Community Medicine
1 questionsAll following are at-risk group adults meriting Hepatitis B vaccination in low endemic areas except for which of the following?
NEET-PG 2012 - Community Medicine NEET-PG Practice Questions and MCQs
Question 841: All following are at-risk group adults meriting Hepatitis B vaccination in low endemic areas except for which of the following?
- A. Medical/nursing personnel
- B. Patients with chronic liver disease
- C. Diabetics on insulin (Correct Answer)
- D. Patients on chronic hemodialysis
Explanation: ***Diabetics on insulin*** - This is the correct answer as the exception based on **guidelines at the time of this exam (2012)**. - At that time, diabetics were **not routinely listed** as a standard at-risk group for hepatitis B vaccination in low endemic areas, though the ACIP was beginning to recognize increased risk in this population. - **Current Update (Post-2012):** The **CDC/ACIP now recommends** hepatitis B vaccination for all previously unvaccinated adults with diabetes aged 19-59 years, due to documented increased risk of HBV infection associated with: - Shared blood glucose monitoring devices - Assisted blood glucose monitoring in healthcare settings - Outbreak investigations showing higher transmission rates - For the purpose of this historical exam question, diabetics were the exception among the listed groups. *Medical/nursing personnel* - Healthcare workers are at **high occupational risk** due to frequent exposure to blood and body fluids. - This has been a **standard, long-standing recommendation** for HBV vaccination regardless of endemic status. - The risk remains present even in low endemic areas due to potential exposure to infected patients. *Patients with chronic liver disease* - Individuals with pre-existing chronic liver disease are at risk of **severe outcomes** if they acquire hepatitis B infection. - Superimposed acute HBV infection can lead to: - Rapid progression to cirrhosis - Acute-on-chronic liver failure - Hepatocellular carcinoma - Vaccination is **crucial for prevention** and has been a standard recommendation. *Patients on chronic hemodialysis* - Hemodialysis patients face **elevated risk** of HBV acquisition due to: - Frequent vascular access procedures - Prolonged time in healthcare settings - Potential for nosocomial transmission in dialysis units - Their **immunocompromised state** increases risk of chronic infection and complications. - Vaccination is a **standard preventive measure** in this population.
Internal Medicine
4 questionsIn which condition is paradoxical splitting of the second heart sound observed?
Which of the following electrolyte imbalances is least likely to be observed in Chronic Renal Failure (CRF)?
What is the best treatment for anemia in patients with Chronic Renal Failure (CRF)?
An adult hypertensive male presented with sudden onset severe headache and vomiting. On examination, there is marked neck rigidity and no focal neurological deficit was found. The symptoms are most likely due to:
NEET-PG 2012 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 841: In which condition is paradoxical splitting of the second heart sound observed?
- A. Right Bundle Branch Block (RBBB)
- B. Left Bundle Branch Block (LBBB) (Correct Answer)
- C. Ventricular Septal Defect (VSD)
- D. Atrial Septal Defect (ASD)
Explanation: ***Left Bundle Branch Block (LBBB)*** - In LBBB, the **left ventricle** depolarizes and contracts *after* the right ventricle, causing the **aortic valve (A2)** to close *after* the **pulmonic valve (P2)** [1]. - During inspiration, right ventricular ejection time is prolonged, which further delays P2. However, in LBBB, A2 is already delayed, and the inspiratory delay of P2 can bring P2 closer to A2, or even cause them to merge, making the splitting *less wide* or *disappear* on inspiration, which is paradoxical. *Right Bundle Branch Block (RBBB)* - RBBB causes a **delay in right ventricular depolarization**, leading to a **delayed P2** (pulmonic valve closure). - This typically results in **wide and fixed splitting of S2**, where the splitting persists during expiration and widens further with inspiration, which is not paradoxical. *Ventricular Septal Defect (VSD)* - A VSD can cause a **loud holosystolic murmur** and may lead to increased pulmonary blood flow. - While it can affect the timing of heart sounds, it does not typically cause paradoxical splitting of S2. *Atrial Septal Defect (ASD)* - An ASD causes a **left-to-right shunt**, leading to chronic volume overload of the right ventricle and increased pulmonary blood flow. - This often results in a **widely fixed splitting of S2**, where the split between A2 and P2 is constant regardless of respiration, which is different from paradoxical splitting.
Question 842: Which of the following electrolyte imbalances is least likely to be observed in Chronic Renal Failure (CRF)?
- A. Hyperkalemia
- B. Hyperphosphatemia
- C. Hypercalcemia (Correct Answer)
- D. Hypocalcemia
Explanation: ***Hypercalcemia*** - In **chronic renal failure (CRF)**, the kidneys' inability to activate vitamin D leads to impaired calcium absorption and **hypocalcemia** [1], [2]. - Additionally, the kidneys fail to excrete phosphate, leading to **hyperphosphatemia**, which further exacerbates hypocalcemia by forming calcium-phosphate precipitates [1]. *Hyperkalemia* - **Hyperkalemia** is a common and serious complication of CRF due to the kidneys' impaired ability to excrete **potassium**. - This is exacerbated by conditions like **metabolic acidosis** and certain medications. *Hyperphosphatemia* - In CRF, the kidneys are unable to adequately excrete **phosphate**, leading to an accumulation of **phosphate** in the blood [1]. - This condition directly contributes to **secondary hyperparathyroidism** and bone disease [1], [2]. *Hypocalcemia* - **Hypocalcemia** is very common in CRF, primarily due to decreased production of **calcitriol (active vitamin D)** by the failing kidneys [2]. - Reduced calcitriol leads to lower intestinal **calcium absorption** and impaired bone mineralization [1].
Question 843: What is the best treatment for anemia in patients with Chronic Renal Failure (CRF)?
- A. Oral Iron Therapy
- B. Erythropoietin Stimulating Agents (Correct Answer)
- C. Blood transfusion
- D. Androgenic Steroids
Explanation: ***Erythropoietin Stimulating Agents*** - **Erythropoietin Stimulating Agents (ESAs)** are the cornerstone of anemia treatment in CRF because the primary cause of anemia in these patients is inadequate production of **endogenous erythropoietin** by the damaged kidneys [1]. - ESAs stimulate the bone marrow to produce red blood cells, effectively reversing the anemia and improving symptoms like fatigue and exercise intolerance [1]. *Oral Iron Therapy* - While **iron deficiency** often coexists with **anemia of chronic disease** in CRF patients, oral iron alone is usually insufficient to correct the anemia; it only addresses the iron component. - Many CRF patients have **functional iron deficiency** due to chronic inflammation, which impairs iron utilization, making oral iron less effective even with adequate stores. *Blood transfusion* - **Blood transfusions** provide a rapid increase in hemoglobin but are not the preferred long-term treatment for anemia in CRF due to risks of **iron overload**, **alloreactions**, and potential sensitization, which can complicate future transplantation. - Transfusions are typically reserved for acute, severe anemia or specific circumstances where ESAs are ineffective or contraindicated. *Androgenic Steroids* - **Androgenic steroids** can stimulate erythropoiesis, but their use is limited due to significant side effects such as **hepatotoxicity**, **virilization**, and **cardiac complications**, making them a less favorable option compared to ESAs. - They are considered a secondary or tertiary option, often in patients unresponsive to primary treatments or when other options are exhausted.
Question 844: An adult hypertensive male presented with sudden onset severe headache and vomiting. On examination, there is marked neck rigidity and no focal neurological deficit was found. The symptoms are most likely due to:
- A. Subarachnoid hemorrhage (Correct Answer)
- B. Intracerebral hemorrhage
- C. Cerebral ischemia
- D. Bacterial meningitis
Explanation: ***Subarachnoid hemorrhage*** - The sudden onset of a **"thunderclap" headache**, vomiting, and **neck rigidity** in a hypertensive patient are classic signs of subarachnoid hemorrhage [1]. - The absence of focal neurological deficits is common, as the bleeding is often in the subarachnoid space rather than directly in brain tissue. *Intracerebral hemorrhage* - While it can cause sudden headache and vomiting, an **intracerebral hemorrhage** would typically present with **focal neurological deficits** corresponding to the affected brain region. - Neck rigidity is less common unless there's significant mass effect or ventricular involvement. *Cerebral ischemia* - **Cerebral ischemia** (e.g., ischemic stroke) usually manifests with **focal neurological deficits** (e.g., weakness, aphasia), often without a severe headache or neck rigidity [2]. - Headache, if present, is usually less severe and not described as "thunderclap." *Bacterial meningitis* - **Bacterial meningitis** presents with headache, fever, and neck rigidity [1], but the onset is typically **gradual** over hours to days, not sudden. - While vomiting can occur, the acute, thunderclap nature linked to hypertension points away from infection as the primary cause.
Ophthalmology
1 questionsCorneal tattooing is done by ?
NEET-PG 2012 - Ophthalmology NEET-PG Practice Questions and MCQs
Question 841: Corneal tattooing is done by ?
- A. Titanium chloride
- B. Aluminium chloride
- C. India ink (Correct Answer)
- D. Gold chloride
Explanation: ***India ink*** - **India ink (carbon black)** is the traditional and most commonly used pigment for corneal tattooing due to its stable black color and inert properties. - It is applied to the **corneal stroma** to mask corneal opacities or for cosmetic purposes in cases of unsightly leucomatous corneal scars. - India ink has been the **gold standard** for corneal tattooing since the 19th century. *Gold chloride* - While **gold preparations** (including platinum-gold) have been used historically for corneal tattooing, they are much less common than India ink. - Gold chloride specifically is not the standard or preferred agent for this procedure. - India ink remains the pigment of choice due to better cosmetic results and established safety profile. *Titanium chloride* - **Titanium chloride** is a corrosive chemical and is not used in corneal tattooing; its application would cause severe damage to the delicate corneal tissue. - It is primarily used in industrial applications and chemical synthesis, not in ophthalmic procedures. *Aluminium chloride* - **Aluminium chloride** is an astringent and antiseptic, often used in dermatological products, but it is not a tattooing pigment for the cornea. - Its chemical properties would be highly irritating to the eye and potentially damaging to corneal cells.
Pediatrics
1 questionsRubella is known to cause all of the following conditions except:
NEET-PG 2012 - Pediatrics NEET-PG Practice Questions and MCQs
Question 841: Rubella is known to cause all of the following conditions except:
- A. Conduction defects
- B. VSD
- C. Microcephaly
- D. Glaucoma (Correct Answer)
Explanation: ***Glaucoma*** - While rubella can cause **ocular defects** such as **cataracts** and **pigmentary retinopathy**, glaucoma is not a typical congenital manifestation of rubella syndrome. - **Congenital glaucoma** is more commonly associated with other genetic syndromes or developmental anomalies. *Microcephaly* - **Microcephaly** is a recognized neurological complication of congenital rubella syndrome, resulting from impaired brain development due to viral infection. - The rubella virus can interfere with the **proliferation and migration** of neuronal cells during fetal development. *VSD* - **Ventricular septal defect (VSD)** is a common congenital heart defect associated with congenital rubella syndrome. - Other cardiac anomalies seen include **patent ductus arteriosus (PDA)** and **pulmonary artery stenosis**. *Conduction defects* - **Conduction defects** and other **cardiac arrhythmias** can occur in congenital rubella syndrome due to direct viral damage to the developing cardiac conduction system. - This can manifest as **bradyarrhythmias** or various degrees of **heart block**.
Pharmacology
1 questionsWhich of the following substances is known to cause predominantly sensory neuropathy?
NEET-PG 2012 - Pharmacology NEET-PG Practice Questions and MCQs
Question 841: Which of the following substances is known to cause predominantly sensory neuropathy?
- A. Pyridoxine excess
- B. Suramin
- C. Cisplatin (Correct Answer)
- D. Vincristine
Explanation: ***Cisplatin*** - **Cisplatin** is a platinum-based chemotherapy drug well-known for causing **dose-dependent peripheral neuropathy**, primarily affecting sensory neurons. - Patients often present with **numbness**, **tingling**, and **loss of proprioception** in a glove-and-stocking distribution. - This is the **most characteristic** drug for **predominantly sensory neuropathy** among chemotherapeutic agents. *Pyridoxine excess* - While **pyridoxine (vitamin B6) excess** can cause sensory neuropathy, it is less commonly observed as a primary cause compared to cisplatin in the context of drug-induced neuropathies. - High doses of pyridoxine can lead to **dorsal root ganglionopathy**, affecting sensory nerve fibers. *Suramin* - **Suramin** is an anthelmintic agent primarily used for treating sleeping sickness, and it is known to cause a variety of side effects, including **renal toxicity** and **neurological symptoms**. - While neurological side effects can occur, they are not typically characterized as a **predominantly sensory neuropathy** in the same way as cisplatin. *Vincristine* - **Vincristine** is a vinca alkaloid chemotherapy agent that causes peripheral neuropathy. - However, vincristine typically causes **mixed motor and sensory neuropathy** with prominent motor involvement (foot drop, wrist drop). - This differs from cisplatin's **predominantly sensory** presentation.
Psychiatry
1 questionsWhich of the following is NOT a characteristic of LEOPARD syndrome?
NEET-PG 2012 - Psychiatry NEET-PG Practice Questions and MCQs
Question 841: Which of the following is NOT a characteristic of LEOPARD syndrome?
- A. Growth retardation
- B. ECG changes
- C. Hypertelorism
- D. Hypergonadism (Correct Answer)
- E. Lentigines
Explanation: ***Hypergonadism*** - **LEOPARD syndrome** is characterized by **hypogonadism** (underdevelopment or dysfunction of the gonads) and delayed puberty, not hypergonadism. - The acronym LEOPARD stands for multiple clinical features which include **L**entigines, **E**CG conduction abnormalities, **O**cular hypertelorism, **P**ulmonary stenosis, **A**bnormal genitalia, **R**etardation of growth, and **D**eafness. *Growth retardation* - **Retardation of growth** is a defining characteristic of LEOPARD syndrome, often manifesting as short stature. - This is part of the "R" in the LEOPARD acronym, indicating a failure to achieve normal growth milestones. *ECG changes* - **ECG conduction abnormalities** (such as prolonged PR interval, bundle branch block, or Wolff-Parkinson-White syndrome) are primary diagnostic features. - These cardiac issues can be significant and contribute to the morbidity associated with the syndrome. *Hypertelorism* - **Ocular hypertelorism**, meaning widely spaced eyes, is a common facial dysmorphism found in individuals with LEOPARD syndrome. - This feature is represented by the "O" in the LEOPARD acronym, along with other craniofacial anomalies. *Lentigines* - **Lentigines** are multiple pigmented macules (small, flat, darkened spots) that are the hallmark dermatologic feature of LEOPARD syndrome. - These represent the "L" in the LEOPARD acronym and are typically present from early childhood, increasing in number with age.
Surgery
1 questionsWhat is the standard intercostal space used for hepatic biopsy?
NEET-PG 2012 - Surgery NEET-PG Practice Questions and MCQs
Question 841: What is the standard intercostal space used for hepatic biopsy?
- A. 5th
- B. 9th (Correct Answer)
- C. 7th
- D. 11th
Explanation: ***Correct Option: 9th*** - The **9th intercostal space** in the mid-axillary line is the standard and most commonly used entry point for percutaneous liver biopsy. - This location provides safe access to the **right lobe of the liver** while avoiding injury to the **pleura** and **lungs** superiorly and minimizing risk to the **kidney** and other abdominal organs inferiorly. - At this level, the liver is sufficiently large and the approach avoids the pleural reflection, which typically descends to the 8th-9th intercostal space. - Standard surgical textbooks (Sabiston, Schwartz) recommend the **8th-10th intercostal space**, with the 9th being most frequently used. *Incorrect Option: 5th* - The **5th intercostal space** is far too high for liver biopsy and would result in puncturing the **lung** or **pleura**, causing **pneumothorax** or hemothorax. - This space is well above the liver margin and is not suitable for hepatic access. *Incorrect Option: 7th* - While the **7th intercostal space** may occasionally be mentioned, it is generally considered **too high** for routine percutaneous liver biopsy. - This level carries increased risk of **pleural injury** as the pleural reflection may extend to this level, especially during deep inspiration. - It is not the standard or preferred approach in current surgical practice. *Incorrect Option: 11th* - The **11th intercostal space** is too low and significantly increases the risk of injuring the **right kidney** or entering the peritoneal cavity with potential injury to bowel or other abdominal structures. - This space is below the optimal liver access zone and is not recommended for routine liver biopsy.