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: What does the Dibucaine number indicate in clinical practice?

Atypical acetylcholinesterase activity. ***Atypical acetylcholinesterase activity*** - The **Dibucaine number** quantifies the inhibition of **pseudocholinesterase (butyrylcholinesterase)** by the local anesthetic dibucaine. - A low Dibucaine number (e.g., < 20-30) indicates a genetically determined **atypical variant** of pseudocholinesterase, leading to prolonged duration of action of drugs like succinylcholine. *Potency of muscle relaxants* - The potency of muscle relaxants is typically assessed by the **ED95**, which is the dose required to produce 95% suppression of twitch response. - While Dibucaine is a local anesthetic that can cause muscle relaxation, the **Dibucaine number** specifically evaluates an enzyme's activity, not the strength of the relaxant itself. *Potency of general anesthetics* - The potency of general anesthetics is primarily measured by the **Minimum Alveolar Concentration (MAC)** required to prevent movement in 50% of patients in response to a noxious stimulus. - The Dibucaine number is unrelated to the mechanism or potency of general anesthetic agents. *None of the options* - This option is incorrect because **Atypical acetylcholinesterase activity** accurately describes what the Dibucaine number indicates. - The Dibucaine number is a specific laboratory test used to identify genetic variations in butyrylcholinesterase, which has significant clinical implications for drug metabolism.

Q: Which anaesthetic agent is neither metabolised by liver nor by kidney?

Atracurium. ***Atracurium*** - **Atracurium** undergoes **Hofmann elimination**, a non-enzymatic chemical degradation in plasma, and also **ester hydrolysis** by non-specific plasma esterases [2]. - This unique metabolism makes its elimination largely independent of **liver** and **kidney function**, making it a good choice for patients with organ dysfunction [2]. *Vecuronium* - Primarily metabolized by the **liver** into active and inactive metabolites [1]. - Its elimination can be prolonged in patients with **hepatic impairment** [1]. *Pancuronium* - Undergoes significant **hepatic metabolism** and subsequent **renal excretion** of both parent drug and metabolites [1]. - Its duration of action is significantly affected by both **liver** and **kidney dysfunction** [1]. *Rocuronium* - Primarily eliminated unchanged via **biliary excretion** (liver) [1]. - Its duration of action is prolonged in patients with **hepatic impairment** [1].

Q: Who is known for demonstrating the levels of ether anesthesia?

Guedel. ***Guedel*** - Arthur Guedel developed and refined the **stages and planes of ether anesthesia** based on clinical observations of respiratory patterns, eye signs, and muscle tone. - His classification system, known as the **Guedel stages**, provided a systematic approach to monitoring anesthetic depth, especially useful before the advent of modern anesthetic agents and monitoring equipment. *Morton* - **William T.G. Morton** is credited with the first successful public demonstration of sulfuric ether as a surgical anesthetic in 1846 during a tooth extraction. - While he pioneered the use of ether for anesthesia, he did not develop the classic stages of anesthetic depth. *Thompson* - There is no widely recognized historical figure named Thompson who is primarily known for defining the **levels or stages of ether anesthesia**. - This name is not associated with the primary discovery or classification of anesthetic depth. *None of the options* - This option is incorrect because **Guedel** is specifically known for his work in defining the stages of ether anesthesia. - Guedel's contributions were significant in standardizing anesthetic practice for many years.

Q: Which of the following is NOT a characteristic of dermatophytosis?

Subdermal infection. ***Subdermal infection*** - Dermatophytosis, or **ringworm**, is characterized by infection of the **superficial keratinized tissues** (skin, hair, nails) and does not typically extend into the subdermal layers. - While fungal infections can be systemic or deep, dermatophytes specifically are restricted to the **stratum corneum** and other dead keratinized structures. *Scaly skin* - **Scaling** is a very common characteristic of dermatophyte infections due to the fungus proliferating within the **stratum corneum**, leading to increased epidermal turnover and shedding. - The scaling can be fine or coarse, often presenting in an **annular (ring-like)** pattern. *Itchy skin* - **Pruritus (itching)** is a prominent symptom of dermatophytosis, often leading patients to seek medical attention. - The itching can range from mild to severe, contributing to discomfort and potential secondary skin excoriations. *Superficial infection* - Dermatophytosis is by definition a **superficial fungal infection**, meaning it is confined to the outermost layers of the skin, hair, and nails. - These fungi produce enzymes such as **keratinases** that allow them to digest keratin, but they generally do not invade viable tissue below the epidermis.

Q: Which of the following skin lesions is not classified as a nevus of melanocytes?

Becker nevus. ***Becker nevus*** - A **Becker nevus** is a **hamartoma** of the **epidermis, dermis, and hair follicles**, characterized by increased epidermal basal layer pigmentation and smooth muscle hyperplasia. - While it contains increased **melanin**, it does **not** involve a proliferation of **melanocytes** themselves, differentiating it from true melanocytic nevi. - It is an **organoid hamartoma** with epidermal and dermal components, not a melanocytic lesion. *Mongolian spot* - A **Mongolian spot** is a **dermal melanocytosis** where melanocytes are entrapped in the dermis during their migration from the neural crest to the epidermis. - While technically termed a "melanocytosis" rather than a "nevus," it represents an **ectopic collection of dermal melanocytes** and is classified among melanocytic lesions. - Unlike Becker nevus, it involves an actual abnormal distribution of melanocytes (not just increased melanin). *Congenital melanocytic nevus* - A **congenital melanocytic nevus** is a benign proliferation of **melanocytes** present at birth, involving the dermis and/or epidermis. - These are true **melanocytic nevi**, with a risk of malignant transformation, particularly in larger lesions (>20 cm). *Dysplastic nevus* - A **dysplastic nevus** (atypical nevus) is an atypical melanocytic nevus with architectural and cytological atypia, considered a potential precursor to melanoma. - It is classified as a **melanocytic nevus** due to the proliferation of atypical melanocytes with architectural disorder.

Q: Which of the following is NOT a feature of atopic dermatitis?

Darier’s Sign. ***Darier's Sign*** - **Darier's sign** is characteristic of **urticaria pigmentosa** (cutaneous mastocytosis), where rubbing a skin lesion causes the formation of an urticarial wheal due to mast cell degranulation - It is **not associated** with the pathogenesis or clinical presentation of **atopic dermatitis** *Dennie-Morgan fold* - **Dennie-Morgan folds** are extra folds or lines in the skin just below the lower eyelids - They are a common clinical sign observed in patients with **atopic dermatitis**, often linked to chronic inflammation and allergic reactions affecting the skin around the eyes *Hertoghe's sign* - **Hertoghe's sign** refers to the thinning or absence of the lateral third of the eyebrows - This sign is often seen in individuals with **atopic dermatitis**, as well as in other conditions like hypothyroidism *Hyperlinearity of palms* - **Hyperlinearity of palms** refers to the exaggerated creases and lines on the palms of the hands - This is a common **stigmata of atopy** and is frequently observed in patients with **atopic dermatitis**, reflecting the underlying predisposition to skin dryness and altered epidermal barrier function

Q: Oculoorogenital ulcers are associated with which of the following conditions?

Behcet's disease. ***Behcet's disease*** - This condition is characterized by **recurrent oral and genital ulcers**, along with **ocular inflammation** (e.g., uveitis), perfectly matching the "Oculoorogenital ulcers" description. - It is a **chronic, relapsing inflammatory disease** of unknown etiology involving vasculitis affecting various organ systems. *Lichen planus* - This is a chronic inflammatory condition affecting the **skin, hair, nails, and mucous membranes**. - While it can cause oral lesions, it typically presents as **purple, polygonal, pruritic papules** on the skin and does not cause genital ulcers or significant ocular involvement like Behcet's. *Systemic lupus erythematosus (SLE)* - SLE is a **systemic autoimmune disease** with diverse manifestations, including skin rashes, arthritis, and internal organ involvement. - Oral ulcers can occur, but **genital ulcers and severe ocular inflammation** as a prominent triad are not typical diagnostic features of SLE. *Psoriasis* - This is a common **chronic inflammatory skin disease** characterized by well-demarcated erythematous plaques with silvery scales. - Psoriasis primarily affects the skin and joints, and **does not typically present with oral, genital, or ocular ulcers** as described.

Q: Which local anesthetic is known for its vasoconstrictive properties?

Cocaine. ***Cocaine*** - Cocaine is unique among local anesthetics for its inherent **sympathomimetic** properties, leading to **vasoconstriction**. - This vasoconstriction is due to its ability to block the reuptake of **norepinephrine** and other catecholamines at adrenergic nerve terminals. *Procaine* - Procaine is an **ester-type** local anesthetic that typically causes **vasodilation**, which can lead to rapid systemic absorption and a shorter duration of action. - It does not possess any inherent vasoconstrictive properties. *Lidocaine* - Lidocaine, an **amide-type** local anesthetic, generally causes **vasodilation** at clinical concentrations. - Due to this vasodilatory effect, **epinephrine** is often added to lidocaine preparations to prolong its action and reduce systemic absorption. *Chlorprocaine* - Chlorprocaine is another **ester-type** local anesthetic known for its rapid onset and short duration of action. - It primarily causes **vasodilation**, similar to procaine, and has no intrinsic vasoconstrictive effects.

Q: Which chamber enlargement shows a double right heart border with a wide subcarinal angle?

Left atrium. ***Left atrium*** - A **double right heart border** on a chest X-ray is a classic sign of **left atrial enlargement**, as the enlarged left atrium bulges into the right atrial silhouette. - The **wide subcarinal angle** (angle between the mainstem bronchi) also indicates left atrial enlargement, as the expanding left atrium pushes the bronchi apart. *Left ventricle* - **Left ventricular enlargement** primarily manifests as a **downward and leftward displacement of the apex** and increased cardiac silhouette on the left. - It does not typically cause a double right heart border or widening of the subcarinal angle. *Right atrium* - **Right atrial enlargement** usually presents as a **prominent right heart border** that extends further to the right than normal. - It does not result in a double right heart border or affect the subcarinal angle. *Right ventricle* - **Right ventricular enlargement** leads to an **anterior bowing of the sternum** (in severe cases) and an upward and leftward displacement of the cardiac apex. - It pushes the left ventricle posteriorly and does not produce a double right heart border or a wide subcarinal angle.

Question 1

All of the following cause myocardial depression except:

Accepted Answer

Etomidate

Answer

Halothane

Answer

Thiopentone

Answer

Ketamine

Question 2

What does the Dibucaine number indicate in clinical practice?

Accepted Answer

Atypical acetylcholinesterase activity

Answer

Potency of muscle relaxants

Answer

Potency of general anesthetics

Answer

None of the options

Question 3

Which anaesthetic agent is neither metabolised by liver nor by kidney?

Accepted Answer

Atracurium

Answer

Vecuronium

Answer

Pancuronium

Answer

Rocuronium

Question 4

Who is known for demonstrating the levels of ether anesthesia?

Accepted Answer

Guedel

Answer

Morton

Answer

Thompson

Answer

None of the options

Question 5

Which of the following is NOT a characteristic of dermatophytosis?

Accepted Answer

Subdermal infection

Answer

Scaly skin

Answer

Itchy skin

Answer

Superficial infection

Question 6

Which of the following skin lesions is not classified as a nevus of melanocytes?

Accepted Answer

Becker nevus

Answer

Dysplastic nevus

Answer

Congenital melanocytic nevus

Answer

Mongolian spot

Question 7

Which of the following is NOT a feature of atopic dermatitis?

Accepted Answer

Darier’s Sign

Answer

Dennie-Morgan fold

Answer

Hyperlinearity of palms

Answer

Hertoghe’s sign

Question 8

Oculoorogenital ulcers are associated with which of the following conditions?

Accepted Answer

Behcet's disease

Answer

Lichen planus

Answer

Systemic lupus erythematosus (SLE)

Answer

Psoriasis

Question 9

Which local anesthetic is known for its vasoconstrictive properties?

Accepted Answer

Cocaine

Answer

Lidocaine

Answer

Chlorprocaine

Answer

Procaine

Question 10

Which chamber enlargement shows a double right heart border with a wide subcarinal angle?

Accepted Answer

Left atrium

Answer

Left ventricle

Answer

Right atrium

Answer

Right ventricle

NEET-PG 2012

Anesthesiology

Dermatology

Internal Medicine

Pharmacology

Radiology