NEET-PG 2020 Practice Questions

Q: A study was conducted to investigate the relationship between COPD and smoking. Data was collected from government hospital records on COPD cases and cigarette sales records from finance and taxation departments. What is the study design?

Ecological study. ***Ecological study*** - This study uses **aggregate data** (COPD cases from hospital records, cigarette sales from taxation departments) at the population level, not individual data. - It investigates the relationship between exposure (smoking) and outcome (COPD) across different populations or groups. *Cross-sectional study* - A **cross-sectional study** collects data on exposure and outcome at a **single point in time** from individuals, which is not the case here as aggregate data is used. - It describes the prevalence of a disease and exposure in a population, but does not examine the relationship using population-level aggregates. *Operational study* - An **operational study** focuses on evaluating the effectiveness and efficiency of health services or programs in real-world settings. - It typically involves assessing how well interventions are implemented and their impact, rather than investigating the relationship between disease and exposure using aggregate data. *Case-control study* - A **case-control study** compares individuals with a disease (cases) to individuals without the disease (controls) and looks back retrospectively to identify exposures. - This design relies on individual-level data and is not suitable when only population-level aggregate data is available.

Q: A 65-year-old female attended the Orthopaedics OPD with a chief complaint of chronic backache. The radiograph of the lumbar spine is obtained. What could be the most probable diagnosis?

Osteoporosis. ***Osteoporosis*** - Chronic backache in a 65-year-old female is a classic presentation of **osteoporosis**, often due to vertebral compression fractures. - Radiographs would show **decreased bone density**, possibly wedging or collapse of vertebral bodies. *Renal Osteodystrophy* - This condition is associated with **chronic kidney disease**, which is not mentioned in the patient's history. - Radiographic features typically include **subperiosteal bone resorption** (especially in phalanges), osteosclerosis ("rugger-jersey spine"), and bone cysts. *Paget's Disease* - Paget's disease is characterized by localized areas of **increased bone turnover**, resulting in disorganized and enlarged bone. - Radiographs would show characteristic features like **bone enlargement**, cortical thickening, and a "cotton wool" appearance, which is not suggested by general backache. *Rheumatoid Arthritis* - Rheumatoid arthritis primarily affects **synovial joints** and typically presents with symmetrical polyarthritis, morning stiffness, and swelling in peripheral joints, not isolated chronic backache. - While it can affect the cervical spine, it rarely presents as isolated chronic low back pain in this age group and has specific radiographic changes like **joint erosions** and narrowing not indicative of osteoporosis.

Q: A middle-aged female presented with a 4cm mass in the upper outer quadrant of the breast. Biopsy showed densely packed cells within large extracellular spaces. Which of the following is the most likely diagnosis of this patient?

Colloid carcinoma of breast. ***Colloid carcinoma of breast*** - This type of carcinoma is characterized by **malignant cells floating in abundant extracellular mucin (colloid)**, which aligns with the description "densely packed cells within large extracellular spaces." - It often presents as a **well-circumscribed mass** and has a generally **good prognosis**. *Tubular carcinoma of breast* - Characterized by **well-differentiated tubules** with open lumens and a single layer of epithelial cells. - It does not typically feature large extracellular spaces filled with mucin. *Medullary carcinoma of breast* - This typically presents as a **soft, fleshy tumor** with syncytial sheets of large anaplastic cells and a prominent lymphoid infiltrate [1]. - It does not involve significant extracellular mucin or large extracellular spaces. *Papillary carcinoma of breast* - This carcinoma is defined by **papillary growth patterns** with fibrovascular cores lined by epithelial cells. - While it can be associated with cystic spaces, these are not typically described as "large extracellular spaces" filled with mucinous material. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 455-456.

Q: A 24 month child, with a weight of 11 kg, has RR of 38 / min, chest indrawing, cough and fever. Management according to IMNCI?

Give antibiotics. ***Give antibiotics*** - The child presents with **chest indrawing** along with cough and fever, which according to **IMNCI guidelines** classifies as **pneumonia**. - Note: RR of 38/min is **within normal limits** for a 24-month-old child (fast breathing threshold is ≥40/min for 12-59 months age group). - The diagnosis of pneumonia is based on the presence of **chest indrawing**, not fast breathing in this case. - According to **IMNCI**, pneumonia (without danger signs) should be treated with **oral antibiotics** (amoxicillin 250 mg twice daily for 5 days) at the primary care level. - The child should be followed up in 2 days and the mother advised on when to return immediately. *Refer to a higher-level health facility for further management.* - Referral is indicated for **severe pneumonia**, which requires presence of any **general danger sign** (inability to drink/breastfeed, persistent vomiting, convulsions, lethargy/unconsciousness, or stridor in calm child). - This child has **pneumonia** (not severe), so outpatient treatment with oral antibiotics is appropriate. *Monitor at home without medical treatment.* - This would be inappropriate as the child has **pneumonia** requiring antibiotic treatment. - Untreated pneumonia can rapidly progress to severe disease and is a **leading cause of child mortality** in developing countries. *Provide symptomatic treatment with antipyretics only.* - While antipyretics (paracetamol) can be given for fever, they do not treat the underlying **bacterial infection**. - Antibiotics are essential to treat pneumonia and prevent complications and mortality.

Q: A boy is planning to travel by bus. Which of the following drugs can be used to prevent motion sickness in this person?

Promethazine. **Promethazine** - **Promethazine** is an **H1 antihistamine** with significant **anticholinergic** properties that effectively blocks muscarinic receptors in the **vestibular system**, making it highly effective for preventing motion sickness. - Its **sedating effects** are also beneficial in relieving the discomfort associated with motion sickness. *Fexofenadine* - **Fexofenadine** is a **second-generation H1 antihistamine** that is **non-sedating** and has minimal anticholinergic activity. - While effective for allergies, its lack of central nervous system penetration and anticholinergic action makes it **ineffective for motion sickness**. *Loratadine* - **Loratadine** is another **second-generation H1 antihistamine**, known for being **non-sedating** and having limited entry into the central nervous system. - It does not possess the significant anticholinergic properties necessary to prevent the **vestibular disturbances** that cause motion sickness. *Cetirizine* - **Cetirizine** is a **second-generation H1 antihistamine** that has **moderate sedative effects** (more than other second-generation agents) and some CNS penetration, but lacks the significant **anticholinergic activity** required for motion sickness prevention. - It is primarily used for allergies and is **not recommended** for the prevention or treatment of motion sickness.

Q: A patient with pulmonary fibrosis comes to the emergency with arrhythmia. Which anti-arrhythmic drug should be avoided?

Amiodarone. ***Amiodarone*** - **Amiodarone** is known to cause **pulmonary toxicity** as a significant adverse effect, which can exacerbate pre-existing **pulmonary fibrosis**. - Its long half-life and **iodine content** contribute to its potential for delayed and severe pulmonary side effects, making it contraindicated in patients with existing lung disease. *Lignocaine* - **Lignocaine** (lidocaine) is a **Class IB antiarrhythmic** primarily used for **ventricular arrhythmias** and is generally safe in patients with pulmonary disease as it does not have significant pulmonary side effects. - Its main toxicities involve the **central nervous system** and cardiovascular system (at high doses). *Procainamide* - **Procainamide** is a **Class IA antiarrhythmic** that can be used for both **atrial and ventricular arrhythmias**, and it does not typically cause pulmonary toxicity. - Potential side effects include a **lupus-like syndrome**, agranulocytosis, and cardiotoxicity, none of which are exacerbated by pulmonary fibrosis. *Verapamil* - **Verapamil** is a **non-dihydropyridine calcium channel blocker** used for **supraventricular tachycardias** and rate control in atrial fibrillation, which does not have significant pulmonary side effects. - Its main concerns relate to **cardiac depression** and **hypotension**, but it is not contraindicated in the context of pulmonary fibrosis.

Q: Prolactin levels are highest in which of the following?

After nipple stimulation. ***After nipple stimulation*** - Nipple stimulation is a powerful physiological stimulus for **prolactin release** from the anterior pituitary. - This reflex is essential for **lactation** and milk let-down, as suckling signals directly enhance prolactin secretion. *After 24 hrs of ovulation* - Prolactin levels do not peak significantly 24 hours after ovulation; while some fluctuation occurs during the menstrual cycle, the highest levels are not seen at this time. - **Luteinizing hormone (LH)** and **follicle-stimulating hormone (FSH)** are the primary hormones exhibiting surges related to ovulation. *After 24 hours of parturition* - While prolactin levels are elevated throughout the third trimester and immediately postpartum, they tend to **decline somewhat** if breastfeeding is not initiated within the first 24-48 hours. - Post-partum, prolactin levels are primarily sustained by **frequent nipple stimulation** from breastfeeding. *Just before parturition* - Prolactin levels are **chronically elevated** during the third trimester of pregnancy, but the **acute highest surge** or peak is typically in response to specific triggers like nipple stimulation, rather than just the state of being immediately pre-partum. - High prolactin during late pregnancy prepares the breasts for lactation but is not necessarily the **absolute peak** that nipple stimulation can elicit.

Q: In a fetus highest oxygen concentration is found in?

Umbilical vein. ***Umbilical vein*** - The **umbilical vein** carries oxygenated blood from the **placenta**, which serves as the site of gas exchange, making its oxygen concentration the highest in the fetal circulation. - This highly oxygenated blood bypasses the fetal lungs via shunts such as the **ductus venosus** and **foramen ovale** to supply vital organs. *Superior vena cava* - The **superior vena cava** carries deoxygenated blood from the upper body and head back to the heart, mixing with oxygenated blood in the right atrium. - Its blood has a relatively **low oxygen saturation** compared to the umbilical vein. *Left ventricle* - The **left ventricle** receives blood that has already mixed in the atria and passed through the foramen ovale, then the left atrium. - While relatively oxygen-rich for systemic circulation, its oxygen concentration is lower than that in the umbilical vein due to **mixing with deoxygenated blood**. *Ascending aorta* - The **ascending aorta** receives blood from the left ventricle, which has a moderate oxygen content. - The blood in the ascending aorta feeds the upper body, but its oxygen saturation is lower than that in the umbilical vein due to the **physiological shunts** and mixing of blood.

Q: What does aquaporin deficiency cause?

Nephrogenic diabetes insipidus. ***Nephrogenic diabetes insipidus*** - Aquaporins, specifically **aquaporin-2**, are crucial for **water reabsorption** in the renal collecting ducts in response to ADH. - A deficiency or dysfunction of aquaporins leads to the kidneys being unable to concentrate urine, resulting in **excessive dilute urine production** and **polydipsia**, characteristic of nephrogenic diabetes insipidus. *Liddle syndrome* - This is an **autosomal dominant** disorder caused by a **gain-of-function mutation** in the **epithelial sodium channel (ENaC)**, leading to increased sodium reabsorption and hypertension. - It does not involve aquaporin deficiency but rather an overactive sodium channel. *Bartter syndrome* - Characterized by mutations in the **Na-K-2Cl cotransporter (NKCC2)** in the thick ascending limb of the loop of Henle, leading to impaired reabsorption of sodium, potassium, and chloride. - It results in **hypokalemia**, **metabolic alkalosis**, and **hypotension**, and is not directly caused by aquaporin deficiency. *Gitelman syndrome* - Caused by mutations in the **thiazide-sensitive Na–Cl cotransporter (NCC)** in the distal convoluted tubule, impairing sodium and chloride reabsorption. - It presents with symptoms similar to thiazide diuretic use, including **hypokalemia**, **hypomagnesemia**, and **metabolic alkalosis**, and is distinct from aquaporin-related disorders.

Q: A middle aged man complains of upper abdominal pain after a heavy meal. There is tenderness in the upper abdomen and on X-ray, widening of the mediastinum is seen with air in the mediastinum. What is the diagnosis?

Spontaneous perforation of the esophagus. ***Spontaneous perforation of the esophagus*** - The combination of **upper abdominal pain after a heavy meal** (suggestive of regurgitation/vomiting), **tenderness in the upper abdomen**, and **widening of the mediastinum with air in the mediastinum (pneumomediastinum)** points strongly to spontaneous esophageal rupture, also known as **Boerhaave syndrome**. - This condition results from a sudden increase in intra-esophageal pressure, often due to forceful vomiting, leading to a full-thickness tear in the esophageal wall. *Perforated peptic ulcer* - While it causes **severe upper abdominal pain** and tenderness, a perforated peptic ulcer primarily leads to **pneumoperitoneum** (free air under the diaphragm) rather than pneumomediastinum. - The abdominal symptoms would be more generalized and severe, and the X-ray findings would typically show free air in the abdominal cavity, not the mediastinum. *Rupture of emphysematous bulla* - This would generally cause **pneumothorax** and/or **subcutaneous emphysema**, and potentially pneumomediastinum, but typically without the profound abdominal pain and tenderness associated with a gastrointestinal event. - It would not be directly linked to a heavy meal or suggest a primary esophageal pathology. *Foreign body in esophagus* - A foreign body could cause pain and dysphagia, and potentially lead to perforation if sharp or impacted for too long, but the primary presentation would likely involve difficulty swallowing or a sensation of obstruction. - The immediate presence of **pneumomediastinum** and severe abdominal pain after a meal makes acute perforation more likely than a simple foreign body impaction without prior perforation.

Question 1

A study was conducted to investigate the relationship between COPD and smoking. Data was collected from government hospital records on COPD cases and cigarette sales records from finance and taxation departments. What is the study design?

Accepted Answer

Ecological study

Answer

Cross-sectional study

Answer

Operational study

Answer

Case-control study

Question 2

A 65-year-old female attended the Orthopaedics OPD with a chief complaint of chronic backache. The radiograph of the lumbar spine is obtained. What could be the most probable diagnosis?

Accepted Answer

Osteoporosis

Answer

Renal Osteodystrophy

Answer

Paget's Disease

Answer

Rheumatoid Arthritis

Question 3

A middle-aged female presented with a 4cm mass in the upper outer quadrant of the breast. Biopsy showed densely packed cells within large extracellular spaces. Which of the following is the most likely diagnosis of this patient?

Accepted Answer

Colloid carcinoma of breast

Answer

Tubular carcinoma of breast

Answer

Medullary carcinoma of breast

Answer

Papillary carcinoma of breast

Question 4

A 24 month child, with a weight of 11 kg, has RR of 38 / min, chest indrawing, cough and fever. Management according to IMNCI?

Accepted Answer

Give antibiotics

Answer

Refer to a higher-level health facility for further management.

Answer

Monitor at home without medical treatment.

Answer

Provide symptomatic treatment with antipyretics only.

Question 5

A boy is planning to travel by bus. Which of the following drugs can be used to prevent motion sickness in this person?

Accepted Answer

Promethazine

Answer

Fexofenadine

Answer

Loratadine

Answer

Cetirizine

Question 6

A patient with pulmonary fibrosis comes to the emergency with arrhythmia. Which anti-arrhythmic drug should be avoided?

Accepted Answer

Amiodarone

Answer

Lignocaine

Answer

Procainamide

Answer

Verapamil

Question 7

Prolactin levels are highest in which of the following?

Accepted Answer

After nipple stimulation

Answer

After 24 hrs of ovulation

Answer

After 24 hours of parturition

Answer

Just before parturition

Question 8

In a fetus highest oxygen concentration is found in?

Accepted Answer

Umbilical vein

Answer

Superior vena cava

Answer

Left ventricle

Answer

Ascending aorta

Question 9

What does aquaporin deficiency cause?

Accepted Answer

Nephrogenic diabetes insipidus

Answer

Liddle syndrome

Answer

Bartter syndrome

Answer

Gitelman syndrome

Question 10

A middle aged man complains of upper abdominal pain after a heavy meal. There is tenderness in the upper abdomen and on X-ray, widening of the mediastinum is seen with air in the mediastinum. What is the diagnosis?

Accepted Answer

Spontaneous perforation of the esophagus

Answer

Perforated peptic ulcer

Answer

Rupture of emphysematous bulla

Answer

Foreign body in esophagus

NEET-PG 2020

Community Medicine

Orthopaedics

Pathology

Pediatrics

Pharmacology

Physiology

Surgery