NEET-PG 2019 Practice Questions

Q: Depth of Anesthesia is best measured by:

BIS. ***BIS*** - The **BIS (Bispectral Index)** is an EEG-derived parameter that provides a quantitative measure of the patient's level of consciousness or depth of anesthesia. - A typical range for adequate surgical anesthesia is a BIS score between **40 and 60**, indicating a low probability of consciousness and recall. *TOF* - **TOF (Train-of-Four)** monitoring is used to assess the level of neuromuscular blockade, measuring the response of a muscle to a series of four electrical stimuli. - While important for managing **muscle relaxants**, it does not directly measure the depth of anesthesia or consciousness. *MAC* - **MAC (Minimum Alveolar Concentration)** is a measure of the potency of an inhaled anesthetic, defined as the concentration at which 50% of patients do not respond to a surgical stimulus. - It reflects the **ED50 of the anesthetic agent** itself rather than the patient's individual depth of anesthesia at a given moment. *Post Tetanic Potentiation* - **Post Tetanic Potentiation (PTP)** is a phenomenon observed during neuromuscular monitoring where a single twitch response is enhanced following a brief tetanus (rapid series of high-frequency stimuli). - PTP is used to assess **deep neuromuscular blockade** and recovery from paralytics, not the depth of anesthesia.

Q: Retinitis pigmentosa is associated with deficiency of:

DHA. ***DHA*** - **Docosahexaenoic acid (DHA)** is the major polyunsaturated fatty acid in the **retinal photoreceptor outer segments** and is crucial for their function. - Deficiency in DHA has been linked to several retinal degeneration disorders, including **retinitis pigmentosa**, suggesting its importance in maintaining retinal health. *Timnodonic acid* - This is an older term for **eicosapentaenoic acid (EPA)**, which is an omega-3 fatty acid. - While EPA is beneficial for overall health, it is **not the primary fatty acid** associated with the direct structural and functional health of retinal photoreceptors as DHA is. *Eicosa pentaenoic acid* - **Eicosapentaenoic acid (EPA)** is an omega-3 fatty acid found in fish oil, known for its anti-inflammatory properties. - While important for general health, EPA is **not as abundant or critical for retinal structure and function** as DHA. *Arachidonic acid* - **Arachidonic acid (AA)** is an omega-6 fatty acid found in cell membranes and is a precursor to pro-inflammatory mediators. - While present in the retina, AA is generally **not associated with a protective or causative role in retinitis pigmentosa** in the same way DHA is.

Q: A 25-year-old female presented to ER unconscious. Her mother tells you about her having recurrent syncopal episodes. Her BP is 80/60 mm Hg and you order an ECG. Treatment is

DC shock. ***DC shock*** - The ECG shows a **wide complex tachycardia** with alternating morphology in the QRS complex, consistent with **Torsades de Pointes**. - Given the patient's **unconsciousness** and **hypotension (80/60 mmHg)**, she is hemodynamically unstable, making immediate **electrical cardioversion (DC shock)** the treatment of choice irrespective of the cause. *Catheter Ablation* - **Catheter ablation** is an invasive procedure used for definitive treatment of recurrent arrhythmias, often considered in patients who are *hemodynamically stable*. - It is not an acute, emergency treatment for an **unstable patient** in a life-threatening arrhythmia. *Adenosine* - **Adenosine** is primarily used to terminate **supraventricular tachycardias (SVTs)** and can be harmful in wide complex tachycardias, especially if due to ventricular tachycardia or Wolff-Parkinson-White syndrome. - Its use is contraindicated in wide complex tachycardias like Torsades de Pointes, and it would not be effective in an **unstable patient** with Torsades de Pointes. *Radiofrequency ablation* - **Radiofrequency ablation** is a type of catheter ablation, which ablates or destroys abnormal electrical pathways in the heart. - Similar to other ablative therapies, it is a **definitive treatment** for recurrent arrhythmias in *stable patients*, not an emergency measure for an unconscious, hypotensive patient with an acute arrhythmia.

Q: McCallum patches/plaques are usually seen in which chamber of the heart?

Left atrium. Left atrium - **McCallum patches** are typically found in the **left atrium**, predominantly on the left atrial endocardium [1]. - They are associated with the regurgitant jet of **rheumatic mitral valve disease**, leading to endocardial thickening and fibrosis [1]. Right atrium - While rheumatic heart disease can affect the right side of the heart, particularly the tricuspid valve, **McCallum patches have a specific association with the left atrium** due to mitral valve involvement [1]. - Endocardial changes in the right atrium are less commonly described as McCallum patches. Left ventricle - The left ventricle is primarily a pumping chamber; while it can undergo hypertrophy or dilation in rheumatic heart disease, **McCallum patches are specific endocardial lesions of the atrium** [1]. - **Jet lesions** can occur in the ventricle due to aortic regurgitation, but these are distinct from atrial McCallum patches. Right ventricle - The right ventricle is also a pumping chamber, and endocardial changes here are not typically referred to as McCallum patches. - Rheumatic involvement of the tricuspid valve can cause right heart strain, but **McCallum patches are characteristic of left atrial involvement** [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, p. 566.

Q: False statement about Barrett esophagus is:

Columnar to squamous metaplasia. ***Columnar to squamous metaplasia*** - Barrett esophagus is characterized by the replacement of the normal **squamous epithelium** of the distal esophagus with **columnar epithelium** [1]. - Therefore, the statement "Columnar to squamous metaplasia" is incorrect as it describes the opposite process, making it the false statement. *Chronic GERD is the predisposing factor* - **Chronic gastroesophageal reflux disease (GERD)** causes repeated exposure of the esophageal lining to stomach acid, leading to cellular damage [1][2]. - This chronic irritation is the primary risk factor for the development of Barrett esophagus [1]. *May lead to malignancy after few years* - Barrett esophagus is a significant risk factor for the development of **esophageal adenocarcinoma** [1][3]. - The metaplastic columnar epithelium can undergo further dysplastic changes, which can progress to invasive cancer over time [2]. *Goblet cells seen on histology* - The distinctive histological feature of Barrett esophagus is the presence of **intestinal metaplasia**, which includes the identification of **goblet cells** within the columnar epithelium [1]. - These goblet cells are a key diagnostic marker for Barrett esophagus [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 348-349. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 764-765. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 765-766.

Q: Drug of choice for Digoxin induced Ventricular Tachycardia:

Lignocaine. ***Lignocaine*** - **Lignocaine** (also known as lidocaine) is the drug of choice for digoxin-induced ventricular tachycardia due to its ability to suppress ventricular arrhythmias without further compromising cardiac contractility [1]. - It works by blocking **sodium channels** in the myocardium, reducing automaticity and stabilizing the cardiac membrane [1]. *Diltiazem* - **Diltiazem** is a calcium channel blocker primarily used for supraventricular tachycardias and angina [1]. - It is contraindicated in digoxin toxicity as it can worsen myocardial depression and AV nodal blockade [1]. *Propranolol* - **Propranolol** is a beta-blocker that can suppress some arrhythmias but is generally not the first-line treatment for digoxin-induced ventricular tachycardia [1]. - Beta-blockers can worsen **bradycardia** and **AV block** often seen in digoxin toxicity [1]. *Verapamil* - **Verapamil** is a calcium channel blocker similar to diltiazem and can exacerbate digoxin toxicity [1]. - It is known to increase serum **digoxin levels** and can worsen the underlying cardiotoxic effects.

Q: Drug inhibiting granulocyte migration is:-

Colchicine. ***Colchicine*** - **Colchicine** inhibits **granulocyte migration** by binding to tubulin, thereby disrupting microtubule assembly and function [2]. - This action is crucial in its use for conditions like **gout**, where it reduces the inflammatory response by preventing neutrophil chemotaxis to crystal deposits [1], [2]. *Montelukast* - **Montelukast** is a **leukotriene receptor antagonist** that primarily reduces bronchoconstriction and inflammation. - While it affects inflammatory pathways, its direct action is not inhibiting granulocyte migration but rather blocking the effects of leukotrienes. *Cromoglycate* - **Cromoglycate** (e.g., cromolyn sodium) is a **mast cell stabilizer** that prevents the release of inflammatory mediators. - Its main mechanism involves preventing mast cell degranulation, not directly inhibiting granulocyte migration. *Felbamate* - **Felbamate** is an **antiepileptic drug** used in the treatment of seizures. - Its mechanism of action involves blocking NMDA receptors and modulating GABAergic transmission; it has no known role in inhibiting granulocyte migration.

Q: Cilastatin is given in combination with Imipenem because:-

Cilastatin prevents degradation of Imipenem in kidney. ***Cilastatin prevents degradation of Imipenem in kidney*** - **Imipenem** is extensively metabolized in the renal tubules by the enzyme **dihydropeptidase-I**, leading to its inactivation and potential nephrotoxicity. - **Cilastatin** is a **dihydropeptidase-I inhibitor** that prevents this enzymatic breakdown, increasing the bioavailability and efficacy of imipenem and reducing the risk of renal damage. *Inhibits the enzymes that digest Imipenem in stomach* - **Imipenem** is a parenteral antibiotic and is not administered orally; therefore, degradation in the stomach is not a relevant concern. - Its combination with cilastatin is specifically to address renal metabolism, not gastric degradation. *Cilastatin increase absorption of Imipenem* - **Cilastatin** does not enhance the absorption of imipenem; its role is primarily to inhibit renal metabolism. - Imipenem is administered intravenously, bypassing the need for gastrointestinal absorption. *Reduces side effects of Imipenem* - While cilastatin does prevent the formation of nephrotoxic metabolites of imipenem, its primary role is to **maintain therapeutic levels** and prevent drug inactivation. - The reduction in **nephrotoxicity** is a consequence of preventing degradation, rather than a direct mitigation of general side effects.

Q: All are true about Decerebrate posture except:-

Flexion of upper extremity and extension of lower extremity. ***Flexion of upper extremity and extension of lower extremity*** - This description corresponds to **decorticate rigidity**, not decerebrate rigidity. - In decorticate rigidity, there is **flexion** of the **upper extremities** and **extension** of the **lower extremities**, indicating a lesion above the red nucleus. *Exaggerated gamma motor neuron discharge* - Decerebrate rigidity is characterized by an **increase in muscle tone** due to disinhibition of extensor muscles, which is mediated by increased **gamma motor neuron activity**. - This increased discharge leads to potentiation of the **stretch reflex**, contributing to the rigidity. *Extension of both upper and lower extremity* - **Decerebrate posture** is defined by **extension of all four limbs** (both upper and lower extremities). - This posture results from a lesion in the brainstem **below the red nucleus** but above the vestibular nuclei, causing disinhibition of the pontine reticular formation and vestibular nuclei, which primarily excite extensor muscles. *Reticulo spinal tract is also involved* - The **reticulospinal tracts** (both pontine and medullary) play a crucial role in regulating muscle tone and posture. - In decerebrate rigidity, the **pontine reticulospinal tract** is overactive due to loss of cortical inhibition, leading to **increased extensor tone**.

Q: A 75-year-old female has chronic backache. X-ray of the spine is shown. What is the most likely diagnosis?

Osteoporosis. ***Osteoporosis*** - The X-ray shows diffuse **osteopenia** (reduced bone density) and **vertebral compression fractures**, particularly visible in the lateral view, which are characteristic findings in elderly patients with osteoporosis and chronic backache. - The vertebral bodies appear **demineralized** and some exhibit a loss of height, suggesting collapse due to weakened bone structure. *Spondylodiscitis* - This condition involves **inflammation of the vertebral body and adjacent intervertebral disc**, typically showing **erosions** of the vertebral endplates and **narrowing of the disc space** on X-ray, which are not clearly evident here as the primary issue. - While it can cause back pain, the dominant finding on this X-ray is widespread bone density loss and fractures, rather than localized infection-related changes. *Pott's spine* - Pott's spine (**tuberculous spondylitis**) is a form of osteomyelitis that causes **destruction of vertebral bodies** and adjacent discs, often leading to a **gibbus deformity** (sharp posterior angulation of the spine). - The X-ray does not show extensive vertebral destruction, paraspinal abscess formation, or typical kyphotic deformity associated with Pott's spine. *Spondylolisthesis* - Spondylolisthesis is characterized by the **forward slippage of one vertebral body over another**, often due to a defect in the pars interarticularis. - While there may be some degenerative changes, there is no clear evidence of significant anterior translation of a vertebral body on the lateral X-ray that would indicate spondylolisthesis.

Question 1

Depth of Anesthesia is best measured by:

Accepted Answer

BIS

Answer

TOF

Answer

MAC

Answer

Post Tetanic Potentiation

Question 2

Retinitis pigmentosa is associated with deficiency of:

Accepted Answer

DHA

Answer

Timnodonic acid

Answer

Eicosa pentaenoic acid

Answer

Arachidonic acid

Question 3

A 25-year-old female presented to ER unconscious. Her mother tells you about her having recurrent syncopal episodes. Her BP is 80/60 mm Hg and you order an ECG. Treatment is

Accepted Answer

DC shock

Answer

Cathether Ablation

Answer

Adenosine

Answer

Radiofrequency ablation

Question 4

McCallum patches/plaques are usually seen in which chamber of the heart?

Accepted Answer

Left atrium

Answer

Right atrium

Answer

Left ventricle

Answer

Right ventricle

Question 5

False statement about Barrett esophagus is:

Accepted Answer

Columnar to squamous metaplasia

Answer

Chronic GERD is the predisposing factor

Answer

May lead to malignancy after few years

Answer

Goblet cells seen on histology

Question 6

Drug of choice for Digoxin induced Ventricular Tachycardia:

Accepted Answer

Lignocaine

Answer

Diltiazem

Answer

Propranolol

Answer

Verapamil

Question 7

Drug inhibiting granulocyte migration is:-

Accepted Answer

Colchicine

Answer

Montelukast

Answer

Cromoglycate

Answer

Felbamate

Question 8

Cilastatin is given in combination with Imipenem because:-

Accepted Answer

Cilastatin prevents degradation of Imipenem in kidney

Answer

Inhibits the enzymes that digest Imipenem in stomach

Answer

Reduces side effects of Imipenem

Answer

Cilastatin increases absorption of Imipenem

Question 9

All are true about Decerebrate posture except:-

Accepted Answer

Flexion of upper extremity and extension of lower extremity

Answer

Exaggerated gamma motor neuron discharge

Answer

Extension of both upper and lower extremity

Answer

Reticulo spinal tract is also involved

Question 10

A 75-year-old female has chronic backache. X-ray of the spine is shown. What is the most likely diagnosis?

Accepted Answer

Osteoporosis

Answer

Spondylodiscitis

Answer

Pott's spine

Answer

Spondylolisthesis

NEET-PG 2019

Anesthesiology

Biochemistry

Internal Medicine

Pathology

Pharmacology

Physiology

Radiology