NEET-PG 2012 Practice Questions

Q: Cocaine was first used as a local anesthetic by?

Carl Koller. ***Carl Koller*** - **Carl Koller** (1857-1944), an Austrian ophthalmologist, is credited with the first clinical use of cocaine as a local anesthetic in 1884. - He demonstrated its efficacy for topical anesthesia in eye surgery, revolutionizing surgical practices. *Holmer Wells* - **Horace Wells** (not Holmer) was an American dentist who pioneered the use of **nitrous oxide** as an anesthetic in dentistry in the 1840s, preceding Koller's work with cocaine. - His contributions were focused on general anesthesia for pain relief during tooth extractions. *Morton* - **William T.G. Morton** was another American dentist who famously demonstrated the use of **ether** as a surgical anesthetic in 1846. - His work popularized surgical anesthesia, but it was not related to cocaine as a local anesthetic. *None of the options* - This option is incorrect because Carl Koller is historically recognized as the pioneer for the clinical use of **cocaine as a local anesthetic**.

Q: What is the critical temperature of Nitrous Oxide (N2O)?

-36.5°C. **-36.5°C** - The **critical temperature** of **nitrous oxide (N2O)** is **36.5°C**, which is the temperature above which it cannot be liquefied by pressure alone. - This value is important for understanding the **physical state** and safe handling of N2O, as deviations can lead to phase changes or storage issues. *-118°C* - This temperature is significantly lower than the actual critical temperature of N2O and is incorrect. - This value might be related to the **boiling point of other gases** but not the critical temperature of N2O. *-36°C* - While close, **-36°C** is not the precise critical temperature for nitrous oxide. - This small difference can be significant in contexts requiring **exact physical properties** of gases. *-30°C* - This temperature is incorrect and is higher than the actual critical temperature of N2O. - At this temperature, N2O would still behave as a **liquefiable gas** under sufficient pressure, indicating it is below its critical point.

Q: Which of the following is NOT a contraindication for spinal anaesthesia?

Hypertension. ***Hypertension*** - While **severe uncontrolled hypertension** may necessitate blood pressure stabilization before surgery, **mild to moderate hypertension** is not an absolute contraindication for spinal anesthesia. - In fact, spinal anesthesia can sometimes be beneficial in hypertensive patients due to its **vasodilatory effects**, which may help lower blood pressure. *Bleeding disorder* - A **bleeding disorder** (e.g., thrombocytopenia, coagulopathy) is a **major contraindication** due to the high risk of **epidural or spinal hematoma** formation. - A hematoma can lead to **spinal cord compression** and irreversible neurological damage. *Raised intracranial tension* - **Raised intracranial tension (ICT)** is a **strict contraindication** because the drop in cerebrospinal fluid (CSF) pressure during spinal anesthesia can worsen the pressure gradient across the foramen magnum. - This can precipitate **herniation of the brainstem** and lead to catastrophic neurological injury or death. *Infection at injection site* - The presence of an **infection at the injection site** is an absolute contraindication as it poses a significant risk of introducing bacteria into the **subarachnoid space**. - This can lead to serious complications such as **meningitis** or a **spinal abscess**.

Q: Which of the following is the MOST characteristic feature of skin tags (acrochordons)?

They are typically pedunculated.. ***They are typically pedunculated.*** - **Skin tags (acrochordons)** are benign soft tissue tumors characterized by their **pedunculated morphology** - they are attached to the skin by a narrow stalk or pedicle. - This **pedunculated appearance** is the **most characteristic** and **defining feature** that distinguishes them from other benign skin lesions. - They are typically **soft, flesh-colored or hyperpigmented**, and range from 1-5 mm in size. *They commonly occur on the neck and axilla.* - While **skin tags** frequently occur in areas of friction such as the neck, axilla, eyelids, groin, and inframammary folds, this **location is not specific**. - Many other skin conditions also favor these sites, so location alone is not a characteristic diagnostic feature. *They are associated with seborrhoeic keratosis.* - There is **no established clinical association** between skin tags and seborrheic keratoses. - Both are common **benign skin growths** in adults but represent different pathological entities with different clinical appearances. *They have malignant potential.* - This is **incorrect**. Skin tags are **benign fibrous polyps** with **no malignant potential**. - They do not require removal unless symptomatic or for cosmetic reasons.

Q: What type of cell are Tzanck cells commonly associated with in skin conditions?

Keratinocyte. ***Keratinocyte*** - **Tzanck cells** are **acantholytic keratinocytes** characterized by loss of intercellular connections, resulting in rounded cells with **large nuclei** and **perinuclear halos**. - They are classically seen in **pemphigus vulgaris** and other acantholytic disorders on **Tzanck smear** preparation. - The Tzanck smear is a simple bedside diagnostic test where the base of a blister is scraped and examined microscopically after staining. *Fibroblast* - **Fibroblasts** are mesenchymal cells in the **dermis** that produce **collagen** and extracellular matrix components. - They are not epithelial cells and do not undergo acantholysis to form Tzanck cells. *Neutrophil* - **Neutrophils** are polymorphonuclear leukocytes involved in acute inflammatory responses and fighting bacterial infections. - They may infiltrate skin lesions but do not transform into Tzanck cells, which are specifically altered keratinocytes. *Lymphocyte* - **Lymphocytes** (T cells and B cells) are immune cells involved in **adaptive immunity**. - They are not the cell type from which Tzanck cells originate; Tzanck cells are acantholytic epidermal keratinocytes.

Q: In a 5-month pregnant female, which of the following statements regarding physiological changes is true?

80-90% have soft systolic murmur. ***80-90% have soft systolic murmur*** - The **increased blood volume** and **cardiac output** during pregnancy lead to increased flow across the aortic and pulmonic valves, often resulting in a **physiological systolic ejection murmur**. - This murmur is typically heard best at the **left sternal border** and usually resolves after delivery. *Cardiac output is reduced* - **Cardiac output actually increases** significantly during pregnancy, typically by 30-50%, to meet the metabolic demands of the fetus and placenta. - This increase is due to both an **increase in heart rate** and **stroke volume**. *Systemic vascular resistance is increased* - **Systemic vascular resistance (SVR) decreases** during pregnancy, primarily due to the **vasodilating effects of progesterone** and the creation of a **low-resistance placental circulation**. - The drop in SVR contributes to the physiological **decrease in blood pressure** often observed in mid-pregnancy. *Increase in CVP* - **Central venous pressure (CVP) typically remains unchanged or slightly decreases** during normal pregnancy. - While blood volume increases, the accompanying **vasodilation and decreased SVR** usually prevent a significant rise in CVP.

Q: Which of the following is the prototypical sympathomimetic agent with both alpha and beta-adrenergic activity?

Epinephrine. ***Epinephrine*** - Epinephrine (adrenaline) is a potent direct-acting **sympathomimetic** that stimulates both **alpha and beta-adrenergic receptors**. - Its diverse effects on the cardiovascular, respiratory, and other systems make it the prototypical agent for demonstrating both receptor activities. *Norepinephrine* - While norepinephrine (noradrenaline) also acts on **alpha and beta-1 receptors**, its affinity for **beta-2 receptors** is significantly lower than epinephrine. - This results in a predominant effect on **vasoconstriction** and cardiac contractility rather than bronchodilation or peripheral vasodilation. *Isoproterenol* - Isoproterenol is a **non-selective beta-adrenergic agonist**, meaning it primarily stimulates **beta-1 and beta-2 receptors**. - It has minimal or no activity at **alpha-adrenergic receptors**, differentiating it from epinephrine's mixed activity. *Dopamine* - Dopamine's effects are **dose-dependent**; at low doses, it primarily stimulates **dopamine receptors** and at moderate doses, it activates **beta-1 receptors**. - At high doses, it can stimulate **alpha-adrenergic receptors**, but its primary and distinguishing characteristic is its agonism at **dopamine receptors**, which epinephrine does not share.

Q: What is the effect of adding epinephrine to lignocaine (a local anesthetic)?

Decreases absorption of local anesthetic. ***Decreases absorption of local anesthetic*** - Epinephrine causes **vasoconstriction** at the site of injection, which reduces the rate at which the local anesthetic is absorbed into the systemic circulation. - This slower absorption leads to a **higher concentration of the anesthetic** at the nerve fibers, prolonging its effect and reducing systemic toxicity. - This is the primary mechanism by which epinephrine enhances local anesthetic efficacy. *Increases distribution of local anesthetic* - The primary effect of epinephrine is to **localize the anesthetic** by reducing its systemic distribution. - This localization is achieved through **vasoconstriction**, which keeps the drug at the desired site rather than allowing it to distribute widely. *Decreases duration of local anesthetic* - By slowing absorption, epinephrine effectively **increases the duration of action** of the local anesthetic. - The anesthetic remains at the site of action for a longer period, providing **extended pain relief**. *Increases metabolism of local anesthetic* - Epinephrine does not directly affect the **metabolic rate** of local anesthetics. - The primary mechanism of metabolism for amides like lignocaine is in the **liver** by cytochrome P450 enzymes.

Q: The most appropriate first-line imaging modality to detect adrenal metastasis due to bronchogenic carcinoma is:

Contrast Enhanced CT abdomen. **Contrast Enhanced CT abdomen** - **Contrast-enhanced CT abdomen** is generally considered the most sensitive and cost-effective imaging modality for detecting **adrenal metastases**. - It allows for detailed visualization of adrenal gland morphology, including size, shape, and enhancement patterns, which can help differentiate benign from malignant lesions. *PET scan* - While **PET (Positron Emission Tomography) scans** are highly sensitive for detecting metabolically active metastatic disease, they are often used as a secondary imaging modality to characterize indeterminate lesions found on CT or MRI. - **PET scans** can have false positives in benign adrenal tumors (e.g., adenomas rich in fat) and are less readily available or higher in cost for initial screening compared to CT. *MRI of the abdomen* - **MRI of the abdomen** can be very useful for further characterization of adrenal masses, especially for distinguishing between lipid-rich adenomas and metastases. - However, for initial detection, especially in the context of screening for distant metastases from bronchogenic carcinoma, **CT is generally preferred due to its wider availability, speed, and lower cost**. *Adrenal radionuclide scan* - **Adrenal radionuclide scans** (e.g., using MIBG or iodocholesterol) are primarily used for functional imaging of adrenal glands, typically to detect specific types of tumors like pheochromocytomas or aldosteronomas. - These scans are **not sensitive for detecting adrenal metastases** from bronchogenic carcinoma, as the metastatic lesions do not typically exhibit the specific uptake patterns targeted by these radiotracers.

Question 1

Cocaine was first used as a local anesthetic by?

Accepted Answer

Carl Koller

Answer

Holmer Wells

Answer

Morton

Answer

None of the options

Question 2

What is the critical temperature of Nitrous Oxide (N2O)?

Accepted Answer

-36.5°C

Answer

-118°C

Answer

-36°C

Answer

-30°C

Question 3

Which of the following is NOT a contraindication for spinal anaesthesia?

Accepted Answer

Hypertension

Answer

Raised intracranial tension

Answer

Bleeding disorder

Answer

Infection at injection site

Question 4

Which of the following is the MOST characteristic feature of skin tags (acrochordons)?

Accepted Answer

They are typically pedunculated.

Answer

They commonly occur on the neck and axilla.

Answer

They have malignant potential.

Answer

They are associated with seborrhoeic keratosis.

Question 5

What type of cell are Tzanck cells commonly associated with in skin conditions?

Accepted Answer

Keratinocyte

Answer

Neutrophil

Answer

Lymphocyte

Answer

Fibroblast

Question 6

Which of the following statements about lepromatous leprosy is true?

Accepted Answer

Lepromatous leprosy typically presents with multiple cutaneous lesions.

Answer

Thickened peripheral nerves are a common feature.

Answer

Erythema nodosum leprosum occurs in less than 50% of cases.

Answer

The lepromin test is usually negative or weakly positive.

Question 7

In a 5-month pregnant female, which of the following statements regarding physiological changes is true?

Accepted Answer

80-90% have soft systolic murmur

Answer

Cardiac output is reduced

Answer

Systemic vascular resistance is increased

Answer

Increase in CVP

Question 8

Which of the following is the prototypical sympathomimetic agent with both alpha and beta-adrenergic activity?

Accepted Answer

Epinephrine

Answer

Isoproterenol

Answer

Norepinephrine

Answer

Dopamine

Question 9

What is the effect of adding epinephrine to lignocaine (a local anesthetic)?

Accepted Answer

Decreases absorption of local anesthetic

Answer

Increases distribution of local anesthetic

Answer

Decreases duration of local anesthetic

Answer

Increases metabolism of local anesthetic

Question 10

The most appropriate first-line imaging modality to detect adrenal metastasis due to bronchogenic carcinoma is:

Accepted Answer

Contrast Enhanced CT abdomen

Answer

PET scan

Answer

MRI of the abdomen

Answer

Adrenal radionuclide scan

NEET-PG 2012

Anesthesiology

Dermatology

Obstetrics and Gynecology

Pharmacology

Radiology