NEET-PG 2020 Practice Questions

Q: Stimulation of the external auditory canal leads to cough due to which nerve?

Auricular branch of vagus. ***Auricular branch Vagus*** - The **auricular branch of the vagus nerve (Arnold's nerve)** innervates the posterior and inferior walls of the external auditory canal. - Stimulation of this nerve can trigger the **cough reflex**, as the vagus nerve is also responsible for innervating the larynx, pharynx, and trachea. *Greater auricular nerve* - The **greater auricular nerve** is a cutaneous nerve from the cervical plexus (C2-C3) that supplies sensation to the skin over the mastoid process, posterior auricle, and part of the earlobe. - It does not directly innervate the external auditory canal in a way that would trigger a cough reflex. *Auriculotemporal nerve* - The **auriculotemporal nerve** is a branch of the mandibular nerve (V3) that provides sensory innervation to the temporomandibular joint, skin over the temple, and part of the external ear. - While it innervates part of the ear, its stimulation does not typically elicit a cough reflex. *Facial Nerve* - The **facial nerve** is primarily responsible for motor innervation of the muscles of facial expression and taste sensation to the anterior two-thirds of the tongue. - Although it has a small sensory component to the external ear (via auricular branches), it is not the primary nerve responsible for the cough reflex when the external auditory canal is stimulated.

Q: In trochlear palsy, which specific eye movement is lost?

Downward gaze and inward rotation of the eye. ***Downward gaze and inward rotation of the eye*** - Trochlear palsy affects the **superior oblique muscle**, which is primarily responsible for **downward gaze** and **intorsion** (inward rotation) of the eye, particularly when the eye is adducted. - Patients often present with **vertical diplopia** and a **head tilt** away from the affected side to compensate for the eye misalignment. *Upward gaze* - Upward gaze is primarily mediated by the **superior rectus muscle** (innervated by the oculomotor nerve) and the **inferior oblique muscle** (also oculomotor nerve). - Trochlear nerve palsy does not directly impair the muscles responsible for moving the eye upwards. *Lateral movement of the eye* - **Lateral movement** (abduction) of the eye is controlled by the **lateral rectus muscle**, which is innervated by the **abducens nerve (CN VI)**. - A loss of lateral movement would indicate an abducens nerve palsy, not a trochlear nerve palsy. *Facial expressions* - **Facial expressions** are controlled by the muscles of facial expression, which are innervated by the **facial nerve (CN VII)**. - This is unrelated to the cranial nerves involved in eye movement.

Q: Proteoglycan present in the glomerular basement membrane is?

Heparan sulfate. ***Heparan sulphate*** - Heparan sulphate is a key component of the **glomerular basement membrane** (GBM), crucial for its **negative charge and filtration function** [1][2]. - It plays a significant role in **filtration barrier** properties and affects the permeability of the GBM to proteins [1]. *Keratan sulphate 1* - Predominantly found in **cartilage** and **corneal tissue**, not associated with the glomerular basement membrane. - It contributes to **mechanical support** but lacks the essential role in renal filtration. *Keratan sulphate 2* - Similar to Keratan sulphate 1, this variant is involved in **cartilage** but not in the structure of the glomerular basement membrane. - Has distinct functions related to **tissue hydration** rather than the filtration dynamics of the GBM. *Chondroitin sulphate* - Commonly located in **cartilage** and connective tissues, it does not play a significant role in the structure of the glomerular basement membrane. - While it assists in **cell signaling** and regeneration, it does not influence the GBM permeability like heparan sulphate. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 905-907. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. With Illustrations By, pp. 34-35.

Q: A Patient falls down often with behavioral change and enuresis. What is the condition associated with him?

Normal pressure hydrocephalus (NPH). ***Normal pressure hydrocephalus (NPH)*** - NPH is characterized by the classic triad of symptoms: **gait disturbance** (leading to falls), **dementia/behavioral changes**, and **urinary incontinence** (enuresis) [1]. - These symptoms arise from the accumulation of cerebrospinal fluid (CSF) in the brain's ventricles without a corresponding increase in intracranial pressure [2]. *Parkinson's disease (PD)* - While PD causes **gait instability** and falls, its primary symptoms include **bradykinesia**, **rigidity**, and **resting tremor**, which are not mentioned. - Behavioral changes can occur later in the disease, but **enuresis** is not a hallmark symptom. *Alzheimer's disease (AD)* - AD primarily presents with **progressive memory loss** and cognitive decline, not gait disturbances or enuresis as early or prominent features. - Falls usually occur much later due to advanced cognitive impairment and not as an initial triad component. *Frontotemporal dementia (FTD)* - FTD is characterized by early and prominent **behavioral and personality changes** or language difficulties. - While falls can occur due to executive dysfunction, **gait disturbance** and **enuresis** as part of a triad are not typical presenting features.

Q: A 42-year-old patient with obstructive jaundice. Alp, Ggt, haptoglobin all increased. The most likely cause is:

Biliary obstruction. ***Alcohol*** - Chronic **alcohol consumption** leads to hepatic injury, causing cholestasis and increased levels of **Alkaline Phosphatase (ALP)** and **Gamma-glutamyl transferase (GGT)** [1, 2]. - Increased **haptoglobin** indicates hemolysis or hepatic dysfunction, commonly seen in alcohol-related liver disease [1]. *Lead* - Lead poisoning typically causes **anemia** and affects **erythropoiesis**, but does not generally increase ALP and GGT levels significantly. - The classic presentation involves **neurological** deficits and **peripheral neuropathy**, rather than obstructive jaundice. *Chronic rf* - Chronic renal failure primarily affects **uremia** and renal function tests, with minimal impact on liver function tests like ALP and GGT. - It is not directly associated with **increased haptoglobin**, which is usually elevated in liver disease. *None of the above* - This option implies that none of the listed causes could lead to the observed lab changes, which is incorrect as **alcohol** is a known cause [1, 2]. - Enhancing liver damage from substances other than alcohol is not applicable based on the information given.

Q: Identify the parasite shown in the image.

Trichuris trichiura. ***Trichuris trichiura*** - The image displays characteristic **lemon-shaped** or **barrel-shaped eggs** with distinctive **polar plugs** at each end, which are pathognomonic for *Trichuris trichiura* (whipworm) eggs. - These eggs are thick-shelled and typically measure 50-55 µm by 20-25 µm, containing an undeveloped larva when passed in feces. *Ancylostoma duodenale* - Eggs of *Ancylostoma duodenale* (Old World hookworm) are **oval-shaped** with blunt ends, and a **thin shell**. - They typically contain a **segmented ovum** or an early-stage larva, lacking the polar plugs seen in the image. *Paragonimus westermani* - *Paragonimus westermani* (lung fluke) eggs are generally **oval-shaped** with a **flattened operculum** at one end, which is not visible in the image. - They are larger than *Trichuris* eggs, often measuring around 80-120 µm by 45-70 µm, and are often coughed up in sputum or passed in feces. *Strongyloides stercoralis* - *Strongyloides stercoralis* primarily produces **larvae** (rhabditiform or filariform) in stool samples rather than eggs. - If eggs are seen (rarely, in cases of severe diarrhea), they are small, thin-shelled, and typically contain a developed larva, unlike the eggs shown.

Q: What is the best treatment option for a septate uterus?

Transcervical hysteroscopic resection of the septum. ***Transcervical hysteroscopic resection of the septum*** - This procedure involves using a **hysteroscope** to visualize and resect the **fibrous or muscular septum** that divides the uterine cavity, restoring a normal uterine shape. - It is considered the gold standard due to its **minimally invasive nature**, effectiveness in improving reproductive outcomes, and lower risk of complications compared to abdominal approaches. *Tompkins Metroplasty* - This is an **abdominal surgical procedure** primarily used for the repair of a **bicornuate uterus**, not typically for a septate uterus. - It involves resecting the uterine fundus to create a single uterine cavity, which is more invasive than hysteroscopic septum resection. *Jones metroplasty* - This procedure is also an **abdominal approach** used for the surgical correction of a **bicornuate uterus**, not a septate uterus. - It involves excising the septal portion and approximating the uterine walls. *Strassmann metroplasty* - This is another **abdominal surgical technique** that is primarily indicated for the repair of a **bicornuate or didelphys uterus**, where a large defect needs to be corrected. - It involves reconstructing the uterus through a fundal incision, which is significantly more invasive than hysteroscopic septal resection for a septate uterus.

Q: Incongruous Homonymous hemianopia with Wernicke's hemianopia pupil is seen with the lesion of

Optic tract lesion. ***Optic tract lesion*** - An **optic tract lesion** typically causes **incongruous homonymous hemianopia** because the fibers are not fully segregated by their retinal origin, leading to unequal visual field defects in the two eyes [1]. - The **Wernicke's hemianopic pupil** is a specific sign associated with optic tract lesions involving the afferent pupillary fibers, where direct light reflex is lost in the hemianopic half of the pupil, but consensual reflex is preserved [1]. *Optic radiation lesion* - An optic radiation lesion generally causes **congruous homonymous hemianopia**, as the fibers are more organized by retinal correspondence further along the visual pathway. - It does not typically present with a Wernicke's hemianopic pupil, as the pupillary fibers usually exit the visual pathway before reaching the optic radiations [1]. *Lateral geniculate body lesion* - A lesion of the lateral geniculate body (LGB) would result in a **congruous homonymous hemianopia**, similar to optic radiation lesions, because the fibers are already well-segregated and organized. - The LGB is primarily a relay station for visual information, and a lesion here would not typically affect the pupillary light reflex in the specific way seen in Wernicke's hemianopic pupil [1]. *Anterior occipital cortex lesion* - Lesions in the anterior occipital cortex, particularly the primary visual cortex, typically cause **macular sparing homonymous hemianopia** due to the dual blood supply to the macular representation area [1]. - Such lesions do not involve the afferent pupillary pathways and therefore would not cause a Wernicke's hemianopic pupil.

Q: A 30-year-old male presents with swelling around the knee joint. Histopathological examination reveals many giant cells interspersed with mononuclear cells. What is the most likely diagnosis?

Giant cell tumour. ***Giant cell tumour*** - The presence of **giant cells** interspersed with **mononuclear cells** in the histopathological examination is characteristic of giant cell tumors [1], often found around the **knee joint** [1]. - Typically occurs in **young adults** and is associated with **subarticular bone lesions** that cause joint swelling [1]. *Osteosarcoma* - Generally presents with **extensive bone destruction** and **persistent pain**, along with a mass, not primarily giant cell formation. - Commonly involves individuals aged **10-20 years**, making it less likely in a 30-year-old male. *Ewing's sarcoma* - Characterized by **small round blue cells** on histology, often with **more aggressive behavior** and less prominent giant cells. - Typically affects the **pelvis** and **long bones**, rather than directly around the knee joint. *Chondrosarcoma* - Primarily characterized by **cartilage formation** with no prominent giant cells, often leading to a confusing diagnosis in imaging. - Usually occurs in **older adults** and does not typically present with predominant giant cells in histopathology. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1205-1206.

Q: What is the most serious complication of measles?

Pneumonia. ***Pneumonia*** - **Pneumonia**, particularly **giant cell pneumonia**, is the most common cause of **measles-related deaths** in young children. - It results from the **direct viral infection** of the lungs or a **secondary bacterial superinfection**. *Croup* - **Croup (laryngotracheobronchitis)** can be a complication of measles, but it is typically **less severe** and **less life-threatening** than pneumonia. - It primarily affects the **upper airways**, causing a barking cough and stridor. *Meningo-encephalitis* - **Meningo-encephalitis** is a serious, albeit **less common**, complication of measles, occurring in approximately 1 in 1,000 cases. - While potentially fatal or leading to neurological sequelae, it is **outranked by pneumonia** in terms of overall mortality attributed to measles. *Otitis media* - **Otitis media** (middle ear infection) is a common complication of measles, but it is generally **not life-threatening**. - It usually responds well to **antibiotic treatment** and rarely leads to severe outcomes.

Question 1

Stimulation of the external auditory canal leads to cough due to which nerve?

Accepted Answer

Auricular branch of vagus

Answer

Greater auricular nerve

Answer

Auriculotemporal nerve

Answer

Facial Nerve

Question 2

In trochlear palsy, which specific eye movement is lost?

Accepted Answer

Downward gaze and inward rotation of the eye

Answer

Upward gaze

Answer

Lateral movement of the eye

Answer

Facial expressions

Question 3

Proteoglycan present in the glomerular basement membrane is?

Accepted Answer

Heparan sulfate

Answer

Keratan sulfate 1

Answer

Keratan sulfate 2

Answer

Chondroitin sulfate

Question 4

A Patient falls down often with behavioral change and enuresis. What is the condition associated with him?

Accepted Answer

Normal pressure hydrocephalus (NPH)

Answer

Parkinson's disease (PD)

Answer

Alzheimer's disease (AD)

Answer

Frontotemporal dementia (FTD)

Question 5

A 42-year-old patient with obstructive jaundice. Alp, Ggt, haptoglobin all increased. The most likely cause is:

Accepted Answer

Biliary obstruction

Answer

Alcohol

Answer

Lead

Answer

None of the options

Question 6

Identify the parasite shown in the image.

Accepted Answer

Trichuris trichiura

Answer

Ancylostoma duodenale

Answer

Strongyloides stercoralis

Answer

Paragonimus westermani

Question 7

What is the best treatment option for a septate uterus?

Accepted Answer

Transcervical hysteroscopic resection of the septum

Answer

Tompkins Metroplasty

Answer

Jones metroplasty

Answer

Strassmann metroplasty

Question 8

Incongruous Homonymous hemianopia with Wernicke's hemianopia pupil is seen with the lesion of

Accepted Answer

Optic tract lesion

Answer

Optic radiation lesion

Answer

Lateral geniculate body lesion

Answer

Anterior occipital cortex lesion

Question 9

A 30-year-old male presents with swelling around the knee joint. Histopathological examination reveals many giant cells interspersed with mononuclear cells. What is the most likely diagnosis?

Accepted Answer

Giant cell tumour

Answer

Osteosarcoma

Answer

Ewing's sarcoma

Answer

Chondrosarcoma

Question 10

What is the most serious complication of measles?

Accepted Answer

Pneumonia

Answer

Croup

Answer

Otitis media

Answer

Meningo-encephalitis

NEET-PG 2020

Anatomy

Biochemistry

Internal Medicine

Microbiology

Obstetrics and Gynecology

Ophthalmology

Pathology

Pediatrics