NEET-PG 2013 Practice Questions

Q: In which vein is Central Venous Pressure (CVP) most accurately monitored?

Internal jugular vein. ***Internal jugular vein*** - The **internal jugular vein** provides the **most direct and consistent access** to the superior vena cava and right atrium, where CVP is accurately measured. - Its straight course and reliable anatomical landmarks make it a preferred site for CVP catheter insertion. *Anterior jugular vein* - The **anterior jugular vein** is smaller and often has a more tortuous course, making consistent and reliable CVP monitoring difficult. - It is not typically chosen for central venous access due to its anatomical variability and smaller caliber. *External jugular vein* - The **external jugular vein** is superficially located and easier to access but often has valves and a more oblique angle to the subclavian vein, making catheter advancement to the central circulation challenging. - Catheter tip placement is less consistent for accurate CVP measurements compared to the internal jugular vein. *Inferior vena cava* - While the **inferior vena cava** eventually drains into the right atrium, access is typically via the femoral vein, which is associated with a higher risk of infection and deep vein thrombosis for long-term CVP monitoring. - Measurements from the inferior vena cava or femoral vein can be affected by **intra-abdominal pressure** and are not as accurately reflective of right atrial pressure as those from the superior vena cava.

Q: Central venous monitoring is typically used for all of the following except:

Administering thrombolytics. ***Administering thrombolytics*** - Central venous monitoring is a technique used to measure central venous pressure (CVP), which reflects right atrial pressure and indirectly **right ventricular preload**. It does not directly relate to the administration of **thrombolytics**. - Thrombolytics are typically administered intravenously through a peripheral or central line to dissolve clots, but CVP monitoring is not a prerequisite or a direct function of this administration. *Regulating the speed and amount of fluid infusion* - **Central venous pressure (CVP)** monitoring is crucial for assessing a patient's **fluid status** and guiding fluid resuscitation. - By continuously monitoring CVP, clinicians can determine whether to increase, decrease, or maintain the rate of **fluid infusion** to optimize cardiac preload without causing fluid overload. *Deciding the need for plasma infusion* - CVP values help assess **circulatory volume** and guide decisions on fluid replacement, including the need for **plasma infusion** in conditions like severe hypovolemia or coagulopathy. - A low CVP in a patient with bleeding or coagulation issues might indicate the need for volume expansion with **plasma**. *Deciding the requirement for blood transfusion* - **Low CVP** can indicate **hypovolemia**, which might be due to blood loss, thereby suggesting the need for a **blood transfusion**. - While not the sole determinant, CVP is one of several physiological parameters used to assess the urgency and amount of **blood products** required to restore circulating volume and oxygen-carrying capacity.

Q: What condition is associated with Lemierre's syndrome?

Thrombophlebitis of IJV. ***Thrombophlebitis of IJV*** - **Lemierre's syndrome** is classically defined as **septic thrombophlebitis of the internal jugular vein (IJV)** following an oropharyngeal infection [1]. - The infection, most commonly caused by *Fusobacterium necrophorum*, spreads from the pharynx to the parapharyngeal space, leading to IJV inflammation and thrombosis [1]. *Carotid sinus aneurysm* - A **carotid sinus aneurysm** is an abnormal focal dilation of the carotid sinus, often associated with atherosclerosis or connective tissue disorders. - It is not directly linked to the pathogenesis or complications of **Lemierre's syndrome**. *Traumatic occlusion of IJV* - **Traumatic occlusion of the IJV** results from direct injury to the neck, leading to vessel compression or damage. - While it affects the IJV, it does not involve the septic thrombophlebitis or preceding oropharyngeal infection characteristic of **Lemierre's syndrome**. *Any of the above* - This option is incorrect because **Lemierre's syndrome** is specifically associated with **septic thrombophlebitis of the IJV**, not with other unrelated vascular conditions affecting the neck.

Q: Deep vein thrombosis most commonly occurs at which site?

Femoral vein. ***Femoral vein*** - The **femoral vein**, along with the **popliteal** and **iliac veins**, are the most common sites for **deep vein thrombosis (DVT)** in the lower extremities [1]. - Due to their size and the dynamics of blood flow in these regions, they are prone to clot formation, especially in the presence of **Virchow's triad**. *Subclavian vein* - While DVT can occur in the subclavian vein (an **upper extremity DVT**), it is less common than in the lower extremities [1]. - Upper extremity DVTs are often associated with **central venous catheters** or **thoracic outlet syndrome**. *External jugular vein* - **External jugular vein thrombosis** is rare and usually associated with local trauma, infection, or central line placement, not typically primary DVT [1]. - It is a superficial vein and not considered a common site for typical deep vein thrombosis. *Internal jugular vein* - **Internal jugular vein thrombosis** is also uncommon as a primary DVT and often secondary to neck infections, malignancies, or indwelling catheters [1]. - Like the subclavian vein, it's considered an upper extremity DVT site, but less frequent than lower extremity sites.

Q: Decreased CVP is seen in

Bacterial sepsis. ***Bacterial sepsis*** - In **sepsis**, widespread **vasodilation** and increased capillary permeability lead to significant fluid redistribution out of the intravascular space [3]. - This results in a decrease in **venous return** and thus a lower **central venous pressure (CVP)** due to relative hypovolemia [2]. *Pneumothorax* - A **pneumothorax** causes increased intrathoracic pressure, compressing the great veins and heart. - This leads to **reduced venous return** and typically an *increase* in CVP, or at least a minimal change, due to obstructed outflow from the right atrium, not a decrease [2]. *PEEP* - **Positive end-expiratory pressure (PEEP)** increases intrathoracic pressure, which impedes venous return to the right atrium [2]. - This elevated pressure can artificially *increase* the measured CVP reading, and it does not typically cause a decrease in intrinsic CVP [2]. *Heart failure* - In **heart failure**, particularly right-sided heart failure or biventricular failure, the heart's pumping efficiency is reduced [1]. - This leads to **venous congestion** and an *increase* in CVP due to fluid overload and the inability of the right ventricle to effectively pump blood forward [2].

Q: Absent P Wave is seen on an ECG in:

Atrial Fibrillation (AF). ***Atrial Fibrillation (AF)*** - In **atrial fibrillation**, the atria beat chaotically and irregularly, leading to the absence of coordinated **atrial depolarization**, thus no distinct P wave is seen [1]. - The ECG characteristically shows an **irregularly irregular rhythm** with narrow QRS complexes and no discernible P waves. *Cor Pulmonale* - Cor pulmonale involves right ventricular hypertrophy and dilation due to lung disease, which can cause peaked **P waves (P pulmonale)** in leads II, III, aVF, indicating right atrial enlargement. - It does not typically lead to the absence of P waves but rather changes in their morphology. *Mitral Stenosis* - **Mitral stenosis** can cause left atrial enlargement, which typically manifests as a broad, notched **P wave (P mitrale)**, especially in lead II, and a prominent negative phase in V1. - P waves are present but altered in appearance due to the increased atrial pressure and volume. *Chronic Obstructive Pulmonary Disease (COPD)* - Patients with **COPD** often show signs of right atrial enlargement, similar to cor pulmonale, resulting in **P pulmonale** on the ECG due to increased pulmonary pressures. - While other ECG changes like low voltage and right axis deviation may be present, the P wave is generally present, though often peaked.

Q: Torsades de pointes is seen in all except

Hyponatremia. ***Hyponatremia*** - **Hyponatremia** (low sodium levels) primarily affects neuronal function and can lead to neurological symptoms like seizures and altered mental status [1]. - It does not directly cause **QT prolongation** or **Torsades de Pointes (TdP)**, which are typically associated with electrolyte imbalances affecting cardiac repolarization. *Hypocalcemia* - **Hypocalcemia** (low calcium levels) can prolong the **QT interval** on an electrocardiogram. - Prolongation of the QT interval increases the risk of developing **Torsades de Pointes**, a life-threatening polymorphic ventricular tachycardia [2]. *Hypomagnesemia* - **Hypomagnesemia** (low magnesium levels) is a common cause and aggravator of **Torsades de Pointes**. - Magnesium plays a crucial role in cardiac ion channel function, and its deficiency can lead to significant **QT prolongation** and ventricular arrhythmias. *Hypokalemia* - **Hypokalemia** (low potassium levels) can prolong the **QT interval** and increase the risk of developing ventricular arrhythmias, including **Torsades de Pointes** [1]. - Potassium channels are essential for cardiac repolarization, and their dysfunction due to low potassium can destabilize myocardial electrical activity [1].

Q: ECG image showing U wave. Patient is on furosemide and beta blocker. What is the most likely diagnosis?

Hypokalemia. ***Hypokalemia*** - The presence of **U waves** on an ECG is a classic sign of **hypokalemia**, often seen when serum potassium levels drop below 3.0 mEq/L. - The patient is taking **furosemide**, a loop diuretic, which commonly causes potassium loss and thus **hypokalemia**. *Hypocalcemia* - Hypocalcemia typically manifests on an ECG as a **prolonged QT interval**, not prominent U waves. - While furosemide can affect calcium, it usually leads to **hypercalcemia** due to volume contraction, not hypocalcemia. *Hyperkalemia* - Hyperkalemia is characterized by **tall, peaked T waves**, a **prolonged PR interval**, and a **widened QRS complex** on an ECG. U waves are absent. - Furosemide *causes* potassium excretion, making hyperkalemia an unlikely finding in this context. *Hypercalcemia* - Hypercalcemia typically causes a **shortened QT interval** on an ECG. U waves are not a feature. - While furosemide may sometimes lead to slight increases in calcium, it is not associated with U waves.

Q: Result of liquorice ingestion

Hypokalemic alkalosis. ***Hypokalemic alkalosis*** - **Licorice** contains **glycyrrhizic acid**, which inhibits **11β-hydroxysteroid dehydrogenase** in the kidneys, preventing the conversion of cortisol to inactive cortisone. - This leads to increased cortisol acting on **mineralocorticoid receptors**, mimicking **aldosterone excess**, resulting in **sodium reabsorption**, **potassium excretion** (hypokalemia), and **hydrogen ion excretion** (metabolic alkalosis). *Hyperkalemic alkalosis* - This option is incorrect because licorice ingestion leads to **hypokalemia** due to increased potassium excretion, not hyperkalemia. - While it does cause alkalosis, the associated potassium imbalance is the opposite of this choice. *Hypokalemic acidosis* - This option is incorrect because licorice ingestion causes a **metabolic alkalosis** due to increased hydrogen ion excretion, not acidosis. - Although it correctly identifies hypokalemia, the acid-base disturbance is wrong. *Hypernatremic acidosis* - This option is incorrect as licorice ingestion initially causes **sodium and water retention** (which can lead to hypernatremia in severe cases, but is not the primary driver of the acid-base), but primarily leads to **metabolic alkalosis**, not acidosis. - The combination of hypernatremia and acidosis is not characteristic of licorice toxicity.

Question 1

In which vein is Central Venous Pressure (CVP) most accurately monitored?

Accepted Answer

Internal jugular vein

Answer

Anterior jugular vein

Answer

External jugular vein

Answer

Inferior vena cava

Question 2

Central venous monitoring is typically used for all of the following except:

Accepted Answer

Administering thrombolytics

Answer

Deciding the need for plasma infusion

Answer

Deciding the requirement for blood transfusion

Answer

Regulating the speed and amount of fluid infusion

Question 3

What condition is associated with Lemierre's syndrome?

Accepted Answer

Thrombophlebitis of IJV

Answer

Carotid sinus aneurysm

Answer

Traumatic occlusion of IJV

Answer

Any of the above

Question 4

Deep vein thrombosis most commonly occurs at which site?

Accepted Answer

Femoral vein

Answer

Subclavian vein

Answer

External jugular vein

Answer

Internal jugular vein

Question 5

Decreased CVP is seen in

Accepted Answer

Bacterial sepsis

Answer

PEEP

Answer

Heart failure

Answer

Pneumothorax

Question 6

Absent P Wave is seen on an ECG in:

Accepted Answer

Atrial Fibrillation (AF)

Answer

Cor Pulmonale

Answer

Mitral Stenosis

Answer

Chronic Obstructive Pulmonary Disease (COPD)

Question 7

Torsades de pointes is seen in all except

Accepted Answer

Hyponatremia

Answer

Hypomagnesemia

Answer

Hypokalemia

Answer

Hypocalcemia

Question 8

ECG image showing U wave. Patient is on furosemide and beta blocker. What is the most likely diagnosis?

Accepted Answer

Hypokalemia

Answer

Hypocalcemia

Answer

Hyperkalemia

Answer

Hypercalcemia

Question 9

Coronary steal phenomenon caused due to

Accepted Answer

Preferential vasodilation of normal coronary vessels over stenotic vessels

Answer

Dilation of large coronary arteries

Answer

Dilation of epicardial coronary vessels

Answer

Dilation of capacitance vessels

Question 10

Result of liquorice ingestion

Accepted Answer

Hypokalemic alkalosis

Answer

Hyperkalemic alkalosis

Answer

Hypokalemic acidosis

Answer

Hypernatremic acidosis

NEET-PG 2013

Anesthesiology

ENT

Internal Medicine

Physiology