NEET-PG 2013 Practice Questions

Q: Inhalational agent of choice for neurosurgery?

Isoflurane. ***Isoflurane*** - **Isoflurane** is preferred in neurosurgery due to its minimal impact on **cerebral blood flow** and **intracranial pressure (ICP)**, allowing cerebral autoregulation to be largely preserved. - It maintains **cerebral perfusion pressure** well and has a relatively fast onset and offset, facilitating neurological assessment post-operatively. *Halothane* - **Halothane** significantly increases **cerebral blood flow** and **intracranial pressure (ICP)**, which is undesirable in neurosurgical patients. - Its slow elimination can prolong recovery and neurological assessment, making it unsuitable for neurosurgery. *Enflurane* - **Enflurane** can cause central nervous system excitation and has been associated with **seizure activity** at higher concentrations, making it contraindicated in neurosurgical procedures. - Like halothane, it can also increase **cerebral blood flow** and **intracranial pressure**. *N2O* - **Nitrous oxide (N2O)** should be avoided in neurosurgery, especially if there's a risk of **intracranial air** or **pneumocephalus**, as it can expand air-filled spaces and increase ICP. - It also has a weak anesthetic effect and is often combined with other agents, but its cerebral vasodilatory properties can still be problematic.

Q: What is the treatment of choice for lichen planus?

Topical corticosteroids. ***Topical corticosteroids*** - **Topical corticosteroids** are the first-line treatment for localized lichen planus due to their potent **anti-inflammatory** and **immunosuppressive** effects. - They effectively reduce **itching**, **inflammation**, and the characteristic **violaceous papules** of lichen planus. *Systemic corticosteroids* - **Systemic corticosteroids** are typically reserved for widespread, severe, or refractory cases of lichen planus, not as initial treatment. - Their use is limited by potential **systemic side effects**, such as **osteoporosis**, **hypertension**, and **diabetes**. *Antihistamines* - **Antihistamines** primarily target **itching** (pruritus) associated with lichen planus but do not address the underlying **inflammatory process** or resolve the skin lesions themselves. - They may be used as an adjunct for symptomatic relief, especially for nocturnal pruritus. *Acitretin* - **Acitretin** is a **retinoid** used for severe or refractory cases of lichen planus (including erosive, oral, and hypertrophic variants), but not as first-line treatment for localized cutaneous disease. - It carries significant **teratogenic risks** and other side effects, making it unsuitable as initial therapy when topical corticosteroids are effective.

Q: What condition is characterized by a short fourth metacarpal?

Pseudohypoparathyroidism. 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.

Q: In which condition is a frozen pelvis commonly observed?

Severe endometriosis. ***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.

Q: What percentage of women typically deliver on their Estimated Due Date (EDD)?

5%. ***5%*** - Only about **5% of women** deliver on their **exact Estimated Due Date (EDD)**. - The EDD is calculated using **Naegele's rule** (280 days from LMP) and serves as an **approximation** rather than a precise prediction. - Most women deliver within a **37-42 week window**, with the majority occurring in the **2 weeks before or after** the EDD. - This reflects the **natural biological variation** in pregnancy duration. *10%* - This percentage is **higher than the actual rate** of delivery on the exact EDD. - While 10% might seem plausible for deliveries within a few days of the EDD, it overestimates delivery on that specific date. *15%* - This percentage **significantly overestimates** the likelihood of delivering precisely on the EDD. - The probability of birth on one specific day out of a several-week delivery window is relatively low. *20%* - This is a substantial **overestimation** of the probability of delivering on the EDD. - The EDD represents a **single day** in a term pregnancy window (37-42 weeks), making such a high percentage statistically unlikely.

Q: Which type of fistula can present with both normal urinary voiding and continuous urine leakage simultaneously?

Ureterovaginal Fistula. ***Ureterovaginal Fistula*** - With a **ureterovaginal fistula**, urine can still flow from the bladder through the urethra, allowing for **normal voiding**. - Simultaneously, urine directly bypasses the bladder from the ureter into the vagina, causing **continuous leakage** independent of bladder function. *Vesicovaginal Fistula* - A **vesicovaginal fistula** typically leads to continuous urine leakage through the vagina because the bladder contents directly escape. - This often results in **no normal voiding** or significantly reduced voiding as urine does not accumulate in the bladder. *Urethrovaginal Fistula* - A **urethrovaginal fistula** connects the urethra directly to the vagina. - This usually results in **urine leakage during voiding** or when pressure is exerted, rather than continuous leakage with normal bladder emptying. *Vesicoperitoneal Fistula* - A **vesicoperitoneal fistula** involves leakage of urine from the bladder into the peritoneal cavity. - This condition presents with **ascites** and abdominal signs, not vaginal leakage or normal voiding combined with continuous leakage.

Q: What is considered a poor prognostic indicator in Pott's paraplegia?

Rapid progression of neurological deficits. ***Rapid progression of neurological deficits*** - **Rapid progression** implies severe spinal cord damage occurring quickly, which is less likely to fully recover even with treatment. - This indicates a more aggressive disease process or significant compression that can lead to irreversible neurological impairment. *Healed disease* - **Healed disease** (even if paraplegia existed previously) indicates that the infection is resolved and the destructive process has stopped, allowing for potential neurological recovery or stability. - While residual neurological deficits might remain, the absence of active inflammation improves the long-term prognosis compared to ongoing damage. *Chronic disease* - **Chronic disease** in the context of Pott's paraplegia often refers to established deficits after a prolonged course, but it doesn't necessarily imply ongoing active deterioration. - The chronicity itself, without rapid progression, suggests a more stable state where the damage has already occurred, and further deterioration might be slow or absent. *Active disease* - **Active disease** means the infection is still present and causing bone destruction, which is a concern. - However, if the neurological deficits are not rapidly progressing, there is still a window for treatment to stop the disease and potentially allow for some recovery, distinguishing it from an acute, rapidly deteriorating situation.

Q: All are features of Paget's disease except which of the following?

Affects only axial skeleton. ***Affects only axial skeleton*** - This statement is **FALSE** and therefore the correct answer to this "EXCEPT" question. - Paget's disease **can affect any bone in the body**, including both axial skeleton (spine, skull, pelvis) and appendicular skeleton (femur, tibia, humerus) [1]. - Common sites include: **pelvis (70%), spine, skull, femur, and tibia** [1]. - While it frequently affects axial bones, it is **not exclusive** to them. *Defect in osteoclasts* - This is a TRUE feature of Paget's disease. - The disease is characterized by **abnormal, hyperactive osteoclasts** with increased number of nuclei (up to 100 vs normal 3-5). - These osteoclasts show **excessive bone resorption activity** followed by disorganized bone formation [1]. - The primary defect involves **increased osteoclast activity and sensitivity to RANKL**. *Can lead to hearing loss* - This is a TRUE feature of Paget's disease. - Skull involvement can lead to **compression of cranial nerve VIII** (vestibulocochlear nerve) [1]. - Enlargement and disorganization of temporal bone can cause **conductive or sensorineural hearing loss**. - Occurs in approximately 30-50% of patients with skull involvement. *Can lead to bone cancer* - This is a TRUE feature of Paget's disease. - **Osteosarcoma** develops in approximately **1%** of Paget's disease patients. - Risk is higher in patients with **polyostotic disease** and long-standing involvement. - This is a rare but serious complication with poor prognosis. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1192-1194.

Q: Which imaging modality delivers the highest dose of radiation?

Cardiac perfusion scan. ***Cardiac perfusion scan*** - A **cardiac perfusion scan (nuclear cardiology)** involves the administration of a radioactive tracer, and the radiation dose can be significant due to the nature and energy of the isotopes used. - While varying, the effective dose for these scans can range from **10 to 30 mSv**, placing it among some of the highest radiation exposures from medical imaging. *CT scan of the chest* - A **CT scan of the chest** provides a relatively high radiation dose compared to plain X-rays, typically ranging from **5 to 7 mSv**. - This is generally lower than some nuclear medicine studies, particularly complex or prolonged cardiac perfusion scans. *Mammogram* - A **mammogram** involves a relatively low dose of radiation, typically in the range of **0.2 to 0.7 mSv**. - Its objective is to image the breast tissue with minimal exposure, making it one of the lower-dose imaging modalities available. *CT scan of the brain* - A **CT scan of the brain** usually delivers a moderate radiation dose, estimated to be around **1 to 2 mSv**. - This is often less than a chest CT due to the smaller volume and different shielding considerations, and significantly less than a cardiac perfusion scan.

Question 1

Inhalational agent of choice for neurosurgery?

Accepted Answer

Isoflurane

Answer

Halothane

Answer

Enflurane

Answer

N2O

Question 2

Acantholysis is not seen in:

Accepted Answer

Lichen planus

Answer

Dermatitis herpetiformis

Answer

Hailey-Hailey disease

Answer

Bullous pemphigoid

Question 3

What is the treatment of choice for lichen planus?

Accepted Answer

Topical corticosteroids

Answer

Systemic corticosteroids

Answer

Antihistamines

Answer

Acitretin

Question 4

What condition is characterized by a short fourth metacarpal?

Accepted Answer

Pseudohypoparathyroidism

Answer

Primary Hyperparathyroidism

Answer

Secondary Hyperparathyroidism

Answer

Scleroderma

Question 5

In which condition is a frozen pelvis commonly observed?

Accepted Answer

Severe endometriosis

Answer

Chronic pelvic inflammatory disease

Answer

Post-radiation pelvic fibrosis

Answer

Advanced cervical carcinoma

Question 6

What percentage of women typically deliver on their Estimated Due Date (EDD)?

Accepted Answer

5%

Answer

15%

Answer

20%

Answer

10%

Question 7

Which type of fistula can present with both normal urinary voiding and continuous urine leakage simultaneously?

Accepted Answer

Ureterovaginal Fistula

Answer

Vesicovaginal Fistula

Answer

Vesicoperitoneal Fistula

Answer

Urethrovaginal Fistula

Question 8

What is considered a poor prognostic indicator in Pott's paraplegia?

Accepted Answer

Rapid progression of neurological deficits

Answer

Healed disease

Answer

Chronic disease

Answer

Active disease

Question 9

All are features of Paget's disease except which of the following?

Accepted Answer

Affects only axial skeleton

Answer

Defect in osteoclasts

Answer

Can lead to hearing loss

Answer

Can lead to bone cancer

Question 10

Which imaging modality delivers the highest dose of radiation?

Accepted Answer

Cardiac perfusion scan

Answer

CT scan of the chest

Answer

Mammogram

Answer

CT scan of the brain

NEET-PG 2013

Anesthesiology

Dermatology

Internal Medicine

Obstetrics and Gynecology

Orthopaedics

Pathology

Radiology