NEET-PG 2024 Practice Questions

Q: A young woman presents with prolapse, and a mesh is being placed. Where is this mesh typically fixed to?

Sacral promontory. ***Sacral promontory*** - In **sacrocolpopexy**, a common surgical procedure for vaginal prolapse, a mesh is attached from the vaginal apex to the **anterior longitudinal ligament** overlying the **sacral promontory**. - This anatomical landmark provides a strong, stable point of fixation to support the vagina and prevent recurrence of prolapse. *Ischial spine* - The **ischial spine** is a common landmark for identifying the **pudendal nerve** and for performing a **pudendal nerve block**, not for mesh fixation in prolapse repair. - It is also relevant in measuring the **interspinous diameter** of the pelvis during childbirth, but not for surgical mesh attachment in this context. *Ischial tuberosity* - The **ischial tuberosity** is the bony prominence on which one sits and is an attachment point for various muscles of the **thigh** and **pelvic floor**. - It is not used as a primary fixation point for mesh in vaginal prolapse repair due to its position and lack of direct support for the vaginal apex. *Pubic symphysis* - The **pubic symphysis** is a cartilaginous joint connecting the two **pubic bones** in the anterior pelvis. - While part of the pelvic framework, it does not provide the appropriate superior posterior support needed for **vaginal apex suspension** in prolapse surgery.

Q: Which of the following is a tumor marker associated with ovarian solid-cystic masses?

AFP. ***AFP (Alpha-fetoprotein)*** - **AFP** is a reliable tumor marker for differentiating **germ cell tumors**, especially **yolk sac tumors**, which often present as an ovarian solid-cystic mass. - Elevated **AFP** levels help in diagnosis, monitoring treatment response, and detecting recurrence of these specific ovarian malignancies. *CEA (Carcinoembryonic antigen)* - **CEA** is primarily associated with **gastrointestinal cancers**, such as colorectal cancer, and is less specific for ovarian masses. - While it can be elevated in some mucinous ovarian carcinomas, it's not the most specific marker for a general solid-cystic ovarian mass. *HCG (Human chorionic gonadotropin)* - **HCG** is a key marker for **gestational trophoblastic disease** and some **germ cell tumors**, such as choriocarcinoma. - It is not typically elevated in most common solid-cystic ovarian masses, especially those of epithelial origin. *HER2/neu (Human Epidermal growth factor Receptor 2)* - **HER2/neu** is primarily associated with **breast cancer** and some gastric cancers, playing a role in targeted therapy. - It is not a standard tumor marker for the general evaluation or diagnosis of ovarian solid-cystic masses.

Q: A 32-year-old woman presents with a new 2 cm black nodular mass near her episiotomy scar. She reports that the mass is painful and tends to increase in size during menstruation. What is the most likely diagnosis?

Endometriosis. ***Endometriosis*** - The location near an **episiotomy scar**, the **painful black nodular mass**, and its tendency to **increase in size during menstruation** are highly characteristic of an **episiotomy scar endometriosis**, also known as cutaneous endometriosis. - This condition involves the presence of **endometrial tissue** outside the uterus, which responds to hormonal fluctuations, explaining the cyclical pain and size changes. *Melanoma* - While a **black nodular mass** could suggest melanoma, the key differentiating factor here is the **cyclical pain and growth with menstruation**, which is not typical for melanoma. - Melanoma is a **malignant tumor** of melanocytes and usually presents with irregular borders, asymmetry, and color variation, without a direct correlation to the menstrual cycle. *Foreign body granuloma* - A **foreign body granuloma** is an inflammatory reaction to non-degradable foreign material, which could be seen at a surgical site like an episiotomy. - However, this condition typically doesn't exhibit the **cyclical pain and growth with menstruation** that is a hallmark of endometriosis. *Inclusion cyst* - An **inclusion cyst** is a benign cyst that develops when epithelial cells become trapped under the skin surface after trauma or surgery. - While it can occur at an episiotomy site, it is usually a **slow-growing mass** that is typically painless (unless infected) and does not fluctuate in size or pain with the menstrual cycle.

Q: A teenage girl presents with a history of amenorrhea. Local examination is shown in the image. What karyotype analysis would you consider for further evaluation?

45 XO. ***45 XO*** - The image shows a **webbed neck** and **short stature** (suggested by the overall body proportions typically associated with Ullrich-Turner Syndrome), alongside primary amenorrhea, which are classic features of **Turner Syndrome**. - **Turner Syndrome** is a chromosomal disorder characterized by the absence of all or part of one X chromosome in females, resulting in a **45, XO karyotype**. *46 XY* - This karyotype indicates a **phenotypic male** with normal male chromosomal constitution. - Individuals with this karyotype would not typically present with **primary amenorrhea** as they do not have a uterus. *46 XX* - This is the **normal female karyotype**, and while a female with this karyotype could experience amenorrhea (e.g., due to Asherman's syndrome or PCOS), the physical features associated with the image (like webbed neck) are not consistent. - This option does not explain the **physical stigmata** often seen in genetic causes of primary amenorrhea, such as in Turner syndrome. *47 XXY* - This karyotype is characteristic of **Klinefelter Syndrome**, which affects males and is associated with hypogonadism and gynecomastia. - It would not be found in a female patient presenting with **amenorrhea** and the physical features shown in the image. *47 XXX* - This karyotype represents **Triple X Syndrome** (Trisomy X), which affects females and typically presents with **normal female appearance** and often normal fertility. - While some individuals may have menstrual irregularities, the **distinctive physical features** shown in the image (webbed neck, short stature) are not characteristic of Triple X syndrome, which usually lacks specific dysmorphic features.

Q: A female presents with postcoital bleeding. Which of the following is the most appropriate investigation?

Pap smear, HPV DNA testing. **Pap smear, HPV DNA testing** - **Postcoital bleeding** is a classic symptom of **cervical cancer**, which can be identified by a **Pap smear** to detect abnormal cervical cells. - **HPV DNA testing** is essential as persistent infection with high-risk human papillomavirus (HPV) genotypes is the primary cause of cervical cancer. *Pap smear, HCV DNA, electrophoresis* - While a **Pap smear** is appropriate for cervical cytology, **HCV DNA testing** is for Hepatitis C virus infection and is not routinely indicated for postcoital bleeding. - **Electrophoresis** is used to analyze proteins (e.g., hemoglobinopathies) and has no direct role in evaluating postcoital bleeding or cervical pathology. *Liquid-based cytology, cervical biopsy* - **Liquid-based cytology** is a method of preparing a Pap smear, but it's not a standalone investigation. - A **cervical biopsy** is a more invasive procedure done *after* initial screening (like Pap smear with HPV testing) suggests abnormalities, not as a primary first-line investigation for postcoital bleeding unless there are visible lesions. *Cervical biopsy, HBV DNA* - A **cervical biopsy** is typically performed following an abnormal **Pap smear** or colposcopy findings, not as the initial diagnostic step for postcoital bleeding. - **HBV DNA testing** is for Hepatitis B virus infection and is irrelevant to the workup of postcoital bleeding.

Q: The image shows a pediatric fracture involving the growth plate. Which classification system and stage best describes this fracture?

Salter Harris 3. ***Salter Harris 3*** - The image shows a **fracture extending from the epiphyseal surface down through the growth plate (physis) and exiting through the epiphysis** into the joint. This configuration is characteristic of a Salter-Harris type III fracture. - Salter-Harris Type III fractures disrupt the **articular cartilage** and can have a poorer prognosis due to potential joint incongruity and growth disturbance if not properly reduced. *Gartland 3* - The **Gartland classification** is specifically used for **supracondylar fractures of the humerus** in children, which is a different type of fracture involving the distal humerus metaphysis, not typically the growth plate itself in this manner. - Gartland type 3 refers to a **completely displaced supracondylar fracture** with no cortical contact, involving the metaphysis proximal to the growth plate. *Gartland 2* - **Gartland type 2** describes a **displaced supracondylar fracture** with an intact posterior cortex, also referring to a fracture of the distal humerus metaphysis, not a trans-growth plate fracture. - This classification is not applicable to the image which clearly depicts a fracture involving the epiphysis and physis. *Salter Harris 2* - A **Salter-Harris type II fracture** involves the **physis and extends into the metaphysis**, creating a triangular fragment known as the "Thurston Holland sign." - In the provided image, the fracture line clearly extends into the **epiphysis**, not just the metaphysis, distinguishing it from a Salter-Harris type II.

Q: Identify the implant shown in the image:

Dynamic hip screw. ***Dynamic hip screw*** - The image shows a **lag screw** inserted into the femoral neck and head, which slides within a **side plate** attached to the femoral shaft with cortical screws. - This construct allows for controlled **dynamic collapse** and impaction at the fracture site, promoting healing and providing stable fixation for **extracapsular hip fractures**. *Cannulated hip screw* - Cannulated screws are typically used in a **parallel configuration** or as a single large screw for hip fractures, particularly **femoral neck fractures**. - They do not feature a **side plate** that extends down the femoral shaft for additional fixation. *Condylar hip screw* - A condylar hip screw (DCS) is used for **distal femur fractures**, often extending into the **condyles**. - It involves a different angulation and design compared to the proximal femoral implant seen, which is fixed to the femoral shaft. *Intramedullary nail* - An intramedullary nail is inserted into the **medullary canal** of the bone, running through its center. - While some hip nails (e.g., trochanteric nails) have a cephalic screw component, they primarily stabilize the shaft from within, unlike the **extracortical side plate** seen here.

Q: A patient presents with a 5th metatarsal fracture. How many days would he/she need to wear a cast?

6-8 weeks. ***6-8 weeks*** - For most **5th metatarsal fractures**, especially **Jones fractures** or more significant avulsion fractures, **non-weight-bearing** immobilization in a cast, boot, or splint is typically required for **6 to 8 weeks** to allow for proper bone healing. - The **poor vascular supply** to the metaphyseal-diaphyseal junction of the 5th metatarsal (in Jones fractures) often necessitates a longer immobilization period. *2-3 weeks* - This duration is generally too short for the adequate healing of most 5th metatarsal fractures, especially those that are **displaced** or involve the **watershed zone**. - A shorter period might be considered for very minor, stable **avulsion fractures** with minimal pain, but even then, a slightly longer protection might be advised. *16-20 weeks* - This length of time is typically reserved for **severe, complex fractures**, open fractures with complications, or cases requiring **multiple surgical interventions** and prolonged rehabilitation, which is not the standard for an uncomplicated 5th metatarsal fracture. - Such an extended period of immobilization could also lead to **significant muscle atrophy** and joint stiffness. *3-5 weeks* - While sometimes considered for **stable avulsion fractures** of the 5th metatarsal base or mild stress fractures, this period is often insufficient for complete healing of the more common and problematic **Jones fracture**. - Rushing the return to weight-bearing can increase the risk of **non-union** or refracture.

Q: Tubectomy is typically performed on which part of the fallopian tube and why?

Isthmus - narrowest. ***Isthmus - narrowest*** - The **isthmus** is preferred for tubectomy because its **narrowest diameter** and thick muscular wall make it easier to ligate and minimize recanalization. - Its narrow lumen also reduces the chances of spontaneous rejoining and pregnancy, ensuring a more effective and permanent sterilization. *Ampulla - uniform thickness of muscle* - The **ampulla** is a wider, more distensible part of the fallopian tube, making it **less suitable for ligation** due to a higher risk of recanalization. - While tubular muscle thickness is a factor, the **ampulla's larger lumen** makes it less ideal for effective and permanent occlusion compared to the isthmus. *Ampulla - widest* - The **ampulla's wider diameter** increases the technical difficulty of creating a secure and permanent occlusion, as ligating a broad segment is less effective. - A wider lumen makes **spontaneous recanalization** more likely, compromising the contraceptive efficacy of the procedure. *Isthmus - uniform thickness of muscle* - While the isthmus does have a relatively **uniform and thick muscular wall**, it is the **narrowness of the lumen** that is the primary reason for its selection in tubectomy. - The consistency of its muscle is a contributing factor to its robustness, but the **small caliber** is key to preventing recanalization.

Question 1

A GSP4 woman comes for routine sonography for the first time. She has four daughters and expresses a desire for a boy this time, asking for sex determination. To abide by ethical guidelines, what should you do?

Accepted Answer

Check routine ANC and sex for developmental abnormalities and do not reveal gender to the patient

Answer

Check routine ANC and sex for developmental abnormalities and do reveal gender to the patient

Answer

Do reveal gender if a girl

Answer

Check only routine ANC, do not check sex

Question 2

A young woman presents with prolapse, and a mesh is being placed. Where is this mesh typically fixed to?

Accepted Answer

Sacral promontory

Answer

Ischial spine

Answer

Ischial tuberosity

Answer

Pubic symphysis

Question 3

Which of the following is a tumor marker associated with ovarian solid-cystic masses?

Accepted Answer

AFP

Answer

CEA

Answer

HCG

Answer

HER2/neu

Question 4

A 32-year-old woman presents with a new 2 cm black nodular mass near her episiotomy scar. She reports that the mass is painful and tends to increase in size during menstruation. What is the most likely diagnosis?

Accepted Answer

Endometriosis

Answer

Melanoma

Answer

Foreign body granuloma

Answer

Inclusion cyst

Question 5

A teenage girl presents with a history of amenorrhea. Local examination is shown in the image. What karyotype analysis would you consider for further evaluation?

Accepted Answer

45 XO

Answer

46 XY

Answer

46 XX

Answer

47 XXY

Answer

47 XXX

Question 6

A female presents with postcoital bleeding. Which of the following is the most appropriate investigation?

Accepted Answer

Pap smear, HPV DNA testing

Answer

Pap smear, HCV DNA, electrophoresis

Answer

Liquid-based cytology, cervical biopsy

Answer

Cervical biopsy, HBV DNA

Question 7

The image shows a pediatric fracture involving the growth plate. Which classification system and stage best describes this fracture?

Accepted Answer

Salter Harris 3

Answer

Gartland 3

Answer

Gartland 2

Answer

Salter Harris 2

Question 8

Identify the implant shown in the image:

Accepted Answer

Dynamic hip screw

Answer

Cannulated hip screw

Answer

Condylar hip screw

Answer

Intramedullary nail

Question 9

A patient presents with a 5th metatarsal fracture. How many days would he/she need to wear a cast?

Accepted Answer

6-8 weeks

Answer

2-3 weeks

Answer

16-20 weeks

Answer

3-5 weeks

Question 10

Tubectomy is typically performed on which part of the fallopian tube and why?

Accepted Answer

Isthmus - narrowest

Answer

Ampulla - uniform thickness of muscle

Answer

Ampulla - widest

Answer

Isthmus - uniform thickness of muscle

NEET-PG 2024

OB/GYN

Orthopaedics

Surgery