NEET-PG 2015 Practice Questions

Q: Dietary deficiency of which vitamin is considered extremely rare?

Vitamin E. ***Vitamin E*** - **Vitamin E deficiency** is exceptionally rare because it is a **fat-soluble vitamin** stored in the body and is widely available in many common foods. - Symptoms of deficiency, when they do occur, are usually seen in individuals with severe **malabsorption syndromes** or genetic abnormalities affecting its metabolism. *Vitamin B6* - **Vitamin B6 deficiency** can occur, especially in individuals with **alcoholism**, those taking certain medications, or with certain chronic diseases. - It can manifest with neurological symptoms, such as **neuropathy** and **seizures**, as well as dermatological issues. *Thiamine* - **Thiamine (Vitamin B1) deficiency** is a known problem in regions with poor nutrition and in chronic alcoholics. - It leads to conditions like **beriberi** (wet and dry) and **Wernicke-Korsakoff syndrome**, affecting the cardiovascular and nervous systems. *Vitamin D* - **Vitamin D deficiency** is common globally, particularly in populations with limited sun exposure or inadequate dietary intake. - It can cause **rickets** in children and **osteomalacia** in adults, impacting bone health.

Q: Which of the following is NOT a manifestation of vitamin E deficiency?

Autonomic dysfunction. ***Autonomic dysfunction*** - **Autonomic dysfunction** is not typically associated with vitamin E deficiency. Instead, it is commonly seen in conditions like **diabetes mellitus**, Parkinson's disease, or certain inherited neuropathies. - Vitamin E primarily acts as an **antioxidant** and is crucial for neurological and red blood cell health. *Hemolytic anemia* - Vitamin E is an **antioxidant** that protects red blood cell membranes from **oxidative damage**. - Its deficiency can lead to increased fragility and **hemolysis** of red blood cells, resulting in hemolytic anemia, particularly in premature infants. *Posterior column abnormalities* - Vitamin E deficiency can cause **neurological dysfunction** due to oxidative damage to neuronal membranes. - This often manifests as degeneration of the **posterior columns** of the spinal cord, leading to impaired proprioception and vibratory sensation. *Cerebellar ataxia* - The **cerebellum** is highly susceptible to oxidative stress, and vitamin E deficiency can lead to damage in this area. - This damage results in **ataxia**, characterized by impaired coordination, balance, and gait disturbances.

Q: In which of the following causes of oral ulcers are auto-antibodies not seen?

Behcet disease. ***Behcet disease*** - Behcet disease is characterized by **recurrent oral and genital ulcers**, along with **eye lesions**, but it does not involve autoantibody formation. - The underlying mechanism is believed to be **immune dysregulation** rather than autoimmunity, making it distinctive. *Celiac disease* - In Celiac disease, **anti-tissue transglutaminase** antibodies are present, which are involved in the body's response to gluten. - Oral ulcers associated with Celiac are often related to nutrient deficiencies, particularly **iron and folate**. *SLE* - Systemic lupus erythematosus (SLE) is marked by various autoantibodies, including **antinuclear antibodies (ANA)** [1]. - Oral ulcers can occur in SLE, and these are a manifestation of its **autoimmune nature** [1]. *Pemphigus* - Pemphigus is characterized by the presence of **autoantibodies** against desmogleins, leading to **blistering** and ulcer formation. - Oral ulcers are common in this condition due to the **disruption of mucosal integrity** caused by the autoimmune response. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, p. 226.

Q: Which fluid is ideally given for a patient experiencing dehydration?

Normal Saline. ***Normal Saline*** - **Normal saline (0.9% sodium chloride)** is an **isotonic solution** that effectively increases **extracellular fluid volume**, making it ideal for treating **dehydration** and hypovolemia [1]. - It closely mimics the **osmolality of plasma** and stays predominantly in the intravascular space, helping to restore circulating volume [1]. *Plasma* - **Plasma** is primarily used for **coagulation factor deficiencies** or volume expansion in cases of severe **hypoproteinemia**, not routine dehydration. - It contains **proteins and clotting factors** that are not typically needed for simple dehydration and carries risks of **allergic reactions and transfusion-related acute lung injury (TRALI)**. *Blood* - **Blood transfusions** are indicated for patients with **significant anemia** or **acute blood loss**, not for generalized dehydration. - Using blood for dehydration would be inappropriate due to risks such as **transfusion reactions**, **infections**, and **iron overload**. *5% dextrose* - **5% dextrose in water (D5W)** is an **isotonic solution initially**, but once the dextrose is metabolized, it becomes **hypotonic**, causing free water to shift into the cells [1]. - While it provides some free water, it is not ideal for primary rehydration in cases of significant volume depletion due to its lack of electrolytes and potential for causing **hyponatremia** if given in large quantities [1].

Q: In a patient presenting with a painful swollen joint and a history of high uric acid levels, which condition is most likely indicated by this clinical presentation?

Gout. ***Gout*** - **Gout** is characterized by sudden, severe attacks of pain, swelling, redness, and tenderness in one or more joints, most often the **big toe** [1],[2]. - A history of **high uric acid levels** (hyperuricemia) is a primary risk factor, as it leads to the formation of **uric acid crystals** in the joint [1],[3]. *Ankylosing spondylitis* - This condition is a chronic inflammatory disease primarily affecting the **spine and sacroiliac joints**, causing stiffness and pain, especially in the morning. - It is not directly associated with **high uric acid levels** or generally presenting as an acute, single swollen joint attack. *Osteoarthritis* - **Osteoarthritis** is a degenerative joint disease characterized by the breakdown of cartilage over time, leading to pain and stiffness, especially with activity. - While it can cause joint swelling, it is typically a gradual process, not an acute, intensely painful attack, and is not linked to **uric acid levels**. *Rheumatoid arthritis* - **Rheumatoid arthritis** is an autoimmune disease causing chronic inflammation, primarily affecting multiple small joints symmetrically. - It presents with prolonged morning stiffness and is not directly caused by **high uric acid levels**, nor is its typical presentation an acute monoarthritis.

Q: Which of the following conditions is least likely to cause multiple painful ulcers on the tongue?

Sarcoidosis. ***Sarcoidosis*** - While sarcoidosis can affect any organ, **oral involvement is rare** and typically presents as **nodules, plaques, or generalized swelling**, not usually multiple painful ulcers on the tongue. - The lesions, when they occur, are often **painless** and appear as submucosal nodules, red patches, or diffuse swelling. *TB* - Oral tuberculosis can present as **multiple painful ulcers** on the tongue, often with a **granulomatous appearance** mimicking squamous cell carcinoma. - These ulcers are typically **irregular, undermined, and persistent**, often associated with pulmonary TB. *Herpes* - **Herpes simplex virus (HSV)** infection, particularly primary herpetic gingivostomatitis, commonly causes **multiple painful ulcers** on the tongue, gums, and other oral mucosa. - These ulcers begin as vesicles that **rupture to form painful erosions** and are a classic presentation of oral herpes. *Behcet disease* - **Oral aphthous ulcers** are a hallmark feature of Behcet disease, commonly presenting as **multiple, recurrent, painful ulcers** on the tongue and other oral mucosal surfaces. - These ulcers are clinically indistinguishable from common aphthous stomatitis but are more frequent and often associated with genital ulcers, skin lesions, and ocular inflammation.

Q: Which of the following is not associated with Carney's triad?

Atrial myxoma. ***Atrial myxoma*** - Atriomyxoma is not part of **Carney's triad**, which primarily includes **paraganglioma**, **chondroma**, and **gastrointestinal stromal tumors (GIST)**. - Carney's triad is a rare genetic condition associated with **multiple neoplasms**, and atrial myxomas are cardiac tumors, not part of this triad. *Paraganglioma* - Paragangliomas are tumors derived from **neuroendocrine cells**, and they are one of the key components of **Carney's triad**. - They typically arise in **chromaffin tissue**, which is involved in catecholamine secretion. *Chondroma* - Chondromas are benign tumors of **cartilage**, also recognized as a component of **Carney's triad**. - They are often found in the **bones** or soft tissues, but they are part of the neoplasms associated with this condition. *GIST* - Gastrointestinal stromal tumors (GISTs) are significant neoplasms linked to **Carney's triad**, arising from **interstitial cells of Cajal** in the GI tract. - They are characterized by specific mutations and can be a source of gastrointestinal symptoms in affected individuals.

Q: Which of the following statements about cross-matching of blood is false?

Donor serum is tested against recipient packed cells. ***Donor serum is tested against recipient packed cells*** - This statement is **FALSE** and describes a **minor crossmatch**, which is rarely performed in modern transfusion practice. - The minor crossmatch tests donor antibodies against recipient cells, but this is not standard practice because donor plasma is significantly diluted during transfusion, making clinically significant reactions rare. - Modern blood banking focuses on the **major crossmatch** as the critical safety measure. *Recipient serum is tested against donor packed cells* - This statement is **TRUE** and accurately describes the **major crossmatch**, which is the standard and most critical pre-transfusion compatibility test. - The major crossmatch detects antibodies in the recipient's serum that could react with donor red blood cell antigens, preventing potentially fatal hemolytic transfusion reactions. *Mandatory in all cases except emergency* - This statement is **TRUE**. Crossmatching is mandatory for safe transfusion practice. - In life-threatening emergencies where delay could be fatal, uncrossmatched O-negative (universal donor) blood may be given, but this is a rare exception. *Involves visible agglutination* - This statement is **TRUE**. A positive crossmatch indicating incompatibility is identified by **visible agglutination** or **hemolysis**. - These visible reactions occur when recipient antibodies bind to donor red blood cell antigens, signaling that transfusion would cause a severe reaction.

Q: What is the number of Barr bodies present in Klinefelter's syndrome?

1. ***1*** - **Klinefelter's syndrome** typically has a 47,XXY karyotype, meaning there are two X chromosomes [1]. - The number of Barr bodies is calculated as **N-1**, where N is the total number of X chromosomes. In this case, 2-1 = **1 Barr body** [1]. - This follows the principle that one X chromosome remains active while additional X chromosomes are inactivated [1]. *0* - **No Barr bodies** are found in individuals with a normal male karyotype (46,XY) or in Turner syndrome (45,XO), neither of which describes Klinefelter's syndrome [1]. - The presence of at least one Barr body indicates the presence of at least two X chromosomes. *2* - **Two Barr bodies** would be indicative of a karyotype with three X chromosomes (e.g., 47,XXX syndrome or Triple X syndrome), which is not Klinefelter's syndrome. - This calculation follows the N-1 rule: 3 X chromosomes - 1 = 2 Barr bodies. *3* - **Three Barr bodies** would correspond to a karyotype with four X chromosomes (e.g., 48,XXXX), which is an even rarer sex chromosome aneuploidy not associated with Klinefelter's syndrome. - The N-1 rule applies: 4 X chromosomes - 1 = 3 Barr bodies. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, pp. 173-174.

Q: What is the best management for a human bite?

Ampicillin plus sulbactam. ***Ampicillin plus sulbactam*** - This combination is effective against the common **aerobic and anaerobic bacteria** found in human bite wounds, including **Eikenella corrodens** and oral streptococci. - The sulbactam component provides **beta-lactamase inhibition**, which is crucial as many oral bacteria produce these enzymes, rendering ampicillin alone ineffective. *Clindamycin plus TMP-SMX* - While clindamycin covers many anaerobes, it has **poor activity against Eikenella corrodens**, a key pathogen in human bites. - **TMP-SMX (trimethoprim-sulfamethoxazole)** also lacks reliable coverage against many oral anaerobes and Eikenella. *Fluoroquinolone* - **Fluoroquinolones** generally have good Gram-negative coverage but often possess **limited activity against oral anaerobes and streptococci** relevant to human bites. - There is a **growing concern for resistance** with fluoroquinolone monotherapy in these types of infections. *Doxycycline* - Doxycycline has a broad spectrum but is **not the first-line choice for human bites** due to inconsistent activity against common oral anaerobes and Eikenella corrodens. - It may be considered in specific cases, but **empiric coverage needs to be broader** for initial management of these **polymicrobial infections**.

Question 1

Dietary deficiency of which vitamin is considered extremely rare?

Accepted Answer

Vitamin E

Answer

Thiamine

Answer

Vitamin B6

Answer

Vitamin D

Question 2

Which of the following is NOT a manifestation of vitamin E deficiency?

Accepted Answer

Autonomic dysfunction

Answer

Posterior column abnormalities

Answer

Cerebellar ataxia

Answer

Hemolytic anemia

Question 3

In which of the following causes of oral ulcers are auto-antibodies not seen?

Accepted Answer

Behcet disease

Answer

SLE

Answer

Pemphigus

Answer

Celiac disease

Question 4

Which fluid is ideally given for a patient experiencing dehydration?

Accepted Answer

Normal Saline

Answer

Plasma

Answer

Blood

Answer

5% dextrose

Question 5

In a patient presenting with a painful swollen joint and a history of high uric acid levels, which condition is most likely indicated by this clinical presentation?

Accepted Answer

Gout

Answer

Ankylosing spondylitis

Answer

Osteoarthritis

Answer

Rheumatoid arthritis

Question 6

Which of the following conditions is least likely to cause multiple painful ulcers on the tongue?

Accepted Answer

Sarcoidosis

Answer

TB

Answer

Herpes

Answer

Behcet disease

Question 7

Which of the following is not associated with Carney's triad?

Accepted Answer

Atrial myxoma

Answer

GIST

Answer

Chondroma

Answer

Paraganglioma

Question 8

Which of the following statements about cross-matching of blood is false?

Accepted Answer

Donor serum is tested against recipient packed cells

Answer

Mandatory in all cases except emergency

Answer

Involves visible agglutination

Answer

Recipient serum is tested against donor packed cells

Question 9

What is the number of Barr bodies present in Klinefelter's syndrome?

Accepted Answer

1

Answer

0

Answer

2

Answer

3

Question 10

What is the best management for a human bite?

Accepted Answer

Ampicillin plus sulbactam

Answer

Clindamycin plus TMP-SMX

Answer

Fluoroquinolone

Answer

Doxycycline

NEET-PG 2015

Biochemistry

Dental

General Medicine

Internal Medicine

Pathology

Surgery