NEET-PG 2015 Practice Questions

Q: Which of the following is the only clinically available depolarizing muscle relaxant?

Suxamethonium. ***Suxamethonium*** - **Suxamethonium** (also known as succinylcholine) is currently the **only depolarizing neuromuscular blocker** available for clinical use. - It works by mimicking acetylcholine, binding to and activating nicotinic acetylcholine receptors at the **neuromuscular junction**, causing initial muscle fasciculations followed by relaxation. *Decamethonium* - **Decamethonium** is a depolarizing neuromuscular blocker but is **no longer clinically available** due to its prolonged action and side effects. - It also acts by opening nicotinic acetylcholine receptor channels, leading to depolarization and muscle paralysis. *Mivacurium* - **Mivacurium** is a **nondepolarizing neuromuscular blocker**, meaning it acts as a competitive antagonist at the acetylcholine receptor. - It is known for its **short duration of action** due to rapid hydrolysis by plasma cholinesterases but is not depolarizing. *None of the options* - This option is incorrect because suxamethonium is indeed a clinically available depolarizing muscle relaxant. - The question specifically asks for the *only* clinically available one, which suxamethonium fulfills.

Q: What is the treatment for extrapyramidal side effects induced by Haloperidol?

Anticholinergic drugs. ***Anticholinergic drugs (effective treatment)*** - **Anticholinergic medications**, such as **benztropine** or **diphenhydramine**, are the primary treatment for **acute extrapyramidal symptoms (EPS)** like dystonia and parkinsonism induced by antipsychotics like haloperidol. - They work by **blocking muscarinic acetylcholine receptors**, helping to restore the balance between dopamine and acetylcholine in the basal ganglia. *Benzodiazepines (used for anxiety and muscle relaxation)* - While benzodiazepines can offer some relief for **akathisia** (a form of EPS characterized by restlessness) due to their sedative and muscle relaxant properties, they are **not the first-line treatment for other acute EPS** such as dystonia or parkinsonism. - They primarily enhance **GABAergic transmission** and are effective for anxiety and seizure control rather than direct antagonism of EPS mechanisms. *Barbiturates (used as sedative-hypnotic drugs)* - **Barbiturates** are strong central nervous system depressants used for sedation, anesthesia, and seizure control, but are **not indicated for the treatment of EPS**. - Their significant **sedative and addictive potential**, along with a narrow therapeutic index, makes them unsuitable for this purpose. *SSRIs (used for depression and anxiety)* - **SSRIs (Selective Serotonin Reuptake Inhibitors)** are antidepressants that work by increasing serotonin levels in the brain and are used to treat depression, anxiety, and obsessive-compulsive disorder. - They **do not have a direct role** in ameliorating dopamine-acetylcholine imbalance responsible for haloperidol-induced EPS.

Q: What is the primary cause of death in Neuroleptic Malignant Syndrome?

None of the options. ***None of the options*** - The **primary cause of death** in Neuroleptic Malignant Syndrome is **renal failure secondary to rhabdomyolysis**, which is not listed among the options. - **Severe muscle rigidity** in NMS leads to massive muscle breakdown (rhabdomyolysis) → release of myoglobin → myoglobinuria → acute tubular necrosis → acute renal failure. - Mortality in NMS ranges from **10-20%**, with renal complications being the leading cause of death. - Other significant causes include **cardiovascular collapse, arrhythmias, DIC**, and **respiratory complications**, but renal failure remains the most common fatal outcome. *Respiratory failure* - While respiratory complications occur in NMS (aspiration pneumonia, respiratory muscle rigidity), this is **not the primary cause of death**. - Respiratory failure can contribute to mortality but is typically **secondary** to other complications or occurs less frequently than renal failure as the direct cause. - It is a serious complication but not the most common fatal outcome. *Liver failure* - **Hepatotoxicity** is not a characteristic feature or primary cause of death in NMS. - Though elevated liver enzymes may occur, liver failure is **not a typical cause of mortality** in NMS. - The pathophysiology centers on **dopamine blockade**, autonomic instability, and muscle breakdown, not hepatic dysfunction. *Drug toxicity* - NMS is an **idiosyncratic reaction** to dopamine antagonists (typical and atypical antipsychotics), not a dose-dependent toxic effect. - Death results from the **physiological complications of the syndrome** (renal failure, cardiovascular collapse, hyperthermia), not from direct drug toxicity or overdose. - The mechanism is related to dopamine receptor blockade and subsequent dysregulation, not toxic poisoning.

Q: The site of lesion in Korsakoff's psychosis is

Mammillary body. ***Mammillary body*** - **Korsakoff's psychosis** is a neurocognitive disorder characterized by severe **memory impairment**, confabulation, and apathy, primarily due to **thiamine deficiency**. - The disease involves damage to several brain areas, most notably the **mammillary bodies** and the dorsal medial nucleus of the thalamus, which are critical for memory formation. *Frontal lobe* - While frontal lobe dysfunction can lead to cognitive deficits, the **primary lesion** in Korsakoff's psychosis is not typically located here. - Damage to the frontal lobe is more commonly associated with executive dysfunction, personality changes, and disinhibition, rather than the profound amnesia seen in Korsakoff's. *Cingulate gyrus* - The cingulate gyrus plays a role in emotion, learning, and memory, but it is **not considered the primary site of lesion** in Korsakoff's psychosis. - Although it can be affected, lesions in the mammillary bodies are more directly linked to the characteristic memory deficits. *Corpus striatum* - The corpus striatum is involved in motor control and habit formation, and its damage is associated with movement disorders like **Parkinson's or Huntington's disease**. - This area is **not the primary site of pathology** in Korsakoff's psychosis, which is fundamentally a memory disorder.

Q: In which condition is sex reassignment surgery typically performed?

Gender dysphoria. ***Gender dysphoria*** - **Sex reassignment surgery** is primarily performed as part of the treatment for **gender dysphoria**, a condition where there is a marked incongruence between an individual's experienced/expressed gender and their assigned sex. - The surgery aims to align the individual's physical appearance with their **gender identity**, alleviating distress and improving quality of life. *Premature ejaculation* - This condition involves consistent or recurrent ejaculation with minimal sexual stimulation before, during, or shortly after penetration and before the person wishes it. - Treatment typically includes behavioral therapies, medication (e.g., SSRIs), and psychological counseling, not surgical intervention. *Erectile dysfunction* - **Erectile dysfunction** is the inability to achieve or maintain an erection firm enough for satisfactory sexual intercourse. - Treatments range from lifestyle changes and oral medications (e.g., PDE5 inhibitors) to vacuum devices, penile injections, and in some cases, penile implants, but not sex reassignment surgery. *Orgasmic dysfunction* - This condition refers to persistent or recurrent delay in, or absence of, orgasm following a normal phase of sexual excitement. - Management often involves psychological counseling, addressing underlying medical conditions, or adjusting medications; it does not involve sex reassignment surgery.

Q: What is a common medical treatment for sexual paraphilias?

Anti-androgens. ***Anti-androgens*** - **Anti-androgens are the established first-line pharmacological treatment** for paraphilias when medication is indicated. - Medications like **medroxyprogesterone acetate (MPA)** and **cyproterone acetate (CPA)** reduce testosterone levels, thereby reducing sexual drive and paraphilic urges. - They are particularly effective in **reducing the frequency and intensity of deviant sexual fantasies and behaviors**. - Used in combination with psychotherapy for comprehensive management of paraphilic disorders. *SSRIs* - May have a role as **adjunctive therapy** for compulsive sexual behaviors or when comorbid OCD, depression, or anxiety is present. - They can help reduce obsessive thoughts but are **not considered the primary treatment** for paraphilias themselves. - More useful for comorbid mood and anxiety symptoms than for core paraphilic symptoms. *Benzodiazepines* - Primarily used for **anxiety and insomnia** due to their sedative effects. - They do not address sexual urges or paraphilic behaviors and have no role in paraphilia treatment. *Opioids* - Prescribed for **pain management** and associated with risk of dependence. - They have **no established role** in the treatment of sexual paraphilias.

Q: Which of the following is not typically associated with dementia?

Alteration of consciousness. ***Alteration of consciousness*** - An **alteration of consciousness** is a hallmark feature of **delirium**, which is an acute confusional state, usually fluctuating. - **Dementia** is primarily characterized by a chronic, progressive decline in cognitive function with **clear consciousness**. *Forgetfulness* - **Forgetfulness**, particularly memory loss impacting daily life, is one of the **earliest and most common symptoms** of dementia. - This symptom progressively worsens, affecting short-term and eventually long-term memory. *Reduced personal care* - As dementia progresses, individuals often experience a decline in their ability to perform **activities of daily living (ADLs)**, including personal care. - This can manifest as forgetting to bathe, difficulty dressing, or neglecting personal hygiene due to cognitive impairment. *Loss of neurons in brain* - **Neurodegeneration**, characterized by the **loss of neurons** and synapses in the brain, is the underlying pathological basis of most types of dementia, such as Alzheimer's disease. - This neuronal loss leads to brain atrophy and the cognitive deficits seen in dementia.

Q: A girl exhibits aggressive behavior such as smashing and throwing objects and verbally abusing hospital staff. However, she shows a different demeanor towards a particular resident doctor. What could be the most likely diagnosis?

Borderline personality disorder. ***Borderline personality disorder*** - Patients with **borderline personality disorder** often exhibit **impulsivity**, intense mood swings, and a pattern of unstable interpersonal relationships, leading to aggressive outbursts. - Their unpredictable behavior and tendency to form intense, unstable attachments or a "favorite person" dynamic are characteristic, as seen in her differing demeanor towards a particular resident doctor. *Bipolar disorder* - While bipolar disorder involves **mood swings**, the behavioral patterns are typically characterized by distinct episodes of **mania** or hypomania and depression, with less emphasis on chronic interpersonal instability and aggression. - The aggression in bipolar disorder is often associated with the manic phase but lacks the consistent pattern of relationship instability and "favorite person" dynamic described. *Schizoaffective disorder* - This disorder involves a combination of **psychotic symptoms** (like delusions or hallucinations) and **mood symptoms** (like depression or mania), which are not explicitly described here as the primary issue. - The aggressive behavior is not primarily driven by psychosis, and the specific interpersonal dynamic with staff is more suggestive of a personality disorder. *Antisocial personality* - **Antisocial personality disorder** is characterized by a pervasive pattern of disregard for and violation of the **rights of others** and may include aggression, but it often involves a lack of empathy and manipulativeness rather than the intense emotional dysregulation and unstable interpersonal patterns seen in borderline personality. - While aggressive behavior is present, the specific description of verbally abusing staff while showing a "different demeanor" towards a particular doctor points away from the typical presentation of antisocial disregard for others.

Q: What is the most common cause of delirium?

Infection. ***Infection*** - **Infections**, particularly urinary tract infections (UTIs) or pneumonia, are a very common and often reversible cause of **delirium**, especially in elderly or immunocompromised patients [1]. - The systemic inflammatory response to infection can lead to neuroinflammation and direct effects on brain function, manifesting as acute changes in attention and cognition. *Liver failure* - While **liver failure** can cause **hepatic encephalopathy**, which presents with altered mental status, it typically has a more gradual onset and a different neurochemical profile than acute delirium caused by infection. - Hepatic encephalopathy is characterized by abnormal ammonia metabolism and often includes motor signs like **asterixis**, which are not universally present in delirium from infection. *Belladonna poisoning* - **Belladonna poisoning** (due to **anticholinergic toxicity**) can cause **delirium**, along with a constellation of symptoms like dilated pupils, dry mouth, and tachycardia. - However, it is a specific toxicological cause and not as broad or commonly encountered as infection as a general cause of new-onset delirium in hospitalized or elderly populations. *None of the options* - This option is incorrect because **infection** is indeed a very common and recognized cause of delirium [1].

Question 1

Which of the following is the only clinically available depolarizing muscle relaxant?

Accepted Answer

Suxamethonium

Answer

Decamethonium

Answer

Mivacurium

Answer

None of the options

Question 2

What is the treatment for extrapyramidal side effects induced by Haloperidol?

Accepted Answer

Anticholinergic drugs

Answer

Barbiturates

Answer

SSRIs

Answer

Benzodiazepines

Question 3

A 25-year-old male believes that his penis is decreasing in size every day and that it will eventually disappear, leading to his death. What is the most likely diagnosis?

Accepted Answer

Delusional Disorder

Answer

Somatic Symptom Disorder

Answer

Illness Anxiety Disorder

Answer

Obsessive-Compulsive Disorder

Question 4

What is the primary cause of death in Neuroleptic Malignant Syndrome?

Accepted Answer

None of the options

Answer

Respiratory failure

Answer

Liver failure

Answer

Drug toxicity

Question 5

The site of lesion in Korsakoff's psychosis is

Accepted Answer

Mammillary body

Answer

Frontal lobe

Answer

Cingulate gyrus

Answer

Corpus striatum

Question 6

In which condition is sex reassignment surgery typically performed?

Accepted Answer

Gender dysphoria

Answer

Premature ejaculation

Answer

Erectile dysfunction

Answer

Orgasmic dysfunction

Question 7

What is a common medical treatment for sexual paraphilias?

Accepted Answer

Anti-androgens

Answer

Benzodiazepines

Answer

SSRIs

Answer

Opioids

Question 8

Which of the following is not typically associated with dementia?

Accepted Answer

Alteration of consciousness

Answer

Reduced personal care

Answer

Loss of neurons in brain

Answer

Forgetfulness

Question 9

A girl exhibits aggressive behavior such as smashing and throwing objects and verbally abusing hospital staff. However, she shows a different demeanor towards a particular resident doctor. What could be the most likely diagnosis?

Accepted Answer

Borderline personality disorder

Answer

Bipolar disorder

Answer

Schizoaffective disorder

Answer

Antisocial personality

Question 10

What is the most common cause of delirium?

Accepted Answer

Infection

Answer

Liver failure

Answer

Belladonna poisoning

Answer

None of the options

NEET-PG 2015

Pharmacology

Psychiatry