NEET-PG 2015 Practice Questions

Q: All of the following drugs increase the risk of postoperative nausea and vomiting after squint surgery in children except?

Propofol. ***Propofol*** - Propofol is known to have **antiemetic properties** and is often used to reduce the incidence of postoperative nausea and vomiting (PONV). - Its mechanism involves modulating **GABA-A receptors** and potentially other pathways that suppress emetic responses. *Halothane* - **Inhalational anesthetics** like halothane are a significant risk factor for PONV, particularly in children and following surgeries like squint repair. - They tend to increase PONV by directly stimulating the **chemoreceptor trigger zone** and altering gut motility. *Opioids* - Opioids, commonly used for postoperative pain control, are a well-known cause of **nausea and vomiting**. - They activate **opioid receptors** in the chemoreceptor trigger zone and the gastrointestinal tract, leading to emesis and delayed gastric emptying. *Nitrous Oxide* - The use of **nitrous oxide** as part of a general anesthetic regimen has been consistently associated with an increased risk of PONV. - It is believed to contribute to PONV by increasing the risk of **bowel distension** and stimulating neurotransmitter release involved in emesis.

Q: Which of the following is NOT one of Bradford Hill's criteria for causation?

Absence of temporal relationship. ***Absence of temporal relationship*** - Bradford Hill's criteria include **temporality** (temporal relationship), which states that the cause must precede the effect in time. - The criterion is the **presence** of a temporal relationship, not its absence. - "Absence of temporal relationship" is therefore NOT one of Bradford Hill's criteria—it is the opposite of what the criterion requires. - This is the correct answer to this "NOT" question. *Strength of association* - This **IS** one of Bradford Hill's criteria. - It refers to the **magnitude of the association** between exposure and outcome (measured by relative risk, odds ratio, etc.). - A stronger association provides more evidence for causality. *Consistency of association* - This **IS** one of Bradford Hill's criteria. - It means the association is observed **repeatedly** across different studies, populations, settings, and times. - Consistent replication strengthens the causal argument. *Specificity of association* - This **IS** one of Bradford Hill's criteria. - It suggests that a specific exposure leads to a specific outcome with limited alternative explanations. - While supportive of causation, Hill noted this criterion is less essential as many exposures have multiple effects.

Q: Which one of the following is NOT a utilization rate?

Population bed ratio. ***Population bed ratio*** - The **population bed ratio** indicates the number of available beds per unit of population, reflecting healthcare **resource availability** rather than resource utilization. - It is a measure of healthcare capacity and access, not how intensively those beds are being used. *Bed occupancy rate* - The **bed occupancy rate** measures the proportion of available hospital beds that are occupied over a given period, directly indicating the **utilization** of bed resources. - A higher rate suggests more efficient use of beds, while a lower rate may indicate underutilization or excess capacity. *Bed turnover ratio* - The **bed turnover ratio** calculates the number of patients discharged per bed over a specific period, reflecting how frequently beds are being used and re-used. - It indicates the **efficiency** with which beds are being utilized and cleared for new patients. *Average length of stay* - The **average length of stay (ALOS)** represents the average number of days a patient remains hospitalized, which directly relates to the **duration of bed utilization** per patient. - A shorter ALOS can indicate more efficient use of beds, while a longer ALOS may suggest higher resource consumption per patient.

Q: Otosclerosis affects which bone?

Stapes. ***Stapes*** - **Otosclerosis** is a condition characterized by abnormal bone growth in the middle ear, specifically around the **stapes footplate**. - This abnormal growth fixates the stapes, preventing it from vibrating properly and leading to **conductive hearing loss**. - **Fenestral otosclerosis** (most common type) directly affects the oval window and stapes footplate. *Incus* - The **incus** is the middle ossicle in the chain, between the malleus and the stapes. - While it can be affected by other middle ear pathologies, otosclerosis primarily targets the **stapes**. *Malleus* - The **malleus** is the outermost ossicle, attached to the eardrum. - Its involvement in otosclerosis is rare and indirect, as the primary site of disease is the **stapes**. *Cochlea* - **Cochlear (retrofenestral) otosclerosis** can occur but is less common and typically causes **sensorineural hearing loss**. - The classic presentation of otosclerosis involves **stapedial fixation** causing conductive hearing loss, not primary cochlear involvement.

Q: Eschar is seen in all the Rickettsial diseases except:

Endemic typhus. ***Endemic typhus*** - **Endemic typhus**, caused by *Rickettsia typhi*, is transmitted by **fleas** and typically presents without an eschar. - The disease is characterized by fever, headache, and a maculopapular rash, but the **inoculation site lesion (eschar) is rare or absent**. *Scrub typhus* - **Scrub typhus**, caused by *Orientia tsutsugamushi*, is known for causing a prominent **eschar** [1] at the site of the **chigger mite bite**. - This **painless black scab** is a classic diagnostic feature of the disease [1]. *Rickettsial pox* - **Rickettsial pox**, caused by *Rickettsia akari*, almost invariably presents with an **eschar**, often referred to as an **inoculation lesion**. - This lesion appears as a papule that vesiculates and then forms a scab, indicating the site of the **mite bite**. *Indian tick typhus* - **Indian tick typhus** (part of the **spotted fever group rickettsioses**), caused by *Rickettsia conorii*, frequently presents with a characteristic **eschar** at the site of the **tick bite**. - This eschar, known as a **tache noire**, is a valuable diagnostic clue in affected patients.

Q: Aspirin sensitive asthma is associated with:

Associated with nasal polyp. **Associated with nasal polyp** - **Aspirin-exacerbated respiratory disease (AERD)**, also known as aspirin-sensitive asthma, is characterized by a triad of **asthma**, **rhinosinusitis with nasal polyposis**, and respiratory reactions to **aspirin** and other NSAIDs [1]. - The presence of **nasal polyps** is a key clinical feature differentiating AERD from other forms of asthma [1]. *Obesity* - While **obesity** can exacerbate asthma severity, it is not specifically associated with the pathogenesis or diagnosis of **aspirin-sensitive asthma**. - It is a general risk factor for various health issues, including more severe asthma, but lacks specificity for AERD. *Extrinsic asthma* - **Extrinsic asthma** (allergic asthma) is typically triggered by environmental allergens and involves an **IgE-mediated response** [2]. - AERD is considered a **non-allergic** or **intrinsic asthma** phenotype, as it is not triggered by traditional allergens but by pharmacologic agents [1]. *Usually associated with urticaria* - **Urticaria** (hives) can be a feature of aspirin and NSAID sensitivity, particularly in some forms of **NSAID-induced urticaria/angioedema**. - However, the classic respiratory reactions of **aspirin-sensitive asthma** (bronchospasm, rhinitis) are distinct from urticarial reactions and typically do not present with primary urticaria.

Q: Which of the following statements about congenital glaucoma is incorrect?

Anterior chamber is shallow. ***Anterior chamber is shallow*** - In congenital glaucoma, the **anterior chamber depth is typically normal or deep**, not shallow. - A shallow anterior chamber is more characteristic of **angle-closure glaucoma**, which is mechanistically different. - This makes the statement incorrect, as congenital glaucoma is associated with a **deep anterior chamber** due to globe enlargement. *Photophobia is most common symptom* - **Photophobia** (sensitivity to light) is indeed one of the classic presenting symptoms in congenital glaucoma. - It forms part of the classic triad: **photophobia, epiphora (tearing), and blepharospasm**. - This occurs due to **increased intraocular pressure** causing corneal edema and irritation. *Thin and blue sclera seen* - The **sclera** can appear thin and blue due to **buphthalmos** (enlargement of the eye) and stretching of the globe. - The stretching allows the underlying **uveal tissue** to show through, giving the characteristic blue appearance. - This is a direct consequence of elevated intraocular pressure in a developing eye. *Haab's Striae may be seen* - **Haab's striae** are **Descemet's membrane tears** that are pathognomonic of congenital glaucoma. - These horizontal or curvilinear breaks occur due to stretching of the cornea from **elevated intraocular pressure**. - They appear as visible linear opacities on corneal examination.

Q: Aetiology of Dressler Syndrome is

Autoimmune. ***Autoimmune*** - Dressler syndrome is a form of **pericarditis** that occurs several days to weeks after myocardial injury (e.g., myocardial infarction, cardiac surgery, trauma). [3] - It is considered an **autoimmune phenomenon** where the body's immune system attacks damaged cardiac tissue. [1] *Viral infection* - While viral infections can cause general pericarditis, Dressler syndrome specifically refers to **post-cardiac injury** inflammation, not direct viral involvement. [2], [3] - Viral pericarditis typically has a more acute presentation without a preceding cardiac event. [2] *Toxin mediated* - There is no evidence to suggest that Dressler syndrome is caused by **toxins** or toxic substances. - The pathogenesis is linked to an immune response to damaged myocardial cells. *Idiopathic cause* - While some forms of pericarditis are idiopathic, Dressler syndrome has a clear **triggering event** (cardiac injury) and a well-understood autoimmune mechanism. [3] - Therefore, it is not classified as idiopathic. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 214-215. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 581-582. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Cardiovascular Disease, pp. 297-298.

Q: Which viral proteins are known to act as carcinogens in causing carcinoma cervix?

E - gene. ***E - gene*** - The **E - gene** in human papillomavirus (HPV) is known to play a crucial role in the **transformation of cervical cells**, leading to cancer development [1]. - Specifically, the **E6 and E7 proteins** encoded by this gene interfere with tumor suppressor functions, contributing to cervical carcinoma [1,2]. *L - gene* - The **L - gene** is associated with the virus's structural proteins, primarily aiding in the formation of the viral capsid. - It does not have a direct role in the oncogenic process leading to cervical cancer. *H - gene* - The **H - gene** is not specifically linked to the oncogenic effects of HPV; it is not recognized for contributing to cancer development. - It is often confused in discussions but doesn't directly influence the carcinogenic pathway like the E gene does. *P 24 - gene* - The **P 24 - gene** is not related to HPV; instead, it is associated with **HIV** and its structural components. - This gene does not play any role in the development of cervical carcinoma or transformation of cervical cells. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1006-1007. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 334-335.

Q: At what age group is Streptococcus pneumoniae pneumonia most commonly observed?

< 5 years. ***< 5 years*** - *Streptococcus pneumoniae* pneumonia is particularly common and severe in **young children**, especially those under the age of 5, due to their developing immune systems. - This age group has a higher incidence of **invasive pneumococcal disease**, including pneumonia and meningitis, making vaccination crucial. *5 - 15 years* - While pneumonia can occur in this age group, it is **less common** than in very young children or older adults. - The immune system is generally more developed and effective at this age, leading to a **lower incidence** of severe pneumococcal infections. *20 - 25 years* - This age group generally has a robust immune system, making *Streptococcus pneumoniae* pneumonia **uncommon** unless there are underlying risk factors such as immunocompromise or chronic medical conditions. - Most cases of pneumonia in young adults are often due to **viral pathogens** or *Mycoplasma pneumoniae*. *30 - 40 years* - Similar to the 20-25 years age group, incidence of *Streptococcus pneumoniae* pneumonia remains **relatively low** in healthy individuals in their 30s and 40s. - Increased risk is typically associated with **chronic illnesses**, smoking, or conditions that weaken the immune system.

Question 1

All of the following drugs increase the risk of postoperative nausea and vomiting after squint surgery in children except?

Accepted Answer

Propofol

Answer

Halothane

Answer

Nitrous Oxide

Answer

Opioids

Question 2

Which of the following is NOT one of Bradford Hill's criteria for causation?

Accepted Answer

Absence of temporal relationship

Answer

Consistency of association

Answer

Specificity of association

Answer

Strength of association

Question 3

Which one of the following is NOT a utilization rate?

Accepted Answer

Population bed ratio

Answer

Bed occupancy rate

Answer

Bed turnover ratio

Answer

Average length of stay

Question 4

Otosclerosis affects which bone?

Accepted Answer

Stapes

Answer

Incus

Answer

Malleus

Answer

Cochlea

Question 5

Eschar is seen in all the Rickettsial diseases except:

Accepted Answer

Endemic typhus

Answer

Scrub typhus

Answer

Rickettsial pox

Answer

Indian tick typhus

Question 6

Aspirin sensitive asthma is associated with:

Accepted Answer

Associated with nasal polyp

Answer

Extrinsic asthma

Answer

Obesity

Answer

Usually associated with urticaria

Question 7

Which of the following statements about congenital glaucoma is incorrect?

Accepted Answer

Anterior chamber is shallow

Answer

Thin and blue sclera seen

Answer

Photophobia is most common symptom

Answer

Haab's Striae may be seen

Question 8

Aetiology of Dressler Syndrome is

Accepted Answer

Autoimmune

Answer

Toxin mediated

Answer

Viral infection

Answer

Idiopathic cause

Question 9

Which viral proteins are known to act as carcinogens in causing carcinoma cervix?

Accepted Answer

E - gene

Answer

P 24 - gene

Answer

L - gene

Answer

H - gene

Question 10

At what age group is Streptococcus pneumoniae pneumonia most commonly observed?

Accepted Answer

< 5 years

Answer

5 - 15 years

Answer

20 - 25 years

Answer

30 - 40 years

NEET-PG 2015

Anesthesiology

Community Medicine

ENT

Internal Medicine

Ophthalmology

Pathology

Pediatrics