NEET-PG 2020 Practice Questions

Q: A 3-year-old boy presents with fever, throat pain, and difficulty swallowing. On examination, there is unilateral tonsillar swelling with deviation of the uvula. What is the most likely diagnosis?

Peritonsillar abscess. ***Peritonsillar abscess*** - This is the most common deep neck infection and typically presents with **unilateral tonsillar swelling**, **uvular deviation**, fever, and severe sore throat with difficulty swallowing (dysphagia) or speaking (muffled voice). - It usually develops as a complication of **acute tonsillitis**, where infection spreads from the tonsil into the peritonsillar space. *Parapharyngeal abscess* - While it can cause fever and severe throat pain, it typically presents with **trismus**, neck swelling below the angle of the mandible, and medial displacement of the lateral pharyngeal wall, rather than direct uvula deviation. - This type of abscess is located in the **parapharyngeal space**, which is lateral to the pharynx, and causes more diffuse swelling. *Ludwig's angina* - This is a rapidly spreading cellulitis of the **submandibular** and **sublingual spaces** and does not primarily involve the tonsils or cause uvular deviation. - Patients typically present with **symmetrical submental swelling**, painful swallowing, and tongue elevation, which can lead to airway obstruction. *Retropharyngeal abscess* - This abscess forms in the space behind the posterior pharyngeal wall and is more common in young children. - It often causes **neck stiffness**, muffled voice, stridor, and difficulty breathing, but less commonly presents with unilateral tonsillar swelling and uvular deviation.

Q: After a renal transplant, what is the most common opportunistic infection?

Cytomegalovirus (CMV). ***Cytomegalovirus (CMV)*** - **CMV** is the most common opportunistic infection after renal transplantation, particularly in the first 6 months due to immunosuppression [1]. - It can cause a range of clinical syndromes, including **fever**, **leukopenia**, **gastroenteritis**, **pneumonitis**, and **hepatitis**, and can also have indirect effects that increase the risk of graft rejection. *Varicella Zoster Virus (VZV)* - While VZV can cause opportunistic infections in transplant recipients (e.g., **shingles**), it is less common than CMV [1]. - VZV typically occurs later post-transplant and is characterized by a **vesicular rash** in a dermatomal distribution. *Coxsackie Virus* - **Coxsackie virus** infections are less frequently reported as significant opportunistic infections in renal transplant recipients compared to other viral pathogens. - They are generally associated with hand-foot-and-mouth disease, herpangina, or myocarditis, which are not the most common post-transplant complications. *Epstein-Barr Virus (EBV)* - **EBV** can cause post-transplant lymphoproliferative disorder (PTLD), which is a serious complication, but EBV infection itself is not the most common opportunistic infection overall [1]. - PTLD is more common in the first year after transplant and often presents with **lymphadenopathy**, **fever**, or **graft dysfunction**.

Q: What is the first line of treatment for osteoporosis in postmenopausal women?

Bisphosphonates. ***Bisphosphonates*** - **Bisphosphonates** are the **first-line therapy** for osteoporosis in postmenopausal women due to their proven efficacy in reducing the risk of fragility fractures [1]. - They work by inhibiting **osteoclast activity**, thereby decreasing bone resorption and increasing bone mineral density [1]. *Ulipristal* - **Ulipristal** is a **selective progesterone receptor modulator** primarily used as an emergency contraceptive or for the treatment of uterine fibroids. - It has no role in the direct treatment or prevention of osteoporosis. *Estrogen* - **Estrogen therapy** can prevent bone loss but is generally not considered first-line for osteoporosis due to potential risks like increased incidence of **venous thromboembolism**, stroke, and certain cancers [1]. - It is typically reserved for women with severe menopausal symptoms who also need osteoporosis prevention [1]. *Calcium and vitamin D supplementation* - While essential for **bone health**, **calcium and vitamin D supplementation** alone is not sufficient to treat established osteoporosis [2]. - They are crucial adjuncts to pharmacotherapy, ensuring adequate building blocks for bone formation, but do not directly address the underlying bone loss mechanism effectively enough as a monotherapy for osteoporosis [1].

Q: A 55 year old male presents with tachypnea and mental confusion. Blood glucose 350 mg/dl, pH = 7.0. What is the most likely acid base disorder?

Metabolic acidosis. Metabolic acidosis - A **pH of 7.0** indicates significant acidemia, and **hyperglycemia (350 mg/dL)** in conjunction with clinical symptoms (tachypnea, mental confusion) strongly suggests **diabetic ketoacidosis (DKA)**, a common cause of high anion gap metabolic acidosis [1]. - Tachypnea is often a **compensatory mechanism** (Kussmaul breathing) to blow off carbon dioxide and raise pH in metabolic acidosis [1], [2]. Metabolic alkalosis - This would present with an **elevated pH (alkalemia)**, which is opposite to the patient's measured pH of 7.0 [2]. - It is typically caused by conditions like severe vomiting or diuretic use, which are not suggested by the clinical presentation [3]. Respiratory alkalosis - This condition involves a **high pH** and a **low PCO2**, often due to hyperventilation [2]. - While the patient is tachypneic, the profound acidemia (pH 7.0) contradicts a primary respiratory alkalosis. Respiratory acidosis - While leading to a low pH, respiratory acidosis is characterized by **elevated PCO2** due to hypoventilation. - The patient's **tachypnea** indicates hyperventilation, which would tend to lower PCO2, making primary respiratory acidosis unlikely.

Q: A 29 year old male was brought to ED with complaints of nausea, vomiting and abdominal cramps 3-4 hours after eating meat at dinner. What is the likely cause of this condition?

Staphylococcus aureus. ***Staphylococcus aureus*** - The rapid onset of symptoms (3-4 hours) after eating meat, characterized by **nausea**, **vomiting**, and **abdominal cramps**, is highly suggestive of preformed toxin-mediated food poisoning, with **Staphylococcus aureus** being a common culprit. - *S. aureus* produces heat-stable enterotoxins that, when ingested, cause prompt gastrointestinal symptoms due to their direct irritant effect on the gut. *Clostridium perfringens* - This bacterium typically causes food poisoning with an incubation period of **8-16 hours** and symptoms primarily include **abdominal cramps** and **diarrhea**, with vomiting being less common. - Symptoms arise from toxins produced *in vivo* after spore ingestion, not preformed toxins, which leads to a longer incubation time. *Clostridium botulinum* - While *Clostridium botulinum* produces a potent neurotoxin, its food poisoning primarily manifests as **neurological symptoms** (e.g., flaccid paralysis, diplopia, dysphagia), not acute gastrointestinal upset like vomiting and cramps. - The incubation period is typically **12-36 hours**, longer than the reported 3-4 hours, and it is usually associated with improperly canned foods. *Salmonella Enteritidis* - *Salmonella* infections usually have a longer incubation period of **6 hours to 6 days**, and while they can cause nausea, vomiting, cramps, and diarrhea, the rapid onset in this case makes *S. aureus* more likely. - Infection typically leads to **inflammatory gastroenteritis**, sometimes with fever, which is not mentioned as a prominent symptom here.

Q: Why is citrate phosphate dextrose (CPD) better than acid citrate dextrose (ACD) for storage of blood?

Contains phosphate and dextrose. ***Contains phosphate and dextrose*** - CPD contains **phosphate**, which acts as a buffer and helps maintain crucial 2,3-bisphosphoglycerate (2,3-BPG) levels in red blood cells, improving oxygen delivery capacity. - The presence of **dextrose** provides a substrate for glycolysis, which is essential for ATP production and red blood cell viability during storage. - This combination allows CPD to extend blood storage life to approximately **35 days** compared to ACD's **21 days**. *Maintains pH stability during storage* - Both ACD and CPD help maintain pH stability due to their **citrate** content, which acts as an anticoagulant and buffer. - However, CPD's phosphate component offers superior buffering capacity, but pH maintenance alone is not the primary distinguishing advantage. - This is a shared characteristic of both solutions, not the key reason CPD is preferred. *Prevents hemolysis in stored blood* - Both CPD and ACD prevent hemolysis by chelating **calcium**, which prevents coagulation and maintains red blood cell integrity. - While both solutions successfully prevent hemolysis, this is not the distinguishing feature that makes CPD superior. - The primary advantage of CPD lies in its better support of red blood cell metabolism and viability through phosphate and dextrose. *Reduces metabolic activity in stored blood* - This is **incorrect** - the purpose of anticoagulant solutions is to preserve blood components, not to reduce metabolic activity. - The dextrose in CPD is provided precisely to **fuel essential metabolic activity** (glycolysis) to sustain red blood cells during storage. - While refrigeration at 1-6°C slows metabolism, CPD actively supports rather than reduces the metabolic processes necessary for RBC survival.

Q: Agent that acts through tyrosine kinase receptor is

Insulin. ***Insulin*** - **Insulin** binds to its receptor, which is a **tyrosine kinase receptor**, leading to autophosphorylation and the activation of intracellular signaling pathways. - This activation is crucial for glucose uptake and metabolism by various cells in the body. *MSH* - **Melanocyte-stimulating hormone (MSH)** acts primarily through **G protein-coupled receptors**, specifically melanocortin receptors. - These receptors activate adenylyl cyclase, leading to an increase in intracellular cAMP. *TSH* - **Thyroid-stimulating hormone (TSH)** also acts via a **G protein-coupled receptor** on thyroid follicular cells. - Its binding stimulates adenylyl cyclase, increasing cAMP and thus thyroid hormone synthesis and release. *TRH* - **Thyrotropin-releasing hormone (TRH)** binds to **G protein-coupled receptors** on pituitary thyrotrophs. - This interaction activates the phospholipase C pathway, leading to the release of TSH.

Question 1

Which vaccine protocol is recommended for health workers in disaster scenarios?

Accepted Answer

Tetanus toxoid, typhoid, and hepatitis A vaccines are recommended

Answer

Only routine immunization vaccines are needed

Answer

Cholera vaccine alone is sufficient for health workers

Answer

Tetanus toxoid alone provides adequate protection

Question 2

A 3-year-old boy presents with fever, throat pain, and difficulty swallowing. On examination, there is unilateral tonsillar swelling with deviation of the uvula. What is the most likely diagnosis?

Accepted Answer

Peritonsillar abscess

Answer

Parapharyngeal abscess

Answer

Ludwig's angina

Answer

Retropharyngeal abscess

Question 3

After a renal transplant, what is the most common opportunistic infection?

Accepted Answer

Cytomegalovirus (CMV)

Answer

Varicella Zoster Virus (VZV)

Answer

Coxsackie Virus

Answer

Epstein-Barr Virus (EBV)

Question 4

What is the first line of treatment for osteoporosis in postmenopausal women?

Accepted Answer

Bisphosphonates

Answer

Ulipristal

Answer

Estrogen

Answer

Calcium and vitamin D supplementation

Question 5

A 70-year-old man is having nasal regurgitation of fluids and hoarseness of voice. On sensory examination, numbness and loss of sensation over the left half of the face with impaired pain and temperature and contralateral pain and temperature loss of the body is noted. Motor examination shows left arm weakness, and cranial nerve examination shows a diminished gag reflex. Which of the following vessel thrombosis leads to this condition?

Accepted Answer

Posterior inferior cerebellar artery

Answer

Middle cerebral artery

Answer

Posterior cerebral artery

Answer

Anterior inferior cerebellar artery

Question 6

A 55 year old male presents with tachypnea and mental confusion. Blood glucose 350 mg/dl, pH = 7.0. What is the most likely acid base disorder?

Accepted Answer

Metabolic acidosis

Answer

Metabolic alkalosis

Answer

Respiratory alkalosis

Answer

Respiratory acidosis

Question 7

A 29 year old male was brought to ED with complaints of nausea, vomiting and abdominal cramps 3-4 hours after eating meat at dinner. What is the likely cause of this condition?

Accepted Answer

Staphylococcus aureus

Answer

Clostridium perfringens

Answer

Clostridium botulinum

Answer

Salmonella Enteritidis

Question 8

Why is citrate phosphate dextrose (CPD) better than acid citrate dextrose (ACD) for storage of blood?

Accepted Answer

Contains phosphate and dextrose

Answer

Maintains pH stability during storage

Answer

Prevents hemolysis in stored blood

Answer

Reduces metabolic activity in stored blood

Question 9

Agent that acts through tyrosine kinase receptor is

Accepted Answer

Insulin

Answer

MSH

Answer

TSH

Answer

TRH

Question 10

A patient is on follow-up for recurrent abdominal pain. USG reveals an aortic aneurysm of 40 mm. What should be the next immediate step?

Accepted Answer

Establish surveillance protocol with repeat imaging in 6-12 months.

Answer

Initiate medical management with beta-blockers.

Answer

Perform surgical intervention immediately.

Answer

Start antihypertensive therapy immediately.

NEET-PG 2020

Community Medicine

ENT

Internal Medicine

Microbiology

Pathology

Pharmacology

Surgery