NEET-PG 2020 Practice Questions

Q: The poison commonly detected in exhumed bodies is:

Arsenic. ***Arsenic*** - **Arsenic** is the most common poison detected in exhumed bodies due to its exceptional **stability** and **resistance to degradation** in decomposing tissues. - It readily binds to **keratin-rich tissues** like hair and nails, making it detectable even after long periods (years to decades). - Known as a "**persistent poison**" in forensic medicine due to its ability to resist putrefaction and remain in tissues indefinitely. *Cadmium* - While **cadmium** is a toxic heavy metal, it is not as frequently detected in exhumed bodies as arsenic due to differing toxicokinetics and post-mortem stability. - Cadmium poisoning often involves **renal and pulmonary toxicity**, and its detection post-mortem might be more challenging after significant decomposition. *Mercury* - **Mercury** can be toxic and persist in some tissues, but its detection in exhumed bodies is less common than arsenic due to its different **metabolic pathways** and **degradation patterns**. - **Elemental mercury** is poorly absorbed, and other forms like **methylmercury** can be found, but their post-mortem stability does not match arsenic's. *Lead* - **Lead** is a heavy metal that causes chronic toxicity and can be detected in bones for extended periods. However, its overall detection rate in exhumed bodies for acute poisoning is typically lower than arsenic. - Lead's clinical presentation often includes **neurological, gastrointestinal, and hematological symptoms**, but its presence in various tissues diminishes over time compared to arsenic's unique persistence.

Q: A patient of Scleroderma presents with acute respiratory distress. Chest X-ray shows B/L reticular basilar shadows. What is the next line of investigation in this patient?

High resolution CT to characterize the lung parenchyma.. ***High resolution CT*** - A **high-resolution CT (HRCT) scan** is the gold standard for evaluating **interstitial lung disease (ILD)**, which is commonly seen in **scleroderma** and presents with basilar reticular shadows on chest X-ray. - HRCT provides detailed images of the lung parenchyma, allowing for accurate characterization of the **fibrotic changes** and extent of ILD. *Pulmonary function tests to assess lung function.* - **Pulmonary function tests (PFTs)** provide functional information about lung capacity and gas exchange but do not offer detailed anatomical imaging of the lung parenchyma. - While essential for monitoring disease progression and severity, PFTs are not the primary diagnostic tool to further characterize the **reticular basilar shadows** seen on X-ray in an acute setting. *Contrast-enhanced CT scan for vascular assessment.* - A **contrast-enhanced CT scan** is primarily used to assess **vascular structures** or rule out conditions like **pulmonary embolism**, which is not directly indicated by the description of bilateral reticular basilar shadows. - The primary concern here is **interstitial lung disease**, which is best evaluated by **HRCT** without contrast. *Echocardiography to evaluate cardiac complications.* - **Echocardiography** is used to assess cardiac function and look for complications like **pulmonary hypertension** or **myocardial fibrosis**, which can occur in scleroderma. - However, it does not directly evaluate the **lung parenchyma** or the cause of the reticular basilar shadows.

Q: Patient with clinical signs of DVT had tachycardia and history of bladder cancer. According to modified Well's scoring, the probability of pulmonary embolism would be :

Intermediate. **Intermediate** - Clinical signs of **DVT (3 points)**, **tachycardia (heart rate > 100 bpm, 1.5 points)**, and a history of **cancer (1 point)** sum up to 5.5 points, which falls within the range for an intermediate probability (2-6 points) on the modified Well's score for PE. - The modified Well's criteria assigns specific points for risk factors and clinical findings, guiding the diagnostic approach for pulmonary embolism [1]. *Low* - A low probability for PE according to the modified Well's score is indicated by a total score of **less than 2 points** [1]. - The patient's presentation accumulates significantly more points than this threshold due to multiple contributing factors. *High* - A high probability for PE according to the modified Well's score is indicated by a total score of **greater than 6 points** [1]. - The patient's score of 5.5 points does not meet this threshold, placing them in the intermediate category.

Q: A 12 year old boy presents with vomiting within 3 hours of consumption of food at a party. What is the likely causative organism responsible for the symptoms?

Staphylococcus aureus. ***Staphylococcus aureus*** - **Vomiting occurring within 1-6 hours of food consumption** is highly characteristic of preformed toxin ingestion, commonly associated with *S. aureus*. - *S. aureus* produces **heat-stable enterotoxins** that cause rapid onset nausea, vomiting, and abdominal cramps. *Clostridium perfringens* - This bacterium typically causes symptoms like **abdominal cramps and diarrhea**, with vomiting being less common. - The onset of illness from *C. perfringens* is usually **8-16 hours** after consumption, which is longer than the 3-hour window in this case. *Clostridium botulinum* - *C. botulinum* causes **botulism**, a neuroparalytic illness, which may include nausea and vomiting in its early stages but is primarily characterized by **flaccid paralysis**. - Symptoms usually appear **12-36 hours** after exposure, which is much longer than the presentation described. *Salmonella* - **Salmonellosis** typically has an incubation period of **6-72 hours**, with symptoms including diarrhea, fever, and abdominal cramps; vomiting may occur but is not as immediate or predominant as with *S. aureus* toxin. - The illness is caused by bacterial colonization and invasion, not preformed toxins, leading to a longer onset compared to the 3-hour presentation.

Q: A 60 years old Female with intermittent bleeding per vagina, endometrial collection, and thickening with anterior bulging of the fundal area on ultrasound. What is the most probable diagnosis?

Endometrial Polyp. ***Endometrial Polyp*** - Intermittent bleeding and an **endometrial collection** with **thickening** are classic signs of an endometrial polyp. - The **anterior bulging of the fundal area** on ultrasound is characteristic of a **localized, sessile polyp** protruding into the endometrial cavity. - Polyps are benign overgrowths of endometrial tissue that commonly present with postmenopausal bleeding. *Submucous Fibroid* - While submucous fibroids can cause intermittent bleeding and fundal bulging, they typically appear as a distinct **hypoechoic mass arising from the myometrium** with a whorled pattern. - Fibroids are solid lesions, whereas the description of "endometrial collection" suggests a more cystic or polypoid nature. *Adenomyosis* - Adenomyosis involves **endometrial tissue within the myometrium**, typically causing diffuse uterine enlargement with a heterogeneous myometrial echotexture. - It usually presents with **dysmenorrhea and menorrhagia** rather than intermittent bleeding with focal fundal bulging. - The ultrasound findings described are more consistent with an **intracavitary lesion** rather than myometrial pathology. *Endometrial Cancer* - Endometrial cancer is an important consideration in postmenopausal bleeding with endometrial thickening. - However, malignancy typically presents with a **heterogeneous, irregular endometrial pattern** with increased vascularity on Doppler. - The description of a **discrete collection with focal bulging** points more toward a **benign, localized lesion** like a polyp rather than diffuse malignancy.

Q: A 45 year old male, known case of Rheumatoid arthritis is on a monotherapy since many years. Symptoms of RA are controlled but suddenly patient develops blurring of vision. Which of the following drug is responsible for sudden effect on vision?

Hydroxychloroquine. ***Hydroxychloroquine*** - **Hydroxychloroquine** [1] is known to cause **retinal toxicity** (maculopathy) as a dose-dependent, long-term side effect, leading to **blurring of vision** and other visual disturbances. - Patients on long-term hydroxychloroquine therapy require regular **ophthalmological screening** to detect and prevent irreversible vision loss. *Methotrexate* - **Methotrexate** is a common DMARD used in RA [1], but its ocular side effects are typically rare and less severe, usually involving **conjunctivitis** or **periorbital edema**. - It does not commonly cause **maculopathy** or sudden profound blurring of vision. *Sulfasalazine* - **Sulfasalazine** [1] can cause a range of side effects, including gastrointestinal issues and various hypersensitivity reactions. - Ocular side effects are infrequent and generally mild, such as **conjunctivitis** or **periorbital edema**, and not severe blurring of vision due to retinal damage. *Leflunomide* - **Leflunomide** is an immunosuppressive DMARD [1] whose common adverse effects include hepatotoxicity, gastrointestinal upset, and hypertension. - Significant **ocular toxicity** leading to blurring of vision, particularly retinal damage, is not a characteristic side effect of **leflunomide**.

Q: Anti-glaucoma drug that acts by increasing uveoscleral outflow is

Latanoprost. ***Latanoprost*** - **Latanoprost** is a **prostaglandin F2α analog** that effectively lowers intraocular pressure by significantly increasing **uveoscleral outflow**. - It works by remodeling the extracellular matrix in the ciliary body and sclera, which facilitates the drainage of aqueous humor through the uveoscleral pathway. *Dorzolamide* - **Dorzolamide** is a **topical carbonic anhydrase inhibitor** that reduces the production of aqueous humor, thus lowering intraocular pressure. - It does not directly affect the uveoscleral outflow pathway. *Pilocarpine* - **Pilocarpine** is a **cholinergic agonist** that primarily works by increasing the **trabecular outflow** of aqueous humor through contraction of the ciliary muscle [1]. - It does not significantly influence the uveoscleral outflow pathway. *Timolol* - **Timolol** is a **beta-adrenergic blocker** that reduces aqueous humor production by the ciliary body [1]. - Its mechanism of action involves decreasing the formation, rather than increasing the outflow, of aqueous humor [1].

Q: Which radiotherapy technique involves the use of remote afterloading to deliver radiation directly to the tumor?

Brachytherapy. ***Correct: Brachytherapy*** - **Remote afterloading** is a hallmark of modern brachytherapy, where radioactive sources are automatically advanced into catheters placed within or near the tumor. - This technique allows for the delivery of a **high dose of radiation directly to the tumor** while sparing surrounding healthy tissues. - Examples include **intracavitary** (cervical cancer), **interstitial** (prostate cancer), and **intraluminal** (esophageal cancer) brachytherapy. *Incorrect: External Beam Radiotherapy* - This technique involves delivering radiation from a machine **outside the body** to target a tumor. - It does not involve the direct placement of radioactive sources within the patient or the use of **remote afterloading**. *Incorrect: Stereotactic Radiotherapy* - While a precise form of external beam radiotherapy using focused beams, it still involves an **external source** of radiation. - It does not utilize internal radioactive sources or **afterloading techniques**. *Incorrect: Proton Beam Radiotherapy* - This is an advanced form of external beam radiotherapy that uses **protons instead of photons** to deliver radiation with high precision. - It does not involve the placement of radioactive sources within the patient or the use of **remote afterloading**.

Question 1

The poison commonly detected in exhumed bodies is:

Accepted Answer

Arsenic

Answer

Lead

Answer

Mercury

Answer

Cadmium

Question 2

A patient of Scleroderma presents with acute respiratory distress. Chest X-ray shows B/L reticular basilar shadows. What is the next line of investigation in this patient?

Accepted Answer

High resolution CT to characterize the lung parenchyma.

Answer

Pulmonary function tests to assess lung function.

Answer

Contrast-enhanced CT scan for vascular assessment.

Answer

Echocardiography to evaluate cardiac complications.

Question 3

A female patient with clinical symptoms of systemic sclerosis presents with shortness of breath and bilateral basal rales. Her chest X-ray showed reticular opacities in bilateral basal fields. What is the next best step?

Accepted Answer

Do HRCT

Answer

Do 2D echocardiography

Answer

Do Pulmonary Function Test

Answer

Do CECT

Question 4

Patient with clinical signs of DVT had tachycardia and history of bladder cancer. According to modified Well's scoring, the probability of pulmonary embolism would be :

Accepted Answer

Intermediate

Answer

Low

Answer

High

Question 5

A 12 year old boy presents with vomiting within 3 hours of consumption of food at a party. What is the likely causative organism responsible for the symptoms?

Accepted Answer

Staphylococcus aureus

Answer

Clostridium perfringens

Answer

Clostridium botulinum

Answer

Salmonella

Question 6

A 60 years old Female with intermittent bleeding per vagina, endometrial collection, and thickening with anterior bulging of the fundal area on ultrasound. What is the most probable diagnosis?

Accepted Answer

Endometrial Polyp

Answer

Submucous Fibroid

Answer

Adenomyosis

Answer

Endometrial Cancer

Question 7

A 45 year old male, known case of Rheumatoid arthritis is on a monotherapy since many years. Symptoms of RA are controlled but suddenly patient develops blurring of vision. Which of the following drug is responsible for sudden effect on vision?

Accepted Answer

Hydroxychloroquine

Answer

Methotrexate

Answer

Sulfasalazine

Answer

Leflunomide

Question 8

Anti-glaucoma drug that acts by increasing uveoscleral outflow is

Accepted Answer

Latanoprost

Answer

Dorzolamide

Answer

Pilocarpine

Answer

Timolol

Question 9

Which radiotherapy technique involves the use of remote afterloading to deliver radiation directly to the tumor?

Accepted Answer

Brachytherapy

Answer

External Beam Radiotherapy

Answer

Stereotactic Radiotherapy

Answer

Proton Beam Radiotherapy

Question 10

A 20 year old boy is brought to the emergency following a RTA (Road Traffic Accident) with respiratory distress and hypotension. He has subcutaneous emphysema and no air entry on the right side. What is the next best step in the management?

Accepted Answer

Needle decompression in the 5th intercostal space in the mid-axillary line

Answer

Start IV fluids after insertion of a wide-bore IV line

Answer

Shift the patient to the ICU and perform intubation

Answer

Initiate positive pressure ventilation

NEET-PG 2020

Forensic Medicine

Internal Medicine

Microbiology

Obstetrics and Gynecology

Pharmacology

Radiology

Surgery