NEET-PG 2012 Practice Questions

Q: Which of the following is used for the diagnosis of asthma?

FEV1. ***FEV1*** - **Forced expiratory volume in 1 second (FEV1)** is the gold standard spirometric parameter for asthma diagnosis - Key diagnostic criteria include: - Reduced **FEV1/FVC ratio** (<0.70 or <0.75-0.80 in adults) - **Bronchodilator reversibility**: ≥12% and ≥200 mL increase in FEV1 after inhaled short-acting β2-agonist - This reversibility distinguishes asthma from fixed obstructive diseases like COPD - Serial **peak expiratory flow (PEF)** monitoring can also demonstrate variability characteristic of asthma *Measurement of tidal volume* - **Tidal volume** measures the amount of air inhaled or exhaled during normal breathing (typically ~500 mL at rest) - Not a diagnostic parameter for asthma as it doesn't assess **airway obstruction** or **hyperresponsiveness** - May be reduced during acute exacerbations but lacks specificity for asthma diagnosis *End expiratory flow rate* - Not a standard diagnostic parameter for asthma - While **mid-expiratory flow rates** (FEF25-75%) and **peak expiratory flow (PEF)** are assessed, **FEV1** remains the primary diagnostic measure - FEV1 provides better reproducibility and standardization for diagnosis *Total lung capacity* - **Total lung capacity (TLC)** represents total lung volume after maximal inhalation - May be normal or increased in asthma due to **air trapping** and hyperinflation - Not used as a primary diagnostic criterion as asthma diagnosis focuses on demonstrating **reversible airflow limitation**, not lung volumes

Q: What is the most common presentation for IgA nephropathy?

Repeated gross hematuria. ***Repeated gross hematuria*** - The hallmark of **IgA nephropathy** is recurrent episodes of **gross hematuria**, particularly following **respiratory infections** [1]. - It is often associated with **renal impairment** but can present initially with **visible blood** in the urine [1]. *Nephritic syndrome* - While IgA nephropathy can lead to nephritic features, it does not commonly present primarily as **nephritic syndrome**, which includes hypertension and edema. - Nephritic syndrome is characterized by significant **proteinuria** and acute renal failure, rather than the classic presentation of hematuria [2]. *Microscopic hematuria* - Although **microscopic hematuria** can occur in IgA nephropathy, it is not the most common and noticeable presentation; **gross hematuria** is more characteristic [1]. - Microscopic hematuria lacks the acute visual symptoms seen in cases proving the diagnosis. *Nephritic syndrome* - This option is a repetition of and does not provide any additional unique characteristics specific to **IgA nephropathy**. - It shares the same clinical features discussed previously and is thus not representative of the most common presentation.

Q: Fibrosis of upper lobe is due to

ABPA. ***ABPA*** - **Allergic bronchopulmonary aspergillosis (ABPA)** is a hypersensitivity reaction to *Aspergillus* species, particularly *A. fumigatus*, which colonize the airways, and commonly leads to **upper lobe fibrosis** and **bronchiectasis**. - The chronic inflammation and recurrent immune responses result in progressive airway damage, characterized on imaging by centrilobular nodules, mucoid impaction, and ultimately **fibrosis in the upper lobes**. Other conditions causing similar upper lobe conglomerate masses include Progressive Massive Fibrosis (PMF) seen in coal worker's pneumoconiosis [1]. *Certain types of pneumonia* - While pneumonia can cause inflammation, it typically leads to **lobar consolidation** or diffuse infiltrates rather than specific upper lobe fibrosis. - **Resolution of pneumonia** usually occurs without significant fibrotic changes, unlike chronic conditions that predispose to fibrosis. *Bronchiectasis* - **Bronchiectasis** is a general term for permanent dilation of the bronchi, which can occur in any lobe, but alone **does not directly cause upper lobe fibrosis** as a primary etiology. - While it often coexists with conditions that cause fibrosis (like ABPA or CF), it's a consequence of airway damage, not the direct cause of the fibrotic process itself; it can however predispose to recurrent infections leading to scarring. *Rheumatoid arthritis* - **Rheumatoid arthritis** can cause interstitial lung disease, including **pulmonary fibrosis**, but it typically manifests as a **basilar or diffuse pattern** rather than predominantly upper lobe fibrosis [2]. - The fibrosis associated with RA-ILD is commonly of a **usual interstitial pneumonia (UIP)** or **non-specific interstitial pneumonia (NSIP)** pattern [2].

Q: Which of the following is NOT a common pathogen causing pneumonia in COPD patients?

Legionella spp. ***Legionella spp*** - While *Legionella* can cause pneumonia, it is **not a common pathogen** specifically in COPD exacerbations or community-acquired pneumonia in these patients [1]. - *Legionella* pneumonia often presents with **extrapulmonary symptoms** like diarrhea and hyponatremia and is typically associated with contaminated water sources [1]. *Haemophilus influenzae* - This is a very common pathogen causing both **acute exacerbations of COPD (AECOPD)** and pneumonia in patients with underlying COPD [1]. - COPD patients often have **impaired mucociliary clearance** and altered airway microbiology, making them susceptible to *H. influenzae* colonization and infection [1]. *Pseudomonas aeruginosa* - *Pseudomonas aeruginosa* is an important pathogen in **severe COPD exacerbations**, especially in patients with frequent exacerbations, bronchiectasis, or prior antibiotic use. - Its presence often indicates a **more severe disease course** and requires specific antibiotic coverage. *Klebsiella pneumoniae* - *Klebsiella pneumoniae* is a significant cause of **pneumonia in immunocompromised individuals**, including those with COPD, diabetes, or alcoholism. - It often leads to **severe, necrotizing pneumonia**, particularly in the upper lobes, and can cause abscess formation.

Q: Kussmaul's sign is classically described in:

Chronic inflammatory heart condition. ***Chronic inflammatory heart condition*** - **Kussmaul's sign**, characterized by a paradoxical rise in **jugular venous pressure (JVP)** during inspiration, is classically seen in conditions like **constrictive pericarditis** [1], which is often a chronic inflammatory heart condition. - This sign reflects the heart's inability to accommodate increased venous return during inspiration due to a rigid, fibrotic pericardium [1]. *Acute cardiac compression* - **Cardiac tamponade** [3], a form of acute cardiac compression, typically presents with **pulsus paradoxus** and muffled heart sounds, not Kussmaul's sign. - While it involves elevated JVP, the paradoxical inspiratory rise is less common compared to constrictive pericarditis. *Acute myocardial damage* - **Acute myocardial infarction** [2] or myocarditis, leading to acute myocardial damage, primarily causes symptoms related to reduced cardiac output and arrhythmias, such as chest pain or dyspnea. - Kussmaul's sign is not a typical feature of acute myocardial damage because the pericardium is usually not rigid or constricting. *Chronic ventricular stiffening* - Conditions involving **chronic ventricular stiffening**, such as **restrictive cardiomyopathy**, can mimic some features of constrictive pericarditis, including elevated JVP and sometimes Kussmaul's sign. - However, the classic description and most prominent cases of Kussmaul's sign are associated with external compression from a diseased pericardium rather than intrinsic myocardial stiffness, although differentiation can be challenging.

Q: Tall T waves on ECG are seen in:

Hyperkalemia. ***Hyperkalemia*** - **Tall, peaked T waves** are a hallmark ECG finding in early to moderate **hyperkalemia**, reflecting altered repolarization due to elevated extracellular potassium [1]. - As potassium levels rise further, other ECG changes may include a **prolonged PR interval**, **widened QRS complex**, and ultimately a **sine wave pattern**, leading to ventricular arrhythmias [1]. *Hypokalemia* - This condition is typically associated with **flattened or inverted T waves**, prominent **U waves**, and a **prolonged QT interval** on the ECG [1]. - The ECG changes in hypokalemia reflect delayed repolarization and increased myocardial instability [1]. *Hypercalcemia* - **Hypercalcemia** is characterized by a **shortened QT interval** on the ECG due to accelerated ventricular repolarization. - T waves, if affected, are usually not tall or peaked but may be wider or slightly less prominent. *Hypocalcemia* - **Hypocalcemia** typically leads to a **prolonged QT interval** on the ECG, primarily due to a lengthened ST segment. - While it can manifest with various T wave morphologies, it does not typically cause the characteristic tall, peaked T waves seen in hyperkalemia.

Q: Coloboma, most common site?

Inferonasal. ***Inferonasal*** - This is the **most common site** for coloboma because it corresponds to the location of the **fetal optic fissure** (choroidal fissure) during development. - Coloboma results from the **incomplete closure** of the fetal optic fissure, which normally occurs around the fifth to seventh week of gestation. *Superotemporal* - While coloboma can occur in various locations, the **superotemporal quadrant** is not the typical site. - Colobomas are usually found in areas consistent with the path of the optic fissure. *Inferotemporal* - This location is less common for colobomas compared to the inferonasal region. - The inferotemporal region does not align with the usual embryological fusion line of the optic fissure. *Superonasal* - Colobomas in the **superonasal quadrant** are rare. - This area is typically unaffected because it is not part of the fetal optic fissure's normal closure pathway.

Q: Expulsive hemorrhage in cataract surgery is from?

Ciliary artery. ***Ciliary artery*** - Expulsive hemorrhage is a rare but devastating complication, typically resulting from the rupture of a **posterior ciliary artery** within the choroid. - This arterial rupture leads to a sudden, massive increase in intraocular pressure and extrusion of intraocular contents. *Vortex vein* - **Vortex veins** drain the choroid, and while their rupture could lead to hemorrhage, it is less likely to cause the highly pressurized, expulsive nature of a choroidal hemorrhage. - Hemorrhage from a vortex vein is generally less severe and less rapid in onset compared to arterial bleeding. *Choroidal vein* - **Choroidal veins** are part of the venous drainage system; bleeding from these vessels would typically be lower pressure and less likely to cause an expulsive hemorrhage. - Venous bleeds are generally slower and do not generate the rapid, violent pressure increase characteristic of expulsive hemorrhage. *None of the options* - This option is incorrect because the rupture of a ciliary artery is the direct cause of expulsive hemorrhage. - The other options are incorrect for the reasons stated above.

Q: A baby is born at 27 weeks of gestation and required mechanical ventilation for 4 weeks and CPAP for 1 week. He was maintained on room air subsequently. Based on the new definition of Bronchopulmonary Dysplasia (BPD), and assuming he remained on room air at 36 weeks post-menstrual age, what is the most appropriate classification of his condition?

Mild BPD. ***Mild BPD*** - The infant required respiratory support (ventilation and CPAP) for an extended period (5 weeks total, far exceeding the 28-day oxygen requirement for BPD diagnosis). - Being on **room air at 36 weeks post-menstrual age** despite prior prolonged support classifies his condition as mild BPD according to the diagnostic criteria. - For infants born <32 weeks gestation, mild BPD is defined as needing oxygen for ≥28 days but breathing room air at 36 weeks PMA. *Moderate BPD* - Moderate BPD would be diagnosed if the infant still required **less than 30% oxygen (FiO2 0.22-0.29) at 36 weeks post-menstrual age**. - This infant was on room air (FiO2 0.21), indicating less severe lung disease than moderate BPD. *Severe BPD* - Severe BPD involves the ongoing need for **30% or greater oxygen (FiO2 ≥0.30)** and/or positive pressure support (CPAP/ventilator) at 36 weeks post-menstrual age. - This infant did not meet these criteria, as he was on room air without any support. *No BPD* - No BPD would require **less than 28 days of oxygen/respiratory support** during the neonatal period. - This infant required mechanical ventilation for 4 weeks and CPAP for 1 week (total 5 weeks = 35 days), clearly exceeding the 28-day threshold for BPD diagnosis. - Despite being stable on room air at 36 weeks PMA, the prolonged earlier support establishes the diagnosis of BPD (mild severity).

Q: Which of the following statements is true regarding anemia of prematurity?

Low reticulocyte response. ***Low reticulocyte response*** - Anemia of prematurity results from several factors, including a **blunted erythropoietin response** to anemia, **shortened red blood cell lifespan**, and **rapid growth with increased blood volume requirements**. - The combination of these factors leads to **insufficient red blood cell production** by the bone marrow, reflected by a **low reticulocyte count** despite anemia. - This low reticulocyte response is a **key diagnostic feature** distinguishing it from hemolytic anemias. *Hemoglobin level <10 gm/dL* - While premature infants with anemia of prematurity develop low hemoglobin, a specific cutoff of **<10 gm/dL is not universally definitive** for diagnosis. - Hemoglobin nadirs vary based on **gestational age** (more premature = lower nadir) and occur at different postnatal ages. - Transfusion thresholds are determined by **clinical stability and symptoms**, not just a single Hb value. *10 ml/kg packed cell transfusion* - This describes a **treatment intervention**, not a characteristic of the disease itself. - Transfusion volume is typically **10-15 ml/kg** when indicated, but the decision to transfuse depends on gestational age, postnatal age, clinical stability, and symptoms like apnea or bradycardia. - This is **not a defining feature** of anemia of prematurity. *Microcytic hypochromic type* - Anemia of prematurity is typically **normocytic, normochromic**, not microcytic hypochromic. - **Microcytic hypochromic** anemia suggests **iron deficiency**, which is a different condition. - The red cells in anemia of prematurity have **normal size (MCV) and normal hemoglobin content** per cell.

Question 1

Which of the following is used for the diagnosis of asthma?

Accepted Answer

FEV1

Answer

Measurement of tidal volume

Answer

End expiratory flow rate

Answer

Total lung capacity

Question 2

What is the most common presentation for IgA nephropathy?

Accepted Answer

Repeated gross hematuria

Answer

Nephritic syndrome

Answer

Nephrotic syndrome

Answer

Microscopic hematuria

Question 3

Fibrosis of upper lobe is due to

Accepted Answer

ABPA

Answer

Rheumatoid arthritis

Answer

Certain types of pneumonia

Answer

Bronchiectasis

Question 4

Which of the following is NOT a common pathogen causing pneumonia in COPD patients?

Accepted Answer

Legionella spp

Answer

Klebsiella pneumoniae

Answer

Pseudomonas aeruginosa

Answer

Haemophilus influenzae

Question 5

Kussmaul's sign is classically described in:

Accepted Answer

Chronic inflammatory heart condition

Answer

Acute myocardial damage

Answer

Acute cardiac compression

Answer

Chronic ventricular stiffening

Question 6

Tall T waves on ECG are seen in:

Accepted Answer

Hyperkalemia

Answer

Hypokalemia

Answer

Hypercalcemia

Answer

Hypocalcemia

Question 7

Coloboma, most common site?

Accepted Answer

Inferonasal

Answer

Superotemporal

Answer

Inferotemporal

Answer

Superonasal

Question 8

Expulsive hemorrhage in cataract surgery is from?

Accepted Answer

Ciliary artery

Answer

Vortex vein

Answer

Choroidal vein

Answer

None of the options

Question 9

A baby is born at 27 weeks of gestation and required mechanical ventilation for 4 weeks and CPAP for 1 week. He was maintained on room air subsequently. Based on the new definition of Bronchopulmonary Dysplasia (BPD), and assuming he remained on room air at 36 weeks post-menstrual age, what is the most appropriate classification of his condition?

Accepted Answer

Mild BPD

Answer

Moderate BPD

Answer

Severe BPD

Answer

No BPD

Question 10

Which of the following statements is true regarding anemia of prematurity?

Accepted Answer

Low reticulocyte response

Answer

Hemoglobin level <10 gm/dL

Answer

10 ml/kg packed cell transfusion

Answer

Microcytic hypochromic type

NEET-PG 2012

Internal Medicine

Ophthalmology

Pediatrics