NEET-PG 2015 Practice Questions

Q: Intercalated disc is present in:

Cardiac muscle. ***Cardiac muscle*** - **Intercalated discs** are unique structures found only in cardiac muscle, forming specialized cell-cell junctions [1]. - These discs contain **gap junctions** for electrical coupling and **desmosomes** for strong adhesion, allowing the heart muscle to contract in a coordinated fashion. *Smooth muscle* - **Smooth muscle cells** are spindle-shaped and lack striations and organized sarcomeres. - They do not possess intercalated discs; instead, communication and coordination are often mediated by **gap junctions** scattered along the cell membranes [2]. *Skeletal muscle* - **Skeletal muscle cells** are long, multinucleated, and highly organized with prominent striations [3]. - They do not have intercalated discs as individual muscle fibers are innervated separately and generally do not directly communicate via specialized junctions for coordinated contraction. *All of the options* - As **intercalated discs** are characteristic features *only* of **cardiac muscle**, this option is incorrect. - Their presence in all three muscle types would contradict the specific cellular organization of smooth and skeletal muscle.

Q: Which is an inhibitor of ferrochelatase ?

Lead. ***Lead*** - **Lead** is a potent environmental toxin that directly inhibits the enzyme **ferrochelatase**, preventing the insertion of **iron** into **protoporphyrin IX** to form heme. - This inhibition leads to the accumulation of **protoporphyrin IX** and can cause **anemia** due to impaired **heme synthesis**. *Mercury* - While **mercury** is a heavy metal and neurotoxin, its primary mechanism of toxicity does not involve direct inhibition of **ferrochelatase**. - Its effects are more commonly associated with protein denaturation and enzyme inactivation through binding with **sulfhydryl groups**. *Iron* - **Iron** is a substrate for **ferrochelatase**, not an inhibitor. **Ferrochelatase** catalyzes the insertion of **iron** into **protoporphyrin IX** to complete the synthesis of **heme**. - Deficiencies or excesses of **iron** can affect **heme synthesis**, but **iron** itself does not inhibit the enzyme in a toxic manner. *Arsenic* - **Arsenic** is a metalloid that is toxic through various mechanisms, including interference with cellular respiration and DNA repair. - However, **arsenic** is not known to be a direct inhibitor of **ferrochelatase** in the same way **lead** is.

Q: Which of the following proteins is primarily responsible for marking other proteins for degradation?

Ubiquitin. **Ubiquitin** - **Ubiquitin** is a small regulatory protein that marks proteins for degradation by targeting them to the **proteasome**. - The ubiquitination process involves a cascade of enzymes (E1, E2, E3) that sequentially attach ubiquitin to the target protein, forming a **polyubiquitin chain**. *RNAse* - **RNAse** (Ribonuclease) is an enzyme that catalyzes the degradation of **RNA into smaller components**. - Its primary function is in **RNA processing** and turnover, not protein degradation. *Zymase* - **Zymase** is a complex of enzymes that catalyzes the **fermentation of sugar into ethanol and carbon dioxide**. - It is commonly found in yeast and is essential for **alcoholic fermentation**, with no role in protein degradation. *Chaperone* - **Chaperone proteins** assist in the **folding of newly synthesized proteins** and the refolding of misfolded or denatured proteins. - Their role is to ensure proper protein structure and function, preventing aggregation, rather than marking proteins for destruction.

Q: What is the mechanism of conversion of trypsinogen to trypsin?

Removal of part of protein. ***Removal of part of protein*** - The conversion of **trypsinogen to trypsin** is an example of **proteolytic activation**, where a specific part of the inactive precursor (zymogen) is cleaved off. - This cleavage occurs at the N-terminus of trypsinogen by **enteropeptidase (or enterokinase)** in the duodenum, exposing the active site and forming active trypsin. *Hydrolysis* - While the removal of a part of the protein involves **hydrolysis of peptide bonds**, this option is too general. - It does not specify the selective nature of the cleavage that leads to activation, nor the fact that it's a specific segment being removed. *Phosphorylation* - **Phosphorylation** is a common mechanism for regulating enzyme activity, but it involves the addition of a **phosphate group**, not the removal of a protein segment. - This process is typically mediated by kinases and does not activate trypsinogen. *Removal of Carboxyl group* - The activation of trypsinogen involves the removal of a small N-terminal peptide, not specifically the removal of a **carboxyl group** from the protein. - While enzymatic cleavage does involve breaking peptide bonds, stating "removal of carboxyl group" is imprecise and does not accurately describe the mechanism.

Q: What is an atypical side effect of montelukast?

Churg-Strauss syndrome. ***Churg-Strauss syndrome*** - The apparent development of **Churg-Strauss syndrome** (eosinophilic granulomatosis with polyangiitis) has been reported in patients treated with montelukast, although it is believed to be related more to the unmasking of the disease rather than a direct drug effect. - This typically occurs when **corticosteroids** are tapered or withdrawn as montelukast takes over, revealing the underlying vasculitis. *Goodpasture syndrome* - **Goodpasture syndrome** is an autoimmune disease causing rapidly progressive glomerulonephritis and pulmonary hemorrhage, characterized by anti-glomerular basement membrane (GBM) antibodies. - There is no established association between montelukast use and the development of Goodpasture syndrome. *Membranous glomerulonephritis* - **Membranous glomerulonephritis** is a common cause of nephrotic syndrome, characterized by immune complex deposition on the glomerular basement membrane. - This condition is not typically linked to the use of montelukast. *Bronchial asthma* - **Bronchial asthma** is the condition montelukast is used to treat, acting as a leukotriene receptor antagonist to reduce inflammation and bronchoconstriction. - It is a primary indication for the drug, not a side effect.

Q: Which of the following combinations does not show synergistic action?

Penicillin plus tetracycline. ***Penicillin plus tetracycline*** - This combination is generally **antagonistic** or **indifferent**, not synergistic. Penicillin is a cell wall synthesis inhibitor that works best on actively growing bacteria, while tetracycline is a bacteriostatic protein synthesis inhibitor that can reduce bacterial growth, thereby diminishing penicillin's effect. - The combination is usually avoided as the **bacteriostatic action of tetracycline** can counteract the **bactericidal action of penicillin**, leading to reduced efficacy, especially in infections requiring rapid bacterial clearance. *Penicillin plus sulfonamide* - This combination can show synergism in some contexts, particularly as sulfonamides inhibit **folate synthesis**, while penicillin inhibits **cell wall synthesis**. - While not a classic synergistic pair for all infections, their mechanisms of action are distinct, and they can sometimes be used together, although specific synergistic effects are more limited compared to other pairs. *Streptomycin plus penicillin* - This is a classic example of **synergistic action**, particularly in conditions like **enterococcal endocarditis**. - Penicillin damages the bacterial cell wall, allowing **streptomycin** (an aminoglycoside) to more easily penetrate the cell and act on ribosomal targets, leading to enhanced bactericidal effect. *Rifampicin plus dapsone* - This combination is a cornerstone of **multi-drug therapy for leprosy**, demonstrating clear synergy against *Mycobacterium leprae*. - **Rifampicin** inhibits bacterial RNA synthesis, and **dapsone** inhibits folate synthesis, attacking different essential bacterial pathways which, when combined, are more effective and reduce the development of resistance.

Q: Which of the following agents requires the MOST caution when combined with spironolactone due to increased risk of hyperkalemia:

ACE inhibitors. ***ACE inhibitors*** - Spironolactone is a **potassium-sparing diuretic** that increases potassium levels by blocking aldosterone's effects in the collecting duct [1]. - **ACE inhibitors** also decrease aldosterone production [2], leading to reduced potassium excretion and a significant risk of **severe hyperkalemia** when combined with spironolactone [1, 2].*Beta-blockers* - While beta-blockers can cause a slight increase in plasma potassium by inhibiting cellular potassium uptake, this effect is generally modest and does not pose a major hyperkalemia risk when co-administered with spironolactone. - Their primary interaction concerns blood pressure and heart rate, not direct potassium handling.*Amlodipine* - Amlodipine is a **calcium channel blocker** that primarily causes vasodilation and does not significantly alter potassium balance. - Therefore, it does not substantially increase the risk of hyperkalemia when used concurrently with spironolactone.*Chlorothiazide* - Chlorothiazide is a **thiazide diuretic** that promotes potassium excretion, leading to a risk of hypokalemia. - When combined with spironolactone, a potassium-sparing diuretic, these agents can **partially offset each other's effects** on potassium balance, potentially reducing the risk of hyperkalemia compared to ACE inhibitors.

Q: What is the normal O2 extraction ratio of tissues?

25 percent. ***25 percent*** - The normal **O2 extraction ratio** (or **oxygen utilization coefficient**) is approximately 25%, meaning tissues extract about one-fourth of the oxygen delivered by arterial blood. - This ratio is crucial for understanding **tissue oxygenation** and can increase significantly during times of high metabolic demand, such as exercise. *5 percent* - An O2 extraction ratio of 5% is **too low** for normal physiological function, indicating that tissues are receiving much more oxygen than they are utilizing. - Such a low ratio would be seen only in situations of **excessive oxygen delivery** or **severely reduced metabolic demand**. *15 percent* - While 15% represents some oxygen extraction, it is **below the normal physiological range** for resting tissues. - An extraction ratio of 15% would mean the tissues are not extracting sufficient oxygen to meet their typical metabolic needs efficiently. *40 percent* - An O2 extraction ratio of 40% is **higher than the normal resting value** and suggests increased oxygen demand by the tissues. - This level of extraction is typically seen during **strenuous exercise** or in conditions of **reduced oxygen delivery** where tissues compensate by extracting more oxygen from available blood.

Q: Lower esophageal sphincter pressure is increased by all of the following substances, EXCEPT:

Secretin. ***Secretin*** - **Secretin** is a gastrointestinal hormone that *decreases* lower esophageal sphincter (LES) pressure - This hormone is released from S cells in the duodenum in response to acidic chyme - Its primary role is to stimulate the pancreas to release **bicarbonate-rich fluid** to neutralize acidic chyme entering the duodenum - By decreasing LES pressure, it facilitates the passage of gastric contents into the duodenum during digestion *Gastrin* - **Gastrin** is a hormone that *increases* lower esophageal sphincter (LES) pressure - This helps prevent gastroesophageal reflux when the stomach is distended - It also stimulates the secretion of **gastric acid** by parietal cells in the stomach - Released from G cells in the gastric antrum in response to protein ingestion *Motilin* - **Motilin** is a peptide hormone that *increases* lower esophageal sphincter (LES) pressure - It initiates the **migrating motor complex (MMC)** during the interdigestive period - Stimulates gastric and intestinal motility - Released from M cells in the duodenum and jejunum *Substance P* - **Substance P** is a neuropeptide that *increases* lower esophageal sphincter (LES) pressure - Functions as both a neurotransmitter and neuromodulator in the enteric nervous system - Plays a role in **smooth muscle contraction** and gastrointestinal motility - Also involved in pain transmission and inflammatory responses

Question 1

Intercalated disc is present in:

Accepted Answer

Cardiac muscle

Answer

Smooth muscle

Answer

Skeletal muscle

Answer

All of the options

Question 2

Which is an inhibitor of ferrochelatase ?

Accepted Answer

Lead

Answer

Mercury

Answer

Iron

Answer

Arsenic

Question 3

Which of the following proteins is primarily responsible for marking other proteins for degradation?

Accepted Answer

Ubiquitin

Answer

RNAse

Answer

Zymase

Answer

Chaperone

Question 4

What is the mechanism of conversion of trypsinogen to trypsin?

Accepted Answer

Removal of part of protein

Answer

Hydrolysis

Answer

Phosphorylation

Answer

Removal of Carboxyl group

Question 5

What is defined as a negative autopsy?

Accepted Answer

No cause of death is found after both gross and histopathological examination.

Answer

Cause is apparent on gross examination but not on histopathological examination.

Answer

Gross findings are minimal.

Answer

Cause is apparent on gross examination but not found due to constraints on the part of the doctor.

Question 6

What is an atypical side effect of montelukast?

Accepted Answer

Churg-Strauss syndrome

Answer

Goodpasture syndrome

Answer

Membranous glomerulonephritis

Answer

Bronchial asthma

Question 7

Which of the following combinations does not show synergistic action?

Accepted Answer

Penicillin plus tetracycline

Answer

Streptomycin plus penicillin

Answer

Rifampicin plus dapsone

Answer

Penicillin plus sulfonamide

Question 8

Which of the following agents requires the MOST caution when combined with spironolactone due to increased risk of hyperkalemia:

Accepted Answer

ACE inhibitors

Answer

Beta-blockers

Answer

Amlodipine

Answer

Chlorothiazide

Question 9

What is the normal O2 extraction ratio of tissues?

Accepted Answer

25 percent

Answer

5 percent

Answer

15 percent

Answer

40 percent

Question 10

Lower esophageal sphincter pressure is increased by all of the following substances, EXCEPT:

Accepted Answer

Secretin

Answer

Motilin

Answer

Gastrin

Answer

Substance P

NEET-PG 2015

Anatomy

Biochemistry

Forensic Medicine

Pharmacology

Physiology