NEET-PG 2020 Practice Questions

Q: Which of the following is a remnant of the Wolffian duct in females?

Gartner’s cyst. ***Gartner’s cyst*** - **Gartner's cysts** are remnants of the **Wolffian duct (mesonephric duct)** in females [3]. These ducts normally regress in females but can persist as vestigial structures [3]. - They typically present as cysts or small ducts along the lateral walls of the vagina or in the broad ligament [2], [3]. *Pouch of Douglas* - The **Pouch of Douglas (rectouterine pouch)** is a peritoneal recess located between the rectum and the uterus, not a remnant of the Wolffian duct [2]. - It is formed during development as the peritoneum drapes over the pelvic organs. *Uterovesical pouch* - The **uterovesical pouch** is a peritoneal reflection located between the uterus and the bladder, separate from the Wolffian duct remnants [1]. - Like the Pouch of Douglas, it is a normal anatomical space formed by the arrangement of the peritoneum in the pelvis. *Broad ligament* - The **broad ligament** is a wide fold of peritoneum that supports the uterus, fallopian tubes, and ovaries. It is not a remnant of the Wolffian duct itself, though Wolffian duct remnants (like Gartner's ducts) can sometimes be found within it [3]. - It serves as a mesentery for the reproductive organs, connecting them to the lateral walls of the pelvis.

Q: The difference between the incidence in the exposed and non-exposed group is best given by:

Attributable risk. ***Attributable risk*** - **Attributable risk** (AR), also known as risk difference, directly quantifies the absolute difference in disease incidence between an **exposed group** and an **unexposed group**. - It represents the amount of disease incidence (or risk) in the exposed group that is **directly attributable to the exposure**, assuming a causal relationship. *Population attributable risk* - **Population attributable risk** (PAR) measures the proportion of disease incidence in the **total population** that is attributable to the exposure. - It takes into account both the impact of the exposure and the **prevalence of the exposure** in the population, which is distinct from simply comparing exposed and non-exposed groups. *Odds ratio* - The **odds ratio** (OR) is a measure of association between an exposure and an outcome, representing the **odds of an outcome occurring in the exposed group** compared to the odds of it occurring in the unexposed group. - It does not directly express the difference in incidence but rather the **ratio of odds**, often used in case-control studies. *Relative risk* - **Relative risk** (RR), or risk ratio, is the ratio of the **incidence of an outcome in the exposed group** to the incidence in the unexposed group. - It indicates how many times more likely an exposed group is to develop the outcome compared to an unexposed group, expressing a **ratio rather than a difference**.

Q: The image of an immunoglobulin is shown below. Which type of immunoglobulin is it?

Immunoglobulin A (IgA). ***Immunoglobulin A (IgA)*** - The image depicts two Y-shaped immunoglobulin monomers linked by a central purple component, which represents the **J-chain**, and enveloped by a yellow structure, which represents the **secretory component**. This **dimeric** structure with a secretory component is characteristic of secretory IgA. - **Secretory IgA** is primarily found in mucosal secretions such as saliva, tears, breast milk, and gastrointestinal fluids, where it plays a crucial role in **mucosal immunity** by preventing pathogen adhesion. *Immunoglobulin G (IgG)* - IgG exists as a **monomer** (single Y-shaped unit) in its functional form. - It is the most abundant immunoglobulin in serum and plays a major role in **secondary immune responses** and can cross the placenta. *Immunoglobulin M (IgM)* - In serum, IgM typically exists as a **pentamer**, meaning five Y-shaped units are joined together by a J-chain, forming a star-like structure. - It is the first antibody produced in a **primary immune response** and is effective in complement activation. *Immunoglobulin E (IgE)* - IgE exists as a **monomer** and is primarily associated with **allergic reactions** and defense against parasites. - It binds to receptors on mast cells and basophils, triggering immune responses upon allergen exposure.

Q: Which of the following does not possess superantigen properties?

Vibrio cholerae. ***Vibrio cholerae*** - This bacterium is primarily known for producing **cholera toxin**, which acts on the **adenylate cyclase** pathway to cause severe watery diarrhea. - While it produces powerful toxins, these do not function as **superantigens**, meaning they do not directly bind to MHC class II and T-cell receptors outside the antigen-binding groove. *Streptococcal pyrogenic exotoxins* - These toxins, produced by **Streptococcus pyogenes**, are well-known **superantigens** that cause symptoms such as **scarlet fever** and **streptococcal toxic shock syndrome**. - They bind directly to MHC class II molecules and T-cell receptors, leading to widespread T-cell activation and massive cytokine release. *Staphylococcal enterotoxins* - Produced by **Staphylococcus aureus**, these toxins are a classic example of **superantigens**, causing symptoms such as **food poisoning** and **toxic shock syndrome**. - They bypass conventional antigen presentation, nonspecifically activating a large proportion of T cells and inducing a massive inflammatory response. *None of these* - This option is incorrect because *Vibrio cholerae* stands out as the organism among the choices that does not produce superantigens. - Both streptococcal pyrogenic exotoxins and staphylococcal enterotoxins are well-established superantigens.

Q: Which antibody is not transmitted from mother to baby?

IgA antibodies. ***IgA antibodies*** - While IgA is found in breast milk and provides **passive immunity** to the infant's gastrointestinal tract, it is **not transferred across the placenta** to the fetus. - This antibody has a larger molecular structure and is primarily involved in **mucosal immunity**, making it unsuitable for transplacental transfer. *Diphtheria IgG antibodies* - **IgG antibodies**, including those for diphtheria, are actively transported across the **placenta** from mother to fetus during the third trimester. - This transfer provides the newborn with **passive immunity** against diphtheria during the first few months of life. *Tetanus IgG antibodies* - Similar to diphtheria IgG, **tetanus IgG antibodies** are efficiently transported across the **placenta** from mother to baby. - This offers crucial **passive protection** against tetanus, particularly important after birth. *Measles IgG antibodies* - **Measles IgG antibodies** from a vaccinated or previously infected mother cross the **placenta** to the fetus. - This maternal transfer provides temporary **passive immunity** to the newborn against measles.

Q: What is the use of the instrument shown in the image?

Laparoscopic sterilization. ***Laparoscopic sterilization*** - The image depicts a **laparoscopic clip applicator**, specifically designed for placing clips on structures like the **fallopian tubes** during laparoscopic sterilization procedures. - This instrument is used to permanently occlude the fallopian tubes, preventing the passage of eggs and sperm for effective **contraception**. *Surgical removal of ectopic pregnancy* - While an ectopic pregnancy can be removed laparoscopically, the instrument shown is a **clip applicator**, not typically used for dissecting or excising tissue in such a procedure. - Surgical removal of an ectopic pregnancy often involves **laparoscopic salpingostomy** or **salpingectomy**, which require cutting, grasping, and coagulating instruments. *Induction of abortion* - **Abortion induction** is typically performed using medical methods (medications) or surgical procedures like **dilation and curettage (D&C)** or **manual vacuum aspiration (MVA)**, none of which involve the specific instrument shown. - This instrument is designed for **occlusion** rather than tissue removal related to abortion. *Creating pneumoperitoneum for laparoscopic procedures* - **Pneumoperitoneum** is created using a **Veress needle** to insufflate carbon dioxide into the abdominal cavity, providing a working space for laparoscopic instruments. - The instrument shown is a **clip applicator**, not a needle for gas insufflation.

Q: A 33-year-old man presents with a 5-week history of calf pain, swelling, and low-grade fever. Serum levels of creatinine kinase are elevated. A muscle biopsy reveals numerous eosinophils and he also has peripheral blood eosinophilia. Which of the following interleukins is primarily responsible for the increase in eosinophils in this patient?

IL-5. ***IL-5*** - **Interleukin-5 (IL-5)** is the **most potent and direct cytokine** responsible for the **differentiation, maturation, activation, and survival of eosinophils**. - IL-5 is produced primarily by **Th2 cells**, mast cells, and eosinophils themselves, and acts directly on eosinophil progenitors in the bone marrow. - In this patient with eosinophilic myositis (likely parasitic infection such as trichinosis), **IL-5 is the primary mediator** of the peripheral blood eosinophilia and tissue eosinophil infiltration. - **Clinical correlation:** Anti-IL-5 therapies (mepolizumab, reslizumab) are used to treat hypereosinophilic conditions, confirming IL-5's central role. *IL-4* - **Interleukin-4 (IL-4)** is produced by Th2 cells and mast cells and promotes the **differentiation of naive T cells into Th2 cells**. - While IL-4 initiates the Th2 immune response that eventually leads to IL-5 production, it does **not directly stimulate eosinophil production or recruitment**. - IL-4 is more involved in IgE class switching and allergic inflammation rather than direct eosinophil regulation. *IL-6* - **Interleukin-6 (IL-6)** is a pleiotropic cytokine involved in the **acute phase response**, inflammation, and hematopoiesis. - While it has broad effects on immune cells, it is **not primarily responsible** for eosinophil production or recruitment. - Elevated in many inflammatory conditions but not specific for eosinophilia. *IL-2* - **Interleukin-2 (IL-2)** is primarily involved in the **proliferation and differentiation of T lymphocytes** and activation of natural killer (NK) cells. - It plays no significant direct role in eosinophil production or recruitment. - More important for T cell-mediated immunity rather than eosinophilic responses.

Q: Which condition is characterized by conjunctival injection, pharyngeal injection, polymorphic rash, and cervical lymphadenopathy?

Kawasaki syndrome. ***Kawasaki syndrome*** - **Kawasaki syndrome** is characterized by a constellation of symptoms including **conjunctival injection**, **pharyngeal injection**, a **polymorphic rash**, and **cervical lymphadenopathy**, often described as the CRASH and burn criteria (Conjunctivitis, Rash, Adenopathy, Strawberry tongue, Hand/foot changes, and Fever). - It is an acute systemic vasculitis, primarily affecting young children, and without treatment, it can lead to **coronary artery aneurysms**. *Measles* - Measles is characterized by a maculopapular rash that typically starts on the face and spreads downwards (cephalocaudal), along with the presence of **Koplik spots** on the buccal mucosa. - While it presents with conjunctivitis and rash, the rash is not polymorphic in the same way as Kawasaki, and cervical lymphadenopathy is less prominent. *Scarlet fever* - **Scarlet fever** is caused by Group A Streptococcus and presents with pharyngitis, fever, and a characteristic **sandpaper-like erythematous rash** with circumoral pallor. - While it has pharyngeal involvement and rash, it lacks the **conjunctival injection** and **polymorphic nature of the rash** seen in Kawasaki syndrome. The rash is typically fine and blanching. - Cervical lymphadenopathy may be present but the overall constellation differs from Kawasaki. *Mumps* - Mumps is an acute viral infection primarily characterized by the swelling of the **parotid glands** (parotitis), often accompanied by fever, headache, and malaise. - It does not typically present with conjunctival injection, a polymorphic rash, or prominent cervical lymphadenopathy as seen in Kawasaki syndrome.

Q: A 35-year-old female experiences a tingling sensation in her arm after watching TV for long hours with her hands under her head. Which type of nerve fibers is most likely to be affected due to this position?

A-beta (Aβ) sensory nerve fibers. ***A-beta (Aβ) sensory nerve fibers*** - The tingling sensation (paresthesia) described is a classic symptom of **A-beta fiber compression**. - **A-beta fibers** are large, myelinated sensory fibers that transmit light touch, pressure, vibration, and proprioception. - These fibers are **most susceptible to mechanical compression** due to their position and structure. - Positioning the hands under the head for extended periods compresses superficial nerves, causing temporary A-beta fiber dysfunction, which manifests as the characteristic "pins and needles" sensation. *B-fibers (autonomic)* - **B-fibers** are preganglionic autonomic fibers that mediate visceral functions, such as organ control and glandular secretions. - Compression of these fibers would lead to symptoms related to autonomic dysfunction (e.g., changes in sweating, blood pressure), not a tingling sensation in the arm. *C-fibers (pain and temperature)* - **C-fibers** are unmyelinated fibers that transmit slow, dull, aching pain and contribute to temperature sensation. - They are **less susceptible to compression** than larger myelinated fibers. - The primary sensation described (tingling/paresthesia) is characteristic of large myelinated fiber (A-beta) dysfunction, not C-fiber involvement. *Sympathetic nerve fibers* - **Sympathetic nerve fibers** regulate involuntary functions like heart rate, blood pressure, and sweating. - Their compression would cause symptoms such as changes in skin temperature, altered sweating, or blood vessel constriction (Horner's syndrome if severe), not a tingling sensation.

Q: Identify the condition in the X-ray given below:

TOF. ***TOF*** - The chest X-ray shows a **boot-shaped heart (coeur en sabot)**, which is highly characteristic of **Tetralogy of Fallot** due to right ventricular hypertrophy and pulmonary artery hypoplasia. - There is also **reduced pulmonary vascular markings** (oligemia), indicating decreased blood flow to the lungs, a typical finding in TOF. *TGA* - Transposition of the Great Arteries (TGA) typically presents with a **"egg-on-a-string" appearance** on chest X-ray, characterized by a narrow mediastinum and cardiomegaly, which is not seen here. - Pulmonary vascularity can be increased or normal in TGA, unlike the decreased vascularity observed in the image. *TAPVC* - Total Anomalous Pulmonary Venous Connection (TAPVC) usually shows a **"snowman" or "figure-of-8" heart** shadow on chest X-ray, due to enlarged SVC and innominate vein. - This condition is also associated with **increased pulmonary vascular markings** and often cardiomegaly, which are absent in the provided image. *Ebstein's anomaly* - Ebstein's anomaly is characterized by a **massively enlarged heart** on chest X-ray due to right atrial enlargement and tricuspid regurgitation. - It often shows **reduced pulmonary vascular markings** due to functional pulmonary stenosis, but the characteristic "boot shape" is not typically present.

Question 1

Which of the following is a remnant of the Wolffian duct in females?

Accepted Answer

Gartner’s cyst

Answer

Pouch of Douglas

Answer

Uterovesical pouch

Answer

Broad ligament

Question 2

The difference between the incidence in the exposed and non-exposed group is best given by:

Accepted Answer

Attributable risk

Answer

Population attributable risk

Answer

Odds ratio

Answer

Relative risk

Question 3

The image of an immunoglobulin is shown below. Which type of immunoglobulin is it?

Accepted Answer

Immunoglobulin A (IgA)

Answer

Immunoglobulin G (IgG)

Answer

Immunoglobulin M (IgM)

Answer

Immunoglobulin E (IgE)

Question 4

Which of the following does not possess superantigen properties?

Accepted Answer

Vibrio cholerae

Answer

Staphylococcal enterotoxins

Answer

Streptococcal pyrogenic exotoxins

Answer

None of these

Question 5

Which antibody is not transmitted from mother to baby?

Accepted Answer

IgA antibodies

Answer

Tetanus IgG antibodies

Answer

Diphtheria IgG antibodies

Answer

Measles IgG antibodies

Question 6

What is the use of the instrument shown in the image?

Accepted Answer

Laparoscopic sterilization

Answer

Surgical removal of ectopic pregnancy

Answer

Induction of abortion

Answer

Creating pneumoperitoneum for laparoscopic procedures

Question 7

A 33-year-old man presents with a 5-week history of calf pain, swelling, and low-grade fever. Serum levels of creatinine kinase are elevated. A muscle biopsy reveals numerous eosinophils and he also has peripheral blood eosinophilia. Which of the following interleukins is primarily responsible for the increase in eosinophils in this patient?

Accepted Answer

IL-5

Answer

IL-4

Answer

IL-6

Answer

IL-2

Question 8

Which condition is characterized by conjunctival injection, pharyngeal injection, polymorphic rash, and cervical lymphadenopathy?

Accepted Answer

Kawasaki syndrome

Answer

Measles

Answer

Scarlet fever

Answer

Mumps

Question 9

A 35-year-old female experiences a tingling sensation in her arm after watching TV for long hours with her hands under her head. Which type of nerve fibers is most likely to be affected due to this position?

Accepted Answer

A-beta (Aβ) sensory nerve fibers

Answer

B - fibers (autonomic)

Answer

C - fibers (pain and temperature)

Answer

Sympathetic nerve fibers

Question 10

Identify the condition in the X-ray given below:

Accepted Answer

TOF

Answer

TGA

Answer

TAPVC

Answer

Ebstein's anomaly

NEET-PG 2020

Anatomy

Community Medicine

Microbiology

Obstetrics and Gynecology

Pathology

Pediatrics

Physiology

Radiology