NEET 2014 MCQ CARDIOLOGY

In the third match of a volleyball tournament, a 15-year-old girl jumps up for a block and collapses. Despite cardiopulmonary resuscitation, she cannot be revived. She had been healthy all her life and complained only of limited episodes of chest pain in games during the current school year. Which of the following pathologic findings of the heart is the medical examiner most likely to find?

• Haphazardly arranged hypertrophied septal myocytes
• Extensive myocardial hemosiderin deposition
• Tachyzoites within foci of myocardial necrosis and inflammation
• Mitral valvular stenosis with left atrial enlargement
• Large, friable vegetations with destruction of aortic valve cusps

Hypertrophic cardiomyopathy is the most common cause of sudden unexplained death in young athletes. There is asymmetric septal hypertrophy that reduces the ejection fraction of the left ventricle, particularly during exercise. Histologically, haphazardly arranged hypertrophic myocardial fibers are seen. Hemochromatosis gives rise to a restrictive cardiomyopathy in middle age. Tachyzoites of Toxoplasma gondii signify myocarditis, a process that may occur in immunocompromised persons. Rheumatic heart disease with chronic valvular changes would be unusual in a patient this age, and the course is most often slowly progressive. Valve destruction with vegetations is seen in infective endocarditis. This would be accompanied by signs of sepsis.

NEET 2014 MCQ Emergency Medicine

NEET 2014 MCQ Emergency Medicine

The dermatitis in newborns referred to as “cradle cap” and rarely associated with hair loss is:

seborrhea

tinea capitis

lichen simplex chronicus

erysipelas

Seborrheic dermatitis is a common dermatitis seen in all age groups, including infants. When appearing on the scalp, it should be differentiated from tinea capitus, a fungal infection with patchy hair loss and hair breakage. Lichen simplex chronicus is extremely pruritic, and not common in neonates. Erysipelas is a bacterial skin infection, characteristically featuring a well-demarcated border of warm red, tender tissue.

 

NEET 2014 MCQ Ophthalmology

Questions

A myope who pushes his spectacles closer to his face and tilts them is

                a              decreasing effectivity, increasing cylinder

                b             decreasing effectivity, decreasing cylinder

                c              increasing effectivity, decreasing cylinder

                d             increasing effectivity, increasing cylinder

The Prentice position refers to

                a              glass prism perpendicular to visual axis

                b             glass prism in frontal plane

                c              plastic prism perpendicular to visual axis

                d             plastic prism in frontal plane

The purpose of Q-switching a laser is to

                a              increase energy, increase power

                b             decrease energy, increase power

                c              decrease energy, decrease power

                d             increase energy, decrease power

Answers-

A myope who pushes his spectacles closer to his face and tilts them is

                d             increasing effectivity, increasing cylinder

The Prentice position refers to

                a              glass prism perpendicular to visual axis

The purpose of Q-switching a laser is to

                b             decrease energy, increase power

NEET 2014 MCQ Ophthalmology

A 30-year-old woman presents to the office with a 3-day history of a unilateral red eye. Her vision is decreased and she has significant photo-phobia. She has a mucus-like discharge. She reports having had ‘flu’ with fever 2 weeks earlier. There is no history of exposure to an individual with a red eye, no history of contact lens wear, and no other associated non-ocular findings. Past medical history is positive for a recent ‘cold sore’ and a history of ‘hay fever.’ The patient is currently taking multivitamins and oral contraceptive pills. Based on the history presented, what is the best course of action?

• Gentamicin ophthalmic solution four times a day for presumed bacterial conjunctivitis
• Cool compresses and observation for presumed viral conjunctivitis
• Ophthalmologic referral for presumed acute angle closure glaucoma
• Ophthalmologic referral for presumed herpes simplex virus-related ocular disease
• Observation and topical antihistamines for presumed allergic conjunctivitis

When dealing with an ‘acute red eye’, it is imperative to establish a history of the present illness. One should explore the course of development, the presence of a discharge (bacterial infections produce more than viral), pain, recent upper respiratory infection (suggesting viral conjunctivitis), photophobia (suggesting iritis), foreign body sensation, itching (suggesting allergic conjunctivitis), burning, associated fever or rash, or decreased visual acuity. Elements of the past ocular history may be relevant, including glaucoma and contact lens wear. A. history of atopic disease may be important in the diagnosis of allergic conjunctivitis. A. history of herpes simplex virus labialis may be significant. In this patient, the history of herpes labialis and significant photophobia are suggestive for herpes simplex virus-related ocular disease.

NEET 2014 ANATOMY CNS MCQ

Which of the following receptors is primarily involved in the nociceptive reflex?

• Free nerve ending
• Golgi tendon organ
• Hair follicle receptor
• Merkel cell ending
• Pacinian corpuscle

Free nerve endings, also called naked nerve endings, are the receptors on fibers that conduct information that the patient interprets as pain; these are lightly (A-delta) and unmyelinated (C-fibers) fibers.

NEET 2014 Embryology MCQ

In oogenesis, which of the following events occurs immediately following the completions of meiosis II?

(A) Degeneration of the zona pellucida

(B) Sperm penetration of the corona radiata

(C) Formation of a female pronucleus

(D) Appearance of the blastocyst

(E) Completion of cleavage

Answer - C.

The secondary oocyte is arrested in metaphase of meiosis II, and it will remain in this meiotic stage until fertilization occurs. Following fertilization, the secondary oocyte completes meiosis II, forming a mature ovum and a polar body. The nucleus of the mature ovum is called the female pronucleus, which fuses with the male pronucleus to form a zygote.

NEET 2014 Oncology / Surgery / Breast MCQ

A 43-year-old woman with a history of diabetes mellitus, hypertension and trigeminal neuralgia presents with daily headaches of 6 months’ duration. She has not seen a physician in 3 years. Her headaches have prevented her from completing normal daily tasks. You find that she has not had any age-appropriate cancer screening. She has a grandmother who developed invasive ductal carcinoma of the left breast at the age of 60 years. What is the current recommendation for breast cancer screening for this patient?

• Screening mammogram 5 years earlier than her grandmother’s diagnosis age
• Screening mammogram every 4 years
• Screening mammogram every 6 months
• Screening mammogram every 1–2 years
• There is no necessity for mammography at this time

Screening mammography, with or without clinical breast examination (CBE) is recommended every 1–2 years for women above the age of 40 years. Screening mammography is not recommended for women below the age of 40 years because the incidence of breast cancer is very low and also because the breasts have dense fibrous tissue, making interpretation difficult.

NEET 2014 MCQs Anatomy CNS

The CT scan of a 73-year-old woman shows an infarcted area in the rostral portions of the dorsomedial nucleus, the anterior nucleus, and the ventral anterior nucleus. Which of the following arteries supply blood to this area of the brain?

• Thalamoperforating
• Anterior choroidal
• Lateral striate (lenticulostriate)
• Medial striate
• Thalamogeniculate

The thalamoperforating arteries serve the more rostral portions of the dorsal thalamus. These vessels may originate as a single trunk or as several vessels from the P₁ segment of the posterior cerebral artery. (p. 154–158, 168–169)

Thanks to Publisher & Author of

Neuroanatomy: An Atlas of Structures, Sections, and Systems

by Duane E. Haines

8th edition published by Wolters Kluwer

The purpose of this post is for the MBBS students to get a feel of this book. A sample question is shown. THIS IS AN EXCELLENT BOOK FOR PURCHASING.

NEET 2014 Neuroanatomy MCQ

Which of the following represent the most common site of aneurysms on the vertebrobasilar system, sometimes referred to as the posterior circulation?

• Bifurcation of the basilar artery (basilar tip)
• Along the course of the vertebral artery
• Junction of the posterior inferior cerebellar artery with the posterior spinal artery
• Junction of the posterior inferior cerebellar artery with the vertebral artery
• Origin of the anterior spinal artery

About 10%–15% of all intracranial aneurysms are found on the vertebrobasilar system. The majority of these are found at the bifurcation of the basilar artery into the posterior cerebral arteries; this point is also called the basilar tip or the basilar head. This type of lesion may compromise the integrity of the oculomotor nerve with corresponding deficits. (pp. 45–46)

Thanks to - 

Neuroanatomy: An Atlas of Structures, Sections, and Systems

by Duane E. Haines

8th edition published by Wolters Kluwer

This post is to make the MBBS students familiarize with this book. This is a good book to learn neuroanatomy. One can purchase it without doubt about quality of material

NEET 2014 ANATOMY Head&Neck

A 3-year-old boy is admitted to the hospital because of a soft, anterior, midline cervical mass. When the patient is asked to protrude his tongue, the mass in the neck is observed to move upward. Which of the following is the most likely diagnosis?

• A thyroglossal duct cyst
• Defect in sixth pharyngeal arch
• A branchial cyst
• Cystic fistula of the third pharyngeal arch
• Defect in first pharyngeal arch

Thyroglossal duct cysts occur due to retention of a remnant of the thyroglossal duct along the path followed by the descending thyroid gland during development. The path begins from the foramen cecum of the tongue and descends in the midline to the final position of the thyroid. The sixth pharyngeal arch provides origin to muscles and cartilage of the neck and would produce a midline mass connected to the tongue. A branchial cyst or fistula would not be present in the midline. The first pharyngeal arch gives rise to muscles of mastication and the malleus and incus. The third pharyngeal arch provides origin to the stylopharyngeus muscle and hyoid bone.

GAS 964-968; GA 503-504

Ref-(Thanks to the Publisher & author.) This post is meant for information of students who are appearing for NEET 2014.I strongly recommend this book as the questions are of good quality. 5 star 

Gray’s Anatomy Review

by Marios Loukas, Gene L. Colborn, Peter Abrahams, and Stephen W. Carmichael

1st edition published by Elsevier

NEET 2014 Surgery

A 35-year-old transient man with a history of alcohol abuse is trying to jump from a moving train when his backpack is caught on the door. He falls out of the train and has an uncontrolled landing where he says that he hit his head. The patient arrives in the emergency department fully immobilized on a long board with a semi-rigid collar in place. He is complaining of leg pain but denies pain in his back or neck. His breathing is clear and his oxygen saturation is 99% of 1 L of oxygen. His blood pressure is 115/75 mm Hg, pulse 80 bpm, and respirations 15 breaths/min. His pupils are round and reactive to light and accommodation, and there is mild bruising over his left temple. His right leg is mildly tender at the knee joint. Which of the following is a contraindication to clearing the cervical spine and removing the collar without additional imaging?

• Bruising over the temple
• History of alcohol abuse
• Impaired motor function of his right knee
• Normal sensation and reflexes
• Presence of posterior midline tenderness

Trauma and Burns/Trauma/Spinal Injuries. Most trauma patients are suspected of having cervical spinal injury until proven otherwise. Cervical trauma often occurs from hyperflexion, hyperextension, vertical compression, or lateral rotation of the neck during an injury. It is possible that this patient injured his neck, and he should be checked for signs of spinal injury. Examination involves assessing midline tenderness, sensation, motor function reflexes, and performing a rectal exam. Exam findings that suggest spinal injury include pain with movement, tenderness, gaps or steps in the spine, edema or bruising over the spine, or spasm of associated muscles. Patients without these symptoms can be cleared, assuming other risk factors (such as increased age, mechanism of injury, falls greater than 1 m, axial loads on the spine, high speed, or dramatic injuries) are not present.

Ref-

Step-Up to Surgery

by Stanley Zaslau and Richard A. Vaughan

2nd edition published by Wolters kluwer

(Thanks to author&Publisher. The post is meant for MBBS students who aspire for PG seat by writing NEET 2014 This is a good book in Surgery)

NEET 2014 Surgery MCQ

A 6-month-old boy is brought to the clinic for evaluation of a red lesion on his forehead. The mother of the child is concerned because the lesion has been rapidly increasing in size and the infant’s maternal grandmother died of melanoma in her 60s. On physical exam, a red, raised lesion about 1 cm × 3 cm with irregular borders can be seen about 3 cm superior to his left eyebrow. What is the best treatment option for this child?

• Do nothing
• Embolization
• Excision with wide margins
• Laser photocoagulation
• Systemic corticosteroid therapy

Pediatric Surgery/Vascular Tumors/Capillary Hemangiomas. This presentation is most consistent with a capillary hemangioma. These vascular tumors most often appear within the first few weeks of life and rapidly increase in size for about a year, after which they begin to spontaneously regress. Most of these hemangiomas, including the one in this question stem, should be left alone because they will most likely regress and pose no threat to the child’s health. Indications for intervention include lesions that threaten to interfere with the eyes or airway or lesions so large they cause thrombocytopenia, congestive heart failure, or significant facial distortion. All of the responses represent possible appropriate interventions, but this patient’s lesion does not currently require treatment of any kind.

(Thanks to the author&Publisher.Purpose of this post is to promote the students to buy such standard books for preparing when they want to appear for NEET 2014.  )

Ref-

Step-Up to Surgery

by Stanley Zaslau and Richard A. Vaughan

2nd edition published by Wolters kluwer

NEET 2014 SPM MCQ

1. All are Zoonosis except

a. Plague

b. HIV

c. JE

d. TB

2. Demarcation line in iceberg disease is between:

a. Symptomatic and asymptomatic cases

b. Diagnosed and undiagnosed cases

c. Apparent and in-apparent cases

d. Case and carriers

3. Isolation not useful for all except:

a. Mumps

b. Measles

c. Hepatitis A

d. Pneumonic plague

4. All of the following indicators are included in physical quality of life index (PQLI) except:

a. Infant mortality rate

b. Literacy rate

c. Per capita income

d. Life expectancy at age one

5. Which of the following vaccine is not included in EPI, schedule :

a. Tetanus Toxid

b. DPT

c. MMR

d. DT

6. Several studies have shown that 85% of cases of lung cancer are due to cigarette smoking. It is a measure of

a. Incidence rate

b. Relative risk

c. Attributable risk

d. Absolute risk

7. About herd immunity, all are true except

a. Depends on clinical and subclinical cases

b. Influenced by immunization.

c. Depends on the presence of alternative host.

d. Herd immunity is constant.

8. All the statements are true about standardization:

a. Standardization allows comparison to be made between two different populatins

b. The national population is always taken as the standard population

c. For Direct standardization, age specific rates of the study population are applied to that of the standard population

d. For indirect standardization age specific rates of the standard population are applied to the study population

9. 'Endemic Disease' means that a disease :

a. Occurs clearly in excess of normal expectancy

b. Is constantly present in a given population group

c. Exhibits seasonal pattern

d. Is prevalent among animals

10. All of the following are true about the Herd Immunity for infectious diseases except :

a. It refers to group protection beyond what is afforded by the protection of immunized individuals

b. It is likely to be more for infections that do not have a sub-clinical phase

c. It is affected by the presence and distribution of alternative animal hosts

d. In the case of tetanus it does not protect the individual

11. Which one of the following is a good index of the severity of an acute disease ?

a. Cause specific death rate

b. Case fatality rate

c. Standardized mortality ratio

d. Five year survival

12. A study began in 1970 with a group of 5000 adults in Delhi who were asked about their alcohol consumption. The occurrence of cancer was studied in this group between 1990-1995. This is an example of :

a. Cross-sectional study

b. Retrospective cohort study

c. Concurrent cohort study

d. Case-control study

13. All of the following are used as proxy measure for incubation period except:

a. Latent period

b. Period of communicability

c. Serial interval

d. Generation time

Answers –

1. b

2. c.

3. d.

4. c.

 5. c.

6. c.

7. d

8. b.

9. b.

10. b

11. b.

12. c.

13. b.

NEET 2014 MCQs in Radiology

1. Regarding the imaging modalities of the chest:
(a) High resolution computed tomography (HRCT) uses a slice thickness
of 4–6 mm to identify mass lesions in the lung.
(b) Spiral CT ensures that no portion of the chest is missed due to variable
inspiratory effort.
(c) MRI shows excellent detail of the lung anatomy.
(d) Bronchography is the technique of choice to visualize the bronchial
tree
(e) CT pulmonary angiography (CTPA) is performed using catheters
placed in a femoral vein.
2. Regarding the development of the lung:
(a) The tracheobronchial groove appears on the ventral aspect of the
caudal end of the pharynx.
(b) The primary bronchial buds develop from the tracheobronchial
diverticulum.
(c) The epithelium lining the alveoli is the same before and after birth.
(d) A persistent tracheo-oesophageal fistula (TOF) is commonly associated
with an atresia of the duodenum.
(e) Uni-lateral pulmonary hypoplasia is usually due to a congenital
diaphragmatic hernia.
1.
(a) False – HRCT uses 1–2 mm slice thickness and a high resolution computer
algorithm to show fine detail of the lung parenchyma, pleura and
tracheobronchial tree. It is not used to delineate masses in the lung.
(b) True
(c) False – currently MRI is a poor technique for showing lung detail. It allows
visualisation of the chest wall, heart, mediastinal and hilar structures.
(d) False – this invasive technique has largely been superseded by HRCT.
(e) False – CTPA is performed to diagnose major pulmonary emboli using a
cannula placed in any peripheral vein and is relatively non-invasive compared
to conventional pulmonary angiography.
2.
(a) True
(b) True – the bronchial buds differentiate into bronchi in each lung.
(c) False – during embryonic life the alveoli is lined by cuboidal epithelium that
lines the rest of the respiratory tract. When respiration commences at birth the
transfer to the flattened pavement epithelium of the alveoli is accomplished.
(d) False – TOF indicates the close developmental relationship between the foregut
and the respiratory passages. It is usually associated with an atresia of the
oesophagus and the fistula is situated below the atretic segment.
(e) True
Ref -Companion to Applied Radiological Anatomy by Arockia Doss (Author), Matthew J. Bull (Author), Alan Sprigg (Author), Paul D. Griffiths (Author)

Factors That Can Lead to False Diagnoses

Physician-specific Problems
Insufficient History and Clinical Examination. A diagnostic
accuracy of 70% is reached through meticulous history-
taking and examination; misleading results are
rare ( 5%). Laboratory analyses and imaging studies
alone achieve a guarantee of only 30% and misleading
results occur in 10% of these cases. Insufficient history
and examination due to lack of time, lack of knowledge,
or lack of communication can therefore never be compensated
by further investigation.
Disregarding the Prevalence of Clinical Pictures. It is
dangerous to compare a present patient with a recent,
rare and interesting case from personal experience, perhaps
out of fear of not recognizing a rare disease.
“Common diseases are common, and rare diseases
are rare.” Our diagnostic efforts must therefore concentrate
primarily on the most probable diseases.
The simplest explanation is often the best one, and one
should try to assign the complaints and medical findings
of a patient to a single clinical picture. The situation
can be more complex in elderly patients.
Unavailable or Inadequate Knowledge. Current knowledge
can become obsolete or false within a few years.
Constant postgraduate training is required (case examination,
journals, books, continuing medical education,
internet).
Physician’s Characteristics. A physician needs an
enormous amount of self-criticism in order not to run
the risk of overestimation of his/her own capabilities.
Professional and personal contact among colleagues on
a regular basis (quality circle meeting) is essential.
Insufficient Judgement. This is an expression of inadequate
logical and structural procedures from the time of
medical findings to the diagnosis (logical thinking).
Failure to distinguish between medical findings and interpretation,
or unknowingly neglecting new results
which do not fit the diagnosis (preconceived notion), are
common mistakes.
A negative echocardiograph finding, for example,
must not lead to the rejection of a diagnosis of bacterial
endocarditis as suggested by a classic history and clinical
findings (according to the Duke criteria). This would
mean the omission of conclusive diagnostic procedures,
such as blood cultures, and empirical therapy possibilities.
Preexisting secondary diseases may obscure symptoms
of an otherwise classic diagnosis, e. g., angina pectoris
as the chief symptom of coronary heart disease is
frequently absent in a diabetic person.
Possible Errors of a Technical Nature. The great number
of available laboratory tests and technical examinations
means that it is necessary that the physician interpreting
the results in the clinical context be up to date on
their diagnostic significance.
Furthermore, the assumed prevalence of a disease is
always considered when assessing test results (pretest
probability). Whereas a slightly elevated serum alkaline
phosphatase level in a patient with lymphoma may indicate
liver involvement, the same value in a screened
asymptomatic patient is in all likelihood a false-positive.
Patient-specific Problems
Incorrect, Biased or Inaccurate Statements (made consciously
or unconsciously). These statements are based
upon forgetfulness, anxiety (e. g., fear of a serious disease
and the corresponding report from the doctor), or
fear of consequences in regard to official matters such as
suitability for military service, ability to drive a motor
vehicle, liability, etc. They may also occur in cases involving
addicts (alcohol, nicotine, analgesics, illicit
drugs), statements of sexual orientation, and consequences
pursuant to insurance laws. Another rare
phenomenon which can lead to false diagnosis is Münchausen
syndrome. The syndrome was named after the
tale of Baron von Münchausen. Such patients feign more
or less plausible, self-induced symptoms and repeatedly
present to physicians and hospitals to secure numerous
diagnostic tests and therapeutic interventions.
Preconceptions. These are conditioned from prior medical
findings and from reading popular medical journals.
They are frequently observed in patients with a smattering
of medical knowledge, and satisfy the need of
causality.
Inappropriate Behavior. This is characterized by a lack of
cooperation, excessive demands, and fear of disease.
Dissimulation for Various Reasons. There are many reasons
for this condition.
Masking of Symptoms and Findings of a Disease. Typical
examples of masking of symptoms are painless acute
abdomen in schizophrenic patients or in relation to
medications which are being taken, e. g., by drug addicts.

Dietary deficiencies and psychiatric symptoms

Which of the following vitamin deficiencies is most likely to lead to a triad of
gastrointestinal disturbance, dermatological symptoms and a heterogeneous
constellation of psychiatric symptoms?
A. Niacin
B. Vitamin A
C. Vitamin B1
D. Vitamin C

E. Vitamin D
Answer
A Nicotinic acid, or niacin, deficiency (A) is also known as pellagra.
It classically manifests with gastrointestinal symptoms, such as
diarrhoea, anorexia and gastritis. The dermatological manifestations
include symmetrical, bilateral bullous lesions in sun-exposed areas.
The psychiatric symptoms initially manifest as apathy, depression, or
irritability. However, in later stages there are more florid symptoms
resembling delirium, psychosis or a Korsakoff-like presentation. If
identified, treatment with nicotinic acid usually leads to prompt and
dramatic improvements in mental state. Vitamin A deficiency (B)
is associated with night-blindness, dry skin and hair and anaemia.
Thiamine, or vitamin B1 deficiency (C) is known as beriberi. The classical
symptoms of this disorder are neuropathy and heart failure. Acute
depletion of thiamine, as seen in alcohol dependence, leads to Wernicke’s
encephalopathy. Vitamin C deficiency (D) leads to scurvy, characterized
by anorexia, diarrhoea, irritability, anaemia, gingival haemorrhage, poor
wound healing, leg pain and swelling over the long bones. Vitamin D
deficiency (E) leads to rickets in children and osteomalacia in adults.
There is now growing evidence of some link with vitamin D to cognitive
functioning. There are speculations about its role in seasonal affective
disorder whereby patients have normal mental function during the year
but during a particular season, e.g. winter, will display a mood disorder
such as depression year after year during that season.

Autoimmune disorders and psychiatry

A 34-year-old woman presents to accident and emergency claiming that the
devil has returned to earth and is hunting her through her neighbours, who are
recording her every movement. The psychiatric assessment shows florid delusions
and auditory hallucinations. She has no past psychiatric history. Her husband tells
you that she was fine up until 2 weeks ago. Her hands have also been shaking
and she has complained that the devil has been torturing her muscles. She has
widespread lymphadenopathy and an enlarged spleen. An unusual rash is present
across her cheeks and nose, which she says is the brand of the devil. What is the
most likely diagnosis?
A. Behçet’s disease
B. CREST syndrome
C. Graves’ disease
D. Systemic lupus erythematosus (SLE)
E. Wegener’s granulomatosis
Answer
D SLE (D) is an autoimmune connective tissue disorder that may affect any
organ in the body. It commonly presents in women (9:1 female to male
ratio), usually in the third or fourth decades. Neuropsychiatric symptoms
may occur at the beginning of the natural course of the disorder,
without any seeming involvement of other organ systems. Unexplained
psychotic symptoms, which may closely resemble schizophrenia, may
occur, as may a dementia-like illness or affective disorders. This woman
is also displaying neurological signs, making a diagnosis of a functional
psychiatric disorder unlikely. The presence of Parkinsonism, widespread
muscle pain, lymphadenopathy and splenomegaly are all consistent
with the diagnosis. The ‘malar rash’, which is highly indicative of SLE,
is present in this woman but its absence does not negate the diagnosis.
Behçet’s disease (A) is an autoimmune disorder characterized by recurrent
mouth ulcers, genital ulcers and uveitis. Neurological or psychiatric
symptoms are uncommon and usually a late presentation. It also tends
to present in the third or fourth decades, but tends to be more common
in men. The CREST syndrome (B) is a form of systemic scleroderma
characterized by the following five cardinal features from which the
acronym is derived: calcinosis, in which there is calcium deposits in
the soft tissue, usually under the skin; Raynaud’s phenomenon, in
which there is bilateral cyanosis of the hands in response to cold or
stress; oesophageal atresia, which presents with symptoms of gastrooesophageal
reflux; sclerodactyly, in which there is thickening of the
skin of the hands and feet, taking on a ‘shiny’ appearance; finally,
telangiectasia, which are lesions caused by dilated blood vessels and
usually present on the face or hands. Psychiatric complications have been
little studied in this disorder, although depression certainly does occur.
Graves’ disease (C) is an autoimmune thyroiditis, which incidentally
may occur co-morbidly with SLE, although the greatest association is
with rheumatoid arthritis. The characteristic symptoms include those of
hyperthyroidism, which in psychiatric terms may resemble an anxiety
disorder, with tachycardia and palpitations. There may be unexplained
weight loss. Systemic symptoms, such as malaise, are also common, as is
exophthalmos and pretibial myxoedema (‘orange peel’ skin on the shin).
The psychiatric symptoms tend to either resemble an anxiety disorder,
or other affective symptoms. Like SLE, women are more commonly
affected, and usually in their 20s or 30s. Wegener’s granulomatosis (E)
is an autoimmune vasculitis that typically affects the lungs, kidneys and
nervous system. It affects males slightly more often with a slightly later
peak of incidence (fourth and fifth decades). The typical presentations are
with dyspnoea, cough, haemoptysis, nasal ulceration, sinusitis, systemic
symptoms, haematuria, and neurological symptoms – typically peripheral
neuropathy but sometimes strokes and seizures. Psychiatric complications
have not typically been described except in case reports.

NEET 2014 Practice Paper

http://www.medpgthrissur.org/portal/Pages/SubscriberRegistration.aspx

1. A 21-year-old footballer presents to A&E
with a stabbing pain above his right knee
joint. He states the pain came on suddenly
while he was sprinting. On examination he
is unable to extend the leg and he walks
with a limp. There is suprapatellar swelling
and an absent knee jerk. What is the likely
diagnosis?
A Fracture of patella
B Injury to posterior cruciate ligament
C Tear of adductor magnus muscle
D Tear of biceps femoris muscle
E Tear of quadriceps tendon
2. During strenuous exercise, what else
occurs besides tachycardia?
A Rise in Paco2
B Increased stroke volume
C Rise in mixed venous blood O2 saturation
D No change to blood pressure
E Increased renal blood flow
3. A patient is found to have
thrombophlebitis migrans. What other
condition must be considered?
A Venous insufficiency
B Diabetes mellitus
C Bronchial carcinoma
D Lyme disease
E Beckwith–Wiedemann syndrome
1E: Tear of quadriceps tendon
A 21-year-old male has sustained an injury of sudden onset, associated with swelling and an
inability to extend at the knee joint and an absent knee reflex. This is consistent with an injury
to the quadriceps group of muscles that lie in the anterior compartment of the thigh and act as
the principal extensors of the knee joint. The mechanism of injury is inconsistent with a fractured
patella.
2B: Increased stroke volume
During strenuous exercise there is an increase in heart rate, stroke volume and cardiac output.
Remember cardiac output is a function of heart rate and stroke volume. During exercise, there is
an increase in respiratory rate (hyperventilation) which will lead to a reduction in Paco2. During
exercise the oxygen demand of skeletal muscle rises, therefore leading to a reduction in mixed
venous blood oxygen concentration. Renal blood flow is autoregulated, so renal blood flow is
preserved and will tend to remain the same. Mean arterial blood pressure is a function of cardiac
output and total peripheral resistance and will increase with exercise, mainly as a result of the
increase in cardiac output that occurs.
3C: Bronchial carcinoma
Thrombophlebitis migrans (or migratory thrombophlebitis) is a condition that results in recurrent
episodes of venous inflammation (phlebitis) associated with thrombosis, that occurs in different
locations (migratory). It is generally caused by inflammatory, or malignant, conditions where
the patient is tipped into a hypercoagulable state. When associated with malignant conditions
it is known as Trousseau’s syndrome and is generally associated with visceral malignancies
(adenocarcinomas), such as gastric, pancreatic, bronchial carcinomas. It is a non-metastatic (or
paraneoplastic) effect of malignancy and is related to factors secreted by tumours.