NEET-PG 2012 Practice Questions

Q: Muir–Torre syndrome shows

Sebaceous gland tumors. ***Sebaceous gland tumors*** - **Muir-Torre syndrome** is a genetic condition characterized by the presence of at least one **sebaceous gland tumor** (adenoma, epithelioma, or carcinoma) and at least one internal malignancy. - It is considered a variant of **Lynch syndrome (hereditary nonpolyposis colorectal cancer - HNPCC)**, stemming from germline mutations in **DNA mismatch repair genes**. *Intestinal polyps (associated with familial adenomatous polyposis)* - While Lynch syndrome (to which Muir-Torre is related) does involve an increased risk of colorectal cancer, **multiple intestinal polyps** are the hallmark of **Familial Adenomatous Polyposis (FAP)**. - FAP is caused by a mutation in the **APC gene**, distinct from the mismatch repair gene mutations seen in Muir-Torre syndrome. *Lisch nodules (associated with Neurofibromatosis type 1)* - **Lisch nodules** are benign **iris hamartomas** typically found in patients with **Neurofibromatosis type 1 (NF1)**. - NF1 is a neurocutaneous disorder caused by a mutation in the **NF1 gene**, presenting with café-au-lait spots, neurofibromas, and optic gliomas, which are unrelated to Muir-Torre syndrome. *Hyperelastic joints (associated with Ehlers-Danlos syndrome)* - **Hyperelasticity of joints** and skin is a characteristic feature of **Ehlers-Danlos syndrome (EDS)**, a group of heritable disorders affecting connective tissue. - EDS is caused by defects in **collagen synthesis or processing**, and its clinical manifestations are distinct from the mucocutaneous and internal malignancies seen in Muir-Torre syndrome.

Q: Jaw tightness is typically seen in:

Giant cell arteritis (GCA). ***Giant cell arteritis (GCA)*** - **Jaw claudication** or tightness, difficulty chewing, and pain in the jaw are classic symptoms of GCA, resulting from **ischemia of the masticatory muscles**. [1] - This condition is a **large vessel vasculitis** that frequently affects the **temporal arteries** and can lead to blindness if untreated. [1] *Polyarteritis nodosa (PAN)* - PAN is a **necrotizing vasculitis** that typically affects **medium-sized arteries**, often sparing the pulmonary circulation. [1] - Common symptoms include **neuropathy**, abdominal pain, and skin lesions (e.g., livedo reticularis), but **jaw tightness is not a typical feature**. *Coarctation of aorta* - This is a **congenital narrowing of the aorta**, leading to symptoms like **upper extremity hypertension**, headache, and claudication in the lower extremities. - **Jaw tightness is not a symptom** associated with coarctation of the aorta. *Granulomatosis with Polyangiitis (GPA)* - GPA is a **small-vessel vasculitis** characterized by **granulomatous inflammation** involving the upper and lower respiratory tracts, and glomerulonephritis. - Symptoms often include **sinusitis**, lung nodules, and kidney disease, but **jaw claudication is not a characteristic presentation**.

Q: Which of the following electrolyte imbalances is least likely to be observed in Chronic Renal Failure (CRF)?

Hypercalcemia. ***Hypercalcemia*** - In **chronic renal failure (CRF)**, the kidneys' inability to activate vitamin D leads to impaired calcium absorption and **hypocalcemia** [1], [2]. - Additionally, the kidneys fail to excrete phosphate, leading to **hyperphosphatemia**, which further exacerbates hypocalcemia by forming calcium-phosphate precipitates [1]. *Hyperkalemia* - **Hyperkalemia** is a common and serious complication of CRF due to the kidneys' impaired ability to excrete **potassium**. - This is exacerbated by conditions like **metabolic acidosis** and certain medications. *Hyperphosphatemia* - In CRF, the kidneys are unable to adequately excrete **phosphate**, leading to an accumulation of **phosphate** in the blood [1]. - This condition directly contributes to **secondary hyperparathyroidism** and bone disease [1], [2]. *Hypocalcemia* - **Hypocalcemia** is very common in CRF, primarily due to decreased production of **calcitriol (active vitamin D)** by the failing kidneys [2]. - Reduced calcitriol leads to lower intestinal **calcium absorption** and impaired bone mineralization [1].

Q: An adult hypertensive male presented with sudden onset severe headache and vomiting. On examination, there is marked neck rigidity and no focal neurological deficit was found. The symptoms are most likely due to:

Subarachnoid hemorrhage. ***Subarachnoid hemorrhage*** - The sudden onset of a **"thunderclap" headache**, vomiting, and **neck rigidity** in a hypertensive patient are classic signs of subarachnoid hemorrhage [1]. - The absence of focal neurological deficits is common, as the bleeding is often in the subarachnoid space rather than directly in brain tissue. *Intracerebral hemorrhage* - While it can cause sudden headache and vomiting, an **intracerebral hemorrhage** would typically present with **focal neurological deficits** corresponding to the affected brain region. - Neck rigidity is less common unless there's significant mass effect or ventricular involvement. *Cerebral ischemia* - **Cerebral ischemia** (e.g., ischemic stroke) usually manifests with **focal neurological deficits** (e.g., weakness, aphasia), often without a severe headache or neck rigidity [2]. - Headache, if present, is usually less severe and not described as "thunderclap." *Bacterial meningitis* - **Bacterial meningitis** presents with headache, fever, and neck rigidity [1], but the onset is typically **gradual** over hours to days, not sudden. - While vomiting can occur, the acute, thunderclap nature linked to hypertension points away from infection as the primary cause.

Q: Which IUD is preferred for menorrhagia?

Mirena. ***Mirena*** - The **Mirena** IUD contains **levonorgestrel**, a progestin, which significantly reduces menstrual blood loss by causing endometrial atrophy. - It is FDA-approved for the treatment of **menorrhagia** and is highly effective in reducing heavy menstrual bleeding. *NOVA T* - **NOVA T** is a **copper IUD**, which can actually *increase* menstrual blood loss and dysmenorrhea, making it unsuitable for menorrhagia. - Copper IUDs work primarily by inducing a **local inflammatory reaction** in the uterus that is spermicidal and prevents fertilization. *Cu IUD* - Like NOVA T, **copper IUDs (Cu IUDs)** are known to exacerbate **heavy menstrual bleeding** and cramping. - They are used for contraception but are generally contraindicated in women with pre-existing menorrhagia. *Gynefix* - **Gynefix** is a frameless copper IUD designed to reduce the side effects of traditional T-shaped copper IUDs. - While it may cause less cramping than other copper IUDs, it still contains copper and can **increase menstrual flow**, making it a poor choice for menorrhagia.

Q: Which fetal presentation is the rarest?

Shoulder. ***Shoulder*** - **Shoulder presentation** (also known as a **transverse lie**) occurs in approximately **0.3% of pregnancies** at term, making it the rarest presentation among the major fetal lie categories. - In this presentation, the fetal long axis is perpendicular to the maternal long axis, and the **shoulder** is typically the presenting part. - Vaginal delivery is not possible, and **cesarean section is mandatory**. *Cephalic* - **Cephalic presentation** is the most common presentation, occurring in about **95% of pregnancies**. - In this presentation, the fetal head is directed downwards towards the maternal pelvis. - This includes vertex, face, brow, and other head-first presentations. *Breech* - **Breech presentation** occurs when the fetal buttocks or feet are the presenting part, seen in about **3-4% of term pregnancies**. - While less common than cephalic, it is significantly more frequent than shoulder presentation. - Includes frank, complete, and footling breech variants. *Face* - **Face presentation** is a rare variant of cephalic presentation where the **fetal face** (chin/mentum) is the presenting part, occurring in about **0.2-0.3% of deliveries**. - The fetal head is hyperextended, with the occiput against the fetal back. - While rare, it is still slightly more common than shoulder presentation in some studies.

Q: What is the most common type of dislocation of the elbow joint?

Posterolateral dislocation. ***Posterolateral dislocation*** - This is the **most common type of elbow dislocation**, accounting for over 90% of cases. - The **radius and ulna displace posterior and lateral** relative to the humerus. *Posterior dislocation* - While common, **pure posterior dislocations are less frequent** than posterolateral disruptions. - In a pure posterior dislocation, the **forearm bones move directly backward**, without a significant lateral component. *Posteromedial dislocation* - This is a **less common type of elbow dislocation**, involving the ulna and radius displacing posterior and medial. - Often associated with **more complex soft tissue and bony injuries**. *Lateral dislocation* - **Pure lateral dislocations of the elbow are rare** and usually involve significant disruption of the medial collateral ligament. - It occurs when the **forearm bones move directly lateral** to the humerus.

Q: In Precocious puberty, the age limit for girls is?

8 years. ***8 years*** - Precocious puberty is defined clinically by the development of secondary sexual characteristics in girls before the age of **8 years old**. - This age cut-off is based on population studies and clinical consensus to identify children needing further evaluation for underlying causes. *10 years* - This age is generally considered within the **normal range** for the onset of puberty, not precocious. - Pubertal development typically begins between ages 8 and 13 in girls. *9 years* - While close to the precocious threshold, **9 years** is still considered within the typical window for the onset of puberty. - The established clinical definition for precocious puberty in girls is explicitly _before_ the age of 8. *11 years* - This age is well within the **normal range** for pubertal onset and progression in girls. - Development of secondary sexual characteristics at this age would not be considered precocious.

Q: A polytrauma patient's CT brain shows a crescent-shaped extra-axial collection with a concave inner margin. What is the most likely diagnosis?

SDH. ***SDH*** - The image shows a **crescent-shaped collection** of hemorrhage with a concave inner margin, consistent with a **subdural hematoma** (SDH). - SDHs result from the tearing of **bridging veins** and typically conform to the brain's surface, crossing suture lines but not limited by bony sutures. *EDH* - An **epidural hematoma (EDH)** characteristically appears as a **lenticular** or **biconvex** shape on CT, not crescent-shaped. - EDHs are typically caused by arterial bleeding, often from the **middle meningeal artery**, and are limited by cranial sutures. *Contusion* - A **contusion** is brain tissue bruising that appears as **heterogeneous areas** of hemorrhage and edema within the brain parenchyma itself. - It would not manifest as a distinct extra-axial collection with a smooth, concave margin. *Diffuse axonal injury* - **Diffuse axonal injury (DAI)** involves widespread microscopic damage to axons, often at the gray-white matter junction. - It may appear as *punctate hemorrhages* or **small lesions** at these junctions on CT, but often the CT can be normal, and it would not present as a large extra-axial collection.

Q: A female patient who underwent surgery for abdominal intestinal perforation presents on the 5th postoperative day with serous discharge and a gap in the wound. What is the most likely diagnosis?

Wound dehiscence. ***Wound dehiscence*** - This is the most likely diagnosis given the presentation of **serous discharge** and a **gap in the wound** on the 5th postoperative day. - **Abdominal intestinal perforation** surgery is a risk factor, and the timing is consistent with **fascial dehiscence**, which can lead to evisceration if left untreated. *Enterocutaneous fistula* - This involves a connection between the **bowel lumen** and the **skin surface**, typically discharging enteric contents (e.g., bile, stool), not just serous fluid. - While a possibility in complicated abdominal surgeries, the description of a "gap in the wound" and serous discharge is more indicative of a **structural failure** of the wound. *Seroma* - A seroma is a collection of **serous fluid** under the skin flap or surgical incision, presenting as a **fluctuant swelling**, but it typically does not involve a "gap in the wound." - It would not usually present with a wound **disruption** that exposes underlying tissue; instead, it's an intact pocket of fluid. *Peritonitis* - This is an **inflammation of the peritoneum**, usually caused by infection, and presents with **severe abdominal pain**, fever, and diffuse tenderness, which are not mentioned here. - While an intestinal perforation would initially cause peritonitis, the current presentation focuses on the **wound site** rather than systemic or diffuse abdominal symptoms.

Question 1

Muir–Torre syndrome shows

Accepted Answer

Sebaceous gland tumors

Answer

Intestinal polyps

Answer

Lisch nodules

Answer

Hyperelastic joints

Question 2

Jaw tightness is typically seen in:

Accepted Answer

Giant cell arteritis (GCA)

Answer

Coarctation of aorta

Answer

Polyarteritis nodosa (PAN)

Answer

Granulomatosis with Polyangiitis (GPA)

Question 3

Which of the following electrolyte imbalances is least likely to be observed in Chronic Renal Failure (CRF)?

Accepted Answer

Hypercalcemia

Answer

Hyperkalemia

Answer

Hyperphosphatemia

Answer

Hypocalcemia

Question 4

An adult hypertensive male presented with sudden onset severe headache and vomiting. On examination, there is marked neck rigidity and no focal neurological deficit was found. The symptoms are most likely due to:

Accepted Answer

Subarachnoid hemorrhage

Answer

Intracerebral hemorrhage

Answer

Cerebral ischemia

Answer

Bacterial meningitis

Question 5

Which IUD is preferred for menorrhagia?

Accepted Answer

Mirena

Answer

NOVA T

Answer

Cu IUD

Answer

Gynefix

Question 6

Which fetal presentation is the rarest?

Accepted Answer

Shoulder

Answer

Cephalic

Answer

Breech

Answer

Face

Question 7

What is the most common type of dislocation of the elbow joint?

Accepted Answer

Posterolateral dislocation

Answer

Posterior dislocation

Answer

Posteromedial dislocation

Answer

Lateral dislocation

Question 8

In Precocious puberty, the age limit for girls is?

Accepted Answer

8 years

Answer

10 years

Answer

9 years

Answer

11 years

Question 9

A polytrauma patient's CT brain shows a crescent-shaped extra-axial collection with a concave inner margin. What is the most likely diagnosis?

Accepted Answer

SDH

Answer

EDH

Answer

Contusion

Answer

Diffuse axonal injury

Question 10

A female patient who underwent surgery for abdominal intestinal perforation presents on the 5th postoperative day with serous discharge and a gap in the wound. What is the most likely diagnosis?

Accepted Answer

Wound dehiscence

Answer

Enterocutaneous fistula

Answer

Peritonitis

Answer

Seroma

NEET-PG 2012

Dermatology

Internal Medicine

Obstetrics and Gynecology

Orthopaedics

Pediatrics

Radiology

Surgery