NEET-PG 2015 Practice Questions

Q: In which part of the body are lesions of Kaposi sarcoma most commonly seen?

Lower extremities. ***Lower extremities*** - Kaposi sarcoma lesions most frequently appear on the **skin of the lower extremities**, especially the feet and ankles. - This predilection is thought to be due to increased **venous stasis** or other local factors. *Upper extremities* - While Kaposi sarcoma can affect the upper extremities, it is a **less common primary site** compared to the lower limbs. - Lesions here are more likely to appear as the disease **progresses or disseminates**. *Torso* - Kaposi sarcoma lesions can occur on the torso, particularly on the **trunk**, but it is not the most common initial presentation. - Visceral involvement of the **gastrointestinal tract** and lungs can often present without skin lesions on the torso. *Head and neck* - Lesions of Kaposi sarcoma can appear on the head and neck, especially on the **face and oral cavity**, particularly in classic Kaposi sarcoma or in individuals with advanced immunosuppression. - However, this is still **less frequent** than involvement of the lower extremities.

Q: Which of the following conditions is least likely to cause multiple painful ulcers on the tongue?

Sarcoidosis. ***Sarcoidosis*** - While sarcoidosis can affect any organ, **oral involvement is rare** and typically presents as **nodules, plaques, or generalized swelling**, not usually multiple painful ulcers on the tongue. - The lesions, when they occur, are often **painless** and appear as submucosal nodules, red patches, or diffuse swelling. *TB* - Oral tuberculosis can present as **multiple painful ulcers** on the tongue, often with a **granulomatous appearance** mimicking squamous cell carcinoma. - These ulcers are typically **irregular, undermined, and persistent**, often associated with pulmonary TB. *Herpes* - **Herpes simplex virus (HSV)** infection, particularly primary herpetic gingivostomatitis, commonly causes **multiple painful ulcers** on the tongue, gums, and other oral mucosa. - These ulcers begin as vesicles that **rupture to form painful erosions** and are a classic presentation of oral herpes. *Behcet disease* - **Oral aphthous ulcers** are a hallmark feature of Behcet disease, commonly presenting as **multiple, recurrent, painful ulcers** on the tongue and other oral mucosal surfaces. - These ulcers are clinically indistinguishable from common aphthous stomatitis but are more frequent and often associated with genital ulcers, skin lesions, and ocular inflammation.

Q: Increased ICP is shown by

Reduction in GCS. ***Reduction in GCS*** - A **decrease in Glasgow Coma Scale (GCS)** score is a primary indicator of increased intracranial pressure (ICP) due to compromised brain function [1], [2]. - Increased ICP can lead to **cerebral ischemia** and neuronal damage, manifesting as altered consciousness and lower GCS scores [1]. *Pupil constriction (Miosis)* - **Miosis**, or pupil constriction, is typically associated with **pontine lesions** or **opioid use**, and rarely directly with increased ICP unless it specifically involves brainstem compression at the pontine level. - Increased ICP more commonly causes **pupil dilation (mydriasis)**, especially unilateral, due to compression of the oculomotor nerve (CN III) [1]. *Systemic hypotension* - **Systemic hypotension** is generally *not* a direct sign of increased ICP; rather, increased ICP often results in **systemic hypertension** as part of Cushing's triad. - Hypotension in the context of brain injury might indicate **spinal shock** or other systemic issues, but generally not directly elevated ICP. *Tachycardia* - **Tachycardia** is also *not* typically associated with increased ICP; instead, **bradycardia** (slow heart rate) is a hallmark sign, forming part of Cushing's triad. - Tachycardia might suggest **hypovolemia**, **pain**, or other systemic stressors, but not directly increased ICP.

Q: What are the expected neurological manifestations in a patient with complete absence of the corpus callosum?

Severe developmental delays. ***Severe developmental delays*** - Complete agenesis of the corpus callosum often results in **significant neurological impairments** due to the disruption of interhemispheric communication essential for coordinated brain function. - This typically manifests as **intellectual disability**, **developmental delays** in motor and speech skills, and difficulties with complex cognitive tasks. *Mild cognitive impairment* - While some individuals with partial agenesis or isolated cases might present with mild cognitive issues, **complete absence** usually leads to more profound deficits. - Mild impairment would not fully capture the extensive neurological challenges associated with a total lack of such a critical brain structure. *Seizures* - Seizures can occur in patients with corpus callosum agenesis, but they are not the **most encompassing** or universally expected neurological manifestation. - Seizures are often part of a broader syndrome of developmental abnormalities rather than the primary expected outcome of the agenesis itself. *No significant neurological deficits* - The corpus callosum is vital for **integrating information** between the cerebral hemispheres, affecting a wide range of sensory, motor, and cognitive functions. - Therefore, its complete absence almost invariably leads to notable neurological deficits, making a lack of significant issues highly unlikely.

Q: The window of implantation occurs at which of the following time periods after fertilization?

6-10 days. ***6-10 days*** - The uterus is most receptive to implantation during the **"window of implantation,"** which occurs roughly **6 to 10 days post-fertilization**, coinciding with the mid-luteal phase. - During this period, the **endometrial lining** undergoes specific changes, guided by hormonal signals from **progesterone**, making it optimal for the blastocyst to attach. *12 days* - While implantation can still occur, the **peak receptivity window** is generally considered to be narrower, between 6 and 10 days. - By day 12, changes in the **endometrial environment** may start to reduce the likelihood of successful implantation. *12 weeks* - **12 weeks** refer to the end of the first trimester of pregnancy and is far too late for the initial implantation event. - Implantation must have occurred much earlier for a viable pregnancy at this stage. *6 weeks* - **6 weeks** refers to an established pregnancy, at which point implantation would have occurred several weeks prior. - The process of implantation is completed within the first two weeks post-fertilization.

Q: A child presented to an orthopaedic clinic with a limp. The surgeon suspected him to have a fixed flexion deformity of the hip. Which test should the surgeon perform to confirm his finding?

Thomas test. ***Thomas test*** - The **Thomas test** is specifically designed to detect a **fixed flexion deformity of the hip**, where the hip cannot fully extend. - During the test, the patient's hip is flexed to flatten the lumbar spine, and if the contralateral leg then rises off the table, it indicates a fixed flexion deformity. *Trendelenburg's test* - The **Trendelenburg's test** assesses the strength and function of the **hip abductor muscles**, primarily the gluteus medius. - A positive result indicates weakness of the abductors on the standing leg, causing the pelvis to drop on the unsupported side, which is unrelated to fixed flexion deformity. *Nelaton's test* - **Nelaton's test** is used to determine the relative position of the **greater trochanter** in relation to the **ischial tuberosity** and **anterior superior iliac spine (ASIS)**, primarily in cases of hip dislocation or fracture. - It would not specifically identify a fixed flexion deformity of the hip joint itself. *Telescoping test* - The **telescoping test** is used to evaluate for hip instability, particularly in infants with **developmental dysplasia of the hip (DDH)**. - It involves applying axial pressure to the femur while moving the hip, assessing for abnormal movement of the femoral head within the acetabulum, and does not directly detect fixed flexion deformity.

Q: The A1 pulley involved in trigger finger is located at the level of which joint?

Metacarpophalangeal joint. ***Metacarpophalangeal joint*** - The **A1 pulley** is located at the base of the finger, overlying the **metacarpophalangeal (MCP) joint**. - Its pathological thickening or narrowing can impede the smooth gliding of **flexor tendons**, causing **trigger finger**. *Proximal Interphalangeal joint* - The **A2** and **A3 pulleys** are located at the level of the **proximal phalanx** and **proximal interphalangeal (PIP) joint**, respectively. - While essential for tendon function, they are not primarily involved in typical **trigger finger**. *Distal Interphalangeal joint* - The **A4** and **A5 pulleys** are located at the level of the **middle phalanx** and **distal interphalangeal (DIP) joint**, respectively. - Pathologies at these pulleys are less common in trigger finger and typically affect the **distal tendon glide**. *Carpometacarpal joint* - The **carpometacarpal (CMC) joints** are located at the base of the hand, between the carpal bones and metacarpals. - There are no A pulleys associated with the CMC joints, and they are not directly involved in the mechanism of **trigger finger**.

Q: Most common site of hypertensive intraparenchymal hemorrhage in the brain?

Putamen. ***Putamen*** - The **putamen** is the most frequent site for **hypertensive intraparenchymal hemorrhages** [1] due to the presence of numerous small, thin-walled arterioles (lenticulostriate arteries) that are highly susceptible to damage from chronic hypertension [1]. - Hemorrhages in this region often cause **contralateral hemiparesis**, **hemianesthesia**, and **gaze deviation** towards the side of the lesion due to involvement of nearby motor and sensory pathways [1]. *Thalamus* - While the **thalamus** is a common site for hypertensive hemorrhages, it is less common than the putamen [1], [2]. - Thalamic hemorrhages typically cause **contralateral sensory loss**, **oculomotor dysfunction**, and sometimes **aphasia** if the dominant hemisphere is affected. *Cerebellum* - **Cerebellar hemorrhages** are less frequent than those in the basal ganglia or thalamus [1]. - Symptoms usually include **ataxia**, **nystagmus**, vomiting, and potential brainstem compression if large. *Pons* - **Pontine hemorrhages** are among the most severe and are often rapidly fatal due to damage to vital brainstem structures [1], [2]. - They typically present with **coma**, **quadriparesis**, **pinpoint pupils**, and rapid progression to respiratory arrest.

Q: Plaques jaunes are seen in which condition?

Atherosclerosis. ***Head injury*** - **Plaques jaunes**, or yellow plaques, are primarily associated with brain injuries, particularly in areas of **contusion** or **hemorrhage** [1]. - These plaques may represent **lipid-laden macrophages** and indicate areas of *necrosis* and inflammation in the brain [1]. *Endocarditis* - Endocarditis is characterized by **vegetations** on heart valves rather than plaques in the brain. - Symptoms typically include **fever**, **murmurs**, and **embolization**, which do not involve yellow plaques. *Syphilis* - Syphilis may cause *gummatous lesions* but is not associated with yellow plaques in the brain. - Typical findings include **rash** and **ulcerative lesions**, particularly during the secondary stage. *Atherosclerosis* - Atherosclerosis involves **plaque formation** in blood vessels but these are not the same as **plaques jaunes** in neurological contexts. - It is characterized by **cholesterol** deposits and plaque rupture leading to cardiovascular events, not plaques seen in head injuries. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1262-1264.

Question 1

In which part of the body are lesions of Kaposi sarcoma most commonly seen?

Accepted Answer

Lower extremities

Answer

Upper extremities

Answer

Torso

Answer

Head and neck

Question 2

Which of the following conditions is least likely to cause multiple painful ulcers on the tongue?

Accepted Answer

Sarcoidosis

Answer

TB

Answer

Herpes

Answer

Behcet disease

Question 3

Increased ICP is shown by

Accepted Answer

Reduction in GCS

Answer

Pupil constriction (Miosis)

Answer

Systemic hypotension

Answer

Tachycardia

Question 4

Which of the following is the MOST characteristic feature of Eaton-Lambert syndrome?

Accepted Answer

Repeated electrical stimulation enhances muscle power in it.

Answer

Neostigmine is not effective for this syndrome.

Answer

It is commonly associated with small cell lung cancer.

Answer

It can affect the ocular muscles.

Question 5

What are the expected neurological manifestations in a patient with complete absence of the corpus callosum?

Accepted Answer

Severe developmental delays

Answer

Mild cognitive impairment

Answer

Seizures

Answer

No significant neurological deficits

Question 6

The window of implantation occurs at which of the following time periods after fertilization?

Accepted Answer

6-10 days

Answer

12 days

Answer

12 weeks

Answer

6 weeks

Question 7

A child presented to an orthopaedic clinic with a limp. The surgeon suspected him to have a fixed flexion deformity of the hip. Which test should the surgeon perform to confirm his finding?

Accepted Answer

Thomas test

Answer

Trendelenburgs test

Answer

Telescoping test

Answer

Nelaton's test

Question 8

The A1 pulley involved in trigger finger is located at the level of which joint?

Accepted Answer

Metacarpophalangeal joint

Answer

Proximal Interphalngeal joint

Answer

Carpometacarpal joint

Answer

Distal Interphalangeal joint

Question 9

Most common site of hypertensive intraparenchymal hemorrhage in the brain?

Accepted Answer

Putamen

Answer

Thalamus

Answer

Cerebellum

Answer

Pons

Question 10

Plaques jaunes are seen in which condition?

Accepted Answer

Atherosclerosis

Answer

Syphilis

Answer

Head injury

Answer

Endocarditis

NEET-PG 2015

Dermatology

Internal Medicine

Obstetrics and Gynecology

Orthopaedics

Pathology