NEET-PG 2019 Practice Questions

Q: In patients with Retinitis pigmentosa, which of the following substances is known to have decreased levels?

Docosahexaenoic acid (DHA). ***Docosahexaenoic acid (DHA)*** - **Docosahexaenoic acid (DHA)** is a crucial **omega-3 fatty acid** abundantly found in the **photoreceptor cell membranes**, particularly in the retina. - Reduced levels of DHA are frequently observed in patients with **retinitis pigmentosa**, suggesting its role in disease pathogenesis and retinal health. *Arachidonic acid* - **Arachidonic acid** is an **omega-6 fatty acid** and a precursor to many signaling molecules, but its levels are **not typically decreased** in retinitis pigmentosa. - It plays a **pro-inflammatory role** and is involved in various physiological processes, distinct from the primary metabolic defects in retinitis pigmentosa. *Linoleic acid* - **Linoleic acid** is an essential **omega-6 fatty acid** and a precursor to arachidonic acid, but its deficiencies are not characteristic of retinitis pigmentosa. - It is crucial for **skin barrier function** and overall health, but its metabolic pathways are distinct from those primarily affected in retinal degenerations. *Thromboxane* - **Thromboxane** is a **lipid mediator** primarily involved in **platelet aggregation** and vasoconstriction. - It is not directly associated with the metabolic pathways or structural integrity of the retina, and its levels are not typically altered in retinitis pigmentosa.

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: Patient presents with pruritus of the interdigital spaces of the left hand as shown in the image. Identify the condition.

Sarcoptes scabiei. ***Sarcoptes scabiei*** - The image shows **papules and excoriations** in the **interdigital spaces**, a classic presentation of **scabies**. Patients typically experience **intense pruritus**, especially at night. - The presence of **burrows**, which are linear or serpiginous tracks, further supports this diagnosis, as these are created by the female mite tunneling into the epidermis. *Dermatitis herpetiformis* - This condition is characterized by **intensely pruritic, symmetrically grouped vesicles and bullae** on extensor surfaces, such as elbows, knees, and buttocks, not primarily interdigital spaces. - It is strongly associated with **celiac disease** and typically responds to a gluten-free diet and dapsone. *Xerotic dermatitis* - **Xerotic dermatitis**, also known as **eczema craquelé** or **winter itch**, is characterized by **dry, fissured skin** that resembles cracked porcelain, often exacerbated by dry weather. - While it causes pruritus, it does not typically present with the papules and burrows seen in scabies, nor is it confined to interdigital spaces in this manner. *Erythema multiforme* - **Erythema multiforme** is an acute, self-limiting inflammatory skin condition characterized by **target lesions** (concentric rings of erythema and edema) and often involves mucous membranes. - It is often triggered by infections (e.g., herpes simplex virus) or drugs and does not primarily present with pruritic papules in interdigital areas.

Q: A patient presents with hoarseness and laryngoscopy reveals a warty, cauliflower-like growth on the vocal cord. Identify the most likely lesion.

Laryngeal papilloma. ***Laryngeal papilloma*** - **Hoarseness** and a **warty, cauliflower-like growth** on the vocal cord are classic descriptions of a laryngeal papilloma, often caused by **HPV infection**. - These lesions can be solitary or multiple, and while benign, they can recur and cause voice changes and respiratory obstruction. *Laryngeal malignancy* - While hoarseness is a common symptom of laryngeal malignancy, the description of a **"warty, cauliflower-like growth"** is more characteristic of a papilloma than most typical carcinomas, which might appear more ulcerative or infiltrative. - Malignancies are more commonly associated with risk factors like **smoking and alcohol use**, and often present with other symptoms like dysphagia or weight loss. *Tracheomalacia* - **Tracheomalacia** refers to softening of the tracheal cartilage, leading to airway collapse, typically causing stridor or respiratory distress. - It does not present as a **discrete growth** on the vocal cords but rather as a diffuse structural weakness of the trachea. *Reinke’s edema* - **Reinke's edema** (polypoid corditis) is characterized by a **gelatinous or fluid-filled swelling** of the vocal cords, usually associated with chronic irritation like smoking. - It presents as a swollen, boggy appearance of the vocal cords, not a warty or cauliflower-like growth.

Q: In the context of gunshot injuries, which of the following describes the characteristics of a close shot entry wound, including signs such as burning, blackening, tattooing around the wound, and the presence of a dirt collar?

Close shot entry wound. ***Close shot entry wound*** - **Burning, blackening, tattooing**, and a **dirt collar** around the wound are classic signs of a **close-range gunshot entry wound**. These findings result from the burning of skin by hot gases, deposition of soot (blackening), and impact of unburnt gunpowder particles (tattooing/stippling) from a firearm discharged at a close distance. - The **"dirt collar"** (also known as a **grease collar** or **abrasion collar**) is caused by the passage of the bullet through the skin, wiping off lubricants, dirt, and residue from the bullet onto the skin around the wound. *Close shot exit wound* - An **exit wound** is typically larger, more irregular, and lacks the characteristics of burning, blackening, or tattooing because the bullet has lost momentum and often tumbles or deforms as it exits the body. - There would also be no dirt collar or soot deposits, as these are associated with the initial entry of the bullet and propellant gases. *Distant shot entry wound* - A **distant shot entry wound** would likely show an abrasion collar and a circular or oval defect, but it would lack the burning, blackening (soot), and tattooing (stippling) as the firearm was discharged from a distance preventing these elements from reaching the skin. - The lack of unburnt powder and gases impacting the skin differentiates it from a close-range shot. *Distant shot exit wound* - A **distant shot exit wound** would exhibit the same characteristics as any exit wound: larger, irregular, and without the signs of burning, blackening, or tattooing. - The absence of close-range effects like soot and stippling on a distant entry wound similarly means they would not be present on a distant exit wound.

Q: What is the PRIMARY mechanism by which Interleukin-1 (IL-1) induces fever?

Endogenous pyrogen. ***Endogenous pyrogen*** - **IL-1** is a potent **endogenous pyrogen** that acts directly on the **hypothalamus**, the body's thermoregulatory center. - It stimulates the production of **prostaglandin E2 (PGE2)** in the hypothalamus, which then resets the body's thermoregulatory set point to a higher temperature, leading to fever. *Stimulates antibody production* - While IL-1 can have broader immune functions and can influence B cell activity, its **primary role in fever** production is not through antibody stimulation. - Antibody production is a function of **B lymphocytes** and is primarily driven by antigen presentation and T cell help. *Inhibits inflammation* - **IL-1** is a key **pro-inflammatory cytokine** that promotes inflammation, rather than inhibiting it. - It induces the expression of various adhesion molecules and inflammatory mediators, contributing to the inflammatory response. *Activates complement cascade* - The **complement cascade** is a part of the innate immune system, typically activated by **antigen-antibody complexes** (classical pathway) or **microbial surfaces** (alternative and lectin pathways). - While IL-1 plays a role in overall immune responses, its direct mechanism for inducing fever does not primarily involve activating the complement system.

Q: 30 year old woman with complaint of dysmenorrhoea, dyspareunia with chronic pelvic pain undergoes hysterectomy. From the cut section of hysterectomy specimen below identify the condition.

Adenomyosis. ***Adenomyosis*** - The image shows a **thickened uterine wall** with poorly demarcated, **cystic or hemorrhagic areas** within the myometrium, which are characteristic macroscopic findings of adenomyosis. - The clinical symptoms of **dysmenorrhea, dyspareunia, and chronic pelvic pain** are classic presentations for adenomyosis, caused by the presence of endometrial glands and stroma within the myometrium. - The **globular uterine enlargement** with diffuse involvement distinguishes this from discrete lesions. *Fibroids (Leiomyoma)* - Fibroids are **well-circumscribed, discrete, rubbery masses** within the myometrium, often bulging from the surface or cut section with a characteristic **whorled appearance**. - While fibroids can cause menorrhagia and bulk symptoms, the diffuse thickening and **ill-defined hemorrhagic foci** in the image are inconsistent with the **sharply defined borders** of leiomyomas. *Endometrial hyperplasia* - Endometrial hyperplasia involves **thickening of the endometrial lining** due to excess estrogen stimulation, typically presenting with abnormal uterine bleeding. - This condition affects the **endometrium (lining) rather than the myometrium (muscle wall)**, and would not show the deep myometrial involvement with cystic spaces seen in the image. - The clinical picture of dysmenorrhea and dyspareunia is more consistent with adenomyosis than hyperplasia. *Endometriosis* - Endometriosis involves the presence of **endometrial tissue outside the uterus**, such as on the ovaries, peritoneum, or pelvic organs. - While it shares similar symptoms like dysmenorrhea and dyspareunia, endometriosis is a **separate condition from adenomyosis** (which is endometrial tissue within the uterine wall). - The image shows the **uterine cut section with myometrial involvement**, not external implants characteristic of endometriosis.

Q: Identify the most likely diagnosis based on the chest X-ray findings in a patient with low-grade fever.

Miliary TB. ***Miliary TB*** - The chest X-ray shows diffuse, small, uniformly distributed nodular opacities (2-3 mm in diameter) bilaterally, characteristic of "**millet seed**" pattern seen in **miliary tuberculosis**. - This pattern results from the hematogenous spread of *Mycobacterium tuberculosis* throughout the lungs, often presenting with **low-grade fever** and constitutional symptoms. *ILD* - **Interstitial lung disease (ILD)** typically shows reticular, nodular, or ground-glass opacities, sometimes with honeycombing, but the pattern is usually more heterogeneous and often basal or peripheral, unlike the uniform fine nodularity seen here. - While some ILDs can present with diffuse nodular patterns, the clinical context of **fever** and the classic "millet seed" appearance are more indicative of miliary TB. *Bronchopneumonia* - **Bronchopneumonia** presents as patchy, often ill-defined, multifocal areas of opacification or consolidation, usually distributed around the bronchi. - It does not typically cause the fine, diffuse, and uniform nodular pattern seen in this image, which represents widespread interstitial or alveolar involvement rather than primarily bronchial inflammation. *Consolidation* - **Consolidation** appears as a homogeneous opacification that obliterates vessels and airway walls, often with air bronchograms, typically confined to a lobe or segment. - The image shows diffuse nodular infiltrates rather than large, confluent areas of homogeneous opacification, making isolated consolidation an unlikely primary description.

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.

Q: Identify the triangle in the image below.

Gastrinoma triangle. ***Gastrinoma triangle*** - The image displays the **gastrinoma triangle** (also known as the **Passaro triangle**), which is the most common location for **gastrinomas** within the abdomen. - This triangle is formed by the superior border of the **duodenum** (first part), the inferior border of the **duodenum** (third part), and the junction of the **cystic duct** and **common bile duct**. *Koch’s triangle* - **Koch's triangle** is an anatomical region within the **right atrium of the heart**, defined by the septal leaflet of the tricuspid valve, the coronary sinus ostium, and the tendon of Todaro. - It is significant as it contains the **atrioventricular (AV) node**, crucial for cardiac conduction. *Hesselbach’s triangle* - **Hesselbach's triangle** is located in the **inguinal region** on the anterior abdominal wall, bounded by the inferior epigastric artery, the lateral border of the rectus abdominis muscle, and the inguinal ligament. - It is a clinically important landmark for differentiating between **direct and indirect inguinal hernias**. *Sherren’s triangle* - **Sherren's triangle** refers to a zone of **hyperesthesia** (increased tactile sensitivity) in the right iliac fossa that can be indicative of **acute appendicitis**. - It is bounded by the umbilicus, the anterior superior iliac spine, and the pubic symphysis, and differs from the anatomical triangles shown in the image.

Question 1

In patients with Retinitis pigmentosa, which of the following substances is known to have decreased levels?

Accepted Answer

Docosahexaenoic acid (DHA)

Answer

Thromboxane

Answer

Arachidonic acid

Answer

Linoleic acid

Question 2

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

Accepted Answer

Pitting

Answer

Pterygium

Answer

Pigmentation

Answer

Ridges

Question 3

Patient presents with pruritus of the interdigital spaces of the left hand as shown in the image. Identify the condition.

Accepted Answer

Sarcoptes scabiei

Answer

Dermatitis herpetiformis

Answer

Xerotic dermatitis

Answer

Erythema multiforme

Question 4

A patient presents with hoarseness and laryngoscopy reveals a warty, cauliflower-like growth on the vocal cord. Identify the most likely lesion.

Accepted Answer

Laryngeal papilloma

Answer

Laryngeal malignancy

Answer

Tracheomalacia

Answer

Reinke’s edema

Question 5

In the context of gunshot injuries, which of the following describes the characteristics of a close shot entry wound, including signs such as burning, blackening, tattooing around the wound, and the presence of a dirt collar?

Accepted Answer

Close shot entry wound

Answer

Close shot exit wound

Answer

Distant shot entry wound

Answer

Distant shot exit wound

Question 6

What is the PRIMARY mechanism by which Interleukin-1 (IL-1) induces fever?

Accepted Answer

Endogenous pyrogen

Answer

Stimulates antibody production

Answer

Inhibits inflammation

Answer

Activates complement cascade

Question 7

30 year old woman with complaint of dysmenorrhoea, dyspareunia with chronic pelvic pain undergoes hysterectomy. From the cut section of hysterectomy specimen below identify the condition.

Accepted Answer

Adenomyosis

Answer

Fibroids

Answer

Endometrial hyperplasia

Answer

Endometriosis

Question 8

Identify the most likely diagnosis based on the chest X-ray findings in a patient with low-grade fever.

Accepted Answer

Miliary TB

Answer

ILD

Answer

Bronchopneumonia

Answer

Consolidation

Question 9

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

Question 10

Identify the triangle in the image below.

Accepted Answer

Gastrinoma triangle

Answer

Hesselbach’s triangle

Answer

Koch’s triangle

Answer

Sherren’s triangle

NEET-PG 2019

Biochemistry

Dermatology

ENT

Forensic Medicine

Pathology

Radiology

Surgery