NEET-PG 2024 Practice Questions

Q: Which of the following is true regarding adipocere formation?

Preservation by saponification. ***Preservation by saponification*** - Adipocere, also known as **grave wax**, is formed through the process of **saponification**, where body fat hydrolyzes into fatty acids. - This process leads to the formation of a **waxy, grayish-white substance** that can preserve the body tissues. *High temperature needed* - Adipocere formation is actually favored by **cooler temperatures**, which slow down putrefaction and create a more conducive environment for saponification. - **High temperatures** typically accelerate decomposition, making adipocere formation less likely. *Cool and dry climate needed* - While a **cool environment** is favorable, adipocere formation primarily requires a **moist or wet environment**, such as burial in damp soil or immersion in water. - A **dry climate** would generally lead to mummification rather than adipocere formation. *Occurs within minutes to hours* - Adipocere formation is a **slow process** that usually takes **several weeks to months** (typically 3 weeks to 3 months) to become evident, and even longer to fully develop. - It does not occur within minutes or hours, which is the timeframe for early post-mortem changes like livor mortis or rigor mortis.

Q: Who orders the autopsy in the case of a Road Traffic Accident (RTA)?

B. Police. **B. Police** - In cases of Road Traffic Accidents (RTAs) and other **medico-legal deaths**, the **police** are typically responsible for ordering an autopsy. - This is because the death is suspicious and may involve criminal investigation, requiring formal authorization from law enforcement to establish the cause and manner of death. *A. Forensic expert* - A **forensic expert** performs the autopsy but does not have the authority to order it. - Their role is to conduct the examination and provide expert findings to the investigating authorities. *C. Lawyer* - A **lawyer** may be involved in the legal proceedings related to the RTA but does not have the authority to order an autopsy. - Their role is to represent clients and use the autopsy findings as evidence in court. *D. Forensic doctor* - A **forensic doctor** (or forensic pathologist) is the medical professional who conducts the autopsy. - They do not initiate the autopsy themselves but perform it upon the request of authorized parties, such as the police or a medical examiner/coroner.

Q: Mees' lines and raindrop pigmentation on the hands are seen in which type of poisoning?

Arsenic. **Arsenic** - **Mees' lines** (transverse white bands on fingernails) and **raindrop pigmentation** (hyperpigmentation with scattered hypopigmented spots) are classic dermatological manifestations of chronic arsenic poisoning. - Arsenic interferes with cellular respiration and DNA repair, leading to systemic effects including characteristic skin changes. *Thallium* - Thallium poisoning is often associated with diffuse **hair loss (alopecia)**, sensory neuropathy, and gastrointestinal symptoms. - It does not typically cause Mees' lines or raindrop pigmentation. *Cadmium* - Chronic cadmium exposure is primarily associated with **renal dysfunction** (Fanconi syndrome), **osteomalacia**, and lung disease. - It does not cause the specific nail or skin pigmentation described. *Lead* - Lead poisoning typically manifests with **gastrointestinal symptoms** (colic), neurological deficits (foot drop), and **anemia**. - While it can cause some dermatological changes, **Mees' lines** and **raindrop pigmentation** are not characteristic features.

Q: The image shows microscopic organisms. What is the most appropriate description of these organisms?

Bacteria. ***Unicellular bacteria*** - The image depicts **bacteria**, which are by definition unicellular prokaryotic microorganisms - Bacteria exhibit varied morphologies (cocci, bacilli, spirilla) which can be visualized under microscopy - This is the most appropriate description among the given options for microscopic bacterial forms *Wall contains silica and chlorophyll* - Silica cell walls are characteristic of **diatoms** (photosynthetic protists), not bacteria - Bacteria have peptidoglycan cell walls, not silica - While some bacteria contain pigments, they do not contain chlorophyll in the same form as eukaryotic organisms *Present only in bone marrow* - This statement is anatomically incorrect for bacteria - Bacteria are ubiquitous and can be found in virtually all environments - Bone marrow primarily contains hematopoietic cells, not bacteria in normal conditions *Not resistant to acid* - This is not a defining characteristic that can be determined from microscopic appearance alone - Many bacteria (e.g., *Mycobacterium tuberculosis*) are **acid-fast** and highly resistant to acid - Acid resistance varies among different bacterial species and requires specific staining (Ziehl-Neelsen) to determine

Q: A USG (ultrasound) shows two babies, one of whom appears to be one month older than the other. What is the term for this condition?

Twin-to-twin transfusion syndrome. ***Twin-to-twin transfusion syndrome*** - The observation of one baby appearing a month older than the other on ultrasound, particularly in a twin pregnancy, is highly suggestive of **twin-to-twin transfusion syndrome (TTTS)**, where there is an unequal sharing of blood between the twins. - This imbalance leads to one twin (the recipient) becoming larger and plethoric, while the other (the donor) becomes smaller and anemic, creating a noticeable size discrepancy, inaccurately noted as an "older" twin. *Superfetation* - **Superfetation** is the rare phenomenon of a second, new pregnancy occurring during an existing pregnancy, resulting in two fetuses of different gestational ages. - While it results in fetuses of different ages, it specifically refers to conception at different times, which is distinct from the described unequal growth within a single multiple pregnancy. *Superfecundation* - **Superfecundation** refers to the fertilization of two or more ova from the same ovulatory cycle by sperm from different acts of coitus or from different fathers. - It results in twins (or multiples) conceived at roughly the same time, but by different sperm, and does not explain a significant age or size discrepancy between the fetuses. *Dichorionic diamniotic twins* - **Dichorionic diamniotic (DCDA) twins** are the most common type of twins, each having their own placenta and amniotic sac. - While they are two separate pregnancies, this term primarily describes the placental and amniotic sac arrangement and does not inherently explain a significant size discrepancy or "age" difference between the twins without an underlying complication like TTTS.

Q: Identify the gene commonly involved in the condition shown in the image?

BRAF V600E. ***BRAF V600E*** - The image displays cells with **Langerhans cell morphology**, including folded nuclei and abundant pale cytoplasm, which are characteristic of **Langerhans cell histiocytosis (LCH)** [1]. - The **BRAF V600E mutation** is the most common genetic alteration found in LCH, present in about 50-60% of cases and activating the MAPK pathway [1]. *RAS* - **RAS mutations** are frequently seen in various cancers, including colorectal adenocarcinoma, pancreatic adenocarcinoma, and non-small cell lung cancer. - While RAS pathway activation can occur in LCH, a direct RAS mutation is not the most common genetic driver; rather, downstream effectors like BRAF V600E are more prominent [1]. *RET* - **RET mutations** are primarily associated with **medullary thyroid carcinoma** (in both sporadic and inherited forms like MEN 2A and MEN 2B) and can also be found in certain types of lung cancer. - They are not a characteristic genetic alteration for Langerhans cell histiocytosis. *P53* - The **TP53 gene** encodes the tumor suppressor protein p53, and mutations in this gene are among the most frequent genetic alterations across a wide spectrum of human cancers. - Although p53 plays a critical role in cell cycle regulation and apoptosis, it is not a primary or common driver mutation specifically associated with Langerhans cell histiocytosis [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 629-630.

Q: A patient presents with tingling sensation in both legs, polyuria, and weight loss. The bone marrow aspirate findings are shown in the image. What is the most likely diagnosis?

Amyloidosis. ***Amyloidosis*** - The image shows **amyloid infiltration** in the bone marrow, characterized by amorphous, eosinophilic deposits that can surround cellular elements. - The clinical symptoms of **tingling sensation** (neuropathy), **polyuria** (renal involvement), and **weight loss** are classic manifestations of systemic amyloidosis due to deposition in nerves, kidneys, and other organs. *Multiple myeloma with renal failure* - While multiple myeloma can cause renal failure and neuropathy, the image provided is more consistent with **amyloid deposition** rather than typical plasma cell proliferation seen in myeloma. - The bone marrow aspirate in multiple myeloma would show a significant increase in **atypical plasma cells**. *Subacute combined degeneration (SACD) with Vitamin B12 deficiency* - SACD causes neurological symptoms like tingling and paresthesia, but it is due to **demyelination** of the spinal cord, not amyloid deposition. - Bone marrow findings in **Vitamin B12 deficiency** would typically show megaloblastic anemia. *Subacute combined degeneration (SACD) with diabetes* - Diabetes can cause neuropathy and polyuria, however, the bone marrow aspirate in this case is not related to diabetes. - SACD is primarily associated with **Vitamin B12 deficiency**, not directly with diabetes, although diabetic neuropathy is common.

Q: TTF-1 (Thyroid Transcription Factor-1) immunohistochemical marker is most commonly seen in which of the following?

Lung adenocarcinoma. ***Lung adenocarcinoma*** - **TTF-1 (Thyroid Transcription Factor-1)** is a nuclear transcription factor that is highly expressed in adenocarcinomas of the lung. Positivity for TTF-1 is a key marker used in the diagnosis of primary lung adenocarcinoma, distinguishing it from other lung cancers and metastatic tumors. - While TTF-1 can also be positive in thyroid follicular and papillary carcinomas, its strong association with **lung adenocarcinoma** makes it a crucial diagnostic marker in this context, especially when differentiating between primary lung tumors and metastases or other lung cancer types. *Squamous Cell Carcinoma (SCC)* - **Squamous cell carcinoma of the lung** is generally **negative for TTF-1**. It typically expresses markers like p40 and CK5/6. - TTF-1 has very low sensitivity and specificity for squamous cell carcinoma, making it a poor choice for identifying this type of lung cancer. *Large cell lung cancer* - **Large cell lung carcinoma** is a diagnosis of exclusion and is typically **negative for TTF-1**, as well as other specific markers for adenocarcinoma or squamous cell carcinoma. - This type of cancer is characterized by large, anaplastic cells that lack features of other specific lung cancer types when viewed under a microscope. *Papillary thyroid carcinoma* - While **papillary thyroid carcinoma** is also **TTF-1 positive**, the question asks for the most common context in which TTF-1 is seen, and TTF-1 is a highly valuable marker for confirming a lung primary in the setting of lung masses. - TTF-1's utility in lung cancer diagnostics is particularly significant for differentiating primary lung adenocarcinomas from metastatic tumors and other lung cancer subtypes.

Q: Which of the following chelating agents is indicated in iron overdose?

Desferrioxamine. ***Desferrioxamine*** - **Desferrioxamine** is a **chelate** formed by the bacterium *Streptomyces pilosus* that has a high affinity for **iron**. - It is currently the most commonly used chelating agent for **acute iron overdose** and **chronic iron overload** conditions like hemochromatosis or transfusional hemosiderosis. *BAL* - **BAL (dimercaprol)** is a chelating agent primarily used for poisoning with **arsenic**, **mercury**, and **gold**. - It works by forming stable cyclic compounds with these metals, facilitating their excretion. *Calcium Edetate* - **Calcium edetate (Calcium-EDTA)** is primarily used for **lead poisoning**. - It works by forming a stable, water-soluble complex with lead, which is then excreted by the kidneys. *DTPA* - **Diethylenetriamine pentaacetate (DTPA)** is a chelating agent primarily used for poisoning with **plutonium** and other **radioactive metals**. - It is not indicated for iron overdose. *Penicillamine* - **Penicillamine** is a chelating agent primarily used for **copper** overload (Wilson's disease) and can also be used for **lead** and **mercury** poisoning. - It is not effective for iron chelation in overdose situations.

Question 1

Which of the following is true regarding adipocere formation?

Accepted Answer

Preservation by saponification

Answer

High temperature needed

Answer

Cool and dry climate needed

Answer

Occurs within minutes to hours

Question 2

Who orders the autopsy in the case of a Road Traffic Accident (RTA)?

Accepted Answer

B. Police

Answer

A. Forensic expert

Answer

C. Lawyer

Answer

D. Forensic doctor

Question 3

Mees' lines and raindrop pigmentation on the hands are seen in which type of poisoning?

Accepted Answer

Arsenic

Answer

Thallium

Answer

Cadmium

Answer

Lead

Question 4

The image shows microscopic organisms. What is the most appropriate description of these organisms?

Accepted Answer

Bacteria

Answer

Wall contains silica and chlorophyll

Answer

Present only in bone marrow

Answer

Not resistant to acid

Question 5

A USG (ultrasound) shows two babies, one of whom appears to be one month older than the other. What is the term for this condition?

Accepted Answer

Twin-to-twin transfusion syndrome

Answer

Superfetation

Answer

Superfecundation

Answer

Dichorionic diamniotic twins

Question 6

Identify the gene commonly involved in the condition shown in the image?

Accepted Answer

BRAF V600E

Answer

RAS

Answer

RET

Answer

P53

Question 7

A patient presents with tingling sensation in both legs, polyuria, and weight loss. The bone marrow aspirate findings are shown in the image. What is the most likely diagnosis?

Accepted Answer

Amyloidosis

Answer

Multiple myeloma with renal failure

Answer

Subacute combined degeneration (SACD) with Vitamin B12 deficiency

Answer

Subacute combined degeneration (SACD) with diabetes

Question 8

A patient has a cerebellar mass, renal tumor, and a family history of similar conditions. Which of the following mutations is most likely present in the family?

Accepted Answer

VHL

Answer

Neurofibromatosis (NF1)

Answer

Tuberous Sclerosis Complex (TSC)

Answer

Li-Fraumeni syndrome

Question 9

TTF-1 (Thyroid Transcription Factor-1) immunohistochemical marker is most commonly seen in which of the following?

Accepted Answer

Lung adenocarcinoma

Answer

Squamous Cell Carcinoma (SCC)

Answer

Large cell lung cancer

Answer

Papillary thyroid carcinoma

Question 10

Which of the following chelating agents is indicated in iron overdose?

Accepted Answer

Desferrioxamine

Answer

BAL

Answer

Calcium Edetate

Answer

DTPA

Answer

Penicillamine

NEET-PG 2024

Forensic Medicine

Microbiology

OB/GYN

Pathology

Pharmacology