NEET-PG

A 58-year-old man presents 90 minutes after the onset of crushing central chest pain. ECG shows 3 mm ST elevation in leads II, III and aVF with reciprocal changes in I and aVL. The nearest centre offering primary percutaneous coronary intervention is 40 minutes away. What is the most appropriate immediate management?

• a.Transfer immediately for primary percutaneous coronary intervention
• b.Give intravenous thrombolysis in the emergency department
• c.Start a heparin infusion and arrange angiography within 72 hours
• d.Await the troponin result before deciding on reperfusion

A 24-year-old woman in an endemic city has had fever for 4 days. Today her temperature has settled but she has severe abdominal pain and vomiting. Platelets are 55 × 10⁹/L and haematocrit has risen from 38% to 47%. Blood pressure is 110/95 mmHg with a pulse of 108/min. What is the most appropriate immediate action?

• a.Transfuse platelets to reduce bleeding risk
• b.Start isotonic crystalloid at 5-7 mL/kg/h and reassess hourly
• c.Give intravenous dexamethasone to reduce capillary leak
• d.Reassure and discharge as the fever has settled

A 70-year-old with severe COPD arrives breathless. On 15 L/min oxygen via a reservoir mask his SpO2 is 99%, he is drowsy, pH 7.21 and PaCO2 9.4 kPa. What is the single most important immediate change?

• a.Reduce inspired oxygen to target SpO2 88-92% and reassess with a repeat blood gas
• b.Increase oxygen further to correct the acidosis
• c.Give intravenous doxapram
• d.Give intravenous aminophylline as first-line therapy

A 62-year-old on empagliflozin is admitted with vomiting after a fasting-based religious observance. Glucose is 9.1 mmol/L, pH 7.24, bicarbonate 13 mmol/L and capillary ketones 4.2 mmol/L. What is the diagnosis?

• a.Hyperosmolar hyperglycaemic state
• b.Euglycaemic diabetic ketoacidosis
• c.Starvation ketosis
• d.Lactic acidosis

A 38-year-old non-smoker has progressive dyspnoea. CT shows lower-zone predominant panacinar emphysema and liver enzymes are mildly raised. What is the most likely underlying cause?

• a.Alpha-1 antitrypsin deficiency
• b.Cystic fibrosis
• c.Lymphangioleiomyomatosis
• d.Sarcoidosis

A 64-year-old man with HFrEF (ejection fraction 28%) is on ramipril, bisoprolol and furosemide with NYHA class II symptoms. eGFR is 62 and potassium 4.2 mmol/L. Which addition offers the greatest mortality benefit?

• a.Increase the furosemide dose
• b.Add digoxin
• c.Add an SGLT2 inhibitor and a mineralocorticoid receptor antagonist
• d.Add amlodipine

A 22-year-old with acute asthma has a silent chest, exhaustion, SpO2 89% on air and a PaCO2 of 6.2 kPa after initial nebulised salbutamol. What does the arterial blood gas indicate?

• a.Improving control, since a normal-to-high PaCO2 is expected
• b.Life-threatening asthma requiring immediate critical care involvement
• c.Probable panic disorder rather than asthma
• d.A need only for oral prednisolone and discharge planning

A 68-year-old woman on metformin 1 g twice daily has an eGFR that has fallen from 52 to 38 mL/min/1.73 m² over 6 months. She is asymptomatic with an HbA1c of 7.4%. What is the correct dose adjustment?

• a.Continue metformin 1 g twice daily and repeat eGFR in a year
• b.Reduce metformin to a maximum of 1 g/day in divided doses and monitor eGFR every 3 months
• c.Stop metformin immediately — it is contraindicated at this eGFR
• d.Increase metformin to 2.5 g/day to compensate for reduced absorption

A patient on metformin with eGFR 48 mL/min/1.73 m² is booked for a contrast-enhanced CT. What should happen to the metformin?

• a.Continue without interruption
• b.Withhold on the day of the scan and restart after 48 hours once renal function is stable
• c.Stop permanently and start insulin
• d.Withhold for 7 days before the scan

A 4-year-old weighing 16 kg has fever and earache. What is the correct oral paracetamol dose and maximum in 24 hours?

• a.240 mg every 4-6 hours, maximum 4 doses in 24 hours
• b.500 mg every 4 hours, maximum 6 doses
• c.80 mg every 8 hours, maximum 3 doses
• d.1 g every 6 hours, maximum 4 g

Which mechanism contributes most to the rise in PaCO2 when a hypercapnic COPD patient receives high-flow oxygen?

• a.Loss of hypoxic pulmonary vasoconstriction increasing dead-space ventilation
• b.Direct depression of the medullary respiratory centre by oxygen
• c.Increased carbon dioxide production by peripheral tissues
• d.Reduced haemoglobin affinity for carbon dioxide in the tissues

A patient with AKI has a potassium of 6.9 mmol/L with peaked T waves and a widening QRS. What is the immediate priority?

• a.Intravenous calcium gluconate, then insulin with dextrose
• b.Oral potassium binder and repeat the level in 4 hours
• c.Intravenous sodium bicarbonate as the sole treatment
• d.Urgent haemodialysis before any drug therapy

An 82-year-old woman is confused with a respiratory rate of 24, blood pressure 104/62 mmHg, temperature 37.1°C and lactate 3.1 mmol/L after a week of dysuria. What best describes her state?

• a.Simple urinary tract infection — oral antibiotics and discharge
• b.Sepsis with hypoperfusion despite a normal temperature and blood pressure
• c.Delirium unrelated to infection
• d.Septic shock requiring immediate vasopressors

A 26-year-old uses a salbutamol inhaler four times a week and has night waking twice a month. She takes no preventer. What is the most appropriate step?

• a.Continue salbutamol alone and review in 6 months
• b.Start low-dose inhaled corticosteroid-formoterol as combined reliever and maintenance therapy
• c.Start oral montelukast alone
• d.Start a long-acting beta-agonist without an inhaled corticosteroid