NEET-PG 2020

334 Questions — Page 20 of 34

Community Medicine

1 questions

Q191

Vector for Zika virus disease is:

Internal Medicine

3 questions

Q191

Which of the following is NOT the feature of secondary ACTH deficiency?

Q192

A patient presented with clinical features of ataxia and incoordination. It is most likely due to involvement of which artery among the following.

Q193

What is the differentiating feature between irritable bowel syndrome and inflammatory bowel disease?

NEET-PG 2020 - Internal Medicine NEET-PG Practice Questions and MCQs

Question 191: Which of the following is NOT the feature of secondary ACTH deficiency?

A. Anorexia
B. Fatigue
C. Hypotension
D. Hyperpigmentation (Correct Answer)

Explanation: ***Hyperpigmentation*** - **Hyperpigmentation** occurs in **primary adrenal insufficiency** (Addison's disease) due to high levels of **ACTH** and co-secreted **melanocyte-stimulating hormone (MSH)** [1]. - In **secondary ACTH deficiency**, ACTH levels are low, so there is no increased stimulation of melanocytes, and thus **hyperpigmentation is absent** [2]. *Anorexia* - **Anorexia** can be a feature of both **primary** and **secondary adrenal insufficiency** due to the general catabolic effects of **cortisol deficiency** and overall endocrine dysfunction. - Reduced cortisol can lead to altered metabolism and appetite, contributing to loss of appetite [2]. *Fatigue* - **Fatigue** is a common and prominent symptom in both **primary** and **secondary adrenal insufficiency** due to **cortisol deficiency** [2]. - Lack of adequate cortisol affects energy metabolism, muscle function, and overall well-being, leading to profound tiredness. *Hypotension* - **Hypotension** is more characteristic of **primary adrenal insufficiency** due to both **cortisol** and **aldosterone deficiency** [1]. - In **secondary ACTH deficiency**, aldosterone secretion is typically preserved (as it's regulated by the **renin-angiotensin system**), but severe **cortisol deficiency** can still contribute to mild hypotension [2].

Question 192: A patient presented with clinical features of ataxia and incoordination. It is most likely due to involvement of which artery among the following.

A. Middle cerebral
B. Posterior cerebral
C. Anterior cerebral
D. Superior cerebellar (Correct Answer)

Explanation: ***Superior cerebellar*** - The superior cerebellar artery supplies the **superior cerebellum**, which is critical for **coordination** and balance [1]. - Involvement of this artery commonly leads to **ataxia**, **dysarthria**, and **ipsilateral limb incoordination** [3]. *Middle cerebral* - The middle cerebral artery primarily supplies the **lateral surface of the cerebrum**, including motor and sensory cortices. - Strokes in this territory typically cause **contralateral hemiparesis**, **aphasia**, and **hemianopia**, not ataxia as a primary symptom [2]. *Posterior cerebellar* - The posterior cerebral artery supplies the **occipital lobe**, **thalamus**, and parts of the temporal lobe. - Occlusion often results in **visual field defects** (hemianopia), **memory deficits**, and sometimes **sensory loss**, but not isolated ataxia [2]. *Anterior cerebral* - The anterior cerebral artery supplies the **medial frontal and parietal lobes**. - Its occlusion typically causes **contralateral leg weakness** (hemiparesis), **behavioral changes**, and **urinary incontinence**.

Question 193: What is the differentiating feature between irritable bowel syndrome and inflammatory bowel disease?

A. Stool calprotectin (Correct Answer)
B. pain in abdomen
C. Diarrhoea
D. Mucus in stools

Explanation: ***Stool calprotectin*** - **Stool calprotectin** is a reliable biomarker used to differentiate between **Inflammatory Bowel Disease (IBD)** and **Irritable Bowel Syndrome (IBS)**. It's a protein released by neutrophils during intestinal inflammation. - Elevated levels of **calprotectin** strongly suggest **mucosal inflammation** characteristic of IBD (Crohn's disease or ulcerative colitis), while normal levels are typical in IBS, which lacks inflammation [1]. *pain in abdomen* - **Abdominal pain** is a common symptom in both IBS and IBD. In IBS, it's often linked to altered bowel habits and is a key diagnostic criterion [1]. - In IBD, abdominal pain is typically due to inflammation, strictures, or abscesses, but its presence alone does not differentiate the conditions . *Diarrhoea* - **Diarrhea** is a prominent symptom in both IBS and IBD. In IBS, it can be a predominant feature (IBS-D), often associated with urgency [1]. - In IBD, diarrhea is usually due to inflammation disrupting normal absorption and secretion, and it may contain blood or mucus . *Mucus in stools* - The presence of **mucus in stools** can occur in both IBS and IBD. In IBS, it's often present without blood and is generally considered part of altered bowel function [1]. - In IBD, mucus in stools, particularly when accompanied by blood, strongly suggests active intestinal inflammation and mucosal damage .

Obstetrics and Gynecology

2 questions

Q191

A woman with 18 weeks gestation presented to the OPD. On abdominal examination, the uterine size was 16 weeks. On USG, oligohydramnios was found, which of the following is suspected?

Q192

35 yr old primigravida conceived after IVF cycle attends obstetrics clinic with 38 weeks gestation. Her obstetric details reveal DiCho-DiAmn twins with 1st twin as breech. Her BP was 140/90 mmHg on 2 occasions with proteinuria +1. How will you manage this case?

NEET-PG 2020 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs

Question 191: A woman with 18 weeks gestation presented to the OPD. On abdominal examination, the uterine size was 16 weeks. On USG, oligohydramnios was found, which of the following is suspected?

A. Jaundice
B. Fetal anemia
C. Anencephaly
D. Renal agenesis (Correct Answer)

Explanation: ***Renal agenesis*** - **Oligohydramnios** (low amniotic fluid) and a **smaller-than-expected uterine size** at 18 weeks gestation are strong indicators of fetal renal agenesis. - Fetal kidneys are crucial for producing amniotic fluid through urine excretion, so their absence or severe malfunction leads to insufficient fluid. *Jaundice* - Not directly associated with **oligohydramnios** or a smaller uterine size. - While it can occur in utero, it doesn't cause a reduction in amniotic fluid volume. *Fetal anemia* - Often associated with **hydrops fetalis** and **polyhydramnios** (excess amniotic fluid), due to increased cardiac output and fluid retention, rather than oligohydramnios. - Doesn't typically present with a uterus smaller than expected for gestational age. *Anencephaly* - A neural tube defect characterized by the absence of a major portion of the brain and skull. - It is usually associated with **polyhydramnios** (excess amniotic fluid) due to impaired fetal swallowing, making it inconsistent with the given findings.

Question 192: 35 yr old primigravida conceived after IVF cycle attends obstetrics clinic with 38 weeks gestation. Her obstetric details reveal DiCho-DiAmn twins with 1st twin as breech. Her BP was 140/90 mmHg on 2 occasions with proteinuria +1. How will you manage this case?

A. Plan a cesarean for termination (Correct Answer)
B. Induction of labour
C. Watch for BP and induce for normal delivery on Expected Date of delivery
D. Watch for BP and terminate (vaginal/ Cesarean) only when BP is normal.

Explanation: ***Plan a cesarean for termination*** - This patient presents with **preeclampsia** (BP 140/90 mmHg on two occasions with proteinuria +1) at **38 weeks gestation**, making delivery appropriate. - The presence of **DiCho-DiAmn twins** with the **first twin in breech presentation** is a strong indication for **cesarean section** to ensure safe delivery and reduce complications. *Induction of labour* - While induction might be considered for preeclampsia, the **breech presentation of the first twin** in a twin pregnancy significantly increases the risks associated with vaginal delivery, making it less safe than a cesarean. - Given the combined risk factors, **cesarean delivery** is the more appropriate choice for optimizing maternal and fetal outcomes. *Watch for BP and induce for normal delivery on Expected Date of delivery* - Preeclampsia necessitates **delivery when the mother reaches 37 weeks or beyond**, not necessarily waiting until the Expected Date of Delivery, especially with other complicating factors. - Furthermore, attempting a **normal vaginal delivery** with a **breech presenting twin 1** carries high risks for both twins and is generally contraindicated. *Watch for BP and terminate (vaginal/ Cesarean) only when BP is normal.* - Delaying termination until blood pressure normalizes is not appropriate management for **preeclampsia** at term; delivery is the definitive treatment. - A persistent **breech presentation of twin 1** also makes vaginal delivery problematic, regardless of blood pressure status.

Pharmacology

2 questions

Q191

Which drug can be given as a nail lacquer treatment in onychomycosis?

Q192

Drug of choice for post menopausal osteoporosis is

NEET-PG 2020 - Pharmacology NEET-PG Practice Questions and MCQs

Question 191: Which drug can be given as a nail lacquer treatment in onychomycosis?

A. Terbinafine
B. Ciclopirox olamine (nail lacquer) (Correct Answer)
C. Nystatin
D. Itraconazole

Explanation: ***Ciclopirox olamine (nail lacquer)*** - **Ciclopirox olamine** is an antifungal agent formulated as a nail lacquer, specifically designed for topical application in **onychomycosis**. - Its mechanism involves interfering with fungal cellular processes, transported directly to the nail bed where the fungal infection resides. *Terbinafine* - **Terbinafine** is primarily an **oral antifungal** medication or available as a topical cream, but not typically in a nail lacquer formulation for onychomycosis. - While highly effective against dermatophytes causing onychomycosis, its systemic absorption is key to its efficacy when administered orally. *Nystatin* - **Nystatin** is an antifungal agent primarily effective against **Candida** species and is not typically used for dermatophyte-induced onychomycosis, nor is it commonly formulated as a nail lacquer. - Its broad spectrum is limited in this context, as most onychomycosis cases are caused by dermatophytes, which are less susceptible to nystatin. *Itraconazole* - **Itraconazole** is a **systemic antifungal** medication, effective in treating onychomycosis, but it is not available as a nail lacquer. - It works by inhibiting fungal cytochrome P450 enzymes, which are critical for ergosterol synthesis, a component of the fungal cell membrane.

Question 192: Drug of choice for post menopausal osteoporosis is

A. Bisphosphonates (Correct Answer)
B. Estrogen
C. Thyroxine
D. Teriparatide

Explanation: ***Bisphosphonates*** - **Bisphosphonates** are considered the **first-line therapy** for established postmenopausal osteoporosis due to their proven efficacy in reducing the risk of vertebral and non-vertebral fractures. - They work by **inhibiting osteoclast activity**, thereby decreasing bone resorption and increasing bone mineral density. *Estrogen* - While **estrogen therapy** can prevent osteoporosis, it is generally not the first-line treatment due to potential risks like increased risk of **breast cancer**, **stroke**, and **venous thromboembolism**. - It is typically reserved for women with severe menopausal symptoms who also require osteoporosis prevention, and often used at the **lowest effective dose for the shortest duration**. *Thyroxine* - **Thyroxine** is a hormone used primarily to treat **hypothyroidism**, a condition where the thyroid gland doesn't produce enough thyroid hormone. - It is **not indicated for the treatment of osteoporosis** and can even worsen bone loss if given in excessive doses, leading to iatrogenic hyperthyroidism. *Teriparatide* - **Teriparatide** is an **anabolic agent** that stimulates new bone formation, making it a powerful option for severe osteoporosis or those who have failed other therapies. - However, it is an injectable medication with a **limited treatment duration** (typically 2 years) and is generally reserved for patients with a **high fracture risk** rather than being the initial drug of choice for all postmenopausal osteoporosis.

Psychiatry

2 questions

Q191

A patient complains of sadness of mood, increased lethargy, early morning awakening, loss of interest and reports no will to live and hears voices asking her to kill self. What is the diagnosis?

Q192

A 1st year medical student presents with recurrent episodes of choking sensation, breathlessness, intense sweating along with feeling of impending doom. Usually the episodes occur prior to exams. What is the most likely diagnosis?

NEET-PG 2020 - Psychiatry NEET-PG Practice Questions and MCQs

Question 191: A patient complains of sadness of mood, increased lethargy, early morning awakening, loss of interest and reports no will to live and hears voices asking her to kill self. What is the diagnosis?

A. Schizophrenia
B. Major depressive disorder plus psychosis (Correct Answer)
C. Schizoaffective disorder
D. Schizotypal personality disorder

Explanation: ***Major depressive disorder plus psychosis*** - The patient presents with classic symptoms of **major depressive disorder**, including persistent sadness, **anhedonia (loss of interest)**, **lethargy**, and **early morning awakening**. - The presence of **auditory hallucinations** (hearing voices asking her to kill herself) indicates **psychotic features** accompanying the severe depression, leading to the diagnosis of major depressive disorder with psychotic features. *Schizophrenia* - While schizophrenia involves psychosis, the primary presentation here is a prominent **depressive syndrome** rather than the typical **positive symptoms (delusions, hallucinations)**, **negative symptoms (alogia, avolition)**, and **disorganized thought** processes characteristic of schizophrenia. - The depressive symptoms are too pervasive and central to the clinical picture to be solely schizophrenia. *Schizoaffective disorder* - This disorder requires a period of **at least two weeks of psychotic symptoms** (hallucinations or delusions) **without prominent mood symptoms**, which is not described. - In this case, the **psychotic symptoms are congruent with the depressed mood** (e.g., voices urging self-harm, reflecting hopelessness), rather than independent. *Schizotypal personality disorder* - This is a pervasive pattern of **social and interpersonal deficits** marked by acute discomfort with, and reduced capacity for, close relationships, as well as by **cognitive or perceptual distortions** and eccentricities of behavior. - It does not involve persistent, severe depressive episodes with overt psychotic symptoms as described, nor significant functional impairment to the extent seen here.

Question 192: A 1st year medical student presents with recurrent episodes of choking sensation, breathlessness, intense sweating along with feeling of impending doom. Usually the episodes occur prior to exams. What is the most likely diagnosis?

A. Panic attack (Correct Answer)
B. Acute stress disorder
C. Generalised anxiety disorder
D. Phobia

Explanation: ***Panic attack (Panic Disorder)*** - The sudden onset of intense fear or discomfort, along with symptoms like **choking sensation**, **breathlessness**, **sweating**, and **feeling of impending doom**, are characteristic of a **panic attack**. - The **recurrent episodes** occurring prior to exams indicate **Panic Disorder**, which is defined by recurrent unexpected panic attacks followed by persistent concern about future attacks. - The situational trigger (exams) suggests a pattern consistent with panic disorder, where attacks may be situationally predisposed. *Acute stress disorder* - This condition occurs within **one month of exposure to a traumatic event** and involves dissociative symptoms, intrusions, avoidance, and arousal symptoms. - The patient describes recurrent episodes tied to exams, not a single acute traumatic event with subsequent stress response. *Generalised anxiety disorder* - Characterized by excessive and **uncontrollable worry** about various events or activities for **at least six months**. - While anxiety is present, the sudden, intense, **episodic nature** of symptoms with a distinct "feeling of impending doom" points away from the chronic, pervasive worry of GAD. - GAD presents with chronic anxiety rather than discrete panic episodes. *Phobia* - A phobia is an **irrational and intense fear** of a specific object or situation (e.g., specific phobia) or social situations (social anxiety disorder). - While exam-related anxiety can be severe, the description points to a **full-blown panic response** with multiple autonomic symptoms (choking, breathlessness, sweating) and psychological distress (impending doom). - Unlike a phobia where avoidance is the primary feature, this patient experiences discrete panic episodes with characteristic somatic symptoms.