Internal Medicine
1 questionsIn the context of hemorrhagic pancreatitis, which sign is indicated by bluish discoloration of the flank?
NEET-PG 2013 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 881: In the context of hemorrhagic pancreatitis, which sign is indicated by bluish discoloration of the flank?
- A. Grey Turner's sign (Correct Answer)
- B. Cullen's sign
- C. Trousseau's sign
- D. None of the options
Explanation: ***Grey Turner's sign*** - This sign refers to **bluish discoloration of the flank** due to **hemorrhage** into the retroperitoneal space, commonly seen in severe hemorrhagic pancreatitis. [1] - The discoloration is caused by **peripancreatic inflammation** and fat necrosis, leading to localized bleeding. *Cullen's sign* - Cullen's sign is characterized by **bluish discoloration around the umbilicus**. - It is also indicative of **retroperitoneal hemorrhage**, but specifically in the periumbilical region. *Trousseau's sign* - This sign refers to **carpal spasm** induced by inflating a blood pressure cuff above systolic pressure for several minutes. - It is indicative of **hypocalcemia**, not hemorrhage, and is seen in conditions like pancreatitis that cause low calcium levels. *None of the options* - This option is incorrect because **Grey Turner's sign** specifically describes the bluish discoloration of the flank associated with hemorrhagic pancreatitis.
Pathology
1 questionsWhich of the following is a premalignant lesion for carcinoma of the rectum?
NEET-PG 2013 - Pathology NEET-PG Practice Questions and MCQs
Question 881: Which of the following is a premalignant lesion for carcinoma of the rectum?
- A. Juvenile polyposis
- B. Adenomatous polyps (Correct Answer)
- C. Familial adenomatous polyposis
- D. Hyperplastic polyps
Explanation: ***Familial polyposis*** - Familial adenomatous polyposis (FAP) is characterized by numerous **adenomatous polyps** in the colon and rectum, which have a high risk of progressing to colorectal cancer [1]. - Individuals with FAP are at significant risk for developing **carcinoma rectum** at a young age if the condition is not managed properly [1]. *Juvenile polyp* - Juvenile polyps are generally **benign** and occur in children, with a very low risk of malignancy. - They do not contribute significantly to the risk of **carcinoma rectum** like adenomatous polyps do. *Adenomatous polyp* - While adenomatous polyps are indeed premalignant [1], the term **Familial polyposis** indicates a hereditary condition that specifically has a higher and more defined risk for rectal carcinoma. - Adenomatous polyps can occur sporadically and do not imply a genetic syndrome like familial polyposis. *FAP* - FAP refers specifically to **familial adenomatous polyposis** [1], which is the same concept as familial polyposis but less encompassed in terms of broad assessment in this context. - It is important to note that **familial polyposis** is a broader term that includes conditions like FAP and indicates a significant risk factor for rectal cancer [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 817, 821-822.
Pharmacology
1 questionsWhich drug is used to keep the patent ductus arteriosus (PDA) open?
NEET-PG 2013 - Pharmacology NEET-PG Practice Questions and MCQs
Question 881: Which drug is used to keep the patent ductus arteriosus (PDA) open?
- A. PGE1 (Correct Answer)
- B. PGI2
- C. PGH2
- D. PGF2α
Explanation: ***PGE1*** - **Prostaglandin E1** (**PGE1**, alprostadil) is used to maintain the patency of the **ductus arteriosus** in neonates with certain congenital heart defects [1], [2]. - It acts as a **vasodilator** on the smooth muscle of the ductus, preventing its closure and allowing for adequate blood flow prior to surgical correction [1], [2]. *PGI2* - **Prostaglandin I2** (**PGI2**, prostacyclin) is a potent **vasodilator** and **platelet aggregation inhibitor** [1]. - While it has cardiovascular effects, it is primarily used for conditions like **pulmonary hypertension** and not for maintaining ductal patency [1]. *PGF2̑* - **Prostaglandin F2̑** (**PGF2̑**) is involved in processes such as **uterine contractions** and **bronchoconstriction** [1], [2]. - It does not play a role in maintaining the patency of the ductus arteriosus. *PGH2* - **Prostaglandin H2** (**PGH2**) is an immediate precursor in the synthesis of various other prostaglandins and thromboxanes. - It is not directly administered as a drug to maintain ductal patency but is an intermediate in their synthesis.
Physiology
1 questionsAt what age do the proportions of intracellular fluid (ICF) and extracellular fluid (ECF) in a child approximate those of an adult?
NEET-PG 2013 - Physiology NEET-PG Practice Questions and MCQs
Question 881: At what age do the proportions of intracellular fluid (ICF) and extracellular fluid (ECF) in a child approximate those of an adult?
- A. 3 years
- B. 4 years
- C. 1 year
- D. 2 years (Correct Answer)
Explanation: ***2 years*** - By the age of **2 years**, the relative proportions of intracellular fluid (ICF) and extracellular fluid (ECF) in a child reach levels comparable to those found in adults. - Infants have a significantly higher percentage of ECF, which gradually decreases as they grow and mature. - This represents the key transition point where adult fluid compartment ratios are first approximated. *1 year* - At **1 year of age**, the ECF proportion is still relatively higher than in adults, though it has decreased from neonatal levels. - The shift towards adult fluid proportions is ongoing and not yet complete. *3 years* - By **3 years of age**, the fluid proportions are already well-established at adult levels, as this milestone is reached by age 2. - This age comes after the initial approximation point, so it is not the earliest age when adult proportions are reached. *4 years* - At **4 years of age**, the child's fluid distribution is well within adult proportions. - The main transition period for fluid compartment ratios is usually completed by age 2, making this age too late to represent the approximation point.
Radiology
2 questionsThe CT severity index in acute pancreatitis is described by:
All the following are true of craniopharyngioma except:
NEET-PG 2013 - Radiology NEET-PG Practice Questions and MCQs
Question 881: The CT severity index in acute pancreatitis is described by:
- A. Balthazar score (Correct Answer)
- B. Mengini score
- C. Chapman score
- D. Napelon score
Explanation: ***Balthazar score*** - The **Balthazar score** (or CT severity index) is a widely used radiological grading system for assessing the severity of **acute pancreatitis** based on findings on computed tomography (CT) scans. It evaluates both pancreatic inflammation and necrosis. - The Balthazar score helps predict the clinical course and potential complications of pancreatitis by assigning points for **pancreatic inflammation** and the extent of **necrosis**. *Mengini score* - The **Mengini score** is not a recognized CT severity index specifically for acute pancreatitis. - This name is not associated with any established scoring system in gastroenterology. *Chapman score* - The **Chapman score** refers to specific somatic points used in **osteopathic manipulative medicine** for diagnosis and treatment, primarily related to lymphatic system dysfunction. - It has no relevance to the radiological assessment or severity grading of acute pancreatitis. *Napelon score* - The **Napelon score** does not exist as a recognized medical scoring system, particularly in the context of acute pancreatitis or medical imaging. - This name is likely a distractor and not associated with medical practice.
Question 882: All the following are true of craniopharyngioma except:
- A. Derived from Rathke's pouch
- B. Contains epithelial cells
- C. Causes visual disturbances
- D. Present in sella or infra-sellar location (Correct Answer)
Explanation: ***Present in sella or infra-sellar location*** - Craniopharyngiomas are typically located in the **suprasellar region**, above the **sella turcica**, where they can compress the optic chiasm. - While they can extend into the sella, their primary location is rarely exclusively intrasellar or infrasellar. *Derived from Rathke's pouch* - This statement is true; craniopharyngiomas arise from remnants of **Rathke's pouch**, the embryonic precursor of the anterior pituitary gland. - This origin explains their characteristic location near the pituitary stalk and third ventricle. *Contains epithelial cells* - This statement is true as **craniopharyngiomas** are benign **epithelial tumors**, specifically adamantinomatous or papillary types. - They are composed of stratified squamous epithelium, often with calcifications and cystic components. *Causes visual disturbances* - This statement is true because the **suprasellar location** of a craniopharyngioma often leads to compression of the **optic chiasm**, resulting in characteristic visual field deficits like bitemporal hemianopsia. - Visual disturbances are a common presenting symptom due to their proximity to the visual pathways.
Surgery
4 questionsWhat is the treatment of choice for squamous cell anal cancer?
Which of the following is the best combination of clinical features of intestinal obstruction?
What is the treatment of choice for medullary carcinoma of the thyroid?
In which condition is the Prehn sign typically positive?
NEET-PG 2013 - Surgery NEET-PG Practice Questions and MCQs
Question 881: What is the treatment of choice for squamous cell anal cancer?
- A. Chemoradiotherapy (Correct Answer)
- B. Laser ablation
- C. Abdominoperineal resection
- D. Cisplatin-based chemotherapy
Explanation: ***Chemoradiotherapy*** - **Chemoradiotherapy** is the standard and most effective treatment for squamous cell anal cancer, offering high rates of **tumor control** and **anal sphincter preservation**. - This combined approach uses both **radiation** and **chemotherapy** (typically 5-fluorouracil and mitomycin-C) to enhance tumor cell killing and reduce recurrence. *Laser ablation* - **Laser ablation** is a minimally invasive technique generally reserved for very small, early-stage **superficial tumors** or **intraepithelial neoplasia**, not for invasive squamous cell anal cancer. - It does not address potential **lymph node involvement** or deliver the comprehensive treatment required for most anal cancers. *Abdominoperineal resection* - **Abdominoperineal resection (APR)** involves the surgical removal of the anus, rectum, and part of the sigmoid colon, leading to a permanent **colostomy**. - This is considered a **salvage therapy** for recurrent disease or for patients who have failed chemoradiotherapy, not a primary treatment. *Cisplatin-based chemotherapy* - While **cisplatin** can be used as a component of chemotherapy regimens for some cancers, it is not the primary single-agent or cornerstone chemotherapy for **squamous cell anal cancer**. - The standard chemotherapy regimen typically includes **5-fluorouracil** and **mitomycin-C** in combination with radiation.
Question 882: Which of the following is the best combination of clinical features of intestinal obstruction?
- A. Vomiting
- B. Fluid level in X-ray > 4
- C. Abdominal distension and vomiting (Correct Answer)
- D. Abdominal distension
Explanation: ***Abdominal distension and vomiting*** - This combination represents **two of the cardinal clinical features** of intestinal obstruction from the classic tetrad (pain, vomiting, distension, constipation). - **Abdominal distension** occurs due to accumulation of gas and fluid proximal to the obstruction. - **Vomiting** occurs as the body attempts to expel contents that cannot pass through the blocked intestine. - The **combination** makes this the most specific and complete answer among the given options. *Vomiting* - While vomiting is indeed a prominent clinical feature of intestinal obstruction, it can occur in numerous other conditions (gastroenteritis, metabolic disorders, CNS pathology). - **Isolated vomiting lacks specificity** for diagnosing intestinal obstruction. *Fluid level in X-ray > 4* - This refers to **multiple air-fluid levels** seen on erect abdominal X-ray, which is a **radiologic/diagnostic finding**, not a clinical feature. - Clinical features are symptoms and signs (what the patient experiences or what is observed on examination), whereas X-ray findings are **investigative/imaging findings**. *Abdominal distension* - While abdominal distension is a key clinical feature of intestinal obstruction, it can also occur in other conditions (ascites, pregnancy, obesity, bowel perforation). - **Isolated distension lacks specificity** compared to the combination with vomiting.
Question 883: What is the treatment of choice for medullary carcinoma of the thyroid?
- A. I-131 ablation
- B. Total thyroidectomy (Correct Answer)
- C. Partial thyroidectomy
- D. Hemithyroidectomy
Explanation: ***Total thyroidectomy*** - This is the **treatment of choice for medullary thyroid carcinoma (MTC)** due to its multifocal nature and high propensity for lymph node metastasis - **Complete surgical resection** (often with central compartment neck dissection) provides the best chance for cure by removing all thyroid tissue and involved lymph nodes - MTC arises from **parafollicular C cells** (calcitonin-producing cells) and frequently involves both lobes, making total thyroidectomy essential *Partial thyroidectomy* - This procedure removes only a portion of the thyroid gland, which is **insufficient for MTC** given its tendency for multifocality and bilateral involvement - Leaves residual thyroid tissue that could harbor undetected disease or develop future recurrences - Does not adequately address the aggressive nature of MTC *I-131 ablation* - **Radioactive iodine therapy** is effective for differentiated thyroid cancers (papillary and follicular) that take up iodine - MTC originates from **parafollicular C cells that do not concentrate iodine**, making I-131 ablation completely ineffective - This is a key distinguishing feature of MTC from other thyroid malignancies *Hemithyroidectomy* - This procedure removes only one thyroid lobe, which is **inadequate for MTC** - Risks leaving behind primary tumor in the contralateral lobe or occult bilateral disease - Fails to address the multifocal nature of MTC, particularly in hereditary cases (MEN 2A, MEN 2B, familial MTC)
Question 884: In which condition is the Prehn sign typically positive?
- A. Acute epididymitis (Correct Answer)
- B. Chronic epididymitis
- C. Testicular torsion
- D. Acute scrotal pain due to other causes
Explanation: ***Acute epididymitis*** - **Prehn sign** is positive when lifting the scrotal sac alleviates pain, as it reduces pressure on the inflamed epididymis. - This sign is commonly used to differentiate **epididymitis** from **testicular torsion**, where pain typically worsens or remains unchanged with elevation. *Chronic epididymitis* - While potentially painful, **chronic epididymitis** usually presents with persistent, dull pain that is less likely to be acutely relieved by scrotal elevation. - The **Prehn sign** is primarily a diagnostic tool for **acute inflammatory conditions** of the epididymis. *Testicular torsion* - In **testicular torsion**, the pain is often sudden, severe, and typically **not relieved** by elevating the testicle; in fact, it may worsen. - This condition is a **surgical emergency** where blood flow to the testicle is compromised. *Acute scrotal pain due to other causes* - Other causes of **acute scrotal pain**, such as **trauma** or **incarcerated hernias**, generally do not exhibit a positive Prehn sign. - The **Prehn sign** is quite specific to the **inflammatory process** of epididymitis affecting pain perception.