NEET-PG 2018 Practice Questions

Q: Anesthesia of choice for cesarean section in severe preeclampsia:-

Spinal. ***Spinal*** - **Spinal anesthesia** is generally preferred in severe preeclampsia because it provides **rapid onset** of dense block, which can be critical for emergent cesarean sections. - It avoids the risks associated with general anesthesia in these patients, such as difficult intubation and exaggerated **hypertensive response** to laryngoscopy. *GA* - **General anesthesia (GA)** in severe preeclampsia carries increased risks due to **airway edema**, potential for difficult intubation, and significant **blood pressure fluctuations** during induction and intubation. - It can exacerbate the already compromised uteroplacental perfusion due to the sympathetic blockade and the potential for a **hypotensive episode**. *Epidural* - While generally safe in less severe preeclampsia, an **epidural** has a **slower onset** compared to spinal anesthesia, which may be a disadvantage in emergent situations. - The gradual sympathetic blockade with an epidural is often preferred to avoid sudden drops in blood pressure, but the delay in achieving a surgical block might not be acceptable in severe, unstable cases. *Combined spinal-epidural (CSE)* - **Combined spinal-epidural (CSE)** offers the rapid onset of a spinal block with the flexibility of an epidural catheter for prolonged anesthesia or postoperative pain control. - However, in cases of severe preeclampsia where **hemodynamic instability** is a major concern, the relatively larger dose of local anesthetic required for epidural component can lead to a more pronounced or rapid drop in blood pressure.

Q: Elevated levels of vanillylmandelic acid (VMA) in urine are characteristically found in which of the following conditions?

Pheochromocytoma. ***Pheochromocytoma*** - **Vanillylmandelic acid (VMA)** is a major urinary metabolite of the **catecholamines epinephrine and norepinephrine**. - **Pheochromocytoma** is a tumor of the adrenal medulla that secretes excessive amounts of these catecholamines, leading to significantly elevated VMA levels in urine. *Phenyl ketonuria* - Characterized by the inability to metabolize **phenylalanine** due to a deficiency of the enzyme **phenylalanine hydroxylase**. - Leads to accumulation of **phenylalanine** and its metabolites, such as **phenylpyruvic acid**, not VMA. *Diabetic ketoacidosis* - A severe complication of **diabetes mellitus** resulting from a profound insulin deficiency, leading to high blood glucose and **ketone body** production. - While it alters metabolism, it does not directly lead to elevated VMA levels. *Alkaptonuria* - A rare genetic disorder caused by a deficiency of the enzyme **homogentisate 1,2-dioxygenase**, involved in **tyrosine metabolism**. - Results in the accumulation of **homogentisic acid**, which is excreted in the urine and turns dark on exposure to air, but does not involve VMA.

Q: In Cystinuria, all of the following amino acids are excreted in urine, except:-

Leucine. ***Leucine*** - Cystinuria is a disorder characterized by impaired transport of **dibasic amino acids** and **cystine**, not neutral amino acids like leucine. - Therefore, **leucine** would be properly reabsorbed and not significantly excreted in the urine. *Cystine* - **Cystine** is one of the four amino acids whose reabsorption is impaired in cystinuria, leading to its excessive excretion in urine and potential **kidney stone** formation. - The defect is in the **renal tubular transport system** for dibasic amino acids and cystine. *Ornithine* - **Ornithine** is a **dibasic amino acid** and its renal reabsorption is defective in cystinuria. - Like cystine, ornithine is excessively excreted in the urine due to the shared transport system. *Arginine* - **Arginine** is also a **dibasic amino acid** whose renal reabsorption is impaired in cystinuria. - Its presence in the urine is increased, along with cystine, ornithine, and lysine, forming the classic pattern of amino acid excretion in this condition.

Q: Which of the following is not true regarding Von Willebrand disease?

Hemarthrosis is the usual presentation. **Hemarthrosis is the usual presentation** - **Hemarthrosis** (bleeding into joints) is characteristic of severe factor deficiencies, such as **hemophilia A or B**, but is uncommon in von Willebrand disease (vWD) [2]. - vWD typically presents with **mucocutaneous bleeding** (e.g., easy bruising, nosebleeds, heavy menstrual bleeding) due to impaired platelet adhesion [2]. *Normal platelet count* - Patients with von Willebrand disease usually have a **normal platelet count**, as the issue is with the function or quantity of **von Willebrand factor (vWF)**, not the number of platelets [3]. - vWF primarily mediates platelet adhesion and protects **factor VIII** from degradation, so platelet production itself is unaffected [1]. *Quantitative defects are seen in subtypes 1 and 3 von Willebrand disease* - **Type 1 vWD** involves a partial **quantitative deficiency** of vWF, meaning reduced levels of otherwise normal vWF. - **Type 3 vWD** is characterized by a severe or near-complete **absence of vWF**, representing the most severe quantitative defect. *Produced by endothelial cells* - **Von Willebrand factor (vWF)** is primarily synthesized and stored in **endothelial cells** (in Weibel-Palade bodies) and also in **megakaryocytes**. - Its production by endothelial cells allows for its release into the bloodstream and subendothelial matrix to facilitate **hemostasis**.

Q: All are false about tigecycline, except:-

It is a broad spectrum antimicrobial. ***It is a broad spectrum antimicrobial*** - **Tigecycline** is known for its wide spectrum of activity, effective against a variety of gram-positive, gram-negative, and anaerobic bacteria. - It is particularly useful in treating infections caused by **multidrug-resistant (MDR)** organisms, including MRSA and VRE. *90% pseudomonas strains are sensitive* - Tigecycline generally has **poor activity** against *Pseudomonas aeruginosa*, and its use is specifically cautioned against for such infections. - **Many *Pseudomonas* strains are intrinsically resistant** to tigecycline, making it an unreliable choice for treating these infections. *It is bactericidal drug* - Tigecycline is a **bacteriostatic** antibiotic, meaning it inhibits bacterial growth rather than directly killing bacteria. - It achieves its effect by binding to the **30S ribosomal subunit**, thereby blocking protein synthesis. *Dose reduction is required in renal failure* - **Tigecycline** is primarily eliminated via **biliary and fecal excretion**, with only a small portion excreted renally. - Therefore, **dose adjustments are generally not required** in patients with renal impairment, but caution is usually advised in severe hepatic impairment.

Q: Maximum increase in prolactin level is caused by:-

Risperidone (Potent D2 receptor antagonist). ***Risperidone (Potent D2 receptor antagonist)*** - Risperidone is a **potent D2 receptor antagonist**, meaning it blocks dopamine's action at these receptors. Since dopamine inhibits prolactin release, blocking D2 receptors leads to a significant increase in **prolactin levels**. - Its high affinity for D2 receptors in the **tuberoinfundibular pathway** is a primary reason for its pronounced effect on prolactin. *Olanzapine (Primarily blocks 5HT2 receptors)* - While olanzapine can cause some prolactin elevation, its primary mechanism involves **5HT2 receptor blockade**, with less potent D2 antagonism compared to risperidone. - The degree of **hyperprolactinemia** associated with olanzapine is generally milder than that seen with risperidone. *Aripiprazole (D2 partial agonist)* - Aripiprazole is a **D2 partial agonist**, meaning it acts as an antagonist when dopamine levels are high and an agonist when dopamine levels are low, effectively stabilizing dopamine activity. - Due to its partial agonism, aripiprazole typically has a **low risk of hyperprolactinemia** and can even normalize elevated prolactin levels caused by other antipsychotics. *Clozapine (Primarily blocks 5HT2 receptors)* - Clozapine primarily blocks **5HT2 receptors** and has relatively weak D2 receptor antagonism, especially transient D2 blockade. - It generally causes **minimal to no prolactin elevation** and is considered a prolactin-sparing antipsychotic.

Q: Which of the following is a feature of Phenylketonuria?

Intellectual disability. ***Intellectual disability*** - Unmanaged **phenylketonuria (PKU)** leads to a toxic buildup of **phenylalanine** in the brain, causing severe and irreversible **intellectual disability**. - This neurotoxic effect is the primary and most devastating long-term consequence if not diagnosed and treated early. *Seizures* - While seizures can occur in **untreated PKU** due to neurotoxicity, they are a less consistent feature compared to intellectual disability. - Seizures typically occur in the context of severe, untreated disease and are considered a complication rather than a defining diagnostic feature. - Intellectual disability is the more universal and characteristic neuropsychiatric manifestation of PKU. *Loss of deep tendon reflexes* - This is not a typical feature of PKU; patients usually present with **increased muscle tone** and **hyperreflexia** due to neurological damage. - Loss of deep tendon reflexes is more characteristic of certain peripheral neuropathies or disorders affecting lower motor neurons. *Macrocephaly* - **Microcephaly**, rather than macrocephaly, can occasionally be observed in severe, untreated PKU due to impaired brain growth. - Macrocephaly is generally associated with conditions like hydrocephalus or certain genetic syndromes, not PKU. *All of the options* - This option is incorrect because the loss of deep tendon reflexes and macrocephaly are not characteristic features of PKU. - While seizures can occur, intellectual disability is the most defining and consistent feature among the options provided.

Q: Glasgow coma scale of a patient with head injury who is confused, localizes to pain on the right side but shows abnormal flexion on the left side, and opens eyes only to painful stimuli on sternum:

11. ***11*** - The Glasgow Coma Scale (GCS) score is calculated by summing the scores for **Eye Response**, **Verbal Response**, and **Motor Response**. - In this case: **Eye Response = 2** (opens eyes to painful stimuli), **Verbal Response = 4** (confused), and **Motor Response = 5** (localizes to pain on the right side). - **Key principle**: When there is **asymmetric motor response**, the **best motor response** is used for GCS calculation, not the worse response or an average. - Right side localizes to pain (M5) and left side shows abnormal flexion (M3), so we use M5. - **Total GCS = E2 + V4 + M5 = 11** *12* - This score would require a better response in at least one GCS component than what is described. - For a GCS of 12, the patient would need either: eyes opening to voice (E3), or obeys commands for motor (M6), or no confusion (V5). - The given patient has E2 + V4 + M5, which totals to 11, not 12. *6* - A score of 6 indicates **severe neurological impairment**, much worse than the described patient. - A GCS of 6 might include: no eye opening (E1) + incomprehensible sounds (V2) + abnormal flexion (M3) = 6. - This is significantly worse than the patient's current state with localizing response and confused speech. *7* - A GCS of 7 also represents **severe neurological deficit**, though not as profound as a score of 6. - This score would typically involve lower responses such as: E1 + V2 + M4 (withdrawal to pain) = 7, or E2 + V1 + M4 = 7. - The described patient has better responses (E2 + V4 + M5 = 11) than this would indicate.

Question 1

Anesthesia of choice for cesarean section in severe preeclampsia:-

Accepted Answer

Spinal

Answer

GA

Answer

Epidural

Answer

Combined spinal-epidural (CSE)

Question 2

Elevated levels of vanillylmandelic acid (VMA) in urine are characteristically found in which of the following conditions?

Accepted Answer

Pheochromocytoma

Answer

Phenyl ketonuria

Answer

Diabetic ketoacidosis

Answer

Alkaptonuria

Question 3

In Cystinuria, all of the following amino acids are excreted in urine, except:-

Accepted Answer

Leucine

Answer

Cystine

Answer

Ornithine

Answer

Arginine

Question 4

True statement regarding upper GI bleeds:

Accepted Answer

The most common cause of upper GI bleeds is peptic ulcer disease, not variceal bleeding.

Answer

Upper GI bleeding is defined as bleeding originating proximal to the ampulla of Vater, not the ligament of Treitz

Answer

Endoscopic banding is the first-line treatment for all types of upper GI bleeding

Answer

Rockall score is primarily used for immediate treatment decisions rather than risk stratification

Question 5

Which of the following is not true regarding Von Willebrand disease?

Accepted Answer

Hemarthrosis is the usual presentation

Answer

Normal platelet count

Answer

Quantitative defects are seen in subtypes 1 and 3 von Willebrand disease

Answer

Produced by endothelial cells

Question 6

In rheumatoid arthritis, which type of cells are prominently involved in the pathogenesis?

Accepted Answer

CD4+ helper cells

Answer

Lymphocyte

Answer

Macrophages

Answer

Dendritic cells

Question 7

All are false about tigecycline, except:-

Accepted Answer

It is a broad spectrum antimicrobial

Answer

90% pseudomonas strains are sensitive

Answer

It is bactericidal drug

Answer

Dose reduction is required in renal failure

Question 8

Maximum increase in prolactin level is caused by:-

Accepted Answer

Risperidone (Potent D2 receptor antagonist)

Answer

Olanzapine (Primarily blocks 5HT2 receptors)

Answer

Aripiprazole (D2 partial agonist)

Answer

Clozapine (Primarily blocks 5HT2 receptors)

Question 9

Which of the following is a feature of Phenylketonuria?

Accepted Answer

Intellectual disability

Answer

Loss of deep tendon reflexes

Answer

All of the options

Answer

Macrocephaly

Answer

Seizures

Question 10

Glasgow coma scale of a patient with head injury who is confused, localizes to pain on the right side but shows abnormal flexion on the left side, and opens eyes only to painful stimuli on sternum:

Accepted Answer

11

Answer

12

Answer

6

Answer

7

NEET-PG 2018

Anesthesiology

Biochemistry

Internal Medicine

Pathology

Pharmacology

Psychiatry

Surgery