NEET-PG 2021 Practice Questions

Q: A 26-year-old male presents with backache, morning stiffness, reduced chest expansion, and reddening of the eyes. The X-ray provided is shown below. What is the most likely diagnosis?

Ankylosing spondylitis. ***Ankylosing spondylitis*** - The patient's symptoms of **backache, morning stiffness, reduced chest expansion**, and **reddening of the eyes** (uveitis) are classic manifestations of ankylosing spondylitis. The X-ray image (though somewhat obscured) shows signs consistent with **sacroiliitis** and possibly early **syndesmophyte formation**, leading to a "bamboo spine" appearance which is pathognomonic. - This condition is a **chronic inflammatory disease** primarily affecting the spine and sacroiliac joints, more common in young men. *Osteopetrosis* - This is a rare genetic disorder characterized by **increased bone density** due to defective osteoclast function, leading to bone fragility. - Clinical features usually include **fractures**, cranial nerve palsies due to narrowed foramina, and **hematologic abnormalities** due to marrow obliteration, not inflammatory back pain or uveitis. *Paget's disease* - **Paget's disease of bone** involves localized areas of excessive bone turnover, leading to disorganized bone structure. - It typically affects older individuals and presents with **bone pain**, skull enlargement, and hearing loss, rather than inflammatory back pain and uveitis in a young male. *Rheumatoid arthritis* - Rheumatoid arthritis is a **chronic autoimmune disease** primarily affecting the **synovial joints**, mostly small joints, symmetrically. - While it can cause systemic inflammation, it typically spares the axial skeleton, and symptoms like severe morning stiffness and reduced chest expansion with specific X-ray findings described are not characteristic.

Q: A 20-year-old patient presents with chronic low backache and early morning stiffness for the last 2 years. For the past 6 months, they have also experienced bilateral heel pain. What is the most likely diagnosis?

Ankylosing spondylitis. ***Ankylosing spondylitis*** - The combination of **chronic low backache** and **early morning stiffness** is highly characteristic of inflammatory back pain seen in ankylosing spondylitis. [1] - **Bilateral heel pain** (enthesitis) is a common extra-articular manifestation of ankylosing spondylitis, further supporting the diagnosis. [1] *Mechanical pain* - **Mechanical back pain** typically worsens with activity and improves with rest, in contrast to inflammatory back pain which improves with activity. [2] - It does not usually present with systemic features or enthesitis like heel pain. [2] *Disc prolapse* - **Disc prolapse** usually presents with radicular pain (nerve pain) that radiates down the leg, often unilateral, and is exacerbated by specific movements or coughing. - Early morning stiffness and bilateral heel pain are not typical features of a disc prolapse. *TB spine* - **TB spine** (Pott's disease) often presents with constitutional symptoms like fever, weight loss, and night sweats along with back pain, which are not mentioned here. - While it causes chronic back pain and stiffness, it's typically more localized with vertebral collapse and neurological deficits, and generally doesn't cause bilateral heel pain.

Q: A 27-year-old woman who delivered a female child 9 months ago presents with complaints of absent periods since childbirth. She has been using contraceptive methods for family planning. Her serum beta-hCG level is 4.9 mIU/ ml , prolactin level is $88 \mathrm{ng} / \mathrm{ml}$, and TSH is 3.8 $\mu \mathrm{IU} / \mathrm{ml}$. What is the most likely reason for her amenorrhea?

Lactational amenorrhea. ***Lactational amenorrhea*** - The patient describes a history of recent childbirth (9 months ago), amenorrhea, and an elevated **prolactin level** (**88 ng/mL**). - While contraceptive methods are being used, persistent **postpartum amenorrhea** with hyperprolactinemia is commonly seen in women who are breastfeeding, even if intermittently. *Hypothyroidism* - Although **hypothyroidism** can cause amenorrhea, the patient's TSH level of **3.8 μIU/mL** is within the normal reference range, making hypothyroidism an unlikely cause. - While mild thyroid dysfunction can impact menstrual cycles, this TSH level alone is not sufficient to explain **amenorrhea**. *Prolactinoma* - A **prolactinoma** is characterized by significantly elevated prolactin levels, often much higher than the **88 ng/mL** seen in this patient (typically > 100-200 ng/mL). - Given the recent childbirth, the elevated prolactin is more likely physiological due to lactation rather than a **pathological tumor**. *Normal pregnancy* - The patient's serum **beta-hCG level of 4.9 mIU/mL** is below the threshold typically considered diagnostic for pregnancy (usually >25 mIU/mL). - This value indicates that a **normal ongoing pregnancy** is highly unlikely.

Q: A pregnant woman comes for a routine antenatal checkup. She had a history of a twin pregnancy one year ago. What is her gravida and para status?

G2P1. ***G2P1*** - **Gravida (G)** refers to the total number of confirmed pregnancies, regardless of outcome. This current pregnancy is her second, making her G2. - **Para (P)** denotes the number of pregnancies that have reached viability (typically 20 weeks gestation or more), producing one or more fetuses. Her previous twin pregnancy, regardless of the number of babies, counts as one para event. *G2P3* - While G2 is correct (current pregnancy + previous twin pregnancy), P3 would imply three separate birth events beyond viability, which is not supported by the history of one twin pregnancy. - The number of babies born in a single pregnancy beyond viability does not increase the 'P' count; it refers to the number of pregnancies carried to term. *G2P2* - G2 is correct, but P2 would mean she had two separate pregnancies that reached viability. She only had one previous pregnancy that reached viability (the twin pregnancy). - The para count is determined by the number of deliveries, not the number of fetuses delivered. *G2P0* - While G2 is correct, P0 would mean she has never carried a pregnancy to the point of viability. - Her history clearly states a twin pregnancy one year ago, indicating a previous pregnancy carried to term, making P0 incorrect.

Q: Which of the following is NOT typically associated with uterine didelphys?

Endometriosis. ***Endometriosis*** - **Endometriosis** is a condition where tissue similar to the lining of the uterus grows outside the uterus; it is not typically associated with specific Müllerian anomalies like uterine didelphys. - While both conditions can cause pelvic pain or infertility, there isn't a direct causal link or increased prevalence of endometriosis specifically due to uterine didelphys. *Premature labor* - **Uterine didelphys** involves two separate uteri, each with its own cervix, which can lead to a smaller uterine cavity in each horn, increasing the risk of **premature labor**. - The abnormal uterine shape and reduced cavity size can compromise the ability to carry a pregnancy to term. *Transverse lie* - The presence of **two separate uterine horns** in uterine didelphys can significantly alter the shape of the uterine cavity, making it difficult for the fetus to assume a regular **longitudinal lie**. - This anatomical variation often predisposes to **malpresentation**, such as **transverse lie**, where the baby lies horizontally across the uterus. *Repeated abortion* - Uterine didelphys is associated with a higher incidence of **repeated abortions** due to various factors including the smaller size of each uterine cavity, potential cervical incompetence, and altered blood supply. - The structural abnormalities can prevent proper implantation or adequate growth of the fetus, leading to recurrent pregnancy losses.

Q: What is the preferred management of a uterine septum?

Hysteroscopic resection of septum. ***Hysteroscopic resection of septum*** - **Hysteroscopic resection of a uterine septum** is the preferred management due to its minimally invasive nature and high success rates in improving reproductive outcomes. - This procedure allows direct visualization and precise removal of the septal tissue, preserving the healthy uterine musculature. *Laparoscopic resection of septum* - While laparoscopic approaches are minimally invasive, directly resecting a uterine septum laparoscopically is generally **not the primary method**. - Laparoscopy is often used for diagnostics or in conjunction with hysteroscopy for guidance, but not typically for primary septal resection alone. *Uterine metroplasty* - **Uterine metroplasty** is a broader term for surgical reconstruction of the uterus, typically reserved for more complex uterine anomalies like a **bicornuate uterus**. - It involves more extensive surgical remodeling of the uterine cavity and is generally **more invasive** than hysteroscopic septal resection. *Laparotomy and resection* - **Laparotomy** involves a large abdominal incision and is a more invasive surgical approach with a longer recovery period. - It is generally **reserved for very complex uterine malformations** or cases where hysteroscopic or laparoscopic approaches are not feasible or have failed.

Q: A patient fell off a bicycle and now complains of pain around the hip, with shortening of the affected limb. The hip is held in a position of flexion, adduction, and internal rotation. What is the most likely diagnosis?

Posterior dislocation. **Posterior dislocation** - **Posterior hip dislocations** typically occur after high-energy trauma (e.g., falls from height, motor vehicle accidents) and present with the affected limb in a classic position of **flexion, adduction, and internal rotation**. - **Shortening of the limb** is also a hallmark sign, often due to the femoral head displacing posteriorly and superiorly. *Intertrochanteric fracture (IT fracture)* - **Intertrochanteric fractures** usually present with the affected limb in **external rotation** and shortening, which is contrary to the internal rotation described in the case. - While pain is present, the specific rotational deformity helps differentiate it from a hip dislocation. *Transcervical fracture* - **Transcervical fractures** (femoral neck fractures) also typically present with the leg in **external rotation** and shortening. - These fractures are common in older adults and often associated with less severe trauma or falls. *Anterior dislocation* - **Anterior hip dislocations** are less common and typically present with the affected limb in a position of **flexion, abduction, and external rotation**. - This presentation is directly opposite to the adduction and internal rotation described in the question.

Q: A hypertensive patient wants to conceive. Which of the following medications needs to be stopped before pregnancy?

ACE inhibitors. ***ACE inhibitors*** - **ACE inhibitors** are **teratogenic** and can cause **fetal kidney damage**, **oligohydramnios**, and **fetal death** if used during pregnancy. - They should be discontinued before conception or immediately upon pregnancy confirmation, and an alternative safe antihypertensive should be initiated. *Alpha Methyl dopa* - **Alpha-methyldopa** is considered one of the **first-line agents** for managing **hypertension in pregnancy** due to its established safety profile. - It reduces peripheral resistance without significantly affecting renal or uteroplacental blood flow. *Calcium Channel Blockers* - **Calcium channel blockers (CCBs)** like nifedipine and amlodipine are **generally considered safe** for use during pregnancy, especially dihydropyridines. - They are often used as **second-line treatments** for managing hypertension in pregnant women. *Labetalol* - **Labetalol** is a **beta-blocker** that is widely used and considered **safe** for treating **hypertension in pregnancy**. - It effectively lowers blood pressure without significant adverse effects on the fetus. *Hydralazine* - **Hydralazine** is a direct vasodilator that is **safe** for use in pregnancy and is commonly used for **acute management** of severe hypertension in pregnant women. - It has a long history of safe use during pregnancy without teratogenic effects.

Q: What is the modality of the test shown in the image?

Hysterosalpingography. ***Hysterosalpingography*** - The image shows a **contrast-filled uterus and fallopian tubes**, characteristic of a **hysterosalpingogram (HSG)**. - An HSG uses **X-rays** and **radiopaque contrast media** to visualize the uterine cavity and assess fallopian tube patency. *Hysteroscopy* - **Hysteroscopy** involves direct visualization of the uterine cavity using a **fiber optic endoscope** inserted through the cervix. - It does not produce an X-ray image with contrast filling the fallopian tubes. *Laparoscopy* - **Laparoscopy** is a minimally invasive surgical procedure that involves inserting a **laparoscope** through an incision in the abdominal wall to view pelvic organs externally. - This image clearly depicts an internal view of the uterus and tubes through contrast, not an external, endoscopic view. *Saline infusion sonography* - **Saline infusion sonography (SIS)**, also known as sonohysterography, uses **ultrasound** imaging during the infusion of saline into the uterus. - While it assesses the uterine cavity, it is an ultrasound-based technique and does not involve X-ray contrast passing through the fallopian tubes, as seen in the image.

Question 1

A 26-year-old male presents with backache, morning stiffness, reduced chest expansion, and reddening of the eyes. The X-ray provided is shown below. What is the most likely diagnosis?

Accepted Answer

Ankylosing spondylitis

Answer

Osteopetrosis

Answer

Paget's disease

Answer

Rheumatoid arthritis

Question 2

A 20-year-old patient presents with chronic low backache and early morning stiffness for the last 2 years. For the past 6 months, they have also experienced bilateral heel pain. What is the most likely diagnosis?

Accepted Answer

Ankylosing spondylitis

Answer

Mechanical pain

Answer

Disc prolapse

Answer

TB spine

Question 3

A 27-year-old woman who delivered a female child 9 months ago presents with complaints of absent periods since childbirth. She has been using contraceptive methods for family planning. Her serum beta-hCG level is 4.9 mIU/ ml , prolactin level is $88 \mathrm{ng} / \mathrm{ml}$, and TSH is 3.8 $\mu \mathrm{IU} / \mathrm{ml}$. What is the most likely reason for her amenorrhea?

Accepted Answer

Lactational amenorrhea

Answer

Hypothyroidism

Answer

Prolactinoma

Answer

Normal pregnancy

Question 4

A pregnant woman comes for a routine antenatal checkup. She had a history of a twin pregnancy one year ago. What is her gravida and para status?

Accepted Answer

G2P1

Answer

G2P3

Answer

G2P2

Answer

G2P0

Question 5

Which of the following is NOT typically associated with uterine didelphys?

Accepted Answer

Endometriosis

Answer

Premature labor

Answer

Transverse lie

Answer

Repeated abortion

Question 6

What is the preferred management of a uterine septum?

Accepted Answer

Hysteroscopic resection of septum

Answer

Laparoscopic resection of septum

Answer

Uterine metroplasty

Answer

Laparotomy and resection

Question 7

A 60-year-old elderly female with a previous history of a Colles fracture is now complaining of backache. Which of the following statements regarding the treatment of this patient is incorrect?

Accepted Answer

Teriparatide should be started before supplementing bisphosphonates

Answer

Oral vitamin D3 is given along with oral calcium

Answer

Calcium requirement is 1200 mg per day

Answer

Bisphosphonates can be given for 3-5 years depending on patient response and risk factors

Question 8

A patient fell off a bicycle and now complains of pain around the hip, with shortening of the affected limb. The hip is held in a position of flexion, adduction, and internal rotation. What is the most likely diagnosis?

Accepted Answer

Posterior dislocation

Answer

Intertrochanteric fracture (IT fracture)

Answer

Transcervical fracture

Answer

Anterior dislocation

Question 9

A hypertensive patient wants to conceive. Which of the following medications needs to be stopped before pregnancy?

Accepted Answer

ACE inhibitors

Answer

Alpha Methyl dopa

Answer

Calcium Channel Blockers

Answer

Labetalol

Answer

Hydralazine

Question 10

What is the modality of the test shown in the image?

Accepted Answer

Hysterosalpingography

Answer

Hysteroscopy

Answer

Laparoscopy

Answer

Saline infusion sonography

NEET-PG 2021

Internal Medicine

OB/GYN

Obstetrics and Gynecology

Orthopaedics

Pharmacology

Radiology