NEET-PG 2021 Practice Questions

Q: While performing a lumbar puncture on a patient presenting with fever, neck rigidity, and altered sensorium, what is the last structure to be encountered by the needle?

Arachnoid membrane. ***Arachnoid membrane*** - The **arachnoid membrane** is the innermost layer the needle punctures before entering the **subarachnoid space** where cerebrospinal fluid (CSF) is collected. - The needle passes through skin, subcutaneous tissue, supraspinous ligament, interspinous ligament, ligamentum flavum, epidural space, and dura mater, with arachnoid mater being the last barrier. *Dura mater* - The **dura mater** is pierced **before** the arachnoid membrane and before entering the subarachnoid space. - It is a tough, fibrous membrane forming the outermost layer of the **meninges**. *Pia mater* - The **pia mater** is in direct contact with the spinal cord and is **not punctured** during a properly performed lumbar puncture. - It is the innermost meningeal layer, adherent to the neural tissue itself. *Ligamentum flavum* - The **ligamentum flavum** is encountered **early** in the lumbar puncture procedure, prior to the epidural space and the meningeal layers. - It is a strong ligament connecting the laminae of adjacent vertebrae. *Supraspinous ligament* - The **supraspinous ligament** is one of the **first structures** encountered during lumbar puncture, after penetrating skin and subcutaneous tissue. - It connects the spinous processes of adjacent vertebrae and is pierced well before reaching the meningeal layers.

Q: The procedure shown in the image is performed to maintain the airway. Which of the following techniques is being used?

Jaw thrust. ***Jaw thrust*** - The image distinctly shows a rescuer performing a **jaw thrust maneuver** by placing fingers under the angles of the patient's mandible and displacing the jaw forward. - This technique is used to open the airway by lifting the tongue off the posterior pharyngeal wall, especially in cases of suspected **cervical spine injury**. *Head stabilization* - While important in trauma, **head stabilization alone** does not open the airway; it prevents movement without actively repositioning the jaw or head. - Head stabilization is a supportive technique, often used in conjunction with airway maneuvers, but it is not the primary airway-opening technique depicted. *In line manual stabilization* - **In-line manual stabilization** is a method where a rescuer holds the patient's head and neck in a neutral, in-line position to prevent movement, particularly during transport or other interventions. - This technique is used to protect the spine from further injury and prevents any movement from the head or neck. *Head tilt chin lift* - The **head tilt-chin lift** involves tilting the head back and lifting the chin, which is a different hand placement and body movement than what is shown. - This maneuver is contraindicated in suspected cervical spine injuries due to the risk of exacerbating spinal cord damage.

Q: A young male was administered regional anesthesia with 0.25% bupivacaine. The patient became unresponsive, and the pulse became unrecordable. What is the best management in this situation?

ECPR with 20% intralipid. ***ECPR with 20% intralipid*** - The scenario describes **Local Anesthetic Systemic Toxicity (LAST)**, likely due to bupivacaine, leading to cardiovascular collapse. - **Intralipid 20%** is the first-line treatment for LAST-induced cardiovascular toxicity, as it acts as a lipid sink for the lipophilic local anesthetic. *ECPR with calcium* - While calcium may be used in certain cardiac arrest scenarios, it is **not the primary treatment for bupivacaine-induced cardiovascular collapse** and LAST. - Calcium might offer some cardiac support but does not directly neutralize the local anesthetic's toxic effects. *ECPR with dobutamine* - **Dobutamine is an inotropic agent** used to improve cardiac contractility but is not indicated as a primary rescue therapy for severe LAST. - It would not address the underlying toxicity caused by bupivacaine and could potentially worsen the situation by increasing myocardial oxygen demand without reversing toxin effects. *ECPR with sodium bicarbonate* - **Sodium bicarbonate** is used to treat metabolic acidosis and can be beneficial in certain drug overdoses to enhance excretion or stabilize cardiac membranes. - However, it is **not the primary or most effective treatment for bupivacaine-induced LAST** and cardiovascular collapse compared to lipid emulsion therapy.

Q: A patient is undergoing surgery where anesthesia is maintained with halothane. The patient develops hyperthermia and muscle rigidity. Which of the following agents is most likely responsible?

Suxamethonium. ***Suxamethonium*** - **Suxamethonium** (succinylcholine) is a depolarizing neuromuscular blocker that can trigger **malignant hyperthermia** in susceptible individuals, characterized by **hyperthermia** and **muscle rigidity**. - This adverse reaction occurs due to an uncontrolled release of calcium from the **sarcoplasmic reticulum** in skeletal muscle, leading to sustained muscle contraction and increased metabolism. *Cisatracurium* - **Cisatracurium** is a non-depolarizing neuromuscular blocker, which works by competing with acetylcholine at the **neuromuscular junction**. - It does not typically cause **malignant hyperthermia** and is less likely to be associated with hyperthermia or muscle rigidity as a direct side effect. *D-tubocurarine* - **D-tubocurarine** is a non-depolarizing neuromuscular blocker that causes muscle relaxation by blocking nicotinic acetylcholine receptors. - While it can cause **histamine release**, leading to hypotension and bronchospasm, it is not implicated in triggering **malignant hyperthermia**. *Rocuronium* - **Rocuronium** is a rapid-onset, intermediate-acting non-depolarizing neuromuscular blocker, used for muscle relaxation during surgery. - Like other non-depolarizing agents, it does not directly trigger **malignant hyperthermia** and is not associated with hyperthermia and muscle rigidity in this context.

Q: A young girl presents to the outpatient department with rough-surfaced lesions over her elbows and knees. She also complains of diminished vision at night. What is the most likely diagnosis?

Phrynoderma. ***Phrynoderma*** - Phrynoderma, also known as **follicular hyperkeratosis**, presents with **rough, horny papules** over extensor surfaces like elbows and knees, often described as "toad skin." - It is a skin manifestation of **vitamin A deficiency**, which also causes **night blindness** (nyctalopia) due to impaired production of rhodopsin. *Folliculitis* - This is an **inflammation of hair follicles**, appearing as small, red bumps or pustules centered around hair follicles. - It is typically caused by bacterial or fungal infections and does not cause **night blindness**. *Pyoderma* - **Pyoderma** refers to a **pus-producing skin infection** caused by bacteria, such as impetigo or cellulitis. - These are characterized by crusts, blisters, or inflamed lesions and are not associated with **rough skin** or **night blindness**. *Keratosis pilaris* - This common genetic condition causes small, rough bumps, typically on the upper arms, thighs, and buttocks, due to **keratin plugging hair follicles**. - While it causes rough skin similar to phrynoderma, it is generally **benign** and does not cause systemic symptoms like **night blindness**.

Q: A male child presents with a mildly painful swelling on his scalp for the last 3 months, as shown in the image. The history reveals that there is a pet dog in the household. What is the most likely diagnosis?

Kerion. ***Kerion*** - A **kerion** is a severe, inflammatory type of **tinea capitis** (ringworm of the scalp) that presents as a **boggy, tender, swollen mass** with pustules and crusting on the scalp. - The **3-month duration** is consistent with a chronic fungal infection rather than an acute bacterial process. - The presence of a **pet dog** in the household is a critical clue, as **zoophilic dermatophytes** (especially *Microsporum canis* from dogs and cats) are common causes of inflammatory tinea capitis that progresses to kerion. - Kerion typically appears as a soft, elevated, "honeycomb-like" mass with oozing and matting of hair. *Abscess* - An **abscess** is a localized collection of pus from bacterial infection and would typically present with **acute onset**, severe pain, fluctuance, and systemic signs of infection. - The **3-month duration** makes a simple bacterial abscess unlikely, as it would typically evolve more rapidly (days to weeks) and require drainage. - The pet exposure and chronic course favor a fungal etiology over bacterial infection. *Scabies* - **Scabies** is caused by the mite *Sarcoptes scabiei* and presents with **intensely itchy papules, vesicles, and burrows**, typically in intertriginous areas (web spaces, wrists, axillae, groin). - Scalp involvement is rare except in infants with crusted scabies, and it does not present as a solitary, boggy, mildly painful swelling. - The clinical presentation and location do not match scabies. *Folliculitis* - **Folliculitis** is inflammation of hair follicles, usually due to bacterial infection (commonly *Staphylococcus aureus*), presenting as **multiple small, red, tender pustules** centered around hair follicles. - While it can occur on the scalp, folliculitis typically involves **multiple discrete lesions** rather than a single large, confluent, boggy mass. - The presentation would be more acute and superficial, not a deep-seated swelling persisting for 3 months.

Q: A hair perforation test was performed on a yeast isolate, and the result was positive. Which of the following organisms is associated with a positive hair perforation test?

Candida albicans. ***Candida albicans*** - The **hair perforation test** is a classic diagnostic test specifically used to identify *Candida albicans*, which characteristically produces **conical projections** when incubated with sterilized blonde hair in water at room temperature. - This test has historically been used as a simple, rapid method for **presumptive identification** of *C. albicans* from other Candida species, indicating the organism's ability to produce **keratinolytic enzymes**. *Candida tropicalis* - *Candida tropicalis* gives a **negative hair perforation test** and does not produce the characteristic hair perforations seen with *C. albicans*. - While it can form **pseudohyphae** and true hyphae, it can be differentiated from *C. albicans* using this test among others. *Candida glabrata* - *Candida glabrata* does **NOT** produce a positive hair perforation test and typically remains in **yeast form**. - It is distinguished from other Candida species by its **smaller cell size** and inability to form germ tubes or hair perforations. *Candida parapsilosis* - *Candida parapsilosis* also gives a **negative hair perforation test** and does not produce hair perforations. - This species can form **pseudohyphae** but the hair perforation test helps distinguish it from *C. albicans*.

Q: A 23-year-old primigravida lives in the same house as her school-going nephew, who contracted a varicella infection. The woman approached the medical center and was tested for varicella antibodies, with a negative result. Which of the following statements are true?

She is susceptible to chickenpox. ***She is susceptible to chickenpox*** - A **negative varicella antibody test** indicates she has not previously been exposed to the **varicella-zoster virus (VZV)** and therefore lacks protective immunity. - As a **primigravida** living with an actively infected individual, she is at high risk of contracting primary chickenpox due to her susceptible status. *She is susceptible to zoster* - **Zoster (shingles)** is caused by the **reactivation of latent VZV** from a previous chickenpox infection, which she has not had. - Without a prior chickenpox infection, there is no dormant virus to reactivate, so susceptibility to zoster is not applicable. *She is immune to chickenpox* - **Immunity to chickenpox** is conferred by prior infection or vaccination, which would result in a **positive varicella antibody test**. - Her **negative antibody test** directly refutes the claim of immunity. *She is immune to zoster* - **Immunity to zoster** is not a primary concept; rather, zoster develops from the reactivation of latent VZV after a primary infection with chickenpox. - Since she is susceptible to chickenpox, she cannot be immune to zoster, which requires prior infection.

Q: A child presents with cyanosis. Based on the chest X-ray provided, what is the most likely diagnosis?

Egg on side, TGA. ***Egg on side, TGA*** - The chest X-ray shows an **"egg on a string"** or **"egg on its side"** appearance, characterized by a **narrow mediastinum** and an **enlarged, egg-shaped heart**. - This classic radiographic finding, combined with childhood **cyanosis**, is highly suggestive of **transposition of the great arteries (TGA)** due to the altered great vessel positions. *Snowman heart, supracardiac TAPVC* - The **"snowman heart"** or **"figure-of-8"** sign is seen in **supracardiac total anomalous pulmonary venous connection (TAPVC)**, where the dilated superior vena cava and anomalous vertical vein create the 'head' and 'body' of a snowman. - This is not seen in the provided X-ray, which shows a different cardiac silhouette. *Cottage loaf heart, Truncus arteriosus* - The term **"cottage loaf heart"** is not a commonly used or recognized radiographic description for specific congenital heart diseases. - **Truncus arteriosus** typically manifests with **cardiomegaly** and **increased pulmonary vascular markings**, but not the distinct "egg on side" appearance shown. *Boot-shaped heart, TOF* - A **"boot-shaped heart"** or **coeur-en-sabot** is characteristic of **tetralogy of Fallot (TOF)**, due to right ventricular hypertrophy and a concave pulmonary artery segment. - The chest X-ray provided does not display this specific morphology but rather the "egg on side" appearance. *Wall-to-wall heart, Ebstein's anomaly* - **Ebstein's anomaly** presents with a **"wall-to-wall heart"** or **"box-shaped heart"** on chest X-ray due to massive right atrial enlargement. - This creates a markedly enlarged cardiac silhouette with decreased pulmonary vascular markings, distinct from the narrow mediastinum and egg-shaped appearance seen in TGA.

Question 1

While performing a lumbar puncture on a patient presenting with fever, neck rigidity, and altered sensorium, what is the last structure to be encountered by the needle?

Accepted Answer

Arachnoid membrane

Answer

Dura mater

Answer

Pia mater

Answer

Ligamentum flavum

Answer

Supraspinous ligament

Question 2

The procedure shown in the image is performed to maintain the airway. Which of the following techniques is being used?

Accepted Answer

Jaw thrust

Answer

Head stabilization

Answer

In line manual stabilization

Answer

Head tilt chin lift

Question 3

A young male was administered regional anesthesia with 0.25% bupivacaine. The patient became unresponsive, and the pulse became unrecordable. What is the best management in this situation?

Accepted Answer

ECPR with 20% intralipid

Answer

ECPR with calcium

Answer

ECPR with dobutamine

Answer

ECPR with sodium bicarbonate

Question 4

A patient is undergoing surgery where anesthesia is maintained with halothane. The patient develops hyperthermia and muscle rigidity. Which of the following agents is most likely responsible?

Accepted Answer

Suxamethonium

Answer

Cisatracurium

Answer

D-tubocurarine

Answer

Rocuronium

Question 5

A 53 year-old male presented with erythematous, edematous plaques on his face over pre-existing hypoesthetic patches. He has been experiencing pain for the last 10 days and has been on multibacillary multidrug therapy (MBMDT) for leprosy for the past two months. What is the most likely diagnosis based on the image?

Accepted Answer

Type 1 Lepra reaction

Answer

Erythema Nodosum Leprosum (ENL)

Answer

Cellulitis of the face

Answer

Erysipelas

Question 6

A young girl presents to the outpatient department with rough-surfaced lesions over her elbows and knees. She also complains of diminished vision at night. What is the most likely diagnosis?

Accepted Answer

Phrynoderma

Answer

Folliculitis

Answer

Pyoderma

Answer

Keratosis pilaris

Question 7

A male child presents with a mildly painful swelling on his scalp for the last 3 months, as shown in the image. The history reveals that there is a pet dog in the household. What is the most likely diagnosis?

Accepted Answer

Kerion

Answer

Abscess

Answer

Scabies

Answer

Folliculitis

Question 8

A hair perforation test was performed on a yeast isolate, and the result was positive. Which of the following organisms is associated with a positive hair perforation test?

Accepted Answer

Candida albicans

Answer

Candida tropicalis

Answer

Candida glabrata

Answer

Candida parapsilosis

Question 9

A 23-year-old primigravida lives in the same house as her school-going nephew, who contracted a varicella infection. The woman approached the medical center and was tested for varicella antibodies, with a negative result. Which of the following statements are true?

Accepted Answer

She is susceptible to chickenpox

Answer

She is susceptible to zoster

Answer

She is immune to chickenpox

Answer

She is immune to zoster

Question 10

A child presents with cyanosis. Based on the chest X-ray provided, what is the most likely diagnosis?

Accepted Answer

Egg on side, TGA

Answer

Snowman heart, supracardiac TAPVC

Answer

Cottage loaf heart, Truncus arteriosus

Answer

Boot-shaped heart, TOF

Answer

Wall-to-wall heart, Ebstein's anomaly

NEET-PG 2021

Anatomy

Anesthesiology

Dermatology

Microbiology

OB/GYN

Pediatrics