NEET-PG 2019 Practice Questions

Q: Structure derived from first pharyngeal arch:

Anterior belly of digastric. ***Anterior belly of digastric*** - The **first pharyngeal arch** (mandibular arch) gives rise to the muscles of mastication, including the **anterior belly of the digastric muscle**. Others are the **mylohyoid muscle**, and the **tensor tympani** and **tensor veli palatini muscles**. - Its nerve supply is the **mandibular nerve (V3)**, which is the nerve of the first pharyngeal arch. *Levator palatini* - The **levator palatini muscle** is derived from the **fourth pharyngeal arch**. - It is innervated by the **pharyngeal plexus**, which contains fibers from the **vagus nerve (CN X)** (nerve of the fourth arch). *Buccinator* - The **buccinator muscle** is derived from the **second pharyngeal arch** (hyoid arch). - It is innervated by the **facial nerve (CN VII)**, which is the nerve of the second pharyngeal arch. *Stylohyoid* - The **stylohyoid muscle** is derived from the **second pharyngeal arch** (hyoid arch). - It is innervated by the **facial nerve (CN VII)**, which is the nerve of the second pharyngeal arch.

Q: Which of the following is the most common method used to know depth of anaesthesia?

BIS. ***BIS*** - The **BIS (Bispectral Index) monitor** is the most common and widely utilized objective method for assessing the depth of anesthesia by analyzing brain electrical activity. - It provides a numerical value, typically from 0 to 100, where lower numbers indicate deeper anesthetic states, aiming for a range of 40-60 during general anesthesia. *Oesophageal contractility* - While esophageal motility can be affected by anesthetic depth, it is **not a standard or common method** for monitoring anesthesia during surgery. - Its measurement is invasive and not directly correlated with cortical brain activity, which is the primary target of most general anesthetics. *Depressed responses* - **Clinical signs of depressed responses** (e.g., lack of purposeful movement, stable vital signs) are important, but they are subjective and less reliable for accurately measuring anesthetic depth, especially in paralyzed patients. - These signs can be influenced by various factors unrelated to anesthetic depth, such as neuromuscular blockade or hypothermia. *Hypotension* - **Hypotension** is a common side effect of general anesthesia, but it is an indicator of the *hemodynamic effects* of anesthetics, not a direct or reliable measure of their depth. - Hypotension can be caused by many factors other than anesthetic depth, such as blood loss, hypovolemia, or cardiac dysfunction, making it a non-specific indicator.

Q: In Wilson’s disease, which of the following substances is excreted in lower amounts in the urine?

Methyl- Histidine. **Important Note:** In Wilson's disease with Fanconi syndrome (proximal renal tubular dysfunction), most substances show **increased** urinary excretion, not decreased. This question appears to test knowledge of what is NOT characteristically elevated. ***Methyl-Histidine*** (Most appropriate answer) - **Methyl-histidine** (3-methylhistidine) is a marker of **muscle protein breakdown** and is not directly affected by the renal tubular dysfunction in Wilson's disease - Unlike phosphate, amino acids, and glucose which are pathologically increased in urine due to Fanconi syndrome, methyl-histidine excretion remains **normal** or is unrelated to copper-induced renal damage - This represents the substance least affected by Wilson's disease pathology *Phosphorus* (Actually INCREASED, not decreased) - **Medically incorrect as stated**: Phosphorus (phosphate) is actually **INCREASED** in urine in Wilson's disease, not decreased - Fanconi syndrome causes **renal phosphate wasting**, leading to hyperphosphaturia and resultant hypophosphatemia - This is a characteristic feature of proximal tubular dysfunction *Serine* (INCREASED due to aminoaciduria) - **Serine** and other amino acids show **generalized aminoaciduria** in Wilson's disease due to impaired proximal tubular reabsorption - Urinary serine is **elevated**, not decreased *Phosphotyrosine* - A phosphorylated amino acid involved in cell signaling, not routinely measured clinically - Not characteristically implicated in Wilson's disease urinary patterns

Q: Which type of study determines the odds ratio?

Case control. ***Case control*** - **Case-control studies** compare individuals with a disease (cases) to individuals without the disease (controls) and look back in time to identify previous exposures. - The **odds ratio** is the primary measure of association used in case-control studies, quantifying the odds of exposure among cases versus controls. *Cohort* - **Cohort studies** follow groups of individuals over time, some exposed to a risk factor and some not, to determine the incidence of a disease. - They typically determine **relative risk**, which is the ratio of incidence rates in exposed versus unexposed groups. *Cross sectional* - **Cross-sectional studies** assess the prevalence of disease and exposure at a single point in time. - They primarily measure **prevalence** and can be used to calculate a **prevalence odds ratio**, but they do not establish temporality between exposure and outcome. *RCT* - **Randomized controlled trials (RCTs)** are interventional studies where participants are randomly assigned to an intervention or control group to determine the effectiveness of a treatment or exposure. - The main measure of effect in RCTs is often the **relative risk reduction**, **absolute risk reduction**, or **number needed to treat**, rather than the odds ratio for observational exposure.

Q: Which of the following nail findings is seen in the condition shown below?

Pitting. ***Pitting*** - The image displays multiple small, **punctate depressions** on the nail plate, which are characteristic features of nail pitting. - Nail pitting is a common finding in conditions affecting the **nail matrix**, such as psoriasis. *Pterygium* - **Pterygium** refers to the forward growth of the proximal nail fold onto the nail plate, or the lateral nail folds onto the nail plate, often leading to nail loss. - This is not observed in the image, which primarily shows depressions rather than overgrowth of skin onto the nail. *Pigmentation* - **Nail pigmentation** involves discoloration of the nail plate, appearing as streaks, spots, or diffuse changes in color (e.g., brown, black, blue). - The nail in the image does not show abnormal discoloration but rather surface irregularities. *Ridges* - **Ridges** in nails (longitudinal or transverse) are linear elevations or grooves on the nail surface. - While some linear texture is present, the predominant feature in the image is distinct, small, and scattered depressions, which are consistent with pitting rather than continuous ridges.

Q: A patient presented with the following picture of Tympanic Membrane. Most Probable diagnosis (marked with arrow):

Tubercular Otitis Media. ***Tubercular Otitis Media*** - The image exhibits **multiple perforations** in the tympanic membrane, along with **pale granulation tissue**, which are classic clinical features of **tubercular otitis media**. - Tubercular ear infections often present insidiously with **painless otorrhea** and **progressive hearing loss**, eventually leading to multiple perforations as the disease advances. *Syphilitic Otitis Media* - Syphilitic otitis media typically presents as **sensorineural hearing loss**, often sudden, and can be associated with **vestibular symptoms**. - It usually does **not cause multiple perforations** or extensive granulation tissue in the tympanic membrane. *Pseudomonas infection* - **Pseudomonas otitis externa** commonly causes severe pain, swelling, and purulent discharge, often seen in _elderly diabetic_ or _immunocompromised_ patients with potentially **malignant otitis externa**. - While *Pseudomonas* can cause chronic suppurative otitis media (CSOM) with a perforation, it doesn't typically lead to **multiple perforations** in the manner depicted. *Fungal Otitis Media* - Fungal otitis media (otomycosis) is characterized by the presence of **black, white, or yellow fungal debris** and hyphae within the external ear canal and on the tympanic membrane. - While it can cause inflammation and sometimes perforation, the image does not show characteristic **fungal elements** or the extensive **granulation tissue** typical of tubercular disease.

Q: Which murmur increases on standing?

HOCM. ***HOCM*** - Standing decreases **venous return** and **left ventricular volume**, which reduces the size of the LV outflow tract and thus exacerbates the obstruction in **hypertrophic obstructive cardiomyopathy (HOCM)**, making the murmur louder [1]. - This maneuver is a key diagnostic feature as reduced preload intensifies the dynamic obstruction. *MR* - **Mitral regurgitation (MR)** is typically a volume overload lesion, and standing (which reduces preload) generally causes the murmur to **decrease** in intensity due to less blood volume ejected back into the atrium [3]. - The murmur of MR is usually a holosystolic murmur radiating to the axilla [3]. *MS* - **Mitral stenosis (MS)** is a fixed obstruction to left ventricular filling. Changes in preload (like standing) do not significantly alter the gradient across the mitral valve or the intensity of the murmur [2]. - Its characteristic murmur is a **mid-diastolic rumble** with an opening snap [1]. *VSD* - A **ventricular septal defect (VSD)** murmur is caused by blood flowing from the high-pressure left ventricle to the low-pressure right ventricle. Standing, by reducing systemic vascular resistance, would typically cause the murmur to **decrease** in intensity as less blood shunts left-to-right. - The murmur is usually a **holosystolic murmur** best heard at the lower left sternal border.

Q: MOA of Teduglutide in short bowel syndrome?

GLP-2 analog. ***GLP-2 analog*** - Teduglutide is a **glucagon-like peptide-2 (GLP-2) analog** that binds to and activates GLP-2 receptors. - This activation promotes **intestinal adaptation** by enhancing mucosal growth, increasing nutrient absorption, and improving fluid balance in patients with short bowel syndrome. *5-HT1A receptor antagonist* - 5-HT1A receptor antagonists are primarily used in conditions related to **serotonin pathways**, such as anxiety or depression. - They do not have a direct mechanism to address the **malabsorption** issues seen in short bowel syndrome. *GLP-1 receptor agonist* - GLP-1 receptor agonists are primarily used in the management of **type 2 diabetes** to enhance insulin secretion and reduce glucagon levels. - While GLP-1 and GLP-2 are related, GLP-1 does not have the same direct **trophic and restorative effects** on the intestinal mucosa as GLP-2. *C-peptide analog* - C-peptide is a byproduct of **insulin production** and its analogs have been studied for potential effects on diabetic neuropathy or nephropathy, but not for intestinal adaptation. - It does not play a direct role in regulating **intestinal growth** or nutrient absorption in the context of short bowel syndrome.

Q: What is the most likely diagnosis for the parotid mass with mixed consistency shown in the image?

Pleomorphic adenoma. ***Pleomorphic adenoma*** - The **mixed consistency** of the parotid mass indicates a **benign tumor**, predominantly of epithelial and mesenchymal origin, typical of pleomorphic adenomas. - This type of tumor is usually **pain-free** and can exhibit a **soft** and **firm** texture on examination [1]. *Sebaceous cyst* - Typically presents as a **smooth, fluctuant nodule** and usually has a **firm consistency** rather than mixed. - Generally not seen as a parotid mass; usually found on the skin in areas with sebaceous glands. *Dermoid cyst* - Generally presents as a **well-defined, soft, and mobile mass**, not commonly associated with mixed consistency. - Often contains **keratin** and has a more homogenous consistency rather than the mixed characteristics of pleomorphic adenoma. *All* - As not all options are suitable for the description of a **mixed consistency parotid mass**, this option is incorrect. - Only **pleomorphic adenoma** aligns with the specific clinical presentation detailed in the question [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 751-753.

Q: Identify the surgical instrument based on its characteristics: a small, triangular blade used for precise incisions.

Blade no. 11. ***Blade no. 11*** - This blade has a **triangular shape** with a strong, pointed tip, making it ideal for **stab incisions** and precise, short cuts. - Its design allows for sharp, accurate penetration, often used in procedures requiring **minimal tissue disruption**. *Blade no. 15* - This is a small, curved blade, primarily used for **fine, precise cuts** in superficial tissues. - Its small size and rounded belly make it suitable for tasks like excising skin lesions or making incisions in delicate areas, not for triangular stab incisions. *Blade no. 10* - The No. 10 blade has a **large, curved cutting edge** and is generally used for making large incisions in skin and muscle. - It is not designed for precise, triangular stab incisions, but rather for broader, sweeping cuts. *Blade no. 12* - This blade is **sickle-shaped** with the cutting edge on the inside curve, used primarily for mucogingival surgery or removing sutures. - Its unique shape allows it to get into tight spaces and cut from a different angle, but it does not have a triangular tip for precise stab incisions.

Question 1

Structure derived from first pharyngeal arch:

Accepted Answer

Anterior belly of digastric

Answer

Levator palatini

Answer

Buccinator

Answer

Stylohyoid

Question 2

Which of the following is the most common method used to know depth of anaesthesia?

Accepted Answer

BIS

Answer

Oesophageal contractility

Answer

Depressed responses

Answer

Hypotension

Question 3

In Wilson’s disease, which of the following substances is excreted in lower amounts in the urine?

Accepted Answer

Methyl- Histidine

Answer

Phosphotyrosine

Answer

Phosphorus

Answer

Serine

Question 4

Which type of study determines the odds ratio?

Accepted Answer

Case control

Answer

Cohort

Answer

Cross sectional

Answer

RCT

Question 5

Which of the following nail findings is seen in the condition shown below?

Accepted Answer

Pitting

Answer

Pterygium

Answer

Pigmentation

Answer

Ridges

Question 6

A patient presented with the following picture of Tympanic Membrane. Most Probable diagnosis (marked with arrow):

Accepted Answer

Tubercular Otitis Media

Answer

Syphilitic Otitis Media

Answer

Pseudomonas infection

Answer

Fungal Otitis Media

Question 7

Which murmur increases on standing?

Accepted Answer

HOCM

Answer

MR

Answer

MS

Answer

VSD

Question 8

MOA of Teduglutide in short bowel syndrome?

Accepted Answer

GLP-2 analog

Answer

5-HT1A receptor antagonist

Answer

GLP-1 receptor agonist

Answer

C-peptide analog

Question 9

What is the most likely diagnosis for the parotid mass with mixed consistency shown in the image?

Accepted Answer

Pleomorphic adenoma

Answer

Sebaceous cyst

Answer

Dermoid cyst

Answer

None of the options

Question 10

Identify the surgical instrument based on its characteristics: a small, triangular blade used for precise incisions.

Accepted Answer

Blade no. 11

Answer

Blade no. 15

Answer

Blade no. 10

Answer

Blade no. 12

NEET-PG 2019

Anatomy

Anesthesiology

Biochemistry

Community Medicine

Dermatology

ENT

Internal Medicine

Pharmacology

Surgery