NEET-PG 2012 Practice Questions

Q: What is the first permanent tooth to erupt?

First molar. ***First molar*** - The **first molars** are typically the first permanent teeth to erupt, usually around **6 years of age**. - They erupt distal to the primary second molars and are not preceded by primary teeth, making them crucial for establishing the **occlusion**. *First premolar* - **First premolars** typically erupt later, between **10 and 11 years of age**, replacing the primary first molars. - Their eruption is part of the **exchange of primary teeth** for permanent successors. *Second premolar* - The **second premolars** erupt even later, usually between **11 and 12 years of age**, replacing the primary second molars. - They are also involved in the **replacement of primary teeth**, not the initial permanent eruption. *Second molar* - **Second molars** erupt much later than the first molars, typically between **11 and 13 years of age**, distal to the first molars. - They are part of the **later stages of permanent dentition development**.

Q: Which of the following conditions is NOT associated with delayed dentition?

Cystic fibrosis. ***Cystic fibrosis*** - **Cystic fibrosis** primarily affects exocrine glands, leading to issues in the respiratory and digestive systems, and does not directly impact tooth development or eruption timing. - While patients with cystic fibrosis may have other oral health concerns due to medications or nutritional deficiencies, **delayed dentition** is not a characteristic feature of the condition itself. *Down syndrome* - Children with **Down syndrome** often experience generalized developmental delays, including delayed eruption of both primary and permanent teeth. - Other common oral manifestations in Down syndrome include **microdontia**, **taurodontism**, and a higher incidence of **periodontal disease**. *Congenital hypothyroidism* - **Congenital hypothyroidism** is associated with significant developmental delays, including skeletal maturation and delayed tooth eruption. - The reduced metabolic rate due to thyroid hormone deficiency impacts bone and tooth development. *Rickets* - **Rickets**, caused by a deficiency in vitamin D, calcium, or phosphate, leads to inadequate mineralization of bone and cartilage, which can affect tooth development and eruption. - Oral manifestations of rickets include **delayed tooth eruption**, enamel hypoplasia, and a higher susceptibility to dental caries.

Q: What is the most common complication associated with carpal tunnel release surgery?

Finger stiffness. ***Finger stiffness*** - Among the options listed, **finger stiffness** is the most recognized complication of carpal tunnel release surgery. - **Post-operative pain, swelling, and scar tissue formation** can lead to reduced range of motion in the digits. - Patients may develop stiffness due to **immobilization**, **scar adhesions**, or apprehension in mobilizing the hand after surgery. - **Note:** In clinical practice, **pillar pain** (pain at the thenar and hypothenar eminences) is actually the most common complication (10-30% of cases), but it is not among the options provided. *Malunion* - **Malunion** refers to improper healing of a fractured bone. - Carpal tunnel release involves dividing the **transverse carpal ligament** (flexor retinaculum), which is a **soft tissue procedure**. - No bone is cut or fractured, so malunion is not relevant to this surgery. *Avascular necrosis* - **Avascular necrosis (AVN)** is bone death due to interrupted blood supply. - AVN affects bones with precarious blood supply (femoral head, scaphoid, lunate in Kienböck's disease). - Carpal tunnel release does not involve bone manipulation and **AVN is not a recognized complication** of this procedure. *Rupture of EPL tendon* - **Extensor Pollicis Longus (EPL) tendon rupture** is classically associated with **distal radius fractures** or inflammatory arthritis. - EPL runs through the **third dorsal compartment** and is anatomically distant from the carpal tunnel (volar wrist). - While median nerve injury is a rare but serious complication of carpal tunnel release, **EPL rupture is not associated** with this surgery.

Q: Tardy ulnar nerve palsy is specifically associated with which type of fracture?

Lateral condyle fracture of the humerus. ***Lateral condyle fracture of the humerus*** - This fracture, especially in children, can lead to **cubitus valgus deformity** as a long-term complication if it heals incorrectly. - The resulting **valgus angulation** at the elbow abnormally stretches the ulnar nerve behind the medial epicondyle, causing **tardy ulnar nerve palsy** years after the initial injury. *Medial condyle fracture of the humerus* - While close to the ulnar nerve, medial condyle fractures are more likely to cause **immediate nerve damage** due to direct impingement, rather than delayed or "tardy" palsy from chronic stretching. - Complications typically involve varus deformity, which does not commonly stretch the ulnar nerve in the same manner as valgus. *Fracture of the humeral shaft* - This type of fracture is more commonly associated with **radial nerve injury** (e.g., wrist drop), especially in fractures of the mid-shaft. - It does not typically lead to long-term deformities at the elbow that would cause **delayed ulnar nerve compression**. *Fracture of the radial shaft* - Radial shaft fractures (e.g., Monteggia, Galeazzi) primarily affect the **radial nerve** or the **posterior interosseous nerve**. - They do not directly involve the elbow joint in a manner that would cause **tardy ulnar nerve palsy**.

Q: All of the following are features of juvenile CML except which of the following?

Philadelphia chromosome is positive. ***Philadelphia chromosome is positive*** - **Juvenile Chronic Myeloid Leukemia (JCML)**, now known as **Chronic Myelomonocytic Leukemia (CMML)** of childhood, is characterized by the **absence** of the **Philadelphia chromosome (Ph chromosome)**. - The Ph chromosome, a t(9;22)(q34;q11) translocation forming the **BCR-ABL1 fusion gene**, is the hallmark of adult Chronic Myeloid Leukemia (CML), but not JCML. *Thrombocytopenia* - **Thrombocytopenia** (low platelet count) is a common feature in JCML due to ineffective hematopoiesis and bone marrow infiltration. - This contrasts with adult CML, where **thrombocytosis** (high platelet count) is more characteristic of the chronic phase. *Fetal Hb is increased* - An **increased level of fetal hemoglobin (HbF)** is a characteristic laboratory finding in children with JCML. - This elevation is related to the dysregulated hematopoiesis and is a useful diagnostic marker. *Lymphadenopathy* - **Lymphadenopathy** (enlarged lymph nodes) is a frequent clinical manifestation in JCML, reflecting the widespread infiltration of monocytic cells. - This is part of the systemic involvement seen in this aggressive myeloproliferative disorder.

Q: What is the treatment of choice for a 5-year-old child with bedwetting?

Motivational therapy. ***Motivational therapy*** - This is the **first-line active treatment** for **primary nocturnal enuresis** in children, involving encouragement, positive reinforcement (star charts), rewards, and education about bladder control. - It focuses on **behavioral strategies** and can be highly effective with parental involvement. - When intervention is pursued at age 5, motivational therapy is preferred over pharmacological options due to safety and effectiveness. *No treatment* - At age 5, **watchful waiting with reassurance** is often appropriate since nocturnal enuresis is common at this age (affects 15-20% of 5-year-olds) and has a **spontaneous resolution rate of 15% per year**. - However, when the question asks for "treatment of choice," it implies active intervention rather than observation alone. - Active behavioral therapy is preferred when bedwetting causes distress or affects the child's self-esteem. *Imipramine* - **Imipramine** is a **tricyclic antidepressant** with anticholinergic effects that can reduce bladder contractions, but it has significant side effects including **cardiac arrhythmias** and is **not first-line treatment**. - It is typically reserved for children ≥7 years after behavioral interventions fail, due to its potential adverse effects and high relapse rate after discontinuation. *Desmopressin* - **Desmopressin** is an **antidiuretic hormone analog** that reduces urine production overnight. - While effective, it is typically reserved for children ≥6 years who are unresponsive to behavioral therapy or for **short-term situational use** (e.g., sleepovers, camps). - Side effects include potential **hyponatremia** and high relapse rate after discontinuation.

Q: What is the minimum weight gain recommended for a malnourished child during the catch-up growth phase of nutritional rehabilitation?

5 gm/kg/day. ***Correct: 5 gm/kg/day*** - According to **WHO guidelines** for management of severe acute malnutrition and **IAP recommendations**, the **minimum acceptable weight gain** during the catch-up growth phase is **5 gm/kg/day**. - This represents the **threshold for adequate nutritional rehabilitation** - gains below this indicate inadequate recovery and require reassessment of the feeding protocol. - Weight gain of 5 gm/kg/day or more indicates that the child is responding to treatment. *Incorrect: 10 gm/kg/day* - A weight gain of **10 gm/kg/day** represents **good/satisfactory catch-up growth**, not the minimum requirement. - This is considered an **optimal target** rather than the minimum acceptable threshold. - While desirable, the question specifically asks for the minimum recommendation, which is 5 gm/kg/day. *Incorrect: 15 gm/kg/day* - A weight gain of **15 gm/kg/day** reflects **excellent catch-up growth** and is at the higher end of optimal targets. - This exceeds both the minimum requirement and the good target. - While indicating very successful rehabilitation, it is not the minimum recommendation. *Incorrect: 20 gm/kg/day* - A weight gain of **20 gm/kg/day** is an **exceptionally high rate** rarely achieved in clinical practice. - While theoretically possible with intensive feeding protocols, this far exceeds the minimum requirement. - Such high rates may require monitoring for refeeding syndrome and metabolic complications.

Q: In children, which of the following is a key diagnostic sign of congestive heart failure (CHF)?

Hepatomegaly. ***Hepatomegaly*** - In children, **hepatomegaly** is a crucial indicator of **right-sided heart failure** due to congestion of the hepatic venous system. - The liver is a compressible organ and can accommodate a significant increase in blood volume, causing it to enlarge considerably before other signs of **venous congestion** become apparent. *Raised JVP* - **Raised jugular venous pressure (JVP)** is often difficult to assess reliably in infants and young children due to their short necks and uncooperative nature. - While present in older children with CHF, it is not considered as sensitive or specific as other signs in younger pediatric patients. *Pedal edema* - **Pedal edema** is less common in pediatric CHF compared to adults, particularly in infants and toddlers. - Their shorter hydrostatic columns and tendency to spend more time supine make dependent edema less prominent. *Basal crepitations* - **Basal crepitations** (rales) indicate **pulmonary edema**, which is a sign of **left-sided heart failure**. - While a part of CHF, **hepatomegaly** is a more consistent and often earlier sign that can be detected across different forms of pediatric CHF (right or left-sided).

Q: Treatment of simple febrile convulsion is based on

Control of fever. ***Control of fever*** - Among the given options, **control of fever** is the most appropriate answer as it represents the **immediate supportive care** for a child with a simple febrile seizure. - Management includes using antipyretics like **paracetamol** or **ibuprofen** to reduce fever and improve comfort. - **Important note:** While fever control is good supportive care, evidence shows that antipyretics do **NOT prevent recurrence** of febrile seizures. The actual cornerstone of management is **reassurance and parental education**. - According to AAP guidelines, simple febrile seizures are benign, self-limited events that require no specific anticonvulsant treatment. *Rectal diazepam* - **Rectal diazepam** is used for **acute termination** of prolonged seizures (>5 minutes) or as rescue therapy for recurrent episodes. - It is NOT indicated for routine management of simple febrile seizures, which typically last <15 minutes and resolve spontaneously. - May be prescribed for home use in select cases with recurrent seizures. *CSF finding* - **CSF analysis** is a **diagnostic procedure**, not a treatment basis. - It is indicated only when there is clinical suspicion of meningitis or meningoencephalitis (e.g., altered sensorium, meningeal signs, complex seizure features). - NOT routinely required for simple febrile seizures in well-appearing children. *Blood reports* - **Blood investigations** are diagnostic, not treatment-guiding for simple febrile seizures. - They may be considered to identify the source of fever or rule out electrolyte abnormalities, but are not the basis of seizure management itself. - Simple febrile seizures do not require routine laboratory workup.

Question 1

What is the first permanent tooth to erupt?

Accepted Answer

First molar

Answer

First premolar

Answer

Second premolar

Answer

Second molar

Question 2

Which of the following conditions is NOT associated with delayed dentition?

Accepted Answer

Cystic fibrosis

Answer

Down syndrome

Answer

Congenital hypothyroidism

Answer

Rickets

Question 3

What is the most common complication associated with carpal tunnel release surgery?

Accepted Answer

Finger stiffness

Answer

Malunion

Answer

Avascular necrosis

Answer

Rupture of EPL tendon

Question 4

Tardy ulnar nerve palsy is specifically associated with which type of fracture?

Accepted Answer

Lateral condyle fracture of the humerus

Answer

Medial condyle fracture of the humerus

Answer

Fracture of the humeral shaft

Answer

Fracture of the radial shaft

Question 5

All of the following are features of juvenile CML except which of the following?

Accepted Answer

Philadelphia chromosome is positive

Answer

Fetal Hb is increased

Answer

Lymphadenopathy

Answer

Thrombocytopenia

Question 6

What is the most common cerebellar tumor in children?

Accepted Answer

Medulloblastoma

Answer

Ependymoma

Answer

PNET

Answer

Astrocytoma

Question 7

What is the treatment of choice for a 5-year-old child with bedwetting?

Accepted Answer

Motivational therapy

Answer

No treatment

Answer

Imipramine

Answer

Desmopressin

Question 8

What is the minimum weight gain recommended for a malnourished child during the catch-up growth phase of nutritional rehabilitation?

Accepted Answer

5 gm/kg/day

Answer

10 gm/kg/day

Answer

15 gm/kg/day

Answer

20 gm/kg/day

Question 9

In children, which of the following is a key diagnostic sign of congestive heart failure (CHF)?

Accepted Answer

Hepatomegaly

Answer

Pedal edema

Answer

Raised JVP

Answer

Basal crepitations

Question 10

Treatment of simple febrile convulsion is based on

Accepted Answer

Control of fever

Answer

Rectal diazepam

Answer

CSF finding

Answer

Blood reports

NEET-PG 2012

Dental

Orthopaedics

Pathology

Pediatrics