Obstetrics and Gynecology
4 questionsWhat is the definitive treatment for preeclampsia?
Which structure is least likely to be injured during common gynecological procedures?
In which scenario is the I-pill (emergency contraceptive) most appropriately used?
Which of the following statements about cholestasis of pregnancy is false?
NEET-PG 2012 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 971: What is the definitive treatment for preeclampsia?
- A. Delivery of the baby (Correct Answer)
- B. Use of antihypertensive medications
- C. Dietary modifications
- D. Increased rest and monitoring
Explanation: ***Delivery of the baby*** - **Preeclampsia** is a multisystem disorder of pregnancy; its pathogenesis is directly linked to the **placenta**. - **Removal of the placenta** through delivery is the only definitive cure for preeclampsia, leading to the resolution of symptoms. *Use of antihypertensive medications* - Antihypertensive medications are used to **manage blood pressure** in preeclampsia, preventing complications like stroke. - They **do not address the underlying cause** of the disease and are not a curative treatment. *Dietary modifications* - While a healthy diet is important during pregnancy, **dietary modifications** alone cannot resolve the pathological processes of preeclampsia. - There is **no specific diet** proven to cure or prevent preeclampsia. *Increased rest and monitoring* - **Increased rest and close monitoring** are supportive measures that can help manage symptoms and detect complications. - These interventions **do not reverse the disease process** and are not a definitive treatment.
Question 972: Which structure is least likely to be injured during common gynecological procedures?
- A. Ureter at pelvic brim
- B. Renal pelvis (Correct Answer)
- C. Urinary bladder
- D. Ureter at infundibulopelvic ligament
Explanation: ***Renal pelvis*** - The **renal pelvis** is anatomically distant from the surgical fields of most common gynecological procedures, making injury unlikely. - Its protected position deep within the abdominal cavity, surrounded by fat and muscle, generally shields it from inadvertent trauma during pelvic surgery. *Ureter at pelvic brim* - The **ureter** crosses the **pelvic brim**, an area often involved in gynecological dissections, especially during procedures like **pelvic lymphadenectomy** or management of large masses. - It is susceptible to injury during instrumentation or clamping in this region due to its close proximity to pelvic vessels. *Urinary bladder* - The **urinary bladder** is frequently in the surgical field during gynecological procedures, particularly those involving the anterior vaginal wall, cervix, or uterus (e.g., **hysterectomy**, **cystocele repair**). - Its thin wall and close proximity make it vulnerable to perforation, laceration, or thermal injury. *Ureter at infundibulopelvic ligament* - The **ureter** passes perilously close to the **infundibulopelvic ligament** (suspensory ligament of the ovary) as it enters the pelvis. - This area is frequently ligated or clamped during **oophorectomy** or adnexal mass removal, placing the ureter at high risk of kinking, ligation, or transection.
Question 973: In which scenario is the I-pill (emergency contraceptive) most appropriately used?
- A. When a contraceptive method fails
- B. After unprotected sexual intercourse
- C. As a regular contraceptive method
- D. In case of contraceptive failure or unprotected sex (Correct Answer)
Explanation: ***In case of contraceptive failure or unprotected sex*** - This is the **most comprehensive and appropriate answer** as it covers **both major indications** for emergency contraception. - The **I-pill (levonorgestrel)** is indicated when there has been unprotected intercourse OR when a contraceptive method has failed (e.g., condom breakage, missed pills, dislodged IUD). - It should be taken as soon as possible, ideally within **72 hours** of the event, though it can be used up to 120 hours with reduced efficacy. - This option correctly encompasses the full scope of emergency contraception use. *After unprotected sexual intercourse* - While this is a **valid indication**, it only covers one scenario and is not as comprehensive as the correct answer. - This option misses situations of contraceptive failure where intercourse was technically "protected" but the method failed. *When a contraceptive method fails* - This is also a **valid indication** but only covers contraceptive accidents (condom breakage, missed pills). - It excludes situations where no contraceptive was used at all. - Like the previous option, it is incomplete compared to the correct answer. *As a regular contraceptive method* - The I-pill is **not intended for routine contraception** due to higher hormone doses and lower efficacy compared to regular methods. - It has a higher side effect profile with frequent use and does not protect against sexually transmitted infections. - Emergency contraception should only be used occasionally in emergency situations.
Question 974: Which of the following statements about cholestasis of pregnancy is false?
- A. Bilirubin level >2mg%
- B. Most common cause of jaundice in pregnancy (Correct Answer)
- C. Oestrogen is involved
- D. Manifestations usually appear in last trimester
Explanation: ***Most common cause of jaundice in pregnancy*** - This statement is **FALSE** - while **intrahepatic cholestasis of pregnancy (ICP)** is the most common **pregnancy-specific** cause of jaundice, it is NOT the most common cause of jaundice overall in pregnancy. - **Viral hepatitis** (especially hepatitis A, B, and E) remains the **most common cause of jaundice in pregnancy** worldwide, accounting for approximately 40-50% of cases. - ICP accounts for about 20-25% of jaundice cases in pregnancy, making it the leading obstetric-specific cause but not the overall leading cause. *Bilirubin level >2mg%* - In ICP, **bilirubin levels** are typically **normal or only mildly elevated** (usually <4 mg/dL, often <2 mg/dL). - However, bilirubin **can exceed 2 mg/dL** in some cases of ICP, particularly in more severe presentations. - The primary diagnostic marker is elevated **serum bile acids** (>10 μmol/L), not bilirubin. *Oestrogen is involved* - **TRUE** - Elevated **estrogen and progesterone levels** during pregnancy play a key role in ICP pathophysiology. - These hormones affect **hepatic bile salt transporters** (particularly BSEP and MDR3), leading to impaired bile secretion in genetically susceptible individuals. *Manifestations usually appear in last trimester* - **TRUE** - ICP typically presents in the **third trimester** (usually after 28 weeks), with **pruritus** as the predominant symptom. - Symptoms resolve within days to weeks after delivery, correlating with declining hormone levels.
Orthopaedics
1 questionsMost common bone for which nailing is done
NEET-PG 2012 - Orthopaedics NEET-PG Practice Questions and MCQs
Question 971: Most common bone for which nailing is done
- A. Radius
- B. Ulna
- C. Tibia (Correct Answer)
- D. Humerus
Explanation: ***Tibia*** - The **tibia** is the most common long bone for which **intramedullary nailing** (IM nailing) is performed, particularly for fractures of the **tibial shaft**. - Its subcutaneous location and strong cortical bone make it amenable to this type of internal fixation, promoting stability and healing. *Radius* - Fractures of the **radius**, especially distal radial fractures, are more commonly treated with **plate and screw fixation** or external fixation, rather than intramedullary nailing. - While IM nailing can be used for some radial shaft fractures, it is not the most common bone for this procedure. *Ulna* - Like the radius, the **ulna** is less frequently fixed with intramedullary nails; **plate and screw fixation** is generally preferred for ulnar shaft fractures. - Its triangular cross-section and the presence of the interosseous membrane complicate IM nailing in some cases. *Humerus* - While **humeral shaft fractures** can be treated with intramedullary nailing, especially in comminuted or pathological fractures, it is overall less common than tibial nailing. - The risk of shoulder and elbow stiffness, as well as radial nerve injury, are considerations with humeral nailing.
Pharmacology
3 questionsWhich of the following is not a definite use for Prostaglandin E2 (PGE2)?
All of the following occurs because of prostaglandin use except?
What is the drug of choice for malaria in pregnancy?
NEET-PG 2012 - Pharmacology NEET-PG Practice Questions and MCQs
Question 971: Which of the following is not a definite use for Prostaglandin E2 (PGE2)?
- A. Induces labour
- B. Keeps patency of PDA (Correct Answer)
- C. Contraception
- D. Therapeutic abortion
Explanation: ***Keeps patency of PDA*** - **Prostaglandin E1 (PGE1)**, not PGE2, is used to maintain the patency of the **ductus arteriosus** in neonates with certain congenital heart defects. - PGE1 causes **vascular smooth muscle relaxation**, preventing closure of the ductus arteriosus. *Contraception* - **PGE2 analogs** are used in various forms of contraception, including emergency contraception and for cervical ripening before elective abortion. - They act by inducing **uterine contractions** and can interfere with implantation or facilitate expulsion of a fertilized egg. *Induces labour* - **PGE2 (dinoprostone)** is commonly used clinically to induce labor by promoting **cervical ripening** and stimulating **uterine contractions**. - It is administered as a vaginal gel or insert to prepare the cervix for delivery. *Therapeutic abortion* - **PGE2 analogs** are used to induce therapeutic abortion, particularly in the second trimester, by causing powerful **uterine contractions** that lead to the expulsion of the fetus. - They are often used in combination with other agents to enhance their efficacy.
Question 972: All of the following occurs because of prostaglandin use except?
- A. Increased motility of bowel
- B. Nausea
- C. Excess water retention (Correct Answer)
- D. Flushes
Explanation: ***Excess water retention*** - **Prostaglandins** generally promote **diuresis** and natriuresis, meaning they help the body excrete water and sodium, rather than retain them [2]. - While some prostaglandins can affect renal blood flow, direct causation of **excess water retention** as a primary side effect is not typical. *Flushes* - **Prostaglandins**, particularly **PGE1** and **PGE2**, are potent **vasodilators** and can cause cutaneous vasodilation, leading to **flushing** and a sensation of warmth [3]. - This effect is often mediated by the relaxation of vascular smooth muscle. *Increased motility of bowel* - Many **prostaglandins**, especially **PGE** and **PGF** series, stimulate **smooth muscle contraction**, including in the gastrointestinal tract [1]. - This increased contraction can lead to **enhanced bowel motility**, sometimes causing diarrhea or abdominal cramping [1]. *Nausea* - **Prostaglandins** can have various systemic effects, and activation of pathways in the central nervous system or direct irritation of the GI tract can lead to symptoms like **nausea** and vomiting [1]. - This is a common side effect, especially with systemic administration.
Question 973: What is the drug of choice for malaria in pregnancy?
- A. Primaquine
- B. Chloroquine (Correct Answer)
- C. Artesunate
- D. Quinine
Explanation: ***Chloroquine*** - **Chloroquine** is the drug of choice for **uncomplicated malaria in pregnancy** caused by **chloroquine-sensitive** strains of *P. vivax*, *P. ovale*, *P. malariae*, and *P. falciparum* [1]. - It has an **established safety profile** in pregnancy across all trimesters and is considered safe by WHO and CDC. - While resistance has emerged in many areas for *P. falciparum*, chloroquine remains effective for *P. vivax* malaria in most regions including India. - For **severe malaria** or **chloroquine-resistant falciparum malaria**, alternative regimens like quinine or artesunate are used [1]. *Quinine* - **Quinine** (usually with clindamycin) is the preferred treatment for **severe malaria** or **chloroquine-resistant *P. falciparum*** malaria in pregnancy, especially in the **first trimester**. - It is safe and effective but can cause side effects like **cinchonism** (tinnitus, headache, nausea) and **hypoglycemia**. - While safe throughout pregnancy, it is not the first-line choice for uncomplicated chloroquine-sensitive malaria. *Primaquine* - **Primaquine** is **contraindicated in pregnancy** because it can cause **hemolytic anemia** in individuals with **G6PD deficiency**, and G6PD status of the fetus cannot be determined [3]. - It is used for **radical cure** of *P. vivax* and *P. ovale* to eliminate liver hypnozoites, but must be deferred until after delivery [3]. *Artesunate* - **Artesunate** and other **artemisinin-based combination therapies (ACTs)** are highly effective antimalarials [2]. - Current WHO guidelines support ACT use in all trimesters for severe malaria when benefits outweigh risks. - For **uncomplicated falciparum malaria**, ACTs are preferred in the **second and third trimesters** in areas with chloroquine resistance [2]. - However, chloroquine remains the classical "drug of choice" for uncomplicated, chloroquine-sensitive malaria in pregnancy [1].
Radiology
1 questionsWhat is the most effective imaging method for the diagnosis of adenomyosis?
NEET-PG 2012 - Radiology NEET-PG Practice Questions and MCQs
Question 971: What is the most effective imaging method for the diagnosis of adenomyosis?
- A. CT scan
- B. Hysterosalpingography
- C. Ultrasound
- D. MRI (Correct Answer)
Explanation: ***MRI*** - **MRI** offers superior soft tissue contrast, allowing for detailed visualization of the **junctional zone** and **myometrial thickening** characteristic of adenomyosis. - It can effectively differentiate adenomyosis from other uterine pathologies like **leiomyomas**, due to its ability to detect **heterogeneous myometrial signal** and small myometrial cysts. *CT scan* - **CT scans** have limited utility in diagnosing adenomyosis due to their **poor soft tissue contrast** in evaluating diffuse uterine conditions. - They expose the patient to **ionizing radiation** and are generally reserved for detecting calcifications or larger structural abnormalities in the pelvis. *Ultrasound* - **Transvaginal ultrasound** is often the first-line imaging modality due to its accessibility and non-invasiveness, but its diagnostic accuracy for adenomyosis is **operator-dependent** and can be limited in subtle cases. - While it can suggest adenomyosis through findings like **globular uterus** or **heterogeneous myometrium**, it often lacks the resolution to definitively characterize the extent and nature of the lesion compared to MRI. *Hysterosalpingography* - **Hysterosalpingography** is primarily used to evaluate the patency of the **fallopian tubes** and the contour of the uterine cavity, making it unsuitable for direct visualization of myometrial pathology. - While it might show an **irregular uterine cavity** if adenomyosis is severe and extends to the endometrium, it cannot definitively diagnose or characterize the condition within the myometrium.
Surgery
1 questionsWhat is a felon or whitlow?
NEET-PG 2012 - Surgery NEET-PG Practice Questions and MCQs
Question 971: What is a felon or whitlow?
- A. Terminal pulp space infection (Correct Answer)
- B. Infection of the ulnar bursa
- C. Infection of the radial bursa
- D. Midpalmar space infection
Explanation: ***Terminal pulp space infection*** - A **felon**, also known as a **whitlow**, is a **closed-space infection** of the **digital pulp** of the fingertip, distal to the distal interphalangeal joint. - This area contains numerous fibrous septa that create multiple small compartments, which, when infected, can lead to increased pressure, severe pain, and potential **ischemic necrosis** of the bone. *Infection of the ulnar bursa* - An infection of the **ulnar bursa** involves the synovial sheath surrounding the flexor tendons of the medial three and a half digits, extending into the palm. - This condition is often referred to as **ulnar bursitis** or **tenosynovitis** and presents with distinct clinical signs, such as swelling in the palm and along the little finger, known as Kanavel's signs. *Infection of the radial bursa* - An infection of the **radial bursa** affects the synovial sheath around the flexor pollicis longus tendon of the thumb. - This condition is known as **radial bursitis** or **thenar space infection** and typically presents with swelling and tenderness confined to the thumb and thenar eminence. *Midpalmar space infection* - A **midpalmar space infection** occurs in the deep fascial space of the palm, located between the flexor tendons and the interosseous muscles. - This infection presents as diffuse swelling and tenderness in the central palm, often with pain on passive extension of the fingers, but does not involve the fingertip pulp directly.