NEET-PG 2013 Practice Questions

Q: The best local anesthetic for prolonged ophthalmic surgery requiring extended post-operative analgesia is:

Bupivacaine. ***Bupivacaine*** - **Bupivacaine** is an amide-type local anesthetic known for its **long duration of action** due to its high protein binding and lipid solubility. - This property makes it ideal for procedures requiring **prolonged analgesia**, such as extended ophthalmic surgery and post-operative pain control. *Tetracaine* - **Tetracaine** is an ester-type local anesthetic primarily used for **topical anesthesia**, especially in ophthalmology. - While effective for surface anesthesia, its duration of action is relatively short, making it unsuitable for prolonged surgical procedures requiring sustained nerve block. *Procaine* - **Procaine** is an ester-type local anesthetic with a **short duration of action** and is generally associated with a higher incidence of allergic reactions. - It is rarely used today for major regional blocks due to its limited potency and short effect, unlike the requirement for prolonged ophthalmic surgery. *Prilocaine* - **Prilocaine** is an amide-type local anesthetic with an **intermediate duration of action**. - Its use is limited in some cases due to its potential to cause **methemoglobinemia** at higher doses, making it less suitable for applications requiring extensive or prolonged regional anesthesia compared to bupivacaine.

Q: Which of the following anesthetic agents is most notable for its analgesic properties?

Ketamine. ***Ketamine*** - **Ketamine** is unique among general anesthetics for its significant **analgesic properties**, which stem from its action as an **NMDA receptor antagonist**. - Its ability to provide pain relief makes it useful in scenarios where both **anesthesia** and **analgesia** are desired, such as for painful procedures or in trauma settings. *Propofol* - While **propofol** is a widely used intravenous anesthetic, it lacks intrinsic **analgesic properties**. Its primary effects are **sedation** and **hypnosis**. - Pain during propofol injection is common, and other analgesics are usually co-administered for painful procedures. *Thiopentone* - **Thiopentone** is an ultrashort-acting barbiturate primarily used for **induction of anesthesia** due to its rapid onset and profound hypnotic effects. - It has **no analgesic properties** and can even lower the pain threshold, requiring concurrent administration of analgesics.

Q: Critical temperature of oxygen is?

-118°C. ***-118°C*** - The **critical temperature** is the temperature above which a gas cannot be liquefied, no matter how much pressure is applied. - For oxygen, its critical temperature is approximately **-118°C**, meaning it can only exist as a gas above this temperature, regardless of pressure. *400°C* - This temperature is significantly **above** the critical temperature of oxygen, so oxygen would always be a gas at this temperature. - It does not represent any specific physical property of oxygen in relation to its phase changes. *20°C* - This temperature is also well **above** oxygen's critical temperature, so oxygen would remain in its gaseous state. - This is approximately room temperature, where oxygen is commonly found as a gas. *36.5°C* - This is close to typical human body temperature and is far **above** the critical temperature of oxygen. - At this temperature, oxygen exists only as a gas.

Q: What is a potential risk for pregnant women who undertake long journeys with prolonged sitting?

Deep vein thrombosis. ***Deep vein thrombosis*** - **Pregnancy** is a **hypercoagulable state** due to increased levels of clotting factors (fibrinogen, factors VII, VIII, X) and decreased protein S activity. - **Prolonged sitting** during long journeys causes **venous stasis** in the lower extremities, which is a key component of **Virchow's triad** for thrombosis (stasis, hypercoagulability, endothelial injury). - **DVT** is the **direct and most specific pathological consequence** of prolonged immobilization during travel in pregnancy. - The risk of **VTE in pregnancy** is **4-5 times higher** than in non-pregnant women, with travel-related DVT being a recognized complication. *Venous thromboembolism* - VTE is an **umbrella term** that encompasses both **DVT and pulmonary embolism**. - While technically correct as a broader category, DVT is the **more specific and direct answer** to what prolonged sitting causes. - In medical education and clinical practice, identifying the **specific pathology** (DVT) is more appropriate than using the general category (VTE). *Pulmonary embolism* - PE is a **complication** of DVT, occurring when a thrombus dislodges and embolizes to the pulmonary circulation. - PE is a **secondary consequence**, not the **primary risk** from prolonged sitting itself. - The direct mechanism of prolonged sitting → venous stasis → **DVT formation** → potential embolization to lungs. *Leg swelling* - **Leg swelling** (edema) is a **symptom**, not a pathological diagnosis. - While leg edema can indicate DVT, it's also common in normal pregnancy due to increased venous pressure and fluid retention. - The question asks for a **risk** (pathological condition), not a symptom.

Q: In Stein-Leventhal syndrome, which hormone is raised?

LH. ***LH*** - In **Stein-Leventhal syndrome** (Polycystic Ovary Syndrome, PCOS), there is an elevated **LH (Luteinizing Hormone)** level. - This high LH-to-FSH ratio contributes to increased **androgen production** by the ovarian theca cells, leading to symptoms like hirsutism and anovulation. *FSH* - **FSH (Follicle-Stimulating Hormone)** levels are typically normal or even low in PCOS, contributing to the elevated LH:FSH ratio. - Low FSH levels impair proper follicle maturation, leading to **anovulation** and the characteristic polycystic appearance of the ovaries. *GnRH* - **GnRH (Gonadotropin-Releasing Hormone)** secretion can be altered in PCOS, often showing increased pulse frequency, which preferentially stimulates LH release over FSH. - However, **GnRH levels themselves are not directly measured** as "raised" in the clinical diagnostic criteria for PCOS. *Progesterone* - **Progesterone** levels are often low or absent in PCOS, particularly in the luteal phase, due to **anovulation**. - The lack of regular ovulation means no corpus luteum forms, which is responsible for progesterone production after ovulation.

Q: What is the most likely cause of yellow-green watery discharge and pruritus in a female patient?

Trichomonas vaginalis. ***Trichomonas vaginalis (Correct)*** - The characteristic presentation of **yellow-green, frothy, watery vaginal discharge** with associated **pruritus** is highly suggestive of **trichomoniasis**. - Other clinical findings may include **dyspareunia**, **dysuria**, and a **"strawberry cervix"** on speculum examination. - Trichomoniasis is a sexually transmitted infection caused by the protozoan *Trichomonas vaginalis*. *Candida (Incorrect)* - **Candidiasis** (yeast infection) typically presents with **thick, white, cottage cheese-like discharge** and severe pruritus, often described as a burning sensation. - The discharge is usually not watery or yellow-green, and the characteristic fishy odor is absent. - pH is typically normal ( 4.5). *Bacterial vaginosis (Incorrect)* - **Bacterial vaginosis** is characterized by a **thin, gray-white discharge** with a **fishy odor**, especially after intercourse or with alkalinization. - The discharge is not typically yellow-green or frothy. - Pruritus may be present but is usually less prominent than with candidiasis or trichomoniasis. *Chlamydia trachomatis (Incorrect)* - **Chlamydia** infection is often **asymptomatic** in women (up to 70% of cases), but when symptoms occur, they may include **mucopurulent cervical discharge**, intermenstrial bleeding, or lower abdominal pain. - It does not typically cause the **profuse, frothy, yellow-green discharge** with significant pruritus described in this clinical presentation. - Chlamydia primarily causes cervicitis rather than vaginitis.

Q: Which of the following is NOT a symptom of nicotine withdrawal?

Increased heart rate. ***Increased heart rate*** - **Increased heart rate** is NOT a symptom of nicotine withdrawal; rather, it is associated with **active nicotine use** due to nicotine's stimulant effects on the sympathetic nervous system. - During **nicotine withdrawal**, the heart rate typically **decreases or normalizes** as the body adjusts to the absence of nicotine's cardiovascular stimulation. - Nicotine acts as a sympathomimetic agent, causing tachycardia during use, but withdrawal does not produce increased heart rate. *Anxiety* - **Anxiety** is one of the most common and prominent symptoms of **nicotine withdrawal**. - As nicotine affects neurotransmitter systems (particularly dopamine, norepinephrine, and serotonin), cessation leads to neurochemical imbalances manifesting as anxiety, irritability, and restlessness. - This symptom typically peaks within the first week of cessation. *Hyperhidrosis* - **Hyperhidrosis** (excessive sweating) is actually a recognized symptom of **nicotine withdrawal**. - Increased sweating can occur as part of the autonomic nervous system dysregulation during the withdrawal period. - This is included among the physical withdrawal symptoms in standard diagnostic criteria. *Weight gain* - **Weight gain** is a well-documented and common consequence of **nicotine withdrawal**. - This occurs due to increased appetite, decreased metabolic rate (as nicotine's metabolic-enhancing effects cease), and behavioral substitution of smoking with eating. - Average weight gain is approximately 4-5 kg in the months following cessation.

Q: Who coined the term 'psychiatry'?

Johann Reil. ***Johann Reil*** - The term "**psychiatry**" (Psychiatrie) was coined by the German physician **Johann Christian Reil** in **1808**. - Reil introduced the term in his work to advocate for a more **humane and medical approach** to mental illness, moving away from purely custodial care. *Moral* - While Reil's efforts were part of a broader movement towards **moral treatment** of the mentally ill, "moral" itself is not the specific context in which the term was coined. - **Moral treatment** emphasized humane care, occupational therapy, and a therapeutic environment, contributing to the development of psychiatry but not coining the word. *Bleuler* - **Eugen Bleuler** is known for coining the term "**schizophrenia**" in the early 20th century. - He significantly contributed to the understanding of psychotic disorders but did not coin the broader term "psychiatry." *Pinel* - **Philippe Pinel** was a French physician who was an instrumental figure in the **humanitarian reform** of mental asylum care in the late 18th century. - He is famous for **unshackling patients** at Bicêtre and Salpêtrière asylums, but he did not coin the term "psychiatry."

Q: Which of the following is considered a poor prognostic factor for schizophrenia?

Poor premorbid adjustment. **Poor premorbid adjustment** - **Poor premorbid adjustment**, indicated by difficulties in social, academic, or occupational functioning before the onset of psychosis, is a consistent predictor of a worse outcome in schizophrenia. - This suggests a more pervasive and entrenched neurodevelopmental vulnerability impacting the individual's ability to cope and integrate socially. *Blunted affect (negative symptom)* - While **blunted affect** is a negative symptom often associated with poorer outcomes than positive symptoms, it is typically considered a *symptom* of the illness rather than a primary prognostic *factor* like premorbid adjustment. - Its presence contributes to disability, but it is not as strong an independent prognostic indicator as the life trajectory prior to illness onset. *Male sex (generally poorer prognosis)* - **Male sex** is generally associated with an **earlier age of onset** and often a **more severe course** of schizophrenia. - However, compared to significant functional impairment before disease onset, it is not as strong an individual predictor of overall long-term prognosis. *Presence of depression (often associated with better outcomes)* - The **presence of depressive symptoms** in schizophrenia is often associated with a **better prognosis**. - This is because depressive features can sometimes indicate a more preserved capacity for emotional experience and insight, which can align with higher functioning.

Q: What is the echogenic lesion size criterion for chronic pancreatitis?

> 3 mm. ***> 3 mm*** - An echogenic lesion **greater than 3 mm** in size is a diagnostic criterion for **chronic pancreatitis** when observed on ultrasound imaging. - This represents one of the **major features** in ultrasound diagnosis of chronic pancreatitis, particularly when echogenic foci demonstrate acoustic shadowing (suggesting calcifications). - This criterion is part of established diagnostic frameworks and helps differentiate pathological calcifications from minor, non-specific findings. *> 4 mm* - While a **4 mm threshold** would indicate significant findings, the established diagnostic criterion for chronic pancreatitis uses **> 3 mm** as the cutoff. - Using a higher threshold would reduce sensitivity for detecting chronic pancreatitis. *> 2 mm* - A lesion larger than **2 mm** is generally considered below the established diagnostic threshold for **chronic pancreatitis**. - This size may represent early changes or incidental findings that are not yet definitive for diagnosis. *> 1 mm* - A lesion **greater than 1 mm** is too small to be a definitive criterion for **chronic pancreatitis** and could represent minor, non-pathological findings. - Such small echogenic foci lack sufficient specificity for diagnosing chronic pancreatic disease.

Question 1

The best local anesthetic for prolonged ophthalmic surgery requiring extended post-operative analgesia is:

Accepted Answer

Bupivacaine

Answer

Tetracaine

Answer

Procaine

Answer

Prilocaine

Question 2

Which of the following anesthetic agents is most notable for its analgesic properties?

Accepted Answer

Ketamine

Answer

Thiopentone

Answer

Propofol

Answer

None of the options

Question 3

Critical temperature of oxygen is?

Accepted Answer

-118°C

Answer

400°C

Answer

20°C

Answer

36.5°C

Question 4

What is a potential risk for pregnant women who undertake long journeys with prolonged sitting?

Accepted Answer

Deep vein thrombosis

Answer

Venous thromboembolism

Answer

Pulmonary embolism

Answer

Leg swelling

Question 5

In Stein-Leventhal syndrome, which hormone is raised?

Accepted Answer

LH

Answer

FSH

Answer

GnRH

Answer

Progesterone

Question 6

What is the most likely cause of yellow-green watery discharge and pruritus in a female patient?

Accepted Answer

Trichomonas vaginalis

Answer

Candida

Answer

Bacterial vaginosis

Answer

Chlamydia trachomatis

Question 7

Which of the following is NOT a symptom of nicotine withdrawal?

Accepted Answer

Increased heart rate

Answer

Anxiety

Answer

Hyperhidrosis

Answer

Weight gain

Question 8

Who coined the term 'psychiatry'?

Accepted Answer

Johann Reil

Answer

Moral

Answer

Bleuler

Answer

Pinel

Question 9

Which of the following is considered a poor prognostic factor for schizophrenia?

Accepted Answer

Poor premorbid adjustment

Answer

Male sex

Answer

Presence of depression

Answer

Blunted affect

Question 10

What is the echogenic lesion size criterion for chronic pancreatitis?

Accepted Answer

> 3 mm

Answer

> 2 mm

Answer

> 1 mm

Answer

> 4 mm

NEET-PG 2013

Anesthesiology

Obstetrics and Gynecology

Psychiatry

Radiology