Recent guideline updates in medicine

75 NEET-PG practice questions on Recent guideline updates in medicine, part of General Medicine. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
Which eye drop for glaucoma can trigger severe bronchospasm in a patient with asthma?
1. ABrimonidine
2. BTimolol
3. CLatanoprost
4. DBrinzolamide
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Answer: B · Timolol
Timolol is a non-selective beta-blocker, and enough is absorbed through the nasolacrimal duct to block beta-2 receptors in the airways, sometimes causing fatal bronchospasm. GINA advises reviewing all beta-blockers, including eye drops, in people with asthma. Prostaglandin analogues such as latanoprost are safer choices. Key point: Timolol eye drops can cause severe bronchospasm in asthma.
- A: Brimonidine is an alpha-2 agonist that does not cause bronchospasm.
- C: Latanoprost is a prostaglandin analogue without beta-blocking effect.
- D: Brinzolamide is a carbonic anhydrase inhibitor, safe in asthma.
Question 2 · Easy
For heart failure with reduced ejection fraction (EF 30%), the ESC 2021 guideline lists which as first-line disease-modifying drugs? 1. ARNI or ACE inhibitor 2. Beta-blocker 3. Mineralocorticoid receptor antagonist 4. SGLT2 inhibitor
1. A1, 2 and 3 only
2. B2 and 4 only
3. C1 and 2 only
4. D1, 2, 3 and 4
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Answer: D · 1, 2, 3 and 4
The ESC 2021 guideline gives class I recommendations to four drug groups in HFrEF: an ACE inhibitor or ARNI, a beta-blocker, an MRA and an SGLT2 inhibitor (dapagliflozin or empagliflozin). Each reduces death and heart-failure admissions, and they are started early, often together, rather than one after the other over months. Diuretics relieve congestion but do not change survival. Key point: HFrEF has four pillars: ACE inhibitor or ARNI, beta-blocker, MRA and SGLT2 inhibitor.
- A: Leaving out the SGLT2 inhibitor misses a class I drug.
- B: ACE inhibitor or ARNI and MRA are also class I.
- C: MRAs and SGLT2 inhibitors are also first-line.
Question 3 · Easy
Under KDIGO criteria, a patient with acute kidney injury who is started on dialysis is placed in which stage, whatever the creatinine?
1. AStage 2
2. BStage 1
3. CRIFLE 'Loss' stage
4. DStage 3
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Answer: D · Stage 3
KDIGO stages AKI by the rise in creatinine or the fall in urine output, and initiation of renal replacement therapy places the patient in stage 3 regardless of the creatinine value. Stage is assigned by whichever criterion gives the highest stage. The higher the stage, the higher the risk of death and of later CKD. Key point: Starting renal replacement therapy automatically means KDIGO AKI stage 3.
- A: Stage 2 is defined by creatinine or urine output, not by the need for dialysis.
- B: Stage 1 is the mildest rise and never includes dialysis.
- C: 'Loss' belongs to the older RIFLE scheme and means persistent failure for over 4 weeks.
Question 4 · Medium
Using standardised office blood pressure readings, what systolic target does KDIGO 2021 suggest for adults with high blood pressure and CKD who are not on dialysis, if they tolerate it?
1. ABelow 120 mmHg
2. BBelow 150 mmHg
3. CBelow 130 mmHg
4. DBelow 140 mmHg
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Answer: A · Below 120 mmHg
KDIGO 2021 suggests a systolic target below 120 mmHg in adults with high BP and CKD, measured by a standardised office technique, largely based on SPRINT, where intensive control reduced cardiovascular events and death. The target is relaxed in people who do not tolerate it, such as those with postural hypotension, frailty or very advanced CKD. Routine, non-standardised readings should not be used to apply this target. Key point: KDIGO 2021 suggests systolic BP below 120 mmHg in CKD, using standardised office readings, if tolerated.
- B: Below 150 mmHg is used for some frail older adults, not as the KDIGO target.
- C: Below 130 mmHg was the older KDIGO and ACC/AHA target for albuminuric CKD.
- D: Below 140 mmHg was an older, less intensive target.
Question 5 · Easy
Post-bronchodilator FEV1/FVC is 0.62 in a retired mill worker who smoked for 30 years. His mMRC dyspnoea grade is 1, CAT score 7, and he had no exacerbations last year. What initial treatment does GOLD advise?
1. AOral roflumilast
2. BLABA + LAMA + ICS
3. CA bronchodilator
4. DLABA + ICS
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Answer: C · A bronchodilator
With few symptoms and no exacerbations, he is in GOLD group A, for whom a bronchodilator (short- or long-acting) is the initial treatment, with a long-acting one preferred if symptoms are frequent. Smoking cessation, vaccination and activity are advised for all. Inhaled steroids are not used without exacerbations. Key point: GOLD group A: a bronchodilator; no inhaled steroid without exacerbations.
- A: Roflumilast is for chronic bronchitis with severe obstruction and exacerbations.
- B: Triple therapy is for group E with high eosinophils.
- D: LABA + ICS is not recommended in COPD.
Question 6 · Easy
A conscious infant choking on a groundnut cannot cry, cough or breathe. What does the AHA 2025 guideline recommend?
1. AHold the infant upside down and shake
2. BAbdominal thrusts as in older children
3. CA blind finger sweep of the mouth
4. DAlternate 5 back blows and 5 chest thrusts
Answer and explanation in LearnFree account
Question 7 · Medium
After ROSC from a VF arrest, a man remains unresponsive. His ECG shows anterior ST elevation and BP is 102/64 mmHg on noradrenaline. Consider: 1. Emergency coronary angiography is indicated. 2. Hypotension should be avoided. 3. Prophylactic antiarrhythmic infusion is routine. 4. Fever should be actively prevented. Which statements are correct?
1. A1 and 2 only
2. B2, 3 and 4 only
3. C1, 2, 3 and 4
4. D1, 2 and 4 only
Answer and explanation in LearnFree account
Question 8 · Hard
Fourteen months after a complete course of anti-rabies vaccine for a cat scratch, a veterinary student is bitten deeply by a stray dog. The wound is washed. What else does he need?
1. ATwo vaccine doses, days 0 and 3, no RIG
2. BA full course plus rabies immunoglobulin
3. CRabies immunoglobulin alone
4. DNothing, as he is still protected
Answer and explanation in LearnFree account
Question 9 · Medium
During a resuscitation audit in a district hospital, the team reviews AHA 2025 advice: 1. Pauses in compressions should be under 10 seconds. 2. The chest compression fraction should be above 60%. 3. Mechanical CPR devices should be used routinely. 4. Double sequential defibrillation is advised for refractory VF. Which statements match the guideline?
1. A1 and 2 only
2. B1, 2 and 3 only
3. C2, 3 and 4 only
4. D1, 2 and 4 only
Answer and explanation in LearnFree account
Question 10 · Medium
ABG in casualty from a woman with acute asthma who can speak only single words: pH 7.37, PaCO2 44 mmHg, PaO2 58 mmHg on room air; peak flow is 30% of her best. What does the PaCO2 indicate?
1. AHyperventilation from anxiety
2. BMetabolic compensation for alkalosis
3. CExhaustion with impending respiratory failure
4. DA mild, well-compensated attack
Answer and explanation in LearnFree account
Question 11 · Medium
Ferritin 62 ng/mL and transferrin saturation 14% are found in a man with symptomatic HFrEF (EF 30%); his haemoglobin is 13.6 g/dL. What does the ESC guideline advise?
1. AIV ferric carboxymaltose
2. BNo treatment, as he is not anaemic
3. COral ferrous sulfate
4. DErythropoietin injections
Answer and explanation in LearnFree account
Question 12 · Medium
During a COPD exacerbation, a man has more breathlessness and more sputum. He has no fever and no signs of pneumonia. Which feature most supports adding an antibiotic?
1. AIncreased sputum purulence
2. BIncreased wheeze
3. CIncreased sputum volume alone
4. DRaised blood eosinophils
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Question 13 · Hard
A diabetologist at a medical college is preparing a teaching session for interns around a patient with type 2 diabetes, eGFR 42 mL/min/1.73 m² and ACR 350 mg/g. Consider these statements about drugs for type 2 diabetes with CKD in the KDIGO diabetes guidance: 1. Metformin is used when eGFR is 30 mL/min/1.73 m² or more. 2. An SGLT2 inhibitor is recommended when eGFR is 20 or more. 3. A long-acting GLP-1 receptor agonist is preferred if more glucose lowering is needed. 4. An ACE inhibitor and an ARB together are recommended for heavy albuminuria. Which are correct?
1. A1, 2, 3 and 4
2. B1, 2 and 3 only
3. C2 and 4 only
4. D1 and 2 only
Answer and explanation in LearnFree account
Question 14 · Hard
In a district hospital with a cath lab, a man with NSTEMI (troponin rise, no instability) is booked for angiography the next morning, within 24 hours. He has had aspirin and fondaparinux. The resident wants to load ticagrelor now. What does the ESC 2023 guideline advise?
1. ADefer P2Y12 loading to angiography
2. BLoad prasugrel at once
3. CLoad clopidogrel at once
4. DLoad ticagrelor 180 mg in the ward now
Answer and explanation in LearnFree account
Question 15 · Hard
On the neurosurgery ward, ten days after a craniotomy for meningioma, a woman becomes acutely breathless. CT pulmonary angiography shows emboli in both main pulmonary arteries with a dilated right ventricle, and her BP stays at 76/48 mmHg despite a fluid bolus and noradrenaline. Her SpO2 is 86% on high-flow oxygen, the JVP is raised and bedside echo shows a D-shaped left ventricle. Her surgeon is worried about bleeding into the operative bed. A cardiothoracic team and interventional radiology are available. Per ESC 2019, what is the best treatment?
1. AAn IVC filter alone
2. BFull-dose systemic alteplase
3. CSubcutaneous enoxaparin on the ward
4. DSurgical embolectomy or catheter-directed therapy
Answer and explanation in LearnFree account
Question 16 · Medium
On 8 L/min oxygen by a simple face mask, a woman with a COPD exacerbation is drowsy with SpO2 99%. ABG: pH 7.36, PaCO2 54 mmHg, HCO3 30 mmol/L. What is the most appropriate change?
1. ASwitch to a Venturi mask, target SpO2 88-92%
2. BStop oxygen completely
3. CGive IV sodium bicarbonate
4. DIncrease oxygen to a non-rebreather mask
Answer and explanation in LearnFree account
Question 17 · Medium
A nurse alone with a pulseless infant in the paediatric ward starts chest compressions. Which compression technique does AHA 2025 recommend?
1. ATwo fingers on the lower sternum
2. BTwo hands as for an adult
3. CA closed fist over the mid-sternum
4. DHeel of one hand or two thumbs
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Question 18 · Medium
LDL cholesterol is 92 mg/dL after eight weeks of atorvastatin 80 mg taken daily without side effects by a man who had a STEMI last year. His ESC/EAS target is LDL below 55 mg/dL. What is the next step?
1. AAdd fenofibrate
2. BAdd omega-3 fatty acids
3. CSwitch to rosuvastatin 5 mg
4. DAdd ezetimibe
Answer and explanation in LearnFree account
Question 19 · Easy
Below which post-bronchodilator FEV1/FVC ratio does GOLD confirm persistent airflow obstruction?
1. A0.80
2. B0.50
3. C0.60
4. D0.70
Answer and explanation in LearnFree account
Question 20 · Hard
In the labour room, a primigravida at 36 weeks with severe pre-eclampsia, who received magnesium sulphate, suddenly becomes unresponsive and pulseless. High-quality CPR with manual left uterine displacement and bag-mask ventilation has continued for 4 minutes without return of circulation. Calcium gluconate has been given. The obstetric and neonatal teams are present in the room. What is the next step?
1. AMove her to the operation theatre first
2. BContinue CPR and wait for ROSC first
3. CStop CPR and declare death
4. DPerimortem caesarean delivery in the room
Answer and explanation in LearnFree account
Question 21 · Medium
Panacinar emphysema in the lower lobes is found on HRCT of a non-smoking lab assistant aged 38 with progressive breathlessness. Liver enzymes are mildly raised. Which test should be done?
1. ASerum ACE level
2. BAnti-GBM antibody
3. CSerum alpha-1 antitrypsin level
4. DSweat chloride test
Answer and explanation in LearnFree account
Question 22 · Medium
LDL cholesterol is 128 mg/dL in a smoker with type 2 diabetes and hypertension, aged 52, who has no known cardiovascular disease. Following ADA, which lipid treatment is best?
1. AAtorvastatin 10 mg daily
2. BAtorvastatin 40-80 mg daily
3. CDiet and exercise alone for six months
4. DEzetimibe alone
Answer and explanation in LearnFree account
Question 23 · Medium
Found drowsy and unable to swallow by his wife at home, a man on insulin has a capillary glucose of 38 mg/dL. What should she give before the ambulance arrives?
1. AAn extra dose of rapid insulin
2. BGlucagon, intramuscular or nasal
3. COral glucose tablets
4. DSugar solution poured into the mouth
Answer and explanation in LearnFree account
Question 24 · Hard
Two exacerbations needing oral prednisolone and one hospital admission in the past year are recorded for a weaver with COPD who has never taken regular inhalers. Post-bronchodilator FEV1/FVC is 0.55, FEV1 44% of predicted, CAT 22. Blood eosinophils are 380/µL. He has no history of asthma or pneumonia. He has stopped smoking and has had influenza and pneumococcal vaccines. Following GOLD 2026, which initial inhaled therapy is most appropriate?
1. ALABA + LAMA + ICS
2. BLABA + ICS in one inhaler
3. CLABA + LAMA
4. DLAMA alone
Answer and explanation in LearnFree account
Question 25 · Medium
A software engineer with type 2 diabetes has BMI 38 kg/m², no cardiovascular or kidney disease, and HbA1c 8.2% on metformin. Weight loss is his main goal. Which addition gives the greatest weight reduction?
1. ADapagliflozin
2. BPioglitazone
3. CTirzepatide
4. DSitagliptin
Answer and explanation in LearnFree account

50 more Recent guideline updates in medicine questions

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Recent guideline updates in medicine

Which eye drop for glaucoma can trigger severe bronchospasm in a patient with asthma?

For heart failure with reduced ejection fraction (EF 30%), the ESC 2021 guideline lists which as first-line disease-modifying drugs? 1. ARNI or ACE inhibitor 2. Beta-blocker 3. Mineralocorticoid receptor antagonist 4. SGLT2 inhibitor

Under KDIGO criteria, a patient with acute kidney injury who is started on dialysis is placed in which stage, whatever the creatinine?

Using standardised office blood pressure readings, what systolic target does KDIGO 2021 suggest for adults with high blood pressure and CKD who are not on dialysis, if they tolerate it?

Post-bronchodilator FEV1/FVC is 0.62 in a retired mill worker who smoked for 30 years. His mMRC dyspnoea grade is 1, CAT score 7, and he had no exacerbations last year. What initial treatment does GOLD advise?

A conscious infant choking on a groundnut cannot cry, cough or breathe. What does the AHA 2025 guideline recommend?

Fourteen months after a complete course of anti-rabies vaccine for a cat scratch, a veterinary student is bitten deeply by a stray dog. The wound is washed. What else does he need?

ABG in casualty from a woman with acute asthma who can speak only single words: pH 7.37, PaCO2 44 mmHg, PaO2 58 mmHg on room air; peak flow is 30% of her best. What does the PaCO2 indicate?

Ferritin 62 ng/mL and transferrin saturation 14% are found in a man with symptomatic HFrEF (EF 30%); his haemoglobin is 13.6 g/dL. What does the ESC guideline advise?

During a COPD exacerbation, a man has more breathlessness and more sputum. He has no fever and no signs of pneumonia. Which feature most supports adding an antibiotic?

In a district hospital with a cath lab, a man with NSTEMI (troponin rise, no instability) is booked for angiography the next morning, within 24 hours. He has had aspirin and fondaparinux. The resident wants to load ticagrelor now. What does the ESC 2023 guideline advise?

On 8 L/min oxygen by a simple face mask, a woman with a COPD exacerbation is drowsy with SpO2 99%. ABG: pH 7.36, PaCO2 54 mmHg, HCO3 30 mmol/L. What is the most appropriate change?

A nurse alone with a pulseless infant in the paediatric ward starts chest compressions. Which compression technique does AHA 2025 recommend?

LDL cholesterol is 92 mg/dL after eight weeks of atorvastatin 80 mg taken daily without side effects by a man who had a STEMI last year. His ESC/EAS target is LDL below 55 mg/dL. What is the next step?

Below which post-bronchodilator FEV1/FVC ratio does GOLD confirm persistent airflow obstruction?

Panacinar emphysema in the lower lobes is found on HRCT of a non-smoking lab assistant aged 38 with progressive breathlessness. Liver enzymes are mildly raised. Which test should be done?

LDL cholesterol is 128 mg/dL in a smoker with type 2 diabetes and hypertension, aged 52, who has no known cardiovascular disease. Following ADA, which lipid treatment is best?

Found drowsy and unable to swallow by his wife at home, a man on insulin has a capillary glucose of 38 mg/dL. What should she give before the ambulance arrives?

A software engineer with type 2 diabetes has BMI 38 kg/m², no cardiovascular or kidney disease, and HbA1c 8.2% on metformin. Weight loss is his main goal. Which addition gives the greatest weight reduction?