NEET-PG 2018 Practice Questions

Q: Which is not included in AIDS related complex?

Ectopic pregnancy. ***Ectopic pregnancy*** - **Ectopic pregnancy** is a gynecological condition related to reproductive health and is **not a direct manifestation** of HIV infection or one of the opportunistic infections/conditions characteristic of AIDS-related complex. - While HIV can affect overall health during pregnancy, an ectopic pregnancy itself is a different medical issue. *Recurrent genital candidiasis* - **Recurrent genital candidiasis** can be a sign of **diminished immune function** in HIV-positive women [1]. - It is often considered an AIDS-defining condition or a common opportunistic infection seen in the progression of HIV to AIDS-related complex [1]. *Generalised lymphadenopathy* - **Generalized lymphadenopathy**, specifically **persistent generalized lymphadenopathy (PGL)**, is a common early manifestation of HIV infection [1]. - It reflects ongoing immune activation and is part of the spectrum of conditions included in AIDS-related complex [1]. *Chronic diarrhea* - **Chronic diarrhea** (lasting more than one month) is a frequent and significant symptom in individuals with HIV infection, particularly as the disease progresses [1]. - It can be caused by various opportunistic infections or directly by HIV, and is a component of AIDS-related complex or AIDS-defining illness [1].

Q: Which drug is used as an adjunct to epinephrine in refractory ventricular fibrillation/ventricular tachycardia during cardiac arrest?

Amiodarone infusion. ***Amiodarone infusion*** - **Amiodarone** is a **Class III antiarrhythmic** drug commonly used in advanced cardiac life support (ACLS) protocols for refractory **ventricular fibrillation (VF)** or **pulseless ventricular tachycardia (VT)** that persists despite defibrillation and epinephrine [1]. - It works by blocking potassium channels, prolonging repolarization and the refractory period, which helps to stabilize the electrical activity of the heart. *Atropine* - **Atropine** is an anticholinergic drug primarily used to treat **symptomatic bradycardia** by increasing heart rate. - It is not indicated for the treatment of **ventricular fibrillation** or **ventricular tachycardia** during cardiac arrest. *High dose vasopressin* - **Vasopressin** was previously included in some ACLS algorithms as an alternative to epinephrine for **vasoconstrictive effects**, but recent guidelines do not support its routine use in cardiac arrest. - While it can cause **vasoconstriction**, there is no evidence that high-dose vasopressin improves outcomes in refractory VF/VT over epinephrine. *Adenosine* - **Adenosine** is an antiarrhythmic drug used to treat **supraventricular tachycardias (SVTs)** by transiently blocking the AV node. - It is not effective for **ventricular fibrillation** or **ventricular tachycardia** and can even be harmful in these rhythms.

Q: Which one of the following statements about Graves' disease is FALSE?

Common in male. ***Common in male*** - Graves' disease is significantly **more common in females** than males, with a female-to-male ratio of approximately 7:1 [1]. It is a female predominant disease [2]. - The peak incidence is between the ages of 20 and 50 years, and it is the most common cause of **hyperthyroidism** in women [1], [2]. *Results in hyperthyroidism* - Graves' disease is characterized by the production of **autoantibodies** against the TSH receptor, leading to excessive stimulation of the thyroid gland [1]. - This overstimulation results in **increased synthesis and release of thyroid hormones**, causing a state of hyperthyroidism [2]. *Autoimmune disorder* - Graves' disease is a classic example of an **organ-specific autoimmune disease** [2]. - The immune system mistakenly produces antibodies that mimic the action of TSH, leading to thyroid overactivity [1]. *Referred to as toxic diffuse goiter* - The term "toxic" refers to the **hyperthyroid state** (thyrotoxicosis), and "diffuse goiter" describes the generally uniform enlargement of the entire thyroid gland [1]. - This terminology accurately reflects the typical presentation of Graves' disease, which involves an overactive, diffusely enlarged thyroid gland [2].

Q: A boy presented with multiple non suppurative osteomyelitis with sickle cell anaemia. What will be the causative organism?

Salmonella. ***Salmonella*** - **Salmonella species** are a well-known cause of **osteomyelitis** in patients with **sickle cell anemia**, due to factors like gut mucosal damage and functional asplenia. [1] - The unique pathophysiology of sickle cell disease, including areas of bone infarction and compromised reticulendothelial system function, predisposes these patients to **Salmonella infections**. [1] *Staphylococcus aureus* - While **Staphylococcus aureus** is the most common cause of osteomyelitis in the general population, it is less likely to be the causative organism in patients with **sickle cell anemia** compared to Salmonella. - Its presence usually indicates other predisposing factors like trauma or prosthetic devices. *H. influenzae* - **Haemophilus influenzae** was a common cause of osteomyelitis in children before widespread vaccination but is now rare, especially with routine immunizations. - It is not specifically associated with a higher risk in patients with **sickle cell disease** for osteomyelitis compared to other pathogens. *Enterobacter species* - **Enterobacter species** can cause osteomyelitis, particularly in immunocompromised individuals or following surgery, but they are not uniquely associated with **sickle cell anemia** as a primary cause compared to Salmonella. - Their involvement in non-suppurative osteomyelitis in this specific patient population is less common.

Q: Which organism is the most common cause of acute bacterial prostatitis?

E.coli. ***E.coli*** - **E.coli** is the most common cause of **acute bacterial prostatitis**, accounting for a significant majority of cases. - It is a **gram-negative rod** commonly found in the gastrointestinal tract and can ascend into the urinary tract and prostate. *Enterococcus* - While **Enterococcus species** can cause urinary tract infections and, less commonly, prostatitis, they are a distant second to E.coli in frequency. - They are **gram-positive cocci** and are often associated with catheter-associated infections or healthcare-acquired infections. *Streptococcus viridans* - **Streptococcus viridans** group bacteria are typically commensals of the oral cavity and are more known for causing **endocarditis** or dental infections. - They are not a common cause of acute bacterial prostatitis. *Peptostreptococcus* - **Peptostreptococcus** is a genus of **anaerobic gram-positive cocci** commonly found in the normal flora of the mouth, gastrointestinal tract, and vagina. - They are typically involved in **polymicrobial anaerobic infections** but are not a primary or common cause of acute bacterial prostatitis.

Q: What type of uterine anomaly is shown in this X-ray HSG image?

Unicornuate uterus. ***Unicornuate uterus*** - The image shows a single, elongated uterine horn with a single fallopian tube arising from it, consistent with a **unicornuate uterus**. - This congenital anomaly results from the **failure of one Müllerian duct to develop**, leading to an abnormally shaped uterus. *Septate uterus* - A **septate uterus** would show a normal uterine fundus with an internal septum dividing the uterine cavity. - This image clearly depicts only **one rudimentary horn** and no visible septum. *Uterus didelphys* - **Uterus didelphys** involves two completely separate uteri, each with its own cervix and vagina. - The image does not show evidence of a **second, separate uterine structure**. *Bicornuate uterus* - A **bicornuate uterus** is characterized by two distinct uterine horns, which fuse at the cervix or lower uterine segment, creating a heart-shaped appearance of the fundus. - The image shows a **single, long horn** rather than two distinct horns.

Q: Extramammary Paget's disease of the vulva is most commonly associated with which other cancer?

Vulvar cancer. ***Vulvar cancer*** - **Extramammary Paget's disease (EMPD)** frequently presents in the vulvar region and is associated with an underlying **adenocarcinoma** in up to 30% of cases. - The disease involves intraepithelial adenocarcinoma cells that can spread locally and, in some instances, indicates a synchronous or metachronous **internal malignancy**, often of genitourinary or gastrointestinal origin, but primarily vulvar adenocarcinoma in this context. *Vaginal cancer* - While Paget's disease can occur in other anogenital areas, its association with **primary vaginal cancer** is much less common compared to vulvar involvement. - **Vaginal Paget's disease** is rare and usually represents secondary spread from a vulvar primary or an underlying bladder/urethral carcinoma. *Cervical cancer* - **Paget's disease** is not typically associated with **cervical cancer**. Cervical cancers are predominantly squamous cell carcinomas or adenocarcinomas arising from the transformation zone. - While cervical adenocarcinoma can present with similar cells to Paget's, it is a distinct entity and not a common association. *Uterine cancer* - **Uterine cancer**, primarily endometrial carcinoma, has no direct or common association with **Paget's disease**. - Paget's disease primarily affects the skin and can be associated with underlying gland cancers, but these are generally in proximity to the epidermal involvement rather than distant uterine sites.

Q: Anaplasia is

Lack of differentiation. ***Lack of differentiation*** - Anaplasia refers to a **loss of differentiation** in cells, making them more primitive and less specialized [1]. - It is often seen in **malignant tumors**, indicating a poor prognosis and aggressive behavior [1]. *Morphological changes* - While anaplasia involves **morphological changes**, this term is too broad and can relate to various cellular alterations, not exclusively anaplasia [1]. - Anaplasia specifically emphasizes **lack of differentiation**, distinct from general changes in cell appearance [1]. *Changing one type of epithelium to another* - This describes a process known as **metaplasia**, where one adult cell type transforms into another, not anaplasia. - Anaplasia signifies a **de-differentiation** rather than a change to a different epithelial type [1]. *Nuclear chromatin* - While changes in **nuclear chromatin** can occur in anaplastic cells, this does not define anaplasia itself [1]. - Anaplasia primarily refers to **loss of cell differentiation**, making this option insufficient to describe the concept [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 276-280.

Q: TRALI occurs within how many hours of transfusion?

6 hours. ***6 hours*** - **Transfusion-related acute lung injury (TRALI)** is defined as new acute lung injury occurring during or within **6 hours** after the completion of a blood transfusion [1]. - It is a severe and potentially life-threatening transfusion reaction characterized by **acute respiratory distress**, **hypoxemia**, and **bilateral pulmonary infiltrates** on chest imaging [1]. *48 hours* - While other transfusion reactions or complications may manifest within 48 hours, TRALI has a more **acute onset**, typically within the first 6 hours. - A pulmonary event occurring between 6 and 48 hours post-transfusion might be considered **delayed TRALI** or another diagnosis like **transfusion-associated circulatory overload (TACO)**, but the classic definition refers to the 6-hour window. *72 hours* - Reactions occurring 72 hours after transfusion are generally considered **delayed transfusion reactions**, which include conditions like **delayed hemolytic transfusion reactions** or **post-transfusion purpura**. - This timeframe is too long for the typical presentation of TRALI, which is characterized by rapid onset. *12 hours* - Although 12 hours falls within an acute window, the most commonly accepted and diagnostically crucial timeframe for TRALI is **within 6 hours** of transfusion. - A reaction occurring between 6 and 12 hours would still be considered suspiciously TRALI, but the strict definition emphasizes the earlier onset.

Q: In hypovolemic shock there is -

Decreased cardiac output. ***Decreased cardiac output*** - **Hypovolemic shock** is fundamentally defined by **decreased circulating blood volume**, which leads to **decreased venous return** to the heart. - According to the **Frank-Starling mechanism**, decreased venous return leads to **decreased preload**, which results in **decreased stroke volume** and consequently **decreased cardiac output**. - This is the **primary hemodynamic characteristic** of hypovolemic shock and is present in ALL cases. - Decreased cardiac output triggers all the compensatory mechanisms seen in hypovolemic shock, including sympathetic activation and RAAS activation. *Afferent arteriolar constriction* - While afferent arteriolar constriction does occur in hypovolemic shock due to **sympathetic activation**, it is a **compensatory response** rather than the primary feature. - The predominant effect at the kidney level is actually a combination of both afferent and efferent arteriolar changes. - This occurs secondary to the decreased cardiac output. *Efferent arteriolar constriction* - **Efferent arteriolar constriction** is mediated primarily by **angiotensin II** and is actually MORE prominent than afferent constriction. - This helps **maintain glomerular filtration rate (GFR)** despite reduced renal blood flow by increasing glomerular hydrostatic pressure. - However, this is also a compensatory response, not the primary feature of hypovolemic shock. *Increased blood flow to kidney* - This is incorrect as hypovolemic shock causes **decreased renal blood flow**. - Blood is redistributed away from the kidneys to vital organs like the heart and brain through compensatory vasoconstriction.

Question 1

Which is not included in AIDS related complex?

Accepted Answer

Ectopic pregnancy

Answer

Recurrent genital candidiasis

Answer

Generalised lymphadenopathy

Answer

Chronic diarrhea

Question 2

Which drug is used as an adjunct to epinephrine in refractory ventricular fibrillation/ventricular tachycardia during cardiac arrest?

Accepted Answer

Amiodarone infusion

Answer

Atropine

Answer

Adenosine

Answer

High dose vasopressin

Question 3

Which one of the following statements about Graves' disease is FALSE?

Accepted Answer

Common in male

Answer

Referred to as toxic diffuse goiter

Answer

Results in hyperthyroidism

Answer

Autoimmune disorder

Question 4

A boy presented with multiple non suppurative osteomyelitis with sickle cell anaemia. What will be the causative organism?

Accepted Answer

Salmonella

Answer

H. influenzae

Answer

Enterobacter species

Answer

Staphylococcus aureus

Question 5

Which organism is the most common cause of acute bacterial prostatitis?

Accepted Answer

E.coli

Answer

Enterococcus

Answer

Streptococcus viridans

Answer

Peptostreptococcus

Question 6

What type of uterine anomaly is shown in this X-ray HSG image?

Accepted Answer

Unicornuate uterus

Answer

Septate uterus

Answer

Uterus didelphys

Answer

Bicornuate uterus

Question 7

Extramammary Paget's disease of the vulva is most commonly associated with which other cancer?

Accepted Answer

Vulvar cancer

Answer

Vaginal cancer

Answer

Cervical cancer

Answer

Uterine cancer

Question 8

Anaplasia is

Accepted Answer

Lack of differentiation

Answer

Changing one type of epithelium to another

Answer

Nuclear chromatin

Answer

Morphological changes

Question 9

TRALI occurs within how many hours of transfusion?

Accepted Answer

6 hours

Answer

48 hours

Answer

72 hours

Answer

12 hours

Question 10

In hypovolemic shock there is -

Accepted Answer

Decreased cardiac output

Answer

Efferent arteriolar constriction

Answer

Increased blood flow to kidney

Answer

Afferent arteriolar constriction

NEET-PG 2018

Internal Medicine

Microbiology

Obstetrics and Gynecology

Pathology

Physiology