Anesthesiology
1 questionsAll of the following cause myocardial depression except:
NEET-PG 2012 - Anesthesiology NEET-PG Practice Questions and MCQs
Question 811: All of the following cause myocardial depression except:
- A. Halothane
- B. Thiopentone
- C. Etomidate (Correct Answer)
- D. Ketamine
Explanation: ***Etomidate*** - **Etomidate** is known for its **hemodynamic stability** and minimal effect on myocardial contractility, making it a suitable induction agent for patients with cardiovascular compromise. - While it can cause some decrease in systemic vascular resistance, it maintains **cardiac output** much better than other agents listed. *Halothane* - **Halothane** is a potent volatile anesthetic that directly depresses **myocardial contractility** and reduces cardiac output. - It sensitizes the myocardium to **catecholamines**, increasing the risk of arrhythmias. *Thiopentone* - **Thiopentone** (thiopental) is a barbiturate that causes significant **dose-dependent myocardial depression** and systemic vasodilation. - This can lead to a substantial decrease in **blood pressure** and cardiac output, especially with rapid administration. *Ketamine* - Although ketamine often causes an increase in heart rate and blood pressure due to **sympathetic stimulation**, it can also have a direct **myocardial depressant effect** when the sympathetic nervous system is exhausted or blocked. - Its indirect stimulant effects *can mask* a direct negative inotropic effect on the myocardium.
Obstetrics and Gynecology
6 questionsWhich of the following statements about the contraction stress test (CST) is MOST accurate?
A 35-year-old woman presents with 4 months of amenorrhea, increased FSH, LH, and decreased estrogen. What is the most likely diagnosis?
Which of the following statements about the postmenopausal state is false?
All are causes of anovulatory amenorrhea except which of the following?
What is a definitive indication for performing a Lower Segment Cesarean Section (LSCS)?
What is the primary use of prophylactic methergin?
NEET-PG 2012 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 811: Which of the following statements about the contraction stress test (CST) is MOST accurate?
- A. Invasive method
- B. Detects fetal well being
- C. Negative test is associated with good fetal outcome (Correct Answer)
- D. Oxytocin is never used in the test
Explanation: ***Negative test is associated with good fetal outcome*** - A **negative CST** indicates that there are no late or significant variable decelerations in response to uterine contractions, suggesting the fetus can tolerate labor. - This finding is strongly correlated with **fetal well-being** and a low likelihood of fetal distress in the near future, with a **negative predictive value of approximately 99%**. *Invasive method* - The CST is considered a **non-invasive test**, as it involves external monitoring of fetal heart rate and uterine contractions. - No instruments are inserted into the body, differentiating it from truly invasive procedures like **amniocentesis**. *Detects fetal well being* - While the CST provides valuable information, it specifically assesses **uteroplacental function and fetal oxygenation reserve** during the stress of contractions, rather than comprehensive fetal well-being. - It identifies fetuses at risk for **uteroplacental insufficiency** but does not evaluate other parameters of fetal health. - Other tests like the **biophysical profile** offer a more comprehensive assessment of fetal well-being, including parameters like fetal breathing, movement, tone, and amniotic fluid volume. *Oxytocin is never used in the test* - **Oxytocin** is frequently used to induce uterine contractions if spontaneous contractions are insufficient for the test (oxytocin challenge test or OCT). - Alternatively, **nipple stimulation** can be used to achieve adequate contractions for the CST.
Question 812: A 35-year-old woman presents with 4 months of amenorrhea, increased FSH, LH, and decreased estrogen. What is the most likely diagnosis?
- A. Premature ovarian insufficiency (Correct Answer)
- B. Menopause
- C. Late menopause
- D. Perimenopause
Explanation: ***Premature ovarian insufficiency (POI)*** - The patient's age (35 years) combined with 4 months of **amenorrhea**, increased **FSH** and **LH**, and decreased **estrogen** is characteristic of premature ovarian insufficiency (also called premature ovarian failure). - The hormonal profile (**hypergonadotropic hypogonadism**) indicates ovarian failure occurring before the age of **40 years**, which defines POI. - POI affects approximately **1% of women under 40** and can present with amenorrhea, infertility, and symptoms of estrogen deficiency. *Menopause* - Menopause is diagnosed after **12 consecutive months of amenorrhea** in a woman, typically occurring around age **51 years** (natural menopause). - While the hormonal profile of elevated FSH/LH and low estrogen is consistent with menopause, the patient's **age of 35 years** and **only 4 months of amenorrhea** do not meet the criteria for natural menopause. *Late menopause* - Late menopause refers to menopause occurring at a later age than average, typically after age **55 years**. - This diagnosis is completely inconsistent with the patient's age of 35 years. *Perimenopause* - Perimenopause is the transitional phase leading up to menopause, characterized by **irregular menstrual cycles** and **fluctuating hormone levels**. - While FSH levels may be elevated at times, perimenopause typically shows **variable hormone levels** rather than the sustained pattern of high FSH/LH with low estrogen seen in this case. - The **sustained amenorrhea** and pronounced hormonal shifts indicate ovarian failure (POI) rather than perimenopausal transition.
Question 813: Which of the following statements about the postmenopausal state is false?
- A. High FSH
- B. Low LH (Correct Answer)
- C. Low estrogen
- D. High androgen
Explanation: ***Low LH*** - This statement is **FALSE** because **LH (luteinizing hormone) levels are markedly elevated** in postmenopausal women. - The drop in ovarian estrogen production removes the **negative feedback** on the pituitary, leading to **increased LH and FSH secretion**. - Both gonadotropins (LH and FSH) are characteristically **high in postmenopause**. *High FSH* - This statement is true; **FSH (follicle-stimulating hormone) levels are markedly elevated** in postmenopausal women. - The elevated FSH is a direct consequence of the **lack of negative feedback** from inhibin and estrogen produced by the ovaries. *Low estrogen* - This statement is true; **estrogen levels plummet significantly** after menopause due to the **cessation of ovarian follicular activity**. - This **estrogen deficiency** is responsible for many postmenopausal symptoms, such as hot flashes, vaginal atrophy, and bone loss. *High androgen* - While androgens are still produced by the adrenal glands and ovaries postmenopause, their **absolute levels also decline with age**. - The statement is somewhat ambiguous, but androgens do **not increase** in absolute terms; rather, the **estrogen-to-androgen ratio changes** because estrogen falls more dramatically.
Question 814: All are causes of anovulatory amenorrhea except which of the following?
- A. Hyperprolactinemia
- B. Drugs
- C. PCOD
- D. Gonadal dysgenesis (Correct Answer)
Explanation: ***Gonadal dysgenesis*** - This condition is a cause of **primary ovarian insufficiency**, leading to amenorrhea but not primarily due to anovulation in a previously cycling individual. - In gonadal dysgenesis, the **ovaries are malformed or absent**, resulting in a lack of follicles and thus no ovulation or estrogen production from the start. *PCOD* - **Polycystic Ovarian Disease** (PCOD/PCOS) is a common cause of anovulatory amenorrhea, characterized by **oligo- or anovulation**, clinical or biochemical hyperandrogenism, and polycystic ovaries on ultrasound. - The hormonal imbalance (e.g., elevated **androgens**, high **LH/FSH ratio**) disrupts normal follicular development and ovulation. *Hyperprolactinemia* - **Elevated prolactin levels** inhibit the pulsatile secretion of **GnRH (Gonadotropin-Releasing Hormone)** from the hypothalamus, which in turn reduces FSH and LH release from the pituitary. - This suppression of gonadotropins leads to impaired follicular development and **anovulation**, resulting in amenorrhea. *Drugs* - Various medications can cause anovulatory amenorrhea by interfering with the **hypothalamic-pituitary-ovarian axis**. - Examples include antipsychotics (which can increase **prolactin levels**), certain antidepressants, opioids, and chemotherapy agents that can damage ovarian function.
Question 815: What is a definitive indication for performing a Lower Segment Cesarean Section (LSCS)?
- A. Mento anterior presentation
- B. Occipito posterior presentation
- C. Vertex presentation
- D. Contracted pelvis (Correct Answer)
Explanation: ***Contracted pelvis*** - A **contracted pelvis** means the maternal pelvic dimensions are too small to allow for the safe passage of the fetus, making a vaginal birth impossible or highly risky. - This **fetopelvic disproportion** (cephalopelvic disproportion) necessitates a C-section to prevent obstructed labor, fetal distress, and potential harm to both mother and baby. - A contracted pelvis is a **definitive indication** for LSCS as vaginal delivery is contraindicated. *Mento anterior presentation* - In a **mento anterior presentation**, the fetal chin (mentum) is anterior, which is a **favorable position** for vaginal delivery as it allows for proper neck extension and engagement. - This presentation does not typically require a C-section unless there are other complicating factors. *Occipito posterior presentation* - While an **occipito posterior presentation** can sometimes lead to prolonged labor or the need for instrumental delivery, it is **not an absolute indication** for C-section. - Many cases can still deliver vaginally, either spontaneously or with rotation, and surgical intervention is usually reserved for failure to progress or fetal distress. *Vertex presentation* - A **vertex presentation** means the fetal head is flexed and presenting first, which is the **most common and ideal presentation** for a vaginal birth. - This presentation is a sign of a normal, potentially uncomplicated delivery and is the opposite of an indication for C-section.
Question 816: What is the primary use of prophylactic methergin?
- A. None of the options
- B. Induction of labour
- C. Induction of abortion
- D. To stop excess bleeding from uterus (Correct Answer)
Explanation: ***To stop excess bleeding from uterus*** - **Methergin (Methylergonovine)** is an **ergot alkaloid** that causes strong contractions of the **uterus**. - Its primary prophylactic use is to **prevent or treat postpartum hemorrhage** by contracting the uterus and compressing blood vessels. *Induction of labour* - **Methergin** is generally **contraindicated for labor induction** as its potent, sustained contractions can cause **hypertonic uterine dysfunction** and fetal distress. - **Oxytocin** is the preferred agent for **labor induction** due to its more physiological contraction pattern. *Induction of abortion* - While methergin can cause uterine contractions, it is **not the primary agent for abortion induction**. - **Prostaglandins (e.g., misoprostol)** and other pharmacological agents are typically used in combination for **medical abortion**. *None of the options* - This option is incorrect because **stopping excess uterine bleeding** is indeed a primary use of prophylactic methergin, particularly in the postpartum period. - The other options describe situations where methergin is either not indicated or is a secondary/contraindicated choice.
Pharmacology
1 questionsWhich local anesthetic is known for its vasoconstrictive properties?
NEET-PG 2012 - Pharmacology NEET-PG Practice Questions and MCQs
Question 811: Which local anesthetic is known for its vasoconstrictive properties?
- A. Lidocaine
- B. Chlorprocaine
- C. Procaine
- D. Cocaine (Correct Answer)
Explanation: ***Cocaine*** - Cocaine is unique among local anesthetics for its inherent **sympathomimetic** properties, leading to **vasoconstriction**. - This vasoconstriction is due to its ability to block the reuptake of **norepinephrine** and other catecholamines at adrenergic nerve terminals. *Procaine* - Procaine is an **ester-type** local anesthetic that typically causes **vasodilation**, which can lead to rapid systemic absorption and a shorter duration of action. - It does not possess any inherent vasoconstrictive properties. *Lidocaine* - Lidocaine, an **amide-type** local anesthetic, generally causes **vasodilation** at clinical concentrations. - Due to this vasodilatory effect, **epinephrine** is often added to lidocaine preparations to prolong its action and reduce systemic absorption. *Chlorprocaine* - Chlorprocaine is another **ester-type** local anesthetic known for its rapid onset and short duration of action. - It primarily causes **vasodilation**, similar to procaine, and has no intrinsic vasoconstrictive effects.
Psychiatry
2 questionsWhich of the following is a recognized type of anxiety disorder?
Derealization and depersonalization are symptoms of which type of disorder?
NEET-PG 2012 - Psychiatry NEET-PG Practice Questions and MCQs
Question 811: Which of the following is a recognized type of anxiety disorder?
- A. Bipolar Disorder
- B. Major Depressive Disorder
- C. Schizophrenia
- D. Panic Disorder (Correct Answer)
Explanation: ***Panic Disorder*** - **Panic disorder** is a recognized **anxiety disorder** characterized by recurrent unexpected **panic attacks** - sudden episodes of intense fear accompanied by physical symptoms like heart palpitations, shortness of breath, chest pain, dizziness, and trembling. - It involves persistent worry about having more attacks (anticipatory anxiety) and maladaptive behavioral changes to avoid situations where attacks might occur. - Classified under **Anxiety Disorders** in DSM-5 and ICD-11. *Major Depressive Disorder* - **Major Depressive Disorder (MDD)** is a **mood disorder**, not an anxiety disorder. - Characterized by persistent depressed mood, loss of interest or pleasure (anhedonia), changes in appetite/sleep, fatigue, feelings of worthlessness, and potential suicidal ideation. - Classified under **Depressive Disorders** in DSM-5, distinct from anxiety disorders, though anxiety symptoms may co-occur. *Bipolar Disorder* - **Bipolar disorder** is a **mood disorder**, not an anxiety disorder. - Characterized by significant mood swings including episodes of mania/hypomania (elevated, expansive, or irritable mood with increased energy) and depression. - Classified under **Bipolar and Related Disorders** in DSM-5, distinct from anxiety disorders. *Schizophrenia* - **Schizophrenia** is a **psychotic disorder**, not an anxiety disorder. - Characterized by disturbances in thought, perception, emotions, and behavior, including hallucinations, delusions, disorganized thinking, and negative symptoms. - Classified under **Schizophrenia Spectrum and Other Psychotic Disorders** in DSM-5, distinct from anxiety disorders.
Question 812: Derealization and depersonalization are symptoms of which type of disorder?
- A. Dissociative disorder (Correct Answer)
- B. Personality disorders
- C. Mania
- D. Anxiety disorders
Explanation: ***Dissociative disorder*** - **Derealization** involves experiencing the outside world as unreal or dreamlike - **Depersonalization** is the experience of feeling detached from one's own body or mental processes - These are hallmark symptoms of **dissociative disorders**, specifically depersonalization-derealization disorder in DSM-5 *Personality disorders* - Characterized by enduring, maladaptive patterns of inner experience and behavior - While some personality disorders (e.g., **borderline personality disorder**) may display transient dissociative symptoms under stress, derealization and depersonalization are not core diagnostic features *Mania* - A state of abnormally elevated mood and energy, involving **racing thoughts**, **decreased need for sleep**, and **impulsive behavior** - Does not typically involve consistent derealization or depersonalization as core features *Anxiety disorders* - Depersonalization can occur transiently during **panic attacks** or severe anxiety - However, when derealization and depersonalization are the primary, persistent symptoms, they indicate a **dissociative disorder** rather than an anxiety disorder