Community Medicine
2 questionsVaccines are available against which types of meningococcus?
Infant mortality rate in India is per 1000 live births?
NEET-PG 2013 - Community Medicine NEET-PG Practice Questions and MCQs
Question 521: Vaccines are available against which types of meningococcus?
- A. Type A
- B. Type B
- C. Type A, B, and C
- D. Type A, B, C, W, and Y (Correct Answer)
Explanation: ***Type A, B, C, W, and Y*** - Vaccines are currently available against **all five major meningococcal serogroups**: A, B, C, W-135, and Y. - **Meningococcal conjugate vaccines (MenACWY)** provide protection against serogroups A, C, W-135, and Y, and are widely used globally. - **Meningococcal B vaccines (MenB)** such as Bexsero and Trumenba specifically target serogroup B, which is a leading cause of meningococcal disease in developed countries. - Combined, these vaccines provide comprehensive coverage against the most epidemiologically important meningococcal serogroups worldwide. *Type A* - While vaccines against **meningococcus type A** do exist (as part of conjugate vaccines), this option is incomplete as it excludes the other important serogroups (B, C, W, Y) for which vaccines are also available. *Type B* - **Type B vaccines** are available and important, particularly in developed countries where serogroup B causes significant disease burden. - However, this option alone is insufficient because vaccines also effectively target other serogroups (A, C, W, Y). *Type A, B, and C* - This option is incomplete because it omits **serogroups W and Y**, for which conjugate vaccines (MenACWY) are readily available and widely used. - The question asks which types vaccines are *available* against, not which are most common, making this an incorrect answer.
Question 522: Infant mortality rate in India is per 1000 live births?
- A. 25
- B. 55
- C. 60
- D. 34 (Correct Answer)
Explanation: ***34*** - As per the **Sample Registration System (SRS)** data around **2012-2013**, India's **Infant Mortality Rate (IMR)** was reported as **34 deaths per 1,000 live births**. - This represents the number of infant deaths (before completing one year of age) per 1,000 live births in a given year. - This was the approximate national average used for the NEET-2013 examination period. *25* - This figure represents a lower IMR than the national average for India during 2012-2013. - While some progressive states like Kerala had achieved IMR closer to this figure, it was not the overall national rate at that time. *55* - This figure is higher than the reported national IMR for India in 2012-2013. - India's IMR had already declined below this level due to improved maternal and child health programs under NRHM (National Rural Health Mission). *60* - This value represents a historical estimate from earlier years (pre-2010). - By 2012-2013, India had made significant progress in reducing infant mortality from these higher historical levels through better healthcare access and immunization coverage.
Pharmacology
8 questionsIn which of the following conditions is Verapamil not typically used?
Drug of choice for familial hypercholesterolemia?
Which of the following is a renin inhibitor?
Nesiritide causes vasodilation through?
Which of the following is a parenteral direct thrombin inhibitor?
Which of the following drugs inhibits the activation of plasminogen?
Which of the following is NOT a side effect of digitalis?
What is Hydroxyethyl starch?
NEET-PG 2013 - Pharmacology NEET-PG Practice Questions and MCQs
Question 521: In which of the following conditions is Verapamil not typically used?
- A. Angina pectoris
- B. Atrial fibrillation
- C. Ventricular tachycardia (Correct Answer)
- D. Hypertension
Explanation: ***Ventricular tachycardia*** - Verapamil, a **non-dihydropyridine calcium channel blocker**, can worsen hemodynamics in patients with **ventricular tachycardia (VT)** by causing profound hypotension or precipitating cardiac arrest. - VT often requires prompt treatment with **antiarrhythmics like amiodarone** or **electrical cardioversion**, as it can be life-threatening. - Verapamil is **contraindicated in VT** due to its negative inotropic effects and risk of hemodynamic collapse. *Angina pectoris* - Verapamil is effectively used to treat angina pectoris by **decreasing myocardial oxygen demand** through negative chronotropic and inotropic effects, and by causing **coronary vasodilation**, improving blood flow. - Its effects help to reduce the frequency and severity of anginal episodes, particularly in **stable angina**. *Atrial fibrillation* - Verapamil is commonly used for **rate control in atrial fibrillation** by **slowing conduction through the AV node**, which decreases the ventricular response rate. - It helps to manage symptoms and prevent complications related to rapid heart rates in this arrhythmia. *Hypertension* - Verapamil is used in the treatment of **hypertension** through its vasodilatory effects and reduction in peripheral vascular resistance. - It is particularly useful in patients who cannot tolerate other antihypertensive agents or as part of combination therapy.
Question 522: Drug of choice for familial hypercholesterolemia?
- A. Nicotinic acid
- B. Lovastatin (Correct Answer)
- C. Cholestyramine
- D. Gemfibrozil
Explanation: ***Lovastatin*** - **Statins** (HMG-CoA reductase inhibitors) are the **first-line therapy** for familial hypercholesterolemia as they effectively lower **LDL cholesterol** levels by inhibiting cholesterol synthesis [1]. - While other agents can be used adjunctively, statins like lovastatin are the cornerstone for managing this genetic condition [2]. *Nicotinic acid* - **Nicotinic acid** (niacin) primarily lowers **triglycerides** and increases **HDL cholesterol**, but it is less potent than statins for reducing LDL-C, especially in familial hypercholesterolemia [1]. - Its use is often limited by significant **side effects** like flushing. *Cholestyramine* - **Cholestyramine** is a **bile acid sequestrant** that binds to bile acids in the intestine, preventing their reabsorption and mildly lowering LDL cholesterol. - It is less effective than statins and often causes **gastrointestinal side effects** such as constipation and bloating. *Gemfibrozil* - **Gemfibrozil** is a **fibrate**, primarily used to lower **triglyceride levels** and increase HDL cholesterol. - It has minimal impact on LDL cholesterol compared to statins and is not the primary treatment for familial hypercholesterolemia [2].
Question 523: Which of the following is a renin inhibitor?
- A. Losartan
- B. Benazepril
- C. Remikiren (Correct Answer)
- D. Imidapril
Explanation: **Remikiren** - **Remikiren** is a direct **renin inhibitor** that acts by binding to the active site of renin, preventing its interaction with angiotensinogen. - This inhibition reduces the formation of **angiotensin I** and subsequently **angiotensin II**, leading to decreased blood pressure. *Losartan* - **Losartan** is an **Angiotensin II Receptor Blocker (ARB)**, meaning it blocks AT1 receptors, preventing angiotensin II from binding. - It does not inhibit renin activity directly but rather acts downstream in the **renin-angiotensin-aldosterone system (RAAS)**. *Benazepril* - **Benazepril** is an **Angiotensin-Converting Enzyme (ACE) inhibitor**, which blocks the enzyme responsible for converting **angiotensin I** to **angiotensin II**. - It does not directly inhibit renin production or activity. *Imidapril* - **Imidapril** is also an **Angiotensin-Converting Enzyme (ACE) inhibitor**, similar to benazepril. - Its mechanism of action involves inhibiting ACE, thereby reducing **angiotensin II** levels, rather than directly inhibiting renin.
Question 524: Nesiritide causes vasodilation through?
- A. ATP
- B. Cyclic adenosine monophosphate (cAMP)
- C. K+ ions
- D. Guanosine 3',5'-cyclic monophosphate (cGMP) (Correct Answer)
Explanation: ***Guanosine 3',5'-cyclic monophosphate (cGMP)*** - **Nesiritide** is a synthetic **B-type natriuretic peptide (BNP)** that acts as a potent vasodilator [2]. - It works by binding to **guanylyl cyclase receptors**, leading to an increase in intracellular **cGMP**, which promotes smooth muscle relaxation [1], [2]. *Cyclic adenosine monophosphate (cAMP)* - While **cAMP** is a crucial second messenger in various cellular processes and can mediate some forms of vasodilation, it is primarily associated with **beta-adrenergic receptor activation**, not the mechanism of action of nesiritide. - Nesiritide's pathway is distinct from those involving **cAMP-mediated** relaxation, which often involves different kinases and protein phosphorylation. *ATP* - **ATP** (adenosine triphosphate) is the primary **energy currency** of the cell and is involved in numerous cellular functions, including muscle contraction and relaxation, but it is not a direct mediator of nesiritide's vasodilatory effects. - Though ATP can be broken down to produce **adenosine**, which has vasodilatory properties, this is not the specific mechanism through which nesiritide causes vasodilation. *K+ ions* - Changes in **potassium ion (K+)** flux across cell membranes are essential for regulating vascular tone, as K+ channel activation can lead to hyperpolarization and relaxation of smooth muscle. - However, **nesiritide's primary mechanism** of action does not involve direct modulation of K+ channels; its vasodilatory effects are mediated by the **cGMP pathway** [2].
Question 525: Which of the following is a parenteral direct thrombin inhibitor?
- A. Ximelagatran
- B. Dabigatran
- C. Argatroban (Correct Answer)
- D. Heparin
Explanation: ***Argatroban*** - **Argatroban** is a **synthetic direct thrombin inhibitor** administered exclusively via **intravenous infusion**, making it a parenteral drug. - It does not require antithrombin for its action and is primarily used in patients with **heparin-induced thrombocytopenia (HIT)**. *Ximelagatran* - **Ximelagatran** was an **oral direct thrombin inhibitor** but was withdrawn from the market due to concerns about severe **liver toxicity**. - As an oral drug, it is not a parenteral medication. *Dabigatran* - **Dabigatran** is a **direct thrombin inhibitor** that is administered **orally** in capsule form (as dabigatran etexilate, a prodrug). - Therefore, it is not a parenteral medication. *Heparin* - **Heparin** is an **indirect thrombin inhibitor** because it requires binding to **antithrombin** to exert its anticoagulant effect. - Although administered parenterally, its mechanism of action is indirect.
Question 526: Which of the following drugs inhibits the activation of plasminogen?
- A. Streptokinase
- B. Aminocaproic acid (Correct Answer)
- C. Reteplase
- D. Clopidogrel
Explanation: ***Correct Option: Aminocaproic acid*** - **Aminocaproic acid** is an antifibrinolytic drug that acts by competitively inhibiting the activation of **plasminogen** to plasmin. - By preventing the formation of plasmin, it stabilizes blood clots and is used to treat excessive bleeding. *Incorrect Option: Streptokinase* - **Streptokinase** is a **thrombolytic agent** that forms a complex with plasminogen, converting uncomplexed plasminogen into plasmin. - This action promotes the degradation of fibrin clots, making it a **fibrinolytic drug**, not an inhibitor of plasminogen activation. *Incorrect Option: Reteplase* - **Reteplase** is a **recombinant tissue plasminogen activator (tPA)** that directly converts plasminogen to plasmin. - This drug actively promotes **fibrinolysis** and clot breakdown, making it a thrombolytic agent. *Incorrect Option: Clopidogrel* - **Clopidogrel** is an **antiplatelet drug** that inhibits platelet aggregation by irreversibly blocking the P2Y12 adenosine diphosphate (ADP) receptor on platelets. - Its mechanism of action is focused on **platelet function**, not on the plasminogen-plasmin system.
Question 527: Which of the following is NOT a side effect of digitalis?
- A. Nausea and vomiting
- B. Ventricular Bigeminy
- C. Vasodilatation (Correct Answer)
- D. Ventricular tachycardia
Explanation: **Vasodilatation** - **Digitalis**, primarily digoxin, is known for its **positive inotropic effect**, increasing myocardial contractility, and for its **vasoconstrictive properties** at higher doses due to sympathetic activation and direct smooth muscle effects, not vasodilatation. - While it can indirectly improve cardiac output and thus tissue perfusion, its direct vascular effects do not typically include widespread vasodilatation. *Ventricular tachycardia* - **Digitalis toxicity** can lead to various arrhythmias, including **ventricular tachycardia**, which is a potentially life-threatening side effect. - This occurs due to increased automaticity and delayed afterdepolarizations in ventricular myocytes. *Nausea and vomiting* - **Gastrointestinal symptoms** such as **nausea and vomiting** are common early signs of digitalis toxicity. - These effects are thought to be mediated by the drug's action on the chemoreceptor trigger zone in the brainstem. *Ventricular Bigeminy* - **Ventricular bigeminy**, characterized by alternating normal and premature ventricular beats, is another classic manifestation of **digitalis toxicity**. - This arrhythmia results from enhanced automaticity and altered conduction properties in the ventricles.
Question 528: What is Hydroxyethyl starch?
- A. Vasodilator
- B. Inotrope
- C. Plasma expander (Correct Answer)
- D. Diuretic
Explanation: ***Plasma expander*** - **Hydroxyethyl starch** is a **colloid solution** used intravenously to increase plasma volume and maintain oncotic pressure. - It is often used in situations of **hypovolemia** or shock to support circulation. *Vasodilator* - A **vasodilator** is a medication that widens blood vessels, typically used to lower blood pressure or improve blood flow. - Hydroxyethyl starch does not directly cause **vasodilation** as its primary mechanism of action. *Inotrope* - An **inotrope** is an agent that alters the force or energy of muscular contractions, mainly affecting the heart's contractility. - Hydroxyethyl starch has no direct effect on **myocardial contractility**. *Diuretic* - A **diuretic** is a substance that promotes increased production of urine, thereby increasing the excretion of water from the body. - While fluid administration can temporarily increase urine output, hydroxyethyl starch is not classified as a **diuretic agent** itself.