NEET-PG 2020 Practice Questions

Q: Type of joint at site marked by the arrow?

Synovial Joint. ***Synovial Joint*** - The arrow points to a joint demonstrating a **joint capsule**, containing **synovial fluid** within a joint cavity, and lined by **hyaline cartilage**, all hallmarks of a synovial joint. - **Synovial joints** are uniquely designed for movement, allowing for a wide range of motion between bones due to their specific structural components. *Syndesmosis* - A syndesmosis is a type of **fibrous joint** where bones are joined by a sheet or bundle of long irregular connective tissue fibers, such as the **interosseous membrane** between the tibia and fibula. - This joint type allows for very little movement, contrasting with the free movement indicated by the visible joint space. *Symphysis* - A symphysis is a type of **cartilaginous joint** where two bones are joined by a pad of **fibrocartilage**, for example, the **pubic symphysis** or intervertebral discs. - This type of joint allows for limited movement and lacks a joint cavity and synovial fluid. *Synarthrosis* - A **synarthrosis** is a **fibrous, immovable joint** typically found in structures like the sutures of the skull, providing strong, rigid connections. - These joints allow for no movement and lack a joint cavity.

Q: Which of the following is the rich source of Vitamin B12?

Meat. ***Meat*** - **Vitamin B12** is primarily found in **animal products** because it is synthesized by bacteria in the digestive tracts of animals. - **Meat**, especially red meat and liver, is an excellent source of this vitamin. *Mango* - Mangoes are a good source of **Vitamin C** and **Vitamin A**, but they contain negligible amounts of Vitamin B12. - As a fruit, mangos are a plant-based food and generally **do not contain B12**. *Carrot* - Carrots are rich in **beta-carotene** (a precursor to Vitamin A) and **fiber**, but they are not a source of Vitamin B12. - Being a vegetable, carrots are a **plant-based food** and lack Vitamin B12. *Spinach* - Spinach is known for its high content of **iron**, **folate**, and **Vitamin K**, but it does not contain Vitamin B12. - Like other plant-based foods, spinach **naturally lacks Vitamin B12**.

Q: A patient presented with clinical features of ataxia and incoordination. It is most likely due to involvement of which artery among the following.

Superior cerebellar. ***Superior cerebellar*** - The superior cerebellar artery supplies the **superior cerebellum**, which is critical for **coordination** and balance [1]. - Involvement of this artery commonly leads to **ataxia**, **dysarthria**, and **ipsilateral limb incoordination** [3]. *Middle cerebral* - The middle cerebral artery primarily supplies the **lateral surface of the cerebrum**, including motor and sensory cortices. - Strokes in this territory typically cause **contralateral hemiparesis**, **aphasia**, and **hemianopia**, not ataxia as a primary symptom [2]. *Posterior cerebellar* - The posterior cerebral artery supplies the **occipital lobe**, **thalamus**, and parts of the temporal lobe. - Occlusion often results in **visual field defects** (hemianopia), **memory deficits**, and sometimes **sensory loss**, but not isolated ataxia [2]. *Anterior cerebral* - The anterior cerebral artery supplies the **medial frontal and parietal lobes**. - Its occlusion typically causes **contralateral leg weakness** (hemiparesis), **behavioral changes**, and **urinary incontinence**.

Q: What is the differentiating feature between irritable bowel syndrome and inflammatory bowel disease?

Stool calprotectin. ***Stool calprotectin*** - **Stool calprotectin** is a reliable biomarker used to differentiate between **Inflammatory Bowel Disease (IBD)** and **Irritable Bowel Syndrome (IBS)**. It's a protein released by neutrophils during intestinal inflammation. - Elevated levels of **calprotectin** strongly suggest **mucosal inflammation** characteristic of IBD (Crohn's disease or ulcerative colitis), while normal levels are typical in IBS, which lacks inflammation [1]. *pain in abdomen* - **Abdominal pain** is a common symptom in both IBS and IBD. In IBS, it's often linked to altered bowel habits and is a key diagnostic criterion [1]. - In IBD, abdominal pain is typically due to inflammation, strictures, or abscesses, but its presence alone does not differentiate the conditions . *Diarrhoea* - **Diarrhea** is a prominent symptom in both IBS and IBD. In IBS, it can be a predominant feature (IBS-D), often associated with urgency [1]. - In IBD, diarrhea is usually due to inflammation disrupting normal absorption and secretion, and it may contain blood or mucus . *Mucus in stools* - The presence of **mucus in stools** can occur in both IBS and IBD. In IBS, it's often present without blood and is generally considered part of altered bowel function [1]. - In IBD, mucus in stools, particularly when accompanied by blood, strongly suggests active intestinal inflammation and mucosal damage .

Q: 35 yr old primigravida conceived after IVF cycle attends obstetrics clinic with 38 weeks gestation. Her obstetric details reveal DiCho-DiAmn twins with 1st twin as breech. Her BP was 140/90 mmHg on 2 occasions with proteinuria +1. How will you manage this case?

Plan a cesarean for termination. ***Plan a cesarean for termination*** - This patient presents with **preeclampsia** (BP 140/90 mmHg on two occasions with proteinuria +1) at **38 weeks gestation**, making delivery appropriate. - The presence of **DiCho-DiAmn twins** with the **first twin in breech presentation** is a strong indication for **cesarean section** to ensure safe delivery and reduce complications. *Induction of labour* - While induction might be considered for preeclampsia, the **breech presentation of the first twin** in a twin pregnancy significantly increases the risks associated with vaginal delivery, making it less safe than a cesarean. - Given the combined risk factors, **cesarean delivery** is the more appropriate choice for optimizing maternal and fetal outcomes. *Watch for BP and induce for normal delivery on Expected Date of delivery* - Preeclampsia necessitates **delivery when the mother reaches 37 weeks or beyond**, not necessarily waiting until the Expected Date of Delivery, especially with other complicating factors. - Furthermore, attempting a **normal vaginal delivery** with a **breech presenting twin 1** carries high risks for both twins and is generally contraindicated. *Watch for BP and terminate (vaginal/ Cesarean) only when BP is normal.* - Delaying termination until blood pressure normalizes is not appropriate management for **preeclampsia** at term; delivery is the definitive treatment. - A persistent **breech presentation of twin 1** also makes vaginal delivery problematic, regardless of blood pressure status.

Q: A 4-year-old male child presents with muscle weakness. His mother reports that her child has difficulty in climbing stairs and getting up from the floor. On muscle biopsy, small degenerated muscle fibers and absence of dystrophin were found. What is the diagnosis?

Duchenne muscular dystrophy. ***Duchenne muscular dystrophy*** - The classic presentation of a young boy with **progressive muscle weakness**, difficulty climbing stairs (**Gowers' sign**), and **absent dystrophin** on muscle biopsy is characteristic of Duchenne muscular dystrophy. - It is an **X-linked recessive disorder** that leads to severe muscle degeneration and weakness due to a complete lack of functional dystrophin protein. *Myotonic dystrophy* - This condition is characterized by **myotonia** (delayed relaxation of muscles after contraction) and typically affects adults, although congenital forms exist. - While it causes muscle weakness, the primary differentiating feature of **myotonia** and its later onset are not present in this case. *Becker's muscle dystrophy* - Becker's muscular dystrophy (BMD) is also an X-linked recessive disorder and a milder form of muscular dystrophy, caused by a **reduced but still functional dystrophin** protein. - Patients with BMD typically present later in childhood or adolescence with slower progression and **some dystrophin** presence, unlike the absent dystrophin and early onset here. *Limb-girdle muscular dystrophy* - This is a group of muscular dystrophies that primarily affect the **pelvic and shoulder girdle muscles**. - It can present with similar weakness, but the **complete absence of dystrophin** found on biopsy points specifically to Duchenne muscular dystrophy, not typical limb-girdle dystrophy, which involves other genetic defects.

Q: Which drug can be given as a nail lacquer treatment in onychomycosis?

Ciclopirox olamine (nail lacquer). ***Ciclopirox olamine (nail lacquer)*** - **Ciclopirox olamine** is an antifungal agent formulated as a nail lacquer, specifically designed for topical application in **onychomycosis**. - Its mechanism involves interfering with fungal cellular processes, transported directly to the nail bed where the fungal infection resides. *Terbinafine* - **Terbinafine** is primarily an **oral antifungal** medication or available as a topical cream, but not typically in a nail lacquer formulation for onychomycosis. - While highly effective against dermatophytes causing onychomycosis, its systemic absorption is key to its efficacy when administered orally. *Nystatin* - **Nystatin** is an antifungal agent primarily effective against **Candida** species and is not typically used for dermatophyte-induced onychomycosis, nor is it commonly formulated as a nail lacquer. - Its broad spectrum is limited in this context, as most onychomycosis cases are caused by dermatophytes, which are less susceptible to nystatin. *Itraconazole* - **Itraconazole** is a **systemic antifungal** medication, effective in treating onychomycosis, but it is not available as a nail lacquer. - It works by inhibiting fungal cytochrome P450 enzymes, which are critical for ergosterol synthesis, a component of the fungal cell membrane.

Q: Drug of choice for post menopausal osteoporosis is

Bisphosphonates. ***Bisphosphonates*** - **Bisphosphonates** are considered the **first-line therapy** for established postmenopausal osteoporosis due to their proven efficacy in reducing the risk of vertebral and non-vertebral fractures. - They work by **inhibiting osteoclast activity**, thereby decreasing bone resorption and increasing bone mineral density. *Estrogen* - While **estrogen therapy** can prevent osteoporosis, it is generally not the first-line treatment due to potential risks like increased risk of **breast cancer**, **stroke**, and **venous thromboembolism**. - It is typically reserved for women with severe menopausal symptoms who also require osteoporosis prevention, and often used at the **lowest effective dose for the shortest duration**. *Thyroxine* - **Thyroxine** is a hormone used primarily to treat **hypothyroidism**, a condition where the thyroid gland doesn't produce enough thyroid hormone. - It is **not indicated for the treatment of osteoporosis** and can even worsen bone loss if given in excessive doses, leading to iatrogenic hyperthyroidism. *Teriparatide* - **Teriparatide** is an **anabolic agent** that stimulates new bone formation, making it a powerful option for severe osteoporosis or those who have failed other therapies. - However, it is an injectable medication with a **limited treatment duration** (typically 2 years) and is generally reserved for patients with a **high fracture risk** rather than being the initial drug of choice for all postmenopausal osteoporosis.

Q: A patient complains of sadness of mood, increased lethargy, early morning awakening, loss of interest and reports no will to live and hears voices asking her to kill self. What is the diagnosis?

Major depressive disorder plus psychosis. ***Major depressive disorder plus psychosis*** - The patient presents with classic symptoms of **major depressive disorder**, including persistent sadness, **anhedonia (loss of interest)**, **lethargy**, and **early morning awakening**. - The presence of **auditory hallucinations** (hearing voices asking her to kill herself) indicates **psychotic features** accompanying the severe depression, leading to the diagnosis of major depressive disorder with psychotic features. *Schizophrenia* - While schizophrenia involves psychosis, the primary presentation here is a prominent **depressive syndrome** rather than the typical **positive symptoms (delusions, hallucinations)**, **negative symptoms (alogia, avolition)**, and **disorganized thought** processes characteristic of schizophrenia. - The depressive symptoms are too pervasive and central to the clinical picture to be solely schizophrenia. *Schizoaffective disorder* - This disorder requires a period of **at least two weeks of psychotic symptoms** (hallucinations or delusions) **without prominent mood symptoms**, which is not described. - In this case, the **psychotic symptoms are congruent with the depressed mood** (e.g., voices urging self-harm, reflecting hopelessness), rather than independent. *Schizotypal personality disorder* - This is a pervasive pattern of **social and interpersonal deficits** marked by acute discomfort with, and reduced capacity for, close relationships, as well as by **cognitive or perceptual distortions** and eccentricities of behavior. - It does not involve persistent, severe depressive episodes with overt psychotic symptoms as described, nor significant functional impairment to the extent seen here.

Q: A 1st year medical student presents with recurrent episodes of choking sensation, breathlessness, intense sweating along with feeling of impending doom. Usually the episodes occur prior to exams. What is the most likely diagnosis?

Panic attack. ***Panic attack (Panic Disorder)*** - The sudden onset of intense fear or discomfort, along with symptoms like **choking sensation**, **breathlessness**, **sweating**, and **feeling of impending doom**, are characteristic of a **panic attack**. - The **recurrent episodes** occurring prior to exams indicate **Panic Disorder**, which is defined by recurrent unexpected panic attacks followed by persistent concern about future attacks. - The situational trigger (exams) suggests a pattern consistent with panic disorder, where attacks may be situationally predisposed. *Acute stress disorder* - This condition occurs within **one month of exposure to a traumatic event** and involves dissociative symptoms, intrusions, avoidance, and arousal symptoms. - The patient describes recurrent episodes tied to exams, not a single acute traumatic event with subsequent stress response. *Generalised anxiety disorder* - Characterized by excessive and **uncontrollable worry** about various events or activities for **at least six months**. - While anxiety is present, the sudden, intense, **episodic nature** of symptoms with a distinct "feeling of impending doom" points away from the chronic, pervasive worry of GAD. - GAD presents with chronic anxiety rather than discrete panic episodes. *Phobia* - A phobia is an **irrational and intense fear** of a specific object or situation (e.g., specific phobia) or social situations (social anxiety disorder). - While exam-related anxiety can be severe, the description points to a **full-blown panic response** with multiple autonomic symptoms (choking, breathlessness, sweating) and psychological distress (impending doom). - Unlike a phobia where avoidance is the primary feature, this patient experiences discrete panic episodes with characteristic somatic symptoms.

Question 1

Type of joint at site marked by the arrow?

Accepted Answer

Synovial Joint

Answer

Syndesmosis

Answer

Symphysis

Answer

Synarthrosis

Question 2

Which of the following is the rich source of Vitamin B12?

Accepted Answer

Meat

Answer

Mango

Answer

Carrot

Answer

Spinach

Question 3

A patient presented with clinical features of ataxia and incoordination. It is most likely due to involvement of which artery among the following.

Accepted Answer

Superior cerebellar

Answer

Middle cerebral

Answer

Posterior cerebral

Answer

Anterior cerebral

Question 4

What is the differentiating feature between irritable bowel syndrome and inflammatory bowel disease?

Accepted Answer

Stool calprotectin

Answer

pain in abdomen

Answer

Diarrhoea

Answer

Mucus in stools

Question 5

35 yr old primigravida conceived after IVF cycle attends obstetrics clinic with 38 weeks gestation. Her obstetric details reveal DiCho-DiAmn twins with 1st twin as breech. Her BP was 140/90 mmHg on 2 occasions with proteinuria +1. How will you manage this case?

Accepted Answer

Plan a cesarean for termination

Answer

Induction of labour

Answer

Watch for BP and induce for normal delivery on Expected Date of delivery

Answer

Watch for BP and terminate (vaginal/ Cesarean) only when BP is normal.

Question 6

A 4-year-old male child presents with muscle weakness. His mother reports that her child has difficulty in climbing stairs and getting up from the floor. On muscle biopsy, small degenerated muscle fibers and absence of dystrophin were found. What is the diagnosis?

Accepted Answer

Duchenne muscular dystrophy

Answer

Myotonic dystrophy

Answer

Becker's muscle dystrophy

Answer

Limb-girdle muscular dystrophy

Question 7

Which drug can be given as a nail lacquer treatment in onychomycosis?

Accepted Answer

Ciclopirox olamine (nail lacquer)

Answer

Terbinafine

Answer

Nystatin

Answer

Itraconazole

Question 8

Drug of choice for post menopausal osteoporosis is

Accepted Answer

Bisphosphonates

Answer

Estrogen

Answer

Thyroxine

Answer

Teriparatide

Question 9

A patient complains of sadness of mood, increased lethargy, early morning awakening, loss of interest and reports no will to live and hears voices asking her to kill self. What is the diagnosis?

Accepted Answer

Major depressive disorder plus psychosis

Answer

Schizophrenia

Answer

Schizoaffective disorder

Answer

Schizotypal personality disorder

Question 10

A 1st year medical student presents with recurrent episodes of choking sensation, breathlessness, intense sweating along with feeling of impending doom. Usually the episodes occur prior to exams. What is the most likely diagnosis?

Accepted Answer

Panic attack

Answer

Acute stress disorder

Answer

Generalised anxiety disorder

Answer

Phobia

NEET-PG 2020

Anatomy

Biochemistry

Internal Medicine

Obstetrics and Gynecology

Pediatrics

Pharmacology

Psychiatry