NEET-PG 2013 Practice Questions

Q: Who coined the term "balanced anaesthesia"?

Lundy (John S. Lundy). ***Lundy (John S. Lundy)*** - **John S. Lundy** is credited with coining the term "**balanced anaesthesia**" in the early 20th century. - This concept describes the use of **multiple anesthetic agents** in combination, each contributing to different aspects of anesthesia (e.g., hypnosis, analgesia, muscle relaxation). *Simpson* - **Sir James Young Simpson** was a Scottish physician who pioneered the use of **chloroform** and ether as anesthetics in the mid-19th century. - While he significantly advanced the field of anesthesia, he did not coin the term "balanced anaesthesia." *Fischer* - **Emil Fischer** was a German chemist who won the Nobel Prize in Chemistry for his work on sugar and purine syntheses. - His contributions were primarily in organic chemistry and biochemistry, not directly in the field of clinical anesthesia terminology. *Morton* - **William T.G. Morton** was an American dentist who famously demonstrated the first public use of **ether** for surgical anesthesia in 1846. - He is known for popularizing ether as a surgical anesthetic but did not coin the term "balanced anaesthesia."

Q: Which of the following anesthetics is known to increase intraocular pressure?

Ketamine. ***Ketamine*** - **Ketamine** is known to increase **intraocular pressure (IOP)**, making it generally avoided in patients with **glaucoma** or those undergoing ocular surgery. - This effect is due to its influence on sympathetic nervous system activity and extraocular muscle tone. *Thiopental* - **Thiopental**, a barbiturate, typically causes a **reduction in intraocular pressure**, which can be beneficial in certain ocular procedures. - Its mechanism involves decreasing cerebral blood flow and metabolic rate, indirectly leading to a decrease in IOP. *Alfentanil* - **Alfentanil**, an opioid, generally has **minimal to no significant effect on intraocular pressure**. - Its primary actions are analgesia and sedation, without direct impact on oculomotor tone or fluid dynamics. *Propofol* - **Propofol** is known to **decrease intraocular pressure**, making it a favorable agent for ophthalmic surgery. - This effect is attributed to a reduction in cerebral blood flow and an inhibition of aqueous humor production.

Q: The Grattage test is used to diagnose which of the following conditions?

Psoriasis. ***Psoriasis*** - The **Grattage test** (candle grease sign) involves **scraping the psoriatic lesion** to reveal characteristic features - First reveals **fine, silvery-white scales** resembling candle wax - Further scraping exposes **pinpoint bleeding points** (**Auspitz sign**) due to exposure of dilated capillaries in dermal papillae - This combination is **pathognomonic for psoriasis** and helps differentiate it from other scaly dermatoses *Tinea capitis* - A **fungal infection of the scalp** caused by dermatophytes - Diagnosed by **KOH mount** (showing fungal hyphae), **fungal culture**, and sometimes **Wood's lamp examination** - The Grattage test is not used for diagnosing fungal infections *Lichen planus* - Characterized by **purplish, polygonal, flat-topped, pruritic papules and plaques** - Surface shows **Wickham's striae** (fine white lines) - Diagnosis is **clinical**, supported by **skin biopsy** showing band-like lymphocytic infiltrate and sawtooth rete ridges - The Grattage test is not applicable *Pemphigus vulgaris* - A severe **autoimmune blistering disorder** with **suprabasal acantholysis** - Presents with **flaccid bullae** that rupture easily, leaving erosions - Diagnosed by **skin biopsy**, **direct immunofluorescence** (intercellular IgG and C3 deposits), and **Nikolsky's sign** (positive) - The Grattage test is not used for bullous disorders

Q: Pathergy test is used for which condition?

Behçet's syndrome. ***Behçet's syndrome*** - The **pathergy test** is a diagnostic test where a sterile needle is used to prick the skin, and a positive result (erythematous papule or pustule) indicates a hyperreactivity of the skin, common in **Behçet's syndrome**. - This syndrome is a **vasculitis** characterized by recurrent oral and genital ulcers, ocular inflammation, and skin lesions, where pathergy is a characteristic feature. *Lichen planus* - This is an **inflammatory dermatosis** affecting the skin, hair, nails, and mucous membranes, characterized by "6 P's": **Pruritic, Purple, Polygonal, Planar, Papules, and Plaques**. - The pathergy test is **not used** in the diagnosis of lichen planus. *Atopic dermatitis* - Also known as **eczema**, it is a chronic, relapsing inflammatory skin condition characterized by dry, itchy skin and often associated with a personal or family history of allergies, asthma, or allergic rhinitis. - Diagnosis is primarily clinical, focusing on characteristic skin lesions and symptoms, and the **pathergy test is not applicable**. *Reiter's syndrome* - Now known as **reactive arthritis**, this condition is an autoimmune disorder that develops in response to an infection elsewhere in the body, typically genitourinary or gastrointestinal. - It classically presents with **arthritis, urethritis, and conjunctivitis** (Can't see, can't pee, can't climb a tree), and the **pathergy test is not used** for its diagnosis.

Q: A man with pain during defecation, no gastrointestinal symptoms, and ulcers extending into the anal canal. Diagnosis?

Genital herpes. Herpes simplex virus (HSV) infection of the anal canal is characterized by lesions that present as painful ulcers [1]. Direct extension into the anal canal is common in individuals with receptive anal intercourse or autoinoculation, often causing symptoms such as anal or rectal pain [1]. CMV proctitis typically causes more diffuse inflammation, often with bloody stools, diarrhea, and abdominal pain, which are not described in this case. While CMV can cause ulcers, they are usually shallow and often associated with immunocompromised states. Gonococcal proctitis often presents with purulent anal discharge, rectal pain, itching, and tenesmus, but typically without deep ulcerations. HIV infection can cause various anorectal complications, including aphthous ulcers, but isolated anal ulcers and defecation pain would prompt investigation into sexually transmitted infections like herpes as a more direct cause.

Q: Refer to the provided ECG image. It demonstrates which of the following?

Ventricular fibrillation (VF). ***Ventricular fibrillation (VF)*** - The ECG shows a chaotic, **irregular electrical activity** with no distinguishable P waves, QRS complexes, or T waves. - This disorganized electrical pattern is characteristic of VF, indicating a severe cardiac emergency. *Supraventricular tachycardia (SVT)* - SVT is characterized by a **rapid, regular rhythm** with narrow QRS complexes, which are absent in this chaotic tracing. - While fast, SVT typically maintains some degree of organized electrical activity, unlike the provided ECG. *Atrial fibrillation (AF)* - AF presents with irregularly irregular rhythm and **absent P waves**, but it still has identifiable **narrow QRS complexes**. - The provided ECG lacks any discernible QRS complexes, making AF an unlikely diagnosis. *Wolff-Parkinson-White (WPW) syndrome* - WPW syndrome is characterized by a **short PR interval** and a **delta wave** on the ECG due to an accessory pathway. - It involves an organized rhythm, although it can predispose to tachyarrhythmias, and doesn't present as the chaotic rhythm shown.

Q: Which of the following statements about chronic osteomyelitis is false?

Involucrum is dead bone. ***Involucrum is dead bone*** - This statement is false because the **involucrum** is the layer of **new bone formation** that surrounds a segment of necrotic (dead) bone, known as the **sequestrum**, in chronic osteomyelitis [1]. - The involucrum represents the body's attempt to wall off the infection and dead bone, and thus, it is living, *reactive bone*, not dead bone [1]. *Reactive new bone formation* - This statement is true; **reactive new bone formation** occurs around infected or necrotic bone in chronic osteomyelitis, forming the **involucrum** [1]. - This process is a hallmark of the body's response to chronic infection and attempts to contain it. *Cloaca is an opening in involucrum* - This statement is true; a **cloaca** is a **fistulous tract** or opening in the **involucrum** that allows pus and necrotic debris from the infected area to drain to the skin surface. - This drainage is a common clinical sign of chronic osteomyelitis. *Sequestrum is hard and dense* - This statement is true; the **sequestrum** is a piece of **necrotic (dead) bone** that has become separated from living bone due to ischemia and infection [1]. - Due to the loss of blood supply and avascular necrosis, it appears **dense, hard, and radiodense** on imaging, representing devitalized bone tissue that is walled off from the body's immune response. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1197-1198.

Q: Which of the following medications is not typically used for the treatment of erectile dysfunction?

Beta blockers. ***Beta blockers*** - **Beta blockers** are primarily used to treat conditions like **hypertension** and **heart disease**. - While they can cause ED as a side effect, they are **not used for its treatment**. *Sildenafil* - **Sildenafil** is a **PDE5 inhibitor** that works by increasing **blood flow to the penis**, facilitating an erection. - It is a **first-line oral medication** widely prescribed for erectile dysfunction. *PG-E* - **PG-E** refers to **Prostaglandin E1** (alprostadil), which can be administered via **intracavernosal injection** or **urethral suppository**. - It directly causes **vasodilation** in the penis, leading to an erection, and is used when oral medications are ineffective or contraindicated. *Papaverine* - **Papaverine** is a **non-specific vasodilator** that can be used as an **intracavernosal injection** for ED. - It works by relaxing **smooth muscle** in the penile arteries, increasing blood flow and inducing an erection, often used in combination with phentolamine.

Q: Which of the following is NOT a typical differential diagnosis for a solitary pulmonary nodule?

Mycetoma. ***Mycetoma*** - A mycetoma is a **fungal infection** that typically affects subcutaneous tissues, skin, and bone, forming granulomas and sinuses. It is not typically seen as a solitary pulmonary nodule. - While pulmonary fungal infections can occur, a mycetoma in the lung typically presents as a **fungus ball (aspergilloma)** within a pre-existing cavity, rather than a solitary, solid nodule. *Tuberculoma* - A tuberculoma is a **granuloma** caused by Mycobacterium tuberculosis, which can present as a well-defined, solitary pulmonary nodule or mass on imaging. - It represents a contained form of tuberculosis and is a common differential for a solitary pulmonary nodule, especially in endemic areas. *Hamartoma* - A hamartoma is a **benign tumor-like malformation** composed of normal tissues (like cartilage, fat, and muscle) that are disorganized. - It is one of the most common benign causes of a solitary pulmonary nodule. *Bronchogenic carcinoma* - Bronchogenic carcinoma, including adenocarcinoma, squamous cell carcinoma, and large cell carcinoma, is the most significant concern when evaluating a solitary pulmonary nodule. - It is a primary **malignant lung tumor** and represents a crucial differential diagnosis due to its poor prognosis if not detected and treated early.

Q: Pulled up cecum is seen in which condition?

Ileocecal tuberculosis (TB). ***Ileocecal tuberculosis (TB)*** - **Ileocecal tuberculosis** commonly causes **fibrosis** and stricture formation in the ileocecal region, which can lead to the **retraction or pulling up of the cecum**. - This "pulled-up cecum" is a characteristic radiographic finding, often associated with a **patulous ileocecal valve** and inflammatory changes. *Cecal carcinoma* - While cecal carcinoma can cause a mass and involve the cecum, it does not typically lead to a "pulled-up" appearance. - Carcinoma usually presents as a **filling defect** or an **obstructing lesion** rather than retraction. *Intussusception* - **Intussusception** involves the telescoping of one part of the intestine into another, usually presenting as a **target sign** on imaging. - This condition does not cause a *pulled-up cecum*; instead, it involves the distal segment invaginating into the proximal segment. *Colon carcinoma* - **Colon carcinoma** can manifest as an **apple-core lesion** or an obstructing mass, but like cecal carcinoma, it generally does not cause the cecum to be pulled upwards. - The pathology is primarily one of **luminal narrowing** or mass obstruction.

Question 1

Who coined the term "balanced anaesthesia"?

Accepted Answer

Lundy (John S. Lundy)

Answer

Simpson

Answer

Fischer

Answer

Morton

Question 2

Which of the following anesthetics is known to increase intraocular pressure?

Accepted Answer

Ketamine

Answer

Thiopental

Answer

Alfentanil

Answer

Propofol

Question 3

The Grattage test is used to diagnose which of the following conditions?

Accepted Answer

Psoriasis

Answer

Tinea capitis

Answer

Lichen planus

Answer

Pemphigus vulgaris

Question 4

Pathergy test is used for which condition?

Accepted Answer

Behçet's syndrome

Answer

Lichen planus

Answer

Atopic dermatitis

Answer

Reiter's syndrome

Question 5

A man with pain during defecation, no gastrointestinal symptoms, and ulcers extending into the anal canal. Diagnosis?

Accepted Answer

Genital herpes

Answer

Cytomegalovirus (CMV)

Answer

Gonococcal infection

Answer

HIV infection

Question 6

Refer to the provided ECG image. It demonstrates which of the following?

Accepted Answer

Ventricular fibrillation (VF)

Answer

Supraventricular tachycardia (SVT)

Answer

Atrial fibrillation (AF)

Answer

Wolff-Parkinson-White (WPW) syndrome

Question 7

Which of the following statements about chronic osteomyelitis is false?

Accepted Answer

Involucrum is dead bone

Answer

Reactive new bone formation

Answer

Cloaca is an opening in involucrum

Answer

Sequestrum is hard and dense

Question 8

Which of the following medications is not typically used for the treatment of erectile dysfunction?

Accepted Answer

Beta blockers

Answer

Papaverine

Answer

Sildenafil

Answer

PG-E

Question 9

Which of the following is NOT a typical differential diagnosis for a solitary pulmonary nodule?

Accepted Answer

Mycetoma

Answer

Tuberculoma

Answer

Hamartoma

Answer

Bronchogenic carcinoma

Question 10

Pulled up cecum is seen in which condition?

Accepted Answer

Ileocecal tuberculosis (TB)

Answer

Cecal carcinoma

Answer

Intussusception

Answer

Colon carcinoma

NEET-PG 2013

Anesthesiology

Dermatology

Internal Medicine

Pathology

Pharmacology

Radiology

Surgery