NEET-PG 2019 Practice Questions

Q: Which of the following is NOT a personal protective equipment (PPE)?

Badges for detecting radiation. ***Badges for detecting radiation*** - While important for safety in environments with radiation exposure, **radiation badges (dosimeters)** are used to **monitor exposure levels**, not to protect the individual from the radiation itself. - They are a measurement tool rather than a physical barrier or protective clothing item. *Lab coat* - A **lab coat** is a primary piece of PPE, designed to protect personal clothing and skin from **splashes, spills, and hazardous substances**. - It forms a **physical barrier** between the wearer and potential contaminants. *Gloves* - **Gloves** are essential PPE used to protect hands from **chemical exposure, biological agents**, and to prevent the transmission of contaminants. - They create a direct barrier for tasks involving contact with hazardous materials. *Goggles* - **Goggles** are crucial PPE for protecting the eyes from **splashes, flying debris, and irritating mists or gases**. - They form a **seal around the eyes**, offering comprehensive protection from various hazards.

Q: Bird-Arthropod-Man transmission is seen in

Japanese encephalitis. ***Japanese encephalitis*** - Japanese encephalitis virus typically cycles between **birds** (especially wading birds like herons) and **mosquitoes** (mainly *Culex* species), with humans and pigs being dead-end hosts. - The mosquito acts as the **arthropod vector** transmitting the virus from infected birds to humans. *Paragonimus westermani* - This is a **lung fluke** with a complex life cycle involving snails and crustaceans as intermediate hosts, and humans or carnivorous mammals as definitive hosts. - It does not involve a **bird-arthropod-man** transmission cycle. *Plague* - Plague is caused by the bacterium *Yersinia pestis* and is primarily transmitted by **fleas** (arthropods) from **rodents** (mammals) to humans. - While it involves arthropods and humans, birds are not part of its primary transmission cycle. *Plasmodium falciparum* - *Plasmodium falciparum* causes **malaria** and is transmitted between humans by **Anopheles mosquitos** (arthropods). - This transmission cycle is typically **human-mosquito-human**, with birds not being involved in the transmission to humans.

Q: Inspiratory stridor is due to lesions of:

Subglottis. ***Subglottis*** - **Inspiratory stridor** is classically associated with **subglottic lesions**, such as **croup (laryngotracheobronchitis)** and **subglottic stenosis**. - The **subglottis** is the **narrowest part of the pediatric airway**, making it particularly susceptible to significant obstruction from inflammation or narrowing. - During inspiration, the negative intrathoracic pressure causes **dynamic collapse** of the subglottic region when narrowed, producing characteristic **high-pitched inspiratory stridor**. - Common causes: **Croup**, subglottic stenosis, subglottic hemangioma. *Supraglottis* - Supraglottic lesions (epiglottis, aryepiglottic folds) can also cause **inspiratory stridor**, particularly in **acute epiglottitis**. - However, supraglottic pathology more commonly presents with **muffled voice** (hot potato voice), **dysphagia**, **drooling**, and **tripod positioning**. - The stridor from supraglottic lesions tends to be **lower-pitched** and is often accompanied by more prominent systemic symptoms. *Trachea* - Tracheal lesions typically produce **biphasic stridor** (both inspiratory and expiratory phases) due to fixed obstruction in the main conducting airway. - The trachea is a more rigid structure; obstruction produces a **harsh, lower-pitched** sound heard in both respiratory phases. - Examples: tracheal stenosis, tracheomalacia, tracheal tumors. *Bronchi* - Bronchial lesions cause **expiratory wheezing** rather than stridor, due to dynamic collapse of small airways during exhalation. - Bronchial obstruction affects the lower airways and presents as **polyphonic wheeze** rather than the monophonic sound of stridor.

Q: Two identical twins will not have same:

Fingerprints. ***Fingerprints*** - **Fingerprints** are unique to each individual, even identical twins, because their formation is influenced by prenatal environmental factors such as **blood flow**, **amniotic fluid pressure**, and **baby's position in the womb**. - These environmental factors affect the development of **dermal ridges** during weeks 6-13 of gestation, leading to distinct patterns. *DNA* - **Identical twins** originate from a single fertilized egg that splits, meaning they share virtually **100% of their DNA**. - While minor epigenetic differences can occur, their core genetic code is the same. *Iris color* - **Iris color** is primarily determined by **genetics**, and since identical twins share the same genetic makeup, they typically have the same (or very similar) **eye color**. - Differences in iris patterns might exist, but the overall color is genetically programmed. *Blood group* - **Blood group** is an inherited trait determined by specific **antigens on red blood cells**, which are encoded by genes. - As identical twins share the same genetic information, they will have the **same blood type**.

Q: A 20-year-old alcoholic malnourished patient presented to the hospital with respiratory distress. His pulse was 112/minute. The patient had edema, hypertension, a systolic murmur along the left sternal edge, and bilateral crepitations in the lungs. A diagnosis of congestive high-output cardiac failure was made. Which vitamin is deficient?

Vitamin B1. ***Vitamin B1*** - The constellation of **high-output cardiac failure** (tachycardia, edema, hypertension, systolic murmur, pulmonary crepitations) in an alcoholic and malnourished patient strongly indicates **wet beriberi**, which is caused by **thiamine (Vitamin B1) deficiency** [1]. - **Alcoholism** is a major risk factor for thiamine deficiency due to poor nutritional intake and impaired absorption/meta [2]. *Vitamin B 6* - Deficiency of **pyridoxine (Vitamin B6)** can cause **sideroblastic anemia**, neurological symptoms like neuropathy and seizures, and **dermatitis**, but typically not high-output cardiac failure. - While alcoholics can be deficient in B6, it doesn't directly cause a primary cardiac syndrome like beriberi. *Vitamin B2* - **Riboflavin (Vitamin B2)** deficiency leads to symptoms such as **cheilosis**, **angular stomatitis**, **glossitis**, and **seborrheic dermatitis**, and sometimes corneal vascularization. - It is not directly associated with the described **congestive high-output cardiac failure** symptoms in this patient. *Vitamin C* - **Scurvy**, caused by **Vitamin C deficiency**, presents with **gingival bleeding**, **perifollicular hemorrhages**, **poor wound healing**, and **joint pain** [3]. - It does not cause high-output cardiac failure, although severe scurvy can lead to anemia and non-specific weakness.

Q: A 55-year-old female on methotrexate presents with continuous pain and swelling of bilateral hand joints. What is the best treatment plan for this patient?

Methotrexate + Sulphasalazine + Hydroxychloroquine. ***Methotrexate + Sulphasalazine + Hydroxychloroquine*** - This combination, known as **triple therapy**, is a well-established and effective strategy for **rheumatoid arthritis** patients who have an inadequate response to methotrexate monotherapy. - The combination of **conventional synthetic DMARDs (csDMARDs)** targets different inflammatory pathways, leading to a synergistic effect and improved disease control. *Double the dose of methotrexate* - While methotrexate doses can be optimized, simply doubling the dose may not be the most effective next step for uncontrolled disease and could increase the risk of **toxicity** without significantly improving efficacy. - Current guidelines often advocate for adding another DMARD or switching to a biologic agent if maximum tolerated methotrexate is insufficient. *Methotrexate + high potency Oral steroids* - Oral steroids are primarily used for **short-term symptom control** during flares or as a bridge therapy, not as a long-term strategy for sustained disease modification due to their significant side effect profile. - Adding high-potency oral steroids long-term with methotrexate would increase the risk of adverse effects like osteoporosis, infections, and adrenal insufficiency. *Stop methotrexate and start Monotherapy with anti-TNF- drugs* - While **anti-TNF drugs** are a powerful next-line treatment, **monotherapy** is generally less effective than combination therapy, especially for patients with active disease. - **Methotrexate is often continued** in combination with anti-TNF drugs even when initiating biological therapies, as it can enhance their efficacy and reduce immunogenicity.

Q: A 65-year-old alcoholic is admitted to the ICU with diagnosis of acute pancreatitis. After 48 hours he is unconscious and has the following findings: $\mathrm{sPO}_{2}=$ $60 \%, \mathrm{pO}_{2}=60 \mathrm{~mm} \mathrm{Hg}, \mathrm{pCO}_{2}=30 \mathrm{~mm} \mathrm{Hg}$ and $\mathrm{HR}=$ 120 bpm . CXR was performed. Diagnosis is?

Shock lung. ***Shock lung*** - The rapid progression to severe hypoxemia (sPO2 60%, pO2 60 mmHg), tachycardia, and the CXR findings of **bilateral diffuse infiltrates** in a patient with severe pancreatitis is highly suggestive of **Acute Respiratory Distress Syndrome (ARDS)**, which is colloquially known as "shock lung". - **Acute pancreatitis** is a common cause of ARDS due to the systemic inflammatory response leading to increased pulmonary vascular permeability and non-cardiogenic pulmonary edema. *Mendelson syndrome* - This syndrome refers to **chemical pneumonitis** caused by aspiration of gastric contents, typically during anesthesia or in patients with impaired consciousness. - While aspiration is a concern in an unconscious patient, the diffuse, widespread infiltrates seen on CXR and the context of severe pancreatitis point more strongly to ARDS. *Nosocomial pneumonia* - Nosocomial pneumonia is an infection acquired in a hospital setting, often characterized by **new onset fever, purulent sputum, and new infiltrate on chest X-ray**. - While possible in an ICU patient, the rapid deterioration, severe hypoxemia, and acute onset after 48 hours of admission with acute pancreatitis are more classic for ARDS than typical nosocomial pneumonia. *Sympathetic pleural effusion* - **Sympathetic pleural effusions** can occur in acute pancreatitis, particularly on the left side, due to localized inflammation. - However, the chest X-ray shows **diffuse bilateral parenchymal infiltrates** rather than predominant pleural fluid, and the severe hypoxemia is indicative of significant lung tissue involvement, not just an effusion.

Q: In exposure and response prevention therapy which one of the following is a poor prognostic factor in OCD?

Hoarding. ***Hoarding*** - **Hoarding** in OCD is considered a **poor prognostic factor** for ERP therapy due to the severe avoidance of discarding items and the strong emotional attachment to possessions. - Individuals with hoarding symptoms often display **low insight** into the irrationality of their hoarding behavior, making it more challenging to engage in and benefit from ERP. *Magical thinking* - While magical thinking can be a feature of OCD, it is not consistently associated with a **worse prognosis** in ERP compared to other symptom dimensions, especially when compared to hoarding. - ERP can effectively target rituals and compulsions driven by magical thoughts by gradually exposing the individual to feared outcomes without enacting the ritual. *Contamination* - **Contamination fears**, though distressing, often respond well to ERP through exposure to feared contaminants and prevention of washing/cleaning rituals. - While challenging, it is generally considered to have a **better prognosis** with ERP than hoarding. *Pathological doubt* - **Pathological doubt**, a core feature of many OCD presentations, is addressed in ERP by exposing individuals to situations that trigger doubt and preventing excessive checking or seeking reassurance. - Like contamination, it typically has a **more favorable prognosis** with ERP compared to hoarding due to the direct ability to target and prevent the compulsive behaviors.

Q: A 75-year-old female has chronic backache. X-ray spine is shown. What is the most likely diagnosis?

Osteoporosis. ***Osteoporosis*** - The X-ray shows diffuse **decreased bone density**, **vertebral body height loss** (compression fractures), and a **biconcave** (codfish) appearance of the vertebral bodies, all classic signs of osteoporosis. - The patient's age (75-year-old female) and chronic backache are consistent with **postmenopausal osteoporosis**, a common cause of such spinal changes. *Pott's spine* - Pott's spine, or **tuberculous spondylitis**, typically presents with **destruction of vertebral bodies** and **intervertebral discs**, often with an associated **paravertebral abscess**. - The X-ray imaging does not show signs of significant disc space narrowing, vertebral destruction, or soft tissue masses that would indicate an infectious process like Pott's spine. *Spondylolisthesis* - **Spondylolisthesis** involves the **anterior slippage of one vertebra over another**, which would be evident as a misalignment in the lateral spinal X-ray. - The image does not demonstrate any significant forward displacement of a vertebral body relative to the one below it. *Spondylodiscitis* - **Spondylodiscitis** is an **infection of the intervertebral disc space** and adjacent vertebral bodies, typically presenting with **erosions** and **destruction at the endplates** and **narrowing of the disc space**. - While there is some disc space narrowing due to degenerative changes, the prominent features of diffuse osteopenia and vertebral compression fractures are not typical of an acute or chronic infection.

Question 1

Which of the following is NOT a personal protective equipment (PPE)?

Accepted Answer

Badges for detecting radiation

Answer

Lab coat

Answer

Gloves

Answer

Goggles

Question 2

Bird-Arthropod-Man transmission is seen in

Accepted Answer

Japanese encephalitis

Answer

Paragonimus westermani

Answer

Plague

Answer

Plasmodium falciparum

Question 3

Inspiratory stridor is due to lesions of:

Accepted Answer

Subglottis

Answer

Supraglottis

Answer

Trachea

Answer

Bronchi

Question 4

Two identical twins will not have same:

Accepted Answer

Fingerprints

Answer

DNA

Answer

Iris color

Answer

Blood group

Question 5

A 20-year-old alcoholic malnourished patient presented to the hospital with respiratory distress. His pulse was 112/minute. The patient had edema, hypertension, a systolic murmur along the left sternal edge, and bilateral crepitations in the lungs. A diagnosis of congestive high-output cardiac failure was made. Which vitamin is deficient?

Accepted Answer

Vitamin B1

Answer

Vitamin B 6

Answer

Vitamin B2

Answer

Vitamin C

Question 6

A 55-year-old female on methotrexate presents with continuous pain and swelling of bilateral hand joints. What is the best treatment plan for this patient?

Accepted Answer

Methotrexate + Sulphasalazine + Hydroxychloroquine

Answer

Double the dose of methotrexate

Answer

Methotrexate + high potency Oral steroids

Answer

Stop methotrexate and start Monotherapy with anti-TNF- drugs

Question 7

A 65-year-old alcoholic is admitted to the ICU with diagnosis of acute pancreatitis. After 48 hours he is unconscious and has the following findings: $\mathrm{sPO}_{2}=$ $60 \%, \mathrm{pO}_{2}=60 \mathrm{~mm} \mathrm{Hg}, \mathrm{pCO}_{2}=30 \mathrm{~mm} \mathrm{Hg}$ and $\mathrm{HR}=$ 120 bpm . CXR was performed. Diagnosis is?

Accepted Answer

Shock lung

Answer

Mendelson syndrome

Answer

Nosocomial pneumonia

Answer

Sympathetic pleural effusion

Question 8

In exposure and response prevention therapy which one of the following is a poor prognostic factor in OCD?

Accepted Answer

Hoarding

Answer

Magical thinking

Answer

Contamination

Answer

Pathological doubt

Question 9

A 75-year-old female has chronic backache. X-ray spine is shown. What is the most likely diagnosis?

Accepted Answer

Osteoporosis

Answer

Pott's spine

Answer

Spondylolisthesis

Answer

Spondylodiscitis

Question 10

Which of the following is true about tenosynovitis of the finger?

Accepted Answer

Tenosynovitis of little finger will spread to thumb rather than ring finger.

Answer

Treatment is conservative.

Answer

Fingers held in mild extension / Extension deformity at the involved fingers.

Answer

With involvement of little finger the infection can spread to the ring finger.

NEET-PG 2019

Community Medicine

ENT

Forensic Medicine

General Medicine

Internal Medicine

Psychiatry

Radiology

Surgery