NEET-PG 2012 Practice Questions

Q: Diagnosis of carcinoid tumour is done by urinary estimation of:

5HIAA. ***5HIAA*** - The urinary estimate of **5-hydroxyindoleacetic acid (5HIAA)** is the primary diagnostic test for **carcinoid tumors** [1], particularly those secreting serotonin. - Elevated levels of **5HIAA** in urine indicate excessive serotonin production, which is characteristic of these tumors. *VMA* - **Vanillylmandelic acid (VMA)** is a metabolite of catecholamines and is primarily used in diagnosing **neuroblastoma** or **pheochromocytoma**, not carcinoid tumors. - Although it indicates catecholamine secretion, it does not correlate with **serotonin** levels associated with carcinoid tumors. *Metanephrines* - **Metanephrines** represent metabolites of catecholamines and are mainly evaluated for **pheochromocytoma**. - They do not provide information on serotonin metabolism or carcinoid tumor activity. *Catecholamines* - Catecholamines such as **epinephrine and norepinephrine** are not specifically related to carcinoid tumors and often indicate other neuroendocrine tumors. - Their levels do not correlate with serotonin or its metabolite, **5HIAA**, used for carcinoid diagnosis. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 12-15.

Q: Most common symptom of genitourinary TB

Hematuria. ***Hematuria*** - **Gross or microscopic hematuria** is the most common symptom of genitourinary tuberculosis, often occurring early in the disease course. - It results from the **inflammatory and destructive changes** caused by Mycobacterium tuberculosis in the urinary tract. *Renal colic* - Renal colic is typically associated with **acute obstruction of the ureter**, often by a renal stone. - While TB can cause strictures leading to obstruction, **colic** itself is not the most common initial symptom. *Increased frequency* - Increased urinary frequency is a common symptom in genitourinary TB, especially with **bladder involvement**. - However, it ranks below hematuria in terms of overall prevalence as the *most common* symptom. *Painful micturition* - **Dysuria** or painful micturition is frequently observed in genitourinary TB, particularly with **bladder or urethral inflammation**. - While common, it is generally less prevalent than hematuria as the presenting complaint.

Q: Primary hyperparathyroidism is suggested by all of the following, except which of the following?

Low urinary calcium levels. ***Low urinary calcium*** - In primary hyperparathyroidism, **urinary calcium levels are typically elevated** due to increased calcium reabsorption in the kidneys [2]. - **Low urinary calcium levels** would suggest a different condition, such as **hypoparathyroidism** or a renal issue affecting calcium excretion [5]. *Increased PTH* - Primary hyperparathyroidism is characterized by **elevated parathyroid hormone (PTH)** levels, as the parathyroid glands are overactive [1][3]. - High PTH contributes to increased serum calcium and bone resorption [2]. *Increased serum calcium* - A hallmark of primary hyperparathyroidism is **hypercalcemia**, resulting from increased bone resorption and renal tubular reabsorption of calcium [1][2]. - The condition often leads to symptoms such as **kidney stones** and **bone pain** due to elevated serum calcium levels [3][4]. *Increased C-AMP* - Elevated levels of **cyclic AMP (C-AMP)** in urine are observed in primary hyperparathyroidism due to the stimulatory effect of PTH on renal tubular reabsorption of calcium. - Increased C-AMP correlates with the action of PTH in promoting calcium release from the bones [2].

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: What is the most reliable test to confirm ovulation after it has occurred?

Serum progesterone. ***Serum progesterone*** - A **serum progesterone level** of greater than **3 ng/mL (or 10 nmol/L)** in the mid-luteal phase (approximately 7 days after the presumed ovulation) reliably indicates that ovulation has occurred. - After ovulation, the **corpus luteum** forms and produces progesterone, causing a characteristic rise in its serum level. *Serum estrogen* - Estrogen levels **peak before ovulation** to trigger the LH surge and also rise during the luteal phase, but a single measurement is not a reliable indicator that ovulation has successfully occurred. - Estrogen levels can fluctuate due to various factors and do not directly confirm the **formation and function of a corpus luteum** as progesterone does. *Both serum estrogen and progesterone* - While both hormones are involved in the menstrual cycle, relying on both simultaneously for confirming *occurred* ovulation is not the most precise method. - A significant rise in **progesterone** *after* the presumed ovulatory event is the key reliable biomarker. *None of the options* - This option is incorrect because **serum progesterone** is a well-established and reliable test for confirming ovulation.

Q: What is a Pulled Elbow?

Partial dislocation of the radial head. ***Partial dislocation of the radial head*** - A pulled elbow, also known as **nursemaid's elbow**, specifically refers to a **subluxation of the radial head** from the annular ligament. - This injury typically occurs in young children when their arm is suddenly pulled or jerked, causing the **radial head** to slip out of the **annular ligament**. *Complete separation of the elbow joint* - A complete separation of the elbow joint would involve a **full dislocation** of the humeroulnar or humeroradial joints, a much more severe injury than a pulled elbow. - This would present with more significant deformity and instability compared to the subtle presentation of a pulled elbow. *Subluxation of proximal radio ulnar joint* - While the injury involves the radius and ulna, the specific subluxation in a pulled elbow is that of the **radial head** at the **humero-radial joint**, not primarily the proximal radio-ulnar joint itself. - The focus is on the annular ligament's integrity around the radial head, rather than direct forces acting on the proximal radio-ulnar articulation. *No injury present* - A pulled elbow is a recognized and common **pediatric orthopedic injury** requiring intervention to reduce the radial head. - The child will typically present with pain, refusal to use the affected arm, and a characteristic holding posture.

Q: Apparent lengthening is seen in which stage of TB Hip

Stage III. ***Stage III*** - In **Stage III (destructive stage)** of TB Hip, significant destruction of the femoral head and acetabulum can lead to superior migration of the greater trochanter. - This superior migration results in **apparent lengthening** of the limb due to the loss of bone structure and joint space. *Stage I* - **Stage I (synovitic stage)** involves inflammation of the synovium with effusion, but no significant bone destruction or joint changes that would cause lengthening. - At this stage, the joint space is usually preserved, and **no appreciable limb length discrepancy** is observed. *Stage II* - **Stage II (cartilage and early bone destruction)** begins to show destruction of articular cartilage and subchondral bone. - While there is some destruction, it is generally not extensive enough to cause the characteristic **apparent lengthening** seen in later stages. *None of the options* - This option is incorrect because **apparent lengthening** is a well-recognized feature during the advanced destructive phase (Stage III) of TB Hip. - The progressive nature of the disease directly contributes to specific radiographic and clinical findings like **unstable hip** and subsequent lengthening or shortening.

Q: What is the treatment of choice for a 5-year-old child with bedwetting?

Motivational therapy. ***Motivational therapy*** - This is the **first-line active treatment** for **primary nocturnal enuresis** in children, involving encouragement, positive reinforcement (star charts), rewards, and education about bladder control. - It focuses on **behavioral strategies** and can be highly effective with parental involvement. - When intervention is pursued at age 5, motivational therapy is preferred over pharmacological options due to safety and effectiveness. *No treatment* - At age 5, **watchful waiting with reassurance** is often appropriate since nocturnal enuresis is common at this age (affects 15-20% of 5-year-olds) and has a **spontaneous resolution rate of 15% per year**. - However, when the question asks for "treatment of choice," it implies active intervention rather than observation alone. - Active behavioral therapy is preferred when bedwetting causes distress or affects the child's self-esteem. *Imipramine* - **Imipramine** is a **tricyclic antidepressant** with anticholinergic effects that can reduce bladder contractions, but it has significant side effects including **cardiac arrhythmias** and is **not first-line treatment**. - It is typically reserved for children ≥7 years after behavioral interventions fail, due to its potential adverse effects and high relapse rate after discontinuation. *Desmopressin* - **Desmopressin** is an **antidiuretic hormone analog** that reduces urine production overnight. - While effective, it is typically reserved for children ≥6 years who are unresponsive to behavioral therapy or for **short-term situational use** (e.g., sleepovers, camps). - Side effects include potential **hyponatremia** and high relapse rate after discontinuation.

Q: Unable to consolidate long-term memory. Which lobe of the brain is involved?

Temporal. ***Temporal*** - The **temporal lobe**, particularly the **hippocampus** within it, is critically involved in the formation and consolidation of new long-term memories [1]. - Damage to the temporal lobe can result in **anterograde amnesia**, the inability to form new memories after the injury [1]. *Frontal* - The **frontal lobe** is primarily responsible for executive functions, **planning**, decision-making, and working memory [1]. - While it contributes to memory retrieval and strategic memory processes, it is not the primary site for the consolidation of long-term memories. *Parietal* - The **parietal lobe** is involved in processing **sensory information**, spatial awareness, and navigation. - It plays a role in attention and short-term memory, but not in the consolidation of long-term memory. *Occipital* - The **occipital lobe** is dedicated to **visual processing** and interpretation of visual information. - It has no direct primary role in the consolidation of long-term memories.

Q: HU is a measure of

CT. ***Correct Answer: CT*** - HU stands for **Hounsfield Units**, a standardized quantitative scale used exclusively in **computed tomography (CT)** to describe the **radiodensity** of tissues based on **X-ray attenuation**. - On this scale, **water is assigned 0 HU**, air is -1000 HU, and dense bone can be +1000 HU or more. - This allows objective measurement and comparison of tissue densities across different CT scanners and examinations. *Incorrect: MRI* - **Magnetic Resonance Imaging (MRI)** does not use Hounsfield Units. - MRI signal intensity is based on the **magnetic properties of tissues** and local hydrogen proton density, not X-ray attenuation. *Incorrect: PET* - **Positron Emission Tomography (PET)** measures the metabolic activity of cells using **radioactive tracers**. - Its output is typically quantified in **Standardized Uptake Value (SUV)**, not Hounsfield Units. *Incorrect: USG* - **Ultrasound (USG)** imaging uses sound waves to create images of internal body structures. - It measures the **acoustic impedance** of tissues and displays findings in terms of echogenicity, not Hounsfield Units.

Question 1

Diagnosis of carcinoid tumour is done by urinary estimation of:

Accepted Answer

5HIAA

Answer

VMA

Answer

Metanephrines

Answer

Catecholamines

Question 2

Most common symptom of genitourinary TB

Accepted Answer

Hematuria

Answer

Increased frequency

Answer

Renal colic

Answer

Painful micturition

Question 3

Primary hyperparathyroidism is suggested by all of the following, except which of the following?

Accepted Answer

Low urinary calcium levels

Answer

Increased serum calcium

Answer

Increased urinary calcium

Answer

Decreased PTH levels

Question 4

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 5

What is the most reliable test to confirm ovulation after it has occurred?

Accepted Answer

Serum progesterone

Answer

Serum estrogen

Answer

Both serum estrogen and progesterone

Answer

None of the options

Question 6

What is a Pulled Elbow?

Accepted Answer

Partial dislocation of the radial head

Answer

Subluxation of proximal radio ulnar joint

Answer

Complete separation of the elbow joint

Answer

No injury present

Question 7

Apparent lengthening is seen in which stage of TB Hip

Accepted Answer

Stage III

Answer

Stage II

Answer

Stage I

Answer

None of the options

Question 8

What is the treatment of choice for a 5-year-old child with bedwetting?

Accepted Answer

Motivational therapy

Answer

No treatment

Answer

Imipramine

Answer

Desmopressin

Question 9

Unable to consolidate long-term memory. Which lobe of the brain is involved?

Accepted Answer

Temporal

Answer

Frontal

Answer

Parietal

Answer

Occipital

Question 10

HU is a measure of

Accepted Answer

CT

Answer

MRI

Answer

PET

Answer

USG

NEET-PG 2012

Biochemistry

Internal Medicine

Obstetrics and Gynecology

Orthopaedics

Pediatrics

Physiology

Radiology