NEET-PG 2019 Practice Questions

Q: Which of the following nerves has the shaded cutaneous territory

Radial. ***Radial*** - The shaded area (dorsal aspect of the thumb, index finger, middle finger, and radial half of the ring finger) corresponds to the **cutaneous innervation of the radial nerve**, specifically its superficial branch. - The radial nerve also supplies extensor muscles in the forearm and hand, but this question specifically addresses its cutaneous distribution. *Posterior interosseous* - The posterior interosseous nerve is a **motor nerve** that primarily supplies muscles in the forearm. - It has **no significant cutaneous sensory distribution**. *Median* - The **median nerve** provides sensory innervation to the palmar aspect of the thumb, index, middle, and radial half of the ring finger, and the dorsal tips of these digits. - Its cutaneous territory does **not extend to the dorsal hand** over the shaded region. *Ulnar* - The **ulnar nerve** innervates the one and a half fingers (little finger and ulnar half of the ring finger) on both the palmar and dorsal aspects. - This distribution is distinct from the shaded area, which covers the radial side of the dorsal hand.

Q: Which IV anesthetic does not cause cardiac depression?

Etomidate. **Etomidate** - **Etomidate** is known for its **minimal cardiovascular effects**, making it a preferred choice in patients with **pre-existing cardiac disease** or hemodynamic instability. - Unlike other IV anesthetics, it causes very little change in **heart rate**, **blood pressure**, or **cardiac output**. *Propofol* - **Propofol** frequently causes **dose-dependent myocardial depression** and **vasodilation**, leading to significant decreases in blood pressure. - Its cardiovascular effects can be problematic in patients with compromised cardiac function. *Thiopentone* - **Thiopentone**, a barbiturate, typically causes **dose-dependent cardiovascular depression**, including reduced **myocardial contractility** and **vasodilation**. - This can result in a decrease in **blood pressure** and **cardiac output**. *Methohexital* - **Methohexital**, another barbiturate, also causes **cardiovascular depression** similar to thiopentone. - It can lead to decreased **blood pressure** due to both **myocardial depression** and **peripheral vasodilation**.

Q: A 65-year-old alcoholic is admitted to the ICU with a diagnosis of acute pancreatitis. After 48 hours, he is unconscious and has the following findings: SpO2= 60%, PO2= 60 mmHg, PCO2=50 mmHg, and HR= 120 bpm. A chest X-ray was performed and is given below. What is the diagnosis of the following condition?

Shock lung. ***Shock lung*** - The patient's presentation with **acute pancreatitis**, followed by rapid onset **severe hypoxemia** (SpO2 60%, PO2 60 mmHg), and **bilateral infiltrates** on chest X-ray are classic signs of **Acute Respiratory Distress Syndrome (ARDS)**, historically known as "shock lung". Pancreatitis is a common cause of ARDS. - The term "shock lung" was used to describe this condition in the context of various forms of shock or severe systemic illness, accurately reflecting the patient's deteriorating state. *Mendelson syndrome* - This syndrome refers to **chemical pneumonitis** caused by the aspiration of gastric contents, often seen in obstetric patients or those with impaired consciousness. - While aspiration is possible in an unconscious alcoholic, the widespread bilateral infiltrates and severe hypoxemia in the context of pancreatitis make ARDS a more fitting diagnosis. *Nosocomial pneumonia* - This is a lung infection acquired in a hospital setting, typically after 48 hours of admission. - While possible in an ICU patient, the rapid onset of severe respiratory failure and the specific context of acute pancreatitis predisposing to ARDS make nosocomial pneumonia less likely as the primary diagnosis for these acute findings, though it could occur later. *Sympathetic pleural effusion* - A sympathetic pleural effusion is a collection of fluid in the pleural space secondary to inflammation in an adjacent organ, such as the pancreas (pancreatic pleural effusion). - While acute pancreatitis can cause pleural effusions, these typically appear as isolated fluid collections and do not account for the severe hypoxemia and widespread bilateral pulmonary infiltrates seen on the X-ray, which are characteristic of ARDS.

Q: Cholesterol gallstones are made up of:-

Crystalline cholesterol monohydrate. ***Crystalline cholesterol monohydrate*** - **Cholesterol gallstones** primarily consist of **crystalline cholesterol monohydrate**, which forms when the bile becomes supersaturated with cholesterol [1]. - The **crystallization** of cholesterol leads to the formation of visible stones within the gallbladder. *Amorphous cholesterol dihydrate* - This form of cholesterol is not typically found as the primary component of **gallstones**. - **Amorphous** structures lack a defined crystalline lattice and are less stable for forming solid stones. *Amorphous cholesterol monohydrate* - While **cholesterol monohydrate** is the core component, it is in a **crystalline** rather than amorphous state in gallstones [1]. - **Amorphous** forms are generally transient intermediates and do not constitute the bulk of the stones. *Crystalline cholesterol dihydrate* - **Dihydrate** forms of cholesterol are not the main constituent of gallstones; the **monohydrate** form is the predominant type [1]. - The specific hydration state of **cholesterol monohydrate** makes it the primary compound found in the solid, crystalline structure of gallstones [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, p. 882.

Q: McCallum patches/plaques are usually seen in which chamber of the heart?

Left atrium. Left atrium - **McCallum patches** are typically found in the **left atrium**, predominantly on the left atrial endocardium [1]. - They are associated with the regurgitant jet of **rheumatic mitral valve disease**, leading to endocardial thickening and fibrosis [1]. Right atrium - While rheumatic heart disease can affect the right side of the heart, particularly the tricuspid valve, **McCallum patches have a specific association with the left atrium** due to mitral valve involvement [1]. - Endocardial changes in the right atrium are less commonly described as McCallum patches. Left ventricle - The left ventricle is primarily a pumping chamber; while it can undergo hypertrophy or dilation in rheumatic heart disease, **McCallum patches are specific endocardial lesions of the atrium** [1]. - **Jet lesions** can occur in the ventricle due to aortic regurgitation, but these are distinct from atrial McCallum patches. Right ventricle - The right ventricle is also a pumping chamber, and endocardial changes here are not typically referred to as McCallum patches. - Rheumatic involvement of the tricuspid valve can cause right heart strain, but **McCallum patches are characteristic of left atrial involvement** [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, p. 566.

Q: Which among the following is NOT part of the classic clinical triad of necrotizing enterocolitis?

Metabolic acidosis. ***Metabolic acidosis*** - Metabolic acidosis is **not** part of the classic clinical triad of necrotizing enterocolitis, though it is a common laboratory finding in severe cases. - The **classic triad of NEC** consists of: **abdominal distension**, **bloody stools**, and **pneumatosis intestinalis** on radiography. - Metabolic acidosis occurs as a consequence of intestinal ischemia and sepsis but is not included in the defining triad. *Abdominal distension* - **Abdominal distension** is a cardinal clinical feature and part of the classic triad. - Results from intestinal inflammation, ileus, and gas accumulation. *Bloody stools* - **Bloody stools** (grossly bloody or occult blood positive) are part of the classic triad. - Reflect mucosal injury and intestinal necrosis. *Pneumatosis intestinalis* - **Pneumatosis intestinalis** (intramural gas on abdominal X-ray) is the pathognomonic radiological finding in the classic triad. - Indicates gas-forming bacterial invasion of the damaged intestinal wall.

Q: Drug of choice for Digoxin induced Ventricular Tachycardia:

Lignocaine. ***Lignocaine*** - **Lignocaine** (also known as lidocaine) is the drug of choice for digoxin-induced ventricular tachycardia due to its ability to suppress ventricular arrhythmias without further compromising cardiac contractility [1]. - It works by blocking **sodium channels** in the myocardium, reducing automaticity and stabilizing the cardiac membrane [1]. *Diltiazem* - **Diltiazem** is a calcium channel blocker primarily used for supraventricular tachycardias and angina [1]. - It is contraindicated in digoxin toxicity as it can worsen myocardial depression and AV nodal blockade [1]. *Propranolol* - **Propranolol** is a beta-blocker that can suppress some arrhythmias but is generally not the first-line treatment for digoxin-induced ventricular tachycardia [1]. - Beta-blockers can worsen **bradycardia** and **AV block** often seen in digoxin toxicity [1]. *Verapamil* - **Verapamil** is a calcium channel blocker similar to diltiazem and can exacerbate digoxin toxicity [1]. - It is known to increase serum **digoxin levels** and can worsen the underlying cardiotoxic effects.

Q: All are true about Decerebrate posture except:-

Flexion of upper extremity and extension of lower extremity. ***Flexion of upper extremity and extension of lower extremity*** - This description corresponds to **decorticate rigidity**, not decerebrate rigidity. - In decorticate rigidity, there is **flexion** of the **upper extremities** and **extension** of the **lower extremities**, indicating a lesion above the red nucleus. *Exaggerated gamma motor neuron discharge* - Decerebrate rigidity is characterized by an **increase in muscle tone** due to disinhibition of extensor muscles, which is mediated by increased **gamma motor neuron activity**. - This increased discharge leads to potentiation of the **stretch reflex**, contributing to the rigidity. *Extension of both upper and lower extremity* - **Decerebrate posture** is defined by **extension of all four limbs** (both upper and lower extremities). - This posture results from a lesion in the brainstem **below the red nucleus** but above the vestibular nuclei, causing disinhibition of the pontine reticular formation and vestibular nuclei, which primarily excite extensor muscles. *Reticulo spinal tract is also involved* - The **reticulospinal tracts** (both pontine and medullary) play a crucial role in regulating muscle tone and posture. - In decerebrate rigidity, the **pontine reticulospinal tract** is overactive due to loss of cortical inhibition, leading to **increased extensor tone**.

Q: All of the following statements are true about Frey's Syndrome except

Sympathetic nerve involvement is the primary cause. ***Sympathetic nerve involvement is the primary cause*** - **This is FALSE (Correct answer for EXCEPT question)** - Frey's syndrome is **NOT** caused by sympathetic nerve involvement - The primary cause is **aberrant regeneration of severed PARASYMPATHETIC fibers** of the auriculotemporal nerve - These parasympathetic fibers mistakenly re-innervate sweat glands (which are sympathetically innervated) instead of the parotid gland - This misdirection causes gustatory sweating during meals *Less chances with enucleation than parotidectomy* - **TRUE** - Enucleation is a less extensive procedure compared to complete parotidectomy - Less tissue removal means less nerve disruption and lower risk of auriculotemporal nerve damage - The risk of Frey's syndrome is directly proportional to the extent of parotid tissue removal *Gustatory sweating* - **TRUE** - This is the hallmark symptom of Frey's syndrome - Characterized by sweating on the skin over the parotid region in response to salivary stimuli (smelling, seeing, or eating food) - Results from misdirected parasympathetic fibers stimulating sweat glands instead of salivary tissue *Aberrant misdirection of parasympathetic fibers of auriculotemporal nerve* - **TRUE** - This is the correct pathophysiological mechanism underlying Frey's syndrome - Following injury to the auriculotemporal nerve during parotid surgery, regenerating parasympathetic secretomotor fibers become misdirected - These fibers intended for the parotid gland instead innervate sweat glands in the overlying skin

Q: What is the name of this triangle?

Gastrinoma triangle. ***Gastrinoma triangle*** - The **gastrinoma triangle** is a region in the abdomen where **gastrinomas** (tumors producing gastrin) are most commonly found. - This anatomical area is bordered by the **cystic duct**, the **second and third portions of the duodenum**, and the **neck and body of the pancreas**. *Cholecystohepatic triangle* - This is also known as **Calot's triangle**, which is not the correct option for gastrinomas. - It is defined by the **cystic duct**, the **common hepatic duct**, and the **inferior border of the liver**. *Doom's triangle* - **"Triangle of Doom"** (or Dôme's triangle) is an anatomical landmark in **laparoscopic inguinal hernia repair**. - It is bounded by the **vas deferens medially** and the **testicular vessels laterally**, containing the **external iliac vessels** which must be avoided during surgery. - This is distinct from the gastrinoma triangle. *Calot's triangle* - **Calot's triangle** is an important anatomical landmark in gallbladder surgery, used to identify structures like the **cystic artery**. - It is distinct from the gastrinoma triangle, as its boundaries relate to the gallbladder and hepatic duct, not the pancreas or duodenum in the context of gastrinomas.

Question 1

Which of the following nerves has the shaded cutaneous territory

Accepted Answer

Radial

Answer

Posterior interosseous

Answer

Median

Answer

Ulnar

Question 2

Which IV anesthetic does not cause cardiac depression?

Accepted Answer

Etomidate

Answer

Propofol

Answer

Thiopentone

Answer

Methohexital

Question 3

A 65-year-old alcoholic is admitted to the ICU with a diagnosis of acute pancreatitis. After 48 hours, he is unconscious and has the following findings: SpO2= 60%, PO2= 60 mmHg, PCO2=50 mmHg, and HR= 120 bpm. A chest X-ray was performed and is given below. What is the diagnosis of the following condition?

Accepted Answer

Shock lung

Answer

Mendelson syndrome

Answer

Nosocomial pneumonia

Answer

Sympathetic pleural effusion

Question 4

Cholesterol gallstones are made up of:-

Accepted Answer

Crystalline cholesterol monohydrate

Answer

Amorphous cholesterol dihydrate

Answer

Amorphous cholesterol monohydrate

Answer

Crystalline cholesterol dihydrate

Question 5

McCallum patches/plaques are usually seen in which chamber of the heart?

Accepted Answer

Left atrium

Answer

Right atrium

Answer

Left ventricle

Answer

Right ventricle

Question 6

Which among the following is NOT part of the classic clinical triad of necrotizing enterocolitis?

Accepted Answer

Metabolic acidosis

Answer

Bloody stools

Answer

Pneumatosis intestinalis

Answer

Abdominal distension

Question 7

Drug of choice for Digoxin induced Ventricular Tachycardia:

Accepted Answer

Lignocaine

Answer

Diltiazem

Answer

Propranolol

Answer

Verapamil

Question 8

All are true about Decerebrate posture except:-

Accepted Answer

Flexion of upper extremity and extension of lower extremity

Answer

Exaggerated gamma motor neuron discharge

Answer

Extension of both upper and lower extremity

Answer

Reticulo spinal tract is also involved

Question 9

All of the following statements are true about Frey's Syndrome except

Accepted Answer

Sympathetic nerve involvement is the primary cause

Answer

Less chances with enucleation than parotidectomy

Answer

Gustatory sweating

Answer

Aberrant misdirection of parasympathetic fibers of auriculotemporal nerve

Question 10

What is the name of this triangle?

Accepted Answer

Gastrinoma triangle

Answer

Cholecystohepatic triangle

Answer

Doom's triangle

Answer

Calot's triangle

NEET-PG 2019

Anatomy

Anesthesiology

Internal Medicine

Pathology

Pediatrics

Pharmacology

Physiology

Surgery