NEET-PG 2017 Practice Questions

Q: What is the name of the marked blood vessel shown in brain circulation?

Posterior communicating artery. ***Posterior communicating artery*** - The arrow points to a vessel connecting the **anterior circulation** (internal carotid artery system) with the **posterior circulation** (vertebrobasilar system) within the **Circle of Willis**. - This specific location and function are characteristic of the **posterior communicating artery**, which typically arises from the internal carotid and joins the posterior cerebral artery. *Middle cerebral artery* - The middle cerebral artery is a large artery that branches off the **internal carotid artery** and typically extends laterally and superiorly to supply a large part of the **cerebral hemispheres**. - It would appear more prominent and more laterally positioned, not forming a direct "communicating" link in the central Circle of Willis as shown. *Internal carotid artery* - The internal carotid artery ascends from the neck into the skull and bifurcates into the **anterior and middle cerebral arteries**. - While visible in the image, the arrow is pointing to a smaller anastomotic branch, not the main trunk of the internal carotid artery. *Anterior communicating artery* - The **anterior communicating artery** connects the two **anterior cerebral arteries** at the anterior aspect of the Circle of Willis. - This is a distinct location from that indicated by the arrow, which shows a vessel connecting anterior to posterior circulation, not linking the two anterior cerebral arteries.

Q: What is the name of the marked blood vessel in the Circle of Willis?

Posterior communicating artery. ***Posterior communicating artery*** - The image displays the Circle of Willis, and the vessel marked with 'X' is connecting the **internal carotid artery** (which branches into the middle and anterior cerebral arteries) to the **posterior cerebral artery**. - This connecting artery is the **posterior communicating artery**, an essential component of the Circle of Willis, ensuring collateral blood flow to the brain. *Middle cerebral artery* - The **middle cerebral artery** branches off the internal carotid artery and typically extends laterally into the Sylvian fissure, supplying a large part of the lateral cerebral cortex. - The marked vessel is clearly connecting proximal arteries within the Circle of Willis, not extending into the cerebral cortex peripherally. *Internal carotid artery* - The **internal carotid artery** enters the skull and gives rise to several branches, including the middle cerebral artery and the posterior communicating artery. - While it's part of the supply to the Circle of Willis, the 'X' points specifically to the **communicating segment** connecting the anterior and posterior circulations, not the main trunk of the internal carotid. *Posterior cerebral artery* - The **posterior cerebral artery** is formed by the bifurcation of the basilar artery and supplies the occipital lobe and parts of the temporal lobe. - The marked vessel is connecting to the posterior cerebral artery, but it is not the posterior cerebral artery itself; rather, it is the vessel **communicating** with it from the anterior circulation.

Q: MRI was performed on a 35-year-old man with progressive myoclonus and apathy. What is the diagnosis? (Recent NEET Pattern 2016-17)

Prion disease. ***Prion disease*** - The MRI shows **cortical ribboning** (hyperintensity in the cortex) and possible signal changes in the basal ganglia, which are characteristic findings in prion diseases such as **Creutzfeldt-Jakob disease (CJD)**. - The clinical presentation of **progressive myoclonus** (sudden, involuntary muscle jerks) and **apathy** (lack of emotion or motivation), especially in a relatively young individual (35 years old), is highly suggestive of CJD or another prion disease. *Herpes simplex encephalitis* - This typically presents with **fever, headache, and focal neurological deficits**, often affecting the **temporal lobes**. - While it can cause FLAIR hyperintensities, it usually begins acutely with more prominent edema and may have hemorrhagic components, and myoclonus is not a primary defining symptom. *SSPE* - **Subacute sclerosing panencephalitis (SSPE)** is a rare, fatal, progressive brain disorder caused by the **measles virus**, primarily affecting children and young adults. - While it can cause progressive neurological deterioration and cognitive decline, myoclonus is often a late feature, and MRI findings often show **white matter demyelination** in later stages, which is not the predominant finding here. *Mesial temporal sclerosis* - This condition is characterized by **atrophy and signal changes in the hippocampus and amygdala** on MRI, typically associated with **temporal lobe epilepsy**. - While it can cause cognitive issues, it usually does not account for widespread cortical ribboning or prominent myoclonus in this age group, and the image does not specifically highlight mesial temporal lobe changes.

Q: A 1-year-old child presents with infantile spasms. EEG done shows: (Recent NEET Pattern 2016-17)

Hypsarrhythmia. ***Hypsarrhythmia*** - The provided EEG shows a chaotic, high-amplitude, and **disorganized background** activity with multifocal spikes and sharp waves, indicative of hypsarrhythmia. - This pattern is characteristic of **infantile spasms**, a severe epilepsy syndrome typically presenting in the first year of life with myoclonic seizures. *Normal record* - A normal EEG would show organized, age-appropriate background rhythms with no pathological discharges. - The presented EEG is clearly **abnormal and highly disorganized**, ruling out a normal record. *Periodic spike wave pattern* - Periodic spike-wave patterns, such as 3-Hz spike-and-wave, are typically seen in **absence seizures**, which manifest as brief staring spells rather than myoclonic seizures. - The EEG in the image is more **chaotic and polymorphous** than a rhythmic, generalized spike-wave pattern. *Burst suppression pattern* - **Burst suppression** is characterized by intermittent bursts of high-amplitude activity alternating with periods of relative electrical silence. - This pattern is typically seen in severe encephalopathies, deep anesthesia, or certain severe epilepsy syndromes like Ohtahara syndrome, but it does not match the **continuous, disorganized high-amplitude** pattern shown.

Q: What is the radiological sign that could best describe this image?

Cobra head sign. ***Cobra head sign*** - This sign is seen in the setting of a **ureterocele**, which is a cystic dilatation of the intravesical (within the bladder) portion of the ureter. - On intravenous urography (IVU) or retrograde pyelography, the dilated ureterocele appears as a filling defect within the bladder, outlined by contrast, creating the characteristic "cobra head" or "spring onion" appearance. *Rim sign* - The **rim sign** is typically associated with **renal calculi** (kidney stones). - It refers to a thin rim of soft tissue or gas surrounding a radiolucent stone, which can sometimes be seen on CT scans. *Fish hook bladder* - This term describes the shape of the bladder in cases of **benign prostatic hyperplasia (BPH)**. - Due to the enlarged prostate elevating and distorting the bladder base, the contrast-filled bladder appears elongated and curved, resembling a fish hook on a cystogram. *Soap bubble* - The "soap bubble" appearance is often used to describe **multiloculated cystic masses** or certain types of tumors, particularly in bone lesions (e.g., aneurysmal bone cyst, fibrous dysplasia). - It refers to multiple small, rounded lucencies giving a bubbly or multicystic appearance on imaging.

Q: A 26-year-old construction worker with a previous history of recurrent kidney stones presents with flank pain. What is the radiological sign demonstrated in the IVP image shown below?

Rim sign. ***Rim sign*** - The image shows a **calcified rim around a radiolucent (non-calcified) center**, which is characteristic of a **calcium oxalate monohydrate stone** on an intravenous pyelogram (IVP). - This sign is also known as the **"lucent-centered calculus"** or **"target sign"** and indicates a partially calcified stone. *Ring sign* - The **ring sign** can refer to various appearances in medical imaging, often indicating a **ring-enhancing lesion** on CT or MRI, which is not applicable to a kidney stone on IVP. - In renal imaging, a ring sign might describe a collection of contrast medium around a tumor or cyst, but not typically a stone with a radiolucent center. *Egg in cup appearance* - This sign is typically associated with **osteochondroma or enchondroma** lesions in bone imaging, where the cartilage cap creates a "cup" for the medullary bone to grow into. - It is not a recognized sign for kidney stones. *Sun burst appearance* - The **sun burst appearance** is characteristic of certain **bone tumors**, particularly **osteosarcoma**, where new bone forms perpendicular to the bone surface. - This description does not apply to the radiological features of kidney stones on IVP.

Q: Which of the following is correct about the NCCT shown below? (Recent NEET Pattern 2016-17)

Intraparenchymal hemorrhage. ***Intraparenchymal hemorrhage*** - The image shows a **hyperdense (bright)** lesion within the brain parenchyma, indicated by the arrows. This appearance on non-contrast CT (NCCT) is characteristic of **acute hemorrhage** (blood) within the brain tissue. - The location and morphology are consistent with blood accumulating directly within the brain substance rather than in the subarachnoid space or as a diffuse cerebral edema. *Acute ischemic stroke* - An **acute ischemic stroke** on NCCT typically appears as a **hypodense (darker)** area due to **edema** and cell death, usually after several hours. The lesion shown in the image is hyperdense. - Early signs of acute ischemic stroke (within the first few hours) can include subtle changes like loss of gray-white matter differentiation or hyperdense vessel signs, but not a distinct hyperdense parenchymal lesion as seen here. *Acute hemorrhagic stroke* - While technically a hemorrhagic stroke, this option is too broad. Hemorrhagic stroke encompasses both intraparenchymal hemorrhage and subarachnoid hemorrhage. - The specific location of the blood within the brain tissue, as opposed to solely in the subarachnoid space, makes "intraparenchymal hemorrhage" a more precise diagnosis. *Subarachnoid hemorrhage* - **Subarachnoid hemorrhage (SAH)** would appear as hyperdensity (blood) in the **sulci, fissures**, and **basal cisterns** surrounding the brain, not within the brain parenchyma itself. - The image clearly shows the lesion within the brain tissue, not in the subarachnoid spaces.

Q: All of the following statements regarding this image are true except:

High fiber diet will reduce the incidence of this defect. **_High fiber diet will reduce the incidence of this defect_** - This statement is **false**. High fiber intake is generally recommended for preventing diverticular disease and not for their treatment in this case. - While fiber can reduce the incidence of diverticulosis, it does not apply to the *defect itself*, which refers to existing diverticula. *Defect occurs usually between tenia coli and the blood vessel entering colonic wall* - This statement is **true**. Diverticula commonly arise at points where **colonic blood vessels** penetrate the muscular layers, creating weak spots. - These areas are anatomically predisposed to herniation due to the passage of **vasa recta** through the muscularis propria. *They are a result of tractional force* - This statement is **true**. Diverticula are generally classified as **false diverticula** (pseudodiverticula) because they are formed by the herniation of mucosa and submucosa through defects in the muscularis. - This herniation is primarily caused by **increased intraluminal pressure** working against the weakened colonic wall, rather than external traction. *Most common site for this defect is sigmoid colon* - This statement is **true**. The **sigmoid colon** is the most common site for diverticular disease due to its narrow lumen and higher intraluminal pressure. - This region experiences the greatest stress during fecal transit, predisposing it to the formation of these outpouchings.

Question 1

What is the name of the marked blood vessel shown in brain circulation?

Accepted Answer

Posterior communicating artery

Answer

Middle cerebral artery

Answer

Internal carotid artery

Answer

Anterior communicating artery

Question 2

What is the name of the marked blood vessel in the Circle of Willis?

Accepted Answer

Posterior communicating artery

Answer

Middle cerebral artery

Answer

Internal carotid artery

Answer

Posterior cerebral artery

Question 3

MRI was performed on a 35-year-old man with progressive myoclonus and apathy. What is the diagnosis? (Recent NEET Pattern 2016-17)

Accepted Answer

Prion disease

Answer

Herpes simplex encephalitis

Answer

SSPE

Answer

Mesial temporal sclerosis

Question 4

A 35-year-old woman presents with thunderclap headache. NCCT was done. All are true about the condition except:

Accepted Answer

Most common cause of death is rebleeding

Answer

Hyponatremia

Answer

Prolonged QT interval

Answer

Nimodipine is drug of choice

Question 5

A 1-year-old child presents with infantile spasms. EEG done shows: (Recent NEET Pattern 2016-17)

Accepted Answer

Hypsarrhythmia

Answer

Normal record

Answer

Periodic spike wave pattern

Answer

Burst suppression pattern

Question 6

Excretory urogram in a two-year-old child with recurrent UTI shows:

Accepted Answer

Drooping water lily sign

Answer

Horse shoe kidney

Answer

Flower vase kidney

Answer

Duplication of kidney

Question 7

What is the radiological sign that could best describe this image?

Accepted Answer

Cobra head sign

Answer

Rim sign

Answer

Fish hook bladder

Answer

Soap bubble

Question 8

A 26-year-old construction worker with a previous history of recurrent kidney stones presents with flank pain. What is the radiological sign demonstrated in the IVP image shown below?

Accepted Answer

Rim sign

Answer

Ring sign

Answer

Egg in cup appearance

Answer

Sun burst appearance

Question 9

Which of the following is correct about the NCCT shown below? (Recent NEET Pattern 2016-17)

Accepted Answer

Intraparenchymal hemorrhage

Answer

Acute ischemic stroke

Answer

Acute hemorrhagic stroke

Answer

Subarachnoid hemorrhage

Question 10

All of the following statements regarding this image are true except:

Accepted Answer

High fiber diet will reduce the incidence of this defect

Answer

Defect occurs usually between tenia coli and the blood vessel entering colonic wall

Answer

They are a result of tractional force

Answer

Most common site for this defect is sigmoid colon

NEET-PG 2017

Anatomy

Internal Medicine

Pediatrics

Radiology

Surgery