NEET-PG 2012 Practice Questions

Q: Which of the following is NOT a contraindication for spinal anaesthesia?

Hypertension. ***Hypertension*** - While **severe uncontrolled hypertension** may necessitate blood pressure stabilization before surgery, **mild to moderate hypertension** is not an absolute contraindication for spinal anesthesia. - In fact, spinal anesthesia can sometimes be beneficial in hypertensive patients due to its **vasodilatory effects**, which may help lower blood pressure. *Bleeding disorder* - A **bleeding disorder** (e.g., thrombocytopenia, coagulopathy) is a **major contraindication** due to the high risk of **epidural or spinal hematoma** formation. - A hematoma can lead to **spinal cord compression** and irreversible neurological damage. *Raised intracranial tension* - **Raised intracranial tension (ICT)** is a **strict contraindication** because the drop in cerebrospinal fluid (CSF) pressure during spinal anesthesia can worsen the pressure gradient across the foramen magnum. - This can precipitate **herniation of the brainstem** and lead to catastrophic neurological injury or death. *Infection at injection site* - The presence of an **infection at the injection site** is an absolute contraindication as it poses a significant risk of introducing bacteria into the **subarachnoid space**. - This can lead to serious complications such as **meningitis** or a **spinal abscess**.

Q: What is the effect of adding epinephrine to lignocaine (a local anesthetic)?

Decreases absorption of local anesthetic. ***Decreases absorption of local anesthetic*** - Epinephrine causes **vasoconstriction** at the site of injection, which reduces the rate at which the local anesthetic is absorbed into the systemic circulation. - This slower absorption leads to a **higher concentration of the anesthetic** at the nerve fibers, prolonging its effect and reducing systemic toxicity. - This is the primary mechanism by which epinephrine enhances local anesthetic efficacy. *Increases distribution of local anesthetic* - The primary effect of epinephrine is to **localize the anesthetic** by reducing its systemic distribution. - This localization is achieved through **vasoconstriction**, which keeps the drug at the desired site rather than allowing it to distribute widely. *Decreases duration of local anesthetic* - By slowing absorption, epinephrine effectively **increases the duration of action** of the local anesthetic. - The anesthetic remains at the site of action for a longer period, providing **extended pain relief**. *Increases metabolism of local anesthetic* - Epinephrine does not directly affect the **metabolic rate** of local anesthetics. - The primary mechanism of metabolism for amides like lignocaine is in the **liver** by cytochrome P450 enzymes.

Q: Which amino acid-derived neurotransmitter is primarily targeted in the pharmacological treatment of depression?

Serotonin. ***Serotonin*** - **Serotonin** is an amino acid-derived neurotransmitter (from **tryptophan**) known to play a crucial role in mood regulation, sleep, appetite, and other functions, making it a primary target for **antidepressant medications**. - Medications like **Selective Serotonin Reuptake Inhibitors (SSRIs)** increase serotonin levels in the brain to alleviate symptoms of depression. *Histamine* - **Histamine** is an amino acid-derived neurotransmitter (from **histidine**) primarily involved in allergic reactions, inflammation, and regulating wakefulness. - While it has some central nervous system effects, its primary role is not directly in the treatment of **depression**. *Acetylcholine* - **Acetylcholine** is a neurotransmitter involved in muscle contraction, learning, memory, and attention, and is not derived from amino acids; it is synthesized from **choline** and acetyl-CoA. - It is not directly used for treating **depression**, although imbalances can play a role in cognitive aspects of some psychiatric disorders. *None of the options* - This option is incorrect because **Serotonin** is indeed an amino acid-derived neurotransmitter (from tryptophan) targeted for treating **depression**. - Many antidepressant drugs work by modulating **serotonergic pathways**.

Q: Which of the following factors is most commonly associated with suicidal tendencies?

Severe depression. ***Severe depression*** - **Major depressive disorder** is the strongest and most common risk factor for suicidal ideation and attempts, significantly increasing suicidal tendencies [1]. - The profound **hopelessness**, **worthlessness**, and altered cognitive processing associated with severe depression contribute largely to suicidal thoughts [2]. - Depression is present in approximately **90%** of individuals who die by suicide. *Female gender* - While **females** have higher rates of **suicide attempts** and self-harm, **males** have a higher rate of completed suicides using more lethal methods. - Female gender alone is not the most common risk factor for suicidal tendencies compared to the profound impact of severe mental illness like depression [1]. *Chronic illness* - **Chronic medical conditions** can increase the risk of depression and subsequent suicidal ideation due to pain, functional limitations, and loss of independence [3]. - However, chronic illness is generally considered an **indirect risk factor**, often mediating its effect through the development of mental health disorders like depression [3]. *Younger age group* - Suicide is a leading cause of death in **adolescents and young adults**, highlighting significant concern in this demographic [1]. - While younger age is a risk factor, especially with concurrent mental health issues or stressors, it is not as universally predictive of suicidal tendencies as severe depression across all age groups [1].

Q: Which of the following is not a characteristic of schizoid personality disorder?

Suspicious. ***Suspicious*** - **Suspiciousness** and mistrust of others are core features of **paranoid personality disorder**, not schizoid personality disorder. - Individuals with schizoid personality disorder are typically apathetic towards others rather than actively distrustful. *Aloof & detached* - Individuals with schizoid personality disorder are characterized by a pervasive pattern of **detachment from social relationships** and a restricted range of emotional expression. - They often appear emotionally cold and indifferent to praise or criticism, indicating their aloof nature. *Prone to fantasy* - People with schizoid personality disorder frequently engage in **excessive daydreaming** and imaginative fantasy as an escape from reality. - This tendency is a coping mechanism for their limited social interaction and emotional expression. *Introspective* - Schizoid individuals tend to be **preoccupied with their inner world** and thoughts, often to the exclusion of external social interactions. - Their introspective nature contributes to their social withdrawal and isolation.

Q: The most appropriate first-line imaging modality to detect adrenal metastasis due to bronchogenic carcinoma is:

Contrast Enhanced CT abdomen. **Contrast Enhanced CT abdomen** - **Contrast-enhanced CT abdomen** is generally considered the most sensitive and cost-effective imaging modality for detecting **adrenal metastases**. - It allows for detailed visualization of adrenal gland morphology, including size, shape, and enhancement patterns, which can help differentiate benign from malignant lesions. *PET scan* - While **PET (Positron Emission Tomography) scans** are highly sensitive for detecting metabolically active metastatic disease, they are often used as a secondary imaging modality to characterize indeterminate lesions found on CT or MRI. - **PET scans** can have false positives in benign adrenal tumors (e.g., adenomas rich in fat) and are less readily available or higher in cost for initial screening compared to CT. *MRI of the abdomen* - **MRI of the abdomen** can be very useful for further characterization of adrenal masses, especially for distinguishing between lipid-rich adenomas and metastases. - However, for initial detection, especially in the context of screening for distant metastases from bronchogenic carcinoma, **CT is generally preferred due to its wider availability, speed, and lower cost**. *Adrenal radionuclide scan* - **Adrenal radionuclide scans** (e.g., using MIBG or iodocholesterol) are primarily used for functional imaging of adrenal glands, typically to detect specific types of tumors like pheochromocytomas or aldosteronomas. - These scans are **not sensitive for detecting adrenal metastases** from bronchogenic carcinoma, as the metastatic lesions do not typically exhibit the specific uptake patterns targeted by these radiotracers.

Q: Which of the following conditions characteristically causes bilateral hypertranslucency of lung fields on chest X-ray?

Emphysema. ***Correct: Emphysema*** - **Emphysema** causes destruction of alveolar walls, leading to enlarged air spaces and **air trapping**, making both lungs appear hypertranslucent on X-ray - This **bilateral hypertranslucency** is due to reduced lung tissue density, decreased vascular markings, and increased air volume - Classic radiographic features include flattened diaphragms, increased retrosternal space, and hyperlucent lung fields *Incorrect: Mcleod syndrome* - Also known as **Swyer–James–MacLeod syndrome**, this condition causes **unilateral** lung or lobe hyperlucency due to post-infectious obliterative bronchiolitis - The key differentiating feature is that it's **unilateral**, whereas the question asks for bilateral hypertranslucency - Affected lung shows air trapping on expiratory films *Incorrect: Pneumothorax* - A **pneumothorax** presents as a **unilateral** or focal hypertranslucent area due to air in the pleural space - Characterized by **absence of lung markings** beyond the visceral pleural line and associated lung collapse - This is a pleural space abnormality, not a bilateral parenchymal lung disease *Incorrect: Poland syndrome* - **Poland syndrome** is a congenital condition with absence or underdevelopment of the pectoralis major muscle - Can lead to **unilateral** apparent hyperlucency on the affected side due to missing chest wall muscle - This is a **chest wall anomaly**, not a parenchymal lung disease causing bilateral hypertranslucency

Q: Which of the following is not typically seen on a chest X-ray in pulmonary artery hypertension?

Narrowing of central arteries. ***Narrowing of central arteries*** - **Pulmonary artery hypertension** is characterized by the **enlargement of the central pulmonary arteries** due to increased pressure. - **Narrowing of central arteries** would contradict the hemodynamic changes seen in pulmonary hypertension. - This is the finding that is **NOT typically seen**, making this the correct answer. *Enlargement of central arteries* - This is a **hallmark radiographic finding** in pulmonary hypertension, reflecting the **dilatation of the main and proximal pulmonary arteries** due to increased pressure. - The **pulmonary artery segment becomes prominent**, often appearing convex on the left heart border. *Peripheral pruning* - This refers to the **abrupt tapering and loss of peripheral pulmonary vascular markings**, indicating reduced blood flow to the distal lung parenchyma. - It is a **common finding in advanced pulmonary hypertension**, as the distal vessels constrict and become obliterated. *None of the options* - This is incorrect since **narrowing of central arteries** is clearly not a typical finding in pulmonary hypertension.

Q: Investigation of choice for intramedullary SOL is -

MRI. ***MRI*** - **Magnetic Resonance Imaging (MRI)** is the investigation of choice for intramedullary lesions due to its superior **soft tissue contrast** and ability to visualize the **spinal cord** parenchyma. - It provides detailed information on lesion size, location, and internal characteristics, which is crucial for diagnosis and surgical planning. *USG* - **Ultrasound (USG)** has limited utility for intramedullary lesions as a primary diagnostic tool because **bone impedes sound waves**, making it difficult to visualize structures within the spinal canal. - It might be used for neonatal spinal screening or intraoperative guidance, but not for definitive diagnosis of intramedullary lesions in adults. *CT* - **Computed Tomography (CT)** excels at visualizing **bone structures** and calcifications, but it provides less detailed information about soft tissue elements like the spinal cord compared to MRI. - While it can identify bony changes associated with intramedullary lesions, it is not the preferred initial imaging modality for characterizing the lesion itself. *X-ray* - **X-rays** provide basic imaging of bone but offer essentially **no visualization of soft tissues** such as the spinal cord or intramedullary lesions. - They are primarily used to identify gross bony abnormalities like fractures or severe degenerative changes, not for subtle intraspinal pathologies.

Q: Popcorn calcification is seen in:

Pulmonary hamartoma. ***Pulmonary hamartoma*** - **Popcorn calcification** is a pathognomonic radiographic finding highly suggestive of **pulmonary hamartoma**, a **benign tumor** composed of cartilage, fat, and connective tissue - This characteristic calcification pattern is due to the presence of **chondroid (cartilaginous) tissue** within the lesion - Appears as coarse, irregular calcifications resembling popcorn on chest X-ray or CT scan *Bronchogenic carcinoma* - Malignant lung lesions typically show **irregular, spiculated, or ill-defined margins** and tend to grow rapidly - While calcification can occur in some lung malignancies, it usually appears as **eccentric, stippled, or amorphous** rather than the distinctive popcorn pattern - Popcorn calcification is not a feature of primary lung cancers *Tuberculosis* - **Granulomatous infections** such as tuberculosis often lead to calcification, but it usually presents as **laminated, clustered, or target-like patterns** in lymph nodes or within granulomas (Ghon lesion, Ranke complex) - **Popcorn calcification** is not a typical feature of active or healed tuberculous lesions *Pulmonary metastases* - **Metastatic lesions** are generally not calcified, although a few primary tumors (e.g., mucinous adenocarcinoma, osteosarcoma, chondrosarcoma) can metastasize as calcified nodules - When calcification is present in metastases, it is rarely in the specific **popcorn pattern** and is usually diffuse, punctate, or amorphous

Question 1

Which of the following is NOT a contraindication for spinal anaesthesia?

Accepted Answer

Hypertension

Answer

Raised intracranial tension

Answer

Bleeding disorder

Answer

Infection at injection site

Question 2

What is the effect of adding epinephrine to lignocaine (a local anesthetic)?

Accepted Answer

Decreases absorption of local anesthetic

Answer

Increases distribution of local anesthetic

Answer

Decreases duration of local anesthetic

Answer

Increases metabolism of local anesthetic

Question 3

Which amino acid-derived neurotransmitter is primarily targeted in the pharmacological treatment of depression?

Accepted Answer

Serotonin

Answer

Histamine

Answer

None of the options

Answer

Acetylcholine

Question 4

Which of the following factors is most commonly associated with suicidal tendencies?

Accepted Answer

Severe depression

Answer

Female gender

Answer

Chronic illness

Answer

Younger age group

Question 5

Which of the following is not a characteristic of schizoid personality disorder?

Accepted Answer

Suspicious

Answer

Prone to fantasy

Answer

Introspective

Answer

Aloof & detached

Question 6

The most appropriate first-line imaging modality to detect adrenal metastasis due to bronchogenic carcinoma is:

Accepted Answer

Contrast Enhanced CT abdomen

Answer

PET scan

Answer

MRI of the abdomen

Answer

Adrenal radionuclide scan

Question 7

Which of the following conditions characteristically causes bilateral hypertranslucency of lung fields on chest X-ray?

Accepted Answer

Emphysema

Answer

Mcleod syndrome

Answer

Poland syndrome

Answer

Pneumothorax

Question 8

Which of the following is not typically seen on a chest X-ray in pulmonary artery hypertension?

Accepted Answer

Narrowing of central arteries

Answer

Enlargement of central arteries

Answer

Peripheral pruning

Answer

None of the options

Question 9

Investigation of choice for intramedullary SOL is -

Accepted Answer

MRI

Answer

USG

Answer

CT

Answer

X-ray

Question 10

Popcorn calcification is seen in:

Accepted Answer

Pulmonary hamartoma

Answer

Bronchogenic carcinoma

Answer

Tuberculosis

Answer

Pulmonary metastases

NEET-PG 2012

Anesthesiology

Pharmacology

Psychiatry

Radiology