colitis?

Transmural involvement. ***Transmural involvement*** - **Crohn's disease** is characterized by **transmural inflammation**, meaning the inflammation extends through all layers of the bowel wall [1]. This deep inflammation can lead to complications like **fistulas**, **strictures**, and **abscesses** [1], [3]. - In contrast, **Ulcerative colitis** typically involves inflammation limited to the **mucosa and submucosa** [4]. *Lymphocyte infiltrate* - Both Crohn's disease and Ulcerative colitis involve a **lymphocyte infiltrate** as part of the chronic inflammatory process [2]. This feature is not specific enough to differentiate between the two conditions. - The presence of lymphocytes, plasma cells, and other inflammatory cells is common in any chronic inflammatory bowel condition. *Mucosal edema* - **Mucosal edema** can be found in both Crohn's disease and Ulcerative colitis due to the inflammatory process. It is a general sign of inflammation rather than a specific differentiating feature. *Pseudopolyps* - **Pseudopolyps** are characteristic of **Ulcerative colitis**, forming as islands of regenerating mucosa in areas of severe inflammation and ulceration [4]. - While they can occasionally be seen in chronic Crohn's disease, they are much more common and prominent in Ulcerative colitis, representing a reparative process rather than primary disease activity. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 365-366. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 366-367. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 806-807. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, p. 809.

Q: Hemolysis is predominantly intravascular in which of the following conditions?

Paroxysmal nocturnal hemoglobinuria. ***Paroxysmal nocturnal hemoglobinuria*** - **PNH** is characterized by a defect in the **PIG-A gene**, leading to a deficiency of **GPI-anchored proteins** like CD55 and CD59 on red blood cells [1]. - This deficiency makes the red blood cells susceptible to complement-mediated lysis, predominantly occurring **intravascularly** [1]. *Warm autoimmune hemolytic anemia* - This condition involves **IgG autoantibodies** binding to red blood cells, which are then primarily removed by **macrophages in the spleen** and liver (extravascular hemolysis) [2]. - The presence of **spherocytes** and a positive direct **antiglobulin test (DAT)** are characteristic [2]. *Cold autoimmune hemolytic anemia* - Involves **IgM autoantibodies** that bind to red blood cells at colder temperatures, often causing agglutination in the peripheral circulation. - While some complement activation and lysis can occur intravascularly, the primary mechanism involves **macrophages in the liver** clearing antibody-coated red cells (extravascular), or red cell destruction in the cooler acral areas. *Spherocytosis* - This is a condition of abnormal red blood cell shape due to defects in **cytoskeletal proteins** (e.g., spectrin, ankyrin), making them less deformable. - These rigid spherocytes are primarily trapped and destroyed by the **phagocytic cells in the spleen**, indicating an **extravascular hemolytic process** [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 650-651. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 602-603.

Q: Tolvaptan is used for:-

SIADH. ***SIADH*** - **Tolvaptan** is a **vasopressin V2 receptor antagonist** that promotes water excretion without affecting sodium, making it ideal for treating **euvolemic and hypervolemic hyponatremia** associated with SIADH. - In **syndrome of inappropriate antidiuretic hormone secretion (SIADH)**, there is excessive **ADH** leading to water retention and dilutional hyponatremia; tolvaptan effectively counters this by blocking vasopressin's action. *Von Willebrand disease* - This is a **bleeding disorder** caused by a deficiency or dysfunction of **von Willebrand factor**, treated with **desmopressin** or factor replacement, not tolvaptan. - Tolvaptan has no role in coagulation pathways or the management of bleeding disorders. *Central DI* - **Central diabetes insipidus (DI)** results from reduced **ADH production** by the hypothalamus or posterior pituitary, leading to excessive water loss. - It is treated with **desmopressin** (synthetic ADH) to replace the deficient hormone, which is the opposite effect of tolvaptan. *Catecholamine resistant Shock* - **Catecholamine-resistant shock** is characterized by persistent hypotension despite high doses of **vasopressors**. - Treatment often involves agents like **vasopressin** (not tolvaptan) or corticosteroids to improve vascular tone, as tolvaptan would worsen the hypotension by promoting diuresis.

Q: A patient presents with a gradually progressive, painless mass persisting for 10 years. The mass is firm to nodular and shows variable consistency within different areas of the swelling. What is the most probable diagnosis?

Pleomorphic adenoma. ***Pleomorphic adenoma*** - A **gradually progressive**, **painless mass** that has been present for 10 years, with a **firm to nodular** consistency and variability at different sites, is highly characteristic of a pleomorphic adenoma. - This benign tumor of salivary glands is known for its **slow growth** and **variable histological composition**, leading to its characteristic consistency. *Dermoid cyst* - Dermoid cysts are typically **present from birth** or early childhood and tend to be **soft and doughy** in consistency, rather than firm or nodular with variable consistency. - While painless, their growth pattern and texture differ from the described mass. *Malignancy* - A mass that has been present for **10 years** and is still described as **gradually progressive** but painless is less likely to be a malignancy, as most malignant tumors tend to grow more rapidly and often present with pain or other symptoms over such a long period. - Malignancies usually demonstrate a more infiltrative and aggressive growth pattern. *Sebaceous cyst* - A sebaceous cyst (epidermoid cyst) typically presents as a **smooth, movable, dome-shaped lump** and contains a cheesy, malodorous material, which is not consistent with a firm to nodular mass with varying consistency. - While they can be long-standing and painless, their characteristic feel and contents are different.

Question 1

Maximum Airway Irritation caused by:-

Accepted Answer

Desflurane

Answer

Halothane

Answer

Enflurane

Answer

Sevoflurane

Answer

Isoflurane

Question 2

Which amino acid is involved in the synthesis of creatinine, NO, and urea?

Accepted Answer

Arginine

Answer

Glycine

Answer

Aspartate

Answer

Citrulline

Question 3

Which of the following is not a dietary fiber?

Accepted Answer

Starch

Answer

Cellulose

Answer

Pectin

Answer

Inulin

Question 4

Most peripheral unit for planning of family planning and other services under RCH program is

Accepted Answer

Sub-centre

Answer

PHC

Answer

District

Answer

Block/ Taluka

Question 5

HIV patient presented with diarrhea. On stool examination, acid-fast organisms (Isospora belli) were seen. What is the drug of choice in this patient?

Accepted Answer

TMP-SMX

Answer

Niclosamide

Answer

Nitazoxanide

Answer

Primaquine

Question 6

Which of the following features distinguishes Crohn's disease from Ulcerative colitis?

Accepted Answer

Transmural involvement

Answer

Lymphocyte infiltrate

Answer

Mucosal edema

Answer

Pseudopolyps

Question 7

Hemolysis is predominantly intravascular in which of the following conditions?

Accepted Answer

Paroxysmal nocturnal hemoglobinuria

Answer

Warm autoimmune hemolytic anemia

Answer

Cold autoimmune hemolytic anemia

Answer

Spherocytosis

Question 8

Which of the following statements is not true about tamoxifen?

Accepted Answer

Tamoxifen is useful in post-menopausal and aromatase inhibitors in premenopausal patients.

Answer

It can cause endometrial carcinoma.

Answer

It is used for visceral metastasis.

Answer

Dose is 20 mg for 5 years.

Question 9

Tolvaptan is used for:-

Accepted Answer

SIADH

Answer

Von Willebrand disease

Answer

Central DI

Answer

Catecholamine resistant Shock

Question 10

A patient presents with a gradually progressive, painless mass persisting for 10 years. The mass is firm to nodular and shows variable consistency within different areas of the swelling. What is the most probable diagnosis?

Accepted Answer

Pleomorphic adenoma

Answer

Dermoid cyst

Answer

Malignancy

Answer

Sebaceous cyst

NEET-PG 2019

Anesthesiology

Biochemistry

Community Medicine

Internal Medicine

Pathology

Pharmacology

Surgery