NEET-PG 2019 Practice Questions

Q: Which muscle originates from 1st pharyngeal arch?

Masseter. ***Masseter*** - The **masseter muscle** is a strong muscle of mastication that originates from the **first pharyngeal arch**. - Muscles derived from the first pharyngeal arch are innervated by the **trigeminal nerve (CN V)**, which also innervates the masseter. *Posterior belly of digastric* - The **posterior belly of the digastric muscle** originates from the **second pharyngeal arch**. - It is innervated by the **facial nerve (CN VII)**, which is associated with the second pharyngeal arch. *Buccinator* - The **buccinator muscle** is a muscle of facial expression that also originates from the **second pharyngeal arch**. - Like other muscles of facial expression, it is innervated by the **facial nerve (CN VII)**. *Stylopharyngeus* - The **stylopharyngeus muscle** originates from the **third pharyngeal arch**. - It is innervated by the **glossopharyngeal nerve (CN IX)**, which is associated with the third pharyngeal arch.

Q: Depth of Anesthesia is best measured by:

BIS. ***BIS*** - The **BIS (Bispectral Index)** is an EEG-derived parameter that provides a quantitative measure of the patient's level of consciousness or depth of anesthesia. - A typical range for adequate surgical anesthesia is a BIS score between **40 and 60**, indicating a low probability of consciousness and recall. *TOF* - **TOF (Train-of-Four)** monitoring is used to assess the level of neuromuscular blockade, measuring the response of a muscle to a series of four electrical stimuli. - While important for managing **muscle relaxants**, it does not directly measure the depth of anesthesia or consciousness. *MAC* - **MAC (Minimum Alveolar Concentration)** is a measure of the potency of an inhaled anesthetic, defined as the concentration at which 50% of patients do not respond to a surgical stimulus. - It reflects the **ED50 of the anesthetic agent** itself rather than the patient's individual depth of anesthesia at a given moment. *Post Tetanic Potentiation* - **Post Tetanic Potentiation (PTP)** is a phenomenon observed during neuromuscular monitoring where a single twitch response is enhanced following a brief tetanus (rapid series of high-frequency stimuli). - PTP is used to assess **deep neuromuscular blockade** and recovery from paralytics, not the depth of anesthesia.

Q: Retinitis pigmentosa is associated with deficiency of:

DHA. ***DHA*** - **Docosahexaenoic acid (DHA)** is the major polyunsaturated fatty acid in the **retinal photoreceptor outer segments** and is crucial for their function. - Deficiency in DHA has been linked to several retinal degeneration disorders, including **retinitis pigmentosa**, suggesting its importance in maintaining retinal health. *Timnodonic acid* - This is an older term for **eicosapentaenoic acid (EPA)**, which is an omega-3 fatty acid. - While EPA is beneficial for overall health, it is **not the primary fatty acid** associated with the direct structural and functional health of retinal photoreceptors as DHA is. *Eicosa pentaenoic acid* - **Eicosapentaenoic acid (EPA)** is an omega-3 fatty acid found in fish oil, known for its anti-inflammatory properties. - While important for general health, EPA is **not as abundant or critical for retinal structure and function** as DHA. *Arachidonic acid* - **Arachidonic acid (AA)** is an omega-6 fatty acid found in cell membranes and is a precursor to pro-inflammatory mediators. - While present in the retina, AA is generally **not associated with a protective or causative role in retinitis pigmentosa** in the same way DHA is.

Q: A 25-year-old female presented to ER unconscious. Her mother tells you about her having recurrent syncopal episodes. Her BP is 80/60 mm Hg and you order an ECG. Treatment is

DC shock. ***DC shock*** - The ECG shows a **wide complex tachycardia** with alternating morphology in the QRS complex, consistent with **Torsades de Pointes**. - Given the patient's **unconsciousness** and **hypotension (80/60 mmHg)**, she is hemodynamically unstable, making immediate **electrical cardioversion (DC shock)** the treatment of choice irrespective of the cause. *Catheter Ablation* - **Catheter ablation** is an invasive procedure used for definitive treatment of recurrent arrhythmias, often considered in patients who are *hemodynamically stable*. - It is not an acute, emergency treatment for an **unstable patient** in a life-threatening arrhythmia. *Adenosine* - **Adenosine** is primarily used to terminate **supraventricular tachycardias (SVTs)** and can be harmful in wide complex tachycardias, especially if due to ventricular tachycardia or Wolff-Parkinson-White syndrome. - Its use is contraindicated in wide complex tachycardias like Torsades de Pointes, and it would not be effective in an **unstable patient** with Torsades de Pointes. *Radiofrequency ablation* - **Radiofrequency ablation** is a type of catheter ablation, which ablates or destroys abnormal electrical pathways in the heart. - Similar to other ablative therapies, it is a **definitive treatment** for recurrent arrhythmias in *stable patients*, not an emergency measure for an unconscious, hypotensive patient with an acute arrhythmia.

Q: Polyuria in adults is commonly defined as urine output exceeding:

40 ml / Kg/ day. ***40 ml / Kg/ day*** - **Polyuria** is clinically defined as urine output exceeding 3 liters per 24 hours (L/day) in adults. - Converting this to a weight-based measurement for an average 75 kg adult, 3 L/day equates to approximately **40 ml/kg/day**. *50 ml/ kg / day* - This value represents a significantly higher urine output than the standard clinical definition of **polyuria**, making it an unlikely threshold. - While excessive, it would indicate a more severe and less common degree of diuresis, not the general definition. *30 ml / Kg/ day* - This value is below the typical threshold for **polyuria** and is closer to what might be considered normal or slightly elevated urine output. - Normal urine output is typically between **0.5-1 ml/kg/hour**, which translates to 12-24 ml/kg/day. *60 ml/ kg / day* - This is a substantially high urine output, indicating a profound level of **diuresis**, well beyond the standard definition of polyuria. - While possible in extreme cases, it is not the common cutoff used for defining polyuria.

Q: A patient presents to the emergency department after sustaining blunt trauma to the left eye. Clinical examination reveals enophthalmos, diplopia on upward gaze, and periorbital ecchymosis. The CT scan image is shown below. What is your diagnosis?

Orbital blow out fracture. ***Orbital blow out fracture*** - This type of fracture commonly results from direct blunt trauma to the eye, causing increased intraorbital pressure and subsequent fracture of the **thinnest orbital walls**, typically the floor or medial wall - Clinical signs often include **enophthalmos** (sunken eye), **diplopia** (especially on upward gaze due to inferior rectus muscle entrapment), **periorbital ecchymosis**, and sometimes **numbness** in the distribution of the infraorbital nerve - CT imaging typically shows a fracture of the orbital floor with herniation of orbital contents into the maxillary sinus (teardrop sign) *Oculomotor nerve paralysis* - Paralysis of the oculomotor nerve (CN III) would lead to characteristic findings such as **ptosis**, **dilated pupil**, and the eye positioned **down and out** - While it can be caused by trauma, it does not typically present with radiographic evidence of a fracture or entrapment of orbital contents *Retrobulbar hemorrhage* - A retrobulbar hemorrhage involves bleeding behind the eyeball, causing a rapid increase in **intraorbital pressure** - This typically presents with **proptosis** (forward displacement of the eye), **pain**, and decreased vision, which can be an ophthalmic emergency, but not primarily characterized by a bony fracture *Orbital roof fracture* - Fractures of the orbital roof are less common than blow-out fractures and often result from **direct trauma to the forehead** - They can be associated with **intracranial injuries** and may present with cerebrospinal fluid leakage and **pneumocephalus**, which are not the primary features described in a typical blow-out injury

Q: False statement about Barrett esophagus is:

Columnar to squamous metaplasia. ***Columnar to squamous metaplasia*** - Barrett esophagus involves the conversion of the normal stratified **squamous epithelium** to **intestinalized columnar epithelium** (metaplasia) due to acid injury. - Describing it as "columnar to squamous" is the reverse of the actual pathological process, making this the **false statement**. *Chronic GERD is the predisposing factor* - Persistent **reflux of gastric contents** into the lower esophagus induces the adaptive change from squamous to columnar cells to better resist acid. - Long-standing **GERD** is the strongest clinical predictor for the development of Barrett esophagus. *May lead to malignancy after few years* - Barrett esophagus is a clinically significant **premalignant condition** that follows a progression of metaplasia-dysplasia-carcinoma. - Patients have a significantly increased risk of developing **esophageal adenocarcinoma** compared to the general population. *Goblet cells seen on histology* - The presence of **intestinal metaplasia**, specifically characterized by **mucin-containing goblet cells**, is required for the diagnosis of Barrett esophagus. - These cells are identifiable on H&E stains and are often highlighted with **Alcian blue** stain to confirm the diagnosis.

Q: Drug inhibiting granulocyte migration is:-

Colchicine. ***Colchicine*** - **Colchicine** inhibits **granulocyte migration** by binding to tubulin, thereby disrupting microtubule assembly and function [2]. - This action is crucial in its use for conditions like **gout**, where it reduces the inflammatory response by preventing neutrophil chemotaxis to crystal deposits [1], [2]. *Montelukast* - **Montelukast** is a **leukotriene receptor antagonist** that primarily reduces bronchoconstriction and inflammation. - While it affects inflammatory pathways, its direct action is not inhibiting granulocyte migration but rather blocking the effects of leukotrienes. *Cromoglycate* - **Cromoglycate** (e.g., cromolyn sodium) is a **mast cell stabilizer** that prevents the release of inflammatory mediators. - Its main mechanism involves preventing mast cell degranulation, not directly inhibiting granulocyte migration. *Felbamate* - **Felbamate** is an **antiepileptic drug** used in the treatment of seizures. - Its mechanism of action involves blocking NMDA receptors and modulating GABAergic transmission; it has no known role in inhibiting granulocyte migration.

Q: Cilastatin is given in combination with Imipenem because:-

Cilastatin prevents degradation of Imipenem in kidney. ***Cilastatin prevents degradation of Imipenem in kidney*** - **Imipenem** is extensively metabolized in the renal tubules by the enzyme **dihydropeptidase-I**, leading to its inactivation and potential nephrotoxicity. - **Cilastatin** is a **dihydropeptidase-I inhibitor** that prevents this enzymatic breakdown, increasing the bioavailability and efficacy of imipenem and reducing the risk of renal damage. *Inhibits the enzymes that digest Imipenem in stomach* - **Imipenem** is a parenteral antibiotic and is not administered orally; therefore, degradation in the stomach is not a relevant concern. - Its combination with cilastatin is specifically to address renal metabolism, not gastric degradation. *Cilastatin increase absorption of Imipenem* - **Cilastatin** does not enhance the absorption of imipenem; its role is primarily to inhibit renal metabolism. - Imipenem is administered intravenously, bypassing the need for gastrointestinal absorption. *Reduces side effects of Imipenem* - While cilastatin does prevent the formation of nephrotoxic metabolites of imipenem, its primary role is to **maintain therapeutic levels** and prevent drug inactivation. - The reduction in **nephrotoxicity** is a consequence of preventing degradation, rather than a direct mitigation of general side effects.

Q: A 75-year-old female has chronic backache. X-ray of the spine is shown. What is the most likely diagnosis?

Osteoporosis. ***Osteoporosis*** - The X-ray shows diffuse **osteopenia** (reduced bone density) and **vertebral compression fractures**, particularly visible in the lateral view, which are characteristic findings in elderly patients with osteoporosis and chronic backache. - The vertebral bodies appear **demineralized** and some exhibit a loss of height, suggesting collapse due to weakened bone structure. *Spondylodiscitis* - This condition involves **inflammation of the vertebral body and adjacent intervertebral disc**, typically showing **erosions** of the vertebral endplates and **narrowing of the disc space** on X-ray, which are not clearly evident here as the primary issue. - While it can cause back pain, the dominant finding on this X-ray is widespread bone density loss and fractures, rather than localized infection-related changes. *Pott's spine* - Pott's spine (**tuberculous spondylitis**) is a form of osteomyelitis that causes **destruction of vertebral bodies** and adjacent discs, often leading to a **gibbus deformity** (sharp posterior angulation of the spine). - The X-ray does not show extensive vertebral destruction, paraspinal abscess formation, or typical kyphotic deformity associated with Pott's spine. *Spondylolisthesis* - Spondylolisthesis is characterized by the **forward slippage of one vertebral body over another**, often due to a defect in the pars interarticularis. - While there may be some degenerative changes, there is no clear evidence of significant anterior translation of a vertebral body on the lateral X-ray that would indicate spondylolisthesis.

Question 1

Which muscle originates from 1st pharyngeal arch?

Accepted Answer

Masseter

Answer

Posterior belly of digastric

Answer

Buccinator

Answer

Stylopharyngeus

Question 2

Depth of Anesthesia is best measured by:

Accepted Answer

BIS

Answer

TOF

Answer

MAC

Answer

Post Tetanic Potentiation

Question 3

Retinitis pigmentosa is associated with deficiency of:

Accepted Answer

DHA

Answer

Timnodonic acid

Answer

Eicosa pentaenoic acid

Answer

Arachidonic acid

Question 4

A 25-year-old female presented to ER unconscious. Her mother tells you about her having recurrent syncopal episodes. Her BP is 80/60 mm Hg and you order an ECG. Treatment is

Accepted Answer

DC shock

Answer

Cathether Ablation

Answer

Adenosine

Answer

Radiofrequency ablation

Question 5

Polyuria in adults is commonly defined as urine output exceeding:

Accepted Answer

40 ml / Kg/ day

Answer

50 ml/ kg / day

Answer

30 ml / Kg/ day

Answer

60 ml/ kg / day

Question 6

A patient presents to the emergency department after sustaining blunt trauma to the left eye. Clinical examination reveals enophthalmos, diplopia on upward gaze, and periorbital ecchymosis. The CT scan image is shown below. What is your diagnosis?

Accepted Answer

Orbital blow out fracture

Answer

Oculomotor nerve paralysis

Answer

Retrobulbar hemorrhage

Answer

Orbital roof fracture

Question 7

False statement about Barrett esophagus is:

Accepted Answer

Columnar to squamous metaplasia

Answer

Chronic GERD is the predisposing factor

Answer

May lead to malignancy after few years

Answer

Goblet cells seen on histology

Question 8

Drug inhibiting granulocyte migration is:-

Accepted Answer

Colchicine

Answer

Montelukast

Answer

Cromoglycate

Answer

Felbamate

Question 9

Cilastatin is given in combination with Imipenem because:-

Accepted Answer

Cilastatin prevents degradation of Imipenem in kidney

Answer

Inhibits the enzymes that digest Imipenem in stomach

Answer

Reduces side effects of Imipenem

Answer

Cilastatin increases absorption of Imipenem

Question 10

A 75-year-old female has chronic backache. X-ray of the spine is shown. What is the most likely diagnosis?

Accepted Answer

Osteoporosis

Answer

Spondylodiscitis

Answer

Pott's spine

Answer

Spondylolisthesis

NEET-PG 2019

Anatomy

Anesthesiology

Biochemistry

Internal Medicine

Ophthalmology

Pathology

Pharmacology

Radiology