NEET-PG 2015 Practice Questions

Q: Modafinil is primarily used for the treatment of which of the following conditions?

Narcolepsy. ***Narcolepsy*** - **Modafinil** is a **eugeroic** (wakefulness-promoting agent) specifically approved and widely used for the treatment of excessive daytime sleepiness associated with **narcolepsy**. - Its mechanism involves increasing **dopamine** and **norepinephrine** levels, and modulating **orexin** pathways, promoting alertness without significant psychomotor stimulation. *Sexual dysfunction* - While sometimes explored off-label for certain types of sexual dysfunction, **modafinil** is not a primary or approved treatment for this condition. - Primary treatments for sexual dysfunction often involve specific medications like **PDE5 inhibitors** or hormone therapy, depending on the cause. *Depression* - **Modafinil** is not a primary antidepressant, although it can be used as an **adjunctive therapy** in some cases to combat residual fatigue or hypersomnia associated with depression. - Standard treatment for depression involves **selective serotonin reuptake inhibitors (SSRIs)**, **serotonin-norepinephrine reuptake inhibitors (SNRIs)**, or other classes of antidepressants. *Anxiety* - **Modafinil** is a stimulant-like drug and can sometimes **exacerbate anxiety** in susceptible individuals due to its catecholaminergic effects. - Primary treatments for anxiety disorders include **selective serotonin reuptake inhibitors (SSRIs)**, **benzodiazepines** (for acute relief), and psychotherapy.

Q: Which of the following typical antipsychotic drugs is least commonly used in depot form?

Chlorpromazine. ***Chlorpromazine*** - Chlorpromazine is a **typical antipsychotic** that is **NOT available in depot form** for clinical use. - It is available only in **oral** and **short-acting injectable** formulations, making it the **least commonly used in depot form** among the options listed. - Its high sedative properties, orthostatic hypotension risk, and pharmacokinetic profile make it unsuitable for long-acting depot formulation. *Haloperidol* - **Haloperidol decanoate** is one of the **most widely used depot formulations** of typical antipsychotics. - Administered intramuscularly every **3-4 weeks**, it is highly effective for **long-term maintenance treatment** in schizophrenia. - Its favorable pharmacokinetic profile makes it ideal for depot preparation. *Fluphenazine* - **Fluphenazine decanoate** and **fluphenazine enanthate** are **well-established depot preparations** with decades of clinical use. - These formulations allow for dosing every **2-4 weeks**, significantly improving **medication adherence** in chronic psychotic disorders. - Fluphenazine depot is a first-line option for long-acting injectable antipsychotic therapy. *Trifluoperazine* - Trifluoperazine is primarily available and used as an **oral medication** for maintenance therapy. - While some limited depot formulations have been reported in older literature, they are **not commonly used in clinical practice**. - However, it is still more available in depot form than chlorpromazine, which has essentially **no depot use**.

Q: Which of the following statements about flumazenil is correct?

Can be used in benzodiazepine overdose. ***Can be used in benzodiazepine overdose*** - **Flumazenil** is a **competitive antagonist** at the **GABA-A receptor**, specifically designed to reverse the effects of **benzodiazepines**. - It binds to the same receptor site as benzodiazepines, effectively blocking their sedative and anxiolytic actions, making it useful in emergent overdose situations. *Can be used in barbiturate poisoning* - **Flumazenil** is **ineffective** in **barbiturate overdose** because barbiturates bind to a different site on the GABA-A receptor than benzodiazepines. - Barbiturates enhance **GABAergic activity** through a distinct mechanism, which flumazenil does not antagonize. *Specific antidote for opiate overdose* - The **specific antidote for opiate overdose** is **naloxone**, which acts as an opioid receptor antagonist. - **Flumazenil** has **no affinity** for opioid receptors and thus no role in reversing opiate toxicity. *None of the options* - This option is incorrect because **flumazenil** is indeed used for **benzodiazepine overdose**, as described above. - Its specific mechanism of action targets benzodiazepine-induced central nervous system depression.

Q: Which of the following is a common feature associated with mania?

Flights of ideas. ***Flights of ideas*** - A **flight of ideas** is characterized by a rapid, continuous, pressured flow of talk with abrupt changes from one topic to another, usually based on understandable associations or plays on words, which is a hallmark feature of **mania**. - This symptom reflects the accelerated thinking and heightened energy typical of a **manic episode**. *Neologism* - **Neologisms** are newly coined words or phrases, often without meaning to others, which are more commonly associated with thought disorders like **schizophrenia**. - While patients with mania can have pressured speech, the formation of nonsensical new words is not a primary or common feature of the condition. *Perseveration* - **Perseveration** involves the persistent repetition of a word, phrase, or gesture despite the absence of a stimulus or the appropriateness of the repetition, often seen in **cognitive disorders** or **schizophrenia**. - It differs from the rapidly shifting topics in a flight of ideas, where new thoughts are constantly being generated rather than a single thought being repeated. *Echolalia* - **Echolalia** is the automatic repetition of vocalizations made by another person, which is mainly observed in conditions such as **autism spectrum disorder** or **Tourette's syndrome**. - This symptom involves imitation rather than the spontaneous generation of accelerated speech and thoughts characteristic of mania.

Q: Which of the following conditions is NOT typically associated with increased REM latency?

Narcolepsy. ***Narcolepsy*** - **Narcolepsy** is characterized by pathologically **decreased REM latency**, not increased. - Patients typically enter REM sleep within **15 minutes** of sleep onset (normal is 60-90 minutes). - **Sleep-onset REM periods (SOREMPs)** are a diagnostic hallmark of narcolepsy, seen on multiple sleep latency testing (MSLT). - Since narcolepsy is associated with *decreased* REM latency, it is definitively **NOT associated with increased REM latency**, making it the correct answer to this negation question. *First night effect* - The **first-night effect** refers to sleep disruption and increased REM latency during the first night of polysomnography in an unfamiliar environment. - This is a well-documented phenomenon that **increases REM latency** due to environmental stress and arousal. *SSRIs* - **Selective serotonin reuptake inhibitors (SSRIs)** significantly suppress REM sleep, leading to **increased REM latency** and decreased total REM sleep time. - This effect is mediated by increased serotonin, which inhibits cholinergic neurons involved in REM sleep generation. - SSRIs can increase REM latency by 30-90 minutes beyond normal values. *Restless leg syndrome* - **Restless leg syndrome (RLS)** primarily causes difficulty initiating sleep and sleep fragmentation due to uncomfortable leg sensations. - While RLS disrupts sleep architecture, its effect on REM latency is **variable and inconsistent** - some studies show minimal impact, while chronic sleep deprivation from RLS may actually decrease REM latency during rebound sleep. - However, RLS is not as clearly and consistently dissociated from increased REM latency as narcolepsy is.

Q: Which of the following conditions is most commonly associated with self-mutilation?

Borderline personality disorder. **_Borderline personality disorder_** - **Self-mutilation** (e.g., cutting, burning) is a common coping mechanism in **borderline personality disorder (BPD)**, used to relieve intense emotional pain or a sense of emptiness. - This behavior is often associated with the characteristic **emotional dysregulation**, **impulsivity**, and unstable interpersonal relationships seen in BPD. - Self-mutilation is included as a diagnostic criterion in DSM-5 for BPD. *Catatonic schizophrenia* - This subtype of schizophrenia is characterized by profound disturbances in psychomotor behavior, such as **immobility**, **mutism**, **posturing**, or **excessive, purposeless motor activity**. - While individuals with catatonia may injure themselves during periods of extreme agitation or impulsivity, **self-mutilation** is not a primary or defining feature of catatonic schizophrenia. *Paranoid schizophrenia* - This type of schizophrenia is dominated by **delusions** (often persecutory or grandiose) and **auditory hallucinations**. - While individuals with paranoid schizophrenia may engage in self-harm if driven by delusional beliefs or command hallucinations, **self-mutilation** as a primary coping mechanism is not a hallmark characteristic of this disorder. *None of the options* - This option is incorrect because **borderline personality disorder** is strongly and specifically associated with self-mutilation.

Q: What is the treatment of choice for acute panic attacks?

Benzodiazepines. ***Correct: Benzodiazepines*** - Benzodiazepines are the **treatment of choice for acute panic attacks** due to their **rapid onset of action** (within minutes) - They work by enhancing **GABA-A receptor** activity, providing immediate anxiolytic effects - Commonly used agents include **alprazolam, lorazepam, and clonazepam** - While effective acutely, they are not recommended for long-term management due to dependence risk *Incorrect: Tricyclic antidepressants (TCAs)* - TCAs are effective for **long-term prophylaxis** of panic disorder, not acute attacks - They have a **delayed onset of action** (2-4 weeks), making them unsuitable for immediate relief - Significant **anticholinergic effects** and potential cardiotoxicity limit their use *Incorrect: Monoamine oxidase inhibitors (MAOIs)* - MAOIs can be effective for panic disorder but are reserved for **treatment-resistant cases** - **Delayed onset of action** (several weeks) makes them inappropriate for acute attacks - Require **dietary restrictions** and have risk of hypertensive crisis with tyramine-containing foods *Incorrect: Barbiturates* - Largely **obsolete** in psychiatric practice, replaced by safer benzodiazepines - **Narrow therapeutic index** with high risk of overdose and respiratory depression - Greater potential for dependence and withdrawal complications - No role in modern management of panic attacks

Q: A girl exhibits aggressive behavior such as smashing and throwing objects and verbally abusing hospital staff. However, she shows a different demeanor towards a particular resident doctor. What could be the most likely diagnosis?

Borderline personality disorder. ***Borderline personality disorder*** - Patients with **borderline personality disorder** often exhibit **impulsivity**, intense mood swings, and a pattern of unstable interpersonal relationships, leading to aggressive outbursts. - Their unpredictable behavior and tendency to form intense, unstable attachments or a "favorite person" dynamic are characteristic, as seen in her differing demeanor towards a particular resident doctor. *Bipolar disorder* - While bipolar disorder involves **mood swings**, the behavioral patterns are typically characterized by distinct episodes of **mania** or hypomania and depression, with less emphasis on chronic interpersonal instability and aggression. - The aggression in bipolar disorder is often associated with the manic phase but lacks the consistent pattern of relationship instability and "favorite person" dynamic described. *Schizoaffective disorder* - This disorder involves a combination of **psychotic symptoms** (like delusions or hallucinations) and **mood symptoms** (like depression or mania), which are not explicitly described here as the primary issue. - The aggressive behavior is not primarily driven by psychosis, and the specific interpersonal dynamic with staff is more suggestive of a personality disorder. *Antisocial personality* - **Antisocial personality disorder** is characterized by a pervasive pattern of disregard for and violation of the **rights of others** and may include aggression, but it often involves a lack of empathy and manipulativeness rather than the intense emotional dysregulation and unstable interpersonal patterns seen in borderline personality. - While aggressive behavior is present, the specific description of verbally abusing staff while showing a "different demeanor" towards a particular doctor points away from the typical presentation of antisocial disregard for others.

Q: In which of the following conditions is behavioral therapy most commonly utilized?

Agoraphobia. ***Agoraphobia*** - **Behavioral therapy**, particularly **exposure therapy**, is the **gold standard and first-line treatment** for agoraphobia. - It involves **systematic desensitization** and gradual exposure to feared situations (e.g., crowded places, public transport, open spaces). - This approach directly reduces **avoidance behaviors** and anxiety responses, making it the most commonly utilized behavioral intervention among these conditions. *Schizophrenia* - While behavioral interventions can be part of a comprehensive treatment plan, **pharmacotherapy** (antipsychotics) is the cornerstone for managing positive and negative symptoms. - Behavioral approaches often focus on **social skills training** and vocational rehabilitation, not primary symptom reduction. *Delirium* - The primary management for delirium involves identifying and treating the **underlying medical cause** and providing supportive care. - Behavioral therapy is generally not indicated as this condition is an **acute organic brain syndrome** requiring medical management. *Neurotic depression* - This term is largely outdated; current diagnostic manuals use terms like **persistent depressive disorder (dysthymia)** or **major depressive disorder**. - While behavioral activation is a component of CBT for depression, the primary treatments are **cognitive behavioral therapy (CBT)** and/or **pharmacotherapy** (antidepressants), rather than purely behavioral therapy.

Q: Most common complication of modified ECT

Amnesia. ***Amnesia*** - **Memory impairment**, particularly affecting **new learning (anterograde)** and **recall of past events (retrograde)**, is the most common and bothersome complication of modified ECT. - While typically transient, some patients may experience **persistent memory difficulties**, especially with autobiographical memories. *Intracerebellar hemorrhage* - **Intracerebellar hemorrhage** is an extremely rare and severe complication of ECT, not a common one. - Such an event would typically be linked to **pre-existing vascular abnormalities** or uncontrolled hypertension during the procedure. *Spinal fracture* - **Spinal fractures** were a significant concern in **unmodified ECT** due to unattenuated muscle contractions. - However, the use of **muscle relaxants** and **anesthesia** in modified ECT has significantly reduced the risk of musculoskeletal injuries, making it uncommon. *Muscle pain* - **Muscle aches** and soreness can occur after ECT due to **succinylcholine-induced fasciculations** and general muscle contraction, particularly in the neck and back. - While common, it is usually mild and easily managed with analgesics, and not considered the "most common complication" compared to cognitive effects.

Question 1

Modafinil is primarily used for the treatment of which of the following conditions?

Accepted Answer

Narcolepsy

Answer

Sexual dysfunction

Answer

Depression

Answer

Anxiety

Question 2

Which of the following typical antipsychotic drugs is least commonly used in depot form?

Accepted Answer

Chlorpromazine

Answer

Haloperidol

Answer

Fluphenazine

Answer

Trifluoperazine

Question 3

Which of the following statements about flumazenil is correct?

Accepted Answer

Can be used in benzodiazepine overdose

Answer

Can be used in barbiturate poisoning

Answer

Specific antidote for opiate overdose

Answer

None of the options

Question 4

Which of the following is a common feature associated with mania?

Accepted Answer

Flights of ideas

Answer

Neologism

Answer

Perseveration

Answer

Echolalia

Question 5

Which of the following conditions is NOT typically associated with increased REM latency?

Accepted Answer

Narcolepsy

Answer

First night effect

Answer

SSRIs

Answer

Restless leg syndrome

Question 6

Which of the following conditions is most commonly associated with self-mutilation?

Accepted Answer

Borderline personality disorder

Answer

Catatonic schizophrenia

Answer

Paranoid schizophrenia

Answer

None of the options

Question 7

What is the treatment of choice for acute panic attacks?

Accepted Answer

Benzodiazepines

Answer

Tricyclic antidepressants (TCAs)

Answer

Monoamine oxidase inhibitors (MAOIs)

Answer

Barbiturates

Question 8

A girl exhibits aggressive behavior such as smashing and throwing objects and verbally abusing hospital staff. However, she shows a different demeanor towards a particular resident doctor. What could be the most likely diagnosis?

Accepted Answer

Borderline personality disorder

Answer

Bipolar disorder

Answer

Schizoaffective disorder

Answer

Antisocial personality

Question 9

In which of the following conditions is behavioral therapy most commonly utilized?

Accepted Answer

Agoraphobia

Answer

Schizophrenia

Answer

Delirium

Answer

Neurotic depression

Question 10

Most common complication of modified ECT

Accepted Answer

Amnesia

Answer

Intracerebellar hemorrhage

Answer

Spinal fracture

Answer

Muscle pain

NEET-PG 2015

Pharmacology

Psychiatry