Human papillomavirus | NEET Based MCQ

Human papillomavirus is most commonly associated with 

A. Rectal polypsb. 
B. Prostate cancer
C. Condylomaacuminatumd. 
D. Hepatic carcinoma

The answer is : C

Papillomavirus infects the skin or mucosa and causes benign tumors. The lesion is termed condylomaacuminatum. These tumors may undergo malignant conversion and become squamous cell carcinomas. Classification of the human papillomavirus is done by DNA hybridization, and to date 46 types have been recognized. Some types, such as 16 and 18 are more frequently associated with carcinoma, while others, such as 6 and 11, are associated with benign tumors or warts.

Rupture of the internal vertebral venous plexus | NEET Based MCQ

Rupture of the internal vertebral venous plexus results in an accumulation of blood in which of the following spaces 

A. Space deep to the pia mater 
B. Space between the arachnoid and duramater
C. Space between duramater and periosteum of vertebra 
D. Space between the arachnoid and pia mater

The answer is .C.

In the spine, the epidural space is the space outside the tough membrane called the dura mater, and within the spinal canal, which is formed by the surrounding vertebrae. Adherent to the inside of the dura is a much thinner and more fragile membrane, the arachnoid mater. Enclosed within the arachnoid is the subarachnoid space, which contains the cerebrospinal fluid, and the spinal cord.

Anterior division of internal iliacartery include | NEET Based MCQ

The branches of anterior division of internal iliacartery include all except 

A. lnternalpudendal
B. Superior gluteal
C. Uterined. 
D. Obturator

The answer is B.

• Internal iliac artery arises at the bifurcation of the common iliac, artery, Opposite the lumbosacral joint (L5/S1 intervertebral disc)
Division Branch

Posterior Iliac artery

·  Superior gluteal artery

·  Iliolumbar artery

·  Lateral sacral arteries

Anterior Iliac Artery- about 8 branches

·  Obturator artery (occasionally from inferior epigastric artery)

·  Inferior gluteal artery

·  Umbilical artery, which later persist as superior vesical artery (remaining artery becomes medial umbilical ligament).

·  Uterine artery (females) or deferential artery (males) Vaginal artery (females, can also arise from uterine artery) or inferior vesical artery (males)

·  Middle rectal artery 

·  Internal pudendal artery

·  Artery of the perineum

·  Accessory obturator artery: The obturator artery sometimes arises from the main stem or from the posterior trunk of the internal iliac, or it may spring from the superior gluteal artery; occasionally it arises from the external iliac. 

Lassa fever, influenza A and B, and respiratory syncytial virus (RSV) | NEET Based MCQ

Which of the following antiviral agents is a purine nucleoside analogue that has shown promise with Lassa fever, influenza A and B, and respiratory syncytial virus (RSV).

A. Amantadine 
B. Rimantadine
C. Vidarabine 
D. Ribavirin

The answer is: D

 As an intravenous agent, ribavirin is effective against Lassa fever in the first week of onset of the disease. It may also be administered as an aerosol that is quite useful in infants with RSV. Unlike amantadine, which is efficacious only with influenza A, ribavirin has activity against both influenza A and B if administered by aerosol in the first 24 h of onset.

HIV – positive patient with a viral load of 750.000 copies of HIV RNA/ml | NEET Based MCQ

HIV – positive patient with a viral load of 750.000 copies of HIV RNA/ml and a total CD4 count of 50 is at an increased risk for a number of infectious diseases. For which of the following diseases the paitent has no added risk than an immune complete host?

A. Pneumocystic pneumonia 
B. Mycobacterial diseas
C. Kaposi’s sarcomad. 
D. Pneumococcal pneumonia

The answer is: D

A low CD4 count does not predict progression to AIDS but does indicate increased chance of opportunistic infection such as those listed. Kaposi’s sarcoma, which has been linked to herpesvirustyp 8, pneumocystis, and mycobacterial disease are three of the most prevalent opportunistic infections.  While HIV-positive patients contract pneumococcal pneumonia, they are probably at no more risk than the general population, as protection against pneumococcal disease is linked to the presence of anticapsular antibody.

Merkel cell carcinoma | NEET Based MCQ

Merkel cell carcinoma is due to 

A. Cytokeratin: 7 
B. Cytokeratin: 19 
C. Cytokeratin: 20 
D. Cytokeratin: 18

The answer is C. Cytokeratin 20:

•   Merkel cell carcinoma (MCC) [trabecular carcinoma, small cell carcinoma of the skin, primary cutaneous neuroendocrine carcinoma] is a rare, aggressive, primary skin cancer exhibiting neuroendocrine differentiation.

•   The histogenesis of MCC is controversial. Possible cells of origin include the epidermal MC, a dermal MC equivalent, a neural-crest-derived cell of the amine precursor uptake and decarboxylation (APUD) system, and a residual epidermal stem cell.

•   Cytogenetic abnormalities are present in 30-47% of MCCs. The most frequent change is loss of heterozygosity due to translocations or deletions of chromosome 1; specifically, 2 distinct regions in the most distal band 1 p36 on the short arm of chromosome 1 are implicated in MCC. Similar abnormalities near this site occur in several neuro cystic tumors, including melanoma, neuroblastoma, and pheochromocytoma. Other abnormalities described in MCC include losses at chromosomes 3, 13, and 22 and partial trisomy 01 chromosomes 1, 11, 18, and X. Unlike neuroendocrine (small cell) carcinoma of the lung, gene amplifications are rare in cutaneous MCC.

•   Cytokeratin 20 is expressed in a dot like paranuclear or crescentic pattern; other low molecular weight (MW) cytokeratin antibodies (E.g., CAM5.2, MNF116), white less specific, react in a similar localization pattern.

•   Electron microscopic findings are characteristic, revealing a lobulated nucleus that may contain rodlets. The cytoplasm is electron-lucent and contains a prominent Golgiapparatus and numerous ribosomes. Intermediate filaments are numerous and often assume a parallel or whorled arrangement near the nucleus, accounting for the dot like pattern of cytokeratin distribution visualized by immunohistochemistry. Desmosomes may be present. Most diagnostic is the dense core granule (80-120 mn in diameter), the source and the locus of the neuroendocrine peptides. 

Chromosome analysis of the fetus | NEET Based MCQ

All of the following can be used to determine a chromosome analysis of the fetus except

A. Amniocentesis 
B. Chorionic villus sampling
C. Percutaneous umbilical blood sampling (PUBS)
D. Fetal umbilical Doppler velocimetry

The answer is D

Fetal tissue for chromosome analysis can be obtained via amniocentesis, chorionic villus sampling (CVS), percutaneousumbilical blood sampling, or direct biopsy of fetal muscle or skin. Amnio- centesis involves obtaining a sample of amniotic fluid, which contains fetal fibroblasts. Chorionic villus sampling involves taking a biopsy of the placenta. In the case of PUBS, the umbilical vein is punctured under direct ultrasound guidance near the placental origin and blood is obtained for genetic analysis. Doppler velocimetry is an ultrasound technique used to examine blood flow through the umbilical artery. IUGR has been associated with abnormal umbilical artery Doppler velocimetry. Therefore, this technique is used with other modalities such as BPP and NSTS to monitor fetal wellbeing.

The placenta of twins | NEET Based MCQ

The placenta of twins may be

A. Dichorionic and monoamniotic in dizygotic (DZ) twins
B. Dichorionic and monoamniotic in monozygotic (MZ) twins
C. Monochorionic and monoamniotic in DZ twins
D. Dichorionic and diamniotic in MZ twins

The answer is D

Dizygotic twins of different sexes always have a dichorionic and diamniotic placenta, and monochorionic monozygotic twins are always of the same sex. The dichorionic placentas of dizygotic twins may be totally separated or intimately fused. Of monozygotic twins, 20 to 30% have dichorionic placentation, the result of separation of the blastocyst in the first 2 days after fertilization. The majority of monozygotic twins have a diamniotic and monochorionic placenta. The least common type of placentation in monozygotic twins is the monochorionic and monoamniotic placenta; its incidence is only about 1%.

Toxicity of local anesthetics | NEET Based MCQ

Which of the following statements regarding toxicity of local anesthetics is false?

A. The first signs of toxicity are dizziness, tinnitus, and nystagmus
B. Systematic convulsions are rare and usually self-limited
C. Most allergic reactions are to aminoamide compounds
D. For patients allergic to local anesthetics, diphenhydramine hydrochloride 1% can be injected into the wound.

The answer is C. Most allergic reactions are to aminoamide compounds

• Slow injections limit the chance for local anesthetic toxicity. When history of allergy is uncertain, an antihistamine such as diphenhydrarnine injected directly into the wound can be used as an alternative and achieves anesthesia in approximately 30 mm.
• True allergic reactions to local anesthetics are rare, especially to aminoamide compounds such as lidocaine and bupivicaine. The ester derivatives of paraaminobenzoic acid, such as procaine, are responsible for most local anesthetic allergic reactions.
• Toxicity should be suspected in patients who complain of dizziness, tinnitus, and periorbital tingling. Rarely, systemic convulsions follow.

• These are usually self-limited because of rapid redistribution of the drug, with resultant lower serum levels. 

Laparoscopic salpingostomy vs. laparotomy with salpingectomy | NEET Based MCQ

In comparing laparoscopic salpingostomy vs. laparotomy with salpingectomy for the treatment of ectopic pregnancy, laparoscopic therapy results in

A. Decreased hospital stays 
B. Lower fertility rate
C. Lower repeat ectopic pregnancy rate
D. Comparable persistent ectopic tissue rate

The answer is a. Conservative laparoscopic treatment of ectopic pregnancy is now commonplace, although not yet universal. With increasing sophistication of techniques and fiberoptics, many microsurgical procedures can be done through the laparoscope. Recent studies suggest that the fertility rates for laparoscopy and laparotomy are comparable, as are the implications of repeat ectopic pregnancies. Certainly laparoscopy, because of its small incision, results in fewer break- downs and shorter hospital stays, but the incidence of complications due to retained ectopic tissue is higher.

Intrauterine fetal demise | NEET Based MCQ

A patient at 17 weeks gestation is diagnosed as having an intrauterine fetal demise. She returns to your clinic 5 weeks later and has not had a miscarriage, although she has had some occasional spotting. This patient isat increased risk for

A. Septic abortion 
B. recurrent abortion
C. Consumptive coagulopathy with hypofibrinogenemia
D. Ectopic pregnancies

The answer is c. In modern clinical medicine, once the diagnosis of fetal demise has been made, the products of conception are removed. If, however, the gestational age is over 14 weeks and the fetal death occurred 5 weeks ago, coagulation abnormalities may be seen. Septic abortions were more frequently seen during the era of illegal abortions, although occasionally sepsis can occur if there is incomplete evacuation of the products of conception in either a therapeutic or spontaneous abortion.

Ectopic pregnancy | NEET Based MCQ

A 27-year-old has just had an ectopic pregnancy. Which of the following events would be most likely to predispose to ectopic pregnancy?

A. Previous tubal surgery
B. Pelvic inflammatory disease (PID)
C. Use of a contraceptive uterine device (IUD)
D. Induction of ovulation

The answer is b. Any factor delaying transit of the ovum through the fallopian tube may predispose a patient to ectopic pregnancy. The major predisposing factor in the development of ectopic pregnancy is pelvic inflammatory disease. However, any operative procedure on the fallopian tubes may increase a patient’s risk. It appears that tubal sterilizations with laparoscopic fulguration have a higher rate of ectopic pregnancy than tubal ligations performed with clips or rings. Women who have had one ectopic pregnancy are at increased risk of having a second. DES exposure, induction of ovulation, and IUD use increase the possibility of ectopic pregnancy.The best choice is B PID.

Instituting single-agent chemotherapy | NEET Based MCQ

Indications for instituting single-agent chemotherapy following evacuation of a hydatidiform mole usually include

A. A rise in HCG titers
B. A plateau of HCG titers for 1 week
C. Return of HCG titer to normal at 6 weeks after evacuation
D. Appearance of liver metastasis

The answer is a. Single-agent chemotherapy is usually instituted if levels of hCG remain elevated 8 weeks after evacuation of a hydatidiform mole. Approximately 50% of the patients who have persistently high hCG titers will develop malignant sequelae. If hCG titers rise or reach a plateau for 2 to 3 successive weeks following molar evacuation, a single-agent chemotherapy should be instituted, provided that thetrophoblastic disease has not metastasized to the liver or brain. The presence of such metastases usually requires initiation of combination chemotherapy. 

Loud pulmonary component of second heart sound heard in | PGI Nov 2017 Preparations MCQ

Loud pulmonary component of second heart sound heard in 

A. Pulmonary hypertension 
B.TOF 
C. Eisenmenger’s syndrome 
D. Pulmonary stenosis 
E. AS

Answer. A. Pulmonary hypertension ; (C) Eisenmenger syndrome

• Pulmonary hypertension: P, loud, normal splitting of S2

• TOF: P2 soft & delayed and is generally inaudible as pulmonary artery pressure is reduced and RV outflow obstruction is there. So, s2 is single, the audible sound is A2.

• Eisenmenger syndrome : P2 is loud as there is pulmonary hypertension

• Pulmonary stenosis: P2 is delayed & softer widely split with normal movement.

• Aortic stenosis : P2 is normal; A2 delayed normal splitting, single paradoxical splitting. 

Malignant neuroleptic syndrome | PGI Nov 2017 Preparations MCQ

Malignant neuroleptic syndrome is seen with all of the following except:

A. Atropine 
B. Halothane
C. Ketamine 
D. Anti psychotics
E. Bromocriptine

Answer. A. Atropine ; (B) Halothane ; (C) Ketamine ; (E)Bromocriptine

Malignant neuroleptic syndrome is seen with Anti-psychotics.

There is rigidity , immobility , tremor , fever and semi consciousness .  Due to anti dopaminergic action of antipsychotics . Anticholinergics of no use , Bromocryptine in large doses may be useful .

Statements about hairy cell | PGI Nov 2017 Preparations MCQ

All of the statements about hairy cell are true except: 

A.Massive lympadenopathy
B. Result from an expansion of neoplastic B lymphocytes
C. Cells are positive for tartarate resistant acid phosphate (TRAP) 
D. The cells express CD 5 consistently
E. Lukemia cells look like broken hair ends

Answer. A.Massive lympadenopathy; (D) The cells express CD5 consistently; (E) Lukemia cells look like broken hair ends

Hairy Cell Leukemia

·        Appearance of leukemia cells-fine hairlike projection

·        Hairy cell rearrange and express immunoglobulin genes which firmly assign them to B cell lineage

·        Characteristic-presence of tartrate resistant acid phosphatase (TRAP)

·        Involve mainly older male

·        Splenomegaly (massive)

·        Hepatomegaly not marked

·        Lymphadenopathy rare

·        Pancytopenia in 50% cases

·        Splenectomy is of benefit

·        Alpha interferon has proved to be effective

·        Hairy cells usually express the pan B-cell markers CD19 & CD20 and some times monocyte associated antigen CD11c, CD25, CD103

Barium-study findings in small intestinal malabsorption | NEET Based MCQ

The barium-study findings in small intestinal malabsorption include all the following except: 

A. Increased bowel transit time 
B. Mucosal atrophy 
C. Stricture of bowel 
D. Flocculation of barium


Ans. C. (stricture of bowel)
Small intestinal malabsorption
There are four racliologic groups of findings in small intestinal malabsorption, related to alteration in:
1. Peristalsis - variable peristalsis is hallmark with hypo and hypertonic segments, overall leading to increased transit
time and segmentation of barium.
However, the transit time may be long/short/normal.
Painless transient intussusception may be seen on fluoroscopy.
2. Caliber - dilatation of segments of bowel coils in 80% cases (>3 cm).
3. Secretions - increased secretions cause dilution of barium and later clumping, segmentation and flocculation of barium.
4. Mucosa - edematous mucosa with thickened valvulae conniventes giving cog-wheel’ pattern (colonization of jejunum), instead of their normal feathery’ pattern; later atrophy occurs and mucosal folds disappear with thinning of bowel wall.
Valvulae conniventes may exhibit five types of appearances:
o Normal
o Squared ends
o Thickening of valvulae
o Reversed jejunoileal pattern
o Absence of valvulae conniventes: “moulage sign” characteristic of sprue

CLL Based Clinical MCQ | NEET Based MCQ

An 80-year-old, asymptomatic man presents with a total leucocyte count of 1 lakh, with 80% lymphocytes and 20% PMC’s. Most probably this patient is suffering from 

A. AML 
B. CML 
C. CLL 
D. TB

Ans. C. (CLL)

Explanation
In the question, following things are the reason for the diagnosis—age, 80 years; asymptomatic; gender—male; TLC—l lakh; lymphocytes 80%; with 20% PMCs.

In CLL,following important points, we should know

• Median age—65 years

• Male percentage—53%

• Increased number of circulating lymphocytes (i.e., >4 x 10⁹/L and usually> 10 x 10⁹/L) and same finding in bone marrow confirm the diagnosis.

• Peripheral blood smear shows many “smudge” or “basket” cells, nuclear remnants of cells damaged by the physical shear stress.

• Trisomy 12 is found in 25% to 30% of patients.

• Typically, CLL is often found incidently when a complete blood count is done for other reason.

Feature of Schizophrenia | NEET Based MCQ

Which one of the following is not a feature of Schizophrenia? 

A. Literally means ‘splitting of mind’ 
B. Peak incidence occurs in 15 to 30 years age group 
C. People with low intelligence are more predisposed 
D. Both C and D

Ans. C. People with low intelligence are more predisposed
 Eugen Bleuler’s Fundamental Symptoms of Schizophrenia

• Ambivalence: Marked inability to decide for or against.
• Austin: Withdrawal into self.
• Affect disturbances: For example, inappropriate affect.

• Association disturbances: Loosening of associations; thought disorder. 

Diagnostic criteria for pulmonary aspergillosis | PGI Nov 2017 Preparations MCQ

Diagnostic criteria for pulmonary aspergillosis 

A. Asthma 
B. Eosinophillia
C. Bilateral chest ipfiltrates
D. increased lgG 
E. Bronchiectasis

Answer. A. Asthma; (B) Eosinophilia; (E) Central bronchiectasis

Diagnostic criteria for bronchopulmonary Aspergillosis:

Primary

(i) Clinical h/o Asthma

(ii) Eosinophilia

(iii) Immediate skin Reactivity to aspergillus antigen

(iv) Precipitating Ab. To aspergillus Antigen

(v) IgE

(vi) Pulmonary infiltrates

(viii) Central bronchiectasis

In ABPA, the pulmonary infiltrates may be patchy , segmental and even whole lung may be involved.