NEET-PG 2019 Practice Questions

Q: Inhalational anesthetic with highest respiratory irritation is:-

Desflurane. ***Desflurane*** - **Desflurane** has the highest **pungency** among common inhalational anesthetics, leading to significant respiratory irritation. - This irritation can manifest as **coughing**, **laryngospasm**, and **bronchospasm**, particularly during induction. *Halothane* - **Halothane** is a less pungent anesthetic and is generally well-tolerated by the respiratory system. - It was historically known for its **bronchodilating properties**, making it less irritating than Desflurane. *Nitrous oxide* - **Nitrous oxide** is a gaseous anesthetic with a very low solubility and virtually no respiratory irritant properties. - It is often used as a carrier gas and is known for its quick onset and offset without causing airway reactivity. *Sevoflurane* - **Sevoflurane** is known for its sweet smell and is considered a non-pungent agent, making it suitable for inhalational induction, especially in children. - It causes minimal respiratory irritation and has **bronchodilating effects**, which are beneficial in patients with reactive airway disease.

Q: Bird-Arthropod-Man transmission is seen in

Japanese encephalitis. ***Japanese encephalitis*** - Japanese encephalitis virus typically cycles between **birds** (especially wading birds like herons) and **mosquitoes** (mainly *Culex* species), with humans and pigs being dead-end hosts. - The mosquito acts as the **arthropod vector** transmitting the virus from infected birds to humans. *Paragonimus westermani* - This is a **lung fluke** with a complex life cycle involving snails and crustaceans as intermediate hosts, and humans or carnivorous mammals as definitive hosts. - It does not involve a **bird-arthropod-man** transmission cycle. *Plague* - Plague is caused by the bacterium *Yersinia pestis* and is primarily transmitted by **fleas** (arthropods) from **rodents** (mammals) to humans. - While it involves arthropods and humans, birds are not part of its primary transmission cycle. *Plasmodium falciparum* - *Plasmodium falciparum* causes **malaria** and is transmitted between humans by **Anopheles mosquitos** (arthropods). - This transmission cycle is typically **human-mosquito-human**, with birds not being involved in the transmission to humans.

Q: Inspiratory stridor is due to lesions of:

Subglottis. ***Subglottis*** - **Inspiratory stridor** is classically associated with **subglottic lesions**, such as **croup (laryngotracheobronchitis)** and **subglottic stenosis**. - The **subglottis** is the **narrowest part of the pediatric airway**, making it particularly susceptible to significant obstruction from inflammation or narrowing. - During inspiration, the negative intrathoracic pressure causes **dynamic collapse** of the subglottic region when narrowed, producing characteristic **high-pitched inspiratory stridor**. - Common causes: **Croup**, subglottic stenosis, subglottic hemangioma. *Supraglottis* - Supraglottic lesions (epiglottis, aryepiglottic folds) can also cause **inspiratory stridor**, particularly in **acute epiglottitis**. - However, supraglottic pathology more commonly presents with **muffled voice** (hot potato voice), **dysphagia**, **drooling**, and **tripod positioning**. - The stridor from supraglottic lesions tends to be **lower-pitched** and is often accompanied by more prominent systemic symptoms. *Trachea* - Tracheal lesions typically produce **biphasic stridor** (both inspiratory and expiratory phases) due to fixed obstruction in the main conducting airway. - The trachea is a more rigid structure; obstruction produces a **harsh, lower-pitched** sound heard in both respiratory phases. - Examples: tracheal stenosis, tracheomalacia, tracheal tumors. *Bronchi* - Bronchial lesions cause **expiratory wheezing** rather than stridor, due to dynamic collapse of small airways during exhalation. - Bronchial obstruction affects the lower airways and presents as **polyphonic wheeze** rather than the monophonic sound of stridor.

Q: A 20-year-old alcoholic malnourished patient presented to the hospital with respiratory distress. His pulse was 112/minute. The patient had edema, hypertension, a systolic murmur along the left sternal edge, and bilateral crepitations in the lungs. A diagnosis of congestive high-output cardiac failure was made. Which vitamin is deficient?

Vitamin B1. ***Vitamin B1*** - The constellation of **high-output cardiac failure** (tachycardia, edema, hypertension, systolic murmur, pulmonary crepitations) in an alcoholic and malnourished patient strongly indicates **wet beriberi**, which is caused by **thiamine (Vitamin B1) deficiency** [1]. - **Alcoholism** is a major risk factor for thiamine deficiency due to poor nutritional intake and impaired absorption/meta [2]. *Vitamin B 6* - Deficiency of **pyridoxine (Vitamin B6)** can cause **sideroblastic anemia**, neurological symptoms like neuropathy and seizures, and **dermatitis**, but typically not high-output cardiac failure. - While alcoholics can be deficient in B6, it doesn't directly cause a primary cardiac syndrome like beriberi. *Vitamin B2* - **Riboflavin (Vitamin B2)** deficiency leads to symptoms such as **cheilosis**, **angular stomatitis**, **glossitis**, and **seborrheic dermatitis**, and sometimes corneal vascularization. - It is not directly associated with the described **congestive high-output cardiac failure** symptoms in this patient. *Vitamin C* - **Scurvy**, caused by **Vitamin C deficiency**, presents with **gingival bleeding**, **perifollicular hemorrhages**, **poor wound healing**, and **joint pain** [3]. - It does not cause high-output cardiac failure, although severe scurvy can lead to anemia and non-specific weakness.

Q: A 55-year-old female on methotrexate presents with continuous pain and swelling of bilateral hand joints. What is the best treatment plan for this patient?

Methotrexate + Sulphasalazine + Hydroxychloroquine. ***Methotrexate + Sulphasalazine + Hydroxychloroquine*** - This combination, known as **triple therapy**, is a well-established and effective strategy for **rheumatoid arthritis** patients who have an inadequate response to methotrexate monotherapy. - The combination of **conventional synthetic DMARDs (csDMARDs)** targets different inflammatory pathways, leading to a synergistic effect and improved disease control. *Double the dose of methotrexate* - While methotrexate doses can be optimized, simply doubling the dose may not be the most effective next step for uncontrolled disease and could increase the risk of **toxicity** without significantly improving efficacy. - Current guidelines often advocate for adding another DMARD or switching to a biologic agent if maximum tolerated methotrexate is insufficient. *Methotrexate + high potency Oral steroids* - Oral steroids are primarily used for **short-term symptom control** during flares or as a bridge therapy, not as a long-term strategy for sustained disease modification due to their significant side effect profile. - Adding high-potency oral steroids long-term with methotrexate would increase the risk of adverse effects like osteoporosis, infections, and adrenal insufficiency. *Stop methotrexate and start Monotherapy with anti-TNF- drugs* - While **anti-TNF drugs** are a powerful next-line treatment, **monotherapy** is generally less effective than combination therapy, especially for patients with active disease. - **Methotrexate is often continued** in combination with anti-TNF drugs even when initiating biological therapies, as it can enhance their efficacy and reduce immunogenicity.

Q: A 35 year old man presented with dry cough and rusty colored sputum. He has a history of eating in a Chinese restaurant very often with consumption of crabs. What is the probable causative agent in this condition?

Paragonimus westermani. ***Paragonimus westermani*** - The key clinical features are **dry cough**, **rusty-colored sputum**, and a history of consuming **crabs**. These are classic indicators of **paragonimiasis**. - *Paragonimus westermani* is a **lung fluke** acquired by eating undercooked freshwater crabs or crayfish. *Pneumocystis jirovecii* - This fungus typically causes pneumonia in **immunocompromised individuals**, like those with HIV/AIDS. - While it can cause a dry cough, **rusty-colored sputum** is not a characteristic sign, and there's no mention of immunocompromise. *Strongyloides stercoralis* - This parasite primarily causes **gastrointestinal symptoms** (e.g., abdominal pain, diarrhea) and can lead to cutaneous manifestations (larva currens). - While lung involvement can occur in severe cases (hyperinfection), it does not typically present with **rusty sputum** or a direct association with crab consumption. *Diphyllobothrium latum* - This is the **fish tapeworm**, acquired by eating undercooked freshwater fish. - It primarily causes **gastrointestinal symptoms** such as abdominal pain and diarrhea, and is known for causing **vitamin B12 deficiency** leading to megaloblastic anemia, not pulmonary symptoms.

Q: Which type of necrosis is characterized by deposition of immune complexes and fibrin in the walls of blood vessels?

Fibrinoid necrosis. ***Fibrinoid necrosis*** - This type of necrosis is classically associated with **immune-mediated vascular damage**, where antigen-antibody complexes are deposited in arterial walls [2]. - The microscopic appearance is characterized by bright pink, amorphous material composed of **fibrin and immune complexes**, giving a fibrin-like staining pattern [1]. *Liquefactive necrosis* - Characterized by the **dissolution of dead cells into a viscous liquid mass**, often seen in bacterial infections or brain infarcts. - The necrotic tissue is replaced by inflammatory cells and fluid, rather than immune complex deposits. *Coagulative necrosis* - Occurs due to **ischemia**, leading to protein denaturation and preservation of cell outlines for a period. - It does not involve the deposition of immune complexes or fibrin in vessel walls. *Caseous necrosis* - A form of coagulative necrosis associated with **tuberculosis**, characterized by a friable, "cheese-like" appearance. - It primarily involves granulomatous inflammation and macrophage accumulation, not immune complex deposition in blood vessels. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 514-518. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 214-242.

Q: Two identical twins will not have same:

Fingerprints. ***Fingerprints*** - **Fingerprints** are unique to each individual, even identical twins, because their formation is influenced by prenatal environmental factors such as **blood flow**, **amniotic fluid pressure**, and **baby's position in the womb**. - These environmental factors affect the development of **dermal ridges** during weeks 6-13 of gestation, leading to distinct patterns. *DNA* - **Identical twins** originate from a single fertilized egg that splits, meaning they share virtually **100% of their DNA**. - While minor epigenetic differences can occur, their core genetic code is the same. *Iris color* - **Iris color** is primarily determined by **genetics**, and since identical twins share the same genetic makeup, they typically have the same (or very similar) **eye color**. - Differences in iris patterns might exist, but the overall color is genetically programmed. *Blood group* - **Blood group** is an inherited trait determined by specific **antigens on red blood cells**, which are encoded by genes. - As identical twins share the same genetic information, they will have the **same blood type**.

Q: In exposure and response prevention therapy which one of the following is a poor prognostic factor in OCD?

Hoarding. ***Hoarding*** - **Hoarding** in OCD is considered a **poor prognostic factor** for ERP therapy due to the severe avoidance of discarding items and the strong emotional attachment to possessions. - Individuals with hoarding symptoms often display **low insight** into the irrationality of their hoarding behavior, making it more challenging to engage in and benefit from ERP. *Magical thinking* - While magical thinking can be a feature of OCD, it is not consistently associated with a **worse prognosis** in ERP compared to other symptom dimensions, especially when compared to hoarding. - ERP can effectively target rituals and compulsions driven by magical thoughts by gradually exposing the individual to feared outcomes without enacting the ritual. *Contamination* - **Contamination fears**, though distressing, often respond well to ERP through exposure to feared contaminants and prevention of washing/cleaning rituals. - While challenging, it is generally considered to have a **better prognosis** with ERP than hoarding. *Pathological doubt* - **Pathological doubt**, a core feature of many OCD presentations, is addressed in ERP by exposing individuals to situations that trigger doubt and preventing excessive checking or seeking reassurance. - Like contamination, it typically has a **more favorable prognosis** with ERP compared to hoarding due to the direct ability to target and prevent the compulsive behaviors.

Question 1

Inhalational anesthetic with highest respiratory irritation is:-

Accepted Answer

Desflurane

Answer

Halothane

Answer

Nitrous oxide

Answer

Sevoflurane

Question 2

Bird-Arthropod-Man transmission is seen in

Accepted Answer

Japanese encephalitis

Answer

Paragonimus westermani

Answer

Plague

Answer

Plasmodium falciparum

Question 3

Inspiratory stridor is due to lesions of:

Accepted Answer

Subglottis

Answer

Supraglottis

Answer

Trachea

Answer

Bronchi

Question 4

A 20-year-old alcoholic malnourished patient presented to the hospital with respiratory distress. His pulse was 112/minute. The patient had edema, hypertension, a systolic murmur along the left sternal edge, and bilateral crepitations in the lungs. A diagnosis of congestive high-output cardiac failure was made. Which vitamin is deficient?

Accepted Answer

Vitamin B1

Answer

Vitamin B 6

Answer

Vitamin B2

Answer

Vitamin C

Question 5

A 55-year-old female on methotrexate presents with continuous pain and swelling of bilateral hand joints. What is the best treatment plan for this patient?

Accepted Answer

Methotrexate + Sulphasalazine + Hydroxychloroquine

Answer

Double the dose of methotrexate

Answer

Methotrexate + high potency Oral steroids

Answer

Stop methotrexate and start Monotherapy with anti-TNF- drugs

Question 6

A 35 year old man presented with dry cough and rusty colored sputum. He has a history of eating in a Chinese restaurant very often with consumption of crabs. What is the probable causative agent in this condition?

Accepted Answer

Paragonimus westermani

Answer

Pneumocystis jirovecii

Answer

Strongyloides stercoralis

Answer

Diphyllobothrium latum

Question 7

Which type of necrosis is characterized by deposition of immune complexes and fibrin in the walls of blood vessels?

Accepted Answer

Fibrinoid necrosis

Answer

Liquefactive necrosis

Answer

Coagulative necrosis

Answer

Caseous necrosis

Question 8

Two identical twins will not have same:

Accepted Answer

Fingerprints

Answer

DNA

Answer

Iris color

Answer

Blood group

Question 9

In exposure and response prevention therapy which one of the following is a poor prognostic factor in OCD?

Accepted Answer

Hoarding

Answer

Magical thinking

Answer

Contamination

Answer

Pathological doubt

Question 10

Which of the following is true about tenosynovitis of the finger?

Accepted Answer

Tenosynovitis of little finger will spread to thumb rather than ring finger.

Answer

Treatment is conservative.

Answer

Fingers held in mild extension / Extension deformity at the involved fingers.

Answer

With involvement of little finger the infection can spread to the ring finger.

NEET-PG 2019

Anesthesiology

Community Medicine

ENT

Internal Medicine

Microbiology

Pathology

Physiology

Psychiatry

Surgery