Internal Medicine
3 questionsAdrenal reserve is best tested by means of infusion with
What is the best immediate management strategy for a patient experiencing respiratory alkalosis due to anxiety-induced hyperventilation?
A 40-year-old male patient presents to the Emergency department with central chest pain for 2 hours. The ECG shows ST segment depression and cardiac troponins are elevated. The patient has a positive history of previous PCI 3 months back. He is administered Aspirin, Clopidogrel, Nitrates, and LMWH in the Emergency Department and shifted to the coronary care unit. What is the best recommended course of further action?
NEET-PG 2013 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 871: Adrenal reserve is best tested by means of infusion with
- A. ACTH (Correct Answer)
- B. Metyrapone
- C. Corticosteroids
- D. LHRH
Explanation: ACTH - The **ACTH stimulation test**, also known as the **cosyntropin test**, is the most common dynamic test for assessing adrenal reserve. - Exogenous ACTH (cosyntropin) stimulates the adrenal glands to produce cortisol; a subnormal response indicates adrenal insufficiency. *Corticosteroids* - **Corticosteroids** are hormones (like cortisol) produced by the adrenal glands, or synthetic versions used as medications; they do not test adrenal reserve but rather *replace* adrenal function. - Administering corticosteroids would interfere with, rather than assess, the adrenal gland's ability to produce its own hormones. *LHRH* - **Luteinizing hormone-releasing hormone (LHRH)** is used to assess the function of the anterior pituitary gland and gonads, not the adrenal glands. - An LHRH stimulation test evaluates the pituitary's ability to release LH and FSH, which in turn stimulate gonadal hormone production. *Metyrapone* - The **metyrapone test** assesses the integrity of the **hypothalamic-pituitary-adrenal axis** by blocking cortisol synthesis, which should lead to an increase in ACTH and 11-deoxycortisol [1]. - While it evaluates a part of adrenal function, it is primarily used to differentiate between primary and secondary adrenal insufficiency, and not a direct measure of cortisol production capacity in response to stimulation.
Question 872: What is the best immediate management strategy for a patient experiencing respiratory alkalosis due to anxiety-induced hyperventilation?
- A. Rebreathing in paper bag (Correct Answer)
- B. IPPV
- C. Normal saline
- D. Acetazolamide
Explanation: ***Rebreathing in paper bag*** - This helps to **increase the inspired CO2 concentration**, thereby correcting the hypocapnia (low CO2) caused by hyperventilation. - It's a simple, non-invasive method to raise arterial PCO2 and normalize blood pH in acute respiratory alkalosis. *IPPV* - **Intermittent positive pressure ventilation (IPPV)** would further reduce CO2 by assisting ventilation and is typically used for respiratory *acidosis* or failure [1]. - This intervention would worsen the patient's respiratory alkalosis rather than alleviating it. *Normal saline* - **Normal saline** administration is primarily used for volume expansion or to correct electrolyte imbalances; it does not directly address respiratory alkalosis. - It would not correct the underlying issue of excessive CO2 exhalation. *Acetazolamide* - **Acetazolamide** is a carbonic anhydrase inhibitor that reduces bicarbonate reabsorption and is used to treat metabolic alkalosis or as a diuretic. - It would not be an immediate or appropriate solution for acute respiratory alkalosis and might even worsen the acid-base balance if used improperly.
Question 873: A 40-year-old male patient presents to the Emergency department with central chest pain for 2 hours. The ECG shows ST segment depression and cardiac troponins are elevated. The patient has a positive history of previous PCI 3 months back. He is administered Aspirin, Clopidogrel, Nitrates, and LMWH in the Emergency Department and shifted to the coronary care unit. What is the best recommended course of further action?
- A. Early Revascularization with PCI (Correct Answer)
- B. Continue conservative management and monitoring of cardiac enzymes and ECG
- C. Continue conservative management and plan for outpatient follow-up
- D. Immediate Revascularization with Coronary Angiography
Explanation: ***Early Revascularization with PCI*** - The patient presents with **NSTEMI** (ST depression, elevated troponins) and is already on antiplatelet and anticoagulant therapy. **Early revascularization** (ideally within 24 hours for high-risk NSTEMI) is indicated to restore blood flow and prevent further myocardial damage [1]. - Given the patient's history of prior **PCI** and the current NSTEMI presentation, this suggests possible **in-stent restenosis** or progression of coronary artery disease, making revascularization crucial. *Continue conservative management and monitoring of cardiac enzymes and ECG* - While initial conservative management with medications is appropriate, simply continuing monitoring without definitive intervention is insufficient for a **high-risk NSTEMI** patient. - The elevated troponins and ST depression indicate ongoing myocardial injury that requires active management beyond just observation [1]. *Continue conservative management and plan for outpatient follow-up* - This approach is entirely inappropriate for a patient presenting with an **acute coronary syndrome (NSTEMI)**. - Outpatient follow-up is for stable conditions, not for an ongoing cardiac event that requires urgent hospital-based intervention. *Immediate Revascularization with Coronary Angiography* - **Immediate revascularization** (within 90 minutes) is primarily indicated for **STEMI** (ST elevation myocardial infarction). - While coronary angiography will precede PCI, the term "immediate" in this context usually refers to the urgency seen in STEMI; NSTEMI typically warrants "early" rather than "immediate" intervention (within 12-24 hours for high-risk patients like this one) [1].
Pathology
1 questionsThe most common translocation seen in patients with Multiple Myeloma is:
NEET-PG 2013 - Pathology NEET-PG Practice Questions and MCQs
Question 871: The most common translocation seen in patients with Multiple Myeloma is:
- A. t(14;16)
- B. t(4;14)
- C. t(11;14) (Correct Answer)
- D. t(14;20)
Explanation: ***t(11;14)*** - This translocation is the **most common cytogenetic abnormality** found in patients with multiple myeloma, occurring in approximately 15-20% of cases. - It results in the juxtaposition of the **IgH gene on chromosome 14** with the **cyclin D1 gene on chromosome 11**, leading to overexpression of cyclin D1. *t(4;14)* - This translocation, occurring in about 5-10% of patients, is associated with a **poor prognosis** in multiple myeloma. - It involves the IgH gene on chromosome 14 and the **FGFR3 and MMSET genes on chromosome 4**, leading to their upregulation. *t(14;16)* - This translocation is also associated with a **poor prognosis** and is less common than t(11;14) or t(4;14), found in about 2-5% of cases. - It involves the **IgH gene on chromosome 14** and the **c-MAF gene on chromosome 16**, leading to overexpression of c-MAF. *t(14;20)* - This translocation is **rarely observed** in multiple myeloma patients, typically occurring in less than 1% of cases. - It involves the **IgH gene on chromosome 14** and the **MAFB gene on chromosome 20**, which can also contribute to disease progression.
Pharmacology
2 questionsWhat is the drug of choice for managing generalized tonic-clonic seizures (GTCS) during pregnancy?
Which drug is used to keep the patent ductus arteriosus (PDA) open?
NEET-PG 2013 - Pharmacology NEET-PG Practice Questions and MCQs
Question 871: What is the drug of choice for managing generalized tonic-clonic seizures (GTCS) during pregnancy?
- A. Lamotrigine (Correct Answer)
- B. CBZ
- C. Levetiracetam
- D. Valproate
Explanation: ***Lamotrigine*** - **Lamotrigine** is considered **one of the preferred drugs** for managing epilepsy during pregnancy due to its relatively **low teratogenic risk** compared to older antiepileptic drugs. - Its established safety profile in pregnancy makes it a preferred option to balance seizure control and **fetal well-being**. - **Important Note:** For **GTCS specifically**, lamotrigine and levetiracetam are both considered appropriate first-line choices, with selection depending on individual patient factors and seizure control history. - Lamotrigine levels **decrease during pregnancy** and require monitoring and dose adjustments. *CBZ* - **Carbamazepine (CBZ)** is associated with an increased risk of **neural tube defects** and other congenital malformations when used during pregnancy, making it less favorable. - While effective for GTCS, its teratogenicity often leads to avoidance or careful consideration of alternatives in pregnant women. *Levetiracetam* - **Levetiracetam** is increasingly recognized as an **excellent choice for GTCS in pregnancy** with a favorable safety profile and growing evidence base. - Many recent guidelines and clinical practices favor levetiracetam as **first-line for GTCS** due to its low risk of major congenital malformations and good efficacy. - It is a **medically appropriate alternative** to lamotrigine, and in some contexts may be preferred, particularly for primary generalized epilepsy. *Valproate* - **Valproate** has the highest risk of **teratogenicity** among common antiepileptic drugs, including a significant risk of **neural tube defects**, developmental delay, autism spectrum disorder, and other anomalies. - Due to these significant risks, valproate is generally **contraindicated** in women of childbearing potential, especially during pregnancy, unless no other effective and safer alternative exists.
Question 872: Which drug is used to keep the patent ductus arteriosus (PDA) open?
- A. PGE1 (Correct Answer)
- B. PGI2
- C. PGH2
- D. PGF2α
Explanation: ***PGE1*** - **Prostaglandin E1** (**PGE1**, alprostadil) is used to maintain the patency of the **ductus arteriosus** in neonates with certain congenital heart defects [1], [2]. - It acts as a **vasodilator** on the smooth muscle of the ductus, preventing its closure and allowing for adequate blood flow prior to surgical correction [1], [2]. *PGI2* - **Prostaglandin I2** (**PGI2**, prostacyclin) is a potent **vasodilator** and **platelet aggregation inhibitor** [1]. - While it has cardiovascular effects, it is primarily used for conditions like **pulmonary hypertension** and not for maintaining ductal patency [1]. *PGF2̑* - **Prostaglandin F2̑** (**PGF2̑**) is involved in processes such as **uterine contractions** and **bronchoconstriction** [1], [2]. - It does not play a role in maintaining the patency of the ductus arteriosus. *PGH2* - **Prostaglandin H2** (**PGH2**) is an immediate precursor in the synthesis of various other prostaglandins and thromboxanes. - It is not directly administered as a drug to maintain ductal patency but is an intermediate in their synthesis.
Physiology
1 questionsAt what age do the proportions of intracellular fluid (ICF) and extracellular fluid (ECF) in a child approximate those of an adult?
NEET-PG 2013 - Physiology NEET-PG Practice Questions and MCQs
Question 871: At what age do the proportions of intracellular fluid (ICF) and extracellular fluid (ECF) in a child approximate those of an adult?
- A. 3 years
- B. 4 years
- C. 1 year
- D. 2 years (Correct Answer)
Explanation: ***2 years*** - By the age of **2 years**, the relative proportions of intracellular fluid (ICF) and extracellular fluid (ECF) in a child reach levels comparable to those found in adults. - Infants have a significantly higher percentage of ECF, which gradually decreases as they grow and mature. - This represents the key transition point where adult fluid compartment ratios are first approximated. *1 year* - At **1 year of age**, the ECF proportion is still relatively higher than in adults, though it has decreased from neonatal levels. - The shift towards adult fluid proportions is ongoing and not yet complete. *3 years* - By **3 years of age**, the fluid proportions are already well-established at adult levels, as this milestone is reached by age 2. - This age comes after the initial approximation point, so it is not the earliest age when adult proportions are reached. *4 years* - At **4 years of age**, the child's fluid distribution is well within adult proportions. - The main transition period for fluid compartment ratios is usually completed by age 2, making this age too late to represent the approximation point.
Radiology
3 questionsA chest X-ray shows bilateral lung infiltrates. What is the next best investigation?
All the following are true of craniopharyngioma except:
The CT severity index in acute pancreatitis is described by:
NEET-PG 2013 - Radiology NEET-PG Practice Questions and MCQs
Question 871: A chest X-ray shows bilateral lung infiltrates. What is the next best investigation?
- A. Sputum examination
- B. CT (Correct Answer)
- C. Bronchoscopy
- D. Echocardiography
Explanation: ***CT*** - A **CT scan (preferably HRCT)** provides a more detailed view of the lung parenchyma, allowing for better characterization of the infiltrates (e.g., location, pattern, presence of nodules, ground-glass opacities, or consolidation). - This detailed imagery is crucial for narrowing down the differential diagnosis and guiding further diagnostic or therapeutic interventions. - **CT is the best next investigation** for characterizing bilateral lung infiltrates seen on chest X-ray. *Sputum examination* - While important for identifying infectious causes, **sputum examination** is often only productive in certain types of pneumonia or infections and might not directly clarify the morphology or distribution of the infiltrates as a CT scan would. - It might be a subsequent step once the nature of the infiltrate is better understood through imaging. *Bronchoscopy* - **Bronchoscopy** is an invasive procedure generally reserved for cases where less invasive methods have failed to yield a diagnosis or when specific findings from imaging (like a CT scan) suggest the need for direct visualization, lavage, or biopsy. - It's not typically the immediate next step after identifying bilateral infiltrates on a chest X-ray. *Echocardiography* - **Echocardiography** is useful for evaluating cardiac causes of bilateral infiltrates (such as pulmonary edema from heart failure). - However, it does not directly visualize or characterize the lung parenchymal infiltrates themselves, making CT more valuable as the next investigation.
Question 872: All the following are true of craniopharyngioma except:
- A. Derived from Rathke's pouch
- B. Contains epithelial cells
- C. Causes visual disturbances
- D. Present in sella or infra-sellar location (Correct Answer)
Explanation: ***Present in sella or infra-sellar location*** - Craniopharyngiomas are typically located in the **suprasellar region**, above the **sella turcica**, where they can compress the optic chiasm. - While they can extend into the sella, their primary location is rarely exclusively intrasellar or infrasellar. *Derived from Rathke's pouch* - This statement is true; craniopharyngiomas arise from remnants of **Rathke's pouch**, the embryonic precursor of the anterior pituitary gland. - This origin explains their characteristic location near the pituitary stalk and third ventricle. *Contains epithelial cells* - This statement is true as **craniopharyngiomas** are benign **epithelial tumors**, specifically adamantinomatous or papillary types. - They are composed of stratified squamous epithelium, often with calcifications and cystic components. *Causes visual disturbances* - This statement is true because the **suprasellar location** of a craniopharyngioma often leads to compression of the **optic chiasm**, resulting in characteristic visual field deficits like bitemporal hemianopsia. - Visual disturbances are a common presenting symptom due to their proximity to the visual pathways.
Question 873: The CT severity index in acute pancreatitis is described by:
- A. Balthazar score (Correct Answer)
- B. Mengini score
- C. Chapman score
- D. Napelon score
Explanation: ***Balthazar score*** - The **Balthazar score** (or CT severity index) is a widely used radiological grading system for assessing the severity of **acute pancreatitis** based on findings on computed tomography (CT) scans. It evaluates both pancreatic inflammation and necrosis. - The Balthazar score helps predict the clinical course and potential complications of pancreatitis by assigning points for **pancreatic inflammation** and the extent of **necrosis**. *Mengini score* - The **Mengini score** is not a recognized CT severity index specifically for acute pancreatitis. - This name is not associated with any established scoring system in gastroenterology. *Chapman score* - The **Chapman score** refers to specific somatic points used in **osteopathic manipulative medicine** for diagnosis and treatment, primarily related to lymphatic system dysfunction. - It has no relevance to the radiological assessment or severity grading of acute pancreatitis. *Napelon score* - The **Napelon score** does not exist as a recognized medical scoring system, particularly in the context of acute pancreatitis or medical imaging. - This name is likely a distractor and not associated with medical practice.