NEET-PG 2019 Practice Questions

Q: Patient with ascending paralysis, areflexia and sphincter sparing is seen in?

G.B.S. **G.B.S** - **Guillain-Barré Syndrome (GBS)** is characterized by **ascending paralysis** and **areflexia**, meaning loss of deep tendon reflexes [1]. - **Sphincter sparing** is also typical in GBS, differentiating it from other causes of paralysis where autonomic involvement can lead to bladder and bowel dysfunction [1]. *Botulism* - Botulism typically presents with **descending paralysis**, weakness starting in the cranial nerves and progressing downwards. - While it causes significant muscle weakness and can lead to **areflexia**, the pattern of paralysis (descending vs. ascending) and the presence of prominent cranial nerve involvement help distinguish it. *Snake bite* - Neurotoxic snake bites can cause **flaccid paralysis** and **areflexia**, but the paralysis often starts at the site of the bite or affects cranial nerves preferentially before generalized ascending paralysis. - The history of a **snake bite** and presence of **local envenomation signs** (swelling, pain) would also be prominent. *Polio* - Polio primarily causes **asymmetric flaccid paralysis** and **areflexia**, due to the destruction of anterior horn cells in the spinal cord. - Unlike GBS, polio does not typically present with an ascending pattern affecting both sides symmetrically and often involves sensory sparing.

Q: Not an AIDS defining illness?

Tertiary Syphilis. ***Tertiary Syphilis*** - While a serious late-stage manifestation of **syphilis**, it is not specifically listed as an **AIDS-defining illness** by the CDC, although HIV-positive individuals may be more susceptible to its complications [1]. - **Neurosyphilis**, a form of tertiary syphilis affecting the central nervous system, is also not an AIDS-defining condition on its own, unlike some other opportunistic infections [1]. *Progressive multifocal leukoencephalopathy (PML)* - PML, caused by the **JC virus**, is an **AIDS-defining illness** characterized by the progressive destruction of myelin in the brain, leading to severe neurological deficits. - It occurs almost exclusively in individuals with severe **immunodeficiency**, such as those with untreated HIV infection. *Lymphoma of brain < 60 years of age* - **Primary central nervous system (CNS) lymphoma** in individuals with HIV, especially those under 60 years of age, is an **AIDS-defining condition** [2]. - Its occurrence is strongly linked to severe immunosuppression in HIV-infected patients [2]. *Extrapulmonary Cryptococcosis* - **Cryptococcosis**, when it affects sites outside the lungs (e.g., **cryptococcal meningitis**), is an **AIDS-defining illness**. - This fungal infection is a common opportunistic infection in individuals with advanced HIV disease.

Q: Which of the following is not an AIDS defining illness?

Hodgkin's lymphoma. ***Hodgkin's lymphoma*** - While patients with HIV are at an increased risk of developing **Hodgkin's lymphoma**, it is not officially classified as an **AIDS-defining illness** by the CDC [3]. - AIDS-defining conditions primarily include certain opportunistic infections and specific malignancies [4]. *Cervical cancer* - **Invasive cervical cancer** is an AIDS-defining illness in HIV-positive women, indicating severe immunosuppression [4]. - This is because HIV infection can accelerate or worsen the progression of **HPV-related cervical dysplasia** to invasive cancer [4]. *Primary CNS lymphoma* - **Primary CNS lymphoma** (brain lymphoma) is an AIDS-defining illness, particularly when associated with **Epstein-Barr virus** [2]. - Its presence indicates a significant degree of **immunodeficiency** in HIV-infected individuals. *Kaposi sarcoma* - **Kaposi sarcoma** is a well-known and common AIDS-defining malignancy, caused by **Human Herpesvirus 8 (HHV-8)** [1]. - It presents as vascular lesions on the skin, mucous membranes, internal organs, and lymph nodes [1].

Q: A lady primigravida developed fluctuant painful mass of breast and fever after 14 days of delivery. Preferred treatment option is:-

Incision and drainage. ***Incision and drainage*** - A **fluctuant, painful mass** in the breast combined with **fever** 14 days postpartum strongly indicates a **breast abscess**, which requires surgical drainage as the definitive treatment. - **I&D removes the pus collection** and is the preferred treatment for an established abscess, usually combined with **appropriate antibiotics** (though the primary intervention is drainage). - After drainage, breastfeeding can typically be **continued from the unaffected breast** while the affected side heals. *Analgesics and continue breast feeding* - While analgesics can relieve pain and continuing breastfeeding is appropriate for **simple mastitis**, these measures are **insufficient for an established abscess** with a fluctuant collection. - An abscess requires drainage; conservative management alone will not resolve a loculated pus collection. *Antipyretic* - An antipyretic will help reduce the **fever symptomatically**, but it does not address the underlying **purulent collection or infection**. - It would only mask symptoms without treating the cause, potentially delaying appropriate surgical intervention. *Stop lactation* - Stopping lactation abruptly can lead to **breast engorgement** and may worsen milk stasis, potentially complicating the infection. - While temporary cessation from the affected breast during acute infection might be considered, outright stopping lactation is **not the preferred primary treatment** for an abscess and may interfere with recovery.

Q: Caspase involved in activation of IL-1 is which of the following?

Caspase 1. ***Caspase 1*** - **Caspase 1** (also known as interleukin-1 beta converting enzyme or ICE) is the primary caspase responsible for the proteolytic cleavage and activation of pro-IL-1β and pro-IL-18 into their mature, active forms. - This activation occurs within the **inflammasome complex**, a multiprotein oligomer that assembles in response to various pathogens and danger signals. *Caspase 5* - While **Caspase 5** is an inflammatory caspase, similar to Caspase 1, it primarily functions in the direct activation of pro-IL-1β in certain contexts, particularly in response to *Gram-negative bacteria* through the non-canonical inflammasome. - However, **Caspase 1** is the canonical and most well-known activator of IL-1 in the classical inflammasome pathway. *Caspase 8* - **Caspase 8** is a key **initiator caspase** in the extrinsic pathway of apoptosis, activated by death receptors like Fas and TNF receptors. - Its primary role is in **apoptotic signaling** and it is not directly involved in the proteolytic activation of IL-1. *Caspase 3* - **Caspase 3** is a major **effector caspase** in both the intrinsic and extrinsic pathways of apoptosis. - It executes apoptosis by cleaving numerous cellular substrates and is not directly involved in the **processing of cytokines** like IL-1.

Q: Congenital Rubella Syndrome includes all except

Intracerebral hemorrhage. ***Intracerebral hemorrhage*** - This is not a typical manifestation of **Congenital Rubella Syndrome** (CRS). Symptoms of CRS primarily include sensory, cardiac, and ocular defects, not bleeding into the brain. *SN deafness* - **Sensorineural (SN) deafness** is a very common and characteristic symptom of **Congenital Rubella Syndrome**, often bilateral, due to damage to the organ of Corti. - It is one of the classic triad of manifestations of CRS. *Cataract* - **Cataracts** (clouding of the lens) are a prominent ocular defect in CRS, often leading to significant vision impairment or blindness. - Ocular defects like cataracts and **microphthalmia** are part of the classic clinical picture. *VSD* - **Ventricular Septal Defect (VSD)** is a common cardiac anomaly seen in CRS, caused by rubella virus infection during heart development. - Other common cardiac defects include **Patent Ductus Arteriosus (PDA)** and **Pulmonary Artery Stenosis**.

Q: Which of the following is a contraindication to the use of Beta Blockers:

Severe asthma with bronchospasm. ***Severe asthma with bronchospasm*** - Beta-blockers, especially **non-selective ones**, can block beta-2 receptors in the lungs, leading to **bronchoconstriction** and worsening asthma symptoms. - This can precipitate a severe **asthma attack** and respiratory distress, making it an **absolute contraindication**. - Even cardioselective beta-blockers should be avoided in severe asthma. *Thyroid storm* - Beta-blockers are often used in **thyroid storm** to manage hyperadrenergic symptoms like **tachycardia** and **tremors**. - Propranolol also has the added benefit of inhibiting peripheral conversion of T4 to T3. - They are not contraindicated but rather an important part of treatment. *Glaucoma* - Topical beta-blockers (e.g., timolol) are commonly used to treat **glaucoma** by **reducing aqueous humor production**, thereby lowering intraocular pressure. - Oral beta-blockers also have this effect and are not contraindicated in glaucoma. *AV nodal reentrant tachycardia (AVNRT)* - Beta-blockers are frequently used in the management of **AVNRT** by slowing AV nodal conduction. - They are effective in both acute termination and prophylaxis of AVNRT episodes. - **Note:** Beta-blockers ARE contraindicated in **atrial fibrillation with Wolff-Parkinson-White syndrome** (pre-excited AF), as blocking the AV node can preferentially conduct through the accessory pathway, potentially causing ventricular fibrillation.

Q: Reason for preferring Cisatracurium over Atracurium is:-

Lesser provocation of histamine release. ***Lesser provocation of histamine release*** - **Cisatracurium** is preferred over atracurium primarily due to its significantly **lower potential to induce histamine release**, leading to fewer cardiovascular side effects like hypotension and tachycardia. - This property makes cisatracurium a **safer option** for patients prone to hemodynamic instability or allergic reactions. *Faster acting than Atracurium* - Both atracurium and cisatracurium are **intermediate-acting** neuromuscular blockers, and their onset times are quite similar, with cisatracurium sometimes having a slightly *slower* onset. - The difference in onset time is **not clinically significant** enough to be a primary reason for preference. *Shorter action than Atracurium* - **Cisatracurium** has a slightly **longer duration of action** compared to atracurium, although both are considered intermediate-acting drugs. - Therefore, a shorter duration of action is **not a reason for its preference**; instead, it might even be a slight disadvantage in certain clinical scenarios requiring rapid reversal. *Does not undergo Hoffman elimination* - Both atracurium and cisatracurium undergo **Hoffman elimination** (non-enzymatic degradation) and ester hydrolysis, which allows for their use in patients with renal or hepatic dysfunction. - This is a shared characteristic, not a distinguishing factor that makes cisatracurium superior, and cisatracurium actually relies *more* heavily on Hoffman elimination.

Q: Which of the following drugs is used for smoking cessation?

Varenicline. ***Varenicline*** - **Varenicline** is a **partial agonist** at the **α4β2 nicotinic acetylcholine receptor**, reducing cravings and withdrawal symptoms while decreasing the rewarding effects of nicotine [2]. - It is a first-line pharmacotherapy for **smoking cessation**, often initiated a week before the target quit date. *Gabapentin* - **Gabapentin** is primarily an **anticonvulsant** and is also used to treat **neuropathic pain**. - It is not indicated for **smoking cessation** and acts by modulating **GABAergic neurotransmission**, unrelated to nicotine dependence. *Acamprosate* - **Acamprosate** is used to maintain **abstinence from alcohol** in patients with alcohol dependence. - Its mechanism involves restoring the balance between **excitation and inhibition** in the brain, which is not directly applicable to nicotine dependence. *Nalmefene* - **Nalmefene** is an **opioid system modulator** used for reducing **alcohol consumption** in adults with alcohol dependence [1]. - It acts as an **opioid receptor antagonist**, a mechanism distinct from the neurotransmitter systems involved in nicotine addiction [1].

Q: Most commonly used approach for retrosternal goitre:-

Transcervical. ***Transcervical*** - The transcervical approach is the **most common and preferred method** for resecting retrosternal goitres, as the majority can be delivered through the **thoracic inlet**. - This approach minimizes morbidity and avoids the need for a **sternotomy** in most cases. *Transthoracic second intercostal space* - This approach is typically reserved for **mediastinal masses** or procedures requiring direct access to the **pleural cavity**, which is generally not necessary for retrosternal goitres. - It would involve a more invasive incision than typically required for a goitre that can be delivered transcervically. *Axillary approach* - The axillary approach is primarily used for **lymph node dissection** in breast cancer or for certain **thoracoscopic procedures**, not for accessing the thyroid gland for retrosternal goitre removal. - Its anatomical location does not provide adequate exposure to the **cervical and mediastinal structures** involved in a retrosternal goitre. *Trans-sternal through anterior mediastinum* - A trans-sternal approach (sternotomy) is a **major surgical procedure** typically reserved for very large, irreducible retrosternal goitres that have significant **mediastinal extension** or are adherent to surrounding structures. - It is avoided whenever possible due to increased morbidity and longer recovery compared to the transcervical approach, making it less commonly used overall.

Question 1

Patient with ascending paralysis, areflexia and sphincter sparing is seen in?

Accepted Answer

G.B.S

Answer

Botulinism

Answer

Snake bite

Answer

Polio

Question 2

Not an AIDS defining illness?

Accepted Answer

Tertiary Syphilis

Answer

Progressive multifocal leukoencephalopathy

Answer

Lymphoma of brain < 60 years of age

Answer

Extrapulmonary Cryptococcosis

Question 3

Which of the following is not an AIDS defining illness?

Accepted Answer

Hodgkin's lymphoma

Answer

Cervical cancer

Answer

Primary CNS lymphoma

Answer

Kaposi sarcoma

Question 4

A lady primigravida developed fluctuant painful mass of breast and fever after 14 days of delivery. Preferred treatment option is:-

Accepted Answer

Incision and drainage

Answer

Analgesics and continue breast feeding

Answer

Antipyretic

Answer

Stop lactation

Question 5

Caspase involved in activation of IL-1 is which of the following?

Accepted Answer

Caspase 1

Answer

Caspase 5

Answer

Caspase 8

Answer

Caspase 3

Question 6

Congenital Rubella Syndrome includes all except

Accepted Answer

Intracerebral hemorrhage

Answer

SN deafness

Answer

Cataract

Answer

VSD

Question 7

Which of the following is a contraindication to the use of Beta Blockers:

Accepted Answer

Severe asthma with bronchospasm

Answer

Thyroid storm

Answer

Glaucoma

Answer

AV nodal reentrant tachycardia (AVNRT)

Question 8

Reason for preferring Cisatracurium over Atracurium is:-

Accepted Answer

Lesser provocation of histamine release

Answer

Faster acting than Atracurium

Answer

Shorter action than Atracurium

Answer

Does not undergo Hoffman elimination

Question 9

Which of the following drugs is used for smoking cessation?

Accepted Answer

Varenicline

Answer

Gabapentin

Answer

Acamprosate

Answer

Nalmefene

Question 10

Most commonly used approach for retrosternal goitre:-

Accepted Answer

Transcervical

Answer

Transthoracic second intercostal space

Answer

Axillary approach

Answer

Trans-sternal through anterior mediastinum

NEET-PG 2019

Internal Medicine

Obstetrics and Gynecology

Pathology

Pediatrics

Pharmacology

Surgery