Internal Medicine
2 questionsIn which condition is a frozen pelvis commonly observed?
What condition is characterized by a short fourth metacarpal?
NEET-PG 2013 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 1231: In which condition is a frozen pelvis commonly observed?
- A. Chronic pelvic inflammatory disease
- B. Severe endometriosis (Correct Answer)
- C. Post-radiation pelvic fibrosis
- D. Advanced cervical carcinoma
Explanation: ***Severe endometriosis*** - A **frozen pelvis** is a classic finding in severe endometriosis, characterized by extensive adhesions and fibrosis that fix pelvic organs together, making them immobile. - This condition involves the presence of **endometrial-like tissue** outside the uterus, leading to chronic inflammation, scarring, and adherence of structures like the uterus, ovaries, and bowel. *Advanced cervical carcinoma* - While advanced cervical carcinoma can cause widespread pelvic involvement and **fixation of organs**, the term "frozen pelvis" is not as commonly or specifically associated with it as it is with severe endometriosis. - The dominant findings would typically relate to the **tumor mass**, local invasion, and potential involvement of lymph nodes or distant metastasis. *Post-radiation pelvic fibrosis* - **Radiation therapy** can certainly lead to significant pelvic fibrosis and adhesions, restricting organ mobility. - However, this is largely an iatrogenic condition following cancer treatment, and while it may present similarly, the term "frozen pelvis" is primarily used in a descriptive fashion for the severe adhesion formations seen in endometriosis. *Chronic pelvic inflammatory disease* - Chronic PID can cause significant pelvic adhesions, tubo-ovarian abscesses, and scarring, leading to pain and infertility. - While it can result in fixed pelvic organs, the extent and specific nature of adhesion formation in PID generally differ from the diffuse, "frozen" quality seen in severe endometriosis, which often involves broader tissue planes.
Question 1232: What condition is characterized by a short fourth metacarpal?
- A. Primary Hyperparathyroidism
- B. Secondary Hyperparathyroidism
- C. Pseudohypoparathyroidism (Correct Answer)
- D. Scleroderma
Explanation: Pseudohypoparathyroidism - **Pseudohypoparathyroidism** is characterized by end-organ resistance to parathyroid hormone (PTH), leading to hypocalcemia and hyperphosphatemia [2, 4]. - Patients often present with **Albright's hereditary osteodystrophy**, which includes characteristic features like a **shortened fourth metacarpal**, short stature, rounded face, and obesity [2, 4]. *Primary Hyperparathyroidism* - **Primary hyperparathyroidism** involves excessive PTH production from an adenoma or hyperplasia of the parathyroid glands [1, 3, 5]. - This typically leads to **hypercalcemia** and **hypophosphatemia**, and does not involve a short fourth metacarpal as a characteristic feature [1, 3, 5]. *Secondary Hyperparathyroidism* - **Secondary hyperparathyroidism** occurs as a compensatory response to hypocalcemia, often due to chronic kidney disease or vitamin D deficiency [1]. - It’s characterized by elevated PTH levels alongside the underlying cause of hypocalcemia, without the classic skeletal deformities seen in pseudohypoparathyroidism [1, 4]. *Scleroderma* - **Scleroderma** is a chronic autoimmune disease characterized by thickening and hardening of the skin and connective tissues. - It can lead to various complications like Raynaud phenomenon and internal organ fibrosis, but a **short fourth metacarpal is not a feature** of this condition.
Obstetrics and Gynecology
6 questionsIn which stage of cervical carcinoma is surgery performed to retain the possibility of conception?
What is the primary hormonal cause of anovulatory dysfunctional uterine bleeding (DUB)?
USG of 28 weeks gestation showing oligohydramnios is likely to be due to?
Which of the following symptoms is least commonly associated with endometriosis?
What is the preferred treatment option for a 21-year-old college girl with mild endometriosis?
All are true about constriction rings except which of the following?
NEET-PG 2013 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 1231: In which stage of cervical carcinoma is surgery performed to retain the possibility of conception?
- A. Stage 1B1 (Correct Answer)
- B. Stage 1B2
- C. Stage 2A
- D. Stage 2B
Explanation: ***Stage 1B1*** - In **Stage 1B1 cervical carcinoma** (FIGO 2018), the tumor size is **≤2 cm** and confined to the cervix, making it amenable to **fertility-sparing surgery** like radical trachelectomy. - This stage allows for removal of the cervix and parametrium while preserving the **uterine body** and ovaries, thus retaining the possibility of conception. - Strict selection criteria must be met including tumor size ≤2 cm, no lymphovascular space invasion, negative lymph nodes, and adequate follow-up compliance. *Stage 1B2* - **Stage 1B2** (FIGO 2018) involves tumors **>2 cm to ≤4 cm** but still confined to the cervix, which generally have a higher risk of recurrence and lymph node metastasis. - While fertility-sparing surgery might be considered in highly selective cases with tumors 2-3 cm, it is much less commonly performed than in Stage 1B1 due to the increased tumor burden and higher oncological risk. *Stage 2A* - In **Stage 2A cervical carcinoma**, the tumor has spread beyond the cervix to involve the upper two-thirds of the vagina (2A1: ≤4 cm, 2A2: >4 cm) but not the parametrium. - The disease extent typically necessitates more aggressive treatment such as radical hysterectomy or **chemoradiation**, precluding preservation of fertility in most cases. *Stage 2B* - **Stage 2B** involves tumor invasion into the **parametrium**, making fertility-sparing surgery contraindicated and typically requiring **definitive chemoradiation**. - The spread of cancer to the parametrium indicates a more advanced disease that cannot be adequately treated by methods that preserve fertility.
Question 1232: What is the primary hormonal cause of anovulatory dysfunctional uterine bleeding (DUB)?
- A. Insufficient progesterone due to anovulation (Correct Answer)
- B. Excess estrogen production from ovarian follicles
- C. Hypothalamic dysfunction affecting ovulation
- D. High levels of progesterone due to luteal phase defect
Explanation: ***Insufficient progesterone due to anovulation*** - Anovulation prevents the formation of a **corpus luteum**, which is responsible for producing progesterone. - The lack of progesterone leads to an **unstable, proliferative endometrium** that eventually sheds irregularly, causing abnormal uterine bleeding. - This is the **primary hormonal defect** in anovulatory DUB. *Excess estrogen production from ovarian follicles* - While **unopposed estrogen** is present in anovulatory cycles, the primary issue is the *absence of progesterone*, not necessarily excess estrogen production. - Estrogen levels may be normal or even low, but without progesterone to stabilize the endometrium, irregular shedding occurs. - Excess estrogen primarily leads to **endometrial hyperplasia** rather than irregular bleeding. *Hypothalamic dysfunction affecting ovulation* - Hypothalamic dysfunction (e.g., due to stress, extreme exercise) can be an *underlying cause* of anovulation. - However, the *primary hormonal mechanism* of the bleeding itself is the subsequent lack of progesterone, not the hypothalamic dysfunction directly. *High levels of progesterone due to luteal phase defect* - A **luteal phase defect** involves *insufficient* progesterone production or response, not high levels. - High progesterone levels would stabilize the endometrium and promote regular shedding, preventing DUB.
Question 1233: USG of 28 weeks gestation showing oligohydramnios is likely to be due to?
- A. Renal pathway obstruction (Correct Answer)
- B. Neuromuscular disorder
- C. Gastrointestinal obstruction
- D. Anencephaly
Explanation: ***Renal pathway obstruction*** - **Oligohydramnios** (low amniotic fluid) in the late second or third trimester is often caused by conditions that impair fetal urine production or outflow. - **Renal pathway obstruction** (e.g., posterior urethral valves, bilateral renal agenesis) prevents the fetus from producing or excreting sufficient urine, a primary source of amniotic fluid. *Gastrointestinal obstruction* - **Gastrointestinal obstruction** is more commonly associated with **polyhydramnios** because it impairs the fetal swallowing of amniotic fluid. - Inability to swallow leads to an *accumulation* of amniotic fluid, not a reduction. *Anencephaly* - **Anencephaly** is typically associated with **polyhydramnios** due to impaired swallowing of amniotic fluid. - The exposed brain tissue can also lead to increased fluid transudation. *Neuromuscular disorder* - **Neuromuscular disorders** can cause **polyhydramnios** if they lead to impaired fetal swallowing due to muscle weakness. - If a neuromuscular disorder affects the renal system, it could potentially cause oligohydramnios, but it is not the primary cause of oligohydramnios itself.
Question 1234: Which of the following symptoms is least commonly associated with endometriosis?
- A. Vaginal discharge (Correct Answer)
- B. Infertility
- C. Chronic pelvic pain
- D. Dyspareunia
Explanation: ***Vaginal discharge*** - **Vaginal discharge** is a symptom more commonly associated with **infections or cervical issues**, rather than endometriosis. - While women with endometriosis may experience occasional discharge, it is **not a primary or characteristic symptom** of the condition itself. *Infertility* - **Infertility** is a very common issue for women with endometriosis, affecting their ability to conceive due to **inflammation, scarring, and anatomical distortion** of reproductive organs. - Endometrial implants can **disrupt ovarian function**, block fallopian tubes, and create a hostile uterine environment. *Chronic pelvic pain* - **Chronic pelvic pain** is the hallmark symptom of endometriosis, often severe and debilitating. - It results from the **inflammation, adhesions, and nerve sensitization** caused by ectopic endometrial tissue growing outside the uterus. *Dyspareunia* - **Dyspareunia**, or **painful intercourse**, is frequently experienced by women with endometriosis. - This symptom typically occurs when endometrial implants are located on the **uterosacral ligaments, posterior cul-de-sac, or rectovaginal septum**, leading to irritation during deep penetration.
Question 1235: What is the preferred treatment option for a 21-year-old college girl with mild endometriosis?
- A. Cyclical OC pill
- B. Continuous OC pill (Correct Answer)
- C. Progesterone only pill
- D. Danazole
Explanation: ***Continuous OC pill*** - For **mild endometriosis** in a young woman, **continuous oral contraceptive pills (OCP)** are the **first-line medical treatment** according to current evidence-based guidelines (ACOG, ESHRE). - Continuous OCP use provides better suppression of endometriosis by creating a **stable hormonal environment** that prevents cyclic menstrual bleeding and retrograde menstruation, which can worsen endometriosis. - This approach effectively manages symptoms like **dysmenorrhea** and **pelvic pain** while preserving future fertility, and is well-tolerated in young women with the added benefit of menstrual suppression. *Cyclical OC pill* - While cyclical OCPs can help manage endometriosis symptoms, they are **less effective** than continuous OCPs because they allow withdrawal bleeding, which may perpetuate retrograde menstruation and endometrial implant stimulation. - Cyclical OCPs may still provide symptom relief but are considered a **second-line option** when continuous use is not acceptable to the patient. *Progesterone only pill* - **Progesterone-only pills (POP)** can suppress endometriosis by inducing amenorrhea and decidualization of endometrial implants, but they may cause **irregular bleeding patterns**, especially in the first few months. - While effective, they are generally considered when combined OCPs are contraindicated (e.g., migraine with aura, thrombotic risk) rather than as first-line for uncomplicated mild endometriosis. *Danazole* - **Danazol** is an androgenic agent that creates a hypoestrogenic environment, leading to atrophy of endometrial tissue, but it is **rarely used today** due to significant androgenic side effects. - Common side effects include **acne**, **hirsutism**, **weight gain**, and **voice deepening**, which are often unacceptable for a 21-year-old woman, making it an obsolete option for first-line management of mild endometriosis.
Question 1236: All are true about constriction rings except which of the following?
- A. Can be caused by excessive use of oxytocin.
- B. Also known as Schroeder's ring. (Correct Answer)
- C. Ring can be palpated per abdomen
- D. Inhalation of amyl nitrate can relax the ring.
Explanation: ***Also known as Schroeder's ring.*** - This statement is **INCORRECT** and is the correct answer to this "except" question. - **Schroeder's ring** is NOT synonymous with constriction rings. Schroeder's ring is a **physiological retraction ring** at the junction of the upper and lower uterine segments, which is a normal finding. - **Constriction rings** are **pathological, localized spastic contractions** of the uterine muscle at any level, causing obstruction to fetal descent. They differ from Bandl's pathological retraction ring. *Can be caused by excessive use of oxytocin.* - **Excessive oxytocin** can lead to **uterine hyperstimulation** and **incoordinate uterine contractions**, which may result in the formation of constriction rings. - This is a known iatrogenic cause of pathological constriction rings during labor. *Ring can be palpated per abdomen* - **Constriction rings** can sometimes be palpated as a **depression or groove** on the uterine surface during abdominal examination when they are well-developed. - They present as localized areas of myometrial spasm that may be clinically detectable. *Inhalation of amyl nitrate can relax the ring.* - **Amyl nitrite** (or amyl nitrate) is a **smooth muscle relaxant** that can be used to relax uterine constriction rings. - It acts as a **vasodilator** and **uterine relaxant**, temporarily relieving the spastic contraction to facilitate delivery or manual manipulation.
Orthopaedics
2 questionsHalopelvic traction is primarily used for correcting which specific spinal deformity?
What is the purpose of the Insall-Salvati index?
NEET-PG 2013 - Orthopaedics NEET-PG Practice Questions and MCQs
Question 1231: Halopelvic traction is primarily used for correcting which specific spinal deformity?
- A. Kyphosis (Correct Answer)
- B. Spondylolisthesis
- C. Scoliosis
- D. Spinal stenosis
Explanation: **Kyphosis** * **Halopelvic traction** is a technique specifically designed to apply sustained corrective forces to the spine, making it particularly effective in treating severe **kyphosis**, especially in young patients prior to surgical correction. * It aids in gradually stretching soft tissues and straightening the spinal curvature over time, often used in cases of congenital or severe developmental kyphosis. *Scoliosis* * While traction can be used in some spinal deformities, **scoliosis** (lateral curvature) is more commonly treated with **bracing** or **surgical fusion**, as halopelvic traction is less effective in correcting the rotational component. * Correction of scoliotic curves typically involves forces applied in multiple planes, which halopelvic traction is not ideally suited for. *Spondylolisthesis* * **Spondylolisthesis** involves the **slippage of one vertebra over another**, which is primarily managed through **stabilization** to prevent further slippage. * Halopelvic traction is not indicated as it could potentially exacerbate instability in the presence of vertebral slippage. *Spinal stenosis* * **Spinal stenosis** refers to the **narrowing of the spinal canal**, which compresses nerves and is usually treated with **decompressive surgery** or **conservative management** for pain relief. * Traction methods are generally not used for spinal stenosis as they do not address the underlying anatomical narrowing and may worsen symptoms.
Question 1232: What is the purpose of the Insall-Salvati index?
- A. To measure ankle dorsiflexion range
- B. To assess patellar height and tendon length ratio (Correct Answer)
- C. To evaluate elbow joint stability
- D. To assess wrist bone alignment
Explanation: ***To assess patellar height and tendon length ratio*** - The **Insall-Salvati index** is a radiographic measurement used to determine **patellar height** by comparing the length of the patellar tendon to the greatest diagonal length of the patella. - It helps in diagnosing conditions like **patella alta** (high-riding patella) or **patella baja** (low-riding patella), which can contribute to knee pain and instability. *To evaluate elbow joint stability* - **Elbow joint stability** is typically assessed through clinical examination for ligamentous integrity (e.g., UCL, RCL) and sometimes dynamic imaging, not by the Insall-Salvati index. - The Insall-Salvati index is specific to the **knee joint** and **patellar position**. *To measure ankle dorsiflexion range* - **Ankle dorsiflexion range** is measured clinically using a goniometer or in 3D motion analysis, not with the Insall-Salvati index. - This index is a specialized measurement for the **patellofemoral joint**. *To assess wrist bone alignment* - **Wrist bone alignment** is evaluated using various radiographic measurements such as the scaphoid-lunate angle or carpal height ratio. - The Insall-Salvati index has no application in the assessment of the **wrist**.