NEET-PG 2020 Practice Questions

Q: The patient is presenting with pain around the base of the thumb. Which tendons are likely involved?

APL & EPB. ***APL & EPB*** - Pain around the base of the thumb, especially with movement, is characteristic of De Quervain's tenosynovitis [1]. This condition involves the **abductor pollicis longus (APL)** and **extensor pollicis brevis (EPB)** tendons [1]. - These two tendons share a common synovial sheath as they pass through the first dorsal compartment of the wrist, making them susceptible to inflammation and friction [1]. *APB & EPL* - **APB (Abductor Pollicis Brevis)** is an intrinsic hand muscle found in the thenar eminence, primarily involved in thumb abduction, and is not typically associated with De Quervain's tenosynovitis. - **EPL (Extensor Pollicis Longus)** is part of the third dorsal compartment and its tendon crosses over the other thumb tendons, and is not inflamed in De Quervain's tenosynovitis. *APB & EPB* - As mentioned, **APB (Abductor Pollicis Brevis)** is an intrinsic hand muscle, not involved in De Quervain's tenosynovitis. - While **EPB (Extensor Pollicis Brevis)** is involved, its combination with APB incorrectly identifies the primary tendons affected in the first dorsal compartment. *APL & EPL* - **APL (Abductor Pollicis Longus)** is one of the correct tendons involved. - **EPL (Extensor Pollicis Longus)** belongs to the third dorsal compartment of the wrist and is not typically affected in De Quervain's tenosynovitis, differentiating it from the tendons in the first dorsal compartment [1].

Q: In which of the following methods of management is the benefit measured in natural units?

Cost-effectiveness analysis. ***Cost-effectiveness analysis*** - In **cost-effectiveness analysis**, the benefits of a healthcare intervention are measured in **natural units** (e.g., lives saved, years of life gained, cases cured, reduction in symptoms). - This method compares the costs of different interventions to achieve a specific health outcome, expressed in a non-monetary unit. *Network analysis* - **Network analysis** is a project management technique used to plan and control complex projects, often for scheduling tasks and identifying critical paths. - Its primary focus is on task dependencies and timelines, not on measuring benefits of management interventions in natural units. *Cost-benefit analysis* - In **cost-benefit analysis**, both the costs and the benefits of an intervention are converted into **monetary units**. - This allows for a comparison where a project is deemed beneficial if its monetary benefits outweigh its monetary costs. *Program budgeting system* - A **program budgeting system** is a financial planning and management tool that links expenditures to the achievement of specific program objectives. - While it focuses on resource allocation and outcomes, it does not primarily measure benefits in natural health units.

Q: Elderly man with a long-standing mole on his face that is increasing in size and showing an irregular border. Diagnosis:

Lentigo maligna. ***Lentigo maligna*** - This type of melanoma commonly affects **elderly individuals** and presents as a **slowly enlarging, irregularly bordered, flat or slightly raised pigmented lesion** on sun-exposed areas like the face. - It often has a **long radial growth phase** before progressing to invasive lentigo maligna melanoma. *Superficial spreading melanoma* - While common, it typically presents on the **trunk or extremities** and has a faster growth rate compared to lentigo maligna. - It often appears as a **flat, asymmetrical lesion with varied colors and irregular borders**, but the age and location details point away from this. *Nodular melanoma* - This is an **aggressive form** that grows vertically from the start, presenting as a **dark, raised, often ulcerated nodule** and typically has a shorter history of rapid growth. - It lacks the characteristic long-standing, flat growth pattern described in the elderly patient's face. *Acral melanoma* - This rare type occurs on the **palms, soles, or under the nails (subungual)**, not typically on the face. - It often appears as a **pigmented streak or patch** in these acral locations.

Q: MC location of gastrinoma in MEN-1 syndrome?

Duodenum. ***Duodenum*** - In **MEN-1 syndrome**, gastrinomas are most commonly located in the **duodenum**, typically presenting as **multiple small submucosal tumors**. - These duodenal gastrinomas in MEN-1 are characteristically **numerous and tiny**, often difficult to detect during surgery. *Jejunum* - The jejunum is an **uncommon location** for gastrinomas in both sporadic cases and MEN-1 syndrome. - Gastrinomas in the jejunum are typically **rare** and not associated with the characteristic presentation of MEN-1. *Ileum* - The ileum is an **extremely rare site** for gastrinomas in any context. - Gastrinomas developing in the ileum are usually **ectopic** and are not part of the typical MEN-1 syndrome presentation. *Pancreas* - While pancreatic gastrinomas can occur in **MEN-1**, they are **less common** than duodenal gastrinomas in this syndrome. - In **sporadic gastrinomas**, the pancreas is relatively more involved compared to MEN-1, where duodenal predominance is more pronounced.

Q: Which antibody is not transmitted from mother to baby?

IgA antibodies. ***IgA antibodies*** - While IgA is found in breast milk and provides **passive immunity** to the infant's gastrointestinal tract, it is **not transferred across the placenta** to the fetus. - This antibody has a larger molecular structure and is primarily involved in **mucosal immunity**, making it unsuitable for transplacental transfer. *Diphtheria IgG antibodies* - **IgG antibodies**, including those for diphtheria, are actively transported across the **placenta** from mother to fetus during the third trimester. - This transfer provides the newborn with **passive immunity** against diphtheria during the first few months of life. *Tetanus IgG antibodies* - Similar to diphtheria IgG, **tetanus IgG antibodies** are efficiently transported across the **placenta** from mother to baby. - This offers crucial **passive protection** against tetanus, particularly important after birth. *Measles IgG antibodies* - **Measles IgG antibodies** from a vaccinated or previously infected mother cross the **placenta** to the fetus. - This maternal transfer provides temporary **passive immunity** to the newborn against measles.

Q: 60-year-old female with a history of intermittent bleeding. What is the diagnosis based on the ultrasound image?

Endometrial polyp. ***Endometrial polyp*** - The ultrasound image shows a well-defined, **echogenic focal lesion within the endometrial cavity**, which is characteristic of an endometrial polyp. - In a 60-year-old female with intermittent bleeding, a polyp is a common cause of **postmenopausal bleeding** and is often identified as an intracavitary mass on ultrasound. - Endometrial polyps appear as **focal, hyperechoic or isoechoic masses** with a smooth contour projecting into the endometrial cavity. *Ca endometrium* - **Endometrial carcinoma** typically appears as diffuse endometrial thickening (>4-5 mm in postmenopausal women), irregular endometrial-myometrial interface, or heterogeneous endometrial echoes, often with evidence of myometrial invasion. - While bleeding is a cardinal symptom of endometrial carcinoma, the distinct **focal, well-circumscribed nature** of the lesion on ultrasound is less typical for carcinoma, which tends to be more diffuse and irregular. *Submucosal fibroid* - A **submucosal fibroid** (leiomyoma) is a benign smooth muscle tumor originating from the myometrium that protrudes into the endometrial cavity. - While it can appear as an intracavitary mass and cause abnormal bleeding, fibroids often have a more **heterogeneous or hypoechoic appearance** with posterior acoustic shadowing, compared to the isoechoic to hyperechoic appearance of a polyp. - The feeding vessel sign (blood flow at the base) is more characteristic of polyps than fibroids. *Endometrial hyperplasia* - **Endometrial hyperplasia** presents as **diffuse, uniform endometrial thickening** rather than a focal intracavitary mass. - It typically shows homogeneous increased echogenicity of the entire endometrium without a discrete, well-defined lesion as seen with a polyp. - While it can cause postmenopausal bleeding, the focal nature of the lesion in this case makes hyperplasia less likely.

Q: A person was given a muscle relaxant that competitively blocks nicotinic receptors. Which of the following drugs is used for reversal of muscle relaxation after surgery?

Neostigmine. ***Neostigmine*** - **Neostigmine** is an **acetylcholinesterase inhibitor** that increases the amount of acetylcholine at the neuromuscular junction, thereby overcoming the competitive block at nicotinic receptors [1], [4]. - This increase in acetylcholine effectively reverses the paralysis caused by **nondepolarizing muscle relaxants**, making it useful for post-surgical recovery [2]. *Carbachol* - **Carbachol** is a **direct-acting cholinergic agonist** that stimulates both muscarinic and nicotinic receptors and is not typically used for reversing competitive neuromuscular blockade. - Its primary use is for glaucoma and to stimulate the bladder or bowels, not to counteract muscle relaxants. *Succinylcholine* - **Succinylcholine** is a **depolarizing muscle relaxant** and would prolong, rather than reverse, muscle blockade if administered after a competitive blocker [3]. - It works by initially causing depolarization and then preventing further muscle contraction, leading to paralysis. *Physostigmine* - **Physostigmine** is an **acetylcholinesterase inhibitor** that crosses the blood-brain barrier, making it more suitable for treating central anticholinergic toxicity rather than peripheral neuromuscular blockade. - While it inhibits acetylcholinesterase, its central effects and potential for seizures limit its use for reversing surgical muscle relaxation.

Q: A 35-year-old female experiences a tingling sensation in her arm after watching TV for long hours with her hands under her head. Which type of nerve fibers is most likely to be affected due to this position?

A-beta (Aβ) sensory nerve fibers. ***A-beta (Aβ) sensory nerve fibers*** - The tingling sensation (paresthesia) described is a classic symptom of **A-beta fiber compression**. - **A-beta fibers** are large, myelinated sensory fibers that transmit light touch, pressure, vibration, and proprioception. - These fibers are **most susceptible to mechanical compression** due to their position and structure. - Positioning the hands under the head for extended periods compresses superficial nerves, causing temporary A-beta fiber dysfunction, which manifests as the characteristic "pins and needles" sensation. *B-fibers (autonomic)* - **B-fibers** are preganglionic autonomic fibers that mediate visceral functions, such as organ control and glandular secretions. - Compression of these fibers would lead to symptoms related to autonomic dysfunction (e.g., changes in sweating, blood pressure), not a tingling sensation in the arm. *C-fibers (pain and temperature)* - **C-fibers** are unmyelinated fibers that transmit slow, dull, aching pain and contribute to temperature sensation. - They are **less susceptible to compression** than larger myelinated fibers. - The primary sensation described (tingling/paresthesia) is characteristic of large myelinated fiber (A-beta) dysfunction, not C-fiber involvement. *Sympathetic nerve fibers* - **Sympathetic nerve fibers** regulate involuntary functions like heart rate, blood pressure, and sweating. - Their compression would cause symptoms such as changes in skin temperature, altered sweating, or blood vessel constriction (Horner's syndrome if severe), not a tingling sensation.

Q: A patient with depression was given Imipramine for 2 weeks. Relatives noticed increased excitement, colorful clothes, and increased talking. What is the next step in management?

Discontinue Imipramine and start Valproate. ***Discontinue Imipramine and start Valproate*** - The patient's symptoms (increased excitement, colorful clothes, increased talking) after starting an antidepressant like **Imipramine** suggest a **manic switch**, indicating undiagnosed **bipolar disorder**. - **Imipramine** should be discontinued as it can exacerbate mania, and a mood stabilizer like **Valproate** is necessary to treat the manic episode. *Continue Imipramine alone* - Continuing Imipramine would likely worsen the manic symptoms, leading to increased agitation and potential harm. - Antidepressants can trigger or worsen manic episodes in individuals with underlying bipolar disorder. *Manage with Valproate alone* - While Valproate is an appropriate treatment for acute mania, simply managing with Valproate alone without discontinuing the offending antidepressant would be suboptimal. - The continued presence of Imipramine would counteract the mood-stabilizing effects of Valproate. *Antipsychotic with Imipramine continued* - Adding an antipsychotic might manage some acute manic symptoms, but continuing Imipramine would maintain the driving force behind the manic switch. - The primary action should be to remove the causative agent (Imipramine) and replace it with a mood stabilizer.

Question 1

The patient is presenting with pain around the base of the thumb. Which tendons are likely involved?

Accepted Answer

APL & EPB

Answer

APB & EPL

Answer

APB & EPB

Answer

APL & EPL

Question 2

In which of the following methods of management is the benefit measured in natural units?

Accepted Answer

Cost-effectiveness analysis

Answer

Network analysis

Answer

Cost-benefit analysis

Answer

Program budgeting system

Question 3

Elderly man with a long-standing mole on his face that is increasing in size and showing an irregular border. Diagnosis:

Accepted Answer

Lentigo maligna

Answer

Superficial spreading melanoma

Answer

Nodular melanoma

Answer

Acral melanoma

Question 4

MC location of gastrinoma in MEN-1 syndrome?

Accepted Answer

Duodenum

Answer

Jejunum

Answer

Ileum

Answer

Pancreas

Question 5

Which antibody is not transmitted from mother to baby?

Accepted Answer

IgA antibodies

Answer

Tetanus IgG antibodies

Answer

Diphtheria IgG antibodies

Answer

Measles IgG antibodies

Question 6

60-year-old female with a history of intermittent bleeding. What is the diagnosis based on the ultrasound image?

Accepted Answer

Endometrial polyp

Answer

Ca endometrium

Answer

Submucosal fibroid

Answer

Endometrial hyperplasia

Question 7

A person was given a muscle relaxant that competitively blocks nicotinic receptors. Which of the following drugs is used for reversal of muscle relaxation after surgery?

Accepted Answer

Neostigmine

Answer

Carbachol

Answer

Succinylcholine

Answer

Physostigmine

Question 8

A 35-year-old female experiences a tingling sensation in her arm after watching TV for long hours with her hands under her head. Which type of nerve fibers is most likely to be affected due to this position?

Accepted Answer

A-beta (Aβ) sensory nerve fibers

Answer

B - fibers (autonomic)

Answer

C - fibers (pain and temperature)

Answer

Sympathetic nerve fibers

Question 9

A patient with depression was given Imipramine for 2 weeks. Relatives noticed increased excitement, colorful clothes, and increased talking. What is the next step in management?

Accepted Answer

Discontinue Imipramine and start Valproate

Answer

Continue Imipramine alone

Answer

Manage with Valproate alone

Answer

Antipsychotic with Imipramine continued

Question 10

A 68-year-old asymptomatic male is found to have an abdominal aortic aneurysm (AAA) measuring 4.5 cm on routine ultrasound screening. What is the most appropriate management?

Accepted Answer

Monitor regularly and consider surgery if size reaches 55mm or symptomatic

Answer

Ultrasound monitoring until size exceeds 70mm

Answer

No treatment unless symptomatic

Answer

Immediate surgical repair for all diagnosed aneurysms regardless of size

NEET-PG 2020

Anatomy

Community Medicine

Dermatology

Internal Medicine

Microbiology

Obstetrics and Gynecology

Pharmacology

Physiology

Psychiatry

Surgery