NEET-PG 2020 Practice Questions

Q: The poison commonly detected in exhumed bodies is:

Arsenic. ***Arsenic*** - **Arsenic** is the most common poison detected in exhumed bodies due to its exceptional **stability** and **resistance to degradation** in decomposing tissues. - It readily binds to **keratin-rich tissues** like hair and nails, making it detectable even after long periods (years to decades). - Known as a "**persistent poison**" in forensic medicine due to its ability to resist putrefaction and remain in tissues indefinitely. *Cadmium* - While **cadmium** is a toxic heavy metal, it is not as frequently detected in exhumed bodies as arsenic due to differing toxicokinetics and post-mortem stability. - Cadmium poisoning often involves **renal and pulmonary toxicity**, and its detection post-mortem might be more challenging after significant decomposition. *Mercury* - **Mercury** can be toxic and persist in some tissues, but its detection in exhumed bodies is less common than arsenic due to its different **metabolic pathways** and **degradation patterns**. - **Elemental mercury** is poorly absorbed, and other forms like **methylmercury** can be found, but their post-mortem stability does not match arsenic's. *Lead* - **Lead** is a heavy metal that causes chronic toxicity and can be detected in bones for extended periods. However, its overall detection rate in exhumed bodies for acute poisoning is typically lower than arsenic. - Lead's clinical presentation often includes **neurological, gastrointestinal, and hematological symptoms**, but its presence in various tissues diminishes over time compared to arsenic's unique persistence.

Q: A 12 year old boy presents with vomiting within 3 hours of consumption of food at a party. What is the likely causative organism responsible for the symptoms?

Staphylococcus aureus. ***Staphylococcus aureus*** - **Vomiting occurring within 1-6 hours of food consumption** is highly characteristic of preformed toxin ingestion, commonly associated with *S. aureus*. - *S. aureus* produces **heat-stable enterotoxins** that cause rapid onset nausea, vomiting, and abdominal cramps. *Clostridium perfringens* - This bacterium typically causes symptoms like **abdominal cramps and diarrhea**, with vomiting being less common. - The onset of illness from *C. perfringens* is usually **8-16 hours** after consumption, which is longer than the 3-hour window in this case. *Clostridium botulinum* - *C. botulinum* causes **botulism**, a neuroparalytic illness, which may include nausea and vomiting in its early stages but is primarily characterized by **flaccid paralysis**. - Symptoms usually appear **12-36 hours** after exposure, which is much longer than the presentation described. *Salmonella* - **Salmonellosis** typically has an incubation period of **6-72 hours**, with symptoms including diarrhea, fever, and abdominal cramps; vomiting may occur but is not as immediate or predominant as with *S. aureus* toxin. - The illness is caused by bacterial colonization and invasion, not preformed toxins, leading to a longer onset compared to the 3-hour presentation.

Q: A patient with pulmonary fibrosis comes to the emergency with arrhythmia. Which anti-arrhythmic drug should be avoided?

Amiodarone. ***Amiodarone*** - **Amiodarone** is known to cause **pulmonary toxicity** as a significant adverse effect, which can exacerbate pre-existing **pulmonary fibrosis**. - Its long half-life and **iodine content** contribute to its potential for delayed and severe pulmonary side effects, making it contraindicated in patients with existing lung disease. *Lignocaine* - **Lignocaine** (lidocaine) is a **Class IB antiarrhythmic** primarily used for **ventricular arrhythmias** and is generally safe in patients with pulmonary disease as it does not have significant pulmonary side effects. - Its main toxicities involve the **central nervous system** and cardiovascular system (at high doses). *Procainamide* - **Procainamide** is a **Class IA antiarrhythmic** that can be used for both **atrial and ventricular arrhythmias**, and it does not typically cause pulmonary toxicity. - Potential side effects include a **lupus-like syndrome**, agranulocytosis, and cardiotoxicity, none of which are exacerbated by pulmonary fibrosis. *Verapamil* - **Verapamil** is a **non-dihydropyridine calcium channel blocker** used for **supraventricular tachycardias** and rate control in atrial fibrillation, which does not have significant pulmonary side effects. - Its main concerns relate to **cardiac depression** and **hypotension**, but it is not contraindicated in the context of pulmonary fibrosis.

Q: A 45 year old male, known case of Rheumatoid arthritis is on a monotherapy since many years. Symptoms of RA are controlled but suddenly patient develops blurring of vision. Which of the following drug is responsible for sudden effect on vision?

Hydroxychloroquine. ***Hydroxychloroquine*** - **Hydroxychloroquine** [1] is known to cause **retinal toxicity** (maculopathy) as a dose-dependent, long-term side effect, leading to **blurring of vision** and other visual disturbances. - Patients on long-term hydroxychloroquine therapy require regular **ophthalmological screening** to detect and prevent irreversible vision loss. *Methotrexate* - **Methotrexate** is a common DMARD used in RA [1], but its ocular side effects are typically rare and less severe, usually involving **conjunctivitis** or **periorbital edema**. - It does not commonly cause **maculopathy** or sudden profound blurring of vision. *Sulfasalazine* - **Sulfasalazine** [1] can cause a range of side effects, including gastrointestinal issues and various hypersensitivity reactions. - Ocular side effects are infrequent and generally mild, such as **conjunctivitis** or **periorbital edema**, and not severe blurring of vision due to retinal damage. *Leflunomide* - **Leflunomide** is an immunosuppressive DMARD [1] whose common adverse effects include hepatotoxicity, gastrointestinal upset, and hypertension. - Significant **ocular toxicity** leading to blurring of vision, particularly retinal damage, is not a characteristic side effect of **leflunomide**.

Q: What does aquaporin deficiency cause?

Nephrogenic diabetes insipidus. ***Nephrogenic diabetes insipidus*** - Aquaporins, specifically **aquaporin-2**, are crucial for **water reabsorption** in the renal collecting ducts in response to ADH. - A deficiency or dysfunction of aquaporins leads to the kidneys being unable to concentrate urine, resulting in **excessive dilute urine production** and **polydipsia**, characteristic of nephrogenic diabetes insipidus. *Liddle syndrome* - This is an **autosomal dominant** disorder caused by a **gain-of-function mutation** in the **epithelial sodium channel (ENaC)**, leading to increased sodium reabsorption and hypertension. - It does not involve aquaporin deficiency but rather an overactive sodium channel. *Bartter syndrome* - Characterized by mutations in the **Na-K-2Cl cotransporter (NKCC2)** in the thick ascending limb of the loop of Henle, leading to impaired reabsorption of sodium, potassium, and chloride. - It results in **hypokalemia**, **metabolic alkalosis**, and **hypotension**, and is not directly caused by aquaporin deficiency. *Gitelman syndrome* - Caused by mutations in the **thiazide-sensitive Na–Cl cotransporter (NCC)** in the distal convoluted tubule, impairing sodium and chloride reabsorption. - It presents with symptoms similar to thiazide diuretic use, including **hypokalemia**, **hypomagnesemia**, and **metabolic alkalosis**, and is distinct from aquaporin-related disorders.

Q: A patient of Scleroderma presents with acute respiratory distress. Chest X-ray shows B/L reticular basilar shadows. What is the next line of investigation in this patient?

High resolution CT to characterize the lung parenchyma.. ***High resolution CT*** - A **high-resolution CT (HRCT) scan** is the gold standard for evaluating **interstitial lung disease (ILD)**, which is commonly seen in **scleroderma** and presents with basilar reticular shadows on chest X-ray. - HRCT provides detailed images of the lung parenchyma, allowing for accurate characterization of the **fibrotic changes** and extent of ILD. *Pulmonary function tests to assess lung function.* - **Pulmonary function tests (PFTs)** provide functional information about lung capacity and gas exchange but do not offer detailed anatomical imaging of the lung parenchyma. - While essential for monitoring disease progression and severity, PFTs are not the primary diagnostic tool to further characterize the **reticular basilar shadows** seen on X-ray in an acute setting. *Contrast-enhanced CT scan for vascular assessment.* - A **contrast-enhanced CT scan** is primarily used to assess **vascular structures** or rule out conditions like **pulmonary embolism**, which is not directly indicated by the description of bilateral reticular basilar shadows. - The primary concern here is **interstitial lung disease**, which is best evaluated by **HRCT** without contrast. *Echocardiography to evaluate cardiac complications.* - **Echocardiography** is used to assess cardiac function and look for complications like **pulmonary hypertension** or **myocardial fibrosis**, which can occur in scleroderma. - However, it does not directly evaluate the **lung parenchyma** or the cause of the reticular basilar shadows.

Q: Which radiotherapy technique involves the use of remote afterloading to deliver radiation directly to the tumor?

Brachytherapy. ***Correct: Brachytherapy*** - **Remote afterloading** is a hallmark of modern brachytherapy, where radioactive sources are automatically advanced into catheters placed within or near the tumor. - This technique allows for the delivery of a **high dose of radiation directly to the tumor** while sparing surrounding healthy tissues. - Examples include **intracavitary** (cervical cancer), **interstitial** (prostate cancer), and **intraluminal** (esophageal cancer) brachytherapy. *Incorrect: External Beam Radiotherapy* - This technique involves delivering radiation from a machine **outside the body** to target a tumor. - It does not involve the direct placement of radioactive sources within the patient or the use of **remote afterloading**. *Incorrect: Stereotactic Radiotherapy* - While a precise form of external beam radiotherapy using focused beams, it still involves an **external source** of radiation. - It does not utilize internal radioactive sources or **afterloading techniques**. *Incorrect: Proton Beam Radiotherapy* - This is an advanced form of external beam radiotherapy that uses **protons instead of photons** to deliver radiation with high precision. - It does not involve the placement of radioactive sources within the patient or the use of **remote afterloading**.

Q: A middle aged man complains of upper abdominal pain after a heavy meal. There is tenderness in the upper abdomen and on X-ray, widening of the mediastinum is seen with air in the mediastinum. What is the diagnosis?

Spontaneous perforation of the esophagus. ***Spontaneous perforation of the esophagus*** - The combination of **upper abdominal pain after a heavy meal** (suggestive of regurgitation/vomiting), **tenderness in the upper abdomen**, and **widening of the mediastinum with air in the mediastinum (pneumomediastinum)** points strongly to spontaneous esophageal rupture, also known as **Boerhaave syndrome**. - This condition results from a sudden increase in intra-esophageal pressure, often due to forceful vomiting, leading to a full-thickness tear in the esophageal wall. *Perforated peptic ulcer* - While it causes **severe upper abdominal pain** and tenderness, a perforated peptic ulcer primarily leads to **pneumoperitoneum** (free air under the diaphragm) rather than pneumomediastinum. - The abdominal symptoms would be more generalized and severe, and the X-ray findings would typically show free air in the abdominal cavity, not the mediastinum. *Rupture of emphysematous bulla* - This would generally cause **pneumothorax** and/or **subcutaneous emphysema**, and potentially pneumomediastinum, but typically without the profound abdominal pain and tenderness associated with a gastrointestinal event. - It would not be directly linked to a heavy meal or suggest a primary esophageal pathology. *Foreign body in esophagus* - A foreign body could cause pain and dysphagia, and potentially lead to perforation if sharp or impacted for too long, but the primary presentation would likely involve difficulty swallowing or a sensation of obstruction. - The immediate presence of **pneumomediastinum** and severe abdominal pain after a meal makes acute perforation more likely than a simple foreign body impaction without prior perforation.

Question 1

The poison commonly detected in exhumed bodies is:

Accepted Answer

Arsenic

Answer

Lead

Answer

Mercury

Answer

Cadmium

Question 2

A 12 year old boy presents with vomiting within 3 hours of consumption of food at a party. What is the likely causative organism responsible for the symptoms?

Accepted Answer

Staphylococcus aureus

Answer

Clostridium perfringens

Answer

Clostridium botulinum

Answer

Salmonella

Question 3

A patient with pulmonary fibrosis comes to the emergency with arrhythmia. Which anti-arrhythmic drug should be avoided?

Accepted Answer

Amiodarone

Answer

Lignocaine

Answer

Procainamide

Answer

Verapamil

Question 4

A 45 year old male, known case of Rheumatoid arthritis is on a monotherapy since many years. Symptoms of RA are controlled but suddenly patient develops blurring of vision. Which of the following drug is responsible for sudden effect on vision?

Accepted Answer

Hydroxychloroquine

Answer

Methotrexate

Answer

Sulfasalazine

Answer

Leflunomide

Question 5

What does aquaporin deficiency cause?

Accepted Answer

Nephrogenic diabetes insipidus

Answer

Liddle syndrome

Answer

Bartter syndrome

Answer

Gitelman syndrome

Question 6

A patient of Scleroderma presents with acute respiratory distress. Chest X-ray shows B/L reticular basilar shadows. What is the next line of investigation in this patient?

Accepted Answer

High resolution CT to characterize the lung parenchyma.

Answer

Pulmonary function tests to assess lung function.

Answer

Contrast-enhanced CT scan for vascular assessment.

Answer

Echocardiography to evaluate cardiac complications.

Question 7

Which radiotherapy technique involves the use of remote afterloading to deliver radiation directly to the tumor?

Accepted Answer

Brachytherapy

Answer

External Beam Radiotherapy

Answer

Stereotactic Radiotherapy

Answer

Proton Beam Radiotherapy

Question 8

A female patient with clinical symptoms of systemic sclerosis presents with shortness of breath and bilateral basal rales. Her chest X-ray showed reticular opacities in bilateral basal fields. What is the next best step?

Accepted Answer

Do HRCT

Answer

Do 2D echocardiography

Answer

Do Pulmonary Function Test

Answer

Do CECT

Question 9

A middle aged man complains of upper abdominal pain after a heavy meal. There is tenderness in the upper abdomen and on X-ray, widening of the mediastinum is seen with air in the mediastinum. What is the diagnosis?

Accepted Answer

Spontaneous perforation of the esophagus

Answer

Perforated peptic ulcer

Answer

Rupture of emphysematous bulla

Answer

Foreign body in esophagus

Question 10

A 20 year old boy is brought to the emergency following a RTA (Road Traffic Accident) with respiratory distress and hypotension. He has subcutaneous emphysema and no air entry on the right side. What is the next best step in the management?

Accepted Answer

Needle decompression in the 5th intercostal space in the mid-axillary line

Answer

Start IV fluids after insertion of a wide-bore IV line

Answer

Shift the patient to the ICU and perform intubation

Answer

Initiate positive pressure ventilation

NEET-PG 2020

Forensic Medicine

Microbiology

Pharmacology

Physiology

Radiology

Surgery