NEET-PG 2017 Practice Questions

Q: The image shows:

Split laceration. ***Split laceration*** - **Split lacerations** result from **blunt force trauma** over a bony prominence, causing the skin to tear with irregular, jagged edges as seen in the image. - The wound shows typical features of tissue tearing rather than clean penetration, with **irregular margins** and evidence of stretching forces. *Stab wound* - **Stab wounds** are caused by **pointed objects** that penetrate cleanly, leaving relatively straight edges with minimal surrounding tissue damage. - The irregular, torn appearance in the image is inconsistent with the **clean, linear defect** typically seen in stab wounds. *Chop wound* - **Chop wounds** are produced by **heavy, sharp-edged instruments** like axes, combining features of incised wounds and lacerations with potential bone involvement. - This type would show a much **wider and deeper cut** with possible bone exposure, which is not evident in this case. *Crush laceration* - **Crush lacerations** occur from **compressive forces**, resulting in **stellate or irregular tears** with extensive soft tissue damage and surrounding bruising. - The wound lacks the **extensive tissue destruction**, **devitalized tissue**, and **significant bruising** characteristic of crush injuries.

Q: The image shows:

Crocodile burn. ***Crocodile burn*** - This image displays a characteristic pattern of **dehydrated skin** that has become **cracked and blackened**, resembling the scales of a crocodile, which is typical of a crocodile burn. - Crocodile burns are often associated with **high-voltage electrical injuries** where the skin is extensively damaged and denatured. *Joule burn* - A Joule burn typically refers to the **internal thermal damage** caused by an electric current flowing through tissues, which may not be immediately visible on the skin's surface in this distinct pattern. - While an electrical injury can cause surface burns, "Joule burn" specifically emphasizes the **heat generation within the body tissues**, not the external appearance shown. *Filigree burn* - A filigree burn, also known as a **Lichtenberg figure**, is a superficial, fern-like skin pattern caused by a **lightning strike**, which is distinct from the extensive, scaly appearance seen here. - These patterns are usually short-lived and represent the path of electrical discharge over the skin, without the widespread tissue destruction evident in the image. *Surface burn* - This is a very general term describing a burn that affects the skin's surface, but it lacks the **specificity** to describe the unique, severe, and distinct desiccation and cracking pattern shown. - The term "surface burn" could apply to many types of burns (e.g., superficial, partial thickness) and does not convey the **characteristic morphology** of a crocodile burn.

Q: The image shows:

Arborescent marks. ***Arborescent marks*** - These are **Lichtenberg figures**, a characteristic branching, fern-like pattern seen on the skin of individuals struck by lightning. - They are cutaneous manifestations of **blood vessel rupture and erythrocyte extravasation** caused by the electrical discharge. *Joule burn* - **Joule burn** is a term for thermal injuries caused by the heat generated from the resistance of tissue to the flow of electrical current, often seen at entry and exit points of an electrical injury. - Unlike arborescent marks, Joule burns present as localized, deep tissue damage, sometimes with charring or necrosis, and do not typically exhibit the branching pattern. *Surface burn* - **Surface burns** are general thermal injuries affecting the skin's outer layers, caused by contact with hot objects, flame, or scalding liquids - They appear as erythema, blistering, or skin loss but do not present with the specific **branching, fern-like pattern** characteristic of electrical injuries. *Crocodile burn* - **Crocodile burn** (or crocodile skin pattern) is a **recognized forensic term** referring to the characteristic splitting and fissuring of heat-exposed skin, resembling crocodile scales. - This pattern results from **heat-induced shrinkage and rupture of the dermis** in bodies exposed to intense fire, and is distinctly different from the branching electrical pattern of arborescent marks.

Q: The image shows:

Hesitation cuts. ***Hesitation cuts*** - The image displays multiple, superficial, parallel incised wounds, primarily on the wrist, which are classic characteristics of **hesitation cuts**. - These wounds are often made by individuals contemplating **suicide** and are typically not immediately life-threatening, reflecting a tentative or experimental attempt before a deeper, fatal cut. *Defense wounds* - **Defense wounds** typically appear on the hands, forearms, and sometimes the legs, resulting from an individual instinctively shielding themselves from an assault. - They tend to be more varied in depth and pattern, often showing signs of struggle and resistance, unlike the uniform, superficial nature seen here. *Radiation injury* - **Radiation injury** or radiation dermatitis presents with skin changes ranging from erythema, desquamation, blistering, or hyperpigmentation, depending on the dose and duration of exposure. - These injuries do not typically involve sharp, incised wounds like those depicted in the image. *Homicidal stab* - A **homicidal stab** implies a deep, forceful wound intended to cause death, often characterized by a single or few much deeper penetrating wounds. - The superficial and numerous nature of the cuts in the image is inconsistent with the typical presentation of a homicidal attack.

Q: A 25-year-old person was repairing the power plug of a geyser at home when he was electrocuted and died. The image shows:

Joule burn. ***Joule burn*** - This lesion is characteristic of an **electrical burn**, also known as a Joule burn or true electrical burn. The intense heat is generated by the passage of electrical current through body tissues (I²R heating), causing direct tissue destruction. - The appearance often includes a **central area of charring or necrosis** (dark, leathery, or blackened tissue) with a raised, crater-like edge, typically seen at entry and exit points of electrical current. *Spark lesion* - A spark lesion is typically a **smaller, superficial burn** caused by a momentary electrical arc or spark that jumps from conductor to skin without current passing through the body. - It usually presents as a **punctate or minor skin defect** with superficial charring and does not involve the extensive, deep tissue damage seen in Joule burns. *Crocodile skin* - "Crocodile skin" is a specific pattern seen in **high-voltage electrical injuries** where the epidermis separates and peels in a characteristic, polygonal pattern resembling crocodile hide. - This is a distinct manifestation of electrical injury, but the question describes a classic Joule burn with entry/exit point characteristics rather than this specific epidermal pattern. *Scald* - A scald is a burn caused by **hot liquid or steam**. - The appearance of scalds typically involves **blistering, redness, and peeling skin**, which is distinctly different from the charred, leathery appearance seen in electrical burns.

Q: The probable cause of death of the patient in the image shown is:

Hanging. ***Hanging*** - The image shows a **ligature mark that is oblique and incomplete**, extending upwards towards the **angle of the jaw or mastoid process** - This is **pathognomonic for hanging** where the knot/point of suspension creates upward pressure - The mark is typically **above the thyroid cartilage** and **higher on one side** (opposite to the knot) - **Key differentiating feature:** Oblique, upward-directed ligature mark with a gap at the knot site *Strangulation* - Ligature strangulation produces a **horizontal, complete ligature mark** that encircles the neck **at or below the thyroid cartilage** - The mark is typically **uniform in depth** and does not show the characteristic upward obliquity - Usually **homicidal**, whereas hanging is most commonly suicidal *Throttling* - A form of **manual strangulation** using hands to compress the neck - Produces **fingernail abrasions**, **finger pad bruises**, and **thumb marks** on the neck - **No ligature mark** is present; instead, there are multiple small contusions and scratch marks - Almost always **homicidal** *Gagging* - Involves **obstruction of the mouth and/or nose** to prevent breathing or vocalization - Does **not produce ligature marks on the neck** - May show injuries around the mouth, lips, or face, but the neck remains unmarked - The mechanism is airway obstruction, not neck compression

Q: The MRI findings shown in the image are consistent with multiple sclerosis. All of the following drugs are useful for management of this patient EXCEPT:

Intravenous immunoglobulin. ***Intravenous immunoglobulin*** - The image shows multiple **periventricular and juxtacortical white matter lesions**, characteristic of **multiple sclerosis (MS)**. IVIG is generally not a first-line treatment or disease-modifying therapy for MS. - While IVIG is used for some autoimmune neurological conditions (e.g., Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy) and acute MS exacerbations in specific cases, it is not a standard long-term management drug for MS. *Methylprednisolone* - **High-dose intravenous methylprednisolone** is the standard treatment for acute exacerbations or relapses in multiple sclerosis to reduce inflammation and shorten the duration of an attack. - It helps to restore the **blood-brain barrier** integrity and reduce edema associated with active demyelinating lesions. *Fingolimod* - Fingolimod is an **oral disease-modifying therapy (DMT)** approved for relapsing forms of MS. - It works by trapping lymphocytes in lymph nodes, preventing them from entering the central nervous system and causing demyelination. *Mitoxantrone* - Mitoxantrone is an **antineoplastic agent** that also has immunosuppressant properties, approved for worsening relapsing-remitting, secondary progressive, and progressive-relapsing MS. - It is used in more **aggressive forms of MS** due to its potential for serious side effects, including cardiotoxicity.

Q: A neonate presents with a congenital heart disease as shown below. Which drug should be started immediately? (Recent NEET Pattern 2016-17)

Alprostadil. ***Alprostadil*** - The image shows a **transposition of the great arteries (TGA)** with the aorta originating from the right ventricle and the pulmonary artery from the left ventricle. In this condition, a patent ductus arteriosus (PDA) is crucial to maintain mixing of oxygenated and deoxygenated blood to ensure systemic circulation. - **Alprostadil (prostaglandin E1 analog)** is used to keep the **ductus arteriosus patent**, allowing for mixing of blood and improving systemic oxygenation in neonates with ductal-dependent congenital heart defects like severe TGA. *Digoxin* - **Digoxin** is a cardiac glycoside used to improve **cardiac contractility** and control heart rate in certain heart conditions, but it is not the immediate drug of choice for maintaining patency of the ductus arteriosus in TGA. - Its primary role is in managing heart failure symptoms or arrhythmias, not directly addressing the immediate ductal dependency of TGA. *Ivabradine* - **Ivabradine** is a hyperpolarization-activated cyclic nucleotide-gated (HCN) channel blocker that selectively reduces heart rate by acting on the **sinoatrial node**. - It is used in adults with chronic heart failure or stable angina, and is not indicated for the acute management of congenital heart defects like TGA in neonates. *Propranolol* - **Propranolol** is a non-selective beta-blocker used to reduce heart rate and blood pressure, or to manage conditions like **tetralogy of Fallot spells**. - It does not have any role in maintaining the patency of the ductus arteriosus, which is critical for survival in ductal-dependent congenital heart lesions like TGA.

Q: Which anti-epileptic drug marked X will act at the site shown?

Tiagabine. ***Tiagabine*** - The image shows the reuptake of **GABA** from the synaptic cleft, and "X" points to this reuptake mechanism. Tiagabine is an anti-epileptic drug that acts by **inhibiting GABA reuptake**. - By inhibiting GABA reuptake, tiagabine increases the concentration of **GABA** in the synapse, enhancing its inhibitory effects and reducing neuronal excitability. *Valproate* - Valproate has multiple mechanisms of action, including inhibiting **GABA transaminase** (GABA-T) which leads to increased GABA levels, but it does not directly act on GABA reuptake. - It also blocks voltage-gated **sodium channels** and T-type calcium channels. *Gabapentin* - Gabapentin is an analogue of GABA but does not act directly on GABA receptors or GABA reuptake. - Its mechanism of action is primarily by binding to the **α2δ subunit of voltage-gated calcium channels**, reducing calcium influx and neurotransmitter release. *Vigabatrin* - Vigabatrin primarily works by irreversibly inhibiting **GABA transaminase (GABA-T)**, the enzyme responsible for the breakdown of GABA. - This leads to a persistent increase in **GABA** levels in the brain, thereby enhancing inhibitory neurotransmission.

Q: Which anti-epileptic drug marked X will act at the site shown?

Tiagabine. ***Tiagabine*** - The image shows site 'X' as a **GABA reuptake transporter** that actively removes GABA from the synaptic cleft back into the presynaptic neuron or glial cells - **Tiagabine** specifically inhibits **GABA reuptake transporters (GAT-1)**, thereby increasing GABA concentration in the synaptic cleft and enhancing its inhibitory effect - This is the mechanism directly targeting the site shown in the diagram *Vigabatrin* - Irreversible inhibitor of **GABA transaminase (GABA-T)**, the enzyme responsible for catabolizing GABA - Acts intracellularly to prevent GABA breakdown, not at the synaptic reuptake transporter shown - Different mechanism from the site depicted *Gabapentin* - GABA analog but does not bind to GABA receptors or interfere with GABA reuptake - Primary mechanism involves modulating **voltage-gated calcium channels (α2δ subunit)**, reducing excitatory neurotransmitter release - Does not act at GABA transporters *Rufinamide* - Prolongs the inactive state of **voltage-dependent sodium channels**, reducing neuronal excitability - Mechanism is distinct from GABA reuptake or metabolism - Does not act at the site shown in the diagram

Question 1

The image shows:

Accepted Answer

Split laceration

Answer

Chop wound

Answer

Crush laceration

Answer

Stab wound

Question 2

The image shows:

Accepted Answer

Crocodile burn

Answer

Joule burn

Answer

Filigree burn

Answer

Surface burn

Question 3

The image shows:

Accepted Answer

Arborescent marks

Answer

Joule burn

Answer

Surface burn

Answer

Crocodile burn

Question 4

The image shows:

Accepted Answer

Hesitation cuts

Answer

Defense wounds

Answer

Radiation injury

Answer

Homicidal stab

Question 5

A 25-year-old person was repairing the power plug of a geyser at home when he was electrocuted and died. The image shows:

Accepted Answer

Joule burn

Answer

Spark lesion

Answer

Crocodile skin

Answer

Scald

Question 6

The probable cause of death of the patient in the image shown is:

Accepted Answer

Hanging

Answer

Strangulation

Answer

Throttling

Answer

Gagging

Question 7

The MRI findings shown in the image are consistent with multiple sclerosis. All of the following drugs are useful for management of this patient EXCEPT:

Accepted Answer

Intravenous immunoglobulin

Answer

Methylprednisolone

Answer

Fingolimod

Answer

Mitoxantrone

Question 8

A neonate presents with a congenital heart disease as shown below. Which drug should be started immediately? (Recent NEET Pattern 2016-17)

Accepted Answer

Alprostadil

Answer

Digoxin

Answer

Ivabradine

Answer

Propranolol

Question 9

Which anti-epileptic drug marked X will act at the site shown?

Accepted Answer

Tiagabine

Answer

Vigabatrin

Answer

Valproate

Answer

Gabapentin

Question 10

Which anti-epileptic drug marked X will act at the site shown?

Accepted Answer

Tiagabine

Answer

Vigabatrin

Answer

Gabapentin

Answer

Rufinamide

NEET-PG 2017

Forensic Medicine

Internal Medicine

Pediatrics

Pharmacology