Practice Paper of NEET PG: Important Questions of MEDICINE

The Important Questions of Medicine for NEET PG exam:

1. Most common cause of lobar hemorrhage in elderly age group ?
A: Hypertension
B: Vascular malformation
C: Coagulopathy
D : Amyloid angiopathy

Correct Answer: D : Amyloid angiopathy

Intraparenchymal bleed with surrounding oedema- CT Scan

  • Though hypertension is the most common cause of intracerebral hemorrhage, the usual site for it is putamen, thalamus, pons and cerebellum.
  • But lobar hemorrhage in elderly is most commonly due to cerebral amyloid angiopathy, where there is amyloid deposition in the walls of cerebral arteries following arteriolar degeneration.

2. Which is the most common preceding infection in bone marrow failure syndromes?
A. Parvo B19
B. EBV
C. HIV
D. Hepatitis

Correct Answer : D. Hepatitis

Aplastic anaemia – bone marrow histology

  • Most common infection preceding bone marrow failure syndrome is hepatitis.
  • It is usually sero negative ( non-A, non- B, non – C ).
  • It accounts for 5% of etiologies.
  • Parvo virus can cause pure red cell aplasia, but it doesn’t usually cause generalised bone marrow failure.

3. Which among the following statements is wrong :
A. Light chains are synthesised in slight excess normally in plasma cells
B. Qualitative assessment of M component can be done by electrophoresis
C. M components are detected in chronic myeloid leukaemia
D. In 20% myelomas, only light chains are produced

Correct answer: B

Plasmacytoma – H&E Stain

  • Qualitative assessment of M component is done by immune electrophoresis.
  • Electrophoresis is used for quantitative assessment of M component.
  • M component can also be detected in other lymphoid malignancies, CML, Can breast, colon cancer , non neoplastic condition like cirrhosis, sarcoidosis, rheumatoid arthritis, myasthenia gravis.

4. A patient is shown a ‘pen’ and was asked to name it. He replied as ‘pencil’. Identify the type of language disorder in this patient.
A. Motor aphasia
B. Phonemic paraphasia
C. Conduction aphasia
D. Semantic paraphasia

Correct answer : B. Semantic paraphasia

 

  • In motor aphasia, fluency, naming and repetition is impaired.
  • Wernicke’s aphasia– comprehension, repetition and naming is impaired, fluency is preserved.
  • Paraphasia – inability to use the appropriate word. There are two types of paraphasia:
    • Semantic paraphasia – use of incorrect but a related word
    • Phonemic paraphasia – the word approximates the correct answer, but is phonetically incorrect. ( eg; plentil instead of pencil )

5. Most specific symptom of temporal arteritis?
A. Visual loss
B. Jaw claudication
C. Temporal headache
D. Polymyalgia rheumatica

Correct answer : B. Jaw claudication

Histopathology of giant cell vasculitis (temporal arteritis) in a cerebral artery.

  • Giant cell arteritis ( temporal arteritis ) is a chronic vasculitis of large and medium vessel arteries, usually affecting the cranial branches of arteries arising from aortic arch.
  • Jaw claudication is an underreported, yet, a very specific symptom of GCA, with a high positive predictive value.

6. The artery that is spared in polyarteritis nodosa?
A. Bronchial artery
B. Renal artery
C. Coronary artery
D. Pulmonary artery

Correct answer : D. Pulmonary artery

Nodular thickened coronary vessels in polyarteritis nodosa. Abundant adipose tissue is also visible.

  • Polyarteritis nodosa is a mulisystem , necrotizing vasculitis of small and medium sized muscular arteries.
  • It is characterised by the involvement of renal and visceral arteries.
  • Pulmonary arteries are not involved in PAN, although rarely bronchial vessels may be involved.

7. Generalised painless lymphadenopathy is seen in?
A. Rocky mountain spotted fever
B. Scrub typhus
C. Epidemic typhus
D. Q fever

Correct answer : B. Scrub typhus

Adult trombiculid mite

  • Scrub typhus is caused by Rickettsia tsutsugamushi.
  • In severe scrub typhus, the patient develops apathy and prostration.
  • Erythematous maculopapular rash appears between 5th and 7th day involving trunk, face and limbs.
  • The patient also develops generalised painless lymphadenopathy.

8. Bacillary angiomatosis is caused by?
A. Bartonella bacilliformis
B. Bartonella rochalimae
C. Rickettsia japonica
D. Bartonella henselae

Correct answer : D. Bartonella henselae

Bartonella henselae in a case of endocarditis appearing as black granulations.

  • Bartonellosis is a group of diseases caused by intracellular gram negative bacilli.
  • Bacillary angiomatosis is an HIV associated disease caused by Bartonella henselae.
  • It can also be caused by Bartonella quintana.

9. Lipoatrophy can occur in patients treated with?
A. Abacavir
B. Tenofovir
C. Stavudine
D. Maraviroc

Correct answer : C. Stavudine

  • The use of thymidine analogue NRTI stavudine is associated with lipoatrophy.
  • When lipoatrophy occurs, therapy should be switched to non thymidine NRTI like abacavir or tenofovir.
  • This will result in gradual resolution of lipoatrophy.

10. Severe muscle weakness is seen in?
A. Cori disease
B. Andersen disease
C. McArdle disease
D. Tarui disease

Correct answer : B. Andersen disease

Glycogen storage disease – liver biopsy

  • Andersen disease is a type 4 glycogen storage disease.
  • It occurs due to deficiency of brancher enzyme.
  • It usually presents in infancy with severe muscle weakness.
  • Cirrhosis can also occur.

11. Protein losing enteropathy with mucosal erosion is seen in?
A. Lymphoma
B. Coeliac disease
C. Menetrier’s disease
D. Systemic lupus erythematosus

Correct answer : A. Lymphoma

Chron’s disease – colon histology

  • Causes of protein losing enteropathy with mucosal erosion are Crohn’s disease, ulcerative colitis, radiation damage and lymphoma.
  • Coeliac disease, Menetrier’s disease and systemic lupus erythematosus can cause protein losing enteropathy without mucosal erosion.

12. All are true regarding hepatitis C infection except?
A. Serum transaminase level is a good predictor of the level of liver fibrosis
B. Telaprevir is effective in management
C. 3% risk of vertical transmission
D. Sharing toothbrushes is a risk factor for transmission

Correct answer : A. Serum transaminase level is a good predictor of the level of liver fibrosis

Hepatitis C virus – electron microscopic image

  • Serum transaminase level in hepatitis C is not a good predictor of the level of liver fibrosis.
  • A liver biopsy is required to assess the degree of liver damage.
  • There is 3% risk for acquisition of chronic hepatitis C by vertical transmission.
  • Sharing of toothbrushes and razors is another risk factor.

13. Sausage digit is seen in?
A. Rheumatoid arthritis
B. Juvenile idiopathic arthritis
C. Enteropathic arthritis
D. Psoriatic arthritis

Correct answer : D. Psoriatic arthritis

Psoriatic arthritis

  • Asymmetrical inflammatory oligoarthritis in seen in psoriatic arthritis.
  • It occurs mostly in hands and feet.
  • Synovitis of the finger or toe along with tenosynovitis, enthesitis and inflammation of the intervening tissue causes sausage digits.

14. Ehrlichiosis is a common coinfection with?
A. Lyme disease
B. Louse borne relapsing fever
C. Tick borne relapsing fever
D. Leptospirosis

Correct answer : A. Lyme disease

Anaplasma phagocytophilum cultured in human promyelocytic cell line HL-60. Basophilic and intracytoplasmic inclusions are seen (arrows).

  • Ehrlichiosis is a tick borne bacterial infection.
  • It is caused by bacteria such as Anaplasma phagocytophilum and Ehrlichia chaffeensis.
  • It is a common coinfection with a lyme disease.

15. Which of the following is seen in Churg-Strauss syndrome?
A. Sinusitis
B. Raynaud’s phenomenon
C. Allergic rhinitis
D. Epistaxis

Correct answer : C. Allergic rhinitis

Eosinophilic vasculitis in Churg Strauss syndrome

  • Churg-Strauss syndrome is a small vessel vasculitis.
  • The acute presentation includes skin lesionseosinophilia and asymmetric mononeuritis multiplex.
  • There can be a prodromal period lasting many years in which the patient can haveallergic rhinitisnasal polyposis and asthma.
  • Treatment is by high dose steroids and cyclophosphamide.
  • Maintenance therapy is by low dose steroids, azathioprine, methotrexate and mycophenolate mofetil.

16. All are true regarding Scheuermann’s osteochondritis except?
A. Dorsal kyphosis
B. Autosomal recessive inheritance
C. Predominantly affects adolescent boys
D. Irregular ossification of vertebral endplates

Correct answer : B. Autosomal recessive inheritance

Autosomal dominant inheritance

  • Scheuermann’s osteochondritis has autosomal dominant inheritance.
  • It commonly affects adolescent boys.
  • It is characterised by irregular ossification of vertebral endplates and dorsal kyphosis.
  • Most patients are asymptomatic.
  • It can present with backache which is aggravated by exercise.
  • Management is by protective postural exercises with avoidance of excessive activity.

17. RANKL is produced by all except?
A. Osteocytes
B. Osteoclasts
C. Activated T cells
D. Bone marrow stromal cells

Correct answer : B. Osteoclasts

RANKL (TNFSF11) – Protein structure rendering

  • RANKL (Receptor Activator of Nuclear factor Kappa B Ligand), also known as Tumor Necrosis Factor ligand Super Family member 11 (TNFSF11) is produced by osteocytes, activated T cells and bone marrow stromal cells.
  • RANKL acts on the RANK receptor present on osteoclasts and their precursors.
  • It promotes maturation of osteoclast precursors into mature osteoclasts.

18. Which of the following substances produced by osteoclasts is responsible for digestion of minerals during bone resorption?
A. Hydrochloric acid
B. Acetic acid
C. Cathepsin K
D. Sclerostin

Correct answer : A. Hydrochloric acid

Osteoclasts – cells responsible for bone resorption

  • Mature osteoclasts attach to bone and form a tight sealing zone.
  • They secrete hydrochloric acid and proteolytic enzymes like cathepsin K.
  • HCl is involved in digestion of bone minerals.
  • Cathepsin K is responsible for degradation of collagen.
  • Sclerostin (SOST) is a glycoprotein produced by osteocytes which inhibits bone formation.

19. Collagen fibrils in bone are crosslinked with?
A. Osteopontin
B. Laminin
C. Fibrillin
D. Pyridinium

Correct answer : D. Pyridinium

Molecular structure of pyridinium

  • Collagen fibrils in bone are cross-linked with pyridinium.
  • It increases bone strength.
  • During bone resorption by osteoclasts, these cross-links are released.
  • They act as biochemical markers of bone resorption.
  • Pyridinium cross-links can be detected in urine.

Collagen fibers – Electron microscopy

20. Most abundant protein of bone is?
A. Laminin
B. Osteocalcin
C. Type 1 collagen
D. Type 2 collagen

Correct answer : C. Type 1 collagen

Collagen triple helix

  • Most abundant protein of bone is type 1 collagen.
  • It is a triple helix formed by two α1 peptide chains and one α2 peptide chain.

21. Which of the following increases bone resorption?
A. Osteoprotegerin (OPG)
B. Oestrogen / testosterone
C. Mechanical loading
D. Interleukin 1

Correct answer : D. Interleukin 1

  • Interleukin 1 stimulates bone resorption and inhibits bone formation.
  • Osteoprotegerin is glycoprotein which acts as a decoy receptor for receptor activator of nuclear factor kappa B ligand (RANKL).
  • It prevents RANKL induced osteoclastic bone resorption. It is produced by osteoblasts.
  • Oestrogen, testosterone and mechanical loading inhibit bone resorption and stimulate bone formation.

22. Which of the following decreases bone resorption?
A. Receptor activator of nuclear factor kappa B ligand (RANKL)
B. Interleukin 1
C. Osteoprotegerin
D. Tumour necrosis factor

Correct answer : C. Osteoprotegerin

Osteoclasts on the surface of a bone

  • Osteoprotegerin is glycoprotein which acts as a decoy receptor for receptor activator of nuclear factor kappa B ligand (RANKL).
  • It prevents RANKL induced conversion of osteoclast precursors to osteoclasts.
  • It is produced by osteoblasts.
  • All the other factors mentioned increase bone resorption.

23. Sclerostin is produced by?
A. Osteocytes
B. Osteoblasts
C. Osteoclasts
D. Chondrocytes

Correct answer : A. Osteocytes

  • Sclerostin (SOST) is a glycoprotein produced by osteocytes.
  • They also synthesize receptor activator of nuclear factor kappa B ligand (RANKL).
  • Both of these are involved in regulating bone formation and resorption.

24. Most common form of arthritis is?
A. Rheumatoid arthritis
B. Psoriatic arthritis
C. Seronegative arthritis
D. Osteoarthritis

Correct answer : D. Osteoarthritis

Heberden’s node (on the index finger of right hand) in a case of osteoarthritis.

Osteoarthritis is the most common form of arthritis. It affects up to 80% of individuals older than 75 years.

25. Which of the following has a male female ratio of 1:1?
A. Rheumatoid arthritis
B. Gout
C. Seronegative spondyloarthritis
D. Polymyalgia rheumatica

Correct answer : C. Seronegative spondyloarthritis

Bamboo spine in ankylosing spondylitis – a type of seronegative arthritis

  • Seronegative spondyloarthritis has a male : female ratio of 1:1.
  • Rheumatoid arthritis and Polymyalgia rheumatica are seen more commonly in females.
  • Gout is more common in males.

26. Triad of skin lesions, asymmetric mononeuritis multiplex and eosinophilia are seen in?
A. Cryoglobulinemic vasculitis
B. Polyarteritis nodosa
C. Churg Strauss Syndrome
D. Giant cell arteritis

Correct answer : C. Churg Strauss Syndrome

Churg Strauss Syndrome

  • Churg Strauss Syndrome is a small vessel vasculitis.
  • Biopsy of affected site reveals small vessel vasculitis with eosinophilic infiltration of vessel wall.

Cryoglobulinemic vasculitis

  • Cryoglobulinemic vasculitis presents with rash over lower limbs, arthralgia, Raynaud’s phenomenon and neuropathy

Polyarteritis nodosa

  • Polyarteritis nodosa presents with fever, myalgia, arthralgia, multisystem involvement and palpable purpura.

Giant cell arteritis

  • Cardinal symptom of giant cell arteritis is headache localised to temporal or occipital region.
  • Visual disturbances can occur.
  • Catastrophic presentation is with blindness in one eye.
  • It is commonly associated with polymyalgia rheumatica.

27. Which of the following genetic mutation has been described in aortic stenosis?
a) KCNH2
b) KCNQ1
c) NOTCH1
d) SCN5A

Correct answer: c) NOTCH1

NOTCH1 mutation can cause severe valvular calcification which can be transmitted in an autosomal dominant pattern. KCNH2 and KCNQ1 are potassium channel genes, mutations of which are seen in long QT syndrome. SCN5A is a sodium channel gene which is mutated in long QT 3 and Brugada syndrome.

28. Which of the following is not a feature of complete heart block on the ECG:
a) Constant RR interval
b) Constant PP interval
c) Constant PR interval
d) PP interval shorter than RR interval

Correct answer: c) Constant PR interval

Complete heart block – ECG

In complete heart block the atria and ventricle are totally dissociated. Hence PR interval is totally varying. Constant PR interval would mean sequential atrioventricular activation, which is absent in complete heart block.

29. Mitral annular area in systole:
a) Decreases by 10%
b) Decreases by 25%
c) Increases by 10%
d) Increases by 25%

Correct answer: b) Decreases by 25%

In systole, when the ventricle contracts, the mitral annulus also contracts, reducing the mitral annular area by about 25% . This is important in preventing mitral regurgitation in systole. When the left ventricle is dilated, with associated annular dilatation, even in the absence of valvular damage, mitral regurgitation can occur. Similarly, when the left ventricular systolic function is poor, the decrease in mitral annular area with systole is reduced, paving the way for mitral regurgitation.

30. Dominant right coronary artery means?
a) Right coronary artery supplies major portion of the myocardium
b) Right coronary artery crosses the crux and gives rise to posterior left ventricular branches
c) Right coronary artery supplies major portion of the left ventricle
d) None of the above

Correct answer: b) Right coronary artery crosses the crux and gives rise to posterior left ventricular branches

Dominant right coronary artery – Angiogram
[ RCA = right coronary artery, Conus = conus branch of the right coronary artery, AM = acute marginal branch, PLV = posterior left ventricular branch, 1 = obstructive lesion in proximal portion of posterior descending artery (PDA). ]

  • Crux is the junction of the interventricular and atrioventricular grooves posteriorly.
  • The dominant artery crosses the crux and supplies the opposite side.
  • If right coronary artery is dominant, it crosses the crux and supplies posterior left ventricular branches.
  • If left coronary artery is dominant, it crosses the crux and also gives rise to the left posterior descending artery (LPDA).
  • In right dominant system, it is the right coronary artery which gives rise to the posterior descending coronary artery (PDA).
  • Sometimes the arteries may be codominant.
  • It may be noted that regardless of the anatomical dominance of the coronary arteries, it is always the left coronary artery which supplies the major portion of the left ventricular myocardium (and also the total myocardium as right ventricular myocardial mass is quite low compared to that of left ventricle).
  • If the right coronary artery is non dominant, lesions in the non dominant artery are ignored from the point of view of coronary revascularization procedures like percutaneous coronary angioplasty.

Non dominant right coronary artery (RCA) – Angiogram
(In contrast to the first image, the RCA does not give rise to the posterior left ventricular branch)

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