NEET-PG 2015 Practice Questions

Q: Group of 4-8 experts talking in front of a large group of audience is known as:

Panel discussion. ***Panel discussion*** - A **panel discussion** involves a small group of experts (4-8) presenting their views and discussing a specific topic in front of a larger audience. - The format typically includes an initial presentation by each panelist, followed by a moderated discussion among the panelists and sometimes questions from the audience. *Symposium* - A **symposium** is a formal meeting at which several experts or specialists deliver short presentations on a particular subject. - While it involves experts, it typically consists of a series of individual presentations rather than an interactive discussion among the presenters. *Workshop* - A **workshop** is a training or educational meeting where participants engage in intensive discussion and activity on a particular subject or project. - The primary focus is on hands-on learning and skill development for the attendees, not primarily on experts talking to an audience. *Seminar* - A **seminar** is a meeting or conference for discussion or training, usually involving a small group of students or professionals. - It often involves a leader or speaker presenting information, followed by discussion, but it is typically smaller and more interactive than a large expert panel.

Q: A girl about to marry has comedonal acne. Drug to treat such a case is:

Retinoids. ***Retinoids*** - **Topical retinoids** (e.g., tretinoin, adapalene) are the gold standard for comedonal acne as they normalize **follicular keratinization** and prevent microcomedone formation. - Being **Category C in pregnancy**, topical retinoids require **contraception counseling** for women of childbearing age but are still first-line treatment with proper precautions. *Benzoyl peroxide* - **Benzoyl peroxide** has mild comedolytic properties but is primarily effective for **inflammatory acne** due to its antimicrobial action against *Cutibacterium acnes*. - Less effective than retinoids for purely **comedonal acne** as it doesn't address the core pathology of abnormal keratinization. *Estrogen* - **Hormonal therapy** with estrogen-containing contraceptives reduces sebum production by suppressing androgens but takes **3-6 months** to show effects. - More suitable for **hormonal acne** with inflammatory lesions rather than purely comedonal acne, and not first-line for this presentation. *Topical antibiotic* - **Topical antibiotics** (clindamycin, erythromycin) target bacterial overgrowth and inflammation but have limited efficacy in **non-inflammatory comedonal acne**. - Risk of **bacterial resistance** when used alone, and they don't address the underlying hyperkeratinization that causes comedone formation.

Q: Hennebert's sign is a false positive fistula test when there is no evidence of middle ear disease causing a fistula of the horizontal semicircular canal. It is seen in?

Meniere’s disease. ***Meniere's disease*** - **Hennebert's sign** is a *false-positive fistula test* resulting from a hypermobile footplate or saccule, or a fibrous band between the stapes footplate and the utricle due to otolithic *hydrops*. - It indicates that changes in external ear canal pressure cause **nystagmus** and **vertigo** due to inner ear fluid displacement, even without a true fistula. - This is the **most common** cause of Hennebert's sign in clinical practice. *Congenital syphilis* - Congenital syphilis can also present with Hennebert's sign as a false-positive fistula test due to inner ear involvement. - However, the question context specifies Hennebert's sign in the absence of middle ear disease, making Meniere's disease the more typical answer. - Other features include **sensorineural hearing loss**, **vestibular dysfunction**, **interstitial keratitis**, and **Hutchinson's teeth**. *Cholesteatoma* - A cholesteatoma often erodes bone, leading to a **true fistula** in the horizontal semicircular canal, especially its lateral aspect. - This would result in a *true positive fistula test* rather than a false positive associated with Hennebert's sign. *Stapedectomy* - A stapedectomy is a surgical procedure to treat otosclerosis, involving the removal of the stapes and insertion of a prosthesis. - While it can lead to complications such as perilymph fistula, it is not directly associated with Hennebert's sign as a *pre-existing condition* causing a false-positive fistula test in the absence of middle ear disease.

Q: Lafora's disease presents with?

Myoclonic epilepsy. ***Myoclonic epilepsy*** - Lafora disease is a rare, neurodegenerative inherited disorder characterized by **progressive myoclonic epilepsy**. - Patients typically experience spontaneous or reflex-induced **myoclonic seizures**, often accompanied by falls [1]. *G.T.C.S* - While generalized tonic-clonic seizures (GTCS) can occur in Lafora disease as the condition progresses, they are not the primary or defining seizure type [3]. - The hallmark presentation is **myoclonic epilepsy**, which may then evolve to include GTCS. *Petit mal epilepsy* - **Petit mal epilepsy**, also known as absence seizures, is characterized by brief, sudden lapses of consciousness without loss of postural tone [1]. - This is a distinct epilepsy syndrome and not the typical presentation of Lafora disease. *Partial seizures* - **Partial seizures** originate in a specific area of the brain and can be simple or complex [2]. - While some focal signs might be observed as the disease advances, Lafora disease is primarily a generalized epilepsy characterized by myoclonus [1].

Q: Which of the following is a feature of crush syndrome -

Myoglobinuria. Myoglobinuria - **Myoglobinuria** is a hallmark of crush syndrome, resulting from the massive release of **myoglobin** from damaged muscle cells into the bloodstream [2]. - This excess myoglobin can precipitate in the renal tubules, leading to **acute kidney injury (AKI)** [1]. *Hypophosphatemia* - Crush syndrome typically results in **hyperphosphatemia**, not hypophosphatemia, due to the release of intracellular phosphate from damaged muscular cells. - The elevated phosphate levels contribute to reciprocal **hypocalcemia** through precipitation. *Hypokalemia* - Crush syndrome is characterized by **hyperkalemia**, caused by the release of intracellular potassium from damaged muscle cells. - **Hyperkalemia** is a significant and life-threatening complication due to its potential for cardiac arrhythmias. *Hypercalcemia* - Crush syndrome typically presents with **hypocalcemia** due to the precipitation of calcium with released phosphate and fatty acids. - Initial **hypocalcemia** may later be followed by **hypercalcemia** during the recovery phase, especially in those with renal failure, but hypocalcemia is more acute.

Q: Hebra nose is caused by:

Frisch bacillus. ***Frisch bacillus*** - **Frisch bacillus**, also known as *Klebsiella rhinoscleromatis*, is the causative agent of **rhinoscleroma**, which often presents as a condition causing tumor-like growths in the nose, leading to the characteristic "Hebra nose." - **Hebra nose** refers to the chronic, deforming nasal lesion associated with late stages of **rhinoscleroma**, characterized by hardening and widening of the nose. *C. diphtheriae* - *Corynebacterium diphtheriae* causes **diphtheria**, primarily affecting the respiratory tract and skin. - It forms a **pseudomembrane** in the throat and can lead to systemic complications due to toxin production, but it does not cause Hebra nose. *Pseudomonas* - *Pseudomonas aeruginosa* is an opportunistic pathogen commonly causing **nosocomial infections**, such as pneumonia, urinary tract infections, and wound infections. - While it can cause various infections, it is not associated with the specific nasal deformity known as Hebra nose. *Staph aureus* - *Staphylococcus aureus* is a common bacterium causing a wide range of infections, including **skin infections** (e.g., boils, cellulitis), **pneumonia**, and **sepsis**. - Although it can cause nasal colonization and local infections, it does not cause the chronic, deforming condition known as Hebra nose.

Q: Not true about gas gangrene:

Cl perfringens produce heat-labile spores. ***Cl perfringens produce heat-labile spores*** - *Clostridium perfringens* spores are, in fact, **heat-resistant**, allowing them to survive harsh conditions and subsequently germinate into vegetative cells causing infection. - This heat resistance is a crucial factor in food poisoning outbreaks and wound infections, as spores can survive cooking temperatures. *Metronidazole is the drug of choice* - While metronidazole can be used as an adjunct, **penicillin G** is generally the primary antibiotic of choice for gas gangrene, often in combination with other agents like clindamycin. - **Surgical debridement** and **hyperbaric oxygen therapy** are also critical components of treatment, as antibiotics alone are often insufficient. *Most common cause is Cl perfringens* - **_Clostridium perfringens_** is indeed the most frequent cause of gas gangrene (clostridial myonecrosis), accounting for approximately 80-95% of cases. - This bacterium produces potent **exotoxins** that cause rapid tissue destruction and gas formation, leading to the characteristic symptoms. *Extensive necrosis of muscles* - Gas gangrene is characterized by **rapid and extensive necrosis of muscle tissue**, which is caused by the potent toxins produced by clostridial species, particularly alpha-toxin. - This muscle destruction leads to systemic toxicity, pain, and the production of gas within the tissues.

Q: Pilocarpine is used in all of the following except:

Malignant Glaucoma. ***Malignant Glaucoma*** - **Pilocarpine** is contraindicated in **malignant glaucoma** because it can worsen the condition by causing **ciliary body edema** and anterior displacement of the lens-iris diaphragm. - This form of glaucoma requires treatment aimed at posterior displacement of the lens-iris diaphragm, often involving **cycloplegics**, **hyperosmotic agents**, or surgical interventions. *Primary, Open Angle Glaucoma* - **Pilocarpine** is an effective **miotic agent** that increases aqueous humor outflow through the **trabecular meshwork**, thereby lowering intraocular pressure. - It can be used as a treatment for **primary open-angle glaucoma**, although it is less commonly used due to its side effects and the availability of better-tolerated medications. *Acute Angle Closure Glaucoma* - **Pilocarpine** is typically used in the management of **acute angle-closure glaucoma** after the intraocular pressure has been acutely lowered by other agents. - It works by inducing **miosis**, which pulls the iris away from the **trabecular meshwork**, opening the angle and facilitating aqueous outflow. *Chronic Synechial Angle Closure Glaucoma* - In **chronic synechial angle-closure glaucoma**, **pilocarpine** can be used to break or prevent the formation of new **peripheral anterior synechiae** by constricting the pupil. - However, its effectiveness is limited if extensive synechiae have already formed, as these physically block the outflow pathway.

Q: Investigation of choice for confirming Henoch Schönlein Purpura is

Renal Biopsy. ***Renal Biopsy*** - **Biopsy (renal or skin)** showing **IgA deposition** is the **confirmatory investigation** for Henoch-Schönlein Purpura (HSP) when histological confirmation is needed [1]. - **Renal biopsy** demonstrates characteristic **IgA-dominant immune deposits** in the mesangium and glomerular capillaries, along with **mesangial proliferation** [1]. - While HSP is primarily a **clinical diagnosis** based on palpable purpura, age < 20 years, abdominal pain, and renal involvement, biopsy provides **definitive confirmation** in atypical presentations or when diagnosis is uncertain. - Immunofluorescence showing **IgA deposition** is the pathognomonic finding [1]. *Serum IgA levels* - Serum IgA levels may be elevated in approximately **50% of HSP cases**, but this is **neither sensitive nor specific**. - **Normal serum IgA does NOT exclude HSP**, making it unreliable as a confirmatory test. - Elevated IgA can occur in many other conditions (IgA nephropathy without vasculitis, liver disease, infections). - Provides only supportive evidence, not confirmation. *CRP levels* - **C-reactive protein (CRP)** is a **non-specific inflammatory marker** that may be elevated in HSP. - Cannot distinguish HSP from other inflammatory or infectious conditions. - Has no role in confirming the diagnosis. *DTPA* - **DTPA scan** assesses **renal perfusion and function** but does not provide diagnostic information about the underlying pathology. - Cannot detect the characteristic **IgA-mediated vasculitis** of HSP. - Not useful for confirming the diagnosis. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 526-527.

Q: Mechanism of action of thiazides is by -

Inhibiting Na+/Cl- symporter in DCT. **Inhibiting Na+/Cl- symporter in DCT** - Thiazide diuretics primarily act on the **distal convoluted tubule (DCT)** of the nephron [2]. - They inhibit the **Na+/Cl- symporter** (NCC channel) on the apical membrane, preventing reabsorption of sodium and chloride ions [1], [2]. *Inhibiting Na+K+2CI- in descending limb of loop of henle* - The descending limb of the loop of Henle is permeable to water but largely impermeable to solutes; there is no significant Na+K+2Cl- symporter activity here. - This mechanism describes the action of loop diuretics, but they act on the **ascending** limb, not the descending limb. *Inhibiting Na+K+2Cl- in ascending limb of loop of henle* - This mechanism describes the action of **loop diuretics** (e.g., furosemide, bumetanide) [3]. - Loop diuretics inhibit the **Na+K+2Cl- cotransporter (NKCC2)** in the thick ascending limb of the loop of Henle, leading to significant diuresis [3]. *Inhibiting Na+/Cl- symporter in PCT* - The **proximal convoluted tubule (PCT)** is primarily responsible for reabsorbing most of the filtered sodium, chloride, bicarbonate, and other solutes. - While sodium is reabsorbed in the PCT, it's mainly through Na+/H+ exchangers and other mechanisms, not a specific Na+/Cl- symporter that is targeted by thiazides [2].

Question 1

Group of 4-8 experts talking in front of a large group of audience is known as:

Accepted Answer

Panel discussion

Answer

Symposium

Answer

Workshop

Answer

Seminar

Question 2

A girl about to marry has comedonal acne. Drug to treat such a case is:

Accepted Answer

Retinoids

Answer

Topical antibiotic

Answer

Estrogen

Answer

Benzoyl peroxide

Question 3

Hennebert's sign is a false positive fistula test when there is no evidence of middle ear disease causing a fistula of the horizontal semicircular canal. It is seen in?

Accepted Answer

Meniere’s disease

Answer

Congenital syphilis

Answer

Cholesteatoma

Answer

Stapedectomy

Question 4

Lafora's disease presents with?

Accepted Answer

Myoclonic epilepsy

Answer

G.T.C.S

Answer

Petit mal epilepsy

Answer

Partial seizures

Question 5

Which of the following is a feature of crush syndrome -

Accepted Answer

Myoglobinuria

Answer

Hypophosphatemia

Answer

Hypokalemia

Answer

Hypercalcemia

Question 6

Hebra nose is caused by:

Accepted Answer

Frisch bacillus

Answer

C. diphtheriae

Answer

Pseudomonas

Answer

Staph aureus

Question 7

Not true about gas gangrene:

Accepted Answer

Cl perfringens produce heat-labile spores

Answer

Metronidazole is the drug of choice

Answer

Most common cause is Cl perfringens

Answer

Extensive necrosis of muscles

Question 8

Pilocarpine is used in all of the following except:

Accepted Answer

Malignant Glaucoma

Answer

Primary, Open Angle Glaucoma

Answer

Acute Angle Closure Glaucoma

Answer

Chronic Synechial Angle Closure Glaucoma

Question 9

Investigation of choice for confirming Henoch Schönlein Purpura is

Accepted Answer

Renal Biopsy

Answer

Serum IgA levels

Answer

CRP levels

Answer

DTPA

Question 10

Mechanism of action of thiazides is by -

Accepted Answer

Inhibiting Na+/Cl- symporter in DCT

Answer

Inhibiting Na+K+2Cl- in ascending limb of loop of henle

Answer

Inhibiting Na+/Cl- symporter in PCT

Answer

Inhibiting Na+K+2Cl- in descending limb of loop of henle

NEET-PG 2015

Community Medicine

Dermatology

ENT

Internal Medicine

Microbiology

Ophthalmology

Pathology

Pharmacology