NEET-PG 2020 Practice Questions

Q: A 5-year-old unimmunized child developed diphtheria. He has a 3-year-old immunized sibling contact, who received the last booster 18 months back. What should be done with the contact?

Single dose of toxoid vaccine. ***Single dose of toxoid vaccine*** - In the context of this question, this is the **best available option** among the choices provided. - For a close contact of diphtheria who was immunized but received their last booster **18 months ago**, guidelines recommend a **booster dose if more than 5 years** have elapsed since the last dose. - However, some protocols recommend a booster for **close contacts regardless of timing** to ensure maximum protection. - **Important note**: The PRIMARY management for diphtheria close contacts is **antibiotic prophylaxis** (Erythromycin 40-50 mg/kg/day for 7 days or single-dose Azithromycin) plus surveillance for 7 days, which is not mentioned in the available options. *No vaccine needed* - This is incorrect because as a **close contact of an active diphtheria case**, prophylactic measures are required. - Even though the child received a booster 18 months ago, additional protection through either antibiotics (primary) or a booster dose may be recommended. - Close contacts require active intervention to prevent secondary transmission. *Three doses of conjugate vaccine* - This represents a **complete primary series**, which is not appropriate for an already immunized child. - The child has already completed primary immunization and received boosters; they do not need to restart the vaccination schedule. - **Conjugate vaccines** (like Hib conjugate) are different formulations, though DTaP is technically a conjugated form of diphtheria toxoid. *Two doses of polysaccharide vaccine* - **Polysaccharide vaccines** are not used for diphtheria prevention. - Diphtheria vaccines are **toxoid-based** (inactivated diphtheria toxin), not polysaccharide-based. - This option represents an incorrect vaccine type for diphtheria prophylaxis.

Q: Indicators of air pollution are:

Sulphur dioxide, smoke, particulate matter. **Correct Option: Sulphur dioxide, smoke, particulate matter** - **Sulphur dioxide (SO₂)** is a major gaseous air pollutant indicator, primarily from fossil fuel combustion and industrial processes - **Smoke** (composed of small solid and liquid particles) is a visible indicator of air pollution - **Particulate matter (PM2.5 and PM10)** represents suspended particulate matter (SPM), significant contributors to air pollution causing respiratory and cardiovascular issues - These three parameters are the **standard indicators** used for air quality monitoring as per NAAQS (National Ambient Air Quality Standards) *Incorrect: Sulphur dioxide, lead, particulate matter* - While SO₂ and particulate matter are correct indicators, **lead** is a toxic heavy metal pollutant but not a standard indicator for routine air quality monitoring - Lead pollution is typically measured separately as a specific hazardous pollutant *Incorrect: Sulphur dioxide, hydrogen sulphide, carbon monoxide* - SO₂ and CO are air pollutants, but **hydrogen sulphide (H₂S)** is more associated with specific industrial emissions and sewage decomposition - This combination misses the critical indicators of **smoke and particulate matter** which are more ubiquitous and routinely monitored *Incorrect: Carbon dioxide, hydrogen sulphide, lead* - **Carbon dioxide (CO₂)** is primarily a greenhouse gas contributing to climate change, not a conventional air pollution indicator for local air quality - H₂S and lead are pollutants but not standard routine indicators - This option lacks the key indicators: SO₂, smoke, and particulate matter

Q: Magnan's symptom is seen in:

Cocaine. ***Cocaine*** - **Magnan's symptom**, also known as **formication**, is a tactile hallucination where an individual perceives insects crawling under their skin, commonly associated with chronic cocaine use. - This symptom is a manifestation of **cocaine-induced psychosis** or severe intoxication, leading to paranoid delusions and abnormal sensory experiences. *Datura* - **Datura** intoxication primarily causes anticholinergic effects, such as **dry mouth**, **dilated pupils**, confusion, and visual hallucinations, but not typically Magnan's symptom. - The hallucinations associated with Datura are often described as vivid and florid, but distinct from the tactile formication seen with cocaine. *Cannabis* - **Cannabis** use can induce altered perceptions, euphoria, anxiety, and sometimes paranoia, but it is not typically associated with tactile hallucinations like Magnan's symptom. - While high doses can lead to psychotic-like symptoms, **formication** is not a characteristic feature of cannabis intoxication. *Opium* - **Opium** and other opioids primarily cause central nervous system depression, leading to euphoria, sedation, pinpoint pupils, and respiratory depression. - Opioid use is not linked to tactile hallucinations such as **formication** or Magnan's symptom.

Q: A known case of COPD with acute exacerbation of symptoms. On examination patient was conscious and alert, pulse was 110 beats/ min and bilateral wheeze present. All of the following are true in the management of the patient except:

Non invasive ventilation is contraindicated. ***Non invasive ventilation is contraindicated*** - This statement is **false**, therefore the correct exception. **Non-invasive ventilation (NIV)** is often indicated and beneficial in the management of acute exacerbations of COPD, especially in patients with **respiratory acidosis** or persistent dyspnea, as it can reduce the need for intubation and improve outcomes [2]. - The patient's presentation (conscious, alert, wheeze, tachycardia) suggests an acute exacerbation, for which NIV is a key intervention unless there are absolute contraindications like cardiac arrest or inability to protect the airway [3]. *Permissible hypercapnia allowed* - **Permissive hypercapnia** is a valid strategy in managing acute exacerbations of COPD, particularly during mechanical ventilation. The goal is to maintain an adequate pH (e.g., >7.20-7.25) rather than normalizing CO2, to avoid **barotrauma** and **volutrauma** from aggressive ventilation [3]. - This approach acknowledges that some CO2 retention is acceptable as long as acidosis is not severe, protecting the lungs from excessive pressure. *Inhalation with salbutamol* - **Inhaled bronchodilators**, such as **salbutamol (a short-acting beta-agonist)**, are a cornerstone of treatment for acute COPD exacerbations [1]. They act rapidly to relieve **bronchospasm** and improve airflow, addressing the wheeze observed in the patient. - Frequent administration of these agents is crucial in the initial management to open up the airways and reduce air trapping. *I/V steroids* - **Systemic corticosteroids**, such as intravenous methylprednisolone or oral prednisone, are essential in managing acute COPD exacerbations. They reduce **airway inflammation** and swelling, leading to improved lung function and reduced recovery time. - Steroids are typically given for a short course (e.g., 5-7 days) to minimize side effects while maximizing therapeutic benefits.

Q: A 24-year-old woman who had a home delivery 2 weeks ago now presents with a complete perineal tear. What is the next line of management?

Repair after 3 months. ***Repair after 3 months*** - Delayed repair, typically after **3 to 6 months**, allows for resolution of **inflammation**, re-epithelialization of the wound edges, and softening of the scar tissue. - This timing optimizes conditions for successful surgical reconstruction by minimizing the risk of **infection** and promoting better tissue healing. *Repair after 3 weeks* - Repairing a complete perineal tear at this stage is too early as the tissue is still highly **inflamed** and prone to **infection** and **dehiscence**. - The wound bed would not have sufficiently healed or softened, making surgical repair more challenging and increasing the likelihood of poor outcomes. *Repair after 6 months* - Waiting for 6 months to repair a complete perineal tear is generally considered too long, as the tissues may become excessively **fibrotic** and less amenable to successful reconstruction. - While sometimes necessary in complex cases, waiting this long can lead to prolonged discomfort and functional issues for the patient. *Repair immediately* - Immediate repair of a complete perineal tear that was missed or inadequately repaired at the time of delivery is typically not recommended several weeks postpartum due to significant **edema**, **inflammation**, and potential for **infection**. - Immediate repair is usually performed **at the time of delivery** if the tear is recognized, not two weeks later.

Q: Which of the following is associated with pauci-immune glomerulonephritis?

Granulomatosis with polyangiitis (GPA). ***Granulomatosis with polyangiitis (GPA)*** - **Pauci-immune glomerulonephritis** is characterized by the absence or scarcity of immune complex deposits in the glomeruli. - This is typical of **ANCA-associated vasculitides**, such as GPA (formerly Wegener's granulomatosis), which cause severe necrotising glomerulonephritis with few immune deposits [1]. *Anti-GBM glomerulonephritis* - This condition is characterized by **linear deposition of anti-GBM antibodies** along the glomerular basement membrane, making it an **immune complex-mediated disease**, not pauci-immune [1]. - It involves autoantibodies attacking the **collagen type IV** in the GBM. *SLE nephritis* - Systemic lupus erythematosus (SLE) nephritis is a classic example of **immune complex-mediated glomerulonephritis**, with abundant immune deposits containing immunoglobulins and complement [1]. - The pathology often shows **full-house immunofluorescence** with IgG, IgA, IgM, C3, and C1q. *IgA nephropathy* - This is characterized by prominent **mesangial deposition of IgA immune complexes**, which is clearly an immune complex-mediated process [1]. - While it can present with different histological patterns, the presence of **IgA deposition** means it is not pauci-immune [1].

Q: Microscopic examination of the reperfused myocardium is likely to have which of the following findings?

Contraction band necrosis. ***Contraction band necrosis*** - This lesion is characteristic of **reperfusion injury**, resulting from the reintroduction of **calcium** into ischemic cells, causing hypercontraction of sarcomeres [1]. - The bands represent irreversibly contracted sarcomeres and are a hallmark of cell death in the setting of restored blood flow [1]. *Neutrophilic infiltration* - While present in myocardial infarction, **neutrophilic infiltration** primarily begins hours after injury and is part of the inflammatory response to necrotic tissue, not a specific marker of reperfusion itself [2]. - It's a general feature of **acute inflammation** and necrosis but doesn't specifically distinguish reperfused myocardium from non-reperfused ischemic injury in the acute phase [2]. *Waviness of fibres* - **Waviness of fibers** is an early microscopic change in **ischemic myocardium**; it's due to the stretching of dead or dying muscle fibers adjacent to healthy, contracting fibers [2]. - This finding is typically seen within the first few hours of ischemia, before significant reperfusion injury is evident. *Cardiac myocyte swelling* - **Cardiac myocyte swelling** (cellular edema) is an early and non-specific sign of **ischemic injury** due to the failure of ion pumps, leading to intracellular accumulation of water [2]. - While present in ischemia, it's not a unique characteristic of reperfusion injury; reperfusion leads to more specific changes like contraction band necrosis [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 554-556. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, p. 552.

Q: A 5 yr old male child presented with H/O recurrent infection. O/E the child has rashes as shown below. Routine blood investigation reveal patient has low platelets. Which of the following diagnosis is possible?

Wiskott Aldrich syndrome. ***Wiskott Aldrich syndrome*** - This syndrome classically presents with a triad of **eczema**, **thrombocytopenia** (low platelets), and **immunodeficiency** (recurrent infections). The rash is consistent with eczema, and the low platelets and recurrent infections match the clinical picture. - It is an **X-linked recessive disorder** primarily affecting boys, explaining the male gender of the child. *Henoch Schoenlein purpura* - This is a **vasculitis** characterized by palpable purpura, arthralgia, abdominal pain, and renal involvement, which would not typically include low platelets or severe recurrent infections as primary features. - The rash of Henoch-Schönlein purpura is often **non-blanching purpura** on the buttocks and lower extremities, distinct from the eczematous rash described. *Job syndrome* - Also known as **hyper-IgE syndrome**, Job syndrome is characterized by recurrent skin abscesses (staph aureus), severe eczema, and elevated IgE levels, but **thrombocytopenia is not a typical feature**. - While recurrent infections and eczema are present, the **low platelet count** makes Wiskott-Aldrich syndrome a more fitting choice. *Measles* - Measles is an **acute viral infection** causing a characteristic maculopapular rash, fever, cough, coryza, and conjunctivitis. - It does not cause chronic recurrent infections or a persistent low platelet count; rather, it's an acute self-limiting illness.

Q: A patient with pH of 7, pCO2 of 30 mmHg and Bicarbonate levels of 10 meq. What is the acid base abnormality?

Metabolic Acidosis. ***Metabolic Acidosis*** - The pH is 7, which is severely **acidotic** (normal range 7.35-7.45). This indicates an acid-base disorder where the body is too acidic. - The **bicarbonate level is 10 mEq/L** (normal range 22-26 mEq/L), which is significantly low, directly contributing to the acidosis and pointing towards a metabolic origin. *Respiratory alkalosis* - This condition involves an **elevated pH** (alkalosis) due to a primary decrease in pCO2. - In this case, the pH is acidic, not alkaline. *Metabolic alkalosis* - This condition involves an **elevated pH** (alkalosis) due to a primary increase in bicarbonate levels. - Here, the pH is acidic and bicarbonate is low, directly contradicting metabolic alkalosis. *Respiratory Acidosis* - This condition involves a **decreased pH** (acidosis) due to a primary increase in pCO2. - Although the pH is acidotic, the pCO2 is 30 mmHg (normal range 35-45 mmHg), which is low, indicating a respiratory compensation rather than the primary cause.

Q: In a preterm baby with respiratory distress syndrome, which type of cell is deficient?

Type 2 alveolar cell. ***Type 2 alveolar cell*** - **Type 2 alveolar cells** (pneumocytes) are responsible for producing and secreting **surfactant**. - A deficiency in these cells, common in preterm infants, leads to insufficient surfactant, causing alveolar collapse and respiratory distress syndrome. *Type 1 alveolar cell* - **Type 1 alveolar cells** are primarily involved in **gas exchange** due to their thin, flat structure. - While essential for respiration, their deficiency is not the primary cause of respiratory distress syndrome in preterm infants. *Alveolar capillary endothelial cell* - **Alveolar capillary endothelial cells** form the walls of the capillaries surrounding the alveoli, facilitating the transfer of gases between the alveoli and blood. - They do not produce surfactant, and their deficiency is not the direct cause of respiratory distress syndrome. *Bronchial mucosal epithelial cell* - **Bronchial mucosal epithelial cells** line the airways and are involved in mucus production and ciliary clearance. - While important for respiratory function, their primary role is not in preventing alveolar collapse in respiratory distress syndrome.

Question 1

A 5-year-old unimmunized child developed diphtheria. He has a 3-year-old immunized sibling contact, who received the last booster 18 months back. What should be done with the contact?

Accepted Answer

Single dose of toxoid vaccine

Answer

No vaccine needed

Answer

Three doses of conjugate vaccine

Answer

Two doses of polysaccharide vaccine

Question 2

Indicators of air pollution are:

Accepted Answer

Sulphur dioxide, smoke, particulate matter

Answer

Sulphur dioxide, lead, particulate matter

Answer

Sulphur dioxide, hydrogen sulphide, carbon monoxide

Answer

Carbon dioxide, hydrogen sulphide, lead

Question 3

Magnan's symptom is seen in:

Accepted Answer

Cocaine

Answer

Datura

Answer

Cannabis

Answer

Opium

Question 4

A known case of COPD with acute exacerbation of symptoms. On examination patient was conscious and alert, pulse was 110 beats/ min and bilateral wheeze present. All of the following are true in the management of the patient except:

Accepted Answer

Non invasive ventilation is contraindicated

Answer

Permissible hypercapnia allowed

Answer

Inhalation with salbutamol

Answer

I/V steroids

Question 5

A 24-year-old woman who had a home delivery 2 weeks ago now presents with a complete perineal tear. What is the next line of management?

Accepted Answer

Repair after 3 months

Answer

Repair after 3 weeks

Answer

Repair after 6 months

Answer

Repair immediately

Question 6

Which of the following is associated with pauci-immune glomerulonephritis?

Accepted Answer

Granulomatosis with polyangiitis (GPA)

Answer

Anti-GBM glomerulonephritis

Answer

SLE nephritis

Answer

IgA nephropathy

Question 7

Microscopic examination of the reperfused myocardium is likely to have which of the following findings?

Accepted Answer

Contraction band necrosis

Answer

Neutrophilic infiltration

Answer

Cardiac myocyte swelling

Answer

Waviness of fibers

Question 8

A 5 yr old male child presented with H/O recurrent infection. O/E the child has rashes as shown below. Routine blood investigation reveal patient has low platelets. Which of the following diagnosis is possible?

Accepted Answer

Wiskott Aldrich syndrome

Answer

Henoch Schoenlein purpura

Answer

Job syndrome

Answer

Measles

Question 9

A patient with pH of 7, pCO2 of 30 mmHg and Bicarbonate levels of 10 meq. What is the acid base abnormality?

Accepted Answer

Metabolic Acidosis

Answer

Respiratory alkalosis

Answer

Metabolic alkalosis

Answer

Respiratory Acidosis

Question 10

In a preterm baby with respiratory distress syndrome, which type of cell is deficient?

Accepted Answer

Type 2 alveolar cell

Answer

Type 1 alveolar cell

Answer

Alveolar capillary endothelial cell

Answer

Bronchial mucosal epithelial cell

NEET-PG 2020

Community Medicine

Forensic Medicine

Internal Medicine

Obstetrics and Gynecology

Pathology

Pediatrics

Physiology