NEET-PG 2022 Practice Questions

Q: A patient with hemolytic anemia has a defect in the enzyme glucose-6-phosphate dehydrogenase. Which of the following pathways is directly affected by this defect?

Pentose phosphate pathway. ***Pentose phosphate pathway*** - **Glucose-6-phosphate dehydrogenase (G6PD)** is the **rate-limiting enzyme** in the **pentose phosphate pathway (PPP)**, initiating the oxidative phase. - Deficiency in G6PD impairs the production of **NADPH**, which is crucial for reducing **oxidative stress** in red blood cells. *Glycolysis* - This pathway metabolizes glucose to pyruvate for **ATP production** and does not directly involve G6PD. - While G6P is an intermediate in both pathways, its conversion in glycolysis is catalyzed by phosphoglucose isomerase, not G6PD. *TCA cycle* - The **tricarboxylic acid (TCA) cycle** is a central metabolic pathway for energy production occurring in the **mitochondria**. - It involves the oxidation of acetyl-CoA and does not directly utilize G6PD. *Urea cycle* - The **urea cycle** is responsible for detoxifying ammonia by converting it into urea, primarily occurring in the **liver**. - This pathway is unrelated to glucose metabolism or G6PD activity.

Q: A patient is diagnosed with scurvy. This condition is due to a deficiency in which vitamin?

Vitamin C. ***Vitamin C*** - **Scurvy** is directly caused by a prolonged and severe deficiency of **Vitamin C (ascorbic acid)**. - Vitamin C is essential for **collagen synthesis**, and its deficiency leads to impaired wound healing, fragile blood vessels, and gum disease, which are hallmarks of scurvy. *Vitamin A* - Deficiency in Vitamin A primarily causes **vision problems**, such as night blindness, and can lead to xerophthalmia, but not scurvy. - It plays a crucial role in **immune function** and cell growth, distinguishing its role from collagen synthesis. *Vitamin D* - A deficiency in Vitamin D is associated with **rickets** in children and **osteomalacia** in adults, conditions primarily affecting bone mineralization. - It is vital for **calcium and phosphate absorption**, which is unrelated to the collagen defects seen in scurvy. *Vitamin E* - Deficiency in Vitamin E is rare and can lead to **neurological symptoms** like ataxia and peripheral neuropathy. - It acts as a **powerful antioxidant**, protecting cells from oxidative damage, which is a different metabolic pathway than Vitamin C's role in collagen.

Q: What is the initial treatment for most patients with growth hormone-secreting pituitary adenoma?

Transphenoidal surgical resection. ***Transphenoidal surgical resection*** - This is the **preferred initial treatment** for most growth hormone (GH)-secreting pituitary adenomas, as it offers the best chance for **cure** and rapid reduction in GH levels [1]. - Success rates are high, especially for **smaller tumors** (microadenomas), and it can quickly relieve mass effect symptoms [1]. *Somatostatin analogs* - These are typically used as **second-line therapy** if surgery is unsuccessful or contraindicated, or in patients not surgical candidates. - They work by **inhibiting GH secretion** but do not usually achieve a complete cure like surgery. *GH receptor antagonists* - These medications, such as pegvisomant, **block the action of GH** at its receptor, normalizing IGF-1 levels. - They are primarily used when other treatments, including surgery and somatostatin analogs, have failed to control GH excess. *Dopamine agonists* - While dopamine agonists (e.g., cabergoline) can **sometimes reduce GH secretion** in a minority of patients, they are significantly less effective for GH-secreting tumors compared to prolactinomas [1]. - They are occasionally used as **adjunctive therapy** or in specific cases where the GH-secreting tumor also co-secretes prolactin [1].

Q: A 40-year-old woman with rheumatoid arthritis presents with eye pain and redness. Examination reveals scleritis. What is the most likely associated systemic complication?

Interstitial lung disease. ***Interstitial lung disease*** - **Scleritis** in a patient with **rheumatoid arthritis** often indicates a more severe, systemic form of the disease. - **Interstitial lung disease (ILD)** is a common and serious **extra-articular manifestation** of rheumatoid arthritis, associated with higher disease activity and worse prognosis. *Cardiomyopathy* - While cardiac involvement can occur in RA (e.g., pericarditis, myocarditis), **cardiomyopathy** is less directly correlated with scleritis as a linked severe systemic complication. - **Rheumatoid arthritis** can increase the risk of cardiovascular disease due to accelerated atherosclerosis and systemic inflammation, but cardiomyopathy itself is not typically the direct systemic complication associated with scleritis. *Renal failure* - **Renal involvement** in rheumatoid arthritis is uncommon, usually related to complications from treatment (e.g., NSAID-induced nephropathy) or secondary amyloidosis, not directly with scleritis. - Scleritis itself does not directly predispose to **renal failure** as a primary systemic complication of RA. *Peripheral neuropathy* - **Peripheral neuropathy** can be a complication of rheumatoid arthritis, particularly in severe cases or vasculitis. - However, it is not as strongly or directly linked to the presence of **scleritis** as **interstitial lung disease** is, in terms of signifying systemic disease severity.

Q: A 45-year-old patient with a history of poorly controlled diabetes presents with sinus pain, nasal discharge, and facial swelling. A biopsy reveals broad, nonseptate hyphae branching at wide angles. What is the most likely causative agent?

Rhizopus spp.. ***Rhizopus spp.*** - The patient's presentation with **sinus pain**, **nasal discharge**, **facial swelling**, and a history of **poorly controlled diabetes** is classic for **mucormycosis** (also known as zygomycosis). - **Biopsy findings** of **broad, nonseptate hyphae branching at wide/irregular angles** are pathognomonic for mucormycosis, most commonly caused by *Rhizopus* species. - Diabetes mellitus, particularly when poorly controlled with **ketoacidosis**, is a major risk factor for rhinocerebral mucormycosis. *Aspergillus fumigatus* - This fungus typically causes infections with **septate hyphae** that **branch at acute angles** (45 degrees), which is morphologically distinct from mucormycosis. - While *Aspergillus* can cause invasive sinusitis in immunocompromised patients, the specific hyphal morphology (nonseptate, wide-angle branching) points away from it. *Candida albicans* - *Candida albicans* is a yeast that typically appears as **oval budding cells** and **pseudohyphae** on microscopy, not broad, nonseptate hyphae. - While it can cause opportunistic infections in diabetic and immunocompromised patients, its microscopic appearance is entirely inconsistent with the biopsy findings. *Cryptococcus neoformans* - *Cryptococcus neoformans* is an **encapsulated yeast** that is typically identified by its **spherical or oval budding cells** with a characteristic **polysaccharide capsule** visible with India ink stain. - It primarily causes **meningitis** and pulmonary infections in immunocompromised hosts, and its morphology (yeast, not hyphae) is entirely different from the described findings.

Q: A patient with HIV presents with extensive anogenital warts. Which HPV types are most commonly associated with malignant transformation in this setting?

Types 16 and 18. ***Types 16 and 18*** - **HPV types 16 and 18** are considered **high-risk** and are responsible for the majority of HPV-related cancers, including cervical, anal, and oropharyngeal cancers. - In HIV-positive individuals, the risk of malignant transformation from HPV infection is significantly increased due to **immunocompromise**. *Types 42 and 43* - **HPV types 42 and 43** are classified as **low-risk** HPV types. - They are primarily associated with **benign anogenital warts** and rarely cause malignant transformation. *Types 31 and 33* - **HPV types 31 and 33** are also considered **high-risk** types and can cause malignant transformation. - However, **types 16 and 18** are more frequently associated with HPV-related cancers than types 31 and 33. *Types 6 and 11* - **HPV types 6 and 11** are **low-risk** types and are the primary cause of **genital warts (condyloma acuminata)**. - While they can cause extensive warts, they have a very low potential for malignant transformation.

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 55-year-old woman is undergoing chemotherapy for breast cancer and experiences severe nausea and vomiting. Which antiemetic, recognized for its minimal extrapyramidal side effects, would be appropriate for her condition?

Ondansetron. ***Ondansetron*** - **Ondansetron** is a 5-HT3 receptor antagonist, highly effective against chemotherapy-induced nausea and vomiting (CINV) due to its action on serotonin receptors in the **chemoreceptor trigger zone** and **gastrointestinal tract**. - It is known for its favorable side effect profile, with **minimal to no extrapyramidal symptoms**, making it a preferred choice in patients where such effects are a concern. *Metoclopramide* - While effective against nausea and vomiting, **metoclopramide** (a D2 receptor antagonist) can cause **extrapyramidal symptoms** such as **dystonia** and **tardive dyskinesia**, especially with prolonged use or higher doses. - Its mechanism of action includes both prokinetic effects and central antiemetic action, but its side effect profile makes it less ideal when avoiding extrapyramidal symptoms is a priority. *Promethazine* - **Promethazine** is a first-generation antihistamine with antiemetic properties, but it can cause significant **sedation** and has some **anticholinergic side effects**. - Although its extrapyramidal risk is lower than some other drugs, it's not the primary choice for chemotherapy-induced nausea due to its sedative effects and generally less potent antiemetic action for CINV compared to 5-HT3 antagonists. *Prochlorperazine* - **Prochlorperazine** is a phenothiazine antipsychotic with strong antiemetic effects, acting primarily as a **dopamine receptor antagonist**. - It carries a significant risk of **extrapyramidal side effects**, including **acute dystonia** and **parkinsonism**, making it less suitable when such side effects must be strictly avoided.

Q: Which of the following statements about the O2-Hb dissociation curve is correct?

It demonstrates cooperative binding.. ***It demonstrates cooperative binding.*** - **Cooperative binding** describes how the binding of one oxygen molecule to hemoglobin increases the affinity of the remaining binding sites for oxygen. - This property gives the O2-Hb dissociation curve its characteristic **sigmoid (S-shaped)** appearance, allowing for efficient oxygen loading in the lungs and unloading in the tissues. *The curve is a straight line.* - The O2-Hb dissociation curve is **sigmoid or S-shaped**, not a straight line, due to the phenomenon of cooperative binding. - A straight line would imply a constant affinity of hemoglobin for oxygen, which is not the case. *It is 100% saturated at a PO2 of 100 mmHg.* - Hemoglobin is typically around **97-98% saturated** at a PO2 of 100 mmHg (arterial blood). - Complete 100% saturation is rarely achieved under physiological conditions. *A hemoglobin molecule can carry 4 molecules of O2.* - While this statement is factually true (one hemoglobin molecule has **four heme groups** and can bind up to **four molecules of oxygen**), it describes the structure and oxygen-carrying capacity of hemoglobin rather than a characteristic of the dissociation **curve itself**. - The question asks about features of the O2-Hb dissociation curve, and cooperative binding is the key property that defines the curve's behavior and sigmoid shape.

Question 1

A patient with hemolytic anemia has a defect in the enzyme glucose-6-phosphate dehydrogenase. Which of the following pathways is directly affected by this defect?

Accepted Answer

Pentose phosphate pathway

Answer

Glycolysis

Answer

TCA cycle

Answer

Urea cycle

Question 2

A patient is diagnosed with scurvy. This condition is due to a deficiency in which vitamin?

Accepted Answer

Vitamin C

Answer

Vitamin A

Answer

Vitamin D

Answer

Vitamin E

Question 3

What is the initial treatment for most patients with growth hormone-secreting pituitary adenoma?

Accepted Answer

Transphenoidal surgical resection

Answer

Somatostatin analogs

Answer

Dopamine agonists

Answer

GH receptor antagonists

Question 4

A 40-year-old woman with rheumatoid arthritis presents with eye pain and redness. Examination reveals scleritis. What is the most likely associated systemic complication?

Accepted Answer

Interstitial lung disease

Answer

Cardiomyopathy

Answer

Renal failure

Answer

Peripheral neuropathy

Question 5

A 45-year-old patient with a history of poorly controlled diabetes presents with sinus pain, nasal discharge, and facial swelling. A biopsy reveals broad, nonseptate hyphae branching at wide angles. What is the most likely causative agent?

Accepted Answer

Rhizopus spp.

Answer

Aspergillus fumigatus

Answer

Candida albicans

Answer

Cryptococcus neoformans

Question 6

A patient with HIV presents with extensive anogenital warts. Which HPV types are most commonly associated with malignant transformation in this setting?

Accepted Answer

Types 16 and 18

Answer

Types 42 and 43

Answer

Types 31 and 33

Answer

Types 6 and 11

Question 7

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 8

A 55-year-old woman is undergoing chemotherapy for breast cancer and experiences severe nausea and vomiting. Which antiemetic, recognized for its minimal extrapyramidal side effects, would be appropriate for her condition?

Accepted Answer

Ondansetron

Answer

Metoclopramide

Answer

Promethazine

Answer

Prochlorperazine

Question 9

Which of the following statements about the O2-Hb dissociation curve is correct?

Accepted Answer

It demonstrates cooperative binding.

Answer

The curve is a straight line.

Answer

It is 100% saturated at a PO2 of 100 mmHg.

Answer

A hemoglobin molecule can carry 4 molecules of O2.

Question 10

A 60-year-old male with a history of smoking presents with severe abdominal pain and a pulsatile abdominal mass. What is the most appropriate next step in managing this patient?

Accepted Answer

CT angiography

Answer

Immediate surgery

Answer

Ultrasound of the abdomen

Answer

Observation

NEET-PG 2022

Biochemistry

Internal Medicine

Microbiology

Pediatrics

Pharmacology

Physiology

Radiology