NEET-PG 2012 Practice Questions

Q: In an EMG/NCV study, which radiculopathy is most closely associated with the H. reflex?

S1 radiculopathy. ***S1 radiculopathy*** - The **H-reflex (Hoffmann reflex)** primarily assesses the integrity of the **S1 nerve root** and the **tibial nerve** pathway. - A diminished or absent H-reflex is a sensitive indicator of **S1 radiculopathy**, often correlating with **Achilles reflex loss** [1]. *L3 radiculopathy* - **L3 radiculopathy** typically affects the **quadriceps muscle** and the **patellar reflex** [1]. - The H-reflex is not a primary diagnostic tool for isolated L3 nerve root involvement. *L4 radiculopathy* - **L4 radiculopathy** usually presents with weakness in **tibialis anterior** and altered sensation over the medial leg/foot [1]. - While it can sometimes impact the patellar reflex, the H-reflex is not the most direct or specific measure for L4 involvement. *L5 radiculopathy* - **L5 radiculopathy** often leads to weakness in **foot dorsiflexion** and **toe extension**, with sensory loss over the dorsum of the foot [1]. - It does not directly involve the reflex arc assessed by the H-reflex.

Q: What is the best method to diagnose an unruptured ectopic pregnancy?

USG. ***Correct Answer: USG*** - **Transvaginal ultrasound (TVS)** is the most common and effective method for diagnosing an unruptured ectopic pregnancy. It allows for visualization of a gestational sac outside the uterus or an adnexal mass. - In conjunction with **serum beta-hCG levels**, TVS helps to differentiate between an intrauterine pregnancy and an ectopic pregnancy, especially when hCG levels are above the discriminatory zone (typically 1500-2000 mIU/mL). - TVS has high sensitivity and specificity for detecting ectopic pregnancy and is **non-invasive**. *Incorrect: Endoscopy* - **Endoscopy** (such as laparoscopy) is a surgical procedure, primarily used for direct visualization and treatment of ectopic pregnancies, not for initial diagnosis. - It is *too invasive* for routine diagnostic purposes in an unruptured ectopic pregnancy. *Incorrect: UPT* - A **urine pregnancy test (UPT)** confirms pregnancy but *cannot determine the location* of the pregnancy. - A positive UPT only indicates the presence of **hCG**, which is elevated in both intrauterine and ectopic pregnancies. *Incorrect: Culdocentesis* - **Culdocentesis** involves aspirating fluid from the cul-de-sac and is used to detect the presence of *free blood* in the peritoneal cavity, indicating a **ruptured** ectopic pregnancy. - It is not useful for diagnosing an **unruptured ectopic pregnancy** and is largely replaced by ultrasound in modern practice.

Q: What is the initial drug of choice for ovarian cancer?

Cisplatin. ***Cisplatin*** - **Cisplatin** is a platinum-based chemotherapy drug that forms DNA adducts, leading to apoptosis and is a **first-line agent** for ovarian cancer. - Historically, it was the platinum agent of choice and is typically used in combination with a taxane (e.g., **paclitaxel**) for initial treatment of advanced disease. - **Note:** In current practice, **carboplatin** has largely replaced cisplatin as the preferred platinum agent due to better tolerability, less nephrotoxicity and neurotoxicity, and easier administration, while maintaining equivalent efficacy. - Among the options listed, **cisplatin remains the correct answer** as it is the only platinum-based first-line agent. *Doxorubicin* - **Doxorubicin** is an **anthracycline antibiotic** used in various cancers but is **not a first-line drug** for ovarian cancer. - It may be used in recurrent or platinum-resistant disease. - Its use is limited due to potential **cardiotoxicity**. *Ifosfamide* - **Ifosfamide** is an **alkylating agent** that is generally reserved for **recurrent** or refractory ovarian cancer. - It is associated with **hemorrhagic cystitis** (preventable with mesna) and neurotoxicity. - Not part of standard first-line treatment. *Methotrexate* - **Methotrexate** is an **antimetabolite** primarily used in other cancers like choriocarcinoma and is **not a standard treatment** for epithelial ovarian cancer. - It works by inhibiting dihydrofolate reductase, disrupting DNA synthesis. - Has no role in first-line ovarian cancer treatment.

Q: Preferred treatment for menorrhagia in reproductive age group?

OCPs. ***OCPs*** - **Combined oral contraceptives (OCPs)** are a common and effective first-line treatment for menorrhagia in reproductive-aged women, particularly when contraception is also desired. - They work by stabilizing the **endometrial lining**, reducing menstrual blood loss and regulating cycles. *NOVA T* - NOVA T is a type of **copper IUD (intrauterine device)**, which is known to potentially *increase* menstrual bleeding and dysmenorrhea, making it unsuitable for menorrhagia. - Its primary function is contraception, not the management of heavy menstrual bleeding. *Cu IUD* - The **copper intrauterine device (Cu IUD)** is generally contraindicated in women with menorrhagia because it can exacerbate heavy menstrual bleeding. - While an effective contraceptive, it does not offer therapeutic benefits for managing heavy periods. *Hysterectomy* - **Hysterectomy** is a surgical procedure for removing the uterus and is considered a definitive treatment for menorrhagia. - However, it is an **invasive procedure** with irreversible loss of fertility, typically reserved for severe cases where conservative treatments have failed or when other uterine pathology is present.

Q: Which of the following describes grade 2 fracture neck femur?

Complete fracture with undisplaced neck. ***Complete fracture with undisplaced neck*** - A **Garden Type II fracture** of the femoral neck is characterized by a **complete fracture line** through the femoral neck. - Despite the complete fracture, the **femoral head remains undisplaced** and in its anatomical position, indicating an intact or minimally disrupted posteromedial soft-tissue hinge. *Incomplete fracture, medial trabeculae intact* - This description corresponds to a **Garden Type I fracture**, which is an **incomplete fracture** of the femoral neck, usually impacted in valgus. - In such cases, the medial trabeculae are often intact, or show buckling on the lateral side, indicating a stable fracture. *Complete fracture with ischemic head* - The presence of an **ischemic head** is a complication that can occur with any displaced femoral neck fracture (Garden Type III or IV), but it's not a primary defining characteristic of a specific Garden grade. - **Avascular necrosis (AVN)** of the femoral head is a risk, especially with displacement, due to disruption of the blood supply. *Moderate displacement of neck, vascularity damaged* - This description is more consistent with a **Garden Type III fracture**, where there is a **complete fracture with moderate displacement** of the femoral head, usually with some varus angulation. - Such displacement significantly increases the risk of **vascular injury** to the femoral head, predisposing to avascular necrosis.

Q: Anterolateral decompression is primarily indicated for

Spinal tuberculosis (Pott's disease). ***Spinal tuberculosis (Pott's disease)*** - **Anterolateral decompression** is crucial for **Pott's disease** to remove infected bone and pus, relieve pressure on the spinal cord, and facilitate fusion. - This approach allows direct access to the anterior spinal column, which is commonly affected by the destructive process of **tuberculosis**. *Spinal metastasis* - While spinal metastasis can cause compression, **anterolateral decompression** is less common as a primary approach; often, surgical treatment involves posterior decompression, stabilization, and adjuvant therapies like radiation. - The goal is often **pain management** and neurological preservation in the context of advanced disease. *Lumbar disc herniation* - **Lumbar disc herniation** is typically addressed by posterior approaches like **microdiscectomy** or laminectomy, which directly access the posterior aspect of the disc. - **Anterolateral decompression** is generally not indicated as the primary treatment for standard disc herniations. *Ankylosing spondylitis* - Surgical intervention in **ankylosing spondylitis** is usually reserved for severe kyphosis or spinal fractures, employing osteotomies and stabilization techniques, often through posterior approaches. - **Anterolateral decompression** is not a standard procedure for the typical manifestations or complications of **ankylosing spondylitis**.

Q: Which of the following bone tumors characteristically presents with nocturnal pain relieved by NSAIDs and shows a radiolucent nidus surrounded by sclerotic bone?

Osteoid osteoma. ***Osteoid osteoma*** - This benign bone tumor is characterized by **nocturnal pain** that is typically **relieved by NSAIDs**, a highly distinctive clinical feature due to prostaglandin production within the nidus. - Radiographically, it presents as a small **radiolucent nidus** (less than 1.5 cm) surrounded by a significant margin of **sclerotic bone**. *Chondrosarcoma* - This is a **malignant cartilage-forming tumor** that usually presents with a dull, aching pain that is often **not relieved by NSAIDs** and may worsen over time. - Radiographically, it appears as a **large, destructive lesion with calcifications**, not a small nidus with surrounding sclerosis. *Enchondroma* - An enchondroma is a **benign cartilaginous tumor** that is typically found in the medullary cavity of long bones, often in the small bones of the hands and feet. - It is usually **asymptomatic** and discovered incidentally, and on imaging, it appears as a **well-circumscribed lytic lesion** without the prominent sclerotic rim or specific nocturnal pain pattern seen in osteoid osteoma. *None of the options* - This option is incorrect because **osteoid osteoma** perfectly matches the clinical and radiographic description provided in the question.

Q: What type of cast is primarily associated with the development of Cast syndrome?

Hip spica cast. ***Hip spica cast*** - A **hip spica cast** encases the trunk and one or both legs, increasing intra-abdominal pressure due to its extensive coverage. - This pressure can compress the **superior mesenteric artery** against the **duodenum**, leading to Cast syndrome (also known as superior mesenteric artery syndrome). *Full arm cast* - A full arm cast does not cover the abdomen and therefore does not exert pressure on the **superior mesenteric artery** or duodenum. - It is associated with complications like compartment syndrome or nerve impingement in the upper extremity, but not Cast syndrome. *Short arm cast* - Similar to a full arm cast, a short arm cast is limited to the forearm and hand and poses no risk for **abdominal compression**. - Complications are localized to the distal upper limb, such as carpal tunnel syndrome or skin breakdown. *Above knee cast* - An above knee cast covers the lower leg and thigh but does not extend to the abdomen. - It does not contribute to the increased intra-abdominal pressure necessary for the development of **superior mesenteric artery syndrome**.

Q: Green stick fracture is

Incomplete fracture. ***Incomplete fracture*** - A **greenstick fracture** is an **incomplete fracture** where the bone bends and cracks but does not break all the way through. - This type of fracture commonly occurs in children because their bones are more flexible and softer than adult bones. *Fracture in adults* - While adults can experience various types of fractures, a **greenstick fracture** is rare in adults due to their more rigid and brittle bones. - Adult bones tend to sustain **complete fractures** or other complex fracture patterns instead of bending partially. *Complete fracture* - A **complete fracture** denotes a break in the bone that severs it into two or more distinct pieces. - **Greenstick fractures** are by definition incomplete, meaning the bone is still partially intact. *Fracture spine* - A **spinal fracture** specifically refers to a break in one or more vertebrae in the spinal column. - While spinal fractures can be complete or incomplete, the term **greenstick fracture** is not typically used to describe fractures of the spine.

Q: What is the most common complication of a felon?

Osteomyelitis. ***Osteomyelitis*** - A **felon** is a severe infection of the **distal pulp space** of the fingertip, which has numerous fibrous septa. - The tightly compartmentalized nature of this space can lead to increased pressure, compromising blood supply and facilitating the spread of infection to the underlying **phalanx bone**, causing **osteomyelitis**. *Subungual hematoma* - A **subungual hematoma** is a collection of blood under the nail, usually resulting from direct trauma. - It is not a complication of an infection like a felon, but rather a separate traumatic injury. *Infective arthritis* - **Infective arthritis** involves the joint space, typically resulting from direct inoculation, hematogenous spread, or spread from adjacent soft tissue infection. - While possible, it is less common for a felon to directly spread to the **distal interphalangeal joint** compared to the more immediate risk of bone involvement. *No complications* - A **felon** is a serious infection that, if left untreated, almost always leads to complications due to the unique anatomy of the fingertip pulp space. - The high pressure within the compartments of the distal pulp makes it prone to necrosis and spread of infection to adjacent structures.

Question 1

In an EMG/NCV study, which radiculopathy is most closely associated with the H. reflex?

Accepted Answer

S1 radiculopathy

Answer

L3 radiculopathy

Answer

L4 radiculopathy

Answer

L5 radiculopathy

Question 2

What is the best method to diagnose an unruptured ectopic pregnancy?

Accepted Answer

USG

Answer

Endoscopy

Answer

UPT

Answer

Culdocentesis

Question 3

What is the initial drug of choice for ovarian cancer?

Accepted Answer

Cisplatin

Answer

Doxorubicin

Answer

Ifosfamide

Answer

Methotrexate

Question 4

Preferred treatment for menorrhagia in reproductive age group?

Accepted Answer

OCPs

Answer

Cu IUD

Answer

Hysterectomy

Answer

NOVA T

Question 5

Which of the following describes grade 2 fracture neck femur?

Accepted Answer

Complete fracture with undisplaced neck

Answer

Incomplete fracture, medial trabeculae intact

Answer

Complete fracture with ischemic head

Answer

Moderate displacement of neck, vascularity damaged

Question 6

Anterolateral decompression is primarily indicated for

Accepted Answer

Spinal tuberculosis (Pott's disease)

Answer

Lumbar disc herniation

Answer

Ankylosing spondylitis

Answer

Spinal metastasis

Question 7

Which of the following bone tumors characteristically presents with nocturnal pain relieved by NSAIDs and shows a radiolucent nidus surrounded by sclerotic bone?

Accepted Answer

Osteoid osteoma

Answer

Chondrosarcoma

Answer

Enchondroma

Answer

None of the options

Question 8

What type of cast is primarily associated with the development of Cast syndrome?

Accepted Answer

Hip spica cast

Answer

Full arm cast

Answer

Short arm cast

Answer

Above knee cast

Question 9

Green stick fracture is

Accepted Answer

Incomplete fracture

Answer

Fracture in adults

Answer

Complete fracture

Answer

Fracture spine

Question 10

What is the most common complication of a felon?

Accepted Answer

Osteomyelitis

Answer

Subungual hematoma

Answer

Infective arthritis

Answer

No complications

NEET-PG 2012

Internal Medicine

Obstetrics and Gynecology

Orthopaedics

Surgery