NEET-PG 2012 Practice Questions

Q: What condition is primarily diagnosed using Von Rosen's view?

Congenital dislocation of the hip (CDH). ***Congenital dislocation of the hip (CDH)*** - **Von Rosen's view** is a specialized X-ray projection used specifically to assess for **developmental dysplasia of the hip (DDH)**, also known as CDH, in infants. - This view helps visualize the relationship between the **femoral head** and the **acetabulum** by positioning the infant's hips in extension, abduction, and internal rotation. *Perthes disease* - **Perthes disease** is an avascular necrosis of the femoral head, typically diagnosed with standard **frog-leg lateral** and **AP pelvic X-rays**. - While it affects the hip, Von Rosen's view is not the primary diagnostic imaging for this condition, which usually presents later in childhood. *Congenital Talipes Equinovarus (CTEV)* - **CTEV**, or **clubfoot**, is a deformity of the foot and ankle, not the hip. - It is primarily diagnosed clinically and then confirmed with **AP and lateral X-rays of the foot** to assess bone alignment. *None of the options* - This option is incorrect because **Congenital dislocation of the hip (CDH)** is indeed primarily diagnosed using Von Rosen's view, among other methods.

Q: Green stick fracture is

Incomplete fracture. ***Incomplete fracture*** - A **greenstick fracture** is an **incomplete fracture** where the bone bends and cracks but does not break all the way through. - This type of fracture commonly occurs in children because their bones are more flexible and softer than adult bones. *Fracture in adults* - While adults can experience various types of fractures, a **greenstick fracture** is rare in adults due to their more rigid and brittle bones. - Adult bones tend to sustain **complete fractures** or other complex fracture patterns instead of bending partially. *Complete fracture* - A **complete fracture** denotes a break in the bone that severs it into two or more distinct pieces. - **Greenstick fractures** are by definition incomplete, meaning the bone is still partially intact. *Fracture spine* - A **spinal fracture** specifically refers to a break in one or more vertebrae in the spinal column. - While spinal fractures can be complete or incomplete, the term **greenstick fracture** is not typically used to describe fractures of the spine.

Q: Treatment of choice for displaced fracture neck femur in a 40 years old female

Multiple screw fixation. ***Multiple screw fixation*** - For a **displaced femoral neck fracture** in a younger patient (40 years old), **internal fixation** with multiple screws is generally the preferred treatment to preserve the native **femoral head**. - This approach aims to achieve **anatomical reduction** and stable fixation, allowing for bone healing and a better long-term functional outcome in active individuals. *Bipolar hemiarthroplasty* - This procedure is typically reserved for older, less active patients with **displaced femoral neck fractures**, particularly those with pre-existing conditions that might limit their longevity or activity level. - While it replaces the femoral head, it does not preserve the native joint, which is a less desirable outcome in a 40-year-old. *THR* - **Total hip replacement** is usually considered for older patients, or younger patients with **pre-existing arthritis** or failed internal fixation, due to concerns about the prosthesis's longevity and potential future revisions. - In a 40-year-old, the goal is typically to preserve the native joint if possible, unless there are other complicating factors. *None of the options* - Internal fixation with multiple screws is a well-established and appropriate treatment for a displaced femoral neck fracture in a 40-year-old patient. - Therefore, one of the provided options is indeed the correct treatment choice for this specific scenario.

Q: Rehydration therapy in a 2 year old severely dehydrated child is -

30 ml/kg in 30 min, 70 ml/kg in 2.5 hours. ***30 ml/kg in 30 min, 70 ml/kg in 2.5 hours*** - This option reflects the recommended rehydration protocol for a severely dehydrated child aged **12 months to 5 years**, where the first 30 ml/kg are given rapidly over 30 minutes, followed by 70 ml/kg over the next 2.5 hours. - This rapid initial infusion helps to quickly restore **circulating volume** and improve perfusion during severe dehydration. *30 ml/kg in 1 hour, 70 ml/kg in 5 hours* - This protocol is typically used for children with **some dehydration**, not severe dehydration, and is usually administered orally when possible. - The slower rate of rehydration would be insufficient for a severely dehydrated child requiring more urgent fluid replacement. *20 ml/kg in 30 min, 80 ml/kg in 2.5 hours* - While reflecting a rapid initial phase, the total volume and distribution of fluids differ from the WHO guidelines for **severe dehydration** in this age group. - The **initial 20 ml/kg over 30 minutes** is generally a slightly lower first bolus than recommended for very severe cases, and the subsequent phase is also adjusted. *75 ml/kg in 4 hours* - This represents a **lower total volume** (75 ml/kg compared to 100 ml/kg) and a different time distribution for severely dehydrated children in the 12 month to 5 year age group. - This protocol is more aligned with the management of **some dehydration** rather than the urgent requirements of severe dehydration.

Q: Most commonly abused opioid -

Diacetylmorphine. ***Diacetylmorphine*** - **Diacetylmorphine**, commonly known as **heroin**, is synthetically derived from **morphine** but is significantly more potent and lipid-soluble, allowing it to cross the **blood-brain barrier** rapidly [1, 3]. - Its rapid onset of action and intense euphoric effects contribute to its high potential for **abuse** and addiction, making it one of the most commonly abused opioids globally, particularly through intravenous injection [1]. *Morphine* - While **morphine** is a potent opioid and has a high potential for abuse, it is often prescribed in clinical settings for severe pain. - Its slower onset and less intense "rush" compared to **heroin** make it less frequently the **primary opioid of abuse** in illicit street drug markets [1]. *Oxycodone* - **Oxycodone** is a highly abused prescription opioid, especially in the form of controlled-release formulations like **OxyContin**, but its abuse is primarily linked to prescription drug diversion rather than being the most common illicitly manufactured opioid of abuse. - While it contributes significantly to the opioid crisis, **heroin** (diacetylmorphine) remains the most commonly abused opioid in the illicit market due to its widespread availability and potency [1]. *Buprenorphine* - **Buprenorphine** is a **partial opioid agonist** used in the treatment of opioid dependence (opioid replacement therapy) due to its ceiling effect on respiratory depression and ability to block the effects of other opioids. - Although it can be abused, particularly in combination with naloxone (Suboxone) via intravenous injection, its primary role is in **medication-assisted treatment**, making it less commonly abused as a standalone illicit opioid compared to **heroin**.

Q: Midazolam does not cause which of the following?

Retrograde amnesia. ***Retrograde amnesia*** - Midazolam, a benzodiazepine, primarily causes **anterograde amnesia** [2], meaning patients have difficulty forming new memories after drug administration. - It does not significantly affect memories formed **before drug administration** (retrograde amnesia). *Anterograde amnesia* - Midazolam is well-known for its ability to induce **anterograde amnesia**, which is often a desirable effect in procedural sedation [2]. - This effect helps patients forget unpleasant or painful procedures performed while under its influence. *Causes tachyphylaxis during high dose infusions* - Prolonged or high-dose infusions of midazolam can lead to **tachyphylaxis**, requiring increased doses to achieve the same effect [1]. - This phenomenon is due to the **down-regulation or desensitization of GABA-A receptors** with continuous stimulation. *Decreased cardiovascular effects as compared to propofol* - Midazolam generally causes **less pronounced cardiovascular depression** (e.g., hypotension) compared to propofol, especially in standard sedative doses [1]. - This makes midazolam a safer option for sedation in some patients with **fragile cardiovascular statuses**.

Q: Which of the following conditions can cause periosteal reactions?

All of the options. ***All of the options*** - **Periosteal reactions** are non-specific findings that indicate periosteal irritation or inflammation, which can be caused by a wide range of pathologies including infection, neoplasia, and trauma. - This option correctly encompasses the various causes listed in the other choices, making it the most accurate answer. *Osteomyelitis* - **Osteomyelitis**, an infection of the bone, can cause inflammation of the surrounding periosteum, leading to periosteal new bone formation. - The type of periosteal reaction can vary, from **lamellated** to **solid**, depending on the chronicity and aggressiveness of the infection. *Syphilis* - **Congenital syphilis** and tertiary acquired syphilis can lead to significant bone involvement, including **periostitis**, which manifests as periosteal reactions. - The classic appearance in children with congenital syphilis is a **wavy** or **irregular cortical thickening** due to widespread periostitis. *Tumor* - Both **primary bone tumors** (e.g., osteosarcoma, Ewing's sarcoma) and **metastatic lesions** can elicit a periosteal response as they invade or irritate the periosteum. - The periosteal reaction in tumors can present as aggressive patterns like a **sunburst** or **Codman's triangle**, indicating rapid bone destruction and new bone formation.

Q: Which of the following appears the same on both T1 and T2 weighted MRI sequences?

Fat. ***Fat*** - On both T1 and T2 weighted MRI sequences, fat appears **bright** (high signal intensity). - This consistent bright signal makes fat a useful internal reference point for signal interpretation. *Gall bladder* - The gall bladder is filled with **bile**, which appears bright on T2-weighted images due to its high water content, but can be variable on T1. - Bile does not maintain consistently the **same signal intensity** as fat on both sequences. *Kidney* - The renal parenchyma typically has **intermediate signal intensity** on both T1 and T2, but its signal characteristics are different from the consistently bright signal of fat. - The signal can vary depending on the specific sequence parameters and hydration status, unlike fat. *CSF* - **Cerebrospinal fluid (CSF)** appears dark (low signal) on T1-weighted images and bright (high signal) on T2-weighted images due to its high water content. - This distinct signal intensity difference between T1 and T2 is contrary to the shared bright appearance of fat on both sequences.

Q: Investigation of choice for screening of proximal internal carotid artery stenosis is :

Doppler ultrasound (USG). ***Doppler ultrasound (USG)*** - **Doppler ultrasound** is the investigation of choice for screening carotid artery stenosis due to its **non-invasive nature**, widespread availability, and cost-effectiveness. It provides excellent anatomical information and hemodynamics, including **blood flow velocity** and presence of **plaque**. - It can effectively estimate the degree of **stenosis** based on flow characteristics and is safe for serial monitoring. *CT angiography* - **CT angiography** provides detailed anatomical imaging of the carotid arteries but involves **ionizing radiation** and **iodinated contrast agents**, making it less suitable for routine screening, especially in patients with renal impairment or contrast allergies. - While it offers higher resolution for certain plaque characteristics, it’s typically reserved for cases where ultrasound findings are inconclusive or for surgical planning. *Magnetic resonance imaging (MRI)* - **MRI** and **MR angiography (MRA)** can visualize carotid stenosis without ionizing radiation but are more expensive and time-consuming than ultrasound, and can be limited by artifacts from patient movement. - Patients with **claustrophobia** or **metallic implants** may not be suitable for MRI, making it less ideal for general screening. *Digital subtraction angiography (DSA)* - **Digital subtraction angiography (DSA)** is the **gold standard** for diagnosing carotid stenosis as it provides the most detailed and accurate images of the arterial lumen. However, it is an **invasive procedure** associated with risks such as stroke, arterial dissection, contrast nephropathy, and radiation exposure. - Due to its invasiveness and potential complications, DSA is typically reserved for cases with **discordant non-invasive findings** or prior to intervention rather than as a primary screening tool.

Q: What is the most common abdominal surgical procedure for complete rectal prolapse?

Rectopexy. ***Rectopexy*** - **Rectopexy** is the most common abdominal surgical procedure for full-thickness rectal prolapse - It involves fixing the rectum to the sacral promontory or presacral fascia (with sutures or mesh) to prevent prolapse - Various modifications exist including suture rectopexy, mesh rectopexy, ventral rectopexy, and resection rectopexy - **Abdominal approach** is preferred in fit patients with better long-term outcomes compared to perineal procedures *Rectal mucosal stapling* - This procedure refers to **stapled hemorrhoidopexy (PPH)** or **STARR procedure** - Primarily used for **internal mucosal prolapse** and hemorrhoids, not full-thickness external rectal prolapse - Involves excising redundant rectal mucosa using circular staplers - Does not address the full-thickness prolapse or provide proper fixation *Placation/wiring* - **Thiersch wiring** is a historical perineal procedure involving placement of a wire or suture around the anus to narrow the anal canal - Now largely abandoned due to high recurrence rates and complications - **Plication** refers to folding tissue but is not a standalone procedure name for rectal prolapse - This terminology is not standard in modern colorectal surgery *Mucosal resection* - Refers to **Delorme's procedure**, a perineal approach involving mucosal sleeve resection with underlying muscle plication - Used in elderly or high-risk patients who cannot tolerate abdominal surgery - Associated with higher recurrence rates compared to abdominal rectopexy - Does not provide the same level of fixation as abdominal procedures

Question 1

What condition is primarily diagnosed using Von Rosen's view?

Accepted Answer

Congenital dislocation of the hip (CDH)

Answer

Perthes disease

Answer

Congenital Talipes Equinovarus (CTEV)

Answer

None of the options

Question 2

Green stick fracture is

Accepted Answer

Incomplete fracture

Answer

Fracture in adults

Answer

Complete fracture

Answer

Fracture spine

Question 3

Treatment of choice for displaced fracture neck femur in a 40 years old female

Accepted Answer

Multiple screw fixation

Answer

None of the options

Answer

Bipolar hemiarthroplasty

Answer

THR

Question 4

Rehydration therapy in a 2 year old severely dehydrated child is -

Accepted Answer

30 ml/kg in 30 min, 70 ml/kg in 2.5 hours

Answer

75 ml/kg in 4 hours

Answer

30 ml/kg in 1 hour, 70 ml/kg in 5 hours

Answer

20 ml/kg in 30 min, 80 ml/kg in 2.5 hours

Question 5

Most commonly abused opioid -

Accepted Answer

Diacetylmorphine

Answer

Morphine

Answer

Oxycodone

Answer

Buprenorphine

Question 6

Midazolam does not cause which of the following?

Accepted Answer

Retrograde amnesia

Answer

Anterograde amnesia

Answer

Decreased cardiovascular effects as compared to propofol

Answer

Causes tachyphylaxis during high dose infusions

Question 7

Which of the following conditions can cause periosteal reactions?

Accepted Answer

All of the options

Answer

Osteomyelitis

Answer

Syphilis

Answer

Tumor

Question 8

Which of the following appears the same on both T1 and T2 weighted MRI sequences?

Accepted Answer

Fat

Answer

Gall bladder

Answer

Kidney

Answer

CSF

Question 9

Investigation of choice for screening of proximal internal carotid artery stenosis is :

Accepted Answer

Doppler ultrasound (USG)

Answer

CT angiography

Answer

Magnetic resonance imaging (MRI)

Answer

Digital subtraction angiography (DSA)

Question 10

What is the most common abdominal surgical procedure for complete rectal prolapse?

Accepted Answer

Rectopexy

Answer

Rectal mucosal stapling

Answer

Placation/wiring

Answer

Mucosal resection

NEET-PG 2012

Orthopaedics

Pediatrics

Pharmacology

Radiology

Surgery