NEET-PG 2019 Practice Questions

Q: Joint involved in movement of head from left to right.

Atlanto axial. ***Atlanto axial*** - The **atlantoaxial joint** is responsible for the **rotation of the head**, allowing for movements such as shaking the head "no." - This joint is a **pivot joint** formed between the atlas (C1 vertebra) and the axis (C2 vertebra), specifically the **dens** of the axis articulating with the anterior arch of the atlas. *Atlanto occipital* - The **atlanto-occipital joint** primarily facilitates **flexion and extension of the head** (nodding "yes" movement). - This joint connects the **atlas (C1)** to the **occipital bone** of the skull. *C2- C3 Joint* - The **C2-C3 joint** is a typical **intervertebral joint** in the cervical spine. - While it contributes to overall cervical spine mobility, it does not primarily mediate the **rotational movement** of the head. *C3- C4 Joint* - The **C3-C4 joint** is another **intervertebral joint** in the cervical spine. - Its main roles include some degree of **flexion, extension, and lateral bending**, but it is not the primary joint for head rotation.

Q: In Krebs cycle and Urea cycle the linking amino acid is

Aspartate. ***Aspartate*** - **Aspartate** acts as the crucial amino acid link between the two cycles - In the urea cycle, aspartate condenses with citrulline to form **argininosuccinate** (via argininosuccinate synthetase) - When argininosuccinate is cleaved, it produces **fumarate**, which enters the Krebs cycle - In the Krebs cycle, fumarate is converted to malate, then to **oxaloacetate**, which can be transaminated back to aspartate - This creates the **aspartate-argininosuccinate shunt**, linking both cycles through nitrogen metabolism *Fumarate* - While **fumarate** is a key metabolic intermediate connecting both cycles, it is **not an amino acid** (it's a dicarboxylic acid) - It is produced in the urea cycle from argininosuccinate cleavage and feeds into the Krebs cycle - This is a common distractor since fumarate does link the cycles, but the question specifically asks for an amino acid *Alanine* - **Alanine** participates in the glucose-alanine cycle for nitrogen transport from muscle to liver - It does not directly link the Krebs cycle and urea cycle in the same manner as aspartate *Arginine* - **Arginine** is a urea cycle intermediate that is cleaved by arginase to produce urea and ornithine - While it's an amino acid in the urea cycle, it does not serve as the linking amino acid between the Krebs cycle and urea cycle

Q: Rubella virus belongs to which family?

Togavirus. ***Togavirus*** - The **Rubella virus** is categorized under the family **Togaviridae**, specifically within the genus *Rubivirus*. - This classification is based on its genetic structure, being an **enveloped, positive-sense, single-stranded RNA virus**. *Rheovirus* - **Reoviruses** are characterized by a **double-stranded segmented RNA genome** and are typically non-enveloped. - This contrasts with Rubella's single-stranded, non-segmented RNA and enveloped structure. *Picornavirus* - **Picornaviruses** are a family of **non-enveloped, positive-sense, single-stranded RNA viruses** that are structurally different from Rubella. - Examples include species like **poliovirus** and **rhinovirus**, which do not share the distinct biological properties of Rubella. *Orthomyxovirus* - **Orthomyxoviruses** are a family of **enveloped, negative-sense, segmented RNA viruses**, which includes influenza viruses. - Their genomic organization and replication strategy are fundamentally different from those of the Rubella virus.

Q: What are Gitter cells?

Modified macrophages in the CNS. ***Modified macrophages in CNS*** - Gitter cells are **modified macrophages** that have phagocytized lipid and other debris in the central nervous system (CNS), particularly in response to injury or disease [1][2]. - They play a crucial role in **cleaning up cellular debris** and are involved in the inflammatory response within the CNS [2]. *Macroglia* - Macroglia refers to **supportive cells** in the CNS, including astrocytes and oligodendrocytes, rather than being specifically modified macrophages. - It does not specifically describe the **phagocytic role** characteristic of Gitter cells. *Oligodendrocytes* - Oligodendrocytes primarily function to **myelinate axons** in the CNS and do not possess the same phagocytic capabilities as Gitter cells. - They are involved in **insulation** of neuronal axons rather than debris clearance. *Astrocytes* - Astrocytes are the principal **supportive glial cells** in the CNS and do not exhibit the characteristics of Gitter cells. - Their functions include **maintaining blood-brain barrier**, regulating blood flow, and supporting neuronal metabolism, not phagocytosis. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Peripheral Nerves and Skeletal Muscles, pp. 1255-1256. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 697-698.

Q: Which among the following is most probable reason for preference of Cisatracurium over atracurium?

Decreased histamine release. ***Decreased histamine release*** - **Cisatracurium** is preferred over atracurium primarily due to its significantly **lower potential for histamine release**, which can cause undesirable side effects like **hypotension**, **tachycardia**, and **bronchospasm**. - This reduced histamine release contributes to a **more stable hemodynamic profile** and **fewer allergic-type reactions**, especially in critically ill or hemodynamically unstable patients. *Increased histamine release* - This is incorrect because **atracurium** is known to cause **more histamine release** compared to cisatracurium, which is why cisatracurium is often preferred. - Increased histamine release is an **undesirable effect** that can lead to adverse cardiovascular and respiratory reactions. *Decreased CNS toxicity* - While both drugs are **quaternary ammonium compounds** and do not readily cross the blood-brain barrier, **CNS toxicity** is not a primary concern or differentiating factor between atracurium and cisatracurium in clinical practice. - The potential for CNS effects from their metabolites (like **laudanosine**) is generally low with standard dosing, and **cisatracurium produces less laudanosine**. *Due to elimination by non-specific plasma esterases* - Both cisatracurium and atracurium are eliminated primarily by **Hofmann elimination** and **non-specific plasma esterases**. This is a shared characteristic, not a reason for cisatracurium's preference over atracurium. - **Hofmann elimination** is a non-enzymatic chemical degradation process that occurs at physiological pH and temperature, making their elimination **independent of renal or hepatic function**.

Q: What is the drug of choice (DOC) for a scorpion sting bite?

Prazosin. ***Prazosin*** - **Prazosin** is an **alpha-1 adrenergic antagonist** that effectively counteracts the symptoms of scorpion envenomation, particularly **autonomic hyperactivity** like hypertension and tachycardia. - It works by blocking the effects of norepinephrine released by the scorpion venom, helping to stabilize vital signs and reduce cardiovascular complications. *EDTA* - **EDTA (ethylenediaminetetraacetic acid)** is a **chelating agent** primarily used to treat **heavy metal poisoning**, such as lead or mercury. - It binds to metal ions, forming a stable complex that can then be excreted from the body; it has no role in scorpion envenomation. *Neostigmine* - **Neostigmine** is an **acetylcholinesterase inhibitor** used to treat conditions like myasthenia gravis or to reverse the effects of neuromuscular blocking agents. - It increases acetylcholine levels at the neuromuscular junction; it is not indicated for the management of scorpion stings. *N-acetylcysteine* - **N-acetylcysteine (NAC)** is primarily used as an **antidote for acetaminophen overdose** and as a mucolytic agent in respiratory conditions. - It replenishes glutathione stores, helping to detoxify harmful metabolites; it has no direct role in treating scorpion venom effects.

Q: Which of the following drugs is used in SIADH?

Tolvaptan. ***Tolvaptan*** - **Tolvaptan** is a **vasopressin receptor antagonist** that blocks the action of **antidiuretic hormone (ADH)** at the **V2 receptors** in the kidneys [1]. - This action promotes **water excretion (aquaresis)** without significantly affecting electrolyte balance, thereby increasing serum sodium levels in patients with **SIADH** [1]. *Desmopressin* - **Desmopressin** is a synthetic analog of **ADH** that primarily acts on **V2 receptors**, promoting water reabsorption [3], [4]. - It is used in conditions like **diabetes insipidus** [3], [4] or **hemophilia** [2] to increase ADH activity or clotting factors, which is contrary to the goal in SIADH. *Von Willebrand factor* - **Von Willebrand factor** is a **glycoprotein** involved in **hemostasis**, promoting platelet adhesion and carrying **factor VIII**. - It plays no role in the direct management of **SIADH** or fluid balance disorders. *Terlipressin* - **Terlipressin** is an analog of **vasopressin** that primarily acts on **V1 receptors**, causing vasoconstriction [5]. - It is used in conditions like **hepatorenal syndrome** or **esophageal variceal bleeding**, not for treating **SIADH**.

Q: Carbapenem which has a tendency to cause maximum seizures?

Imipenem. ***Imipenem*** - **Imipenem** is associated with the highest risk of **seizures** among the carbapenems, particularly in patients with **renal impairment**, pre-existing **CNS disorders**, or high doses. - Its high affinity for **GABA-A receptors** in the central nervous system is thought to contribute to its proconvulsant effects. *Ertapenem* - While all carbapenems carry some risk of seizures, **ertapenem** has a **lower incidence** compared to imipenem. - It is often favored in patients without CNS infections or severe renal dysfunction due to its once-daily dosing. *Doripenem* - **Doripenem** also has a relatively **low risk of seizures** compared to imipenem. - It is generally well-tolerated, with side effects similar to other carbapenems but at a reduced frequency for CNS events. *Meropenem* - **Meropenem** is known to have a **lower seizure potential** than imipenem, making it a preferred choice for patients with a history of seizures or those with CNS infections. - Its **reduced affinity** for GABA-A receptors contributes to its better CNS tolerability.

Q: Vasopressin acts through which aquaporin channels in the collecting duct?

Aquaporin 2. ***Aquaporin 2*** - Vasopressin (ADH) stimulates the insertion of **Aquaporin 2 (AQP2)** channels into the apical membrane of collecting duct cells, increasing water reabsorption. - This process is crucial for the kidney's ability to concentrate urine and maintain **water balance**. *Aquaporin 1* - **Aquaporin 1 (AQP1)** is predominantly found in the proximal tubules and descending limb of the loop of Henle, where **constitutive water reabsorption** occurs, independent of vasopressin. - It plays a role in bulk water reabsorption rather than regulated fine-tuning. *Aquaporin 3* - **Aquaporin 3 (AQP3)** is located on the **basolateral membrane** of collecting duct cells, facilitating the exit of water from the cell into the interstitial fluid. - While essential for water movement, its insertion into the membrane is **not directly regulated by vasopressin** in the same way as AQP2. *Aquaporin 4* - **Aquaporin 4 (AQP4)** is also found on the **basolateral membrane** of collecting duct cells and in other tissues like the brain. - Similar to AQP3, it allows water to leave the cell but is not the primary target for vasopressin-mediated regulation of water permeability.

Q: Tubuloglomerular feedback control is useful for which one of the following?

GFR. ***GFR*** - **Tubuloglomerular feedback (TGF)** is a critical autoregulatory mechanism that maintains a relatively constant **glomerular filtration rate (GFR)** despite fluctuations in arterial blood pressure. - The **macula densa** cells at the end of the thick ascending limb of the loop of Henle sense the **volume** and **sodium chloride concentration** of the tubular fluid and release paracrine factors to adjust afferent arteriolar resistance. *Plasma sodium* - While TGF senses the **sodium chloride concentration** in the filtrate, its primary role is to regulate GFR, not directly control systemic plasma sodium levels. - Plasma sodium is primarily regulated by hormones like **ADH** and **aldosterone**, which influence water reabsorption and sodium excretion. *Plasma volume* - **Plasma volume** is regulated predominantly by hormonal mechanisms (e.g., **renin-angiotensin-aldosterone system**, **ADH**, **ANP**) and control over overall sodium and water balance, rather than by the acute, intrinsic GFR regulation of TGF. - Changes in plasma volume can indirectly affect GFR, but TGF is not the direct control mechanism for plasma volume itself. *Determining tubular secretion* - **Tubular secretion** is the process by which solutes are actively transported from the peritubular capillaries into the tubular lumen. - TGF influences **glomerular filtration**, not directly the rates of tubular secretion, which are regulated by specific transport proteins and physiological needs.

Question 1

Joint involved in movement of head from left to right.

Accepted Answer

Atlanto axial

Answer

Atlanto occipital

Answer

C2- C3 Joint

Answer

C3- C4 Joint

Question 2

In Krebs cycle and Urea cycle the linking amino acid is

Accepted Answer

Aspartate

Answer

Fumarate

Answer

Alanine

Answer

Arginine

Question 3

Rubella virus belongs to which family?

Accepted Answer

Togavirus

Answer

Orthomyxovirus

Answer

Rheovirus

Answer

Picornavirus

Question 4

What are Gitter cells?

Accepted Answer

Modified macrophages in the CNS

Answer

Microglia

Answer

Astrocytic cells

Answer

Oligodendrocytic cells

Question 5

Which among the following is most probable reason for preference of Cisatracurium over atracurium?

Accepted Answer

Decreased histamine release

Answer

Increased histamine release

Answer

Decreased CNS toxicity

Answer

Due to elimination by non-specific plasma esterases

Question 6

What is the drug of choice (DOC) for a scorpion sting bite?

Accepted Answer

Prazosin

Answer

EDTA

Answer

Neostigmine

Answer

N-acetylcysteine

Question 7

Which of the following drugs is used in SIADH?

Accepted Answer

Tolvaptan

Answer

Desmopressin

Answer

Terlipressin

Answer

Von Willebrand factor

Question 8

Carbapenem which has a tendency to cause maximum seizures?

Accepted Answer

Imipenem

Answer

Ertapenem

Answer

Doripenem

Answer

Meropenem

Question 9

Vasopressin acts through which aquaporin channels in the collecting duct?

Accepted Answer

Aquaporin 2

Answer

Aquaporin 1

Answer

Aquaporin 4

Answer

Aquaporin 3

Question 10

Tubuloglomerular feedback control is useful for which one of the following?

Accepted Answer

GFR

Answer

Plasma sodium

Answer

Plasma volume

Answer

Determining tubular secretion

NEET-PG 2019

Anatomy

Biochemistry

Microbiology

Pathology

Pharmacology

Physiology