NEET-PG 2013 Practice Questions

Q: Which of the following anesthetic agents causes the LEAST severe complications when accidentally injected intra-arterially?

Propofol. **Propofol** * **Propofol** has a relatively low incidence and severity of complications if accidentally injected intra-arterially because of its **lipid emulsion formulation** and mild irritant properties compared to other agents. * While any intra-arterial injection can cause problems, the milder venoconstriction and less direct tissue damage make its intra-arterial complication profile less severe than alternative agents. *Thiopentone* * **Thiopentone** (Thiopental) is highly alkaline, and accidental intra-arterial injection can cause **intense pain**, **vasospasm**, and **gangrene** due to precipitation in the arterioles and widespread endothelial damage. * This severe complication arises from its extreme pH and crystal formation, leading to profound ischemia. *Midazolam* * Accidental intra-arterial injection of **Midazolam** can cause **pain**, **spasm**, and **local tissue damage** due to its relatively acidic pH and solvent properties, though generally less severe than thiopentone. * While not as catastrophic as thiopentone, it can still lead to significant discomfort and localized vascular issues. *Methohexitone* * **Methohexitone** is also an alkaline barbiturate derivative, similar in nature to thiopentone, and its intra-arterial injection carries a significant risk of **vasospasm**, **pain**, and potentially **tissue necrosis**. * Its strong irritant properties and ability to precipitate within the vasculature make it a dangerous agent for inadvertent intra-arterial administration.

Q: Which anaesthetic is contraindicated in renal failure?

Methoxyflurane. ***Methoxyflurane*** - Methoxyflurane undergoes significant **metabolism** to produce inorganic **fluoride ions**, which are directly **nephrotoxic**. - This nephrotoxicity can cause **high-output renal failure** with reduced concentrating ability, making it contraindicated in patients with pre-existing renal impairment. *Isoflurane* - Isoflurane is minimally metabolized and produces very low levels of **fluoride ions**, making it generally **safe** for use in patients with renal failure. - Its elimination is primarily via the **lungs**, with very little hepatic metabolism or renal excretion of active compounds. *Desflurane* - Desflurane is also minimally metabolized, similar to isoflurane, and therefore produces negligible amounts of **fluoride ions**. - It is considered a **safe option** for patients with renal impairment due to its predominantly pulmonary elimination and lack of nephrotoxic metabolites. *Halothane* - While halothane can cause **hepatotoxicity**, it is generally **not directly nephrotoxic** in the way methoxyflurane is. - Its metabolism, though more extensive than isoflurane or desflurane, does not produce clinically significant levels of nephrotoxic fluoride ions to contraindicate its use in renal failure.

Q: What does a Tzanck smear in varicella-zoster virus infection typically show?

Multinucleated giant cells. ***Multinucleated giant cells*** - A Tzanck smear identifies **multinucleated giant cells** with intranuclear inclusions, which are characteristic **cytopathic effects** of herpesviruses like VZV [1]. - These cells result from the fusion of infected keratinocytes, a hallmark finding in **herpes simplex** and **varicella-zoster infections** [1]. *Acantholytic cells* - Acantholytic cells are seen in conditions like **pemphigus vulgaris**, where there is loss of cell-to-cell adhesion between keratinocytes, leading to intraepidermal blistering. - While VZV can cause blistering, the primary cytological finding on Tzanck smear is not acantholysis but rather the presence of multinucleated cells. *Epidermal spongiosis* - Spongiosis refers to **intercellular edema** of epidermal cells, leading to widening of the intercellular spaces, typically seen in **eczematous dermatoses** [1]. - This finding is not specific to viral infections and does not represent the characteristic cytopathic effect of VZV on a Tzanck smear. *Necrotic cells* - Necrotic cells, or dead cells, are a general finding in many inflammatory and infectious processes where tissue damage occurs. - While VZV infection can lead to cell necrosis, the presence of isolated necrotic cells is not the specific, diagnostic feature for VZV on a Tzanck smear. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 366-367.

Q: Treatment of dermatitis herpetiformis:

All of the options. ***All of the options*** - **Dermatitis herpetiformis (DH)** is a chronic, intensely itchy blistering skin condition associated with **celiac disease**. - Effective management involves both a **gluten-free diet** to address the underlying autoimmune process and medications like **dapsone** or **sulfonamides** for symptomatic relief. *Gluten-free diet* - A strict **gluten-free diet** is crucial for long-term management as it addresses the underlying small intestinal enteropathy associated with **celiac disease** and **dermatitis herpetiformis**. - While it may take several months to see full skin improvement, it can eventually lead to resolution of skin lesions and reduced or eliminated need for medication. *Dapsone* - **Dapsone** is a rapidly effective medication for alleviating the intense itching and rash of **dermatitis herpetiformis**, often providing relief within 24-48 hours. - It works by inhibiting neutrophil migration and inflammation, but does not treat the underlying gluten-sensitive enteropathy. *Sulfonamide* - **Sulfonamides**, such as sulfapyridine or sulfamethoxypyridazine, can be used as an alternative for patients who cannot tolerate **dapsone** or who respond inadequately to it. - Like dapsone, these medications provide symptomatic relief by reducing inflammation and neutrophil activity in the skin, but do not address the gluten-induced intestinal damage.

Q: Lovibond profile sign is seen in ?

Nail clubbing. Nail clubbing - The Lovibond profile sign (Lovibond's angle or profile sign) is a clinical finding where the angle between the nail plate and the proximal nail fold straightens or becomes greater than 180 degrees. - This sign is a key indicator of nail clubbing, which is often associated with underlying systemic conditions such as respiratory or cardiac diseases [1]. Koilonychia (spoon nails) - Koilonychia presents as concave or spoon-shaped nails, where the nail plate is depressed centrally with everted edges [1]. - This condition is typically associated with iron deficiency anemia and does not involve an alteration of the Lovibond angle. Platynochia (flat nails) - Platynochia refers to nails that are unusually flat without the normal convex curvature. - This is a descriptive term for nail shape and is not specifically evaluated by the Lovibond profile sign. Onycholysis (separation of the nail from the nail bed) - Onycholysis is the detachment of the nail plate from the nail bed, usually starting at the distal free edge. - This condition is unrelated to the angle of the nail and the nail fold, which are assessed by the Lovibond profile sign.

Q: Most common site of ectopic pregnancy is -

Tubal. ***Tubal*** - The **fallopian tubes** are the most common site for ectopic pregnancies, accounting for over **95%** of all cases. - This is because the fertilized ovum typically implants in the tube rather than reaching the uterus. *Abdominal* - **Abdominal ectopic pregnancies** are rare, occurring when the fertilized egg implants in the abdominal cavity. - They account for about **1%** of all ectopic pregnancies and often result in significant maternal complications. *Ovarian* - **Ovarian ectopic pregnancies** are very rare, occurring when the ovum is fertilized within the ovary itself. - They represent less than **1%** of all ectopic cases and can be difficult to diagnose. *Cervical* - **Cervical ectopic pregnancies** involve implantation within the cervical canal. - These are also very rare (less than **1%** of ectopic pregnancies) and are associated with a high risk of severe hemorrhage.

Q: What is the primary hormonal cause of anovulatory dysfunctional uterine bleeding (DUB)?

Insufficient progesterone due to anovulation. ***Insufficient progesterone due to anovulation*** - Anovulation prevents the formation of a **corpus luteum**, which is responsible for producing progesterone. - The lack of progesterone leads to an **unstable, proliferative endometrium** that eventually sheds irregularly, causing abnormal uterine bleeding. - This is the **primary hormonal defect** in anovulatory DUB. *Excess estrogen production from ovarian follicles* - While **unopposed estrogen** is present in anovulatory cycles, the primary issue is the *absence of progesterone*, not necessarily excess estrogen production. - Estrogen levels may be normal or even low, but without progesterone to stabilize the endometrium, irregular shedding occurs. - Excess estrogen primarily leads to **endometrial hyperplasia** rather than irregular bleeding. *Hypothalamic dysfunction affecting ovulation* - Hypothalamic dysfunction (e.g., due to stress, extreme exercise) can be an *underlying cause* of anovulation. - However, the *primary hormonal mechanism* of the bleeding itself is the subsequent lack of progesterone, not the hypothalamic dysfunction directly. *High levels of progesterone due to luteal phase defect* - A **luteal phase defect** involves *insufficient* progesterone production or response, not high levels. - High progesterone levels would stabilize the endometrium and promote regular shedding, preventing DUB.

Q: Indications for ECT are all except?

Severe manic attack. ***Severe manic attack*** - While **severe mania IS a recognized indication for ECT**, it is generally considered **less commonly used as first-line therapy** compared to the other options listed. - In clinical practice, **acute severe mania** is typically managed initially with **antipsychotics and mood stabilizers** (lithium, valproate), with ECT reserved for **treatment-resistant cases** or when rapid response is critical. - ECT is highly effective for severe mania, particularly with **psychotic features** or **medication intolerance**, but is not the **most typical first-choice indication** compared to severe depression or catatonia. - This question reflects the **relative clinical priority** of ECT indications rather than absolute contraindication. *Severe depression with suicidal risk* - This is the **most common and well-established indication for ECT**. - ECT provides **rapid antidepressant effect** (often within 1-2 weeks) and is particularly indicated when there is **imminent suicide risk**, **psychotic depression**, or **treatment-resistant depression**. - Response rates exceed 70-90% in severe depression, making it a primary indication. *Catatonic schizophrenia* - **Catatonia is one of the strongest indications for ECT**, regardless of underlying etiology (schizophrenia, mood disorders, or medical conditions). - ECT rapidly resolves **catatonic symptoms** including mutism, stupor, posturing, and waxy flexibility. - Often considered **first-line treatment** for severe or malignant catatonia due to life-threatening complications. *Severe psychosis* - ECT is indicated for **severe psychotic disorders** that are **treatment-resistant** or when patients cannot tolerate antipsychotic medications. - Particularly effective in **acute psychotic agitation**, **treatment-refractory schizophrenia**, and psychosis with high risk of harm. - Provides rapid symptom control when pharmacotherapy has failed or is contraindicated.

Q: What does the term 'Folie-à-deux' refer to?

Sharing of delusion. ***Sharing of delusion*** - **Folie-à-deux**, also known as **shared psychotic disorder**, describes a rare psychiatric syndrome in which a **delusional belief** is transmitted from one individual to another. - It typically occurs between two people in a close relationship, where one individual (the primary case) develops a delusion and the other person (the secondary case) subsequently adopts the same delusion. *Delusion of persecution* - A **delusion of persecution** is a specific type of delusion where an individual believes they are being harmed, harassed, or conspired against by others. - While it can be the content of a shared delusion in folie-à-deux, the term itself refers to the *type* of delusion, not the *sharing* mechanism. *Delusion of double* - "Delusion of double" is not a standard term for folie-à-deux. - This phrase might be confused with **delusional misidentification syndromes** (like Capgras syndrome where a person believes someone has been replaced by an identical impostor), but this is a different concept from shared psychotic disorder. *None of the options* - This option is incorrect because "sharing of delusion" accurately defines folie-à-deux.

Q: What is the most common feature of sarcoidosis on chest X-ray?

Bilateral hilar lymphadenopathy. ***Bilateral hilar lymphadenopathy*** - **Bilateral hilar lymphadenopathy** is the hallmark radiological feature of sarcoidosis, seen in over 75% of cases. - This finding, often symmetrical, represents the accumulation of **non-caseating granulomas** in the lymph nodes. - Classic presentation in **Stage I and Stage II** sarcoidosis. *Pleural effusion* - **Pleural effusions** are uncommon in sarcoidosis, occurring in less than 5% of cases. - When present, they are usually small and unilateral, and their presence should prompt consideration of alternative diagnoses. *Cavitation* - **Cavitation** is a rare manifestation of sarcoidosis and is more characteristic of infectious processes like **tuberculosis** or certain fungal infections. - If seen, it usually suggests severe parenchymal involvement or superimposed infection. *Reticular opacities* - While **reticular opacities** (interstitial changes) can be seen in later stages of sarcoidosis, representing **pulmonary fibrosis**, they are not the *most common* initial finding. - These opacities indicate chronic disease progression (Stage III/IV) rather than the initial presentation.

Question 1

Which of the following anesthetic agents causes the LEAST severe complications when accidentally injected intra-arterially?

Accepted Answer

Propofol

Answer

Thiopentone

Answer

Methohexitone

Answer

Midazolam

Question 2

Which anaesthetic is contraindicated in renal failure?

Accepted Answer

Methoxyflurane

Answer

Isoflurane

Answer

Desflurane

Answer

Halothane

Question 3

What does a Tzanck smear in varicella-zoster virus infection typically show?

Accepted Answer

Multinucleated giant cells

Answer

Acantholytic cells

Answer

Epidermal spongiosis

Answer

Necrotic cells

Question 4

Treatment of dermatitis herpetiformis:

Accepted Answer

All of the options

Answer

Dapsone

Answer

Sulfonamide

Answer

Gluten-free diet

Question 5

Lovibond profile sign is seen in ?

Accepted Answer

Nail clubbing

Answer

Koilonychia (spoon nails)

Answer

Platynochia (flat nails)

Answer

Onycholysis (separation of the nail from the nail bed)

Question 6

Most common site of ectopic pregnancy is -

Accepted Answer

Tubal

Answer

Cervical

Answer

Abdominal

Answer

Ovarian

Question 7

What is the primary hormonal cause of anovulatory dysfunctional uterine bleeding (DUB)?

Accepted Answer

Insufficient progesterone due to anovulation

Answer

Excess estrogen production from ovarian follicles

Answer

Hypothalamic dysfunction affecting ovulation

Answer

High levels of progesterone due to luteal phase defect

Question 8

Indications for ECT are all except?

Accepted Answer

Severe manic attack

Answer

Severe psychosis

Answer

Catatonic schizophrenia

Answer

Severe depression with suicidal risk

Question 9

What does the term 'Folie-à-deux' refer to?

Accepted Answer

Sharing of delusion

Answer

Delusion of persecution

Answer

Delusion of double

Answer

None of the options

Question 10

What is the most common feature of sarcoidosis on chest X-ray?

Accepted Answer

Bilateral hilar lymphadenopathy

Answer

Cavitation

Answer

Pleural effusion

Answer

Reticular opacities

NEET-PG 2013

Anesthesiology

Dermatology

Internal Medicine

Obstetrics and Gynecology

Psychiatry

Radiology