NEET-PG 2013 Practice Questions

Q: Which of the following conditions is primarily treated with Vitamin B6?

Homocystinuria. ***Homocystinuria*** - The most common form of **homocystinuria** is caused by **cystathionine β-synthase (CBS) deficiency**, which requires **pyridoxal phosphate (Vitamin B6)** as a cofactor. - Approximately **50% of patients** with CBS deficiency are **B6-responsive**, making **high-dose Vitamin B6 (100-500 mg/day)** a **first-line primary treatment** for these cases. - This is a **clinically significant condition** that requires treatment, manifesting with features like **ectopia lentis, marfanoid habitus, intellectual disability, and thromboembolism**. - B6 supplementation enhances residual CBS enzyme activity and reduces plasma homocysteine levels. *Cystathionuria* - Caused by **cystathionine γ-lyase deficiency**, which also uses **Vitamin B6** as a cofactor. - This is generally a **benign, asymptomatic condition** that does **NOT require treatment**. - While B6 can reduce cystathionine accumulation, it is **not a primary treatment indication** because the condition is clinically insignificant. *Xanthurenic aciduria* - Caused by **kynureninase deficiency** in the **tryptophan metabolism pathway**, which requires **pyridoxal phosphate**. - This is a **rare and usually benign condition** that does not typically require treatment. - Not a primary indication for B6 therapy. *None of the options* - Incorrect, as **Homocystinuria** (CBS deficiency) is a **primary indication** for high-dose Vitamin B6 therapy in B6-responsive patients.

Q: What is the most common cause of an oroantral fistula?

Tooth extraction. ***Tooth extraction*** - Extrinsic trauma, particularly during the **extraction of maxillary posterior teeth**, is the most frequent cause of an oroantral fistula. - The close anatomical relationship between the **roots of maxillary molars and premolars** and the floor of the maxillary sinus makes this a common complication. *TB* - While tuberculosis can cause various oral and maxillofacial lesions, it is an **extremely rare cause** of oroantral fistulas. - TB lesions typically present as **ulcerations or granulomas**, rather than direct fistulous tracts to the sinus. *Penetrating injury* - Penetrating injuries can certainly cause communication between the oral cavity and the maxillary sinus, but they are **less common than tooth extractions** in their overall incidence. - Such injuries are usually associated with **trauma or foreign bodies**, which are not the primary mechanism for most oroantral fistulas. *Maxillary sinusitis* - Maxillary sinusitis can occasionally lead to bone erosion and communication with the oral cavity, but it is **not the most common etiology** for an oroantral fistula. - Sinusitis more often causes **symptoms such as facial pain, pressure, and discharge**, rather than a direct fistula as a primary presentation.

Q: Calciphylaxis is a severe life-threatening condition. Which of the following is most commonly associated with it?

End stage Renal disease. ***End stage Renal disease*** - Calciphylaxis frequently occurs in patients with **end-stage renal disease**, primarily associated with **secondary hyperparathyroidism** [1] and **calcium-phosphate imbalance**. - It leads to **cutaneous ischemia** and necrosis, often requiring aggressive management due to its high **mortality rate**. *Parathyroidectomy* - While parathyroidectomy may affect calcium levels, it is not directly linked to calciphylaxis. - Calciphylaxis more commonly develops due to underlying **chronic renal failure** [1] rather than surgical interventions. *Hyperthyroidism* - Hyperthyroidism primarily causes symptoms related to metabolism, **thyroid hormone excess**, and does not lead to calciphylaxis. - There is no direct correlation between hyperthyroid states and the pathophysiology of calciphylaxis. *Medullary carcinoma thyroid* - This condition involves **medullary thyroid carcinoma**, associated with calcitonin production and does not cause calciphylaxis. - Patients typically experience **thyroid-related symptoms** rather than the vascular complications seen in calciphylaxis.

Q: A diabetic patient presents with hyperkalemia and urinary pH < 5.5. What is the MOST likely underlying cause?

Type IV RTA. ***Type IV RTA*** - Patients with **diabetes mellitus** frequently develop **hyporeninemic hypoaldosteronism**, leading to Type IV RTA [1]. - This condition is characterized by **hyperkalemia** and **acidosis** with a paradoxically low urinary pH (typically < 5.5). *Uremia* - **Uremia** can cause hyperkalemia and acidosis, but it is a broader term for severe kidney failure and not the most specific underlying cause for the given urinary findings. - While patients with uremia can have aciduria, the combination of **diabetic hyperkalemia** and acid urine points more directly to a specific tubular defect. *Primary hyperaldosteronism* - **Primary hyperaldosteronism** is characterized by **hypertension**, **hypokalemia**, and metabolic alkalosis, which is the opposite of the patient's presentation [1]. - This condition involves excessive aldosterone production, leading to increased potassium excretion [1]. *Type I Renal tubular acidosis* - **Type I RTA** (distal RTA) is characterized by the inability to acidify urine, resulting in a **urinary pH > 5.5** despite systemic acidosis [1]. - While it can cause hypokalemia (due to increased distal K+ secretion) and acidosis, the elevated urinary pH is a key differentiating factor from this patient's presentation [1].

Q: Which Goldmann type is considered the standard in perimetry?

Goldmann type III (commonly used stimulus size). ***Goldmann type III (commonly used stimulus size)*** - This stimulus size is the **international standard** for kinetic perimetry and ensures comparability of visual field charts worldwide. - It provides a balance between **sensitivity** and minimizing the effects of **pupil size** and other ocular factors. *Goldmann type I (small stimulus size)* - While very small, this stimulus type is **not the standard** for general perimetry. - It is sometimes used for detecting **subtle defects** or for patients with very good visual acuity, but its small size can make it harder to detect. *Goldmann type II (medium-small stimulus size)* - This stimulus size is **smaller than the standard** and is not universally adopted for perimetry. - It offers slightly more sensitivity than the standard but can be more affected by **refractive errors** or media opacities. *Goldmann type IV (large stimulus size)* - This stimulus is **much larger than the standard** and is typically used for detecting **gross defects** or in patients with severely impaired vision. - Its large size makes it **less sensitive** to smaller visual field abnormalities.

Q: Which of the following is a specific sign of albinism?

Iris transillumination. ***Iris transillumination*** - This is a highly **specific sign** of albinism, resulting from the severe reduction or absence of pigment in the iris. - When light shines through the pupil, it passes through the unpigmented iris, creating a visible red reflex, indicating the lack of pigment that normally blocks the light. *Sensitivity to light (photophobia)* - While common in albinism due to the lack of pigment in the iris and retina allowing more light to enter the eye, **photophobia is not specific** to albinism. - It can be a symptom of various other ocular conditions like uveitis, corneal abrasions, or migraines. *Involuntary eye movements (nystagmus)* - **Nystagmus is frequently associated with albinism** due to foveal hypoplasia and impaired visual development but is **not specific**. - It can also be caused by neurological disorders, inner ear problems, or other ocular conditions. *Decreased visual acuity* - **Reduced vision is a characteristic feature of albinism** resulting from foveal hypoplasia and abnormal optic nerve pathways, but it is **not specific** to the condition. - Numerous eye conditions, such as refractive errors, cataracts, and retinal diseases, can lead to decreased visual acuity.

Q: What is the APGAR score for a baby that grimaces in response to stimulation?

1. ***1*** - A score of **1** is given for **grimace** in response to stimulation, indicating some reflex irritability but not a vigorous cry or sneeze. - This response shows a minimal protective reflex, suggesting the baby is not completely flaccid but also not optimally responsive. - The APGAR scoring for reflex irritability ranges from 0 to 2, with grimacing specifically scoring **1 point**. *0* - A score of **0** for reflex irritability is reserved for **no response** or **complete absence** of reflexes. - This would indicate a severely depressed neurological state, unlike the grimace observed. *2* - A score of **2** for reflex irritability is given for a **vigorous cry**, **sneeze**, **cough**, or **active withdrawal** from stimulation. - A grimace is a less robust response than these, thus not warranting a score of 2. *3* - The APGAR scoring system uses a **0-2 scale** for each of the five components (Appearance, Pulse, Grimace, Activity, Respiration). - The maximum score for any single component is **2**, making 3 an invalid score. - Total APGAR scores range from 0-10, but individual components never exceed 2.

Q: Which prostaglandin inhibitor is used in the treatment of patent ductus arteriosus (PDA)?

Indomethacin. ***Indomethacin*** - **Indomethacin** is a non-steroidal anti-inflammatory drug (**NSAID**) that inhibits **prostaglandin synthesis**, particularly **prostaglandin E2 (PGE2)**. - **PGE2** helps keep the **ductus arteriosus** open in utero; by inhibiting its production, indomethacin facilitates the closure of a **patent ductus arteriosus (PDA)** in neonates. *Misoprostol* - **Misoprostol** is a **prostaglandin E1 (PGE1) analog** and is used to induce labor, treat gastric ulcers, and for medical abortions. - It would work to **maintain** rather than close the **ductus arteriosus** if used in a neonate with a heart defect requiring patency. *Dinoprostone* - **Dinoprostone** is a **prostaglandin E2 analog** used for cervical ripening and labor induction. - It is not used for closing a **PDA**; its prostaglandin agonistic action would likely keep the **ductus arteriosus open**. *PGE-2* - **Prostaglandin E2 (PGE2)** is a naturally occurring prostaglandin that helps maintain the patency of the **ductus arteriosus** in the fetus. - Administering **PGE2** would keep the **ductus arteriosus open**, which is the opposite of the desired effect when treating a **PDA**.

Q: What is the treatment of choice for squamous cell anal cancer?

Chemoradiotherapy. ***Chemoradiotherapy*** - **Chemoradiotherapy** is the standard and most effective treatment for squamous cell anal cancer, offering high rates of **tumor control** and **anal sphincter preservation**. - This combined approach uses both **radiation** and **chemotherapy** (typically 5-fluorouracil and mitomycin-C) to enhance tumor cell killing and reduce recurrence. *Laser ablation* - **Laser ablation** is a minimally invasive technique generally reserved for very small, early-stage **superficial tumors** or **intraepithelial neoplasia**, not for invasive squamous cell anal cancer. - It does not address potential **lymph node involvement** or deliver the comprehensive treatment required for most anal cancers. *Abdominoperineal resection* - **Abdominoperineal resection (APR)** involves the surgical removal of the anus, rectum, and part of the sigmoid colon, leading to a permanent **colostomy**. - This is considered a **salvage therapy** for recurrent disease or for patients who have failed chemoradiotherapy, not a primary treatment. *Cisplatin-based chemotherapy* - While **cisplatin** can be used as a component of chemotherapy regimens for some cancers, it is not the primary single-agent or cornerstone chemotherapy for **squamous cell anal cancer**. - The standard chemotherapy regimen typically includes **5-fluorouracil** and **mitomycin-C** in combination with radiation.

Q: Which of the following stages of Breast Cancer corresponds to the following features: a breast mass of 6 x 3 cm, ipsilateral supraclavicular lymph node involvement, and distant metastasis that cannot be assessed?

T3 N3c MX. ***T3 N3c MX*** - A **breast mass of 6 x 3 cm** indicates a T3 tumor (tumor size > 5 cm). - **Ipsilateral supraclavicular lymph node involvement** is classified as N3c disease. **Distant metastasis that cannot be assessed** is denoted by MX. *T4 N3 MX* - A **T4 classification** is reserved for tumors with direct extension to the chest wall or skin, or inflammatory breast cancer, which is not mentioned here. - While N3c and MX are correct for the nodal and metastatic status, the T stage is inaccurate based on the provided tumor size. *T4 N1 M1* - A **T4 classification** is incorrect as the mass size alone (6 x 3 cm) does not meet T4 criteria. - **N1** denotes involvement of 1-3 axillary lymph nodes, which is less extensive than supraclavicular involvement (N3c). **M1** indicates confirmed distant metastasis, but the question states it "cannot be assessed" (MX). *T4 N0 M0* - **T4** is incorrect, as this stage is for direct chest wall/skin involvement or inflammatory breast cancer. - **N0** signifies no regional lymph node metastasis, contradicting the presence of supraclavicular lymph node involvement. **M0** indicates no distant metastasis, whereas the question specifies it cannot be assessed (MX).

Question 1

Which of the following conditions is primarily treated with Vitamin B6?

Accepted Answer

Homocystinuria

Answer

Cystathionuria

Answer

None of the options

Answer

Xanthourenic aciduria

Question 2

What is the most common cause of an oroantral fistula?

Accepted Answer

Tooth extraction

Answer

TB

Answer

Penetrating injury

Answer

Maxillary sinusitis

Question 3

Calciphylaxis is a severe life-threatening condition. Which of the following is most commonly associated with it?

Accepted Answer

End stage Renal disease

Answer

Parathyroidectomy

Answer

Medullary carcinoma thyroid

Answer

Hyperthyroidism

Question 4

A diabetic patient presents with hyperkalemia and urinary pH < 5.5. What is the MOST likely underlying cause?

Accepted Answer

Type IV RTA

Answer

Uremia

Answer

Primary hyperaldosteronism

Answer

Type I Renal tubular acidosis

Question 5

Which Goldmann type is considered the standard in perimetry?

Accepted Answer

Goldmann type III (commonly used stimulus size)

Answer

Goldmann type I (small stimulus size)

Answer

Goldmann type II (medium-small stimulus size)

Answer

Goldmann type IV (large stimulus size)

Question 6

Which of the following is a specific sign of albinism?

Accepted Answer

Iris transillumination

Answer

Sensitivity to light (photophobia)

Answer

Involuntary eye movements (nystagmus)

Answer

Decreased visual acuity

Question 7

What is the APGAR score for a baby that grimaces in response to stimulation?

Accepted Answer

1

Answer

0

Answer

2

Answer

3

Question 8

Which prostaglandin inhibitor is used in the treatment of patent ductus arteriosus (PDA)?

Accepted Answer

Indomethacin

Answer

PGE-2

Answer

Misoprostol

Answer

Dinoprostone

Question 9

What is the treatment of choice for squamous cell anal cancer?

Accepted Answer

Chemoradiotherapy

Answer

Laser ablation

Answer

Abdominoperineal resection

Answer

Cisplatin-based chemotherapy

Question 10

Which of the following stages of Breast Cancer corresponds to the following features: a breast mass of 6 x 3 cm, ipsilateral supraclavicular lymph node involvement, and distant metastasis that cannot be assessed?

Accepted Answer

T3 N3c MX

Answer

T4 N3 MX

Answer

T4 N1 M1

Answer

T4 N0 M0

NEET-PG 2013

Biochemistry

Dental

Internal Medicine

Ophthalmology

Pediatrics

Pharmacology

Surgery