NEET-PG 2020 Practice Questions

Q: The patient is presenting with pain around the base of the thumb. Which tendons are likely involved?

APL & EPB. ***APL & EPB*** - Pain around the base of the thumb, especially with movement, is characteristic of De Quervain's tenosynovitis [1]. This condition involves the **abductor pollicis longus (APL)** and **extensor pollicis brevis (EPB)** tendons [1]. - These two tendons share a common synovial sheath as they pass through the first dorsal compartment of the wrist, making them susceptible to inflammation and friction [1]. *APB & EPL* - **APB (Abductor Pollicis Brevis)** is an intrinsic hand muscle found in the thenar eminence, primarily involved in thumb abduction, and is not typically associated with De Quervain's tenosynovitis. - **EPL (Extensor Pollicis Longus)** is part of the third dorsal compartment and its tendon crosses over the other thumb tendons, and is not inflamed in De Quervain's tenosynovitis. *APB & EPB* - As mentioned, **APB (Abductor Pollicis Brevis)** is an intrinsic hand muscle, not involved in De Quervain's tenosynovitis. - While **EPB (Extensor Pollicis Brevis)** is involved, its combination with APB incorrectly identifies the primary tendons affected in the first dorsal compartment. *APL & EPL* - **APL (Abductor Pollicis Longus)** is one of the correct tendons involved. - **EPL (Extensor Pollicis Longus)** belongs to the third dorsal compartment of the wrist and is not typically affected in De Quervain's tenosynovitis, differentiating it from the tendons in the first dorsal compartment [1].

Q: Which of the following diseases is primarily water-related?

Cholera. ***Cholera*** - Cholera is caused by the bacterium **Vibrio cholerae**, which is typically transmitted through the consumption of **contaminated water or food**. - This disease is a classic example of a **waterborne illness**, with outbreaks often linked to inadequate sanitation and unsafe drinking water. *Yellow fever* - Yellow fever is a **viral hemorrhagic disease** transmitted by infected **mosquitoes**, primarily Aedes aegypti. - While mosquitoes may breed in water, the disease itself is not directly transmitted through water consumption. *Scabies* - Scabies is a **skin infestation** caused by the mite **Sarcoptes scabiei**, which burrows into the outer layer of the skin. - Transmission occurs through **direct, prolonged skin-to-skin contact**, not through water. *Dysentery* - Dysentery is an **intestinal inflammation** causing bloody diarrhea, which can be caused by bacteria (e.g., Shigella) or amoebas (e.g., Entamoeba histolytica). - Although it can be transmitted through contaminated water or food, it is a broader term for a symptom, and **cholera is more exclusively and primarily focused on water-borne transmission mechanisms**.

Q: Blood bags are disposed of in

Yellow bag. ***Yellow bag*** - **Yellow bags** are designated for **infectious waste** including items contaminated with **blood and body fluids** according to **Bio-Medical Waste Management Rules, 2016**. - **Blood bags** (both used and expired) are specifically categorized under **soiled waste** requiring disposal in **yellow bags**. - This waste is either incinerated or subjected to plasma pyrolysis to eliminate **bloodborne pathogens**. *Red bag* - **Red bags** are used for **contaminated recyclable waste** such as tubing, catheters, IV sets (without needles), and gloves. - While red bags handle contaminated items, they are meant for waste that can potentially be recycled after appropriate treatment, **not for blood bags**. *Black bag* - **Black bags** are designated for **general non-infectious waste** (municipal solid waste) such as paper, packaging materials, and food waste. - Disposing blood bags in black bags would violate **biomedical waste management regulations** and pose serious **infection control risks**. *White bag* - **White bags/containers** are puncture-proof containers used for **sharp waste** including needles, scalpels, and broken glass. - Blood bags are not classified as sharps and require different disposal methods due to their **infectious liquid content**.

Q: Identify the condition causing this infection on the upper arm

Tinea corporis (body ringworm). ***Tinea corporis (body ringworm)*** - This lesion, depicted on the upper arm, is characteristic of **tinea corporis** due to its **annular, erythematous, and scaly border with central clearing**. - The term "corporis" refers to the **body surface**, excluding the scalp, hands, feet, groin, and nails. *Tinea capitis (scalp ringworm)* - Tinea capitis specifically affects the **scalp** and can present with scaling, hair loss, and inflammation. - The image clearly shows a lesion on the **upper arm**, not the scalp. *Tinea cruris (jock itch)* - Tinea cruris is a fungal infection found in the **groin area**, often extending to the inner thighs and buttocks. - The location of the lesion in the image, on the **upper arm**, rules out tinea cruris. *Tinea manus (hand ringworm)* - Tinea manus affects the **hands**, typically causing dryness, scaling, and sometimes blister formation on the palms or between the fingers. - The lesion in the image is located on the **upper arm**, not the hand.

Q: What poison will you detect in the skeleton even after decomposition

Arsenic. ***Arsenic*** - **Arsenic** has a high affinity for **keratin-rich tissues** like hair, nails, and skin, and also gets incorporated into bones. - Its presence in the skeleton and other tissues can be detected long after death, even in cases of **emaciation** or advanced decomposition. *Lead* - **Lead** primarily accumulates in **bones** due to its chemical similarity to calcium, where it can reside for decades. - While detectable in the skeleton, arsenic is often considered in forensic toxicology when looking for poisons in highly decayed remains due to its long-term persistence in various tissues. *Mercury* - **Organic mercury** forms, like **methylmercury**, primarily accumulate in the **brain and kidneys**, and to a lesser extent in hair and nails. - While some inorganic forms can be found in bone, its persistence and detectability in the skeleton after significant decomposition are generally less prominent than arsenic. *Cadmium* - **Cadmium** preferentially accumulates in the **kidneys and liver**, with a smaller proportion stored in bones. - While it can be detected in bone, its persistence in decayed remains and diagnostic significance as a poison in the skeleton is not as universal as arsenic.

Q: A young man met with a motorbike accident and had injuries to ileum and jejunum. Therefore the entire ileum and partial jejunum were resected. Which of the following would the patient suffer from

Vitamin B12 malabsorption due to ileal resection. **Vitamin B12 malabsorption due to ileal resection** - The **terminal ileum** is the primary site for the absorption of **vitamin B12** (cobalamin) complexed with intrinsic factor [3]. - Its resection would directly lead to the inability to absorb this vitamin, resulting in **B12 deficiency** and associated symptoms like macrocytic anemia [3]. *Atrophic gastritis unrelated to resection* - **Atrophic gastritis** is a chronic inflammatory condition of the stomach lining leading to loss of glandular tissue and often impaired production of **intrinsic factor**. - While it can cause B12 malabsorption, it is an independent condition and not a direct consequence of ileum and jejunum resection. *Constipation due to dietary changes* - Resection of the ileum and jejunum primarily impacts **nutrient absorption** and can lead to diarrhea due or **short bowel syndrome** [1], rather than constipation. - While diet changes can affect bowel habits, prolonged **severe gastrointestinal resection** is more likely to cause malabsorption-related diarrhea [1], [2]. *No significant symptoms* - The **ileum** and **jejunum** are crucial for the absorption of most nutrients, including vitamins, minerals, fats, and carbohydrates [4]. - Resection of these segments, especially a significant portion, would lead to **malabsorption syndromes** with various severe symptoms, potentially including weight loss, diarrhea, and nutritional deficiencies [1], [4].

Q: Esophageal manometry was performed - it revealed panesophageal pressurization with distal contractile integrity as >450mm Hg pressure in the body. What will be the diagnosis?

Type 3 achalasia. The diagnosis is Type 3 achalasia. This condition is characterized by panesophageal pressurization, indicating diffuse, simultaneous contractions throughout the esophagus. The high distal contractile integrity (>450 mmHg pressure) further supports Type 3 achalasia, which involves significant spastic contractions. In contrast, while high-resolution manometry allows for the accurate classification of these motility abnormalities [1], other types present differently. Type 1 achalasia (classic achalasia) is marked by failed esophageal peristalsis and absent or minimal esophageal pressurization [1]. The primary characteristic is incomplete or absent lower esophageal sphincter (LES) relaxation, not hypercontractility [1]. Type 2 achalasia is identified by esophageal panesophageal pressurization (simultaneous contractions), but with normal to high contractile pressures, not the extremely high values seen here. Jackhammer esophagus involves hypercontractility (distal contractile integral >8000 mmHg·cm·s) and is characterized by rapid, repetitive, and fragmented contractions, rather than the diffuse panesophageal pressurization and spasticity typical of Type 3 achalasia [2].

Q: A person was given a muscle relaxant that competitively blocks nicotinic receptors. Which of the following drugs is used for reversal of muscle relaxation after surgery?

Neostigmine. ***Neostigmine*** - **Neostigmine** is an **acetylcholinesterase inhibitor** that increases the amount of acetylcholine at the neuromuscular junction, thereby overcoming the competitive block at nicotinic receptors [1], [4]. - This increase in acetylcholine effectively reverses the paralysis caused by **nondepolarizing muscle relaxants**, making it useful for post-surgical recovery [2]. *Carbachol* - **Carbachol** is a **direct-acting cholinergic agonist** that stimulates both muscarinic and nicotinic receptors and is not typically used for reversing competitive neuromuscular blockade. - Its primary use is for glaucoma and to stimulate the bladder or bowels, not to counteract muscle relaxants. *Succinylcholine* - **Succinylcholine** is a **depolarizing muscle relaxant** and would prolong, rather than reverse, muscle blockade if administered after a competitive blocker [3]. - It works by initially causing depolarization and then preventing further muscle contraction, leading to paralysis. *Physostigmine* - **Physostigmine** is an **acetylcholinesterase inhibitor** that crosses the blood-brain barrier, making it more suitable for treating central anticholinergic toxicity rather than peripheral neuromuscular blockade. - While it inhibits acetylcholinesterase, its central effects and potential for seizures limit its use for reversing surgical muscle relaxation.

Q: Patient with pulmonary fibrosis. Which antiarrhythmic drug is contraindicated?

Amiodarone. Amiodarone - **Amiodarone** is contraindicated in patients with pulmonary fibrosis due to its well-known and potentially severe pulmonary toxicity, which can exacerbate existing lung conditions or induce new ones like **interstitial lung disease**. Dose-related pulmonary toxicity is the most important adverse effect, and potentially fatal pulmonary fibrosis can be observed even at low doses [1]. - Its long half-life means that its toxic effects, including **pulmonary toxicity**, can persist for an extended period even after discontinuation [1], [2]. *Flecainide* - **Flecainide** is a Class IC antiarrhythmic drug primarily associated with cardiac side effects and is generally not contraindicated in patients with pulmonary fibrosis. - Its main risks include **proarrhythmia**, especially in patients with structural heart disease, but not pulmonary issues [3]. *IV ibutilide* - **IV ibutilide** is a Class III antiarrhythmic agent used for rapid conversion of atrial fibrillation/flutter and is not specifically contraindicated in pulmonary fibrosis. - Its primary concern is the risk of **QT prolongation** and **Torsades de Pointes**, rather than pulmonary complications. *Lidocaine* - **Lidocaine** is a Class IB antiarrhythmic typically used for ventricular arrhythmias, especially in the setting of acute myocardial infarction. It is not contraindicated in pulmonary fibrosis. - Its main side effects are **neurological (e.g., seizures, paresthesias)** at higher doses, not pulmonary complications.

Question 1

The patient is presenting with pain around the base of the thumb. Which tendons are likely involved?

Accepted Answer

APL & EPB

Answer

APB & EPL

Answer

APB & EPB

Answer

APL & EPL

Question 2

Which of the following diseases is primarily water-related?

Accepted Answer

Cholera

Answer

Scabies

Answer

Yellow fever

Answer

Dysentery

Question 3

Blood bags are disposed of in

Accepted Answer

Yellow bag

Answer

Black bag

Answer

Red bag

Answer

White bag

Question 4

Identify the condition causing this infection on the upper arm

Accepted Answer

Tinea corporis (body ringworm)

Answer

Tinea capitis (scalp ringworm)

Answer

Tinea cruris (jock itch)

Answer

Tinea manus (hand ringworm)

Question 5

What poison will you detect in the skeleton even after decomposition

Accepted Answer

Arsenic

Answer

Lead

Answer

Mercury

Answer

Cadmium

Question 6

A young man met with a motorbike accident and had injuries to ileum and jejunum. Therefore the entire ileum and partial jejunum were resected. Which of the following would the patient suffer from

Accepted Answer

Vitamin B12 malabsorption due to ileal resection

Answer

Atrophic gastritis unrelated to resection

Answer

Constipation due to dietary changes

Answer

No significant symptoms

Question 7

Esophageal manometry was performed - it revealed panesophageal pressurization with distal contractile integrity as >450mm Hg pressure in the body. What will be the diagnosis?

Accepted Answer

Type 3 achalasia

Answer

Type 2 achalasia

Answer

Jackhammer esophagus

Answer

Type 1 achalasia (classic achalasia)

Question 8

A person was given a muscle relaxant that competitively blocks nicotinic receptors. Which of the following drugs is used for reversal of muscle relaxation after surgery?

Accepted Answer

Neostigmine

Answer

Carbachol

Answer

Succinylcholine

Answer

Physostigmine

Question 9

Patient with pulmonary fibrosis. Which antiarrhythmic drug is contraindicated?

Accepted Answer

Amiodarone

Answer

Flecainide

Answer

Lidocaine

Answer

IV ibutilide

Question 10

A 68-year-old asymptomatic male is found to have an abdominal aortic aneurysm (AAA) measuring 4.5 cm on routine ultrasound screening. What is the most appropriate management?

Accepted Answer

Monitor regularly and consider surgery if size reaches 55mm or symptomatic

Answer

Ultrasound monitoring until size exceeds 70mm

Answer

No treatment unless symptomatic

Answer

Immediate surgical repair for all diagnosed aneurysms regardless of size

NEET-PG 2020

Anatomy

Community Medicine

Dermatology

Forensic Medicine

Internal Medicine

Pharmacology

Surgery