Internal Medicine
2 questionsWhat is the most appropriate initial management for paralysis resulting from organophosphorus poisoning?
Anemia with reticulocytosis is seen in -
NEET-PG 2013 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 301: What is the most appropriate initial management for paralysis resulting from organophosphorus poisoning?
- A. Supportive care, including respiratory support (Correct Answer)
- B. Atropine to counteract muscarinic symptoms
- C. Oximes to reactivate acetylcholinesterase
- D. No specific antidote
Explanation: **Supportive care, including respiratory support** * **Paralysis** in organophosphorus poisoning (OPP) is often due to **nicotinic effects** at the neuromuscular junction, leading to respiratory muscle weakness and failure [2]. * **Respiratory support** through mechanical ventilation is crucial to maintain oxygenation and prevent complications while awaiting the effects of antidotal therapy [1], [2]. * *Atropine to counteract muscarinic symptoms* * **Atropine** primarily blocks **muscarinic receptors**, effectively treating symptoms like bradycardia, bronchorrhea, and miosis [2]. * It does **not reverse the nicotinic effects** responsible for muscle paralysis and respiratory failure. * *Oximes to reactivate acetylcholinesterase* * **Oximes (e.g., pralidoxime)** reactivate **acetylcholinesterase**, thereby addressing the underlying cause of acetylcholine accumulation [2]. * They are most effective if given **early** before irreversible aging of the enzyme occurs, but their effect on established paralysis can be limited without concurrent respiratory support [2]. * *No specific antidote* * This statement is incorrect; **atropine** and **oximes** are specific antidotes for organophosphorus poisoning [2]. * While these antidotes are vital, initial management prioritizing **airway and breathing support** is paramount due to the life-threatening respiratory paralysis [1].
Question 302: Anemia with reticulocytosis is seen in -
- A. Hemolysis (Correct Answer)
- B. Iron deficiency anemia
- C. Vitamin B12 deficiency
- D. Aplastic anemia
Explanation: ***Hemolysis*** - Reticulocytosis indicates a compensatory response to anemia, often occurring in hemolytic processes where the **bone marrow increases red blood cell production** in response to red blood cell destruction. - Conditions like **sickle cell disease** or **autoimmune hemolytic anemia** lead to hemolysis, further confirming increased reticulocyte count. *Iron deficiency anemia* - Typically presents with a **low reticulocyte count** as the bone marrow does not have sufficient iron to produce new red blood cells. - This condition is characterized by **microcytic, hypochromic** red blood cells due to inadequate iron stores. *Vitamin B12 deficiency* - Often results in a **macrocytic anemia** with a variable reticulocyte count; however, reticulocytosis is generally not seen initially. - This deficiency affects DNA synthesis, leading to ineffective erythropoiesis and the presence of **megaloblastic changes**. *Aplastic anemia* - Characterized by a **decrease in all types of blood cells** (pancytopenia) and typically has a **low reticulocyte count** due to bone marrow failure. - There is insufficient production of red blood cells, hence **reticulocytosis is not observed**.
Pathology
2 questionsLocalized Langerhans cell histiocytosis affecting head and neck is?
Which is not a feature of paroxysmal nocturnal hemoglobinuria?
NEET-PG 2013 - Pathology NEET-PG Practice Questions and MCQs
Question 301: Localized Langerhans cell histiocytosis affecting head and neck is?
- A. Eosinophilic granuloma (Correct Answer)
- B. Letterer-siwe disease
- C. Pulmonary Langerhans cell histiocytosis
- D. Hand-Schuller-Christian disease
Explanation: ***Eosinophilic granuloma*** - This is a localized form of **Langerhans cell histiocytosis** that typically presents in the head and neck region, often affecting areas like the skull and mandible [1]. - Characterized by **bone lesions** and may present with **pain or swelling** in the affected area, making it a prominent form in children and young adults. *Pulmonary langerhans cell histiocytosis* - Primarily affects the **lungs** and is associated with **cough, dyspnea**, and pulmonary nodules, not the head and neck region. - Occurs predominantly in **smokers** and involves interstitial lung disease patterns on imaging studies. *Hand-schuller-christian disease* - This condition is a systemic form of Langerhans cell histiocytosis that affects multiple systems rather than being localized, commonly presenting with **diabetes insipidus** and bone lesions. - It is often associated with **exophthalmos** and may involve lymphadenopathy, affecting older children and adults, not localized head and neck involvement. *Letterer-siwe disease* - This represents the acute, disseminated form of Langerhans cell histiocytosis, affecting infants, and is marked by systemic symptoms like **fever**, **rash**, and **hepatosplenomegaly** [1]. - Typically presents with serious manifestations and not specifically localized in the **head and neck area** as seen in eosinophilic granuloma. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, p. 630.
Question 302: Which is not a feature of paroxysmal nocturnal hemoglobinuria?
- A. Thrombocytopenia
- B. Hemolysis
- C. Increased LAP score (Correct Answer)
- D. Thrombosis
Explanation: ***Increased LAP score*** - In paroxysmal nocturnal hemoglobinuria, the **LAP score** is typically **low** due to ineffective hematopoiesis and not elevated. - The presence of a low LAP score is inconsistent with the features of this condition, making it the correct choice. *Thrombosis* - Paroxysmal nocturnal hemoglobinuria is **associated with a high risk of thrombosis**, particularly in the **venous system** [2]. - This is due to **increased platelet activation** and excessive thrombin generation resulting from hemolysis. *Hemolysis* - **Hemolysis** is a hallmark feature of paroxysmal nocturnal hemoglobinuria, where there is **destruction of red blood cells** [2,3]. - Patients often present with signs of hemolytic anemia including **elevated bilirubin** and **low haptoglobin** levels. *Thrombocytopenia* - **Thrombocytopenia** is a common finding in paroxysmal nocturnal hemoglobinuria due to **expanded consumption** of platelets during episodes of hemolysis. - This can lead to an **increased risk of bleeding** in affected patients. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 601-602. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 650-651.
Pharmacology
5 questionsIn the context of pharmacology, which plasma protein do acidic drugs primarily bind to?
Muscarinic cholinergic receptors are seen at all sites, except?
Which of the following statements about clonidine is incorrect?
Which of the following is classified as an antispasmodic agent?
Which urinary bladder spasmolytic has local anesthetic properties?
NEET-PG 2013 - Pharmacology NEET-PG Practice Questions and MCQs
Question 301: In the context of pharmacology, which plasma protein do acidic drugs primarily bind to?
- A. Globulin
- B. Albumin (Correct Answer)
- C. α1-acid glycoprotein
- D. None of the options
Explanation: ***Albumin*** - **Albumin** is the most abundant plasma protein and has multiple binding sites for a wide range of drugs, particularly **acidic drugs**. - Its high concentration and diverse binding capabilities make it the primary transporter for many **lipophilic** and **anionic drugs**. *Globulin* - **Globulins** are a diverse group of proteins, some of which bind to drugs, but they primarily transport **hormones**, **metals**, and **vitamins**, not acidic drugs. - They are less significant for binding acidic drugs compared to albumin. *α1-acid glycoprotein* - **α1-acid glycoprotein** primarily binds to **basic drugs** due to its numerous acidic residues. - While it plays a crucial role in binding basic compounds, it has limited affinity for acidic drugs. *None of the options* - This option is incorrect because **albumin** is a well-established and significant plasma protein for binding acidic drugs. - Specific plasma proteins are known to bind different types of drugs, and for acidic drugs, albumin is the primary binder.
Question 302: Muscarinic cholinergic receptors are seen at all sites, except?
- A. Stomach
- B. CNS
- C. Glands
- D. Neuromuscular junction (Correct Answer)
Explanation: ***Neuromuscular junction*** - The **neuromuscular junction** primarily contains **nicotinic cholinergic receptors**, not muscarinic receptors. - Activation of these nicotinic receptors by acetylcholine causes muscle contraction. *Stomach* - The stomach contains **muscarinic M3 receptors** which mediate gastric acid secretion and smooth muscle contraction. - Activation by acetylcholine via the vagus nerve promotes digestion. *CNS* - The **central nervous system** has various subtypes of **muscarinic receptors (M1-M5)** distributed throughout, playing roles in learning, memory, and motor control. - These receptors modulate neuronal excitability and neurotransmitter release. *Glands* - Most exocrine glands (e.g., salivary, lacrimal, sweat glands) are richly supplied with **muscarinic receptors**, primarily **M3**. - Activation leads to increased glandular secretion.
Question 303: Which of the following statements about clonidine is incorrect?
- A. Alpha 2 receptor agonist
- B. Sudden withdrawal causes rebound hypertension
- C. Controls loose motions due to diabetic neuropathy
- D. First line for AMI (Correct Answer)
Explanation: ***First line for AMI*** - Clonidine is **not first-line** for **Acute Myocardial Infarction (AMI)** as it can cause **bradycardia** and **hypotension**, potentially worsening cardiac output. - First-line AMI treatments include **thrombolytics**, **antiplatelet agents** (aspirin), **beta-blockers**, and **ACE inhibitors** for optimal cardiac protection. *Alpha 2 receptor agonist* - Clonidine is indeed an **alpha-2 adrenergic receptor agonist** that acts centrally in the **medulla oblongata**. - It reduces **sympathetic outflow** from the CNS, leading to decreased **heart rate**, **blood pressure**, and **peripheral vascular resistance**. *Sudden withdrawal causes rebound hypertension* - Abrupt clonidine discontinuation causes dangerous **rebound hypertension** due to sudden loss of **sympathetic inhibition**. - **Gradual tapering** over 1-2 weeks is essential to prevent this potentially life-threatening complication. *Controls loose motions due to diabetic neuropathy* - Clonidine effectively treats **diabetic diarrhea** by stimulating **alpha-2 receptors** in the enteric nervous system. - It **slows intestinal transit** and **enhances fluid absorption**, making it useful for **autonomic neuropathy-related** gastrointestinal symptoms.
Question 304: Which of the following is classified as an antispasmodic agent?
- A. Dicyclomine (Correct Answer)
- B. Physostigmine
- C. Tropicamide
- D. None of the options
Explanation: ***Dicyclomine*** - **Dicyclomine** is an **anticholinergic** medication that works by blocking muscarinic receptors, thereby reducing smooth muscle spasm in the gastrointestinal tract. - It is commonly used to treat symptoms of **irritable bowel syndrome (IBS)**, such as abdominal pain and cramping. *Physostigmine* - **Physostigmine** is a **cholinesterase inhibitor** that increases the concentration of acetylcholine at the synaptic cleft. - It is used to treat **anticholinergic poisoning** by reversing the effects of anticholinergic drugs, rather than acting as an antispasmodic itself. *Tropicamide* - **Tropicamide** is an **anticholinergic** agent primarily used as a **mydriatic** (pupil dilator) and **cycloplegic** (paralyzes the ciliary muscle) for ophthalmic examinations. - Its action is localized to the eye and it does not have significant systemic antispasmodic effects. *None of the options* - This option is incorrect because one of the listed medications is indeed classified as an antispasmodic agent. - When "None of the options" appears as a choice, it should only be selected if all other options are clearly incorrect.
Question 305: Which urinary bladder spasmolytic has local anesthetic properties?
- A. Tamsulosin
- B. Terazosin
- C. Oxybutynin (Correct Answer)
- D. Yohimbine
Explanation: ***Oxybutynin*** - Possesses both **anticholinergic properties** (bladder smooth muscle relaxation) and **direct local anesthetic properties**, which contribute to its spasmolytic effect on the detrusor muscle. - The **local anesthetic action** directly reduces bladder detrusor muscle contractions, explaining its efficacy in treating urge incontinence and overactive bladder. - This dual mechanism makes it unique among bladder spasmolytics. *Tamsulosin* - Is an **alpha-1 adrenergic receptor blocker** used for benign prostatic hyperplasia (BPH) by relaxing smooth muscle in the prostate and bladder neck. - Does **not have local anesthetic properties** and is not a bladder detrusor spasmolytic. *Terazosin* - Also an **alpha-1 adrenergic receptor blocker**, similar to tamsulosin, used for BPH and hypertension. - Acts via **vascular and prostatic smooth muscle relaxation**, without local anesthetic or bladder spasmolytic effects. *Yohimbine* - Is an **alpha-2 adrenergic receptor antagonist** known for increasing sympathetic outflow. - Does **not have bladder spasmolytic effects** or local anesthetic properties.
Psychiatry
1 questionsWhich of the following develop first during dependence of a substance ?
NEET-PG 2013 - Psychiatry NEET-PG Practice Questions and MCQs
Question 301: Which of the following develop first during dependence of a substance ?
- A. Tolerance
- B. Physical dependence
- C. Psychological dependence (Correct Answer)
- D. Withdrawal symptoms
Explanation: ***Psychological dependence*** - **Psychological dependence** often develops first, characterized by an emotional need for the substance to experience pleasure or avoid discomfort. - This involves a strong **craving** and compulsive drug-seeking behavior despite negative consequences, driven by the substance's effect on brain reward pathways. *Tolerance* - **Tolerance** means that increasing doses of the substance are required to achieve the same effect previously achieved with lower doses. - While it often develops early in substance use, the initial "need" to use the substance is often psychological before physiological adaptations occur. *Physical dependence* - **Physical dependence** describes the body's physiological adaptation to the substance, leading to withdrawal symptoms if use is stopped or reduced. - It typically develops after consistent, prolonged use and is usually preceded by psychological dependence and often tolerance. *Withdrawal symptoms* - **Withdrawal symptoms** are the physiological and psychological signs that occur when a dependent person stops or drastically reduces their substance intake. - These are a direct manifestation of physical dependence and thus develop once physical dependence has been established.