NEET-PG 2012 Practice Questions

Q: In a patient with suspected vitamin B12 deficiency, which condition would result in an abnormal Schilling test?

Intrinsic factor deficiency. ***Intrinsic factor deficiency*** - The Schilling test assesses the absorption of **vitamin B12**. **Intrinsic factor** is crucial for B12 absorption in the ileum. - Deficiency of intrinsic factor, as seen in **pernicious anemia**, directly impairs B12 absorption, leading to an abnormal Schilling test result [1]. *Amylase deficiency* - **Amylase** is an enzyme involved in the digestion of carbohydrates, not vitamin B12 absorption [2]. - Its deficiency would primarily cause carbohydrate malabsorption symptoms, not an abnormal Schilling test. *Pancreatic endocrine insufficiency* - **Pancreatic endocrine function** relates to hormone production (e.g., insulin, glucagon), while exocrine function involves digestive enzymes. - Impairment of endocrine function does not directly affect vitamin B12 absorption or the Schilling test. *Lipase deficiency* - **Lipase** is an enzyme essential for the digestion of fats [2]. - Its deficiency would lead to fat malabsorption (steatorrhea) but would not affect vitamin B12 absorption or the Schilling test results.

Q: What is a definitive indication for performing a Lower Segment Cesarean Section (LSCS)?

Contracted pelvis. ***Contracted pelvis*** - A **contracted pelvis** means the maternal pelvic dimensions are too small to allow for the safe passage of the fetus, making a vaginal birth impossible or highly risky. - This **fetopelvic disproportion** (cephalopelvic disproportion) necessitates a C-section to prevent obstructed labor, fetal distress, and potential harm to both mother and baby. - A contracted pelvis is a **definitive indication** for LSCS as vaginal delivery is contraindicated. *Mento anterior presentation* - In a **mento anterior presentation**, the fetal chin (mentum) is anterior, which is a **favorable position** for vaginal delivery as it allows for proper neck extension and engagement. - This presentation does not typically require a C-section unless there are other complicating factors. *Occipito posterior presentation* - While an **occipito posterior presentation** can sometimes lead to prolonged labor or the need for instrumental delivery, it is **not an absolute indication** for C-section. - Many cases can still deliver vaginally, either spontaneously or with rotation, and surgical intervention is usually reserved for failure to progress or fetal distress. *Vertex presentation* - A **vertex presentation** means the fetal head is flexed and presenting first, which is the **most common and ideal presentation** for a vaginal birth. - This presentation is a sign of a normal, potentially uncomplicated delivery and is the opposite of an indication for C-section.

Q: Expulsive hemorrhage in cataract surgery is from?

Ciliary artery. ***Ciliary artery*** - Expulsive hemorrhage is a rare but devastating complication, typically resulting from the rupture of a **posterior ciliary artery** within the choroid. - This arterial rupture leads to a sudden, massive increase in intraocular pressure and extrusion of intraocular contents. *Vortex vein* - **Vortex veins** drain the choroid, and while their rupture could lead to hemorrhage, it is less likely to cause the highly pressurized, expulsive nature of a choroidal hemorrhage. - Hemorrhage from a vortex vein is generally less severe and less rapid in onset compared to arterial bleeding. *Choroidal vein* - **Choroidal veins** are part of the venous drainage system; bleeding from these vessels would typically be lower pressure and less likely to cause an expulsive hemorrhage. - Venous bleeds are generally slower and do not generate the rapid, violent pressure increase characteristic of expulsive hemorrhage. *None of the options* - This option is incorrect because the rupture of a ciliary artery is the direct cause of expulsive hemorrhage. - The other options are incorrect for the reasons stated above.

Q: Which of the following describes grade 2 fracture neck femur?

Complete fracture with undisplaced neck. ***Complete fracture with undisplaced neck*** - A **Garden Type II fracture** of the femoral neck is characterized by a **complete fracture line** through the femoral neck. - Despite the complete fracture, the **femoral head remains undisplaced** and in its anatomical position, indicating an intact or minimally disrupted posteromedial soft-tissue hinge. *Incomplete fracture, medial trabeculae intact* - This description corresponds to a **Garden Type I fracture**, which is an **incomplete fracture** of the femoral neck, usually impacted in valgus. - In such cases, the medial trabeculae are often intact, or show buckling on the lateral side, indicating a stable fracture. *Complete fracture with ischemic head* - The presence of an **ischemic head** is a complication that can occur with any displaced femoral neck fracture (Garden Type III or IV), but it's not a primary defining characteristic of a specific Garden grade. - **Avascular necrosis (AVN)** of the femoral head is a risk, especially with displacement, due to disruption of the blood supply. *Moderate displacement of neck, vascularity damaged* - This description is more consistent with a **Garden Type III fracture**, where there is a **complete fracture with moderate displacement** of the femoral head, usually with some varus angulation. - Such displacement significantly increases the risk of **vascular injury** to the femoral head, predisposing to avascular necrosis.

Q: Tardy ulnar nerve palsy is specifically associated with which type of fracture?

Lateral condyle fracture of the humerus. ***Lateral condyle fracture of the humerus*** - This fracture, especially in children, can lead to **cubitus valgus deformity** as a long-term complication if it heals incorrectly. - The resulting **valgus angulation** at the elbow abnormally stretches the ulnar nerve behind the medial epicondyle, causing **tardy ulnar nerve palsy** years after the initial injury. *Medial condyle fracture of the humerus* - While close to the ulnar nerve, medial condyle fractures are more likely to cause **immediate nerve damage** due to direct impingement, rather than delayed or "tardy" palsy from chronic stretching. - Complications typically involve varus deformity, which does not commonly stretch the ulnar nerve in the same manner as valgus. *Fracture of the humeral shaft* - This type of fracture is more commonly associated with **radial nerve injury** (e.g., wrist drop), especially in fractures of the mid-shaft. - It does not typically lead to long-term deformities at the elbow that would cause **delayed ulnar nerve compression**. *Fracture of the radial shaft* - Radial shaft fractures (e.g., Monteggia, Galeazzi) primarily affect the **radial nerve** or the **posterior interosseous nerve**. - They do not directly involve the elbow joint in a manner that would cause **tardy ulnar nerve palsy**.

Q: In which condition is pannus formation typically observed?

RA. ***RA*** - **Pannus** is a characteristic feature of **rheumatoid arthritis**, representing an aggressive, hyperplastic synovial tissue that invades and destroys cartilage and bone [1], [2]. - This destructive granulation tissue primarily consists of fibroblasts, macrophages, and inflammatory cells, contributing to joint erosion [1]. *Osteoarthritis (OA)* - While **osteophytes** (bone spurs) and **cartilage degradation** are hallmarks of OA, **pannus formation** is not seen. - OA involves breakdown of articular cartilage due to mechanical stress and biochemical changes, not synovial invasion. *Gout (Gouty Arthritis)* - Gout is characterized by the deposition of **monosodium urate crystals** in joints, leading to acute inflammation [4]. - The formation of **tophi** (urate crystal deposits) is typical, but not **pannus** [4]. *Psoriatic Arthritis (PsA)* - PsA can cause joint inflammation and erosion similar to RA but does not typically involve the extensive **pannus formation** characteristic of RA [3]. - Specific features of PsA include **enthesitis**, dactylitis and involvement of **DIP joints** [3]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 677-678. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, p. 1212. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1214-1215. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, p. 1218.

Q: Double aortic arch is associated with which syndrome?

DiGeorge syndrome. ***DiGeorge syndrome*** - **DiGeorge syndrome** is caused by a **22q11.2 deletion** affecting the development of the third and fourth pharyngeal pouches, leading to **thymic hypoplasia**, **parathyroid hypoplasia**, and **cardiac anomalies**. - Common cardiac defects include **interrupted aortic arch type B**, **truncus arteriosus**, **tetralogy of Fallot**, and **VSD**. - **Double aortic arch** can occur in 22q11.2 deletion syndrome, though it is less common than other cardiac anomalies; however, among the syndromes listed, this represents the most appropriate association. - The question tests recognition that various cardiac arch anomalies, including double aortic arch, may be seen in this genetic syndrome. *CATCH 22 syndrome* - This is an **acronym** for DiGeorge syndrome: **C**ardiac defects, **A**bnormal facies, **T**hymic hypoplasia, **C**left palate, **H**ypocalcemia, and **22q11 deletion**. - It is **essentially the same condition** as DiGeorge syndrome, just using different nomenclature. - While technically correct, "DiGeorge syndrome" is the more standard medical terminology currently used. *Shprintzen syndrome* - **Shprintzen syndrome** (also called **velocardiofacial syndrome or VCFS**) is caused by the **same 22q11.2 deletion** as DiGeorge syndrome. - It represents a **phenotypic variant within the 22q11.2 deletion syndrome spectrum**, with more emphasis on palatal and facial features. - Since it shares the same genetic basis, it can also present with similar cardiac anomalies, but "DiGeorge syndrome" is the more commonly recognized term for this genetic disorder. *None of the options* - This is incorrect because the three syndromes listed above (DiGeorge, CATCH 22, and Shprintzen) all refer to **22q11.2 deletion syndrome** or its variants, which can be associated with various cardiac anomalies including double aortic arch. - Among the listed options, **DiGeorge syndrome** is the most appropriate and widely recognized answer.

Q: All of the following occurs because of prostaglandin use except?

Excess water retention. ***Excess water retention*** - **Prostaglandins** generally promote **diuresis** and natriuresis, meaning they help the body excrete water and sodium, rather than retain them [2]. - While some prostaglandins can affect renal blood flow, direct causation of **excess water retention** as a primary side effect is not typical. *Flushes* - **Prostaglandins**, particularly **PGE1** and **PGE2**, are potent **vasodilators** and can cause cutaneous vasodilation, leading to **flushing** and a sensation of warmth [3]. - This effect is often mediated by the relaxation of vascular smooth muscle. *Increased motility of bowel* - Many **prostaglandins**, especially **PGE** and **PGF** series, stimulate **smooth muscle contraction**, including in the gastrointestinal tract [1]. - This increased contraction can lead to **enhanced bowel motility**, sometimes causing diarrhea or abdominal cramping [1]. *Nausea* - **Prostaglandins** can have various systemic effects, and activation of pathways in the central nervous system or direct irritation of the GI tract can lead to symptoms like **nausea** and vomiting [1]. - This is a common side effect, especially with systemic administration.

Q: What is the drug of choice for malaria in pregnancy?

Chloroquine. ***Chloroquine*** - **Chloroquine** is the drug of choice for **uncomplicated malaria in pregnancy** caused by **chloroquine-sensitive** strains of *P. vivax*, *P. ovale*, *P. malariae*, and *P. falciparum* [1]. - It has an **established safety profile** in pregnancy across all trimesters and is considered safe by WHO and CDC. - While resistance has emerged in many areas for *P. falciparum*, chloroquine remains effective for *P. vivax* malaria in most regions including India. - For **severe malaria** or **chloroquine-resistant falciparum malaria**, alternative regimens like quinine or artesunate are used [1]. *Quinine* - **Quinine** (usually with clindamycin) is the preferred treatment for **severe malaria** or **chloroquine-resistant *P. falciparum*** malaria in pregnancy, especially in the **first trimester**. - It is safe and effective but can cause side effects like **cinchonism** (tinnitus, headache, nausea) and **hypoglycemia**. - While safe throughout pregnancy, it is not the first-line choice for uncomplicated chloroquine-sensitive malaria. *Primaquine* - **Primaquine** is **contraindicated in pregnancy** because it can cause **hemolytic anemia** in individuals with **G6PD deficiency**, and G6PD status of the fetus cannot be determined [3]. - It is used for **radical cure** of *P. vivax* and *P. ovale* to eliminate liver hypnozoites, but must be deferred until after delivery [3]. *Artesunate* - **Artesunate** and other **artemisinin-based combination therapies (ACTs)** are highly effective antimalarials [2]. - Current WHO guidelines support ACT use in all trimesters for severe malaria when benefits outweigh risks. - For **uncomplicated falciparum malaria**, ACTs are preferred in the **second and third trimesters** in areas with chloroquine resistance [2]. - However, chloroquine remains the classical "drug of choice" for uncomplicated, chloroquine-sensitive malaria in pregnancy [1].

Q: Which of the following is a negative symptom of schizophrenia?

Alogia (poverty of speech). ***Alogia (poverty of speech)*** - **Alogia** refers to a reduction in the **fluency and productivity of speech**, which is a classic **negative symptom** of schizophrenia indicating a *loss* or *absence* of normal functions. - Negative symptoms are characterized by deficits in normal emotional responses or other thought processes. *Hallucination* - **Hallucinations** are perceptual experiences that occur in the absence of an external stimulus, most commonly **auditory** in schizophrenia. - They are considered **positive symptoms** because they represent an *addition* or *distortion* of normal functions. *Delusion* - A **delusion** is a fixed, false belief that is not amenable to change in light of conflicting evidence, such as **persecutory** or **grandiose delusions**. - Delusions are also categorized as **positive symptoms** as they involve an *exaggeration* or *distortion* of normal thought content. *Motor hyperactivity* - **Motor hyperactivity** involves excessive or uncontrolled body movements and is not a typical symptom of schizophrenia. - While schizophrenia can involve **psychomotor agitation**, this is distinct from generalized hyperactivity and is not a core negative symptom.

Question 1

In a patient with suspected vitamin B12 deficiency, which condition would result in an abnormal Schilling test?

Accepted Answer

Intrinsic factor deficiency

Answer

Amylase deficiency

Answer

Pancreatic endocrine insufficiency

Answer

Lipase deficiency

Question 2

What is a definitive indication for performing a Lower Segment Cesarean Section (LSCS)?

Accepted Answer

Contracted pelvis

Answer

Mento anterior presentation

Answer

Occipito posterior presentation

Answer

Vertex presentation

Question 3

Expulsive hemorrhage in cataract surgery is from?

Accepted Answer

Ciliary artery

Answer

Vortex vein

Answer

Choroidal vein

Answer

None of the options

Question 4

Which of the following describes grade 2 fracture neck femur?

Accepted Answer

Complete fracture with undisplaced neck

Answer

Incomplete fracture, medial trabeculae intact

Answer

Complete fracture with ischemic head

Answer

Moderate displacement of neck, vascularity damaged

Question 5

Tardy ulnar nerve palsy is specifically associated with which type of fracture?

Accepted Answer

Lateral condyle fracture of the humerus

Answer

Medial condyle fracture of the humerus

Answer

Fracture of the humeral shaft

Answer

Fracture of the radial shaft

Question 6

In which condition is pannus formation typically observed?

Accepted Answer

RA

Answer

Osteoarthritis (OA)

Answer

Gout (Gouty Arthritis)

Answer

Psoriatic Arthritis (PsA)

Question 7

Double aortic arch is associated with which syndrome?

Accepted Answer

DiGeorge syndrome

Answer

CATCH 22 syndrome

Answer

Shprintzen syndrome

Answer

None of the options

Question 8

All of the following occurs because of prostaglandin use except?

Accepted Answer

Excess water retention

Answer

Increased motility of bowel

Answer

Nausea

Answer

Flushes

Question 9

What is the drug of choice for malaria in pregnancy?

Accepted Answer

Chloroquine

Answer

Primaquine

Answer

Artesunate

Answer

Quinine

Question 10

Which of the following is a negative symptom of schizophrenia?

Accepted Answer

Alogia (poverty of speech)

Answer

Hallucination

Answer

Delusion

Answer

Motor hyperactivity

NEET-PG 2012

Biochemistry

Obstetrics and Gynecology

Ophthalmology

Orthopaedics

Pathology

Pediatrics

Pharmacology

Psychiatry