Internal Medicine
2 questionsWhat condition is characterized by a short fourth metacarpal?
In which condition is a frozen pelvis commonly observed?
NEET-PG 2013 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 1231: 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.
Question 1232: 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.
Obstetrics and Gynecology
3 questionsAll are true about constriction rings except which of the following?
What is the preferred treatment option for a 21-year-old college girl with mild endometriosis?
Which of the following symptoms is least commonly associated with endometriosis?
NEET-PG 2013 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 1231: 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.
Question 1232: 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 1233: 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.
Orthopaedics
5 questionsWindswept deformity is seen in which condition?
Most common site of osteochondritis dissecans?
Which condition can lead to the formation of loose bodies in the joint?
What is the purpose of the Insall-Salvati index?
Halopelvic traction is primarily used for correcting which specific spinal deformity?
NEET-PG 2013 - Orthopaedics NEET-PG Practice Questions and MCQs
Question 1231: Windswept deformity is seen in which condition?
- A. Hyperparathyroidism
- B. Scurvy
- C. Rheumatoid Arthritis
- D. Rickets (Correct Answer)
Explanation: ***Rickets*** - **Windswept deformity** is characterized by bilateral knee deformities where one knee is in **valgus** and the other is in **varus**. - This condition is caused by a deficiency in **vitamin D**, **calcium**, or **phosphate**, leading to improper bone mineralization and subsequent bone deformities. *Rheumatoid Arthritis* - Rheumatoid arthritis is a **chronic autoimmune inflammatory disease** primarily affecting the synovial joints. - While it can cause joint deformities, they typically involve symmetric joint swelling, pain, and stiffness, with characteristic deformities like **ulnar deviation** or **swan-neck deformities**, rather than windswept deformity. *Hyperparathyroidism* - Hyperparathyroidism leads to excessive production of **parathyroid hormone**, which causes increased bone resorption and elevated blood calcium levels. - It can result in bone fragility, **osteitis fibrosa cystica**, and kidney stones, but it does not cause specific windswept deformity. *Scurvy* - Scurvy results from a severe deficiency of **vitamin C**, which is essential for collagen synthesis. - It presents with symptoms like bleeding gums, poor wound healing, and perifollicular hemorrhages, but it does not typically cause windswept deformity of the knees.
Question 1232: Most common site of osteochondritis dissecans?
- A. Lateral part of the medial femoral condyle (Correct Answer)
- B. Medial part of the medial femoral condyle
- C. Lateral part of the lateral femoral condyle
- D. Medial part of the lateral femoral condyle
Explanation: ***Lateral part of the medial femoral condyle*** - This is the **most common site** for osteochondritis dissecans in the knee, accounting for about 85% of cases. - The condition involves a localized area of **osteonecrosis and subchondral bone separation** from the epiphysis, typically afflicting this specific load-bearing region. *Medial part of the medial femoral condyle* - This location is **less common** for osteochondritis dissecans compared to the lateral aspect of the medial femoral condyle. - While osteochondral lesions can occur on any part of the condyle, the specific biomechanical stresses make the lateral part more susceptible. *Lateral part of the lateral femoral condyle* - Osteochondritis dissecans is **rarely found** in this location. - The lateral femoral condyle is generally less involved in osteochondritis dissecans of the knee. *Medial part of the lateral femoral condyle* - This site is also an **uncommon location** for osteochondritis dissecans. - The disease has a strong predilection for the medial femoral condyle, particularly its lateral aspect.
Question 1233: Which condition can lead to the formation of loose bodies in the joint?
- A. Rheumatoid arthritis
- B. Ankylosing spondylitis
- C. Osteoarthritis (Correct Answer)
- D. Systemic lupus erythematosus
Explanation: ***Osteoarthritis*** - In **osteoarthritis**, the **degenerative process** of cartilage can lead to fragments breaking off and floating within the joint space, forming **loose bodies**. - These loose bodies, also known as **joint mice**, can cause mechanical symptoms like locking, clicking, or catching in the joint. *Rheumatoid arthritis* - **Rheumatoid arthritis** is an **inflammatory autoimmune disease** primarily affecting the synovium. - While it can cause joint damage, it typically does not lead to the formation of cartilaginous or bony loose bodies. *Ankylosing spondylitis* - **Ankylosing spondylitis** is a **chronic inflammatory disease** primarily affecting the spine and sacroiliac joints. - Its hallmark is new bone formation and fusion of vertebrae, not the formation of loose bodies within the joint. *Systemic lupus erythematosus* - **Systemic lupus erythematosus (SLE)** is a systemic autoimmune disease that can affect multiple organs, including joints. - While it can cause **non-erosive arthritis**, it does not typically result in the formation of loose bodies.
Question 1234: 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**.
Question 1235: 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.