NEET-PG 2012 Practice Questions

Q: Investigation of choice in pheochromocytoma is:

Urinary catecholamines. ***Urinary catecholamines*** - Measurement of **24-hour urinary fractionated metanephrines and catecholamines** is the initial **biochemical test of choice**. - These biochemical tests are preferred over plasma levels due to the **episodic release** of hormones from a pheochromocytoma, which can lead to high false-negative rates in single plasma measurements. *CT scan* - While a **CT scan** is a crucial **imaging modality** for localizing a pheochromocytoma once the biochemical diagnosis is established [1], it is not the *initial* diagnostic investigation. - Imaging should be performed only after **biochemical confirmation** to avoid unnecessary investigations of incidental adrenal masses [1]. *MIBG scan* - An **MIBG scan** (metaiodobenzylguanidine scan) is a **functional imaging study** used primarily for **localizing metastatic pheochromocytomas** [1] or for cases where CT/MRI is equivocal. - It is not the initial investigation but rather a **secondary imaging test** [1]. *MRI Scan* - **MRI** is an alternative **imaging modality** to CT for localizing pheochromocytomas [1], especially in pregnant women or when radiation exposure is a concern. - Like CT, it serves as a **localization tool** after biochemical confirmation, not the diagnostic test itself.

Q: Which of the following statements about cholestasis of pregnancy is false?

Most common cause of jaundice in pregnancy. ***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 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.

Q: What is the treatment for uterine prolapse in nulliparous women?

Manchester operation. ***Manchester operation*** - This procedure is sometimes considered for **nulliparous women** with uterine prolapse, particularly if combined with cervical elongation. - It involves **amputation of the cervix** and support of the cardinal ligaments, which can address the prolapse while preserving uterine function. *Sling used involving rectus sheath* - A sling using the rectus sheath is typically employed for **stress urinary incontinence**, not primarily for uterine prolapse. - While it supports the urethra and bladder neck, it does not directly address the descent of the uterus. *Anterior colporrhaphy* - This procedure repairs a **cystocele** (prolapse of the bladder into the vagina) by tightening the anterior vaginal wall. - It does not directly manage **uterine prolapse** itself, though a cystocele can coexist with uterine descent. *Posterior colporrhaphy* - This surgical repair targets a **rectocele** (prolapse of the rectum into the vagina) by tightening the posterior vaginal wall. - Similar to anterior colporrhaphy, it addresses a specific vaginal wall defect rather than the **uterine position**.

Q: What is the presenting part in a transverse lie?

Shoulder. ***Shoulder*** - In a **transverse lie**, the fetal **shoulder** is the part that presents over the pelvic inlet. - This occurs when the fetal long axis is 90 degrees to the maternal spine. *Face* - A **face presentation** is a type of **cephalic presentation** where the head is hyperextended, and the face is the presenting part. - This is not characteristic of a transverse lie. *Vertex* - A **vertex presentation** is the most common and ideal **cephalic presentation**, where the head is flexed and the top of the head (vertex) is the presenting part. - This indicates a longitudinal lie, not a transverse lie. *Brow* - A **brow presentation** is also a type of **cephalic presentation** where the fetal head is partially extended, and the brow is the presenting part. - Like vertex and face presentations, this occurs with a longitudinal fetal lie.

Q: What is the definitive treatment for preeclampsia?

Delivery of the baby. ***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.

Q: In children, which of the following is a key diagnostic sign of congestive heart failure (CHF)?

Hepatomegaly. ***Hepatomegaly*** - In children, **hepatomegaly** is a crucial indicator of **right-sided heart failure** due to congestion of the hepatic venous system. - The liver is a compressible organ and can accommodate a significant increase in blood volume, causing it to enlarge considerably before other signs of **venous congestion** become apparent. *Raised JVP* - **Raised jugular venous pressure (JVP)** is often difficult to assess reliably in infants and young children due to their short necks and uncooperative nature. - While present in older children with CHF, it is not considered as sensitive or specific as other signs in younger pediatric patients. *Pedal edema* - **Pedal edema** is less common in pediatric CHF compared to adults, particularly in infants and toddlers. - Their shorter hydrostatic columns and tendency to spend more time supine make dependent edema less prominent. *Basal crepitations* - **Basal crepitations** (rales) indicate **pulmonary edema**, which is a sign of **left-sided heart failure**. - While a part of CHF, **hepatomegaly** is a more consistent and often earlier sign that can be detected across different forms of pediatric CHF (right or left-sided).

Q: What is the definition of phobia?

An intense, irrational fear that leads to avoidance. ***An intense, irrational fear that leads to avoidance*** - A phobia is primarily an **intense and persistent fear** reaction that is **irrational** in nature, meaning it is disproportionate to the actual danger posed by the object or situation. - This overwhelming fear invariably leads to **avoidance behavior**, where the individual actively tries to stay away from the feared stimulus. *Fear of specific objects or situations* - While phobias often involve specific objects or situations, this definition alone is insufficient as it doesn't capture the **intensity**, **irrationality**, or the **avoidance** component that are hallmarks of a true phobia. - Many people experience fear of specific things without it reaching the clinical threshold of a phobia, as long as it doesn't cause significant distress or impairment. *A type of anxiety disorder characterized by excessive fear* - This definition is broadly correct but is not the most precise or complete definition of a phobia itself. - While phobias are indeed a type of **anxiety disorder** and involve excessive fear, the key defining features of **irrationality** and **avoidance** are not explicitly stated, nor is the clear distinction from generalized anxiety. *A severe anxiety disorder characterized by irrational fear* - Similar to the previous option, this highlights the **irrational fear** and categorizes it as an **anxiety disorder**. - However, it omits the crucial element of **avoidance**, which is a defining diagnostic criterion and a hallmark behavioral response in phobias, and it also uses the broad term "severe" when the impact can vary.

Q: The most appropriate first-line imaging modality to detect adrenal metastasis due to bronchogenic carcinoma is:

Contrast Enhanced CT abdomen. **Contrast Enhanced CT abdomen** - **Contrast-enhanced CT abdomen** is generally considered the most sensitive and cost-effective imaging modality for detecting **adrenal metastases**. - It allows for detailed visualization of adrenal gland morphology, including size, shape, and enhancement patterns, which can help differentiate benign from malignant lesions. *PET scan* - While **PET (Positron Emission Tomography) scans** are highly sensitive for detecting metabolically active metastatic disease, they are often used as a secondary imaging modality to characterize indeterminate lesions found on CT or MRI. - **PET scans** can have false positives in benign adrenal tumors (e.g., adenomas rich in fat) and are less readily available or higher in cost for initial screening compared to CT. *MRI of the abdomen* - **MRI of the abdomen** can be very useful for further characterization of adrenal masses, especially for distinguishing between lipid-rich adenomas and metastases. - However, for initial detection, especially in the context of screening for distant metastases from bronchogenic carcinoma, **CT is generally preferred due to its wider availability, speed, and lower cost**. *Adrenal radionuclide scan* - **Adrenal radionuclide scans** (e.g., using MIBG or iodocholesterol) are primarily used for functional imaging of adrenal glands, typically to detect specific types of tumors like pheochromocytomas or aldosteronomas. - These scans are **not sensitive for detecting adrenal metastases** from bronchogenic carcinoma, as the metastatic lesions do not typically exhibit the specific uptake patterns targeted by these radiotracers.

Q: Which of the following is not considered a contraindication for pancreaticoduodenectomy?

Portal vein involvement. ***Portal vein involvement*** - While extensive portal vein invasion can make the procedure challenging, **segmental portal vein involvement without complete occlusion or direct invasion of the superior mesenteric artery** is often considered resectable with venous reconstruction and is not an absolute contraindication. - Advancements in surgical techniques and patient selection criteria allow for **safe resection and reconstruction of the portal vein** in carefully chosen cases, improving outcomes for patients who would otherwise be deemed inoperable. *Metastasis* - The presence of **distant metastases** (e.g., to the liver, peritoneum, or lungs) unequivocally indicates **Stage IV disease** and is an absolute contraindication to pancreaticoduodenectomy, as the surgery would not offer a curative benefit. - In such cases, systemic chemotherapy or palliative care is the more appropriate treatment approach, as resection would not alter the overall prognosis. *Stage III CA head of pancreas* - **Stage III carcinoma of the head of the pancreas** often implies **locally advanced disease** that involves major peripancreatic vessels, such as the superior mesenteric artery or celiac axis. - This level of extensive vascular involvement typically renders the tumor **unresectable**, making pancreaticoduodenectomy surgically unfeasible and a contraindication. *Extensive invasion of superior mesenteric vein* - **Extensive involvement of the superior mesenteric vein (SMV)**, particularly if it completely occludes the lumen or involves a long segment making reconstruction impossible, is generally considered a contraindication to pancreaticoduodenectomy. - While limited SMV involvement with reconstructive options might be resectable, **extensive, unreconstructable invasion** signifies locally advanced disease beyond surgical cure.

Q: How much length is increased in Z-plasty when it is done at 60 degrees?

75%. ***75%*** - A **60-degree Z-plasty** lengthens the central limb by approximately **75%** of its original length. This configuration provides a balance between length gain and flap viability. - The greater the angle of the Z-plasty limbs, the greater the theoretical lengthening, but also the larger the flaps and the increased risk of complications. *25%* - A **30-degree Z-plasty** typically provides about **25% lengthening** of the central limb. This angle offers less lengthening but is useful for smaller scars or when skin mobility is limited. - While it provides some lengthening, it falls significantly short of the length achieved with a 60-degree Z-plasty. *50%* - A **45-degree Z-plasty** generally results in approximately **50% lengthening**. This is an intermediate option, providing moderate lengthening. - This option does not match the significant lengthening associated with the larger 60-degree angle. *100%* - To achieve approximately **100% length gain**, larger angles such as **75 or 90-degree Z-plasty** might be considered. However, these angles are less commonly used due to increased flap size and tension at the base. - A standard 60-degree Z-plasty does not provide a 100% increase in length.

Question 1

Investigation of choice in pheochromocytoma is:

Accepted Answer

Urinary catecholamines

Answer

CT scan

Answer

MIBG scan

Answer

MRI Scan

Question 2

Which of the following statements about cholestasis of pregnancy is false?

Accepted Answer

Most common cause of jaundice in pregnancy

Answer

Bilirubin level >2mg%

Answer

Oestrogen is involved

Answer

Manifestations usually appear in last trimester

Question 3

What is the treatment for uterine prolapse in nulliparous women?

Accepted Answer

Manchester operation

Answer

Anterior colporrhaphy

Answer

Posterior colporrhaphy

Answer

Sling used involving rectus sheath

Question 4

What is the presenting part in a transverse lie?

Accepted Answer

Shoulder

Answer

Face

Answer

Vertex

Answer

Brow

Question 5

What is the definitive treatment for preeclampsia?

Accepted Answer

Delivery of the baby

Answer

Use of antihypertensive medications

Answer

Dietary modifications

Answer

Increased rest and monitoring

Question 6

In children, which of the following is a key diagnostic sign of congestive heart failure (CHF)?

Accepted Answer

Hepatomegaly

Answer

Pedal edema

Answer

Raised JVP

Answer

Basal crepitations

Question 7

What is the definition of phobia?

Accepted Answer

An intense, irrational fear that leads to avoidance

Answer

Fear of specific objects or situations

Answer

A type of anxiety disorder characterized by excessive fear

Answer

A severe anxiety disorder characterized by irrational fear

Question 8

The most appropriate first-line imaging modality to detect adrenal metastasis due to bronchogenic carcinoma is:

Accepted Answer

Contrast Enhanced CT abdomen

Answer

PET scan

Answer

MRI of the abdomen

Answer

Adrenal radionuclide scan

Question 9

Which of the following is not considered a contraindication for pancreaticoduodenectomy?

Accepted Answer

Portal vein involvement

Answer

Metastasis

Answer

Extensive invasion of superior mesenteric vein

Answer

Stage III CA head of pancreas

Question 10

How much length is increased in Z-plasty when it is done at 60 degrees?

Accepted Answer

75%

Answer

50%

Answer

25%

Answer

100%

NEET-PG 2012

Internal Medicine

Obstetrics and Gynecology

Pediatrics

Psychiatry

Radiology

Surgery