NEET-PG 2013 Practice Questions

Q: Which of the following statements about Nitrous Oxide (N2O) is true?

Least potent inhalational anesthetic. **Least potent inhalational anesthetic** - Nitrous oxide has a **high Minimum Alveolar Concentration (MAC)** of approximately 104%, making it the least potent of the commonly used inhalational anesthetics. - Its high MAC means a very high concentration is required to achieve surgical anesthesia, which is why it is typically used as an adjunct to more potent agents. *Lighter than air* - The molecular weight of nitrous oxide (N2O) is 44, which is **heavier than air** (average molecular weight approximately 29 g/mol). - Its density is greater than air, meaning it would tend to sink rather than rise. *Effective muscle relaxant* - Nitrous oxide provides **minimal to no skeletal muscle relaxation** benefits. - If muscle relaxation is required, a neuromuscular blocking agent must be administered separately. *Does not cause diffusion hypoxia* - Nitrous oxide rapidly diffuses out of the blood into the alveoli during emergence, diluting the oxygen and carbon dioxide there. - This rapid diffusion can lead to **diffusion hypoxia** (also known as the "second gas effect"), necessitating the administration of 100% oxygen during recovery to prevent this complication.

Q: Inhalational agent of choice for neurosurgery?

Isoflurane. ***Isoflurane*** - **Isoflurane** is preferred in neurosurgery due to its minimal impact on **cerebral blood flow** and **intracranial pressure (ICP)**, allowing cerebral autoregulation to be largely preserved. - It maintains **cerebral perfusion pressure** well and has a relatively fast onset and offset, facilitating neurological assessment post-operatively. *Halothane* - **Halothane** significantly increases **cerebral blood flow** and **intracranial pressure (ICP)**, which is undesirable in neurosurgical patients. - Its slow elimination can prolong recovery and neurological assessment, making it unsuitable for neurosurgery. *Enflurane* - **Enflurane** can cause central nervous system excitation and has been associated with **seizure activity** at higher concentrations, making it contraindicated in neurosurgical procedures. - Like halothane, it can also increase **cerebral blood flow** and **intracranial pressure**. *N2O* - **Nitrous oxide (N2O)** should be avoided in neurosurgery, especially if there's a risk of **intracranial air** or **pneumocephalus**, as it can expand air-filled spaces and increase ICP. - It also has a weak anesthetic effect and is often combined with other agents, but its cerebral vasodilatory properties can still be problematic.

Q: Which of the following anesthetic agents causes the LEAST severe complications when accidentally injected intra-arterially?

Propofol. **Propofol** * **Propofol** has a relatively low incidence and severity of complications if accidentally injected intra-arterially because of its **lipid emulsion formulation** and mild irritant properties compared to other agents. * While any intra-arterial injection can cause problems, the milder venoconstriction and less direct tissue damage make its intra-arterial complication profile less severe than alternative agents. *Thiopentone* * **Thiopentone** (Thiopental) is highly alkaline, and accidental intra-arterial injection can cause **intense pain**, **vasospasm**, and **gangrene** due to precipitation in the arterioles and widespread endothelial damage. * This severe complication arises from its extreme pH and crystal formation, leading to profound ischemia. *Midazolam* * Accidental intra-arterial injection of **Midazolam** can cause **pain**, **spasm**, and **local tissue damage** due to its relatively acidic pH and solvent properties, though generally less severe than thiopentone. * While not as catastrophic as thiopentone, it can still lead to significant discomfort and localized vascular issues. *Methohexitone* * **Methohexitone** is also an alkaline barbiturate derivative, similar in nature to thiopentone, and its intra-arterial injection carries a significant risk of **vasospasm**, **pain**, and potentially **tissue necrosis**. * Its strong irritant properties and ability to precipitate within the vasculature make it a dangerous agent for inadvertent intra-arterial administration.

Q: Which anaesthetic drug contributes to green house effect?

Desflurane. **Desflurane** - **Desflurane** has the highest **global warming potential (GWP)** among commonly used volatile anesthetics, primarily due to its long atmospheric half-life and potent infrared absorption. - Its environmental impact is also amplified by its high **minimum alveolar concentration (MAC)** and low blood solubility, requiring higher delivered concentrations for anesthesia. *Enflurane* - **Enflurane** has a lower GWP compared to desflurane and is less commonly used in modern practice. - While it contributes to the greenhouse effect, its impact is significantly less than that of desflurane due to differences in chemical structure and atmospheric persistence. *Sevoflurane* - **Sevoflurane** has a relatively low GWP and a short atmospheric half-life compared to desflurane, making it a more environmentally friendly option among volatile anesthetics. - Although it still contributes to atmospheric warming, its overall environmental impact is considerably less than desflurane's. *Halothane* - **Halothane** is a potent greenhouse gas but is no longer used in many parts of the world due to concerns about hepatotoxicity and its significant ozone-depleting potential. - While it contributes to atmospheric warming, its current lack of clinical use limits its ongoing contribution to the greenhouse effect compared to currently utilized agents.

Q: Bonney's test is used to determine which of the following?

Urinary incontinence due to stress. ***Urinary incontinence due to stress*** - **Bonney's test** is specifically designed to assess whether a patient's **stress urinary incontinence** is correctable by elevating the urethrovesical junction. - A positive result, where urine leakage stops with elevation, suggests that surgical correction to support the urethra may be beneficial. *Uterine prolapse* - While related to pelvic floor dysfunction, **uterine prolapse** is assessed by clinical examination for descent of the uterus, not specifically with Bonney's test. - Its presence is determined by visible or palpable protrusion of the cervix or uterus through the vaginal opening. *Vesicovaginal fistula* - A **vesicovaginal fistula** involves an abnormal connection between the bladder and vagina, leading to continuous urine leakage. - This condition is typically diagnosed using dye tests (e.g., tampon test) or cystoscopy, not Bonney's test. *Ureteric fistula* - A **ureteric fistula** is an abnormal connection involving the ureter, often resulting in continuous urine leakage outside the normal urinary tract. - Diagnosis usually involves imaging studies like IV urography or CT urogram, as Bonney's test is not relevant for this condition.

Q: Red degeneration of fibroid is seen in which of the following?

Mid pregnancy. ***Mid pregnancy*** - **Red degeneration**, or **carneous degeneration**, is most common during the **second and third trimesters of pregnancy** due to increased metabolic demands of the growing fibroid outstripping its blood supply. - The rapid growth leads to **ischemia**, hemorrhage, and necrosis within the fibroid, causing acute abdominal pain. *Early pregnancy* - While fibroids can grow in early pregnancy, **red degeneration** is less common as the uterine blood supply is generally still adequate to meet the fibroid's metabolic needs. - Other forms of degeneration, like **hyaline degeneration**, are more frequently observed in non-pregnant or early pregnant states. *Puerperium* - In the puerperium, fibroids typically undergo **regression** rather than degeneration, as the hormonal stimulation (estrogen and progesterone) that promoted their growth significantly decreases. - The uterus involutes rapidly, and fibroids often shrink. *Nulliparous women* - Nulliparous women can have fibroids and experience various forms of degeneration, but **red degeneration** specifically is rare outside of pregnancy. - Degeneration in nulliparous women is more commonly **hyaline** or **cystic** degeneration.

Q: Which of the following statements about radical hysterectomy in stage Ib cervical cancer compared to radiotherapy is false?

It is less complicated than radiotherapy.. ***It is less complicated than radiotherapy.*** - Radical hysterectomy is a **major surgical procedure** with potential complications like **hemorrhage**, infection, **ureteral injury**, and **lymphedema**, which can be significant and life-altering. - Radiotherapy, while having its own set of side effects (e.g., **vaginal stenosis**, bladder/rectal irritation), typically avoids the acute surgical risks and recovery period associated with extensive surgery. *Chance of recurrence is lower with radical hysterectomy.* - For early-stage cervical cancer (Ib1/Ib2), both **radical hysterectomy** and **radiotherapy** provide **comparable outcomes** in terms of recurrence rates. - The choice between therapies often depends on patient factors, surgeon expertise, and pathological findings, but neither consistently demonstrates a significantly lower recurrence rate over the other in large cohorts. *Ovarian function can be preserved.* - In younger patients undergoing **radical hysterectomy**, it is often possible to **preserve the ovaries** by transplanting them or avoiding their removal if not directly involved, thus maintaining **endocrine function**. - **Pelvic radiotherapy**, in contrast, invariably leads to **ovarian radiation** and subsequent **ovarian failure** and menopause. *Chance of survival is higher with radical hysterectomy.* - For early-stage cervical cancer (Ib), **overall survival rates** are generally **equivalent** between radical hysterectomy and primary radiotherapy. - Meta-analyses and large retrospective studies have shown **similar 5-year survival rates** for both treatment modalities when applied appropriately to well-selected patients.

Q: A patient presents with bilateral ovarian carcinoma, capsule involvement, ascites, and paraaortic lymphadenopathy. What is the appropriate stage of the disease?

Stage 3C. ***Stage 3C*** - **Bilateral ovarian carcinoma** with **capsule involvement**, **ascites**, and especially **paraaortic lymph node metastases** are defining features of Stage IIIC ovarian cancer. - Involvement of **retroperitoneal lymph nodes**, including paraaortic nodes, automatically upstages the disease to Stage III, irrespective of other abdominal spread. *Stage 1C* - This stage refers to ovarian cancer confined to **one or both ovaries**, with evidence of rupture, capsule involvement, or malignant cells in ascites/peritoneal washings, but **without lymph node involvement**. - The presence of **paraaortic lymphadenopathy** in this patient immediately excludes Stage 1C. *Stage 2C* - Stage 2 ovarian cancer involves one or both ovaries with **pelvic extension** beyond the ovaries, but still **without lymph node involvement**. - The patient's involvement of **paraaortic lymph nodes** goes beyond pelvic extension and therefore excludes Stage 2C. *Stage 4C* - Stage 4 ovarian carcinoma involves **distant metastasis** beyond the peritoneal cavity or distant lymph nodes (e.g., pleural effusion with positive cytology, parenchymal liver/spleen metastasis). - While paraaortic lymphadenopathy indicates advanced disease, it falls within the criteria for Stage 3 due to its location, not Stage 4.

Q: Most common presentation of cervical cancer is -

Abnormal vaginal bleeding. ***Abnormal vaginal bleeding*** - **Abnormal vaginal bleeding** is the most frequent presenting symptom of cervical cancer, often manifesting as **postcoital bleeding**, intermenstrual bleeding, or heavier, longer menstrual periods. - This symptom arises as the tumor on the cervix ulcerates and bleeds due to its friable nature and rich vascularization. *Pelvic pain* - **Pelvic pain** is typically a symptom of more **advanced cervical cancer**, indicating tumor invasion into surrounding tissues or nerves. - It is not usually an early or the most common presenting symptom, unlike abnormal bleeding. *Pain during intercourse* - **Pain during intercourse (dyspareunia)** can be a symptom of cervical cancer, particularly with larger lesions or those causing inflammation. - However, it is less common than abnormal bleeding and often occurs concurrently with or after the onset of bleeding symptoms. *Unusual vaginal discharge* - An **unusual vaginal discharge**, which may be watery, foul-smelling, or blood-tinged, can occur with cervical cancer. - While a common symptom, it is generally considered less frequent than abnormal vaginal bleeding as the primary presenting complaint.

Q: What is the standard radiation dose to point A in the cervix for brachytherapy in the treatment of cervical cancer?

8000 rad. ***8000 rad*** - The standard **total cumulative radiation dose** to **Point A** in the cervix for the treatment of cervical cancer is approximately **8000 rad (80 Gy)**. - This represents the **combined dose** from external beam radiation therapy (EBRT, typically 45-50 Gy) plus intracavitary brachytherapy (typically 30-40 Gy to Point A). - Point A is a classical reference point defined as **2 cm superior to the external cervical os and 2 cm lateral to the uterine canal**, representing the location where the uterine artery crosses the ureter. - This total dose aims to provide adequate tumor control while minimizing toxicity to surrounding organs like the bladder and rectum. *6000 rad* - A total dose of **6000 rad** is insufficient for definitive local control of cervical cancer. - This dose is below the therapeutic threshold and would result in significantly higher rates of local recurrence and treatment failure. - Adequate doses are essential for curative intent in cervical cancer management. *10000 rad* - A dose of **10000 rad** to Point A would be excessively high and significantly increase the risk of severe acute and late toxicities to surrounding tissues. - Such a high dose could lead to serious complications including **rectovaginal or vesicovaginal fistulas, proctitis, cystitis, bowel strictures, and tissue necrosis**. - The therapeutic window would be exceeded, causing more harm than benefit. *4000 rad* - A dose of **4000 rad** would be substantially lower than the standard therapeutic dose for cervical cancer. - This suboptimal dose would likely result in **inadequate tumor control and increased risk of local recurrence**. - It is far below the dose required for curative treatment of cervical cancer.

Question 1

Which of the following statements about Nitrous Oxide (N2O) is true?

Accepted Answer

Least potent inhalational anesthetic

Answer

Lighter than air

Answer

Effective muscle relaxant

Answer

Does not cause diffusion hypoxia

Question 2

Inhalational agent of choice for neurosurgery?

Accepted Answer

Isoflurane

Answer

Halothane

Answer

Enflurane

Answer

N2O

Question 3

Which of the following anesthetic agents causes the LEAST severe complications when accidentally injected intra-arterially?

Accepted Answer

Propofol

Answer

Thiopentone

Answer

Methohexitone

Answer

Midazolam

Question 4

Which anaesthetic drug contributes to green house effect?

Accepted Answer

Desflurane

Answer

Enflurane

Answer

Sevoflurane

Answer

Halothane

Question 5

Bonney's test is used to determine which of the following?

Accepted Answer

Urinary incontinence due to stress

Answer

Uterine prolapse

Answer

Vesicovaginal fistula

Answer

Ureteric fistula

Question 6

Red degeneration of fibroid is seen in which of the following?

Accepted Answer

Mid pregnancy

Answer

Early pregnancy

Answer

Nulliparous women

Answer

Puerperium

Question 7

Which of the following statements about radical hysterectomy in stage Ib cervical cancer compared to radiotherapy is false?

Accepted Answer

It is less complicated than radiotherapy.

Answer

Chance of recurrence is lower with radical hysterectomy.

Answer

Ovarian function can be preserved.

Answer

Chance of survival is higher with radical hysterectomy.

Question 8

A patient presents with bilateral ovarian carcinoma, capsule involvement, ascites, and paraaortic lymphadenopathy. What is the appropriate stage of the disease?

Accepted Answer

Stage 3C

Answer

Stage 1C

Answer

Stage 2C

Answer

Stage 4C

Question 9

Most common presentation of cervical cancer is -

Accepted Answer

Abnormal vaginal bleeding

Answer

Pelvic pain

Answer

Pain during intercourse

Answer

Unusual vaginal discharge

Question 10

What is the standard radiation dose to point A in the cervix for brachytherapy in the treatment of cervical cancer?

Accepted Answer

8000 rad

Answer

6000 rad

Answer

10000 rad

Answer

4000 rad

NEET-PG 2013

Anesthesiology

Obstetrics and Gynecology

Radiology