NEET-PG 2015 Practice Questions

Q: All of the following drugs increase the risk of postoperative nausea and vomiting after squint surgery in children except?

Propofol. ***Propofol*** - Propofol is known to have **antiemetic properties** and is often used to reduce the incidence of postoperative nausea and vomiting (PONV). - Its mechanism involves modulating **GABA-A receptors** and potentially other pathways that suppress emetic responses. *Halothane* - **Inhalational anesthetics** like halothane are a significant risk factor for PONV, particularly in children and following surgeries like squint repair. - They tend to increase PONV by directly stimulating the **chemoreceptor trigger zone** and altering gut motility. *Opioids* - Opioids, commonly used for postoperative pain control, are a well-known cause of **nausea and vomiting**. - They activate **opioid receptors** in the chemoreceptor trigger zone and the gastrointestinal tract, leading to emesis and delayed gastric emptying. *Nitrous Oxide* - The use of **nitrous oxide** as part of a general anesthetic regimen has been consistently associated with an increased risk of PONV. - It is believed to contribute to PONV by increasing the risk of **bowel distension** and stimulating neurotransmitter release involved in emesis.

Q: Which of the following is the common cause of respiratory failure type 2 ?

Chronic bronchitis exacerbation. ***Chronic bronchitis exacerbation*** - **Chronic bronchitis** is a common cause of **Type 2 respiratory failure**, characterized by **hypercapnia** (elevated CO2) due to impaired alveolar ventilation [1]. - An exacerbation worsens **airflow obstruction** and leads to increased work of breathing and CO2 retention [1]. *Acute attack asthma* - While severe asthma can cause respiratory failure, it typically presents initially as **Type 1 (hypoxemic)**, with severe bronchospasm and V/Q mismatch [2]. - **Hypercapnia** in asthma is a sign of **severe, impending respiratory collapse** rather than the primary cause of respiratory failure. *ARDS* - **Acute Respiratory Distress Syndrome (ARDS)** is a classic cause of **Type 1 (hypoxemic) respiratory failure**, characterized by widespread inflammation and fluid accumulation in the lungs [2]. - ARDS primarily involves impaired oxygenation rather than CO2 elimination issues, unless it progresses to severe stages with significant muscle fatigue. *Pneumonia* - **Pneumonia** predominantly causes **Type 1 (hypoxemic) respiratory failure** due to consolidation and V/Q mismatch in affected lung areas, leading to impaired oxygen diffusion [2]. - While severe, widespread pneumonia can eventually lead to ventilatory failure, its initial and primary impact is on oxygenation.

Q: Aspirin sensitive asthma is associated with:

Associated with nasal polyp. **Associated with nasal polyp** - **Aspirin-exacerbated respiratory disease (AERD)**, also known as aspirin-sensitive asthma, is characterized by a triad of **asthma**, **rhinosinusitis with nasal polyposis**, and respiratory reactions to **aspirin** and other NSAIDs [1]. - The presence of **nasal polyps** is a key clinical feature differentiating AERD from other forms of asthma [1]. *Obesity* - While **obesity** can exacerbate asthma severity, it is not specifically associated with the pathogenesis or diagnosis of **aspirin-sensitive asthma**. - It is a general risk factor for various health issues, including more severe asthma, but lacks specificity for AERD. *Extrinsic asthma* - **Extrinsic asthma** (allergic asthma) is typically triggered by environmental allergens and involves an **IgE-mediated response** [2]. - AERD is considered a **non-allergic** or **intrinsic asthma** phenotype, as it is not triggered by traditional allergens but by pharmacologic agents [1]. *Usually associated with urticaria* - **Urticaria** (hives) can be a feature of aspirin and NSAID sensitivity, particularly in some forms of **NSAID-induced urticaria/angioedema**. - However, the classic respiratory reactions of **aspirin-sensitive asthma** (bronchospasm, rhinitis) are distinct from urticarial reactions and typically do not present with primary urticaria.

Q: Which of the following is seen in sarcoidosis

Increased calcium levels in the blood (Hypercalcemia). ***Increased calcium levels in the blood (Hypercalcemia)*** - In sarcoidosis, activated macrophages in granulomas produce **1-alpha hydroxylase**, which converts **25-hydroxyvitamin D to 1,25-dihydroxyvitamin D (calcitriol)** [1]. - This increased calcitriol leads to enhanced intestinal **calcium absorption** and occasional bone resorption, resulting in **hypercalcemia** [1]. *Decreased calcium levels in the blood (Hypocalcemia)* - **Hypocalcemia** is not characteristic of sarcoidosis; the disease typically involves dysregulated vitamin D metabolism causing elevated, not decreased, calcium [1]. - Conditions like **hypoparathyroidism** or **vitamin D deficiency** (unrelated to the sarcoidosis pathogenesis) would cause hypocalcemia. *Increased phosphate levels in the blood (Hyperphosphatemia)* - **Hyperphosphatemia** is not a feature of sarcoidosis. Calcium and phosphate levels often have an inverse relationship, so with hypercalcemia, phosphate levels tend to be normal or slightly decreased due to suppression of parathyroid hormone. - Hyperphosphatemia is more commonly associated with **renal failure** or certain **endocrine disorders**. *Decreased phosphate levels in the blood (Hypophosphatemia)* - While **hypophosphatemia** can occur in conditions with high vitamin D activity (as increased active vitamin D can promote renal phosphate excretion), it is not the primary or most notable electrolyte disturbance specifically linked to sarcoidosis. - **Hypercalcemia** is the more consistently observed electrolyte abnormality in sarcoidosis related to ectopic vitamin D production [1].

Q: Parasitosis of extraocular eye muscles is seen in?

Trichinella infection. ***Trichinella infection*** - **Trichinellosis** (caused by *Trichinella spiralis*) commonly involves the **extraocular muscles** during the muscle encystment phase [1]. - Ocular symptoms like **periorbital edema**, eosinophilic myositis of extraocular muscles, and subconjunctival hemorrhage are characteristic [1]. *Cysticercus infection* - **Cysticercosis**, caused by *Taenia solium* larvae, can affect the eye, predominantly forming **subretinal** or **vitreous cysts** [2]. - While it can involve orbital muscles, involvement of extraocular muscles is less typical and less specific than in trichinellosis [2]. *Amoebic infection* - **Amoebic infections** primarily cause **keratitis** (e.g., *Acanthamoeba*) [3] or can lead to granulomatous encephalitis in immunocompromised individuals. - They do not typically cause direct parasitosis of the extraocular muscles. *Ascariasis infection* - **Ascariasis**, caused by *Ascaris lumbricoides*, is an intestinal nematode and is not known to infect the extraocular muscles. - Ocular manifestations are rare and usually involve migration of adult worms to the orbit or eyelid, not muscle encystment. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 404-405. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 403-404. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 735-736.

Q: In which of the following conditions does Berlin's edema occur?

After concussional trauma. ***After concussional trauma*** - **Berlin's edema**, also known as **commotio retinae**, is a form of **retinal edema** that occurs following **blunt trauma** to the eye. - It results from the disruption of the **photoreceptor outer segments** and retinal pigment epithelium, leading to a **dull, gray-white appearance** of the retina. *Open angle glaucoma* - Characterized by **progressive optic nerve damage** and visual field loss, typically due to elevated intraocular pressure, without retinal edema. - The primary pathology involves the **trabecular meshwork**, not direct retinal swelling. *After cataract surgery* - A common complication is **cystoid macular edema** (Irvine-Gass syndrome), which affects the macula and can cause blurred vision. - This is distinct from Berlin's edema, as it is a **post-surgical inflammatory response**, not a direct traumatic injury. *Diabetic retinopathy* - Involves various retinal changes due to diabetes, such as **microaneurysms**, hemorrhages, and **macular edema** from leaky vessels. - It is a **metabolic and vascular disease**, not a direct consequence of acute ocular trauma.

Q: All of the following are complications of traumatic hyphema except which of the following?

Corneal Ulcer. ***Corneal Ulcer*** - A **corneal ulcer** is typically caused by infection, trauma, or exposure keratitis and is not a direct complication of blood in the anterior chamber from a **traumatic hyphema**. - While prolonged elevation of **intraocular pressure** from hyphema could theoretically impair corneal health, a direct ulcer is not a typical or primary complication. *Rebleeding* - **Rebleeding** is a common and serious complication of hyphema, usually occurring 2-7 days after the initial injury. - It often results in a more significant bleed and carries a higher risk of complications such as **elevated intraocular pressure** and **blood staining of the cornea**. *Pupillary Block* - **Pupillary block** can occur if the amount of blood from the hyphema prevents the flow of aqueous humor from the posterior to the anterior chamber. - This blockage leads to a buildup of **aqueous humor** in the posterior chamber, causing the iris to bow forward and potentially precipitating **acute angle-closure glaucoma**. *Posterior synechiae* - **Posterior synechiae** can develop due to inflammation (uveitis) associated with the hyphema, where the iris adheres to the anterior lens capsule. - This complication can lead to **irregular pupil shape**, **pupillary block glaucoma**, or other visual disturbances.

Q: What is the most common eye lesion in HIV?

Cotton wool spots. ***Cotton wool spots*** - These are the most common ocular manifestation in HIV-positive individuals, resulting from **ischemic retinal nerve fiber layer damage**. - While not vision-threatening themselves, their presence indicates **microvascular damage** and can be a sign of systemic disease progression. *Kaposi Sarcoma of Lid* - While Kaposi sarcoma can affect the eyelids in HIV patients, it is **not the most common ocular lesion**. - It presents as a **reddish-purple nodule** or plaque and is an indicator of advanced immunosuppression. *CMV Retinitis* - Cytomegalovirus (CMV) retinitis is a significant and **vision-threatening opportunistic infection** in advanced HIV. - However, it occurs in patients with **severe immunosuppression** (low CD4 counts) and is less common overall than cotton wool spots. *Choroiditis* - Choroiditis, an inflammation of the choroid, can occur in HIV patients due to various opportunistic infections or directly from the virus. - It is **less prevalent** than cotton wool spots and typically requires specific etiologies beyond HIV itself.

Q: Which optical instrument utilizes the principle of total internal reflection?

Gonioscope. ***Gonioscope*** - A **gonioscope** uses mirrors or prisms to allow visualization of the **anterior chamber angle**, leveraging **total internal reflection** to bypass the normal optical limitations of the cornea. - The principle of total internal reflection occurs when light traveling from a denser medium (like the prism/mirror in the gonioscope) hits an interface with a less dense medium (like air or the aqueous humor) at an angle greater than the **critical angle**, causing all light to reflect back. *Pachymeter* - A **pachymeter** is used to measure the **thickness of the cornea**, typically employing ultrasound or optical methods. - It does not rely on total internal reflection but rather on the time-of-flight of sound waves or the reflection/scattering of light from corneal layers. *Ophthalmoscope* - An **ophthalmoscope** is used to examine the posterior segment of the eye, including the **fundus**, optic disc, and retina. - It works by directing a light source into the eye and viewing the reflected light, using lenses to focus the image, without utilizing total internal reflection. *Lensometer* - A **lensometer** (or focimeter) is an optician's instrument used to measure the prescription of eyeglasses or contact lenses, including **sphere, cylinder, and axis**. - Its operation is based on standard lens optics and does not involve the principle of total internal reflection.

Q: Which of the following is NOT a feature of CHARGE syndrome?

Esophageal Atresia. ***Esophageal Atresia*** - While other **tracheoesophageal abnormalities** can occur in CHARGE syndrome, **esophageal atresia** is not typically considered one of the core diagnostic criteria. - The acronym CHARGE stands for a specific set of features, and esophageal atresia is not directly included, unlike **choanal atresia**. *Eye Coloboma* - **Coloboma** of the eye, particularly the iris or retina, is a **major diagnostic feature** of CHARGE syndrome. - This congenital malformation results from incomplete closure of the **choroid fissure** during development. *Congenital heart disease* - Various types of **congenital heart defects**, such as **tetralogy of Fallot** or an **atresia of the aortic valve**, are common in CHARGE syndrome. - These cardiac anomalies are a **major diagnostic criterion** and significantly impact patient management. *Choanal Atresia* - **Choanal atresia** represents the "A" in the CHARGE acronym and is a **major diagnostic criterion**. - This condition involves blockage of the nasal passages and is one of the most characteristic features of the syndrome. *Urinary tract defects* - **Genital and urinary abnormalities** are frequently observed in individuals with CHARGE syndrome. - These can include **hypoplastic genitalia** and **kidney abnormalities**, classifying as a **minor diagnostic feature**.

Question 1

All of the following drugs increase the risk of postoperative nausea and vomiting after squint surgery in children except?

Accepted Answer

Propofol

Answer

Halothane

Answer

Nitrous Oxide

Answer

Opioids

Question 2

Which of the following is the common cause of respiratory failure type 2 ?

Accepted Answer

Chronic bronchitis exacerbation

Answer

Acute attack asthma

Answer

ARDS

Answer

Pneumonia

Question 3

Aspirin sensitive asthma is associated with:

Accepted Answer

Associated with nasal polyp

Answer

Extrinsic asthma

Answer

Obesity

Answer

Usually associated with urticaria

Question 4

Which of the following is seen in sarcoidosis

Accepted Answer

Increased calcium levels in the blood (Hypercalcemia)

Answer

Decreased calcium levels in the blood (Hypocalcemia)

Answer

Increased phosphate levels in the blood (Hyperphosphatemia)

Answer

Decreased phosphate levels in the blood (Hypophosphatemia)

Question 5

Parasitosis of extraocular eye muscles is seen in?

Accepted Answer

Trichinella infection

Answer

Cysticercus infection

Answer

Amoebic infection

Answer

Ascariasis infection

Question 6

In which of the following conditions does Berlin's edema occur?

Accepted Answer

After concussional trauma

Answer

Open angle glaucoma

Answer

After cataract surgery

Answer

Diabetic retinopathy

Question 7

All of the following are complications of traumatic hyphema except which of the following?

Accepted Answer

Corneal Ulcer

Answer

Pupillary Block

Answer

Posterior synechiae

Answer

Rebleeding

Question 8

What is the most common eye lesion in HIV?

Accepted Answer

Cotton wool spots

Answer

Kaposi Sarcoma of Lid

Answer

CMV Retinitis

Answer

Choroiditis

Question 9

Which optical instrument utilizes the principle of total internal reflection?

Accepted Answer

Gonioscope

Answer

Pachymeter

Answer

Ophthalmoscope

Answer

Lensometer

Question 10

Which of the following is NOT a feature of CHARGE syndrome?

Accepted Answer

Esophageal Atresia

Answer

Congenital heart disease

Answer

Urinary tract defects

Answer

Eye Coloboma

Answer

Choanal Atresia

NEET-PG 2015

Anesthesiology

Internal Medicine

Microbiology

Ophthalmology

Psychiatry