NEET-PG 2020 Practice Questions

Q: During intraoperative period following capnograph waveform is seen. What does it signify.

Return of spontaneous ventilation. ***Return of spontaneous ventilation*** - The capnogram shows a gradual increase in **tidal volume** and then a drop with a notch towards the end, which is characteristic of the patient taking an occasional **spontaneous breath**. - This pattern, where the patient's own respiratory effort adds to or takes over mechanical ventilation, signifies the **return of spontaneous ventilation**. *Airway obstruction* - Airway obstruction typically manifests as a **sharper upstroke** (phase II) and a **prolonged expiratory phase** (phase III) with a sloped plateau, sometimes with a 'shark fin' appearance if severe. - The waveform in the image does not demonstrate these specific characteristics of obstructed airflow. *Oesophageal intubation* - **Esophageal intubation** would show either **no CO2 waveform** (flat line) or very small, sporadic waveforms due to gastric CO2, which quickly disappear as gastric CO2 depletes. - The sustained CO2 levels and clear respiratory pattern seen in the image rule out esophageal intubation. *Hyperventilation* - **Hyperventilation** would lead to a **decrease in end-tidal CO2 (ETCO2)** values as more CO2 is exhaled. The waveform morphology itself would typically remain normal, just shifted to lower CO2 levels. - While the patient might be breathing more, the specific notch pattern is not indicative of simple hyperventilation but rather spontaneous efforts.

Q: A 70 year old patient presented with history of fever, repeated aspiration and coughing in the night. On examination there is a swelling on left side of neck which produces gurgling sound on compression. Following is the barium swallow study of the patient. What is the most likely diagnosis?

Zenker's diverticulum. ***Zenker's diverticulum*** - The patient's symptoms of **fever**, **repeated aspiration**, and **coughing at night** are classic for a Zenker's diverticulum, particularly in an older patient. - The presence of a **neck swelling** producing a **gurgling sound on compression** (Boyce's sign) is highly indicative of a Zenker's diverticulum, which is essentially a pharyngeal pouch. The barium swallow image likely shows contrast pooling in such a pouch. *Plummer Vinson syndrome* - Characterized by **dysphagia**, **iron-deficiency anemia**, and **esophageal webs**. - While it causes dysphagia, it does not typically present with a gurgling neck swelling or significant aspiration as described. *Dysphagia Lusoria* - This is a rare condition caused by an **aberrant right subclavian artery** compressing the esophagus. - It primarily causes dysphagia due to extrinsic compression, without the associated neck swelling, gurgling sound, or significant aspiration risk from food pooling within a diverticulum. *Laryngocoele* - A laryngocele is an **abnormal sac** or pouch that arises from the **laryngeal ventricle** and may extend externally, presenting as a neck swelling. - While it can cause a neck swelling, it is **air-filled**, not fluid or food-filled, and therefore would not typically produce a gurgling sound on compression or be clearly visible on a barium swallow as a contrast-filled pouch like in the image provided.

Q: Which of the following is not done in high altitude sickness?

Digoxin. ***Digoxin*** - **Digoxin** is a cardiac glycoside used for heart conditions like **atrial fibrillation** and **heart failure**. It has no role in the treatment of high altitude sickness. - Its primary actions are to increase **myocardial contractility** and decrease heart rate, which are not beneficial in addressing the hypobaric hypoxia of high altitude. *Rapid descent* - **Rapid descent** is the most effective and often immediate treatment for severe forms of high altitude sickness, such as **High Altitude Cerebral Edema (HACE)** or **High Altitude Pulmonary Edema (HAPE)** [2]. - It involves moving the affected individual to a significantly lower altitude to alleviate the effects of **hypoxia** [2]. *Acetazolamide* - **Acetazolamide** is a **carbonic anhydrase inhibitor** commonly used for the prevention and treatment of high altitude sickness [2]. - It works by inducing a **metabolic acidosis**, which stimulates **respiration** and increases **oxygenation**. *Oxygen* - Administering **supplemental oxygen** is a crucial treatment for high altitude sickness, especially in more severe cases [2]. - It directly counteracts the **hypoxia** experienced at high altitudes, improving symptoms and preventing progression [1], [2].

Q: Pulmonary Plethora is seen in -

TAPVC. ***TAPVC*** - **Total Anomalous Pulmonary Venous Connection (TAPVC)** leads to all pulmonary veins draining into the systemic circulation, causing a left-to-right shunt at the atrial level back into the right atrium. - This persistent shunting results in increased blood flow to the lungs, manifesting as **pulmonary plethora** on chest X-ray due to engorged pulmonary vessels [3]. *Tricuspid Atresia* - **Tricuspid atresia** results in an absence of the tricuspid valve, severely limiting blood flow from the right atrium to the right ventricle. - This condition typically leads to **pulmonary oligemia** (reduced blood flow to the lungs), not pulmonary plethora. *CoA* - **Coarctation of the aorta (CoA)** is a narrowing of the aorta, typically distal to the left subclavian artery [2]. - While it can lead to complications like heart failure, it generally does not directly cause **pulmonary plethora** unless there are associated shunts. *TOF* - **Tetralogy of Fallot (TOF)** is characterized by four defects: ventricular septal defect, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy [1]. - The most significant hemodynamic feature is **pulmonary stenosis**, which reduces blood flow to the lungs, leading to **pulmonary oligemia**, often described as a "boot-shaped" heart on X-ray [1].

Q: Which of the following is a Category A bioterrorism agent?

Bacillus anthracis. ***Bacillus anthracis*** - **_Bacillus anthracis_** (causing anthrax) is a classic example of a **Category A bioterrorism agent** due to its high mortality, ease of dissemination, and potential for major public health impact. - Category A agents are considered the **highest priority** because they pose a significant risk to national security. *Brucella* - **_Brucella_** species are classified as **Category B bioterrorism agents**. - They are moderately easy to disseminate and can cause moderate morbidity but generally have a **low mortality rate**. *Nipah virus* - **Nipah virus** is categorized as a **Category C bioterrorism agent**. - These are emerging pathogens that could be engineered for mass dissemination in the future, but their current risk is lower than Category A or B. *Coxiella* - **_Coxiella burnetii_** (causing Q fever) is classified as a **Category B bioterrorism agent**. - It is relatively easy to disseminate and can cause high morbidity but has a **low mortality rate**.

Q: Large, irregular and friable vegetations are seen in?

Infective endocarditis. ***Infective endocarditis*** - **Large, irregular, and friable vegetations** are characteristic of infective endocarditis, formed by a mesh of **platelets, fibrin, microorganisms**, and inflammatory cells [1]. - These vegetations can lead to serious complications such as **embolization** and destruction of heart valves [2]. *Rheumatic heart disease* - Characterized by **small, warty vegetations** that are typically located on the lines of closure of the heart valves, not large and friable [1]. - These vegetations are sterile and result from inflammation and fibrin deposition, usually not involving active microbial infection. *Non-bacterial thrombotic endocarditis (NBTE)* - Features **small, sterile vegetations** composed of fibrin and platelets, often found on previously undamaged valves [1]. - These vegetations are typically **firm** and non-inflammatory, distinct from the friable and infected vegetations of infective endocarditis. *Libman-sacks endocarditis* - Manifests as **sterile, verrucous vegetations** that can occur on either side of the valve leaflets (aortic or mitral) in patients with **systemic lupus erythematosus (SLE)** [1]. - While they can be large, they are usually not described as friable in the same manner as infective endocarditis and are sterile. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, p. 568. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Cardiovascular Disease, pp. 295-296.

Q: Which of the following is a cause of Hirschsprung disease in a patient?

Failure of migration of neural crest cells. ***Failure of migration of neural crest cells*** - Hirschsprung disease is characterized by the absence of **ganglion cells** (Auerbach and Meissner plexuses) in the distal colon [1]. - This aganglionosis results from the failure of **neural crest cells** to migrate completely from the esophagus to the anus during embryonic development [1]. *Failure of involution of vitelline duct* - This condition is associated with **Meckel's diverticulum**, which is a remnant of the vitelline duct, not Hirschsprung disease. - **Meckel's diverticulum** can cause symptoms like GI bleeding or obstruction, but it does not involve aganglionosis of the colon. *Excessive peristalsis of the affected part of the gut* - Hirschsprung disease is characterized by a **lack of peristalsis** in the aganglionic segment, leading to functional obstruction [1]. - The healthy, proximal colon may show increased peristalsis in an attempt to overcome the obstruction, but the affected segment itself is aperistaltic. *Obstruction secondary to an infectious agent* - Obstruction due to an infectious agent is typically related to **inflammatory processes** or strictures caused by infections (e.g., severe colitis). - This mechanism of obstruction does not involve the **developmental anomaly** of missing ganglion cells, which is central to Hirschsprung disease. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 94-95.

Q: A 2 year child presented with low grade fever and stridor. What is the likely diagnosis?

Acute Laryngotracheobronchitis. ***Acute Laryngotracheobronchitis*** - The combination of **low-grade fever** and **stridor** in a 2-year-old child strongly suggests **croup**, which is medically known as acute laryngotracheobronchitis. - Croup is characterized by **inflammation** of the larynx, trachea, and bronchi, often presenting with a **barking cough** and inspiratory stridor. The X-ray image would show the characteristic **steeple sign**. *Acute Bacterial Tracheitis* - This is a more severe bacterial infection that can present with stridor but typically shows **higher fever**, **toxic appearance**, and rapid clinical deterioration. - Unlike croup, bacterial tracheitis patients appear **more ill** and may have **purulent secretions** requiring more aggressive management. *Acute Epiglottitis* - A serious condition characterized by **rapid onset of high fever**, **dysphagia**, drooling, and a **"tripod" position**, which are not indicated by the given symptoms. - The stridor in epiglottitis is typically quieter and may indicate more severe airway obstruction compared to the characteristic stridor of croup. *Foreign Body aspiration* - While foreign body aspiration can cause stridor, it is typically an **acute event** with a sudden onset of choking, coughing, and respiratory distress. - There is no mention of a choking episode or sudden onset, and a low-grade fever is less typical for an uncomplicated foreign body aspiration.

Q: Which of the following, if normal, would be most significant in making PEM unlikely?

Lean body mass. ***Lean body mass*** - A normal **lean body mass** indicates adequate muscle and organ tissue, which is the primary component affected by **Protein-Energy Malnutrition (PEM)**. - Maintaining normal lean body mass despite potential weight loss makes significant PEM, especially the **marasmic type**, less likely. *Extracellular fluid (ECF)* - **Extracellular fluid (ECF)** can be normal or even increased in cases of **edematous PEM** (kwashiorkor) due to decreased oncotic pressure, making it an unreliable indicator for excluding PEM. - Normal ECF does not rule out the depletion of protein, fat, and muscle mass that characterizes PEM. *Serum Potassium* - **Serum potassium** levels can be normal or abnormal (low or high) in PEM depending on hydration status, renal function, and refeeding syndrome, making it a non-specific indicator for excluding the condition. - It does not directly reflect the overall **nutritional status** or body composition changes seen in PEM. *Skin fold thickness* - **Skin fold thickness** measures subcutaneous fat stores, which can be normal or even preserved in some forms of PEM, particularly **kwashiorkor**, even when severe protein deficiency exists. - While reduced skin fold thickness suggests **marasmus**, a normal value does not conclusively rule out **protein deficiency** or other forms of PEM.

Q: Which one of the following is not a component of THORACOSCORE?

Complication of surgery. ***Complication of surgery*** - THORACOSCORE is a **risk prediction model** for thoracic surgery used to estimate the *probability of mortality and significant morbidity*, but it does not account for the complications of surgery itself as a component. - The score uses **pre-operative patient characteristics** and co-morbidities to predict outcomes, not post-operative events. *Performance status* - **Performance status**, such as the **ECOG scale**, is a crucial component of THORACOSCORE, reflecting the patient's general health and functional capacity prior to surgery. - A lower performance status (indicating poorer functional ability) increases the predicted risk in THORACOSCORE. *Priority of surgery* - The **priority of surgery** (e.g., elective, urgent, emergency) is an important factor in THORACOSCORE, as emergency procedures generally carry a higher risk. - This variable helps to capture the urgency and associated physiological stress on the patient at the time of presentation for surgery. *ASA grading* - The **American Society of Anesthesiologists (ASA) physical status classification system** is a component of THORACOSCORE, assessing the patient's overall health status and anesthetic risk. - A higher ASA grade (indicating more severe systemic disease) contributes to a higher predicted risk in the THORACOSCORE model.

Question 1

During intraoperative period following capnograph waveform is seen. What does it signify.

Accepted Answer

Return of spontaneous ventilation

Answer

Airway obstruction

Answer

Oesophageal intubation

Answer

Hyperventilation

Question 2

A 70 year old patient presented with history of fever, repeated aspiration and coughing in the night. On examination there is a swelling on left side of neck which produces gurgling sound on compression. Following is the barium swallow study of the patient. What is the most likely diagnosis?

Accepted Answer

Zenker's diverticulum

Answer

Plummer vinson syndrome

Answer

Dysphagia Lusoria

Answer

Laryngocoele

Question 3

Which of the following is not done in high altitude sickness?

Accepted Answer

Digoxin

Answer

Rapid descent

Answer

Acetazolamide

Answer

Oxygen

Question 4

Pulmonary Plethora is seen in -

Accepted Answer

TAPVC

Answer

Tricuspid Atresia

Answer

CoA

Answer

TOF

Question 5

Which of the following is a Category A bioterrorism agent?

Accepted Answer

Bacillus anthracis

Answer

Brucella

Answer

Nipah virus

Answer

Coxiella

Question 6

Large, irregular and friable vegetations are seen in?

Accepted Answer

Infective endocarditis

Answer

Rheumatic heart disease

Answer

Non-bacterial thrombotic endocarditis (NBTE)

Answer

Libman-sacks endocarditis

Question 7

Which of the following is a cause of Hirschsprung disease in a patient?

Accepted Answer

Failure of migration of neural crest cells

Answer

Failure of involution of vitelline duct

Answer

Excessive peristalsis of the affected part of the gut

Answer

Obstruction secondary to an infectious agent

Question 8

A 2 year child presented with low grade fever and stridor. What is the likely diagnosis?

Accepted Answer

Acute Laryngotracheobronchitis

Answer

Acute Bacterial Tracheitis

Answer

Acute Epiglottitis

Answer

Foreign Body aspiration

Question 9

Which of the following, if normal, would be most significant in making PEM unlikely?

Accepted Answer

Lean body mass

Answer

Serum Potassium

Answer

Skin fold thickness

Answer

Extracellular fluid (ECF)

Question 10

Which one of the following is not a component of THORACOSCORE?

Accepted Answer

Complication of surgery

Answer

Performance status

Answer

Priority of surgery

Answer

ASA grading

NEET-PG 2020

Anesthesiology

ENT

Internal Medicine

Microbiology

Pathology

Pediatrics

Surgery