Anesthesiology
1 questionsInhalational anesthetic with highest respiratory irritation is:-
NEET-PG 2019 - Anesthesiology NEET-PG Practice Questions and MCQs
Question 261: Inhalational anesthetic with highest respiratory irritation is:-
- A. Desflurane (Correct Answer)
- B. Halothane
- C. Nitrous oxide
- D. Sevoflurane
Explanation: ***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.
Community Medicine
1 questionsBird-Arthropod-Man transmission is seen in
NEET-PG 2019 - Community Medicine NEET-PG Practice Questions and MCQs
Question 261: Bird-Arthropod-Man transmission is seen in
- A. Paragonimus westermani
- B. Plague
- C. Plasmodium falciparum
- D. Japanese encephalitis (Correct Answer)
Explanation: ***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.
ENT
1 questionsInspiratory stridor is due to lesions of:
NEET-PG 2019 - ENT NEET-PG Practice Questions and MCQs
Question 261: Inspiratory stridor is due to lesions of:
- A. Supraglottis
- B. Trachea
- C. Bronchi
- D. Subglottis (Correct Answer)
Explanation: ***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.
Internal Medicine
2 questionsA 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?
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?
NEET-PG 2019 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 261: 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?
- A. Vitamin B 6
- B. Vitamin B1 (Correct Answer)
- C. Vitamin B2
- D. Vitamin C
Explanation: ***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.
Question 262: 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?
- A. Double the dose of methotrexate
- B. Methotrexate + high potency Oral steroids
- C. Methotrexate + Sulphasalazine + Hydroxychloroquine (Correct Answer)
- D. Stop methotrexate and start Monotherapy with anti-TNF- drugs
Explanation: ***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.
Microbiology
1 questionsA 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?
NEET-PG 2019 - Microbiology NEET-PG Practice Questions and MCQs
Question 261: 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?
- A. Pneumocystis jirovecii
- B. Paragonimus westermani (Correct Answer)
- C. Strongyloides stercoralis
- D. Diphyllobothrium latum
Explanation: ***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.
Pathology
1 questionsWhich type of necrosis is characterized by deposition of immune complexes and fibrin in the walls of blood vessels?
NEET-PG 2019 - Pathology NEET-PG Practice Questions and MCQs
Question 261: Which type of necrosis is characterized by deposition of immune complexes and fibrin in the walls of blood vessels?
- A. Liquefactive necrosis
- B. Coagulative necrosis
- C. Caseous necrosis
- D. Fibrinoid necrosis (Correct Answer)
Explanation: ***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.
Physiology
1 questionsTwo identical twins will not have same:
NEET-PG 2019 - Physiology NEET-PG Practice Questions and MCQs
Question 261: Two identical twins will not have same:
- A. DNA
- B. Iris color
- C. Blood group
- D. Fingerprints (Correct Answer)
Explanation: ***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**.
Psychiatry
1 questionsIn exposure and response prevention therapy which one of the following is a poor prognostic factor in OCD?
NEET-PG 2019 - Psychiatry NEET-PG Practice Questions and MCQs
Question 261: In exposure and response prevention therapy which one of the following is a poor prognostic factor in OCD?
- A. Magical thinking
- B. Contamination
- C. Hoarding (Correct Answer)
- D. Pathological doubt
Explanation: ***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.
Surgery
1 questionsWhich of the following is true about tenosynovitis of the finger?
NEET-PG 2019 - Surgery NEET-PG Practice Questions and MCQs
Question 261: Which of the following is true about tenosynovitis of the finger?
- A. Treatment is conservative.
- B. Fingers held in mild extension / Extension deformity at the involved fingers.
- C. With involvement of little finger the infection can spread to the ring finger.
- D. Tenosynovitis of little finger will spread to thumb rather than ring finger. (Correct Answer)
Explanation: ***Tenosynovitis of little finger will spread to thumb rather than ring finger.*** - The **little finger's flexor tendon sheath** connects directly to the **ulnar bursa**, which communicates with the **radial bursa** (thumb's sheath) in approximately **80% of individuals** through the space of Parona. - This **bursal communication** creates a direct pathway for infection spread from the little finger to the thumb, making it the most common route of propagation in flexor tenosynovitis. *With involvement of little finger the infection can spread to the ring finger.* - While anatomically possible through **fascial plane connections**, direct spread to the ring finger is **less common** than spread to the thumb via established bursal pathways. - The **ulnar bursa-radial bursa connection** provides a more direct and frequently utilized route for infection propagation than lateral spread to adjacent digits. *Treatment is conservative.* - **Purulent flexor tenosynovitis** requires urgent **surgical incision and drainage** to prevent irreversible tendon damage and loss of function. - Conservative treatment with antibiotics alone is inadequate for established infections and may lead to **tendon necrosis** and permanent disability. *Fingers held in mild extension / Extension deformity at the involved fingers.* - Patients with tenosynovitis characteristically hold the affected finger in **mild flexion** as part of **Kanavel's four cardinal signs**. - **Extension** of the finger causes severe pain due to stretching of the inflamed tendon sheath, so patients avoid this position naturally.