NEET-PG 2013 Practice Questions

Q: Which of the following is not a clinical feature of Bronchiectasis?

Night sweats. ***Night sweats*** - While **night sweats** can be present in chronic infections, they are not considered a primary or defining clinical feature directly associated with the pathology of bronchiectasis itself. - They are more commonly linked with systemic conditions like **tuberculosis** or malignancy, which would require alternative diagnostic pathways. *Hemoptysis* - **Hemoptysis** (coughing up blood) is a common and often alarming symptom of bronchiectasis due to the inflammation and damage to the bronchial walls and underlying vasculature [1]. - Blood vessels in damaged airways are prone to rupture, leading to bleeding, which can range from blood-streaked sputum to massive hemorrhage [1]. *Chest pain* - **Chest pain** can occur in bronchiectasis, often related to the chronic cough, pleural inflammation, or musculoskeletal strain from persistent coughing. - It can also be a symptom if there's an associated infection or inflammation extending to the pleura. *Productive cough* - A **chronic productive cough** with significant amounts of purulent sputum is the hallmark symptom of bronchiectasis [1]. - This is due to the impaired mucociliary clearance and chronic infection within the dilated, damaged airways .

Q: What is the recommended rate of correction for sodium deficit in patients with chronic hyponatremia?

0.5 mmol/hour. ***0.5 mmol/hour*** [1] - This rate of correction is recommended to avoid **osmotic demyelination syndrome (ODS)**, also known as central pontine myelinolysis [1]. - The aim is to correct the sodium deficit gradually, with a maximum increase not exceeding **8-10 mmol/L in any 24-hour period** [1]. *1 mmol/hour* - This rate is generally considered too rapid for chronic hyponatremia and increases the risk of **osmotic demyelination syndrome**. - While acceptable in some acute severe cases, it is typically avoided in chronic settings where the brain has adapted to lower osmolality. *1.5 mmol/hour* - This rate would lead to an even faster correction of sodium, significantly elevating the risk of **osmotic demyelination syndrome**. - It would result in a correction of 36 mmol/L over 24 hours, far exceeding the recommended daily limit of 8-10 mmol/L. *2.0 mmol/hour* - Such a rapid correction rate is highly dangerous and almost guarantees the development of **osmotic demyelination syndrome**. - This aggressive correction would lead to severe brain injury due to rapid osmotic shifts.

Q: What is the primary cause of Waterhouse-Friderichsen syndrome?

Adrenal hemorrhage after meningococcal infection. ***Adrenal hemorrhage after meningococcal infection*** - **Waterhouse-Friderichsen syndrome** is characterized by **massive, bilateral adrenal hemorrhage**, leading to acute adrenal insufficiency [1]. - It is most commonly associated with overwhelming **meningococcal sepsis**, particularly due to *Neisseria meningitidis* [1]. *Adrenal hemorrhage post malignancy* - While malignancies can cause adrenal hemorrhage, it is not the primary cause of **Waterhouse-Friderichsen syndrome**. - This syndrome is specifically linked to severe **bacterial sepsis**, not typically cancer-related adrenal bleeding [1]. *Congenital adrenal deficiency* - **Congenital adrenal hyperplasia (CAH)** involves genetic defects affecting cortisol synthesis, leading to chronic adrenal insufficiency. - It does not involve acute **adrenal hemorrhage** as seen in Waterhouse-Friderichsen syndrome. *Adrenal hemorrhage after corticosteroid withdrawal* - Abrupt withdrawal of corticosteroids can precipitate an **adrenal crisis** due to suppression of the hypothalamic-pituitary-adrenal (HPA) axis [2]. - However, it does not typically cause the characteristic **massive adrenal hemorrhage** seen in Waterhouse-Friderichsen syndrome [2].

Q: All are parts of anterior segment of eye except?

Vitreous. ***Vitreous*** - The **vitreous humor**, or simply vitreous, is a transparent, gel-like substance that fills the space posterior to the lens and anterior to the retina, making it part of the **posterior segment** of the eye [3]. - Its main function is to maintain the shape of the eye and keep the retina in place. *Lens* - The **lens** is a transparent, biconvex structure located behind the iris and in front of the vitreous, making it a key component of the **anterior segment** [2]. - It works to focus light onto the retina, changing shape to alter the focal length of the eye. *Cornea* - The **cornea** is the transparent, outermost layer of the eye that covers the iris, pupil, and anterior chamber, clearly positioning it within the **anterior segment** [2]. - It plays a crucial role in focusing light into the eye. *Aqueous humor* - The **aqueous humor** is a clear, watery fluid located in the space between the cornea and the lens (the anterior and posterior chambers), which is definitively part of the **anterior segment** [1]. - It nourishes the cornea and lens and maintains intraocular pressure.

Q: Phlyctenular conjunctivitis is primarily associated with hypersensitivity to which of the following?

Staphylococcus. ***Staphylococcus*** - **Phlyctenular conjunctivitis** is characterized by delayed (Type IV) hypersensitivity reactions to bacterial antigens, most commonly from **Staphylococcus aureus**. - This condition often presents with small, nodular lesions (phlyctenules) on the conjunctiva or cornea, which are essentially collections of inflammatory cells responding to bacterial proteins. - **Important note**: **Mycobacterium tuberculosis** is another well-documented cause of phlyctenular conjunctivitis, particularly in TB-endemic regions, and should be considered in the differential diagnosis. - Other triggers include protein antigens from organisms colonizing the ocular surface. *Chlamydia* - While **Chlamydia trachomatis** can cause chronic conjunctivitis (e.g., trachoma, adult inclusion conjunctivitis), it does not typically lead to the distinct nodular lesions seen in phlyctenular conjunctivitis. - Ocular chlamydial infections are primarily characterized by follicular conjunctivitis and pannus formation. *Pneumococcus* - **Streptococcus pneumoniae** (Pneumococcus) is a common cause of acute bacterial conjunctivitis, characterized by purulent discharge and redness. - However, it is not associated with the specific delayed hypersensitivity reaction that defines phlyctenular conjunctivitis. *Aspergillus* - **Aspergillus** species are fungi and are more commonly implicated in fungal keratitis or allergic bronchopulmonary aspergillosis, particularly in immunocompromised individuals. - Fungal infections of the conjunctiva are rare and do not typically manifest as phlyctenular conjunctivitis.

Q: Parachute lesions are associated with which of the following conditions?

Eale's disease. ***Eale's disease*** - **Eale's disease** is an idiopathic retinal perivasculitis affecting young males, characterized by recurrent vitreous hemorrhages. - In the context of this question (NEET-2013), the term "parachute lesions" refers to the characteristic pattern of hemorrhages seen in Eale's disease. - The disease features retinal periphlebitis, capillary non-perfusion, and neovascularization leading to vitreous hemorrhage. - **Note:** The term "parachute hemorrhages" in broader ophthalmology typically describes preretinal/subhyaloid hemorrhages that settle inferiorly (boat-shaped), more commonly seen in proliferative diabetic retinopathy. *Diabetes* - **Diabetic retinopathy** presents with microaneurysms, dot-blot hemorrhages, hard exudates, cotton-wool spots, and neovascularization. - While proliferative diabetic retinopathy can cause preretinal "parachute-shaped" hemorrhages (boat-shaped hemorrhages that settle inferiorly), this is not the association being tested in this NEET-2013 question. - The specific context of this exam question associates the term with Eale's disease. *Sickle cell anemia* - **Sickle cell retinopathy** features characteristic sea-fan neovascularization in the peripheral retina. - Can cause salmon-patch hemorrhages, black sunburst lesions, and angioid streaks. - While vitreous hemorrhage can occur, "parachute lesions" is not standard terminology for sickle cell retinopathy manifestations. *None of the options* - This option is incorrect because **Eale's disease** is the correct answer according to the NEET-2013 exam key.

Q: Hordeolum internum is?

Acute infection of Meibomian gland. ***Acute infection of Meibomian gland*** - A **hordeolum internum** is an acute, purulent infection of the **Meibomian glands**, which are sebaceous glands located within the tarsal plate of the eyelid. - The infection primarily manifests on the **inner surface of the eyelid** due to the gland's location, causing localized inflammation and pain. *Acute infection of Zeis gland* - An acute infection of a **Zeis gland** (a sebaceous gland connected to an eyelash follicle) is known as a **hordeolum externum**, or external stye. - Unlike a hordeolum internum, a **hordeolum externum** usually points externally at the lid margin. *Acute infection of Moll gland* - An acute infection of a **Moll gland** (apocrine sweat glands located near the lid margin) is also a type of **hordeolum externum**. - While it's an acute infection of an eyelid gland, it is not specifically referred to as a **hordeolum internum**. *Chronic infection of Zeis gland* - A chronic infection of a **Zeis gland** is not a typical designation for eyelid lesions; chronic inflammatory processes of sebaceous glands often lead to conditions like a **chalazion**, though chalazia are more commonly associated with Meibomian glands. - This option incorrectly identifies the gland for a hordeolum internum and specifies **chronic infection**, whereas a hordeolum is inherently **acute**.

Q: Brown tumors are seen in:

Hyperparathyroidism. ***Hypeparathyroidism*** - Brown tumors, also called osteitis fibrosa cystica, are **osteolytic lesions** associated specifically with **hyperparathyroidism** due to increased osteoclastic activity [1][2]. - Elevated levels of **parathyroid hormone (PTH)** lead to bone resorption, giving rise to the characteristic bone changes seen in this condition [1][2]. *Neurofibromatosis* - Neurofibromatosis primarily presents with **neurofibromas**, café-au-lait spots, and skin-related findings, not with brown tumors. - Bone manifestations include **scoliosis** or **plexiform neurofibromas**, but they do not typically lead to brown tumors. *Pigmented villonodular synovitis* - This is a **joint condition** featuring hyperplastic synovial tissue and local joint swelling, but it does not involve **bone changes** typical of brown tumors. - Characterized by **pigmented nodules** in the synovium, it doesn't cause osteolytic lesions seen in hyperparathyroidism. *Osteomalacia* - Osteomalacia is primarily due to **vitamin D deficiency**, leading to softening of the bones, not the formation of **brown tumors**. - It results in bone pain and weakness, with radiological changes such as **Looser's zones** rather than the well-defined lucencies associated with brown tumors. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1105-1106. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, p. 1194.

Q: Retrocardiac lucency with air fluid level is seen in

Hiatus hernia. ***Hiatus hernia*** - A **hiatus hernia** occurs when part of the stomach protrudes into the chest through the **esophageal hiatus** of the diaphragm. - This can lead to a **retrocardiac lucency** (gas-filled stomach) with an **air-fluid level** visible on chest X-rays due to gastric contents. - The herniated gastric fundus appears as a characteristic gas bubble behind the heart, particularly well-seen on lateral chest radiographs. *Distal esophageal obstruction* - While distal esophageal obstruction can cause esophageal dilation and sometimes an **air-fluid level** within the esophagus, it generally presents as a tubular structure *behind* the heart rather than a distinct retrocardiac lucency representing a portion of the stomach. - The appearance would be more suggestive of a dilated esophagus filled with contents, not a herniated stomach. *Diaphragmatic eventration* - **Diaphragmatic eventration** is an abnormal elevation of a portion of the diaphragm, often due to congenital weakness or phrenic nerve paralysis. - It does not typically cause a **retrocardiac lucency** with an **air-fluid level**, as it involves the diaphragm itself rather than the herniation of an abdominal organ. - It may show elevation of the hemidiaphragm but without the characteristic gas-filled viscus appearance. *None of the options* - Hiatus hernia is a well-established radiological diagnosis for retrocardiac lucency with an **air-fluid level**, making this option clearly incorrect.

Q: Best prognostic factor for head injury is:

Glasgow coma scale. ***Glasgow coma scale*** - The **Glasgow Coma Scale (GCS)** is a standardized tool used to assess the level of consciousness in head injury patients, providing an objective measure of neurological function. - A **lower GCS score** correlates with a greater severity of injury and poorer prognosis, making it the most reliable predictor of outcome. *Age* - While age can influence recovery, with **older patients generally having worse outcomes** due to less neural plasticity and pre-existing comorbidities, it is not the single best prognostic factor. - Younger patients often have better recovery potential, but their prognosis is still heavily dependent on the immediate severity of the brain injury. *Mode of injury* - The mode of injury (e.g., blunt trauma, penetrating injury) provides information about the mechanism and potential **types of injury**, but does not directly quantify the severity of brain damage or predict long-term outcomes as precisely as GCS. - While **high-impact injuries** tend to be more severe, the actual neurological deficit measured by GCS is a better indicator of prognosis. *CT* - **CT scans** are crucial for identifying specific neurological injuries like hemorrhage, edema, or fractures, which can guide immediate management. - However, the findings on a CT scan do not solely determine prognosis; a patient with a relatively normal CT can still have a poor outcome if their **GCS is low**, indicating widespread neuronal dysfunction not always visible on imaging.

Question 1

Which of the following is not a clinical feature of Bronchiectasis?

Accepted Answer

Night sweats

Answer

Hemoptysis

Answer

Chest pain

Answer

Productive cough

Question 2

What is the recommended rate of correction for sodium deficit in patients with chronic hyponatremia?

Accepted Answer

0.5 mmol/hour

Answer

1 mmol/hour

Answer

1.5 mmol/hour

Answer

2.0 mmol/hour

Question 3

What is the primary cause of Waterhouse-Friderichsen syndrome?

Accepted Answer

Adrenal hemorrhage after meningococcal infection

Answer

Adrenal hemorrhage post malignancy

Answer

Adrenal hemorrhage after corticosteroid withdrawal

Answer

Congenital adrenal deficiency

Question 4

All are parts of anterior segment of eye except?

Accepted Answer

Vitreous

Answer

Lens

Answer

Cornea

Answer

Aqueous humor

Question 5

Phlyctenular conjunctivitis is primarily associated with hypersensitivity to which of the following?

Accepted Answer

Staphylococcus

Answer

Chlamydia

Answer

Pneumococcus

Answer

Aspergillus

Question 6

Parachute lesions are associated with which of the following conditions?

Accepted Answer

Eale's disease

Answer

Diabetes

Answer

Sickle cell anemia

Answer

None of the options

Question 7

Hordeolum internum is?

Accepted Answer

Acute infection of Meibomian gland

Answer

Chronic infection of Zeis gland

Answer

Acute infection of Moll gland

Answer

Acute infection of Zeis gland

Question 8

Brown tumors are seen in:

Accepted Answer

Hyperparathyroidism

Answer

Pigmented villonodular synovitis

Answer

Osteomalacia

Answer

Neurofibromatosis

Question 9

Retrocardiac lucency with air fluid level is seen in

Accepted Answer

Hiatus hernia

Answer

Distal esophageal obstruction

Answer

Diaphragmatic eventration

Answer

None of the options

Question 10

Best prognostic factor for head injury is:

Accepted Answer

Glasgow coma scale

Answer

Age

Answer

Mode of injury

Answer

CT

NEET-PG 2013

Internal Medicine

Ophthalmology

Pathology

Radiology

Surgery