NEET-PG 2020 Practice Questions

Q: Maximum work hours for a person including overtime under the Factories Act:

60 hours. ***60 hours*** - Under the **Factories Act**, the total number of hours worked by an adult in any week, including **overtime**, shall not exceed **sixty hours**. - This limit is crucial for ensuring workers' health and safety, preventing **over-fatigue**, and promoting a reasonable work-life balance. *48 hours* - The **Factories Act** stipulates that no adult worker shall be required or allowed to work in a factory for more than **forty-eight hours in any week**. - However, this limit refers to the standard work week and **does not include overtime**, which is allowed within an additional limit. *50 hours* - This option is incorrect as it does not align with the maximum weekly work hours, including overtime, stipulated by the **Factories Act**. - There is no specific provision in the **Factories Act** that sets a combined standard and overtime work limit at exactly 50 hours per week. *100 hours* - This option is significantly higher than the maximum work hours allowed by the **Factories Act**, including overtime. - Working 100 hours per week would be a serious violation of labor laws, as it would expose workers to **severe health risks** and **occupational hazards**.

Q: What poison will you detect in the skeleton even after decomposition

Arsenic. ***Arsenic*** - **Arsenic** has a high affinity for **keratin-rich tissues** like hair, nails, and skin, and also gets incorporated into bones. - Its presence in the skeleton and other tissues can be detected long after death, even in cases of **emaciation** or advanced decomposition. *Lead* - **Lead** primarily accumulates in **bones** due to its chemical similarity to calcium, where it can reside for decades. - While detectable in the skeleton, arsenic is often considered in forensic toxicology when looking for poisons in highly decayed remains due to its long-term persistence in various tissues. *Mercury* - **Organic mercury** forms, like **methylmercury**, primarily accumulate in the **brain and kidneys**, and to a lesser extent in hair and nails. - While some inorganic forms can be found in bone, its persistence and detectability in the skeleton after significant decomposition are generally less prominent than arsenic. *Cadmium* - **Cadmium** preferentially accumulates in the **kidneys and liver**, with a smaller proportion stored in bones. - While it can be detected in bone, its persistence in decayed remains and diagnostic significance as a poison in the skeleton is not as universal as arsenic.

Q: Esophageal manometry was performed - it revealed panesophageal pressurization with distal contractile integrity as >450mm Hg pressure in the body. What will be the diagnosis?

Type 3 achalasia. The diagnosis is Type 3 achalasia. This condition is characterized by panesophageal pressurization, indicating diffuse, simultaneous contractions throughout the esophagus. The high distal contractile integrity (>450 mmHg pressure) further supports Type 3 achalasia, which involves significant spastic contractions. In contrast, while high-resolution manometry allows for the accurate classification of these motility abnormalities [1], other types present differently. Type 1 achalasia (classic achalasia) is marked by failed esophageal peristalsis and absent or minimal esophageal pressurization [1]. The primary characteristic is incomplete or absent lower esophageal sphincter (LES) relaxation, not hypercontractility [1]. Type 2 achalasia is identified by esophageal panesophageal pressurization (simultaneous contractions), but with normal to high contractile pressures, not the extremely high values seen here. Jackhammer esophagus involves hypercontractility (distal contractile integral >8000 mmHg·cm·s) and is characterized by rapid, repetitive, and fragmented contractions, rather than the diffuse panesophageal pressurization and spasticity typical of Type 3 achalasia [2].

Q: Identify the parasite shown in the image.

Trichuris trichiura. ***Trichuris trichiura*** - The image displays characteristic **lemon-shaped** or **barrel-shaped eggs** with distinctive **polar plugs** at each end, which are pathognomonic for *Trichuris trichiura* (whipworm) eggs. - These eggs are thick-shelled and typically measure 50-55 µm by 20-25 µm, containing an undeveloped larva when passed in feces. *Ancylostoma duodenale* - Eggs of *Ancylostoma duodenale* (Old World hookworm) are **oval-shaped** with blunt ends, and a **thin shell**. - They typically contain a **segmented ovum** or an early-stage larva, lacking the polar plugs seen in the image. *Paragonimus westermani* - *Paragonimus westermani* (lung fluke) eggs are generally **oval-shaped** with a **flattened operculum** at one end, which is not visible in the image. - They are larger than *Trichuris* eggs, often measuring around 80-120 µm by 45-70 µm, and are often coughed up in sputum or passed in feces. *Strongyloides stercoralis* - *Strongyloides stercoralis* primarily produces **larvae** (rhabditiform or filariform) in stool samples rather than eggs. - If eggs are seen (rarely, in cases of severe diarrhea), they are small, thin-shelled, and typically contain a developed larva, unlike the eggs shown.

Q: Which distension medium is used for hysteroscopy with bipolar cautery?

NS. ***NS*** - **Normal Saline (NS)** is an **electrolyte-containing solution** (0.9% NaCl) and is thus safe to use with **bipolar electrosurgery** because it does not conduct current across the tissue but only between the two poles of the instrument. - Its isotonicity minimizes fluid shifts and its clear nature allows for good visualization. *Glycine* - **Glycine** is a **non-electrolyte solution** that is used with **monopolar electrosurgery**, as it does not conduct electrical current to the patient but only through the active electrode. - Using it with bipolar devices is unnecessary and can lead to complications such as **dilutional hyponatremia** and **hyperammonemia** if significant intravascular absorption occurs. *Carbon Dioxide* - **Carbon dioxide** is used as a distension medium for **diagnostic hysteroscopy** because of its lack of risk for fluid overload and clear visualization. - It is **contraindicated with electrosurgery** because of the risk of **gas embolism** and its potential for impaired visualization with significant bleeding. *Dextran 70* - **Dextran 70** is a **high-viscosity, non-electrolyte solution** primarily used for diagnostic hysteroscopy when blood or mucus obscures the view. - It is **contraindicated for electrosurgery** due to its non-conductive nature and the risk of **anaphylactic reactions** and **pulmonary edema** from volume expansion.

Q: Which of the following is not considered a prokinetic agent?

Diphenylmethane. Diphenylmethane derivatives (e.g., bisacodyl, sodium picosulfate) are stimulant laxatives, not prokinetic agents. While they do increase colonic motility, they work by direct stimulation of the colonic mucosa and myenteric plexus, causing increased water secretion and peristalsis [3]. Prokinetic agents specifically enhance coordinated gastrointestinal motility through modulation of neurotransmitters (acetylcholine, dopamine, serotonin, motilin), whereas laxatives work through different mechanisms (osmotic effects, stimulation, bulk formation). Therefore, diphenylmethane derivatives are classified as laxatives, not prokinetics. Dopamine antagonist - Dopamine antagonists like metoclopramide and domperidone block D2 receptors in the chemoreceptor trigger zone and GI tract, enhancing acetylcholine release and promoting gastric emptying [2]. - They are commonly used as prokinetic agents and antiemetics [2]. 5HT4 agonist - 5HT4 agonists (e.g., cisapride, prucalopride) stimulate serotonin receptors in the enteric nervous system, increasing acetylcholine release and enhancing colonic motility [1]. - They are effective prokinetic agents for conditions like chronic constipation and gastroparesis [1]. Macrolides - Certain macrolide antibiotics, such as erythromycin, act as motilin receptor agonists at sub-antibiotic doses. - By mimicking motilin, they stimulate gastric and intestinal contractions (phase III of migrating motor complex), functioning as prokinetic agents.

Q: A person was given a muscle relaxant that competitively blocks nicotinic receptors. Which of the following drugs is used for reversal of muscle relaxation after surgery?

Neostigmine. ***Neostigmine*** - **Neostigmine** is an **acetylcholinesterase inhibitor** that increases the amount of acetylcholine at the neuromuscular junction, thereby overcoming the competitive block at nicotinic receptors [1], [4]. - This increase in acetylcholine effectively reverses the paralysis caused by **nondepolarizing muscle relaxants**, making it useful for post-surgical recovery [2]. *Carbachol* - **Carbachol** is a **direct-acting cholinergic agonist** that stimulates both muscarinic and nicotinic receptors and is not typically used for reversing competitive neuromuscular blockade. - Its primary use is for glaucoma and to stimulate the bladder or bowels, not to counteract muscle relaxants. *Succinylcholine* - **Succinylcholine** is a **depolarizing muscle relaxant** and would prolong, rather than reverse, muscle blockade if administered after a competitive blocker [3]. - It works by initially causing depolarization and then preventing further muscle contraction, leading to paralysis. *Physostigmine* - **Physostigmine** is an **acetylcholinesterase inhibitor** that crosses the blood-brain barrier, making it more suitable for treating central anticholinergic toxicity rather than peripheral neuromuscular blockade. - While it inhibits acetylcholinesterase, its central effects and potential for seizures limit its use for reversing surgical muscle relaxation.

Q: What is the reflex in which there is inhibition of gastric emptying when there is acid and hypertonic solution in the duodenum?

Enterogastric. ***Enterogastric*** - The **enterogastric reflex** is initiated when the duodenum detects the presence of acid and hypertonic solutions, signifying that the chyme is not yet ready for further digestion and absorption. - This reflex inhibits **gastric emptying** to allow more time for the stomach to process its contents and for the duodenum to neutralize the acid and dilute the hypertonic solution. *Gastroileal* - The **gastroileal reflex** increases motility in the ileum when the stomach is distended, facilitating the movement of chyme into the large intestine. - This reflex does not primarily involve the inhibition of gastric emptying due to duodenal contents. *Gastrocolic* - The **gastrocolic reflex** increases the motility of the colon in response to the stretching of the stomach by food. - Its main function is to prepare the large intestine for upcoming chyme and does not directly inhibit gastric emptying. *Myenteric* - The **myenteric plexus** (Auerbach's plexus) is a network of neurons located between the longitudinal and circular layers of the muscularis propria throughout the gastrointestinal tract. - While it plays a crucial role in controlling gut motility and is involved in numerous reflexes, it refers to a neural plexus rather than a specific reflex mechanism for inhibiting gastric emptying due to duodenal stimuli.

Q: A patient with depression was given Imipramine for 2 weeks. Relatives noticed increased excitement, colorful clothes, and increased talking. What is the next step in management?

Discontinue Imipramine and start Valproate. ***Discontinue Imipramine and start Valproate*** - The patient's symptoms (increased excitement, colorful clothes, increased talking) after starting an antidepressant like **Imipramine** suggest a **manic switch**, indicating undiagnosed **bipolar disorder**. - **Imipramine** should be discontinued as it can exacerbate mania, and a mood stabilizer like **Valproate** is necessary to treat the manic episode. *Continue Imipramine alone* - Continuing Imipramine would likely worsen the manic symptoms, leading to increased agitation and potential harm. - Antidepressants can trigger or worsen manic episodes in individuals with underlying bipolar disorder. *Manage with Valproate alone* - While Valproate is an appropriate treatment for acute mania, simply managing with Valproate alone without discontinuing the offending antidepressant would be suboptimal. - The continued presence of Imipramine would counteract the mood-stabilizing effects of Valproate. *Antipsychotic with Imipramine continued* - Adding an antipsychotic might manage some acute manic symptoms, but continuing Imipramine would maintain the driving force behind the manic switch. - The primary action should be to remove the causative agent (Imipramine) and replace it with a mood stabilizer.

Q: Which of the following is not a component of the Thoracoscore?

Expected complications post-surgery. ***Expected complications post-surgery*** - While patient risk assessment tools aim to predict surgical outcomes, the **Thoracoscore** specifically calculates risk based on present patient characteristics and surgical plan, not based on a list of expected complications. - Expected complications are a *result* of the risk score, not an input into its calculation. *ASA classifications* - The **American Society of Anesthesiologists (ASA) Physical Status Classification System** is a crucial component of the Thoracoscore, reflecting the patient's overall health status and comorbidity burden. - A higher ASA classification indicates greater surgical risk and contributes to the Thoracoscore calculation. *Surgery priorities* - **Surgery priority** (e.g., elective, urgent, emergency) is an important factor in the Thoracoscore, as urgent or emergent surgeries are associated with higher risk. - This parameter helps categorize the immediacy and complexity of the surgical intervention. *Performance status* - The patient's **performance status**, often assessed using scales like the Eastern Cooperative Oncology Group (ECOG) or Karnofsky, is a significant predictor of surgical outcome and is included in the Thoracoscore. - A lower performance status (indicating poorer functional capacity) increases the calculated surgical risk.

Question 1

Maximum work hours for a person including overtime under the Factories Act:

Accepted Answer

60 hours

Answer

48 hours

Answer

50 hours

Answer

100 hours

Question 2

What poison will you detect in the skeleton even after decomposition

Accepted Answer

Arsenic

Answer

Lead

Answer

Mercury

Answer

Cadmium

Question 3

Esophageal manometry was performed - it revealed panesophageal pressurization with distal contractile integrity as >450mm Hg pressure in the body. What will be the diagnosis?

Accepted Answer

Type 3 achalasia

Answer

Type 2 achalasia

Answer

Jackhammer esophagus

Answer

Type 1 achalasia (classic achalasia)

Question 4

Identify the parasite shown in the image.

Accepted Answer

Trichuris trichiura

Answer

Ancylostoma duodenale

Answer

Strongyloides stercoralis

Answer

Paragonimus westermani

Question 5

Which distension medium is used for hysteroscopy with bipolar cautery?

Accepted Answer

NS

Answer

Glycine

Answer

Carbon Dioxide

Answer

Dextran 70

Question 6

Which of the following is not considered a prokinetic agent?

Accepted Answer

Diphenylmethane

Answer

Dopamine antagonist

Answer

5HT4 agonist

Answer

Macrolides

Question 7

A person was given a muscle relaxant that competitively blocks nicotinic receptors. Which of the following drugs is used for reversal of muscle relaxation after surgery?

Accepted Answer

Neostigmine

Answer

Carbachol

Answer

Succinylcholine

Answer

Physostigmine

Question 8

What is the reflex in which there is inhibition of gastric emptying when there is acid and hypertonic solution in the duodenum?

Accepted Answer

Enterogastric

Answer

Gastroileal

Answer

Gastrocolic

Answer

Myenteric

Question 9

A patient with depression was given Imipramine for 2 weeks. Relatives noticed increased excitement, colorful clothes, and increased talking. What is the next step in management?

Accepted Answer

Discontinue Imipramine and start Valproate

Answer

Continue Imipramine alone

Answer

Manage with Valproate alone

Answer

Antipsychotic with Imipramine continued

Question 10

Which of the following is not a component of the Thoracoscore?

Accepted Answer

Expected complications post-surgery

Answer

Surgery priorities

Answer

ASA classifications

Answer

Performance status

NEET-PG 2020

Community Medicine

Forensic Medicine

Internal Medicine

Microbiology

Obstetrics and Gynecology

Pharmacology

Physiology

Psychiatry

Surgery