NEET-PG 2012 Practice Questions

Q: All of the following cause myocardial depression except:

Etomidate. ***Etomidate*** - **Etomidate** is known for its **hemodynamic stability** and minimal effect on myocardial contractility, making it a suitable induction agent for patients with cardiovascular compromise. - While it can cause some decrease in systemic vascular resistance, it maintains **cardiac output** much better than other agents listed. *Halothane* - **Halothane** is a potent volatile anesthetic that directly depresses **myocardial contractility** and reduces cardiac output. - It sensitizes the myocardium to **catecholamines**, increasing the risk of arrhythmias. *Thiopentone* - **Thiopentone** (thiopental) is a barbiturate that causes significant **dose-dependent myocardial depression** and systemic vasodilation. - This can lead to a substantial decrease in **blood pressure** and cardiac output, especially with rapid administration. *Ketamine* - Although ketamine often causes an increase in heart rate and blood pressure due to **sympathetic stimulation**, it can also have a direct **myocardial depressant effect** when the sympathetic nervous system is exhausted or blocked. - Its indirect stimulant effects *can mask* a direct negative inotropic effect on the myocardium.

Q: Which of the following diseases has the maximum Disability-Adjusted Life Years (DALY) loss?

Unipolar depression (Major Depressive Disorder). ***Unipolar depression (Major Depressive Disorder)*** - **Major Depressive Disorder (MDD)** is considered a leading cause of **disability worldwide**, contributing significantly to DALYs due to its high prevalence, chronicity, and disabling nature. - The long-term impact on daily functioning, productivity, and overall quality of life makes it the mental disorder with the largest burden of disease. *Schizophrenia (Mental Disorder)* - While **schizophrenia** causes severe disability and is highly impactful on individuals and society, its prevalence is lower than that of unipolar depression. - The DALY burden for schizophrenia is substantial, but **unipolar depression** affects a much larger proportion of the global population. *Bipolar depression (Bipolar Disorder)* - **Bipolar disorder (depressive episodes)** also contributes significantly to disability, but it is less prevalent than unipolar depression. - Although the depressive phases are often more severe than unipolar depression, the overall DALYs are lower due to its **comparatively lower incidence**. *Mania (Bipolar Disorder Episode)* - **Mania**, a component of bipolar disorder, can cause significant impairment during an episode but is typically **episodic** and less frequent than depressive states in bipolar disorder. - The DALYs attributed to manic episodes alone are generally lower than the overall burden of persistent depressive states found in unipolar depression.

Q: Epulis arises from -

Gingiva. ***Gingiva*** - **Epulis** refers to a localized, tumor-like enlargement of the **gingiva** (gum tissue). - These lesions are typically inflammatory or reactive in nature, arising from the connective tissue of the gum. *Enamel* - **Enamel** is the hard, outermost protective layer of the tooth crown, which is of ectodermal origin. - Lesions originating from enamel itself are rare and typically involve developmental defects or structural damage, not soft tissue growths like epulis. *Root of teeth* - The **root of the teeth** is embedded in the alveolar bone and covered by cementum, with the surrounding structures including the periodontal ligament and alveolar bone. - While infections or cysts can arise from the root, epulis specifically describes a growth of the overlying **gingival tissue**. *Pulp* - The **pulp** is the soft tissue inside the tooth containing nerves, blood vessels, and connective tissue. - Pathologies originating from the pulp are typically infectious (pulpitis), degenerative, or involve growth of odontogenic tissues (e.g., pulp polyps within the tooth chamber), not surface gingival lesions.

Q: Which biomarker is typically elevated in the plasma of patients with chronic heart disease?

B-type natriuretic peptide (BNP). ***B-type natriuretic peptide (BNP)*** - **BNP** is a hormone secreted by **ventricular cardiomyocytes** in response to increased wall stretch and pressure overload, making it a strong indicator of **myocardial stress** and **chronic heart failure** [1]. - Elevated levels correlate with the **severity of heart failure**, aiding in diagnosis and prognosis [1]. *Endothelin-1* - **Endothelin-1** is a potent **vasoconstrictor** involved in vascular tone regulation and endothelial dysfunction. - While it can be elevated in conditions like **pulmonary hypertension** and **atherosclerosis**, it is not a primary diagnostic biomarker for chronic heart disease in general. *Troponin T* - **Troponin T** is a cardiac-specific protein that is released into the bloodstream following **myocardial injury or necrosis**. - While it is a crucial biomarker for **acute coronary syndromes** (e.g., heart attack), persistently elevated levels are not typical for stable chronic heart disease unless there is ongoing subclinical myocardial damage. *Cortisol* - **Cortisol** is a **stress hormone** produced by the adrenal glands, involved in metabolism, immune response, and blood pressure regulation. - While chronic stress can impact cardiovascular health, cortisol itself is not a specific diagnostic biomarker for chronic heart disease.

Q: In a 5-month pregnant female, which of the following statements regarding physiological changes is true?

80-90% have soft systolic murmur. ***80-90% have soft systolic murmur*** - The **increased blood volume** and **cardiac output** during pregnancy lead to increased flow across the aortic and pulmonic valves, often resulting in a **physiological systolic ejection murmur**. - This murmur is typically heard best at the **left sternal border** and usually resolves after delivery. *Cardiac output is reduced* - **Cardiac output actually increases** significantly during pregnancy, typically by 30-50%, to meet the metabolic demands of the fetus and placenta. - This increase is due to both an **increase in heart rate** and **stroke volume**. *Systemic vascular resistance is increased* - **Systemic vascular resistance (SVR) decreases** during pregnancy, primarily due to the **vasodilating effects of progesterone** and the creation of a **low-resistance placental circulation**. - The drop in SVR contributes to the physiological **decrease in blood pressure** often observed in mid-pregnancy. *Increase in CVP* - **Central venous pressure (CVP) typically remains unchanged or slightly decreases** during normal pregnancy. - While blood volume increases, the accompanying **vasodilation and decreased SVR** usually prevent a significant rise in CVP.

Q: 35 yr old with 4 months amenorrhea with increased FSH, decreased estrogen. What is the diagnosis?

Premature ovarian failure. ***Premature ovarian failure*** - The combination of **amenorrhea** for 4 months in a 35-year-old, with **increased FSH** and **decreased estrogen**, is characteristic of premature ovarian failure, indicating the ovaries are no longer responding to FSH stimulation. - This condition signifies the cessation of ovarian function before the age of 40, leading to menopausal symptoms and infertility. *Pituitary dysfunction* - Pituitary dysfunction might lead to **decreased FSH** (hypogonadotropic hypogonadism) due to insufficient stimulation of the ovaries, not increased FSH. - In cases of pituitary adenomas, increased prolactin can cause amenorrhea, but FSH would not be elevated in the manner described. *Hypothalamic dysfunction* - Hypothalamic dysfunction, such as **functional hypothalamic amenorrhea**, typically presents with **low or normal FSH and LH levels** (hypogonadotropic hypogonadism) due to reduced GnRH pulsatility. - This condition is often associated with stress, excessive exercise, or low body weight, and would not cause elevated FSH as seen here. *Polycystic Ovary Syndrome* - **Polycystic Ovary Syndrome (PCOS)** is characterized by **anovulation**, resulting in amenorrhea or oligomenorrhea, but typically involves **elevated androgens** and a **high LH-to-FSH ratio**, with FSH levels generally normal or low, and estrogen levels often normal or slightly elevated. - It would not present with simultaneously high FSH and low estrogen, which points to ovarian failure rather than anovulation with intact ovarian reserve.

Q: What is the ideal angle for Z-plasty?

60°. ***60°*** - An angle of **60°** is considered ideal for Z-plasty because it provides the best balance between **lengthening the scar** and maintaining **tissue viability**. - This angle typically results in a **75% gain in length** along the central limb of the Z-plasty, while ensuring the flaps have a broad enough base for adequate blood supply. *90°* - While a **90°** angle would provide the most lengthening (around 100%), it creates very **thin, narrow flap tips** that are highly susceptible to **ischemia and necrosis** due to compromised blood supply. - This angle is generally avoided in Z-plasty due to the high risk of **flap complications**. *45°* - A **45°** angle results in less lengthening (approximately 50% gain) compared to a 60° angle, which may not be sufficient for significant release of scar contractures. - While it offers excellent flap viability due to wider bases, the **suboptimal lengthening** makes it less efficient for many Z-plasty applications. *75°* - An angle of **75°** would yield greater lengthening than 60°, but it also compromises flap viability making the flap susceptible to **necrosis**. - The benefits of increased length are often outweighed by the increased **risk of complications** when using this angle.

Q: What is the first-line intervention for acute symptomatic hydroureter with ureteral obstruction requiring urgent decompression?

Endoscopic ureteral stenting. ***Endoscopic ureteral stenting*** - **Endoscopic ureteral stenting** is the primary intervention for **acute symptomatic ureteral obstruction** requiring urgent decompression when the obstruction causes **hydroureter**. - This minimally invasive procedure provides immediate drainage from the kidney to the bladder, preventing further renal damage, managing pain, and relieving obstruction. - **Indications for urgent stenting** include: infected hydronephrosis, impaired renal function, intractable pain, solitary kidney with obstruction, or bilateral obstruction. - Alternative to stenting is **percutaneous nephrostomy**, particularly when retrograde stent placement fails or in infected systems. *Antibiotic prophylaxis alone* - While antibiotics are essential when infection complicates obstruction (pyonephrosis), **antibiotics alone cannot relieve the mechanical obstruction**. - The physical blockage must be addressed to prevent progressive renal damage and sepsis. *Immediate ureterolithotomy* - **Open ureterolithotomy** is a definitive surgical treatment but is **not first-line** for acute obstruction. - It is more invasive and typically reserved for failed endoscopic management, large impacted stones, or anatomical abnormalities preventing endoscopic access. - Modern approach favors initial decompression followed by definitive treatment (ureteroscopy, ESWL, or surgery). *Urinary alkalization* - **Urinary alkalization** may help dissolve **uric acid stones** over time but does not provide immediate relief of acute obstruction. - This is an adjunctive measure for specific stone types, not an emergency intervention for symptomatic hydroureter.

Q: Circumcision is contraindicated in

Hypospadias. ***Hypospadias*** - In **hypospadias**, the **urethral opening** is located on the underside of the penis, and the foreskin is **essential** for **reconstructive surgery** (urethroplasty) to correct the defect. - Removing the foreskin via circumcision would eliminate this vital tissue, making surgical repair extremely difficult or impossible. - This is the **most absolute contraindication** to circumcision in pediatric urology. *Balanitis* - **Balanitis** is inflammation of the glans penis, often due to poor hygiene or infection. - Circumcision is actually a **treatment** for recurrent balanitis, not a contraindication. - It represents an **indication** for circumcision, not a contraindication. *Paraphimosis* - **Paraphimosis** is a urological emergency where the retracted foreskin becomes trapped behind the glans, causing vascular compromise. - Immediate management involves manual reduction or dorsal slit procedure. - Once the acute condition is resolved, elective circumcision can be performed to prevent recurrence—**not a contraindication**. *Exstrophy of bladder* - **Bladder exstrophy** is a severe congenital anomaly involving the epispadias-exstrophy complex, where the bladder is exposed outside the body. - The foreskin is typically **preserved for penile reconstruction** during complex staged repairs. - While this is also considered a **contraindication to circumcision** in most cases, **hypospadias** remains the **classic and most absolute contraindication** taught in medical education and is the expected answer for this question.

Question 1

All of the following cause myocardial depression except:

Accepted Answer

Etomidate

Answer

Halothane

Answer

Thiopentone

Answer

Ketamine

Question 2

Which of the following diseases has the maximum Disability-Adjusted Life Years (DALY) loss?

Accepted Answer

Unipolar depression (Major Depressive Disorder)

Answer

Schizophrenia (Mental Disorder)

Answer

Bipolar depression (Bipolar Disorder)

Answer

Mania (Bipolar Disorder Episode)

Question 3

Epulis arises from -

Accepted Answer

Gingiva

Answer

Enamel

Answer

Root of teeth

Answer

Pulp

Question 4

Which biomarker is typically elevated in the plasma of patients with chronic heart disease?

Accepted Answer

B-type natriuretic peptide (BNP)

Answer

Endothelin-1

Answer

Troponin T

Answer

Cortisol

Question 5

In a 5-month pregnant female, which of the following statements regarding physiological changes is true?

Accepted Answer

80-90% have soft systolic murmur

Answer

Cardiac output is reduced

Answer

Systemic vascular resistance is increased

Answer

Increase in CVP

Question 6

35 yr old with 4 months amenorrhea with increased FSH, decreased estrogen. What is the diagnosis?

Accepted Answer

Premature ovarian failure

Answer

Pituitary dysfunction

Answer

Hypothalamic dysfunction

Answer

Polycystic Ovary Syndrome

Question 7

In the initial management of a hemodynamically unstable polytrauma patient, what is the recommended initial crystalloid bolus dose of Ringer's lactate for assessment and stabilization?

Accepted Answer

1000 ml Ringer's lactate bolus, then regulated by clinical indicators

Answer

2000 ml Ringer's lactate bolus

Answer

250 ml Ringer's lactate bolus

Answer

500 ml Ringer's lactate bolus, then regulated by clinical indicators

Question 8

What is the ideal angle for Z-plasty?

Accepted Answer

60°

Answer

90°

Answer

45°

Answer

75°

Question 9

What is the first-line intervention for acute symptomatic hydroureter with ureteral obstruction requiring urgent decompression?

Accepted Answer

Endoscopic ureteral stenting

Answer

Antibiotic prophylaxis alone

Answer

Immediate ureterolithotomy

Answer

Urinary alkalization

Question 10

Circumcision is contraindicated in

Accepted Answer

Hypospadias

Answer

Paraphimosis

Answer

Exostrophy of bladder

Answer

Balanitis

NEET-PG 2012

Anesthesiology

Community Medicine

Dental

Internal Medicine

Obstetrics and Gynecology

Surgery