NEET-PG 2013 Practice Questions

Q: All are common sites of primary cancer for bone metastasis except:

Brain. ***Brain*** - The **brain** is not a common site for primary bone metastasis, as bone metastases typically originate from organs like the **breast**, **lung**, and **prostate**. - While brain tumors can metastasize to bone, the reverse (primary bone cancer) occurring here is rare. *Breast* - Breast cancer is one of the **most prevalent sources** of bone metastases, commonly affecting the spine and pelvis. - Symptoms often include **bone pain** and potential fractures due to metastasis. *Brain* - Similar to , while brain tumors can metastasize, **primary cancers** do not commonly originate in the bone. - The **metastatic spread** to the brain from other primary sites is common, but not the other way around. *Breast* - Again, breast cancer commonly leads to **bone metastasis**, accounting for a significant percentage of these cases. - It is important to identify busy metastasis to **manage** symptoms and improve patient outcomes.

Q: What will the aspirated synovial fluid in a case of septic arthritis typically show?

Markedly increased polymorphonuclear leukocytes. ***Markedly increased polymorphonuclear leukocytes*** - **Septic arthritis** is characterized by an acute infection within the joint, leading to a profound inflammatory response with a significant influx of **neutrophils** (polymorphonuclear leukocytes) into the synovial fluid. - A synovial leukocyte count greater than **50,000 cells/mm³** with over **75% neutrophils** is highly suggestive of septic arthritis. *Clear and straw-colored fluid* - This description typically corresponds to **normal synovial fluid** or fluid from a mild **non-inflammatory condition**, which is not consistent with bacterial infection. - Normal synovial fluid is usually **transparent**, indicating the absence of significant cellular debris or inflammatory cells. *Low viscosity fluid* - While septic synovial fluid can have reduced viscosity due to the breakdown of **hyaluronic acid** by bacterial enzymes and inflammatory mediators, this characteristic alone is not the most definitive diagnostic feature. - Reduced viscosity is also observed in other inflammatory conditions, making it less specific than direct cellular analysis for diagnosing infection. *Cloudy or purulent fluid* - The presence of **cloudy** or **purulent (pus-like)** fluid *is* often seen in septic arthritis, reflecting the high cell count and protein content. - However, this is a **gross visual observation**, and a more precise and diagnostic indicator is the microscopic finding of markedly increased **polymorphonuclear leukocytes**.

Q: What is Hegar's sign in obstetrics?

Softening of the uterine isthmus. ***Softening of the uterine isthmus*** - **Hegar's sign** is an early presumptive sign of pregnancy characterized by the **softening of the lower uterine segment (isthmus)**, which can be palpated during a bimanual examination. - This softening makes the fundus and cervix feel like separate entities, indicating increased vascularity and changes due to hormonal influence. *Uterine contractions* - While contractions do occur during pregnancy (e.g., **Braxton Hicks contractions**), they are not what defines Hegar's sign. - **Uterine contractions** are typically associated with labor or placental abruption, not the specific softening of the isthmus. *Fetal movement* - **Fetal movement** (quickening) is a positive sign of pregnancy perceived by the mother, usually after 16-20 weeks gestation. - This is entirely distinct from Hegar's sign, which is a physical finding upon examination of the uterus. *Cyanosis of the vagina* - **Cyanosis of the vagina** and cervix is known as **Chadwick's sign**, another presumptive sign of pregnancy. - Chadwick's sign is due to increased vascularity and venous congestion, causing a bluish discoloration, but it's not the softening described in Hegar's sign.

Q: What percentage of ectopic pregnancies occur in the fallopian tube?

90%. ***90%*** - Approximately **90-95%** of all ectopic pregnancies occur within the fallopian tube, making it the most common site. - The **ampulla** is the most frequent tubal site, accounting for about 80% of tubal ectopics, followed by the isthmus and fimbrial end. *75%* - While a significant percentage, **75%** falls short of the actual prevalence of tubal ectopic pregnancies. - This percentage does not accurately reflect the high frequency of implantation within the fallopian tube. *80%* - **80%** is a common statistic for ectopic pregnancies occurring in the **ampulla** specifically, which is a segment of the fallopian tube. - However, the overall percentage for all fallopian tube locations is higher than 80%. *67%* - **67%** is too low and does not represent the vast majority of ectopic pregnancies that are found within the fallopian tube. - Such a low percentage would imply a higher incidence of ectopic pregnancies in other locations (e.g., ovary, cervix, abdomen), which is not the case.

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: How is Brodie's abscess classified?

Chronic osteomyelitis (Brodie's abscess). ***Chronic osteomyelitis (Brodie's abscess)*** - Brodie's abscess is a **subacute or chronic localized osteomyelitis**, characterized by an intraosseous abscess often surrounded by a thick layer of sclerotic bone. - It represents a **contained infection** within the bone, lacking the widespread inflammatory response seen in acute forms. *Acute osteomyelitis* - Characterized by a **rapid onset** of severe pain, fever, and inflammation, usually within days to weeks of infection. - It involves a **widespread inflammatory process** and potential for bone destruction, differentiated from the contained and indolent nature of Brodie's abscess. *Subacute osteomyelitis* - This term describes an osteomyelitis with a more gradual onset and less severe symptoms than acute osteomyelitis, typically lasting several weeks to a few months. - While Brodie's abscess can present subacutely, it is specifically classified as a **form of chronic osteomyelitis** due to its localized, walled-off nature and prolonged course. *Septic arthritis* - Involves an infection within a **joint space**, leading to inflammation and destruction of articular cartilage. - It is distinct from Brodie's abscess, which is an infection of the **bone tissue itself**, not the joint.

Q: What is the most common malignant tumor of the skeletal system?

Metastasis. ***Metastasis*** - **Skeletal metastasis** is overwhelmingly the most common malignant tumor involving bone, as many primary cancers (e.g., breast, prostate, lung) frequently spread to bone [1]. - While not originating in the bone, these metastatic deposits are malignant neoplasms within the skeletal system, making them the most prevalent. *Multiple myeloma* - This is a **primary malignancy of plasma cells** that arises in the bone marrow, causing destructive bone lesions. - It is the most common **primary malignant bone tumor** in adults, but still less common than metastatic disease. *Osteosarcoma* - This is the most common **primary malignant bone tumor** in **children and adolescents**, primarily affecting long bones [2]. - While a significant primary bone cancer, its incidence is lower than that of metastatic bone disease across all age groups [1]. *Chondrosarcoma* - This is a malignant tumor of **cartilage-forming cells** and is the second most common primary bone cancer in adults, after multiple myeloma [3]. - It is much less common than metastatic disease and osteosarcoma [1], [3]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 671-672. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, p. 1202. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, p. 1204.

Q: Which of the following statements about chronic osteomyelitis is false?

Involucrum is dead bone. ***Involucrum is dead bone*** - This statement is false because the **involucrum** is the layer of **new bone formation** that surrounds a segment of necrotic (dead) bone, known as the **sequestrum**, in chronic osteomyelitis [1]. - The involucrum represents the body's attempt to wall off the infection and dead bone, and thus, it is living, *reactive bone*, not dead bone [1]. *Reactive new bone formation* - This statement is true; **reactive new bone formation** occurs around infected or necrotic bone in chronic osteomyelitis, forming the **involucrum** [1]. - This process is a hallmark of the body's response to chronic infection and attempts to contain it. *Cloaca is an opening in involucrum* - This statement is true; a **cloaca** is a **fistulous tract** or opening in the **involucrum** that allows pus and necrotic debris from the infected area to drain to the skin surface. - This drainage is a common clinical sign of chronic osteomyelitis. *Sequestrum is hard and dense* - This statement is true; the **sequestrum** is a piece of **necrotic (dead) bone** that has become separated from living bone due to ischemia and infection [1]. - Due to the loss of blood supply and avascular necrosis, it appears **dense, hard, and radiodense** on imaging, representing devitalized bone tissue that is walled off from the body's immune response. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1197-1198.

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 condition is characterized by a 'moth-eaten' appearance of the bones?

Multiple myeloma. ***Multiple myeloma*** [1][2] - Characterized by **punched-out lytic lesions** in bones, often described as **moth-eaten** appearance on imaging [1]. - Associated with **elevated serum proteins** and **Bence Jones proteins** in urine, confirming the diagnosis [2]. *Eosinophilic granuloma* - Usually presents with **solitary bone lesions** and is linked to **Langerhans cell histiocytosis** rather than the moth-eaten pattern. - Does not typically cause generalized **lytic bone lesions** seen in cases of multiple myeloma. *Chondromyxoid fibroma* - Generally appears as a **well-defined cortical lesion** and is not associated with a moth-eaten appearance. - It predominantly affects the **metaphysis** of long bones and shows a characteristic **cartilaginous matrix**. *Osteoid osteoma* - Presents with a **nidus** of osteoid formation, leading to localized bone pain, and does not exhibit a moth-eaten consistency. - Tends to cause **cortical bone thickening** rather than the diffuse lytic lesions associated with multiple myeloma. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, p. 608. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 616-617.

Question 1

All are common sites of primary cancer for bone metastasis except:

Accepted Answer

Brain

Answer

Prostate

Answer

Lung

Answer

Thyroid

Question 2

What will the aspirated synovial fluid in a case of septic arthritis typically show?

Accepted Answer

Markedly increased polymorphonuclear leukocytes

Answer

Clear and straw-colored fluid

Answer

Low viscosity fluid

Answer

Cloudy or purulent fluid

Question 3

What is Hegar's sign in obstetrics?

Accepted Answer

Softening of the uterine isthmus

Answer

Uterine contractions

Answer

Fetal movement

Answer

Cyanosis of the vagina

Question 4

What percentage of ectopic pregnancies occur in the fallopian tube?

Accepted Answer

90%

Answer

75%

Answer

80%

Answer

67%

Question 5

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 6

How is Brodie's abscess classified?

Accepted Answer

Chronic osteomyelitis (Brodie's abscess)

Answer

Acute osteomyelitis

Answer

Subacute osteomyelitis

Answer

Septic arthritis

Question 7

What is the most common malignant tumor of the skeletal system?

Accepted Answer

Metastasis

Answer

Chondrosarcoma

Answer

Multiple myeloma

Answer

Osteosarcoma

Question 8

Which of the following statements about chronic osteomyelitis is false?

Accepted Answer

Involucrum is dead bone

Answer

Reactive new bone formation

Answer

Cloaca is an opening in involucrum

Answer

Sequestrum is hard and dense

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 condition is characterized by a 'moth-eaten' appearance of the bones?

Accepted Answer

Multiple myeloma

Answer

Osteoid osteoma

Answer

Eosinophilic granuloma

Answer

Chondromyxoid fibroma

NEET-PG 2013

Internal Medicine

Obstetrics and Gynecology

Orthopaedics

Pathology

Radiology