NEET-PG 2021 - Pharmacology Practice Questions

Q: A patient has a history of vomiting and was given an antiemetic. The patient subsequently developed abnormal movements (likely extrapyramidal symptoms or dystonia). What medication should be given to manage these abnormal movements?

Benzhexol. ***Benzhexol*** - **Extrapyramidal symptoms (EPS)** and **dystonia** are often caused by dopamine receptor blockade, and **anticholinergic medications** like benzhexol help restore the **dopamine-acetylcholine balance**. - Benzhexol is a **muscarinic antagonist** that effectively reduces drug-induced Parkinsonism, dystonia, and akathisia by acting centrally. - It is the **preferred oral agent** for ongoing management of drug-induced movement disorders. *Diphenhydramine* - Diphenhydramine is an **antihistamine** with **anticholinergic properties** that can be used for **acute dystonic reactions**, particularly when given parenterally (IV/IM). - While effective for acute management, benzhexol is generally preferred for **ongoing oral therapy** and has more potent central anticholinergic effects. *Hyoscine* - While hyoscine is also an **anticholinergic agent**, it is primarily used for preventing **motion sickness** and managing **postoperative nausea and vomiting**. - Its efficacy in reversing acute extrapyramidal symptoms induced by neuroleptics or antiemetics is generally **less pronounced** compared to agents like benzhexol. *Methyl dopa* - Methyl dopa is an **alpha-2 adrenergic agonist** primarily used in the treatment of **hypertension**, especially in pregnancy. - It works by reducing sympathetic outflow and is **not indicated** for managing extrapyramidal symptoms or dystonia. *Cyproheptadine* - Cyproheptadine is an **antihistamine** with **serotonin antagonist** properties, used to treat allergic reactions, appetite stimulation, and occasionally **serotonin syndrome**. - It does not have significant anticholinergic effects that would alleviate medication-induced extrapyramidal symptoms or dystonia.

Q: Which of the following is false about pheochromocytoma?

Propranolol is the preferred drug for hypertension control. ***Propranolol is the preferred drug for hypertension control*** - Propranolol, a **beta-blocker**, is generally contraindicated as monotherapy in pheochromocytoma because blocking beta-receptors unopposed can lead to a **hypertensive crisis** due to unopposed alpha-adrenergic vasoconstriction. - **Alpha-blockers** (e.g., phenoxybenzamine) are the first-line agents for hypertension control, followed by beta-blockers once adequate alpha-blockade is established. *Surgery is the treatment of choice* - **Surgical resection** of the tumor is indeed the definitive treatment for pheochromocytoma once the patient has been appropriately prepared with alpha-blockade. - This approach aims to remove the source of excessive catecholamine production and resolve the associated symptoms. *VMA (vanillylmandelic acid) is a diagnostic test* - **VMA** is a metabolic breakdown product of catecholamines, and its measurement in a **24-hour urine collection** is a long-standing method for diagnosing pheochromocytoma. - Elevated VMA levels indicate overproduction of catecholamines, which is characteristic of the tumor. *Catecholamines are a diagnostic test* - Measuring **plasma free metanephrines** and **24-hour urinary fractionated metanephrines** (which are methylated metabolites of catecholamines) are highly sensitive and specific diagnostic tests for pheochromocytoma. - Elevated levels confirm the excessive secretion of these hormones by the tumor. *Most pheochromocytomas are benign* - Approximately **90% of pheochromocytomas are benign**, with only about 10% being malignant. - The **"rule of 10s"** is a helpful mnemonic: 10% bilateral, 10% extra-adrenal, 10% malignant, 10% familial, and 10% occur in children.

Q: A 50-year-old patient with renal insufficiency was recently operated on for pyelolithotomy. Which drug is the most appropriate choice for post-operative analgesia?

Acetaminophen. ***Acetaminophen*** - **Acetaminophen** is primarily metabolized in the liver, with minimal renal excretion, making it a safer option for patients with **renal insufficiency**. - It provides effective **analgesia** without the adverse renal effects associated with NSAIDs. *Diclofenac sodium* - **Diclofenac** is a non-steroidal anti-inflammatory drug (**NSAID**) that can impair renal function, especially in patients with pre-existing **renal insufficiency**, by inhibiting prostaglandin synthesis. - Its use can lead to further **kidney damage** or exacerbate existing renal impairment. *Naproxen* - **Naproxen** is an **NSAID** that carries a significant risk of causing acute kidney injury in patients with **compromised renal function**. - It reduces renal blood flow and glomerular filtration rate, making it unsuitable for this patient. *Indomethacin* - **Indomethacin** is a potent **NSAID** known for its adverse renal effects, including acute renal failure. - It should be avoided in patients with **renal insufficiency** due to its potential to further decline kidney function. *Ketorolac* - **Ketorolac** is a potent **NSAID** commonly used for post-operative pain but is **contraindicated** in patients with renal insufficiency. - It has significant nephrotoxic potential and can cause acute renal failure, especially in patients with pre-existing kidney disease.

Q: A hypertensive patient wants to conceive. Which of the following medications needs to be stopped before pregnancy?

ACE inhibitors. ***ACE inhibitors*** - **ACE inhibitors** are **teratogenic** and can cause **fetal kidney damage**, **oligohydramnios**, and **fetal death** if used during pregnancy. - They should be discontinued before conception or immediately upon pregnancy confirmation, and an alternative safe antihypertensive should be initiated. *Alpha Methyl dopa* - **Alpha-methyldopa** is considered one of the **first-line agents** for managing **hypertension in pregnancy** due to its established safety profile. - It reduces peripheral resistance without significantly affecting renal or uteroplacental blood flow. *Calcium Channel Blockers* - **Calcium channel blockers (CCBs)** like nifedipine and amlodipine are **generally considered safe** for use during pregnancy, especially dihydropyridines. - They are often used as **second-line treatments** for managing hypertension in pregnant women. *Labetalol* - **Labetalol** is a **beta-blocker** that is widely used and considered **safe** for treating **hypertension in pregnancy**. - It effectively lowers blood pressure without significant adverse effects on the fetus. *Hydralazine* - **Hydralazine** is a direct vasodilator that is **safe** for use in pregnancy and is commonly used for **acute management** of severe hypertension in pregnant women. - It has a long history of safe use during pregnancy without teratogenic effects.

Q: What is a potential consequence of administering indomethacin beyond 36 weeks of gestation?

Premature closure of the patent ductus arteriosus (PDA). ***Premature closure of the patent ductus arteriosus (PDA)*** - **Indomethacin**, a non-steroidal anti-inflammatory drug (NSAID), inhibits **prostaglandin synthesis**, which is crucial for maintaining PDA patency in utero. - **Premature closure of the PDA** beyond 36 weeks of gestation can lead to **pulmonary hypertension** and **fetal heart failure**, as blood flow through the fetal circulation would be significantly altered. - This is the **most serious cardiovascular complication** of indomethacin use in late pregnancy. *Teratogenic* - While some medications can be teratogenic (cause birth defects), **indomethacin** is not generally considered to have a significant teratogenic risk when used in the third trimester. - The primary concern with NSAID use in late pregnancy is related to their effects on fetal circulation and renal function, not structural anomalies. *No effect* - This statement is incorrect because **indomethacin** has well-documented and significant effects on fetal circulation, particularly on the **ductus arteriosus**, especially in the third trimester. - Its mechanism of action profoundly impacts the maintenance of the fetal circulatory shunts. *Still birth* - While **indomethacin** use in late pregnancy can lead to serious fetal complications such as **pulmonary hypertension** and **renal dysfunction**, leading to **fetal compromise**, it does not directly or exclusively cause stillbirth. - The specific and most direct consequence on the cardiovascular system is the premature closure of the PDA. *Oligohydramnios* - While **oligohydramnios** (decreased amniotic fluid) can occur with prolonged NSAID use due to **decreased fetal urine output** from renal effects, this is not the primary concern beyond 36 weeks. - The more immediate and serious risk is **premature PDA closure** with its cardiovascular consequences.

Q: What is the most suitable antibiotic to treat the condition shown in the image ?

Amoxicillin & Clavulanic Acid. ***Amoxicillin & Clavulanic Acid*** - The image shows a **paronychia** (an infection around the fingernail), likely bacterial, which typically involves **Gram-positive cocci** like *Staphylococcus aureus* or *Streptococcus spp.* - **Amoxicillin & Clavulanic Acid** is a broad-spectrum antibiotic effective against these common skin pathogens, including **beta-lactamase producing strains** of *Staphylococcus aureus* - This is the **first-line empiric treatment** for uncomplicated paronychia *Norfloxacin* - **Norfloxacin** is a **fluoroquinolone** primarily used for **urinary tract infections** and some gastrointestinal infections - It has limited efficacy against the common skin flora responsible for paronychia and is not a first-line choice for skin and soft tissue infections *Metronidazole* - **Metronidazole** is an antibiotic primarily effective against **anaerobic bacteria** and certain parasites - Paronychia is typically caused by aerobic bacteria, making metronidazole an inappropriate choice for empiric treatment *Amikacin* - **Amikacin** is an **aminoglycoside** antibiotic, usually reserved for serious Gram-negative bacterial infections due to its potential **ototoxicity** and **nephrotoxicity** - It is administered intravenously and is not suitable for a localized skin infection like paronychia unless there are severe systemic complications *Ciprofloxacin* - **Ciprofloxacin** is a **fluoroquinolone** with broader coverage than norfloxacin, including some Gram-positive organisms - However, it has **suboptimal activity against Streptococcus species** and methicillin-susceptible *S. aureus* compared to beta-lactam antibiotics - FDA guidelines recommend **avoiding fluoroquinolones for uncomplicated infections** due to serious side effects (tendon rupture, peripheral neuropathy) when safer alternatives exist

Question 1

A patient has a history of vomiting and was given an antiemetic. The patient subsequently developed abnormal movements (likely extrapyramidal symptoms or dystonia). What medication should be given to manage these abnormal movements?

Accepted Answer

Benzhexol

Answer

Hyoscine

Answer

Methyl dopa

Answer

Cyproheptadine

Answer

Diphenhydramine

Question 2

Which of the following is false about pheochromocytoma?

Accepted Answer

Propranolol is the preferred drug for hypertension control

Answer

Surgery is the treatment of choice

Answer

VMA (vanillylmandelic acid) is a diagnostic test

Answer

Catecholamines are a diagnostic test

Answer

Most pheochromocytomas are benign

Question 3

A 50-year-old patient with renal insufficiency was recently operated on for pyelolithotomy. Which drug is the most appropriate choice for post-operative analgesia?

Accepted Answer

Acetaminophen

Answer

Diclofenac sodium

Answer

Naproxen

Answer

Indomethacin

Answer

Ketorolac

Question 4

A patient with hypertension, peripheral edema, and chronic kidney disease (CKD) presents for management. Which of the following medications would be the best choice?

Accepted Answer

Chlorthalidone

Answer

Aliskiren

Answer

Beta blocker

Answer

Prazosin

Answer

Furosemide

Question 5

A hypertensive patient wants to conceive. Which of the following medications needs to be stopped before pregnancy?

Accepted Answer

ACE inhibitors

Answer

Calcium Channel Blockers

Answer

Labetalol

Answer

Hydralazine

Answer

Alpha-methyldopa

Question 6

What is a potential consequence of administering indomethacin beyond 36 weeks of gestation?

Accepted Answer

Premature closure of the patent ductus arteriosus (PDA)

Answer

Teratogenic

Answer

No effect

Answer

Still birth

Answer

Oligohydramnios

Question 7

What is the most suitable antibiotic to treat the condition shown in the image ?

Accepted Answer

Amoxicillin & Clavulanic Acid

Answer

Norfloxacin

Answer

Metronidazole

Answer

Amikacin

Answer

Ciprofloxacin

Question 8

A patient on multidrug therapy (MBMDT) for leprosy presents with inflammation over preexisting lesions and nerve involvement. What is the best approach for treatment?

Accepted Answer

Continue anti-leprosy treatment (ALT) and start steroids

Answer

Continue anti-leprosy treatment (ALT) and start thalidomide

Answer

Stop anti-leprosy treatment (ALT) and start thalidomide

Answer

Stop anti-leprosy treatment (ALT) and start steroids

Answer

Stop anti-leprosy treatment (ALT) temporarily and reassess

NEET-PG 2021 — Pharmacology