NEET-PG 2015 Practice Questions

Q: Isaac syndrome is characterized by -

Peripheral nerve hyperexcitability. Isaac syndrome is characterized by - ***Peripheral nerve hyperexcitability*** - Isaac syndrome, also known as **neuromyotonia** or **Isaacs' syndrome**, is fundamentally characterized by symptoms arising from **peripheral nerve hyperexcitability**. [1] - This hyperexcitability leads to continuous muscle fiber activity even at rest, manifesting as **muscle stiffness, cramps, myokymia, and fasciculations**. *Opsoclonus syndrome* - This syndrome is characterized by **rapid, irregular, chaotic eye movements** (**opsoclonus**) and often associated with **myoclonus (rapid muscle jerks)** and **ataxia (impaired coordination)**. - While it can be paraneoplastic, it involves the **central nervous system**, specifically the brainstem and cerebellum, not primarily peripheral nerve hyperexcitability. *Encephalitis* - **Encephalitis** is an inflammation of the **brain parenchyma**, typically caused by viral infections. - Its clinical presentation includes fever, headache, altered mental status, and seizures, which are distinct from the primary neuromuscular symptoms of Isaac syndrome. *Limbic encephalitis syndrome* - **Limbic encephalitis** is a form of encephalitis specifically affecting the **limbic system** of the brain, leading to symptoms like **memory loss, seizures, and psychiatric disturbances**. - This condition involves **central nervous system inflammation** and does not directly cause the peripheral nerve hyperexcitability seen in Isaac syndrome.

Q: Blood transfusion associated acute lung injury occurs due to -

HLA-mediated reaction. ***HLA-mediated reaction*** - Transfusion-related acute lung injury (TRALI) is primarily caused by **antibodies** in the donor plasma (usually anti-HLA or anti-HNA antibodies) reacting with the recipient's **neutrophils** [1]. - This interaction leads to neutrophil activation and sequestration in the pulmonary vasculature, causing **endothelial damage** and increased capillary permeability [1]. *Nosocomial infections* - Nosocomial infections are **hospital-acquired infections** and are not a direct cause of TRALI. - While infections can lead to lung injury, the mechanism of TRALI is distinct and immunologically mediated by donor antibodies. *Auto-immune disorder* - An autoimmune disorder involves the body's immune system attacking its own tissues, which is not the primary mechanism of TRALI. - TRALI is an **alloimmune reaction** where donor antibodies react with host antigens, rather than a pre-existing autoimmune condition. *Genetic susceptibility* - While genetic factors might sometimes play a role in an individual's general inflammatory response or susceptibility to certain conditions, they are **not the direct or primary cause** of TRALI. - The acute lung injury in TRALI is triggered by specific **antibody-antigen interactions** during the transfusion.

Q: Thyroid nodule in a 65 year old male who is clinically euthyroid is most likely to be

Follicular adenoma. ***Follicular adenoma*** - Typically presents as a **solitary, well-defined nodule** in euthyroid patients, making it a common finding in this demographic. - It is often **benign** and can be differentiated from malignancies through imaging and cytological evaluation. *Multinodular goiter* - Usually involves multiple nodules rather than a **single nodule**, and patients often present with thyroid dysfunction [1]. - More common in women, and does not fit the profile of a solitary nodule in a euthyroid male. *Follicular Carcinoma* - While it can present as a nodule, it typically involves **elevated risk factors** such as family history and certain genetic mutations. - Euthyroid status alone is insufficient for a diagnosis of malignancy without further alarming features. *Thyroid Cyst* - Cysts are usually **fluid-filled** and may not present as solid nodules, which are common in cases described. - They tend to be **asymptomatic** and are generally **benign**, lacking the solid characteristics of a follicular adenoma.

Q: What is the primary hormonal cause of hot flushes experienced during menopause?

Decreased estrogen levels. ***Decreased estrogen levels*** - **Decreased estrogen** is the primary hormonal change during menopause, leading to thermoregulatory dysfunction in the hypothalamus. - This hormonal imbalance causes the **vasomotor symptoms** like hot flushes and night sweats. *Increased noradrenaline* - While **noradrenaline** (norepinephrine) is involved in thermoregulation, its increase is a **secondary event** triggered by the initial estrogen deficiency, not the primary cause. - Increased noradrenaline can exacerbate the **vasodilation** and heat dissipation experienced during a hot flush. *Increased noradrenaline with normal estrogen levels* - This option is incorrect because hot flushes are characteristic of menopause, which is defined by **decreased estrogen levels**. - **Normal estrogen levels** would typically prevent the severe thermoregulatory instability that causes hot flushes. *Both increased noradrenaline and decreased estrogen levels* - Although both factors are involved, the question asks for the **primary hormonal cause**. **Decreased estrogen** initiates the cascade of events, including the subsequent alteration of neurotransmitter levels like noradrenaline. - Noradrenaline's role is more of a **mediator** in the physiological response to the primary estrogen deficiency.

Q: Who devised the correction of CTEV by serial casting?

Ignacio Ponseti. ***Ignacio Ponseti*** - Dr. Ignacio Ponseti developed the **Ponseti method**, a non-surgical technique for correcting **congenital talipes equinovarus (CTEV)**, commonly known as clubfoot. - This method involves a series of **gentle manipulations** and **serial casting**, followed by the use of a foot abduction brace. *Gerhardt Kuntscher* - **Gerhardt Kuntscher** was a German surgeon known for developing the **intramedullary nail** for fixing long bone fractures. - His contributions revolutionized the surgical management of fractures, but he did not develop the method for CTEV correction. *Gavril Ilizarov* - **Gavril Ilizarov** was a Soviet orthopedic surgeon famous for inventing the **Ilizarov apparatus**, an external fixator used for limb lengthening and complex fracture treatment. - His work focused on osteogenesis and bone regeneration, not the non-surgical correction of clubfoot. *Hugh Owen Thomas* - **Hugh Owen Thomas** was a Welsh orthopedic surgeon regarded as the "father of British orthopaedic surgery," known for the development of the **Thomas splint**. - His contributions were primarily in managing fractures and tuberculosis of the joints, independent of CTEV correction techniques.

Q: Child with 10 episodes of diarrhea in last 24 hours with sunken dry eyes, very slow skin pinch, and absent tears. Management is

Administer intravenous Ringer's lactate. ***Administer intravenous Ringer's lactate*** - The child presents with signs of **severe dehydration** (sunken dry eyes, very slow skin pinch, absent tears, 10 episodes of diarrhea), which necessitates **rapid intravenous fluid resuscitation**. - **Ringer's lactate** is an isotonic crystalloid solution that effectively replenishes intravascular volume and corrects electrolyte imbalances, making it the most appropriate initial management for severe dehydration. *Encourage breastfeeding* - While **breastfeeding** is crucial for hydration and nutrition in children with diarrhea, it is insufficient to correct **severe dehydration** rapidly. - This intervention is more suitable for managing **mild to moderate dehydration** or for rehydration after initial stabilization. *Administer 10% dextrose solution* - **10% dextrose solution** is used primarily to correct **hypoglycemia** or provide a source of calories, not for rapid volume expansion in severe dehydration. - Administering hypertonic solutions like 10% dextrose without adequate volume can worsen dehydration or cause electrolyte disturbances. *Provide oral rehydration solution (ORS)* - **Oral rehydration solution (ORS)** is the gold standard for treating **mild to moderate dehydration** and preventing dehydration due to diarrhea. - However, in cases of **severe dehydration**, where the child may be lethargic, vomiting frequently, or have impaired absorption, ORS alone is often insufficient and intravenous fluids are required for initial stabilization.

Q: Which of the following is not considered a contraindication for undergoing an MRI?

Ryle's tube. ***Ryle's tube*** - A **Ryle's tube** is a form of nasogastric tube made of radiopaque plastic, which is entirely **MRI-safe** and does not interact with magnetic fields. - It is made from inert materials that are **non-ferromagnetic**, posing no risk during an MRI scan. *Cardiac pacemaker* - **Cardiac pacemakers** contain metallic components that can malfunction, demagnetize, or migrate due to the strong magnetic fields and radiofrequency pulses of an MRI. - This can lead to **arrhythmias**, **pacemaker failure**, or **heating of leads**, posing a significant risk to the patient. *Cochlear implant* - **Cochlear implants** contain strong magnets and electronic components that can be damaged or displaced by the MRI's magnetic field. - This can cause **pain**, **implant damage**, or **hearing loss** for the patient. *Metallic splinter in eye* - A **metallic splinter in the eye** is a severe contraindication because the strong magnetic field can cause the metal fragment to move. - This movement can lead to **tissue damage**, **hemorrhage**, or **blindness** if it dislodges in the delicate structures of the eye.

Q: An Incisional wound heals by

Primary Healing. ***Primary Healing*** - An **incisional wound** is typically a clean, sharply incised wound with **minimal tissue loss** and edges that can be approximated. - **Primary healing** (or first intention) occurs when the wound edges are surgically closed, leading to rapid healing with minimal scarring. *Secondary Healing* - This type of healing occurs in wounds with **significant tissue loss** or infection, where the edges cannot be approximated. - The wound must heal by **granulation tissue formation** and **wound contraction**, resulting in a larger scar. *Epithelialization* - **Epithelialization** is a vital process in all types of wound healing, where epithelial cells migrate to cover the wound surface. - However, it describes a *process* rather than a *mode* of overall wound healing for a closed incisional wound. *Delayed primary Healing* - **Delayed primary healing** (or tertiary intention) involves leaving a wound open for a period (e.g., to control infection or edema) before closing it surgically. - This approach is not typical for a clean incisional wound but is used in cases where primary closure is initially unsafe.

Question 1

Isaac syndrome is characterized by -

Accepted Answer

Peripheral nerve hyperexcitability

Answer

Opsoclonus syndrome

Answer

Encephalitis

Answer

Limbic encephalitis syndrome

Question 2

Blood transfusion associated acute lung injury occurs due to -

Accepted Answer

HLA-mediated reaction

Answer

Nosocomial infections

Answer

Auto-immune disorder

Answer

Genetic susceptibility

Question 3

Thyroid nodule in a 65 year old male who is clinically euthyroid is most likely to be

Accepted Answer

Follicular adenoma

Answer

Multinodular goiter

Answer

Thyroid cyst

Answer

Follicular carcinoma

Question 4

What is the primary hormonal cause of hot flushes experienced during menopause?

Accepted Answer

Decreased estrogen levels

Answer

Increased noradrenaline with normal estrogen levels

Answer

Increased noradrenaline

Answer

Both increased noradrenaline and decreased estrogen levels

Question 5

Who devised the correction of CTEV by serial casting?

Accepted Answer

Ignacio Ponseti

Answer

Gerhardt Kuntscher

Answer

Gavril Ilizarov

Answer

Hugh Owen Thomas

Question 6

Child with 10 episodes of diarrhea in last 24 hours with sunken dry eyes, very slow skin pinch, and absent tears. Management is

Accepted Answer

Administer intravenous Ringer's lactate

Answer

Administer 10% dextrose solution

Answer

Encourage breastfeeding

Answer

Provide oral rehydration solution (ORS)

Question 7

Which of the following is not considered a contraindication for undergoing an MRI?

Accepted Answer

Ryle's tube

Answer

Cardiac pacemaker

Answer

Cochlear implant

Answer

Metallic splinter in eye

Question 8

An Incisional wound heals by

Accepted Answer

Primary Healing

Answer

Secondary Healing

Answer

Epithelialization

Answer

Delayed primary Healing

Question 9

Which of the following statements accurately describes a subtotal thyroidectomy?

Accepted Answer

Removal of 1 lobe with isthmus and the second lobe partially

Answer

Removal of one lobe and isthmus

Answer

Removal of both lobes leaving behind 6-8 grams of tissue

Answer

Removal of entire thyroid with cervical lymphnodes

Question 10

A 35 year old male came with jaundice, palpable mass in the right hypochondrium not associated with pain. The probable diagnosis is -

Accepted Answer

Pancreatic head carcinoma

Answer

Hepatocellular carcinoma

Answer

Choledochal cyst

Answer

Acute cholecystitis

NEET-PG 2015

Internal Medicine

Obstetrics and Gynecology

Orthopaedics

Pediatrics

Radiology

Surgery