NEET-PG 2012 Practice Questions

Q: Which circuit is specifically designed for anaesthesia in infants?

Ayres t piece. ***Ayres t piece*** - The **Ayres t piece (Jackson-Rees modification)** lacks a reservoir bag, which reduces **dead space** and resistance, making it ideal for infants with low tidal volumes. - Its simple design and **low resistance** minimize the work of breathing, crucial for neonates and infants. *Bains circuit* - The Bains circuit is a **modified Mapleson D system** often used in older children and adults. - It features a concentric design with a fresh gas flow lumen inside the expiratory limb, making it suitable for moderate to high fresh gas flows but less ideal for the very low tidal volumes of infants. *Magill circuit* - The Magill circuit is a **Mapleson A system**, most efficient for **spontaneous ventilation** in adults, requiring low fresh gas flows. - Its design with the APL valve near the patient leads to significant rebreathing if used with controlled ventilation or in infants due to their small tidal volumes. *Water's circuit* - The Water's circuit (also known as the **Mapleson E or F system**) is primarily used as an open-system mask for **spontaneous respiration**, often for induction or emergency situations. - It provides minimal control over ventilation and is generally not preferred for precise anesthesia management in any age group, especially not infants.

Q: Fast induction and recovery is seen in?

N2O. ***N2O*** - **Nitrous oxide (N2O)** has a very **low blood-gas partition coefficient**, meaning it rapidly equilibrates between the alveolar gas and blood. - This rapid equilibration leads to a **fast onset of anesthetic action** (induction) and quick elimination from the body (recovery). *methoxyflurane* - **Methoxyflurane** has a **high blood-gas partition coefficient**, which means it has high solubility in blood. - This high solubility leads to **slow induction and prolonged recovery** as more anesthetic needs to be dissolved and then eliminated from the blood. *ether* - **Diethyl ether** also has a relatively **high blood-gas partition coefficient**, resulting in slow induction and recovery. - Its high solubility in blood and tissues means it takes longer to achieve and then dissipate its anesthetic effect. *halothane* - **Halothane** has a **moderate blood-gas partition coefficient**, leading to a slower induction and recovery compared to N2O. - While faster than methoxyflurane or ether, its solubility is still significant enough to delay its onset and offset.

Q: Which of the following statements about halothane is false?

Constricts bronchii. ***Constricts bronchii*** - Halothane is a **bronchodilator** that relaxes bronchial smooth muscle, making it useful in patients with asthma or COPD. - The statement that it constricts bronchi is **false**. *Volatile liquid with sweet odour* - **Halothane** is a **volatile liquid** and is known for its characteristic **sweet, non-pungent odour**. - This property makes it well-tolerated during induction of anesthesia, particularly in pediatric patients. *Sensitises heart to adrenaline* - Halothane **sensitizes the myocardium** to the effects of **catecholamines**, including adrenaline (epinephrine). - This can lead to the development of **cardiac arrhythmias**, especially ventricular arrhythmias, when adrenaline is administered or endogenous levels are high. *Causes malignant hyperthermia* - Halothane is a potent trigger for **malignant hyperthermia**, a rare but life-threatening pharmacogenetic disorder. - This condition is characterized by a rapid and severe increase in body temperature, muscle rigidity, and metabolic derangements due to uncontrolled release of calcium from the sarcoplasmic reticulum.

Q: Which of the following diseases has the maximum Disability-Adjusted Life Years (DALY) loss?

Unipolar depression (Major Depressive Disorder). ***Unipolar depression (Major Depressive Disorder)*** - **Major Depressive Disorder (MDD)** is considered a leading cause of **disability worldwide**, contributing significantly to DALYs due to its high prevalence, chronicity, and disabling nature. - The long-term impact on daily functioning, productivity, and overall quality of life makes it the mental disorder with the largest burden of disease. *Schizophrenia (Mental Disorder)* - While **schizophrenia** causes severe disability and is highly impactful on individuals and society, its prevalence is lower than that of unipolar depression. - The DALY burden for schizophrenia is substantial, but **unipolar depression** affects a much larger proportion of the global population. *Bipolar depression (Bipolar Disorder)* - **Bipolar disorder (depressive episodes)** also contributes significantly to disability, but it is less prevalent than unipolar depression. - Although the depressive phases are often more severe than unipolar depression, the overall DALYs are lower due to its **comparatively lower incidence**. *Mania (Bipolar Disorder Episode)* - **Mania**, a component of bipolar disorder, can cause significant impairment during an episode but is typically **episodic** and less frequent than depressive states in bipolar disorder. - The DALYs attributed to manic episodes alone are generally lower than the overall burden of persistent depressive states found in unipolar depression.

Q: In which of the following conditions is the Koebner phenomenon most commonly observed?

Psoriasis. ***Correct: Psoriasis*** - **Psoriasis** is the **most classic and commonly cited example** of the Koebner phenomenon (isomorphic response) - New psoriatic plaques characteristically develop at sites of cutaneous trauma, scratches, or surgical incisions in 25-50% of psoriasis patients - This is a **pathognomonic feature** frequently tested in competitive exams and considered the prototype condition for demonstrating this phenomenon - The mechanism involves inflammatory cascades triggered by trauma in genetically predisposed skin *Incorrect: Lichen planus* - While lichen planus does exhibit the Koebner phenomenon with purplish polygonal papules appearing along scratch lines, it is **less commonly observed** compared to psoriasis - Seen in approximately 10-25% of lichen planus cases - Not considered the primary example when teaching about Koebner phenomenon *Incorrect: Viral warts* - Viral warts can demonstrate **pseudo-Koebner phenomenon** where new warts form along trauma lines due to viral inoculation - This is more accurately described as **autoinoculation** rather than true isomorphic response - Less commonly discussed in the context of classic Koebner phenomenon compared to psoriasis *Incorrect: All of the options* - While all three conditions can show Koebner-like responses, the question asks for "**most commonly observed**" - Psoriasis remains the **gold standard** and most frequently encountered example in clinical practice and medical literature

Q: Which of the following is not a feature of dermatomyositis?

Salmon Patch. ***Salmon Patch*** - A **salmon patch** (also known as a nevus simplex or stork bite) is a common, benign vascular birthmark that presents as a flat, red or pink patch. - It is **not associated with dermatomyositis** and has no pathogenic link to the condition. *Gottron's patch* - **Gottron's patches** are a classic cutaneous manifestation of dermatomyositis, characterized by erythematous, violaceous, or dusky red papules or plaques over the **extensor surfaces of the metacarpophalangeal and interphalangeal joints**. - Their presence is highly suggestive of dermatomyositis, often preceding or co-occurring with muscle weakness. *Periungual telangiectasias* - **Periungual telangiectasias** are dilated capillaries around the nail folds and are a common skin manifestation of dermatomyositis. - They represent small vessel vasculopathy, a histological feature, and suggest microvascular damage often seen in systemic connective tissue diseases like dermatomyositis. *Mechanic's hands* - **Mechanic's hands** are a cutaneous feature seen in dermatomyositis (and other inflammatory myopathies like antisynthetase syndrome). - They are characterized by **hyperkeratosis**, fissuring, and scaling of the skin, particularly on the lateral and palmar aspects of the fingers, resembling the hands of a manual laborer.

Q: What is the presenting part in a transverse lie?

Shoulder. ***Shoulder*** - In a **transverse lie**, the fetal **shoulder** is the part that presents over the pelvic inlet. - This occurs when the fetal long axis is 90 degrees to the maternal spine. *Face* - A **face presentation** is a type of **cephalic presentation** where the head is hyperextended, and the face is the presenting part. - This is not characteristic of a transverse lie. *Vertex* - A **vertex presentation** is the most common and ideal **cephalic presentation**, where the head is flexed and the top of the head (vertex) is the presenting part. - This indicates a longitudinal lie, not a transverse lie. *Brow* - A **brow presentation** is also a type of **cephalic presentation** where the fetal head is partially extended, and the brow is the presenting part. - Like vertex and face presentations, this occurs with a longitudinal fetal lie.

Q: Midazolam does not cause which of the following?

Retrograde amnesia. ***Retrograde amnesia*** - Midazolam, a benzodiazepine, primarily causes **anterograde amnesia** [2], meaning patients have difficulty forming new memories after drug administration. - It does not significantly affect memories formed **before drug administration** (retrograde amnesia). *Anterograde amnesia* - Midazolam is well-known for its ability to induce **anterograde amnesia**, which is often a desirable effect in procedural sedation [2]. - This effect helps patients forget unpleasant or painful procedures performed while under its influence. *Causes tachyphylaxis during high dose infusions* - Prolonged or high-dose infusions of midazolam can lead to **tachyphylaxis**, requiring increased doses to achieve the same effect [1]. - This phenomenon is due to the **down-regulation or desensitization of GABA-A receptors** with continuous stimulation. *Decreased cardiovascular effects as compared to propofol* - Midazolam generally causes **less pronounced cardiovascular depression** (e.g., hypotension) compared to propofol, especially in standard sedative doses [1]. - This makes midazolam a safer option for sedation in some patients with **fragile cardiovascular statuses**.

Q: Which of the following is a negative symptom of schizophrenia?

Alogia (poverty of speech). ***Alogia (poverty of speech)*** - **Alogia** refers to a reduction in the **fluency and productivity of speech**, which is a classic **negative symptom** of schizophrenia indicating a *loss* or *absence* of normal functions. - Negative symptoms are characterized by deficits in normal emotional responses or other thought processes. *Hallucination* - **Hallucinations** are perceptual experiences that occur in the absence of an external stimulus, most commonly **auditory** in schizophrenia. - They are considered **positive symptoms** because they represent an *addition* or *distortion* of normal functions. *Delusion* - A **delusion** is a fixed, false belief that is not amenable to change in light of conflicting evidence, such as **persecutory** or **grandiose delusions**. - Delusions are also categorized as **positive symptoms** as they involve an *exaggeration* or *distortion* of normal thought content. *Motor hyperactivity* - **Motor hyperactivity** involves excessive or uncontrolled body movements and is not a typical symptom of schizophrenia. - While schizophrenia can involve **psychomotor agitation**, this is distinct from generalized hyperactivity and is not a core negative symptom.

Q: "Sunray appearance" on X-rays is suggestive of:

An Osteogenic sarcoma. ***An Osteogenic sarcoma*** - The **"sunray appearance" (or sunburst)** on X-rays is a classic radiographic finding pathognomonic for **osteosarcoma**, especially in adults and adolescents. - This appearance is due to the **periosteal new bone formation** that grows perpendicular to the bone surface, creating a radiating spicule pattern. *A type of bone cancer that can show various radiographic appearances* - While true that bone cancers can show various appearances, the "sunray appearance" is specific enough to strongly point to a particular type, rather than just a general category. - This option is too broad and does not provide the most precise diagnosis indicated by the specific radiographic sign. *A metastatic tumour in the bone* - Metastatic bone lesions typically present with **lytic (bone destruction)** or **blastic (bone formation)** patterns, or a mixed pattern, but rarely produce the periosteal "sunray" appearance. - The characteristic radiographic finding for metastasis would often involve multiple lesions and different periosteal reactions, such as an **onion skin appearance** in some aggressive cases, but not typically sunray. *An Ewing's sarcoma* - Ewing's sarcoma commonly presents with an **"onion skin" periosteal reaction** due to multiple layers of new bone formation. - While both are primary bone tumors, the radiographic findings are distinctly different, allowing for differentiation.

Question 1

Which circuit is specifically designed for anaesthesia in infants?

Accepted Answer

Ayres t piece

Answer

Bains circuit

Answer

Magill circuit

Answer

Water's circuit

Question 2

Fast induction and recovery is seen in?

Accepted Answer

N2O

Answer

Methoxyflurane

Answer

Ether

Answer

Halothane

Question 3

Which of the following statements about halothane is false?

Accepted Answer

Constricts bronchii

Answer

Volatile liquid with sweet odour

Answer

Causes malignant hyperthermia

Answer

Sensitises heart to adrenaline

Question 4

Which of the following diseases has the maximum Disability-Adjusted Life Years (DALY) loss?

Accepted Answer

Unipolar depression (Major Depressive Disorder)

Answer

Schizophrenia (Mental Disorder)

Answer

Bipolar depression (Bipolar Disorder)

Answer

Mania (Bipolar Disorder Episode)

Question 5

In which of the following conditions is the Koebner phenomenon most commonly observed?

Accepted Answer

Psoriasis

Answer

Lichen planus

Answer

All of the options

Answer

Viral warts

Question 6

Which of the following is not a feature of dermatomyositis?

Accepted Answer

Salmon Patch

Answer

Periungual telangiectasias

Answer

Gottron's patch

Answer

Mechanic's hands

Question 7

What is the presenting part in a transverse lie?

Accepted Answer

Shoulder

Answer

Face

Answer

Vertex

Answer

Brow

Question 8

Midazolam does not cause which of the following?

Accepted Answer

Retrograde amnesia

Answer

Anterograde amnesia

Answer

Decreased cardiovascular effects as compared to propofol

Answer

Causes tachyphylaxis during high dose infusions

Question 9

Which of the following is a negative symptom of schizophrenia?

Accepted Answer

Alogia (poverty of speech)

Answer

Hallucination

Answer

Delusion

Answer

Motor hyperactivity

Question 10

"Sunray appearance" on X-rays is suggestive of:

Accepted Answer

An Osteogenic sarcoma

Answer

A metastatic tumour in the bone

Answer

An Ewing's sarcoma

Answer

A type of bone cancer that can show various radiographic appearances

NEET-PG 2012

Anesthesiology

Community Medicine

Dermatology

Obstetrics and Gynecology

Pharmacology

Psychiatry

Radiology