NEET-PG 2019 Practice Questions

Q: Which type of collagen is maximum in skin?

Type I. ***Type I*** - **Type I collagen** is the most abundant type of collagen in the human body, constituting about 90% of total collagen [1]. - It provides **strength and structural support** to tissues like skin, bone, tendons, and ligaments [1]. *Type III* - **Type III collagen** is often found alongside Type I collagen in many tissues, but it is typically more prominent in **distensible tissues** like blood vessel walls and intestine. - While present in the skin, it is not the most abundant type; it contributes to **skin elasticity** and is abundant in early wound healing. *Type II* - **Type II collagen** is primarily found in **cartilage**, providing resistance to pressure and flexibility. - It is not a major component of the skin. *Type IV* - **Type IV collagen** is a major component of the **basement membrane**, forming a mesh-like network that provides support and acts as a filter. - It is found beneath epithelial cells, including those in the skin, but it is not the predominant collagen type within the dermal layer itself.

Q: Frey's syndrome occurs due to aberrant misdirection of fibers from salivary glands to sweat glands. These fibers come from which of the following?

Glossopharyngeal. ***Glossopharyngeal*** - Frey's syndrome (auriculotemporal syndrome) is caused by injury to the **auriculotemporal nerve**, a branch of the **mandibular division of the trigeminal nerve**, which carries postganglionic parasympathetic fibers from the **otic ganglion** that originated in the glossopharyngeal nerve. - These parasympathetic fibers, normally destined for the **parotid gland** to stimulate salivation, aberrantly regenerate and innervate sweat glands and blood vessels in the skin over the parotid region, leading to sweating and flushing upon mastication. *Facial* - The facial nerve primarily controls **muscles of facial expression**, taste sensation from the anterior two-thirds of the tongue, and parasympathetic innervation of the **submandibular** and **sublingual glands**, and lacrimal gland. - While it has some parasympathetic function, its fibers are not involved in innervating the parotid gland or the aberrant sweating seen in Frey's syndrome. *Trigeminal* - The trigeminal nerve is responsible for general sensation in the face and mastication, but its fibers are **not the source of the parasympathetic neurons** causing Frey's syndrome. - The auriculotemporal nerve, a branch of the trigeminal's mandibular division, *carries* these aberrant fibers, but they originate from the glossopharyngeal nerve. *Vagus* - The vagus nerve supplies efferent parasympathetic innervation to many organs in the thorax and abdomen, and sensory innervation for the pharynx, larynx, and taste from the epiglottis. - It plays no role in the innervation of the salivary glands relevant to Frey's syndrome or in the aberrant sweating mechanism.

Q: A 26 year old female patient presented with fever, oral ulcers, sensitivity to light and rash over the malar area of the face sparing the nasolabial folds of both side. Which of the following indicates the condition associated with these manifestations?

SLE. ***SLE*** - The combination of **fever**, **oral ulcers**, **photosensitivity**, and a **malar rash** (which typically spares the nasolabial folds), particularly in a young female, is classic for **Systemic Lupus Erythematosus (SLE)** [1]. - SLE is a **chronic autoimmune inflammatory disease** that can affect multiple organ systems [2]. *Rosacea* - Rosacea often presents with **facial erythema**, **telangiectasias**, and papulopustules, primarily on the central face, but it does not typically involve oral ulcers, fever, or photosensitivity in the same way as SLE [4]. - The rash of rosacea is usually not a classic malar rash sparing the nasolabial folds, and it is not an autoimmune systemic disease. *Dermatomyositis* - Dermatomyositis is characterized by **proximal muscle weakness** and specific skin manifestations like **Gottron's papules** (over joints), **heliotrope rash** (periorbital edema), and a **shawl sign**, which differ from the presented symptoms [3]. - While it can cause light sensitivity and a rash, the distribution and associated symptoms (like no mention of muscle weakness) are not typical for a primary presentation of dermatomyositis. *Psoriasis* - Psoriasis typically presents with **well-demarcated erythematous plaques** covered with **silvery scales**, commonly on extensor surfaces like elbows and knees, and can also affect nails and joints. - It does not typically cause fever, oral ulcers, or a malar rash with nasolabial fold sparing, which are hallmarks of SLE.

Q: A 9-year-old child presented to OPD with complaints of high-grade fever, vomiting, and one episode of seizure. CSF examination was done and Gram staining of the culture showed lanceolate-shaped gram-positive diplococci. What is the probable causative agent?

Streptococcus pneumoniae. ***Streptococcus pneumoniae*** - The description of **lanceolate-shaped gram-positive diplococci** in CSF is characteristic of *S. pneumoniae*. - This bacterium is a common cause of **bacterial meningitis** in children and can present with high fever, vomiting, and seizures. *Haemophilus influenzae* - This is a **gram-negative coccobacillus**, which would appear as small, pleomorphic rods rather than lanceolate-shaped diplococci on Gram stain. - While it causes meningitis, its Gram stain morphology is distinct from *S. pneumoniae*. *Streptococcus agalactiae* - *S. agalactiae* (Group B Streptococcus) is a **gram-positive coccus**, but it typically appears in **chains** and is a major cause of neonatal meningitis, not usually in a 9-year-old child. - Its morphology on Gram stain would not be described as lanceolate diplococci. *Neisseria meningitidis* - *N. meningitidis* is a **gram-negative diplococcus** and would appear as kidney-bean shaped or flattened paired cocci, not gram-positive. - Though a common cause of meningitis, the Gram stain morphology described rules it out.

Q: Rubella is caused by

Togavirus. ***Correct Answer: Togavirus*** - Rubella virus is classified under the genus *Rubivirus* within the family **Togaviridae** - Togaviruses are **enveloped, positive-sense, single-stranded RNA viruses** - Rubella causes German measles, characterized by mild fever and maculopapular rash - Important for congenital rubella syndrome when infection occurs during pregnancy *Incorrect: Paramyxovirus* - This family includes viruses like **measles (rubeola)** and **mumps** - Paramyxoviruses are enveloped, negative-sense, single-stranded RNA viruses - Different structural and genetic characteristics from rubella virus *Incorrect: Orthomyxovirus* - This family primarily consists of **influenza viruses** (types A, B, and C) - Orthomyxoviruses are enveloped, **negative-sense, segmented** RNA viruses - The segmented genome distinguishes them from rubella virus *Incorrect: Flavivirus* - This family includes **dengue virus**, **yellow fever virus**, and **Zika virus** - While flaviviruses are also enveloped, positive-sense, single-stranded RNA viruses, they belong to the family *Flaviviridae*, not Togaviridae - Different envelope proteins and replication strategies distinguish them from rubella virus

Q: A patient with GCT, which of the following is false?

Chemotherapy is the mainstay of treatment. ***Chemotherapy is the mainstay of treatment*** - This statement is **false** because **Giant Cell Tumor of Bone (GCT)** therapy primarily involves **surgical resection**, with or without adjuvant therapies like **denosumab**. - **Chemotherapy** is generally *not* the first-line treatment for GCT, as these tumors respond poorly to it; it's usually reserved for cases of **metastatic GCT** or when other treatments fail. *Defined margins* - GCTs often present radiographically with **well-defined, non-sclerotic margins**, which indicates a lytic lesion that is often locally aggressive but typically doesn't invade widely. - While they are locally destructive, their borders are usually visible, helping distinguish them from other bone tumors. *Epiphyseo-metaphyseal location* - GCTs commonly originate in the **metaphysis** of long bones and **extend into the epiphysis** after the growth plate has closed. - This characteristic location near a joint is a classic diagnostic feature of GCT, especially in adults. *Eccentric* - GCTs typically arise **eccentrically** within the bone, meaning they originate off-center in the bone marrow cavity before expanding and thinning the cortex. - This eccentric growth pattern is a distinguishing feature, particularly in contrast to other bone tumors which might be centrally located.

Q: Bellini duct cancer is seen in which of the following?

Kidney. ***Kidney*** - Bellini duct carcinoma is a **rare and aggressive subtype of renal cell carcinoma (RCC)**, originating from the collecting ducts of Bellini in the kidney. [1] - It accounts for a very small percentage of all RCCs and is characterized by a **poor prognosis**. *Liver* - The liver is affected by primary cancers like **hepatocellular carcinoma** and **cholangiocarcinoma**, or by metastatic disease, none of which arise from Bellini ducts. - Bellini ducts are structures **exclusive to the kidney**, not found in the liver. *Spleen* - Primary cancers of the spleen are **extremely rare**, with most malignant lesions being **lymphomas** or metastases. [2] - The spleen is a **lymphoid organ** and does not contain Bellini ducts. *Heart* - Primary cardiac tumors are uncommon, with the majority being **benign myxomas**. Malignant tumors include **sarcomas**. - The heart's anatomy is distinct and **does not contain any structures analogous to Bellini ducts**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 959-961. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 605-606.

Q: Wrong statement about SGLT (sodium-glucose linked transporter):

SGLT2 inhibitors worsen heart failure. ***SGLT2 inhibitors worsen heart failure*** - This statement is incorrect because **SGLT2 inhibitors** have been shown to **improve outcomes in heart failure**, reducing hospitalizations and cardiovascular mortality, even in patients without diabetes. - Their beneficial effects in heart failure are attributed to mechanisms such as **osmotic diuresis**, natriuresis, improved cardiac energetics, and reduced preload and afterload. - Landmark trials like **DAPA-HF** and **EMPEROR-Reduced** demonstrated significant benefits in heart failure with reduced ejection fraction (HFrEF). *SGLT2 inhibitors produce weight loss* - **SGLT2 inhibitors** cause **glucosuria** (excretion of glucose in the urine), leading to a loss of calories and subsequent modest weight loss (2-3 kg). - This effect is a common and beneficial side effect, contributing to improved metabolic profiles in patients with type 2 diabetes. *SGLT1 is present in the intestine and kidneys* - **SGLT1** is the primary transporter responsible for glucose absorption in the **small intestine** and is also found in the **kidneys' S3 segment** of the proximal tubule. - In the kidneys, it plays a minor role in glucose reabsorption compared to SGLT2, but it is critical for dietary glucose absorption. *SGLT1 has low capacity and high affinity* - **SGLT1** is characterized by its **high affinity** for glucose (Km ~0.4 mM), allowing it to efficiently reabsorb glucose even at low concentrations. - However, it has a **lower capacity** compared to SGLT2, meaning it reabsorbs a smaller absolute amount of glucose despite its strong binding.

Q: Oral factor Xa inhibitor is:

Rivaroxaban. ***Rivaroxaban*** - **Rivaroxaban** is a direct oral anticoagulant (DOAC) that specifically inhibits **factor Xa**, preventing thrombin generation and clot formation. - It is administered **orally** and is widely used for preventing and treating venous thromboembolism and stroke in atrial fibrillation. *Bivalirudin* - **Bivalirudin** is a **direct thrombin inhibitor** (DTI), not a factor Xa inhibitor. - It is administered **intravenously**, primarily used in percutaneous coronary interventions. *Dabigatran* - **Dabigatran** is an **oral direct thrombin inhibitor** (DTI), which directly inhibits thrombin (factor IIa). - It does not inhibit factor Xa; its mechanism of action is distinct from that of factor Xa inhibitors. *Fondaparinux* - **Fondaparinux** is an **indirect factor Xa inhibitor** that requires antithrombin for its anticoagulant activity. - It is administered **subcutaneously**, distinguishing it from oral factor Xa inhibitors like rivaroxaban.

Q: A 40 years old male was brought emergency with severe abdominal pain. On examination, pulse rate was 112/minute and systolic BP was 80 mmHg. Chest x-ray is given below. What is the most appropriate management?

Exploratory laparotomy. ***Exploratory laparotomy*** - The chest x-ray shows **pneumoperitoneum (air under the diaphragm)**, which, combined with severe abdominal pain, tachycardia, and hypotension (signs of **septic shock**), is highly indicative of a **perforated viscus**. - **Emergency exploratory laparotomy** is the definitive treatment to identify and repair the perforation, control contamination, and prevent further deterioration. *Saline wash of stomach* - This procedure is typically used for gastric lavage in cases of **poisoning or drug overdose**, or to clear the stomach in preparation for endoscopy. - It does not address a viscus perforation or the widespread abdominal contamination and systemic septic response seen in this patient. *Intercostal tube drainage* - **Intercostal tube drainage** (chest tube placement) is used to drain air (pneumothorax) or fluid (pleural effusion, hemothorax, empyema) from the pleural space, not the abdominal cavity. - While there is air visible on the x-ray, it is **subdiaphragmatic (pneumoperitoneum)**, not within the pleural space, and thus a chest tube would be ineffective and inappropriate. *IV antibiotics* - **Intravenous antibiotics** are crucial for managing sepsis associated with a perforated viscus and should be administered promptly. - However, antibiotics alone are **not sufficient** to treat the underlying mechanical problem of a perforation, which requires surgical repair to prevent ongoing bacterial contamination and sepsis.

Question 1

Which type of collagen is maximum in skin?

Accepted Answer

Type I

Answer

Type III

Answer

Type II

Answer

Type IV

Question 2

Frey's syndrome occurs due to aberrant misdirection of fibers from salivary glands to sweat glands. These fibers come from which of the following?

Accepted Answer

Glossopharyngeal

Answer

Facial

Answer

Trigeminal

Answer

Vagus

Question 3

A 26 year old female patient presented with fever, oral ulcers, sensitivity to light and rash over the malar area of the face sparing the nasolabial folds of both side. Which of the following indicates the condition associated with these manifestations?

Accepted Answer

SLE

Answer

Rosacea

Answer

Dermatomyositis

Answer

Psoriasis

Question 4

A 9-year-old child presented to OPD with complaints of high-grade fever, vomiting, and one episode of seizure. CSF examination was done and Gram staining of the culture showed lanceolate-shaped gram-positive diplococci. What is the probable causative agent?

Accepted Answer

Streptococcus pneumoniae

Answer

Haemophilus influenzae

Answer

Streptococcus agalactiae

Answer

Neisseria meningitidis

Question 5

Rubella is caused by

Accepted Answer

Togavirus

Answer

Paramyxovirus

Answer

Orthomyxovirus

Answer

Flavivirus

Question 6

A patient with GCT, which of the following is false?

Accepted Answer

Chemotherapy is the mainstay of treatment

Answer

Defined margins

Answer

Epiphyseo-metaphyseal location

Answer

Eccentric

Question 7

Bellini duct cancer is seen in which of the following?

Accepted Answer

Kidney

Answer

Liver

Answer

Spleen

Answer

Heart

Question 8

Wrong statement about SGLT (sodium-glucose linked transporter):

Accepted Answer

SGLT2 inhibitors worsen heart failure

Answer

SGLT2 inhibitors produce weight loss

Answer

SGLT1 is present in the intestine and kidneys

Answer

SGLT1 has low capacity and high affinity

Question 9

Oral factor Xa inhibitor is:

Accepted Answer

Rivaroxaban

Answer

Bivalirudin

Answer

Dabigatran

Answer

Fondaparinux

Question 10

A 40 years old male was brought emergency with severe abdominal pain. On examination, pulse rate was 112/minute and systolic BP was 80 mmHg. Chest x-ray is given below. What is the most appropriate management?

Accepted Answer

Exploratory laparotomy

Answer

Saline wash of stomach

Answer

Intercostal tube drainage

Answer

IV antibiotics

NEET-PG 2019

Anatomy

Internal Medicine

Microbiology

Orthopaedics

Pathology

Pharmacology

Surgery