NEET-PG 2012 Practice Questions

Q: In the context of bone metastasis, which of the following bones is least likely to be a site of metastasis?

Fibula. ***Fibula*** - The **fibula** is not commonly involved in **metastatic disease**, primarily due to its low blood supply compared to other bones. - While it can occasionally show metastatic lesions, it's **rare** when compared to more commonly affected sites. *Humerus* - The **humerus** can be affected by metastasis, often from lung or breast cancers [1], as it is one of the long bones involved in **hematogenous spread**. - Common presentations include **lytic or blastic lesions**, which indicate bone damage from metastatic processes. *Femur* - The **femur** is frequently involved in metastatic lesions, particularly in patients with malignancies like **prostate or breast cancer** [1]. - Symptoms may include **pain** and **pathologic fractures** due to the weakening of the bone structure from metastasis [1]. *Spine* - The **spine** is a common site for metastases, especially from cancers such as **lung, breast, and prostate** [1]. - Bone scans often reveal **vertebral body lesions**, leading to complications like **spinal cord compression** [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 674-675.

Q: What is a common complication of joint tuberculosis?

Fibrous ankylosis. ***Fibrous ankylosis*** - Joint tuberculosis commonly leads to **fibrous ankylosis** due to chronic inflammation and destruction of articular cartilage, promoting the formation of fibrous tissue that limits joint movement. - This complication results from the body's attempt to heal the persistent inflammatory process, creating a stiff and immoveable joint. *Bony ankylosis* - While possible in severe, long-standing cases, **bony ankylosis** (fusion of bones) is less common in joint tuberculosis than fibrous ankylosis. - It typically occurs in diseases like **ankylosing spondylitis** or advanced rheumatoid arthritis, where new bone formation bridges joint spaces. *Normal healing* - **Normal healing** with full restoration of joint function is rare in untreated or late-diagnosed joint tuberculosis due to the destructive nature of the infection. - The disease often causes significant damage to cartilage and bone, precluding complete recovery without sequelae. *None of the options* - This option is incorrect because **fibrous ankylosis** is a well-recognized and frequent complication of joint tuberculosis. - The chronic inflammatory response and tissue destruction inherent to the disease make complications highly probable.

Q: In elbow, osteochondritis usually involves

Capitulum. ***Capitulum*** - The **capitulum** of the humerus is the most common site for **osteochondritis dissecans (OCD)** in the elbow, especially in throwing athletes and gymnasts. - This condition involves an avascular necrosis of the subchondral bone leading to a detachment of a cartilage fragment. *Olecranon* - The **olecranon** is part of the ulna and is more commonly affected by **stress fractures** or **bursitis**, not typically osteochondritis. - While it articulates with the trochlea, it does not bear the primary compressive forces that lead to osteochondritis in the same way the capitulum does. *Trochlea* - The **trochlea** of the humerus articulates with the trochlear notch of the ulna and is less frequently involved in primary osteochondritis compared to the capitulum. - Pathologies here are more likely related to **instability** or **fractures**. *Radial head* - The **radial head** articulates with the capitulum and is more prone to **fractures** or degenerative changes like **osteoarthritis**. - While it can be affected by **osteochondral lesions**, the capitulum is the classic site for elbow osteochondritis dissecans.

Q: After chronic use of steroids severe pain in right hip with immobility is due to

Avascular necrosis. ***Avascular necrosis*** - Chronic **steroid use** is a major risk factor for avascular necrosis (AVN), particularly affecting the **femoral head** of the hip. - Reduced blood supply leads to bone death, resulting in severe pain and impaired mobility. *Perthes disease* - This is a condition of idiopathic **avascular necrosis of the femoral head** occurring in **children**, primarily between ages 4-10. - It is not associated with steroid use and typically presents in a different age group. *Hip dislocation* - Hip dislocation presents with **acute, severe pain** and an inability to bear weight or move the hip, often due to significant trauma. - While it causes immobility, it is an **acute traumatic event** rather than a chronic consequence of steroid use. *Osteoarthritis* - Osteoarthritis is a degenerative joint disease characterized by **cartilage breakdown** and joint pain that typically **worsens with activity** and improves with rest. - While chronic hip pain can be due to osteoarthritis, its direct link to steroid use for severe pain and immobility as described is less prominent than AVN.

Q: A baby is born at 27 weeks of gestation and required mechanical ventilation for 4 weeks and CPAP for 1 week. He was maintained on room air subsequently. Based on the new definition of Bronchopulmonary Dysplasia (BPD), and assuming he remained on room air at 36 weeks post-menstrual age, what is the most appropriate classification of his condition?

Mild BPD. ***Mild BPD*** - The infant required respiratory support (ventilation and CPAP) for an extended period (5 weeks total, far exceeding the 28-day oxygen requirement for BPD diagnosis). - Being on **room air at 36 weeks post-menstrual age** despite prior prolonged support classifies his condition as mild BPD according to the diagnostic criteria. - For infants born <32 weeks gestation, mild BPD is defined as needing oxygen for ≥28 days but breathing room air at 36 weeks PMA. *Moderate BPD* - Moderate BPD would be diagnosed if the infant still required **less than 30% oxygen (FiO2 0.22-0.29) at 36 weeks post-menstrual age**. - This infant was on room air (FiO2 0.21), indicating less severe lung disease than moderate BPD. *Severe BPD* - Severe BPD involves the ongoing need for **30% or greater oxygen (FiO2 ≥0.30)** and/or positive pressure support (CPAP/ventilator) at 36 weeks post-menstrual age. - This infant did not meet these criteria, as he was on room air without any support. *No BPD* - No BPD would require **less than 28 days of oxygen/respiratory support** during the neonatal period. - This infant required mechanical ventilation for 4 weeks and CPAP for 1 week (total 5 weeks = 35 days), clearly exceeding the 28-day threshold for BPD diagnosis. - Despite being stable on room air at 36 weeks PMA, the prolonged earlier support establishes the diagnosis of BPD (mild severity).

Q: Which of the following statements is true regarding anemia of prematurity?

Low reticulocyte response. ***Low reticulocyte response*** - Anemia of prematurity results from several factors, including a **blunted erythropoietin response** to anemia, **shortened red blood cell lifespan**, and **rapid growth with increased blood volume requirements**. - The combination of these factors leads to **insufficient red blood cell production** by the bone marrow, reflected by a **low reticulocyte count** despite anemia. - This low reticulocyte response is a **key diagnostic feature** distinguishing it from hemolytic anemias. *Hemoglobin level <10 gm/dL* - While premature infants with anemia of prematurity develop low hemoglobin, a specific cutoff of **<10 gm/dL is not universally definitive** for diagnosis. - Hemoglobin nadirs vary based on **gestational age** (more premature = lower nadir) and occur at different postnatal ages. - Transfusion thresholds are determined by **clinical stability and symptoms**, not just a single Hb value. *10 ml/kg packed cell transfusion* - This describes a **treatment intervention**, not a characteristic of the disease itself. - Transfusion volume is typically **10-15 ml/kg** when indicated, but the decision to transfuse depends on gestational age, postnatal age, clinical stability, and symptoms like apnea or bradycardia. - This is **not a defining feature** of anemia of prematurity. *Microcytic hypochromic type* - Anemia of prematurity is typically **normocytic, normochromic**, not microcytic hypochromic. - **Microcytic hypochromic** anemia suggests **iron deficiency**, which is a different condition. - The red cells in anemia of prematurity have **normal size (MCV) and normal hemoglobin content** per cell.

Q: Diarrhoea in a child of 12 months, dose of Zinc is?

20 mg / 10 - 14 day. **20 mg / 10 - 14 day** - For children aged **12 months and older**, the recommended dose of zinc for acute diarrhea is **20 mg** once daily for **10 to 14 days**. - This dosage helps reduce the severity and duration of diarrheal episodes and prevents future occurrences. *1 mg / 10 - 14 day* - This dosage is **too low** and would be ineffective in treating or preventing the future incidence of diarrhea in a 12-month-old child. - Subtherapeutic doses will not provide the necessary micronutrient support during diarrheal illness. *10 mg / 10 - 14 day* - This is the recommended dose for children **under 6 months of age**, not for a 12-month-old child. - While it's a correct dosage for a different age group, it is an insufficient dose for a 12-month-old. *15 mg / 10 - 14 day* - This dose is **not the standard recommendation** by major health organizations like WHO or UNICEF for any age group for treating diarrhea. - It falls between the standard dosages and may not provide optimal benefit.

Q: At what age do children typically begin to say short sentences of 4-5 words?

4 years. ***4 years*** - By this age, children typically have a vocabulary of **1,500-2,500 words** and can construct sentences of **4-5 words**, demonstrating improved grammatical structure and complexity. - They can also tell simple stories and use pronouns and plurals correctly. *2 years* - Children at this age typically combine **two to three words** into short phrases, such as "more milk" or "daddy go." - Their vocabulary usually consists of about **50-200 words**, not enough for 4-5 word sentences. *3 years* - Three-year-olds usually speak in **three- to four-word sentences**, such as "I want big cookie." - Their vocabulary is typically around **900-1,000 words**, but they are still developing the complexity needed for consistent 4-5 word sentences. *5 years* - By age five, children can typically speak in much **longer and more complex sentences** (5-6+ words) and are mastering grammar rules. - They can comprehend and communicate more nuanced ideas, surpassing the milestone of 4-5 word sentences.

Q: Which of the following is a common symptom of neonatal lupus?

Cutaneous lesion. ***Cutaneous lesion*** - **Cutaneous lesions** are the most common manifestation of neonatal lupus, typically appearing as an **annular erythematous rash** on the face and scalp. - These lesions often develop after exposure to **ultraviolet light** and usually resolve within 6 months as maternal autoantibodies clear from the infant's system. *Thrombocytopenia* - While **hematologic abnormalities** such as thrombocytopenia can occur in neonatal lupus, they are less common than cutaneous lesions. - **Thrombocytopenia** refers to a low platelet count, which can increase the risk of bleeding. *All of the options* - While all listed options (cutaneous lesions, thrombocytopenia, and heart block) can be features of neonatal lupus, **cutaneous lesions** are the most frequently observed symptom. - Choosing "All of the options" would imply equal commonality or presence of all in every case, which is not accurate. *Heart block* - **Congenital heart block** is a serious, but less common and often irreversible, manifestation of neonatal lupus, caused by maternal antibodies attacking the fetal cardiac conduction system. - It usually presents as **bradycardia** and may require a pacemaker, but it is not the most common symptom overall.

Q: What is the recommended CPR ratio for infants when performed by 2 rescuers?

15 : 2. ***15 : 2*** - For **infants and children**, when there are **two or more rescuers**, the recommended compression-to-ventilation ratio is **15 compressions to 2 breaths**. - This ratio provides a better balance between compressions and ventilations to optimize outcomes in pediatric cardiac arrest. *30 : 2* - The **30:2 ratio** is primarily recommended for **adult CPR**, or for **single rescuers** performing CPR on infants and children. - Using this ratio for two-rescuer infant CPR would likely lead to inadequate ventilation and potentially worse outcomes. *1 : 3* - A 1:3 ratio (1 compression to 3 breaths) is not a standard recommended ratio for CPR in any age group based on current guidelines. - This ratio would significantly prioritize ventilations over chest compressions, which is not ideal for maintaining circulation. *1 : 5* - A 1:5 ratio (1 compression to 5 breaths) is not a standard recommended ratio for CPR in any age group. - This ratio heavily emphasizes ventilations and would result in insufficient chest compressions, which are crucial for blood flow.

Question 1

In the context of bone metastasis, which of the following bones is least likely to be a site of metastasis?

Accepted Answer

Fibula

Answer

Femur

Answer

Humerus

Answer

Spine

Question 2

What is a common complication of joint tuberculosis?

Accepted Answer

Fibrous ankylosis

Answer

Bony ankylosis

Answer

Normal healing

Answer

None of the options

Question 3

In elbow, osteochondritis usually involves

Accepted Answer

Capitulum

Answer

Olecranon

Answer

Trochlea

Answer

Radial head

Question 4

After chronic use of steroids severe pain in right hip with immobility is due to

Accepted Answer

Avascular necrosis

Answer

Perthes disease

Answer

Hip dislocation

Answer

Osteoarthritis

Question 5

A baby is born at 27 weeks of gestation and required mechanical ventilation for 4 weeks and CPAP for 1 week. He was maintained on room air subsequently. Based on the new definition of Bronchopulmonary Dysplasia (BPD), and assuming he remained on room air at 36 weeks post-menstrual age, what is the most appropriate classification of his condition?

Accepted Answer

Mild BPD

Answer

Moderate BPD

Answer

Severe BPD

Answer

No BPD

Question 6

Which of the following statements is true regarding anemia of prematurity?

Accepted Answer

Low reticulocyte response

Answer

Hemoglobin level <10 gm/dL

Answer

10 ml/kg packed cell transfusion

Answer

Microcytic hypochromic type

Question 7

Diarrhoea in a child of 12 months, dose of Zinc is?

Accepted Answer

20 mg / 10 - 14 day

Answer

1 mg / 10 - 14 day

Answer

10 mg / 10 - 14 day

Answer

15 mg / 10 - 14 day

Question 8

At what age do children typically begin to say short sentences of 4-5 words?

Accepted Answer

4 years

Answer

2 years

Answer

3 years

Answer

5 years

Question 9

Which of the following is a common symptom of neonatal lupus?

Accepted Answer

Cutaneous lesion

Answer

All of the options

Answer

Thrombocytopenia

Answer

Heart block

Question 10

What is the recommended CPR ratio for infants when performed by 2 rescuers?

Accepted Answer

15 : 2

Answer

30 : 2

Answer

1 : 3

Answer

1 : 5

NEET-PG 2012

Orthopaedics

Pediatrics