NEET-PG 2012 Practice Questions

Q: Which of the following is a tributary of the coronary sinus?

Great cardiac vein. ***Great cardiac vein*** - The **great cardiac vein** is a major tributary that drains into the **coronary sinus**, carrying deoxygenated blood from the anterior and left ventricular walls [1]. - It travels alongside the **anterior interventricular artery** (LAD) and then wraps around the left side of the heart to join the coronary sinus [1]. *Anterior cardiac vein* - The **anterior cardiac veins** typically collect blood directly into the **right atrium**, bypassing the coronary sinus [1]. - They primarily drain the anterior wall of the right ventricle. *Thebesian vein* - **Thebesian veins** (or venae cordis minimae) are small veins that drain blood from the **myocardium directly into the heart chambers**, predominantly the atria [1]. - They represent a direct communication between the myocardial capillaries and the heart chambers, not tributaries of the coronary sinus. *Smallest cardiac vein* - The term "smallest cardiac vein" is often used synonymously with **Thebesian veins** [1]. - These veins empty directly into the **heart chambers**, serving as an ancillary drainage system, rather than converging into the coronary sinus.

Q: Which is the primary segment of the liver drained by the right hepatic vein?

VII. ***VII*** - The **right hepatic vein** drains the **posterior segment** of the right lobe, which includes segments **VI and VII**. Segment VII is particularly well-drained by this vein. [3] - Understanding hepatic venous drainage is crucial for **surgical planning** and interpreting imaging studies of the liver. [4] *I* - Segment I, the **caudate lobe**, is unique in its venous drainage, often by small veins directly into the **inferior vena cava (IVC)** or occasionally into the left and middle hepatic veins. [1] - It has a separate blood supply and drainage which differentiates it from other segments. [4] *II* - Segment II is part of the **left lateral segment** and is primarily drained by the **left hepatic vein**. - The left hepatic vein typically drains segments II and III. [2] *IV* - Segment IV, or the **quadrate lobe**, is primarily drained by the **middle hepatic vein**. - The middle hepatic vein also drains segment VIII and the anterior aspect of segment V.

Q: Which of the following is not a boundary of Koch's triangle?

Limbus fossa ovalis. ***Limbus fossa ovalis*** - The **limbus fossa ovalis** is a prominent oval ridge on the **interatrial septum** that surrounds the fossa ovalis. - It is **not involved** in forming the boundaries of Koch's triangle, which is located in the **right atrium** near the AV node [1]. *Tricuspid valve ring* - The **tricuspid valve ring** (or annulus) forms one of the key anatomical boundaries of **Koch's triangle**, specifically its base [1]. - This **fibrous ring** anchors the tricuspid valve leaflets and marks the inferior aspect of the triangle [1]. *Coronary sinus* - The **coronary sinus ostium** (opening) forms another crucial boundary of **Koch's triangle** [1]. - It is located at the **inferior-posterior aspect** of the interatrial septum, opening into the right atrium [1]. *Tendon of todaro* - The **Tendon of Todaro** is a fibrous structure that forms the superior boundary of **Koch's triangle** [1]. - It extends from the **Eustachian valve** (of the inferior vena cava) towards the central fibrous body, playing a role in **AV nodal localization** [1].

Q: The thyrocervical trunk is a branch of which part of subclavian artery?

1st part. ***1st part*** - The **thyrocervical trunk** is one of the three primary branches arising from the **first part** of the subclavian artery. - The first part lies medial to the **anterior scalene muscle**. *2nd part* - The **second part** of the subclavian artery gives rise to the **costocervical trunk**. - This part lies posterior to the **anterior scalene muscle**. *3rd part* - The **third part** of the subclavian artery typically has no branches or may give off the **dorsal scapular artery**. - This part lies lateral to the **anterior scalene muscle**. *4th part* - This option is incorrect as the **subclavian artery has only three parts**, divided by their relationship to the anterior scalene muscle. - There is no anatomical fourth part of the subclavian artery.

Q: Maxillary bone does not articulate with:

Ethmoid. ***Ethmoid (Marked Correct - PYQ 2012)*** - This question reflects traditional teaching where the **maxilla-ethmoid articulation** was considered minimal or indirect. - In modern anatomy, the **maxilla DOES articulate with the ethmoid bone** via the uncinate process of the ethmoid and the medial wall of the maxillary sinus. - However, per the **NEET-PG 2012 answer key**, ethmoid was accepted as the correct answer, likely because this articulation is small and often not emphasized in basic anatomy teaching. - The maxilla has major articulations with: frontal, zygomatic, nasal, lacrimal, palatine, inferior nasal concha, vomer, and contralateral maxilla. *Sphenoid* - The **maxilla clearly articulates** with the **greater wing of the sphenoid bone** at the inferior orbital fissure. - This articulation is substantial and forms the posterolateral floor of the orbit. - The sphenoid-maxillary articulation contributes to the boundaries of the **pterygopalatine fossa**. *Frontal* - The **maxilla articulates extensively** with the **frontal bone** at the frontomaxillary suture. - This articulation forms the medial orbital rim and part of the anterior cranial floor interface. - This is one of the most prominent maxillary articulations. *Lacrimal* - The **maxilla articulates directly** with the **lacrimal bone**, forming the anterior part of the medial orbital wall. - Together they form the **lacrimal groove** which houses the lacrimal sac. - This articulation is essential for the nasolacrimal drainage pathway.

Q: What is the lower limit of the retropharyngeal space?

Bifurcation of trachea. Bifurcation of trachea - The retropharyngeal space extends inferiorly to approximately the level of T4-T5 vertebrae, corresponding to the bifurcation of the trachea and the superior mediastinum. - This space lies between the buccopharyngeal fascia (posterior to pharynx) and the alar layer of prevertebral fascia. - Clinically, infections or abscesses in this space can descend into the posterior mediastinum, making knowledge of this inferior extent crucial for surgical management. - Note: Some anatomical texts describe the space ending at T1-T2, but for clinical and surgical purposes, the functional inferior limit extends to the bifurcation of the trachea. C7 - While some texts describe the retropharyngeal space as terminating around C7 (level of the lower border of cricoid cartilage), this represents the narrower definition. - The clinical and surgical definition extends the space further inferiorly to allow for tracking of infections into the chest. - C7 alone does not represent the accepted lower limit for examination purposes. 4th esophageal constriction - The fourth esophageal constriction is not a standard anatomical landmark (esophagus has 3-4 constrictions depending on classification). - Esophageal constrictions are luminal narrowings within the esophagus itself and do not define the boundaries of the retropharyngeal space, which is a fascial space posterior to both pharynx and esophagus. None of the options - This is incorrect because bifurcation of the trachea is the recognized lower limit of the retropharyngeal space for clinical and examination purposes. - Understanding this anatomical boundary is essential for predicting the spread of deep neck space infections.

Q: Glycogen synthase is activated by?

Insulin. **Insulin** - Insulin activates **glycogen synthase** through a signaling cascade that dephosphorylates the enzyme, shifting it to its active form (glycogen synthase a). - This activation promotes **glycogen synthesis** in the liver and muscles, lowering blood glucose levels. *Glucagon* - **Glucagon** primarily acts to increase blood glucose levels by activating **glycogen phosphorylase** and inhibiting glycogen synthase. - It promotes the breakdown of glycogen (glycogenolysis) rather than its synthesis. *Epinephrine* - **Epinephrine** (adrenaline) also promotes **glycogenolysis** (glycogen breakdown) by activating glycogen phosphorylase. - Its main role is to provide rapid energy during stress, not to store glucose as glycogen. *AMP* - **AMP** (adenosine monophosphate) is a key allosteric activator of **AMP-activated protein kinase (AMPK)**, which phosphorylates and inactivates glycogen synthase. - High AMP levels signal a low energy state, prompting ATP-generating pathways like glycogenolysis, not glycogen synthesis.

Q: What coenzyme is required by gulonate dehydrogenase for its activity?

NAD. ***NAD*** - **Gulonate dehydrogenase** is an enzyme involved in the **uronic acid pathway**, specifically in the conversion of **L-gulonate to D-xylulose**. - This reaction is an **NAD-dependent oxidation**, meaning **NAD** acts as the electron acceptor, being reduced to **NADH**. *NADP* - **NADP** (nicotinamide adenine dinucleotide phosphate) is primarily involved in **anabolic pathways** like **fatty acid synthesis** and the **pentose phosphate pathway**, often in reduction reactions where it is converted to **NADPH**. - While structurally similar to NAD, it is generally not the direct coenzyme for gulonate dehydrogenase. *FAD* - **FAD** (flavin adenine dinucleotide) is a coenzyme derived from **riboflavin** (vitamin B2) and is typically involved in **redox reactions** where it repeatedly accepts and donates electrons, often in dehydrogenase reactions involving **carbon-carbon double bonds**. - Enzymes like **succinate dehydrogenase** (in the citric acid cycle) or acyl-CoA dehydrogenase (in fatty acid oxidation) utilize FAD, but not gulonate dehydrogenase. *FMN* - **FMN** (flavin mononucleotide) is another coenzyme derived from **riboflavin** and serves as a prosthetic group in various **flavoproteins**, often facilitating **single-electron transfers**. - It is frequently found in complexes like **NADH dehydrogenase** (Complex I of the electron transport chain) but is not the required coenzyme for gulonate dehydrogenase activity.

Q: Which of the following is the most characteristic symptom of obstruction of the inferior vena cava?

Paraumblical dilatation. ***Paraumbilical dilatation*** - Obstruction of the **inferior vena cava (IVC)** leads to collateral circulation through superficial veins, especially around the umbilicus, causing **paraumbilical dilatation** (caput medusae). - This collateral flow bypasses the obstructed IVC to return blood to the superior vena cava system. *Thoraco-epigastric dilatation* - This pattern of collateral circulation is more characteristic of **superior vena cava (SVC) obstruction**, where blood from the upper body needs to bypass the SVC. - The dilated veins would typically be seen on the chest and upper abdomen, draining towards the femoral veins. *Oesophageal varices* - **Oesophageal varices** are typically caused by **portal hypertension** [1], often secondary to liver cirrhosis, not directly by IVC obstruction. - They represent portosystemic collateral veins, diverging from the portal system to the systemic circulation [1]. *Haemorrhoids* - **Haemorrhoids** are dilated veins in the anal canal, most commonly caused by **straining** during defecation or conditions that increase intra-abdominal pressure [2]. - While they can be a sign of portal hypertension [1], **IVC obstruction** is not their primary or most characteristic cause.

Q: ANP acts at which site?

Collecting duct. ***Collecting duct*** - Atrial Natriuretic Peptide (**ANP**) exerts its primary effect on the **collecting duct** by inhibiting sodium reabsorption, leading to increased sodium and water excretion (natriuresis and diuresis). - This action helps to reduce blood volume and blood pressure in conditions like **hypervolemia**. *Glomerulus* - While ANP does cause **afferent arteriolar dilation** and **efferent arteriolar constriction**, increasing **glomerular filtration rate** (GFR), its direct tubular action is most prominent in the collecting duct. - The primary function of the glomerulus is **filtration**, influenced by many factors including pressure, but it is not the main site of ANP's direct tubular reabsorptive effects. *Loop of Henle* - The loop of Henle is responsible for establishing the **medullary osmotic gradient** and reabsorbing a significant amount of sodium and water. - ANP has minor effects on the loop of Henle, but its most impactful reabsorptive modulation occurs downstream in the collecting duct. *PCT* - The **proximal convoluted tubule (PCT)** is where the bulk of reabsorption of filtered substances (e.g., glucose, amino acids, most sodium and water) occurs. - ANP has very little direct influence on the reabsorptive processes of the PCT.

Question 1

Which of the following is a tributary of the coronary sinus?

Accepted Answer

Great cardiac vein

Answer

Anterior cardiac vein

Answer

Smallest cardiac vein

Answer

Thebesian vein

Question 2

Which is the primary segment of the liver drained by the right hepatic vein?

Accepted Answer

VII

Answer

I

Answer

II

Answer

IV

Question 3

Which of the following is not a boundary of Koch's triangle?

Accepted Answer

Limbus fossa ovalis

Answer

Tricuspid valve ring

Answer

Coronary sinus

Answer

Tendon of Todaro

Question 4

The thyrocervical trunk is a branch of which part of subclavian artery?

Accepted Answer

1st part

Answer

2nd part

Answer

3rd part

Answer

4th part

Question 5

Maxillary bone does not articulate with:

Accepted Answer

Ethmoid

Answer

Frontal

Answer

Lacrimal

Answer

Sphenoid

Question 6

What is the lower limit of the retropharyngeal space?

Accepted Answer

Bifurcation of trachea

Answer

4th esophageal constriction

Answer

C7

Answer

None of the options

Question 7

Glycogen synthase is activated by?

Accepted Answer

Insulin

Answer

Glucagon

Answer

AMP

Answer

Epinephrine

Question 8

What coenzyme is required by gulonate dehydrogenase for its activity?

Accepted Answer

NAD

Answer

FAD

Answer

FMN

Answer

NADP

Question 9

Which of the following is the most characteristic symptom of obstruction of the inferior vena cava?

Accepted Answer

Paraumblical dilatation

Answer

Thoraco-epigastric dilatation

Answer

Haemorrhoides

Answer

Oesophageal varices

Question 10

ANP acts at which site?

Accepted Answer

Collecting duct

Answer

Glomerulus

Answer

Loop of Henle

Answer

PCT

NEET-PG 2012

Anatomy

Biochemistry

Internal Medicine

Physiology