NEET-PG 2013

1544 Questions — Page 86 of 155

Internal Medicine

3 questions

Q851

Which of the following is NOT a characteristic feature of systemic sclerosis?

Q852

In total parenteral nutrition, which of the following parameters is not routinely measured daily?

Q853

Prepyloric or channel ulcer in the stomach is termed as:

NEET-PG 2013 - Internal Medicine NEET-PG Practice Questions and MCQs

Question 851: Which of the following is NOT a characteristic feature of systemic sclerosis?

A. Calcinosis cutis
B. Digital ulcers
C. Acroosteolysis
D. Gottron's papules (Correct Answer)

Explanation: ***Gottron's papules*** - **Gottron's papules** are pathognomonic for **dermatomyositis**, not systemic sclerosis. They are red, scaling papules found over the extensor surfaces of the metacarpophalangeal (MCP) and interphalangeal (IP) joints. - While both systemic sclerosis and dermatomyositis are connective tissue diseases, their distinct cutaneous manifestations aid in differentiation. *Acroosteolysis* - **Acroosteolysis** refers to the resorption of the distal phalanges, a common feature in systemic sclerosis, particularly in severe cases. - This symptom contributes to the characteristic digital abnormalities seen in the disease. *Calcinosis cutis* - **Calcinosis cutis** is the deposition of calcium in the skin and subcutaneous tissues, often seen in subsets of systemic sclerosis, especially the CREST syndrome. - It can manifest as firm, white-yellow nodules or plaques and contribute to skin breakdown. *Digital ulcers* - **Digital ulcers** are a frequent and debilitating complication of systemic sclerosis, resulting from severe **vasculopathy** [1] and **ischemia** [1]. - They are often painful and can lead to significant tissue loss and infection.

Question 852: In total parenteral nutrition, which of the following parameters is not routinely measured daily?

A. Electrolyte
B. Fluid intake and output
C. Magnesium
D. Liver function tests (LFTs) (Correct Answer)

Explanation: ***Liver function tests (LFTs)*** - **LFTs** are typically monitored periodically (e.g., weekly or bi-weekly) in patients on TPN, not daily, unless there are specific concerns about liver dysfunction [1]. - Daily monitoring is generally not required because changes in liver function due to TPN are usually insidious and not acutely life-threatening in hours. *Electrolyte* - **Electrolytes** (e.g., sodium, potassium, chloride) are crucial for cellular function and fluid balance [2]. They can fluctuate rapidly with TPN administration and patient's clinical status. - Daily measurement ensures prompt correction of imbalances to prevent serious complications like **cardiac arrhythmias** or neurological disturbances [2]. *Fluid intake and output* - **Fluid intake and output** are essential for assessing **hydration status** and preventing fluid overload or dehydration, which can change rapidly [2]. - Daily monitoring helps guide adjustments to fluid administration in TPN and other intravenous fluids. *Magnesium* - **Magnesium** is an important electrolyte involved in numerous enzymatic reactions and neuromuscular function, and its levels can be significantly affected by TPN [2]. - Daily or frequent monitoring is often necessary, especially in the initial phases of TPN or in patients with pre-existing deficiencies, to prevent complications such as **cardiac arrhythmias** or **weakness** [2].

Question 853: Prepyloric or channel ulcer in the stomach is termed as:

A. Type 3 (Correct Answer)
B. Type 1
C. Type 4
D. Type 2

Explanation: ***Type 3*** - **Type 3 ulcers** are located in the **prepyloric region** or within the **pyloric channel** of the stomach. - They are often associated with **duodenal ulcers** and are characterized by **normal to high acid secretion**. *Type 1* - **Type 1 ulcers** are typically found in the **lesser curvature of the stomach body**, not the prepyloric region. - These ulcers are usually associated with **low or normal acid secretion** and are often linked to *H. pylori* infection. *Type 2* - **Type 2 ulcers** involve both a **gastric ulcer** (usually in the body) and an **active or healed duodenal ulcer**. - They are associated with **normal to high acid secretion**, but the location is not exclusively prepyloric. *Type 4* - **Type 4 ulcers** are located high on the **lesser curvature near the gastroesophageal junction**. - They are associated with **low acid secretion** and are sometimes termed **juxta-esophageal ulcers**.

Pharmacology

1 questions

Q851

XDR-TB is defined as resistance to which of the following drug combinations?

Radiology

2 questions

Q851

What is the primary use of the Balthazar scoring system?

Q852

Retrocardiac lucency with air fluid level is seen in

NEET-PG 2013 - Radiology NEET-PG Practice Questions and MCQs

Question 851: What is the primary use of the Balthazar scoring system?

A. Acute Pancreatitis (Correct Answer)
B. Acute Appendicitis
C. Acute Cholecystitis
D. Cholangitis

Explanation: ***Acute Pancreatitis*** - The Balthazar score (also known as the **CT Severity Index** for pancreatitis) is primarily used to assess the severity of **acute pancreatitis** based on findings from a **CT scan**. - It evaluates pancreatic inflammation and necrosis, correlating with patient prognosis and the risk of complications. *Acute Appendicitis* - Acute appendicitis is typically diagnosed clinically, often with the help of the **Alvarado score** or imaging like ultrasound/CT, but not the Balthazar score. - The Balthazar score's focus on pancreatic changes is irrelevant to appendiceal inflammation. *Acute Cholecystitis* - Diagnosis of acute cholecystitis is based on clinical signs, lab tests, and imaging (ultrasound showing **gallbladder wall thickening**, pericholecystic fluid, or stones). - The Balthazar scoring system does not apply to the assessment of gallbladder inflammation. *Cholangitis* - Cholangitis is an infection of the bile ducts, diagnosed using the **Tokyo Guidelines**, which consider systemic inflammation, cholestasis, and imaging of biliary obstruction. - The Balthazar score is specific to pancreatic inflammation and does not provide information relevant to cholangitis.

Question 852: Retrocardiac lucency with air fluid level is seen in

A. Distal esophageal obstruction
B. Diaphragmatic eventration
C. Hiatus hernia (Correct Answer)
D. None of the options

Explanation: ***Hiatus hernia*** - A **hiatus hernia** occurs when part of the stomach protrudes into the chest through the **esophageal hiatus** of the diaphragm. - This can lead to a **retrocardiac lucency** (gas-filled stomach) with an **air-fluid level** visible on chest X-rays due to gastric contents. - The herniated gastric fundus appears as a characteristic gas bubble behind the heart, particularly well-seen on lateral chest radiographs. *Distal esophageal obstruction* - While distal esophageal obstruction can cause esophageal dilation and sometimes an **air-fluid level** within the esophagus, it generally presents as a tubular structure *behind* the heart rather than a distinct retrocardiac lucency representing a portion of the stomach. - The appearance would be more suggestive of a dilated esophagus filled with contents, not a herniated stomach. *Diaphragmatic eventration* - **Diaphragmatic eventration** is an abnormal elevation of a portion of the diaphragm, often due to congenital weakness or phrenic nerve paralysis. - It does not typically cause a **retrocardiac lucency** with an **air-fluid level**, as it involves the diaphragm itself rather than the herniation of an abdominal organ. - It may show elevation of the hemidiaphragm but without the characteristic gas-filled viscus appearance. *None of the options* - Hiatus hernia is a well-established radiological diagnosis for retrocardiac lucency with an **air-fluid level**, making this option clearly incorrect.

Surgery

4 questions

Q851

The most common cause of acquired AV fistula is:

Q852

Which of the following is a component of the Alvarado score?

Q853

What is the preferred palliative surgical procedure for rectal prolapse in elderly patients who are unfit for more invasive surgery?

Q854

Which of the following stages of Breast Cancer corresponds to the following features: a breast mass of 6 x 3 cm, ipsilateral supraclavicular lymph node involvement, and distant metastasis that cannot be assessed?

NEET-PG 2013 - Surgery NEET-PG Practice Questions and MCQs

Question 851: The most common cause of acquired AV fistula is:

A. Bacterial infection
B. Fungal infection
C. Blunt trauma
D. Penetrating trauma (Correct Answer)

Explanation: ***Penetrating trauma*** - **Penetrating trauma** is the most common cause of **acquired AV fistulas** due to direct injury to adjacent artery and vein. - This type of injury can result from causes like **gunshot wounds, stab wounds, or iatrogenic procedures** (e.g., catheterizations). *Bacterial infection* - While infections can cause vascular damage, they are **not the most common cause** of acquired AV fistulas. - Infections like **endocarditis** or localized abscesses can lead to vascular erosion, but this is less frequent than trauma. *Fungal infection* - **Fungal infections** are a much rarer cause of vascular damage leading to AV fistulas compared to bacterial infections or trauma. - They typically occur in immunocompromised individuals or in specific settings, not as a common cause of acquired AV fistulas. *Blunt trauma* - **Blunt trauma** can cause vascular injury, but it is **less likely to directly create an AV fistula** compared to penetrating trauma. - Blunt force is more commonly associated with vessel rupture, dissection, or pseudoaneurysm formation, rather than a direct connection between an artery and a vein.

Question 852: Which of the following is a component of the Alvarado score?

A. Leucopenia
B. Diarrhea
C. Periumbilical pain
D. Loss of appetite (Correct Answer)

Explanation: ***Loss of appetite*** - **Anorexia** (loss of appetite) is a key symptom considered in the Alvarado score, contributing 1 point to the total. - This symptom is often one of the **earliest indicators** of acute appendicitis. *Leucopenia* - The Alvarado score uses **leukocytosis** (elevated white blood cell count greater than 10,000/mm³), not leucopenia, as a component. - **Leucopenia** (decreased white blood cell count) is generally not indicative of acute appendicitis. *Diarrhea* - While diarrhea can sometimes accompany appendicitis, it is **not a specific component** of the Alvarado score. - The score focuses on classic appendicitis symptoms like **migratory and right lower quadrant pain**. *Periumbilical pain* - The Alvarado score specifically considers **migratory pain to the right iliac fossa** (RLQ tenderness) as a component, not just periumbilical pain. - Although pain often starts periumbilically, the score emphasizes the **subsequent migration** of pain.

Question 853: What is the preferred palliative surgical procedure for rectal prolapse in elderly patients who are unfit for more invasive surgery?

A. Delorme's procedure
B. Wells' procedure
C. Thiersch's operation (Correct Answer)
D. Low anterior resection

Explanation: ***Thiersch's operation*** - **Thiersch's operation** is a perineal procedure involving the placement of a **circum-anal cerclage** (a non-absorbable suture) around the anal canal to prevent external prolapse. - It is preferred in elderly or frail patients due to its **minimal invasiveness**, low operative risk, and suitability for local or regional anesthesia as a palliative measure for symptoms. *Delorme's procedure* - **Delorme's procedure** is a perineal approach that involves the **mucosal stripping** of the prolapsed rectum, plication of the muscularis, and re-anastomosis. - While less invasive than abdominal approaches, it is more complex than Thiersch's and may still carry higher operative risks for very frail patients. *Wells' procedure* - **Wells' procedure** (rectopexy via an abdominal approach) involves **mobilization of the rectum** and its fixation to the sacrum, often with a mesh. - This is a more invasive abdominal procedure with a higher operative risk, making it unsuitable for elderly patients unfit for major surgery. *Low anterior resection* - **Low anterior resection** is a major abdominal procedure primarily used for rectal cancer or severe inflammatory bowel disease, involving the **surgical removal of a segment of the rectum**. - It is a highly invasive procedure with significant morbidity and mortality, making it inappropriate for the palliative management of rectal prolapse in frail elderly patients.

Question 854: Which of the following stages of Breast Cancer corresponds to the following features: a breast mass of 6 x 3 cm, ipsilateral supraclavicular lymph node involvement, and distant metastasis that cannot be assessed?

A. T4 N3 MX
B. T4 N1 M1
C. T4 N0 M0
D. T3 N3c MX (Correct Answer)

Explanation: ***T3 N3c MX*** - A **breast mass of 6 x 3 cm** indicates a T3 tumor (tumor size > 5 cm). - **Ipsilateral supraclavicular lymph node involvement** is classified as N3c disease. **Distant metastasis that cannot be assessed** is denoted by MX. *T4 N3 MX* - A **T4 classification** is reserved for tumors with direct extension to the chest wall or skin, or inflammatory breast cancer, which is not mentioned here. - While N3c and MX are correct for the nodal and metastatic status, the T stage is inaccurate based on the provided tumor size. *T4 N1 M1* - A **T4 classification** is incorrect as the mass size alone (6 x 3 cm) does not meet T4 criteria. - **N1** denotes involvement of 1-3 axillary lymph nodes, which is less extensive than supraclavicular involvement (N3c). **M1** indicates confirmed distant metastasis, but the question states it "cannot be assessed" (MX). *T4 N0 M0* - **T4** is incorrect, as this stage is for direct chest wall/skin involvement or inflammatory breast cancer. - **N0** signifies no regional lymph node metastasis, contradicting the presence of supraclavicular lymph node involvement. **M0** indicates no distant metastasis, whereas the question specifies it cannot be assessed (MX).