NEET-PG 2012 Practice Questions

Q: Which nerve is primarily involved in cubital tunnel syndrome?

Ulnar nerve. Ulnar nerve - **Cubital tunnel syndrome** is a condition caused by compression of the **ulnar nerve** as it passes through the cubital tunnel at the medial epicondyle of the elbow. - Symptoms typically include numbness and tingling in the **little finger** and **half of the ring finger**, along with weakness of intrinsic hand muscles [2]. *Radial nerve* - The **radial nerve** is primarily involved in conditions like **radial tunnel syndrome** or radial nerve palsy (**wrist drop**), affecting primarily extensor muscles of the forearm and hand. - Its compression site is typically in the **radial tunnel** near the elbow, distinct from the cubital tunnel. *Median nerve* - The **median nerve** is involved in **carpal tunnel syndrome** at the wrist, causing numbness and tingling in the thumb, index, middle, and radial half of the ring finger [2]. - Compression around the elbow (e.g., pronator teres syndrome) can also affect the median nerve, but this is less common than cubital tunnel syndrome [1]. *Axillary nerve* - The **axillary nerve** is responsible for sensation over the deltoid region and motor function of the deltoid and teres minor muscles. - It is often injured with **shoulder dislocations** or fractures of the surgical neck of the humerus, unrelated to cubital tunnel syndrome.

Q: Which of the following conditions is most commonly associated with resorption of the distal phalanx?

Scleroderma. ***Scleroderma*** - **Scleroderma** (systemic sclerosis) can cause characteristic changes in the distal phalanges, specifically **acro-osteolysis**, leading to resorption of the **distal tufts** [1]. - This is often associated with **Raynaud's phenomenon**, **digital ischemia**, and **calcinosis**, leading to severe circulatory compromise in the digits [1]. *Hyperparathyroidism* - **Primary hyperparathyroidism** causes bone resorption due to increased parathyroid hormone, primarily affecting the **subperiosteal bone** (especially in the radial aspect of the middle phalanges), leading to a "lace-like" appearance on X-ray. - While it causes bone resorption, **distal phalanx tuft resorption** is not its most common or prominent skeletal feature compared to scleroderma. *Reiter's syndrome* - **Reiter's syndrome** (now known as reactive arthritis) is an inflammatory arthropathy usually involving large joints of the lower extremities in an **asymmetric** pattern. - It does not typically cause **resorption of the distal phalanx**; instead, it's associated with enthesitis, dactylitis, and periostitis. *Osteitis deformans (Paget's disease)* - **Paget's disease** is characterized by abnormal bone remodeling, leading to enlarged, deformed bones that are prone to fracture, predominantly affecting the **pelvis, spine, skull, and long bones**. - It causes areas of localized bone destruction and excessive bone formation, but **distal phalanx resorption** is not a feature of this condition.

Q: What is the definitive management for adenomyosis?

Hysterectomy (surgical removal of the uterus).. ***Hysterectomy (surgical removal of the uterus)*** - This is considered the **definitive management** for adenomyosis because it completely removes the uterine tissue where the ectopic endometrial glands are found. - Hysterectomy effectively eliminates the source of symptoms such as **heavy menstrual bleeding** and **pelvic pain** by removing the uterus entirely. *Endometrial ablation* - Endometrial ablation involves destroying the **lining of the uterus** and is primarily used for heavy menstrual bleeding. - It is **ineffective for adenomyosis** since the endometrial tissue is embedded deep within the myometrium and is not fully reached by ablation. *Hormonal therapy (e.g., Danazol) for temporary symptom relief* - **Danazol** (an androgen derivative) can suppress ovarian function and reduce symptoms of adenomyosis by shrinking endometrial tissue. - However, its effects are **temporary**, and symptoms typically return upon cessation of treatment, making it not a definitive solution. *Hormonal therapy (e.g., GNRH analogue) for temporary symptom relief* - **GnRH analogues** induce a temporary menopausal state, which can significantly reduce symptoms by inhibiting estrogen production, leading to atrophy of the adenomyotic tissue. - This treatment is also **temporary**, and symptoms often recur once the medication is stopped; it's often used as a bridge to surgery or for women nearing menopause.

Q: A 35 year old female with history of repeated D&C now has secondary amenorrhea. What is your diagnosis?

Asherman's syndrome. ***Asherman's syndrome*** - This syndrome is characterized by the formation of **intrauterine adhesions** or scar tissue following uterine trauma, often from repeated **Dilation and Curettage (D&C)** procedures. - The adhesions can prevent the normal growth and shedding of the **endometrial lining**, leading to **secondary amenorrhea** and infertility. *Hypothyroidism* - While hypothyroidism can cause menstrual irregularities, including **amenorrhea**, it would not typically be linked to a history of **repeated D&C procedures**. - The mechanism involves **hormonal imbalances** (e.g., elevated **TRH leading to elevated prolactin**), not scarring of the uterus. *Kallman syndrome* - This is a rare genetic condition causing **hypogonadotropic hypogonadism** and **anosmia** (loss of smell), leading to **primary amenorrhea**. - It does not involve uterine scarring and is not associated with D&C procedures or **secondary amenorrhea**. *Sheehan's syndrome* - Sheehan's syndrome is **postpartum hypopituitarism** caused by **ischemic necrosis of the pituitary gland** after severe hemorrhage during or after childbirth. - It would present with symptoms like **lactation failure** and could cause **secondary amenorrhea**, but it is not related to repeated D&C procedures.

Q: Tdap vaccine is given in between which weeks of pregnancy?

27-36 weeks. ***27-36 weeks*** - The **Tdap vaccine** is recommended during this window in **every pregnancy** to maximize the transfer of **maternal antibodies** to the fetus. - This timing provides effective protection against **pertussis (whooping cough)** for the newborn from birth until their own vaccinations begin. *10-16 weeks* - This period is generally too early for optimal **passive immunity transfer** to the fetus against pertussis. - While other vaccines might be considered, **Tdap is specifically timed later** for maximum antibody benefit. *17-22 weeks* - This window is also typically considered too early for the Tdap vaccine to provide the **highest level of antibody transfer** to the newborn. - The goal is to administer the vaccine when **maternal antibody levels peak closer to delivery**. *22-26 weeks* - While closer to the recommended timeframe, this still falls slightly outside the **optimal window (27-36 weeks)** for the Tdap vaccine. - Delaying slightly longer ensures **peak antibody levels** for the longest possible passive immunity.

Q: 6 year old son of pregnant woman is suffering from chicken pox. Which of the following is given to pregnant woman?

Only immunoglobulin. ***Only immunoglobulin*** - Giving **immunoglobulin** to a pregnant woman exposed to **chickenpox** provides immediate passive immunity, which is crucial as she is at risk of infection from her child. - This is particularly important because chickenpox during pregnancy can lead to severe maternal disease and congenital varicella syndrome in the fetus. *Acyclovir + immunoglobulin* - **Acyclovir** is an antiviral that treats active varicella infection but is not typically given prophylactically in combination with immunoglobulin for exposure unless the woman is already immunocompromised or develops symptoms. - The primary goal for exposed pregnant women is preventing infection through passive immunity, not immediately treating a potential infection. *Vaccination* - **Varicella vaccine** is a live attenuated vaccine and is **contraindicated** during pregnancy due to the theoretical risk of fetal infection. - It is used for pre-conception immunity or post-exposure prophylaxis in non-pregnant individuals if given within a short window, but not for pregnant women. *Acyclovir* - **Acyclovir** is an antiviral medicine used to treat active chickenpox infections, not to prevent infection immediately after exposure. - It would be considered if the pregnant woman develops symptoms of chickenpox, but not as a primary prophylactic measure in this scenario.

Q: Which of the following drugs is not commonly used for menorrhagia?

Clomiphene. ***Clomiphene*** - **Clomiphene citrate** is a selective estrogen receptor modulator used primarily to **induce ovulation** in women with infertility, not to treat menorrhagia. - Its mechanism involves blocking estrogen receptors in the hypothalamus, leading to increased release of **gonadotropins (FSH and LH)**. - It has no role in the management of heavy menstrual bleeding. *Methergin* - **Methergine (methylergonovine)** is an ergot alkaloid that causes sustained uterine contractions. - It is primarily used for **postpartum hemorrhage** and control of bleeding after abortions (acute obstetric bleeding). - While it can control acute uterine bleeding, it is **not used for chronic menorrhagia management** due to its side effects and availability of better alternatives. - It is an acute intervention, not a treatment for cyclic heavy menstrual bleeding. *GnRH* - **GnRH agonists** (e.g., leuprolide) are used to treat menorrhagia by inducing a **hypoestrogenic state**, which leads to endometrial atrophy and reduced menstrual bleeding. - They are often used as a temporary measure before surgery or for short-term management due to potential side effects like **hot flashes and bone loss**. *NSAIDS* - **Nonsteroidal anti-inflammatory drugs (NSAIDs)**, such as ibuprofen or naproxen, reduce prostaglandin production, which can decrease **menstrual blood loss** by affecting uterine contractility and vasoconstriction. - They are a common first-line treatment for menorrhagia, especially when associated with **painful periods (dysmenorrhea)**.

Q: Sequestrum is best defined as

A piece of dead bone surrounded by infected tissue. ***A piece of dead bone surrounded by infected tissue*** * A sequestrum is a fragment of **necrotic (dead) bone** that has become separated from the surrounding living bone in the context of **chronic osteomyelitis**. * The dead bone is typically surrounded by **infected granulation tissue and pus**, making it the classic definition taught in the context of bone infections. * The sequestrum acts as a **nidus for persistent infection**, as antibiotics cannot penetrate the avascular dead bone, making surgical removal often necessary. *A piece of dead bone without surrounding infection* * While a sequestrum is fundamentally dead bone, in clinical practice and standard teaching, it is **intrinsically associated with infection** in osteomyelitis. * The phrase "without surrounding infection" makes this option incorrect, as the classic sequestrum occurs in the **inflammatory milieu of chronic osteomyelitis**. *A piece of bone with compromised blood supply* * This describes **ischemic or avascular bone**, which is the **initial pathological event** that leads to bone death. * However, this is not the definition of sequestrum itself—the sequestrum is the **end result** (dead bone fragment) rather than bone with compromised vascularity. * A sequestrum has **no blood supply** (completely avascular), not merely compromised supply. *None of the options* * This is incorrect because the first option accurately captures the **standard definition of sequestrum** as taught in the context of chronic osteomyelitis in medical education.

Q: Cloacae are openings found in which of the following?

Involucrum. ***Involucrum*** - **Cloacae** are openings or sinuses that develop in the **involucrum**, which is the new bone formation that surrounds a segment of necrotic bone (sequestrum) during osteomyelitis. - These openings act as channels for the discharge of **pus** and inflammatory debris from the infected bone to the external environment. *Sequestrum* - A **sequestrum** is a piece of **necrotic (dead) bone** that has become separated from the surrounding healthy bone due to osteomyelitis. - While central to the pathology, the cloacae are openings *through the involucrum* that encases the sequestrum, not in the sequestrum itself. *Normal bone* - **Normal bone** does not contain cloacae; these structures are a pathological feature indicative of chronic osteomyelitis. - Healthy bone remodels and resorbs normally, without the formation of channels for pus drainage. *Myositis* - **Myositis** is an inflammation of the **muscles**, not bone, and does not involve the formation of cloacae. - While it can be caused by infection, the pathological changes are localized to muscle tissue.

Q: What is the most common type of degeneration observed in uterine fibroids?

Hyaline. ***Hyaline*** - **Hyaline degeneration** is the most frequent type of degeneration in uterine fibroids, occurring in about **60% of cases** [1]. - It involves the replacement of smooth muscle and connective tissue with **acellular, glassy, eosinophilic hyaline material** [1]. *Calcareous* - **Calcareous degeneration** (calcification) occurs when hyaline degeneration calcifies, typically seen in **postmenopausal women** or older fibroids. - While it can occur, it is a **secondary change** following hyaline degeneration rather than the primary and most common form. *Red* - **Red degeneration** (carneous degeneration) is acute, often occurring during **pregnancy** due to rapid growth and hemorrhagic infarction. - It presents with **acute pain** and is less common than hyaline degeneration. *Cystic* - **Cystic degeneration** is characterized by liquefaction within the fibroid, leading to the formation of **cysts**. - This typically results from advanced **hyaline degeneration** and is less common than hyaline degeneration itself. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1024-1025.

Question 1

Which nerve is primarily involved in cubital tunnel syndrome?

Accepted Answer

Ulnar nerve

Answer

Radial nerve

Answer

Median nerve

Answer

Axillary nerve

Question 2

Which of the following conditions is most commonly associated with resorption of the distal phalanx?

Accepted Answer

Scleroderma

Answer

Hyperparathyroidism

Answer

Reiter's syndrome

Answer

Osteitis deformans (Paget's disease)

Question 3

What is the definitive management for adenomyosis?

Accepted Answer

Hysterectomy (surgical removal of the uterus).

Answer

Endometrial ablation.

Answer

Hormonal therapy (e.g., Danazol) for temporary symptom relief.

Answer

Hormonal therapy (e.g., GnRH analogue) for temporary symptom relief.

Question 4

A 35 year old female with history of repeated D&C now has secondary amenorrhea. What is your diagnosis?

Accepted Answer

Asherman's syndrome

Answer

Hypothyroidism

Answer

Kallman syndrome

Answer

Sheehan's syndrome

Question 5

Tdap vaccine is given in between which weeks of pregnancy?

Accepted Answer

27-36 weeks

Answer

10-16 weeks

Answer

17-22 weeks

Answer

22-26 weeks

Question 6

6 year old son of pregnant woman is suffering from chicken pox. Which of the following is given to pregnant woman?

Accepted Answer

Only immunoglobulin

Answer

Acyclovir + immunoglobulin

Answer

Vaccination

Answer

Acyclovir

Question 7

Which of the following drugs is not commonly used for menorrhagia?

Accepted Answer

Clomiphene

Answer

GnRH

Answer

NSAIDS

Answer

Methergin

Question 8

Sequestrum is best defined as

Accepted Answer

A piece of dead bone surrounded by infected tissue

Answer

A piece of dead bone without surrounding infection

Answer

A piece of bone with compromised blood supply

Answer

None of the options

Question 9

Cloacae are openings found in which of the following?

Accepted Answer

Involucrum

Answer

Sequestrum

Answer

Normal bone

Answer

Myositis

Question 10

What is the most common type of degeneration observed in uterine fibroids?

Accepted Answer

Hyaline

Answer

Calcareous

Answer

Red

Answer

Cystic

NEET-PG 2012

Anatomy

Internal Medicine

Obstetrics and Gynecology

Orthopaedics

Pathology